La resezione del carcinoma del pancreas T4 (unresectable primary tumor) dopo chemioterapia neoadiuvante con FOLFIRINOX modificato: risultati ad interim di uno studio prospettico di fase II

RIASSUNTO INTRODUZIONE Al momento della diagnosi il carcinoma duttale del pancreas è definito "resecabile" solo nel 20% dei pazienti. In assenza di metastasi a distanza, approssimativamente, nel 30-40% dei pazienti la chirurgia non viene eseguita a causa della estensione locale del tumore. Questi pazienti potrebbero ancora essere presi in considerazione per un intervento chirurgico resettivo pancreatico, nel caso in cui siano responsivi ad una chemioterapia/chemioradioterapia neoadiuvante. In questo lavoro riportiamo i risultati preliminari di uno studio prospettico di fase II, che coniuga una polichemioterapia neoadiuvante ad alte dosi con chirurgia resettiva pancreatica aggressiva. PAZIENTI E METODI Tutti i pazienti arruolati nello studio sono stati selezionati da un gruppo di lavoro multidisciplinare, composto da chirurghi, oncologi e radiologi. I criteri di inclusione sono: carcinoma del pancreas localmente avanzato con sospetto coinvolgimento arterioso (T4; stadio III "primary unresectable") e casi selezionati di T3, ECOG Performance Status 0-1, età 18-75 anni. Tutti i pazienti sono stati sottoposti ad un protocollo chemioterapico di fase II, che impiega il regime "FOLFIRINOX modificato". La risposta tumorale alla chemioterapia neoadiuvante è stata valutata in accordo con i criteri RECIST mediante acquisizione TC, confrontando lo stato pre-neoadiuvante con i dati di imaging ottenuti ogni 4 settimane. L'opportunità di aggiungere un trattamento locale, sia esso chirurgico o radioterapico, è stata valutata da gruppo di lavoro multidisciplinare dopo ogni controllo radiologico mediante TC

Breast Melanoma Metastases: Do We Know Enough? A very Rare Case with a Poor Prognosis: Case Report

The incidence of malignant melanoma (MM) is increasing especially in the western population; in Europe, the incidence is less than 10-20 new cases of melanoma per 100,000 inhabitants..

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

P070 Outcomes of hand-sewn versus stapled anastomosis for loop ileostomy reversal after ileal pouch-anal anastomosis in a tertiary center (12th Scientific and Annual Meeting of the European Society of Coloproctology, 20\u201322 September 2017, CityCube, Berlin, Germany)

Aim: There is evidence towards superiority of stapled closure of loop ileostomy after low rectal anastomosis compared to hand suture in terms of operative time and bowel obstruction rate. The aim of this study is to compare the 30-day outcomes of the two techniques for ileostomy closure after ileal pouch-anal anastomosis (IPAA). Method: Consecutive patients undergoing ileostomy closure after IPAA between 2011\u20132106 were retrospectively included. Patients\u2019 characteristics and perioperative outcomes were compared. Results: Hand-sewn suture and stapled anastomosis were performed in 280 (84.3%) and 52 (15.7%) patients. The two groups had comparable demographic characteristics. The median operative time was the same between groups (90 min). The incidence of Clavien-Dindo grade I (6.4% vs. 9.6%), II (4.3% vs. 1.9%) and IIIb (1.4% vs. 3.8%), the median days to flatus (2 vs. 2.5, P 0.3) and the length of hospital stay (6 days in both, P 0.9) were similar between groups. A slightly higher although non-significant rate of bowel obstruction was observed in the stapled group (3.8% vs. 2.5%, P 0.6). Conclusion: The loop ileostomy after IPAA should be closed according to the surgeon\u2019s preference using indifferently the hand-sewn or the stapled technique, as the expected outcomes are similar

Morbidity associated with closure of ileostomy after a three-stage ileal pouch-anal anastomosis

The aim of the study was to compare the perioperative outcomes of patients undergoing ileostomy closure after a three-stage ileal pouch-anal anastomosis to a control group of patients who had elective colorectal resections and stoma, and to analyse the differences based on the technique of closure. The cases were retrospectively compared for demographic characteristics and postoperative outcomes. Chi-square, Fisher's exact and Wilcoxon rank sum tests were used as appropriate. Between 2011 and 2016, 338 patients having their stoma reversed after three-stage IPAA were compared to 158 patients in the control group. A younger age (43.2 vs 60.6 years, p < 0.0001), a lower body mass index (22 vs 24.4 kg/m2, p < 0.0001), a higher rate of hand-sewn anastomosis (84.3 vs 15.7%, p < 0.0001), a lower rate of intraoperative complications (0 vs 1.2%, p = 0.038), a shorter operative time (91.5 vs 99.4 min, p = 0.0046) and length of hospital stay (6.6 vs 7.6 days, p = 0.045) were seen in the IPAA group. The 30-day rate of wound infection, anastomotic leak (0.6 vs 0.6%), small bowel obstruction (SBO, 8 vs 11.4%) and reoperation (1.8 vs 1.3%) was similar. Among IPAA patients, the hand-sewn anastomosis was correlated with a higher chance of developing SBO (9.1 vs 1.9%, p = 0.03). Closure of ileostomy after three-stage IPAA is associated with low rate of serious complications, despite the higher number of previous abdominal surgeries. This supports the construction of routine ileostomy during IPAA to reduce the risk of pelvic sepsis

Third national surgical consensus conference of the Italian Association of Breast Surgeons (ANISC) on management after neoadjuvant chemotherapy: The difficulty in reaching a consensus

Introduction: Neoadjuvant chemotherapy (NAC) has a profound impact on surgical management of breast cancer. For this reason, the Italian Association of Breast Surgeons (ANISC) promoted the third national Consensus Conference on this subject, open to multidisciplinary specialists. Materials and methods: The Consensus Conference was held on-line in November 2022, and after an introductory session with five core-team experts, participants were asked to vote on eleven controversial issues, while results were collected in real-time with a polling system. Results: A total of 164 dedicated specialists from 74 Breast Centers participated. Consensus was reached for only three of the eleven issues, including: 1) the indication to assess the response with Magnetic Resonance Imaging (79&nbsp;%); 2) the need to re-assess the biological factors of the residual tumor if present (96&nbsp;%); 3) the possibility of omitting a formal axillary node dissection for cN1 patients if a pathologic Complete Response (pCR) was confirmed with analysis of one or more sentinel lymph nodes (82&nbsp;%). The majority voted in favor of mapping both the breast and nodal lesions pre-NAC (59&nbsp;%), and against the omission of sentinel lymph node biopsy in cN0 patients in the case of pathologic or clinical Complete Response (69&nbsp;%). In cases of cT3/cN1+ tumors with pCR, only 8&nbsp;% of participants considered appropriate the omission of Post-Mastectomy Radiation Therapy. Conclusion: There is still a wide variability in surgical approaches after NAC in the "real world". As NAC is increasingly used, multidisciplinary teams should be attuned to conforming their procedures to the rapid advances in this field