Contemporary snapshot of tumor regression grade (TRG) distribution in locally advanced rectal cancer: a cross sectional multicentric experience.

Pre-operative chemoradiotherapy (CRT) followed by surgical resection is still the standard treatment for locally advanced low rectal cancer. Nowadays new strategies are emerging to treat patients with a complete response to pre-operative treatment, rendering the optimal management still controversial and under debate. The primary aim of this study was to obtain a snapshot of tumor regression grade (TRG) distribution after standard CRT. Second, we aimed to identify a correlation between clinical tumor stage (cT) and TRG, and to define the accuracy of magnetic resonance imaging (MRI) in the restaging setting. Between January 2017 and June 2019, a cross sectional multicentric study was performed in 22 referral centers of colon-rectal surgery including all patients with cT3-4Nx/cTxN1-2 rectal cancer who underwent pre-operative CRT. Shapiro-Wilk test was used for continuous data. Categorical variables were compared with Chi-squared test or Fisher's exact test, where appropriate. Accuracy of restaging MRI in the identification of pathologic complete response (pCR) was determined evaluating the correspondence with the histopathological examination of surgical specimens.In the present study, 689 patients were enrolled. Complete tumor regression rate was 16.9%. The "watch and wait" strategy was applied in 4.3% of TRG4 patients. A clinical correlation between more advanced tumors and moderate to absent tumor regression was found (p = 0.03). Post-neoadjuvant MRI had low sensibility (55%) and high specificity (83%) with accuracy of 82.8% in identifying TRG4 and pCR.Our data provided a contemporary description of the effects of pre-operative CRT on a large pool of locally advanced low rectal cancer patients treated in different colon-rectal surgical centers

Long term sequelae after 1,311 primary inguinal hernia repairs

Background: Aim of this study was to analyze long-term sequelae, risk factors, and satisfaction after inguinal hernia primary repair. Methods: A postal questionnaire was mailed to all patients operated between January 1997 and December 2004 for inguinal hernia repair. Patients who had a lump in the groin and patients who experienced chronic problems were invited for a physical examination. Patients who reported having chronic pain were asked to fill out the short-form McGill Pain Questionnaire (SF-MPQ). Results: Chronic pain was present in 18.1% of cases. The strongest risk factors were presence of recurrence, use of heavyweight mesh, and age younger than 66 years. By means of the SF-MPQ, we found that the pain reported by most patients was sensory-discriminative in quality, with "tender" and "aching" being the most common descriptors used. About 71.3% of replies used descriptors typical of nociceptive pain, 8.9% of neuropathic pain, and 19.8% of nociceptive plus neuropathic. Chronic pain was severe in 2.1% of patients and interfered with normal activities, work, and exercise. The cumulative recurrence rate was 2.1%. There was a strong correlation between lump and recurrence. Patients declared themselves satisfied with the result of the operation in 93.1% of cases. Due to chronic pain, 6.5% of patients were unsatisfied. Conclusions: This study demonstrates that the main problem after inguinal hernia repair remains chronic pain, which was the primary reason of dissatisfaction. The SF-MPQ is feasible and easy to administer to all patients and provides important information about qualitative features of the pain

Preliminary results of transumbilical single-port laparoscopic cholecystectomy

Single-port laparoscopic cholecystectomy was developed with the aim of reducing the invasiveness of traditional laparoscopy, diminishing postoperative pain and morbidity. The aim of this prospective study was to assess the feasibility and the efficacy of this new approach. Between April and December 2009, a total of 21 patients underwent single-port laparoscopic cholecystectomy for symptomatic gallbladder stone disease. Single surgeon, elective patient, no preoperative diagnosis of common bile duct stone and no previous upper abdominal surgery were the selection criteria chosen for the study. Attempt to reproduce the standard technique (routine intraoperative cholangiography) was considered. Twenty patients (95.2%) successfully completed single-port surgery, and the median operative time was 65 min (range 40-122). Conversion to standard laparoscopic cholecystectomy was required for one patient (4.8%) for a difficult haemostasis. Intraoperative cholangiography was performed for 14 patients (66.7%). Seven patients (33.3%) were discharged on the same day of the operation; median hospital stay was 1 day (range 1-4). No postoperative complications were observed; one patient was reoperated on the same day of surgery because of unexplained abdominal pain and leucocytosis, but relaparoscopy demonstrated no fluid collection. On the 1st postoperative day, median VAS was 3. Most patients declared to be satisfied with the result of the operation and the resulting scar. Transumbilical single-port access cholecystectomy is feasible using standard laparoscopic instruments. It may reduce morbidity, postoperative pain and may offer cosmetic advantages compared with standard laparoscopic approach. However, presently the procedure may be performed only by surgeons with wide experience with this operation through standard laparoscopic access

TRAITEMENT CHIRURGICAL DU REFLUX GASTRO-OESOPHAGIEN PAR COELIOSCOPIE : ETAT DE L\u2019ART

Le reflux gastro-\u153sophagien est une pathologie fr\ue9quente et pose un probl\ue8me de sant\ue9 publique en raison de sa pr\ue9valence \ue9lev\ue9e, de son \ue9volution chronique et du recours fr\ue9quent \ue0 un traitement. Le traitement peut \ueatre m\ue9dical ou chirurgical. La fundoplicature repr\ue9sente le traitement chirurgical de choix; elle a pour but d'entourer le bas de l'\u153sophage d'un anneau d'estomac pour former une valve antireflux. Actuellement, la voie d'abord de r\ue9f\ue9rence est la laparoscopie qui am\ue9liore de mani\ue8re importante les suites op\ue9ratoires, en les rendant en particulier moins douloureuses, tout en r\ue9duisant la dur\ue9e d'hospitalisation et en raccourcissant la p\ue9riode de convalescence. Le point encore \ue0 d\ue9battre est le choix de la technique chirurgicale entre la fundoplicature totale de Nissen ou Nissen-Rossetti et la fundoplicature post\ue9rieure selon Toupet. Dans la litt\ue9rature la plus r\ue9cente, les deux techniques semblent \ueatre comparables en termes de r\ue9sultats. La plus faible morbidit\ue9 de la technique de Toupet peut \ueatre contrebalanc\ue9e par la meilleure efficacit\ue9 \ue0 long terme de l'intervention de Nissen. Il nous semble que la fundoplicature totale selon Nissen est plus efficace en termes de contr\uf4le du reflux \ue0 long terme que la fundoplicature partielle. Dans notre s\ue9rie, le taux de dysphagie s\ue9v\ue8re est acceptable et la plupart des patients sont satisfaits

Rendez-vous endolaparoscopico nel trattamento della calcolosi colecisto-coledocica

Premessa Molti studi hanno dimostrato l\u2019efficacia del rendez-vous endo-laparoscopico nel trattamento in un unico tempo della coledocolitiasi associata alla litiasi della colecisti. Scopo dello studio Scopo del presente studio \ue8 l\u2019analisi della tecnica del rendez-vous in pazienti con litiasi colecisto-coledocica in termini di effica-cia, fattibilit\ue0, morbilit\ue0 e mortalit\ue0. Metodi Dal 1998 al 2008, sono stati sottoposti consecutivamentea a rendez-vous endo-laparoscopico 37 pazienti, 22 donne e 15 uomini con un\u2019et\ue0 media di 63 anni (range: 33-82). Il rendez-vous consiste nell\u2019effettuare, nella medesima seduta operatoria, video-laparo-colecistectomia, colangiografia intra-operatoria, colangio-pancreatografia retrograda endoscopica (CRPE), eventuale papillosfinterotomia endoscopica e bonifica della via biliare principale. Risultati La mortalit\ue0 intra- e post-operatoria \ue8 stata nulla. Nessun intervento ha richiesto la conversione open. La durata mediana dell\u2019intervento \ue8 stata di 150 minuti (range: 65-270). Complicanze intra-operatorie minori si sono verificate in 6 pazienti (16,2%), ma non hanno determinato n\ue9 conversione, n\ue9 prolungamento della durata dell\u2019intervento. Complicanze post-operatorie maggiori si sono verificate nel 10,8% dei casi (2 sanguinamenti della papilla e 2 fistole biliari), guariti con terapia conservativa e con una degenza mediana di 16 giorni. Si sono verificate 2 pancreatiti acute lievi (5,4%), trattate conservativamente e con risoluzione completa del quadro patologico. Considerando globalmente tutti i pazienti, la degenza post-operatoria mediana \ue8 stata di 5 giorni. Ad un follow-up mediano di 60 mesi (range: 6-72), tutti i pazienti sono in buone condizioni generali. Conclusioni Il rendez-vous endo-laparoscopico rappresenta una tecnica valida ed efficace nel trattamento della calcolosi colecisto-coledocica, con un successo del 97,3% nella nostra esperienza. Permette in un unico tempo la risoluzione della duplice patologia. Il limite della metodica \ue8 rappresentato dalle difficolt\ue0 logistico-organizzative, soprattutto quando la coledocolitiasi \ue8 accertata intra-operatoriamente

Analysis of post-surgical pain after inguinal hernia repair : a prospective study of 1,440 operations

Background: Pain remains a significant clinical problem after inguinal hernia repair. We prospectively assessed post-surgical pain following herniorrhaphy in 1,440 operations with the aim of describing the characteristics and identifying predisposing factors for pain. Methods: Pain quality was assessed with the short-form McGill Pain Questionnaire (SF-MPQ); pain character was estimated as either nociceptive or neuropathic in nature. Results: A total of 38.3% of replies reported pain (acute or chronic), and 18.7% reported chronic pain. Independent risk factors for pain were young age, BMI >25, day surgery, and use of Radomesh. In patients with chronic pain, independent risk factors were young age, BMI >25 and use of Radomesh. Analysis of the SF-MPQ revealed that the pain reported by most patients was sensory-discriminative in quality. The most common descriptors were tender and aching. Patients with chronic pain reported more intense pain and used sensory descriptors of greater mean intensity than patients with acute pain. A total of 73.9% of replies used descriptors typical of nociceptive pain, 6.5% used descriptors typical of neuropathic pain and 19.6% used nociceptive plus neuropathic descriptors. Patients considered to have nociceptive pain used significantly more sensory descriptors than those considered to have neuropathic pain. By contrast patients with neuropathic pain used more affective descriptors than those with nociceptive pain. Neuropathic pain was reported as more difficult to treat with analgesics than nociceptive pain and neuropathic plus nociceptive pain. Conclusions: Our study confirms that herniorrhaphy frequently produces chronic pain, which can reduce quality of life. The SF-MPQ is a useful instrument to administer to all patients and provides important information about qualitative properties of the pain

Preoperative CEA, NSE, SCC, TPA and CYFRA 21.1 serum levels as prognostic indicators in resected non-small cell lung cancer

In 62 patients affected by resectable non-small cell lung cancer (NSCLC) submitted to radical surgery we evaluated the prognostic significance of CEA, NSE, SCC, TPA and CYFRA 21.1 serum levels at diagnosis, as well as the predictive ability of these tumor markers with respect to histological type and pathological stage. The group was composed of 56 male and 6 female patients; the median age was 62 years (range 29-73 years). Thirty-four patients had a histological diagnosis of adenocarcinoma and 28 of squamous cell carcinoma; with regard to pathological stage, 32 patients had stage I, 4 patients stage II and 23 patients stage IIIA disease. A good predictive ability with respect to histological type was obtained with SCC serum levels; as for pathological stage, TPA and CYFRA 21.1 were found to have moderate predictive ability. In this series of patients, at a median follow-up of 55 months after surgery, we found that both TPA and CYFRA 21.1 serum levels at diagnosis were reliable predictors of overall survival, high values of these markers being associated with a worse prognosis

Does Pathological Stage and Nodal Involvement Influence Long Term Oncological Outcomes after CROSS Regimen for Adenocarcinoma of the Esophagogastric Junction? A Multicenter Retrospective Analysis

Simple SummaryChemoradiotherapy according to CROSS regimen is the standard of care for locally advanced esophageal cancer. The studies conducted on this topic have demonstrated the benefits of this type of treatment particularly for squamocellular cancers. Its application for adenocarcinoma has evidenced different results and few studies have investigated its role for adenocarcinomas of esophagogastric junction. Our intent is to evaluate the relation between pathological (yp) stage after CROSS regimen followed by surgery for adenocarcinoma of cardia and overall (OS) and disease-free survival (DFS) in a retrospectively analyzed group of patients. Sites of relapse after surgery were also analyzed. Our results evidenced no differences in term of OS and DFS according to different pathological response after chemoradiotherapy and surgery. Further analyses could be performed to identify the histological and molecular characteristics of these tumors and predict the efficacy of systemic therapy identifying patients who can most benefit from this type of treatment.Background:After the results reported by the "Chemoradiotherapy for esophageal Cancer Followed by Surgery Study" (CROSS) trial, neo-adjuvant chemoradiotherapy became the standard treatment for locally advanced cancers of esophagus and gastroesophageal junction (GEJ). Excellent results were reported for squamocellular carcinomas (SCCs). Since the advent of the CROSS regimen, the results of surgery for esophageal adenocarcinomas (EAC) have cast some doubts about its efficacy on overall survival (OS) even in the presence of local response. This study evaluated the relation between pathological (yp) stage after CROSS regimen followed by surgery for adenocarcinoma of cardia and overall (OS) and disease-free survival (DFS). Sites of relapse after surgery were also analyzed. Methods: Patients submitted to the CROSS regimen for locally advanced EAC of the cardia followed by transthoracic esophagectomy were analyzed. Actuarial OS and DFS were analyzed and stratified according to yp stage. The site of relapse, distal and local, was also analyzed. Results: The study included 132 patients. The 50-month OS and DFS were 45% and 6.7%, respectively. No differences emerged analyzing OS according to yp stage. Time to relapse was significantly longer for yp Stage I and II, and for yp N0, compared with yp N+. Recurrence occurred in 48 cases (36.3%) with a 9 months median time to relapse. Local and distal relapse were 10 (7.5%) and 38 (28.7%) cases, respectively (p <= 0.001). Conclusions: Pathological stage after CROSS regimen does not relate to OS and DFS. Time to recurrence is significantly longer for yp Stages I and II and ypN0. Chemoradiotherapy in a neoadjuvant setting may influence the site of relapse, significantly reducing local recurrences

PRELIMINARY RESULTS OF CLINICAL EVALUATION OF THE FREE/TOTAL PROSTATE-SPECIFIC ANTIGEN RATIO IN A MULTICENTRIC STUDY

none13noneTERRONE C; G. AIMO; E. BOMBARDIERI; A. CIANETTI; M. CORREALE; P. BARIOLI; M. BARICHELLO; S. MASSARON; E. SEREGNI; D. MARZANO; I. ABBATE; A. PAGLIARULO; M. GIONTerrone, C; G., Aimo; E., Bombardieri; A., Cianetti; M., Correale; P., Barioli; M., Barichello; S., Massaron; E., Seregni; D., Marzano; I., Abbate; A., Pagliarulo; M., Gio