Cytoreduction plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in colorectal cancer patients: a single-center cohort study

BACKGROUND: In this study, we report our experience of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC), focusing on the factors affecting survival. METHODS: All patients with surgically treated PC from colorectal cancer and with no involvement of other organs referred to our institute from March 2005 to December 2017 were included in the analysis. RESULTS: Thirty-eight patients underwent CRS-HIPEC, and all had a completeness of cytoreduction score of 0 (CC0). The median operating time was 645 min (interquartile range [IQR] 565-710). Five patients (13.1%) had Clavien-Dindo grade >\u20092 postoperative complications. Median overall survival (OS) was 60 months. In the Cox regression for OS, calculated on the CRS-HIPEC group, the peritoneal cancer index (PCI) >\u20096 (hazard ratio [HR] 4.48, IQR 1.68-11.9, P = 0.003) and significant nodal involvement (N2) (HR 3.89, IQR 1.50-10.1, P = 0.005) were independent prognostic factors. Median disease-free survival (DFS) was 16 months. Only N2 (HR 2.44, IQR 1.11-5.36, P = 0.027) was a significantly negative prognostic factor for DFS in multivariate analysis. CONCLUSIONS: CRS-HIPEC can substantially improve survival. However, patients with high PCI (PCI >\u20096) and significant nodal involvement (N2) may not benefit from the procedure

Unexpected High Response Rate to Traditional Therapy after Dendritic Cell-Based Vaccine in Advanced Melanoma: Update of Clinical Outcome and Subgroup Analysis

We reviewed the clinical results of a dendritic cell-based phase II clinical vaccine trial in stage IV melanoma and analyzed a patient subgroup treated with standard therapies after stopping vaccination. From 2003 to 2009, 24 metastatic melanoma patients were treated with mature dendritic cells pulsed with autologous tumor lysate and keyhole limpet hemocyanin and low-dose interleukin-2. Overall response (OR) to vaccination was 37.5% with a clinical benefit of 54.1%. All 14 responders showed delayed type hypersensitivity positivity. Median overall survival (OS) was 15 months (95% CI, 8–33). Eleven patients underwent other treatments (3 surgery, 2 biotherapy, 2 radiotherapy, 2 chemotherapy, and 4 biochemotherapy) after stopping vaccination. Of these, 2 patients had a complete response and 5 a partial response, with an OR of 63.6%. Median OS was 34 months (range 16–61). Our results suggest that therapeutic DC vaccination could favor clinical response in patients after more than one line of therapy

Melanoma maligno dell’esofago: case report

rimary malignant melanoma of the oesophagus is an uncommon neoplasm comprising less than 0.2% of all primary oesophageal neoplasms. The world literature reports about 250 cases. Several reports suggest that it has a mean survival rate of 2-5% at 5 years and a median survival of 10 months. Dysphagia is the commonest symptom. This tumor has an aggressive biological behavior: hematogenous and lymphatic metastases are very common. A 51 year old female presented to our observation for a four month history of worsening dysphagia associated with regurgitation and weight loss. There was no prior history of cutaneous or ocular melanoma. Diagnosis was done on base of endoscopic biopsies. Staging procedures included chest-abdomen computerized tomography (CT) scan, followed by 18-Flurodeoxyglucose positron emission tomography (FDG PET/CT). She was treated with a combination of subtotal oesophageal resection, mediastinal lynphadenectomy and immuno-modulatory therapy with alfa-interferon. Tha patient is alive and disease-free after 18 month follow-up

Robotic vs laparoscopic splenectomy for splenomegaly: A retrospective comparative cohort study

BACKGROUND: The aim of this study was to evaluate the role of robotic total splenectomy for splenomegaly, comparing this approach with the laparoscopic technique. METHODS: We conducted a retrospective review of all patients who underwent minimally invasive splenectomy for splenomegaly (maximum splenic diameter>15\u202fcm) at our institution between 2000 and 2017. RESULTS: A total of 39 patients (27 laparoscopic vs 12 robotic splenectomies) were included in the study. Operative time was significantly longer in the robotic group (270\u202fmin vs 180\u202fmin, p\u202f=\u202f0.007) (Table 2). Median intraoperative blood loss was 350\u202fml for laparoscopic procedures while it was 100\u202fml for the robotic ones (p\u202f=\u202f0.032). Conversion to open surgery was required in 4 cases of laparoscopic splenectomy while no conversion were registered in the robotic group. No significant differences were seen in postoperative morbidity and mortality between the two groups. CONCLUSIONS: Robotic splenectomy for splenomegaly is associated with less blood loss and longer operative times than the laparoscopic procedure

Un caso di sarcoma fibromixoide a basso grado con rara localizzazione retroperitoneale sconfinata all’inguine

Introduzione: Il sarcoma fibromixoide a basso grado (LGFMS) è una rara neoplasia che di solito colpisce giovani adulti ma riportata anche in bambini e di solito a partenza dai tessuti molli delle estremità prossimali. Riportiamo un caso di LGFMS con eccezionale localizzazione retroperitoneale e sconfinante all’inguine. Caso clinico: Un uomo di 40 anni dopo una storia di dolori addominali ingravescenti e sintomi sub-occlusivi, veniva sottoposto prima ad ecografia addominale e poi a TC con mdc per una massa retroperitoneale di 11x10x10 cm adesa al muscolo ileo-psoas dx che dislocava medialmente anse ileali,cieco e vescica. Per l’aggravamento rapido della sintomatologia è stato sottoposto direttamente a chirurgia senza previa biopsia. Si è proceduto ad exeresi radicale previa biopsia intraoperatoria (sarcoma a basso grado) della massa, che dislocava senza comprimere i vasi spermatici ed iliaci, e che sconfinava con una propaggine di 4 cm in regione inguinale attraverso la lacuna vasorum. L’istologia della massa di 480 g ha posto diagnosi di LGFMS nella variante “a rosette giganti”. Non è stata eseguita nessuna terapia adiuvante. Dopo uno stretto follow-up basato su TC toraco-addominale e risonanza magnetica (RMN), il paziente dopo 18 mesi è vivo e libero da malattia. Conclusioni: Il LGFMS è un tumore con basso grado istologico ma con alto rischio di recidiva locale e rischio significativo di metastatizzazione anche tardiva. Bisogna sempre sospettare questo raro tumore ed inviare i tessuti per esami di citogenetica o genetica molecolare se presenti dubbi. Precauzioni speciali vanno poste nell’interpretazione di biopsie con blanda cellularità fusiforme in bambini. Un accurato follow-up è richiesto dopo chirurgia radicale

The role of sentinel node tumor burden in modeling the prognosis of melanoma patients with positive sentinel node biopsy: an Italian melanoma intergroup study (N = 2,086)

The management of melanoma patients with metastatic melanoma in the sentinel nodes (SN) is evolving based on the results of trials questioning the impact of completion lymph node dissection (CLND) and demonstrating the efficacy of new adjuvant treatments. In this landscape, new prognostic tools for fine risk stratification are eagerly sought to optimize the therapeutic path of these patients

GOSAFE - Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery:early analysis on 977 patients

Objective: Older patients with cancer value functional outcomes as much as survival, but surgical studies lack functional recovery (FR) data. The value of a standardized frailty assessment has been confirmed, yet it's infrequently utilized due to time restrictions into everyday practice. The multicenter GOSAFE study was designed to (1) evaluate the trajectory of patients' quality of life (QoL) after cancer surgery (2) assess baseline frailty indicators in unselected patients (3) clarify the most relevant tools in predicting FR and clinical outcomes. This is a report of the study design and baseline patient evaluations. Materials & Methods: GOSAFE prospectively collected a baseline multidimensional evaluation before major elective surgery in patients (≥70 years) from 26 international units. Short−/mid−/long-term surgical outcomes were recorded with QoL and FR data. Results: 1003 patients were enrolled in a 26-month span. Complete baseline data were available for 977(97.4%). Median age was 78 years (range 70–94); 52.8% males. 968(99%) lived at home, 51.6% without caregiver. 54.4% had ≥ 3 medications, 5.9% none. Patients were dependent (ADL 20 s (5.2%) or ASAIII-IV (48.8%). Major comorbidities (CACI > 6) were detected in 36%; 20.9% of patients had cognitive impairment according to Mini-Cog. Conclusion: The GOSAFE showed that frailty is frequent in older patients undergoing cancer surgery. QoL and FR, for the first time, are going to be primary outcomes of a real-life observational study. The crucial role of frailty assessment is going to be addressed in the ability to predict postoperative outcomes and to correlate with QoL and FR