Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Stunned and necrotic areas. Role of MRI. Italian Cooperative Study.

..

Treatment of congestive heart failure with oral enoximone.

Treatment of congestive heart failure with oral enoximone

Impact of Control Point Angular Separation on the Dosimetric Accuracy of VMAT Plans

n/

LAPAROSCOPIC APPENDECTOMY FOR ACUTE APPENDICITIS: WHAT SPACE IS THERE FOR TRAINING RESIDENTS?

Introduction: Material and methods: We performed a retrospective study examining the records of patients with acute appendicitis that underwent laparoscopy appendectomy at our institution from September 2011 to June 2017. Cases were divided in two groups: those performed by a trainee (G1) and those performed by the senior surgeon (G2). In each group we compared preoperative characteristics, operative data and postoperative morbidity and mortality.Results: During the study period, 922 patients with clinical diagnosis of appendicitis underwent laparoscopic appendectomy at our institution: of these, 386 cases were performed primarily by residents and 536 were performed by senior surgeons. There were no statistical differences in pre-operative characteristics of patients. The two groups did not differ significantly regarding operative times (G1:67 \ub1 19 vs G2:70 \ub1 26 minutes), postoperative major complications (G1:9% vs G2:19%), length of stay (3 \ub1 2 days for both groups), and 30-days mortality (none)., operative times (67 \ub1 19 vs 70 \ub1 26 min; respectively), major complications (2% vs 3%; respectively) and length of hospital stay (3 \ub1 2 vs 3 \ub1 3). Multivariate analysis confirmed that the type of main surgeon was not an independent risk factor for postoperative morbidity. Conclusion: Postoperative results of laparoscopic appendectomies do not differ significantly if surgeries are performed by residents as opposed to specialists. Appendectomy can provide teaching opportunities without compromising results for patients. References: Disclosure: No significant relationships

Adjuvant radiotherapy for a prostate cancer after renal transplantation and review of the literature

Renal transplant recipients are a population usually considered at a higher risk of malignancies, mostly skin cancer and lymphoproliferative disorder. In recent years, prostate cancer in renal transplant recipients has been becoming more frequent. This is probably due to the growing age and the longer survival of the transplanted patients. We report the case of a 50-year-old man with prostate cancer and renal allograft, who received radiotherapy after prostatectomy at the Institute of Radiotherapy of the University of Florence. Radiotherapy is part of the standard treatment for many cases of prostate cancer. According to the few series reported in the literature and also to our experience, radiation therapy is feasible also in renal transplant recipients with accurate treatment planning