Laparoscopic right hemicolectomy: the SICE (Societ\ue0 Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Background: While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons\u2019 attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods: One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results: ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients\u2019 characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions: In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration: Clinical trial (Identifier: NCT03934151)

Surgical treatment of isolated lung and adrenal metastasis from colorectal cancer. Case report.

INTRODUCTION: Up to 30% of stage I and II colorectal cancers (CRCs) treated with surgical resection alone show disease recurrence, indicating that lymph node (LN) involvement was probably underestimated. Lung is a common site of CRC metastasis, whereas adrenal glands are rarely involved. CASE REPORT: On July 2004 a 56-year old woman underwent left hemicolectomy for a stage I sigmoid cancer. Four years later a lobectomy was performed for an isolated lung metastasis; thirteen months thereafter she underwent left adrenalectomy for adrenal metastasis. No lymph node involvement has ever been demonstrated either histopathologically or radiologically. At present, the patient is alive and apparently disease-free. DISCUSSION: The presence of LN occult metastasis, that might explain recurrence in stage I and II CRCs, has recently been investigated by means of immunohistochemistry and polymerase chain reaction; evidence of LN metastasis obtained with the latter technique is associated to a worse outcome. There have been very few cases that resemble our patient's neoplastic progression and they were either stage III neoplasms or rectal cancers. Our patient's primitive localization in the sigmoid colon makes it difficult to imagine why the liver has not been a site of metastasis. Finally, surgery has an important role in treating isolated metastasis in both lungs and adrenal glands. KEY WORDS: Colorectal cancer, Lung metastasis, Solitary adrenal metastasis

Dalla biologia molecolare ai nuovi approcci terapeutici del cancro colorettale: ricerca di base, sperimentazione clinica ed implicazioni chirurgiche

Gli Autori analizzano, attraverso una ampia disamina della let - teratura, le moderne conoscenze circa la storia naturale del cancro colorettale nell’ottica biologico-molecolare e genetica. Vengono passati in rassegna la patogenesi delle cripte aberranti e delle poliposi familiari adenomatose e la oncogenesi dei cancri colo - rettali di tipo sporadico, anche sulla scorta di esperienze personali circa lo studio e l’applicazione clinica dei geni del sistema di ripara - zione del DNA. Pur se dal punto di vista chirurgico non si è ancora in grado di proporre significative variazioni alle tecniche di trattamento fin qui consolidate e coadiuvate, nelle forme più avanzate, da trattamenti radio e chemioterapici di tipo adiuvante o neoadiuvante che non hanno fin qui consentito significativi miglioramenti per ciò che attie - ne periodo libero da malattia e sopravvivenza, al momento non è ancora affidabile una terapia genica radicale che possa portare alla reintroduzione nelle cellule di un gene difettoso reso funzionale. Sono comunque allo studio farmaci apparentemente in grado di agire in maniera preventiva e sulla evoluzione dei cancri colorettali di tipo sporadico e sui precursor

[Evaluation of the effect of H2-histamine antagonists in the natural history of stomach cancer].

On a study population of 131 patients the Authors evaluate possible differences related to the use of H2 blockers. Patients were divided in 2 groups: one (70 cases) studied before the introduction of H2 blockers and the other (61 cases) treated with H2 blockers. The influence of endoscopy for the early diagnosis of gastric cancer was also considered. The Authors conclude that H2 blockers do not have a negative influence from a surgical point of view, however the correct diagnosis may often be delayed and this is not acceptable for an era in which early diagnosis is feasible

Alterazione della espressione delle tubuline cellulari alfa e beta in pazienti affetti da cancro colorettale di tipo sporadico

Gli Autori indagano sul significato clinico-patologico della alte - razione delle tubuline alfa e beta, componenti dei microtubuli del citoscheletro delle cellule della mucosa colica, in 16 pazienti operati per cancro colo-rettale di tipo sporadico. Essi valutano l’alterazione dell’espressione proteica delle tubuline alfa e beta nelle cellule della mucosa tumorale colica, in tessuti aspor - tati chirurgicamente, mediante metodica immunoistochimica attra - verso l’impiego di anticorpi monoclonali specifici. La perdita di espressione delle tubuline alfa e beta è stata riscon - trata nel 56,2% dei soggetti esaminati, mentre l’alterazione isolata della tubulina alfa è stata riscontrata nell’81,2% dei pazienti. Tali dati sembrano concordare con quelli sperimentali di Porter, che ha recentemente ipotizzato che l’alterazione delle strutture micro - tubulari sarebbe da interpretare come espressione della risposta cellu - lare al danno del DNA e quindi alla degenerazione in senso neopla - stico di un compartimento cellulare

Trattamento integrato del carcinoma della mammella: revisione della nostra esperienza

Nell’Occidente industrializzato il cancro della mammella rappresenta la più frequente neoplasia maligna nelle donne e da oltre 30 anni se ne registra un progressivo aumento di frequenza. La mortalità è rimasta sostanzialmente invariata. Gli Autori, sulla base di una casistica accumulata in cinque anni di attività, tracciano un percorso diagnostico-terapeutico allo scopo di contribuire ad una linea di condotta, pratica e attuale, in tema di cancro dell