Search

Background and Objectives: The aim of our study was to retrospectively evaluate the results of 2 groups of patients admitted and treated for rectal cancer. Methods: One hundred and fifty-one patients were available for evaluation. Eighty (group A) were radically operated with the standard technique; 71 (group B) underwent total mesorectal excision (TME). Groups were similar according to demographics, staging, and pathological data. Mean follow-up was 73.5 months. Results: No operative mortality was observed. Complications were 15% in group A and 32% in group B. Local recurrence rates were 41.2% in group A and 12.6% in group B. Distant metastases occurred in 21.2% and 7.6%, respectively, in groups A and B. Cancer-related mortality was 62.5% in the non-TME group and 19.5% in the TME group. Overall 5-year survival rates were 32.4% in group A and 70.5% in group B. Disease-free survival rates were 25% in group A and 62.3% in group B. Conclusions: TME appears to lower the incidence of cancer-related mortality, with a higher incidence of postoperative complications. Further studies need to be done to assess the real benefits of TME in the surgical treatment of rectal cancer.

Antonio Bolognese, Francesco Schillaci, Marcello Bezzi

From 1990 to 2003 have been admitted 105 patients with pelvic recurrence from rectal cancer. Fifty-nine patients have been selected and 25 patients underwent surgery. We evaluate the prognostic factors and the 3 years disease-free survival. The 60% of the patients after R0 resection and the 20% of the patients who underwent R1-R2 resection are alive. The evaluation of the prognostic factors allows early diagnosis of recurrence with a better long time survival.

The aim of this work is the investigation of the level of expression of the vascular endothelial growth factor (VEGF) and metalloproteases (such as Cox-2) in the colon rectal cancer. The final goal is the correlation with liver metastases. Molecular biology approaches will be adopted: in particular: RT-PCR, quantitative real time PCR with fluorescent probes, immunolocalizations and Western blotting This is a proposal of research. The work is under development and results and conclusions cannot be at the moment anticipated. However, in recent publication we found human polyomavirus DNA sequences in colorectal tumors.

Surgical oncology can currently be definite "bio-surgery" in as more frequently uses in pre-, intra and postoperative phase biological substances what growth factors, cytokines, anti-adhesion and neoangiogenesis inhibiting molecules with a potential reduction of the local recurrences and improvement of survival rates. The increasing and continuous development of the genic therapy, cellular therapies, immunotherapy, chemotherapy and radiotherapy in the cancer treatment, "force" surgeon to interrogate himself on the role of the radical surgery through the "advanced" tumors of the digestive tract. Surgery alone, continuous to be in terms of recovery, the most effective treatment against tumor, (62% of the recoveries), also if its combination with other therapies improve the results especially in the advanced tumors. Chemotherapy has had positive results in the treatment of solid tumors, sometimes like adjuvant or neoadjuvant treatment to a radical surgery, improving the survival rates. Surgical oncology of "tomorrow" must be necessarily a quality surgery performed from a surgeon possessing some necessary requisite: technical ability, specific base-formation on physiopathologic knowledge in constant evolution, standardization ability of surgical techniques and therapeutic protocols. Such requisite will allow surgeon reach the main goal of surgical oncology what the local control of tumor, reduction of local recurrences, offer an good enough quality of life getting all the possible information on the local development of tumor and on the ways of diffusion. All these elements will be necessary for formulate a reliable prognostic judgment, more and more requested from the patients.

The aim of this study was to determine the best surgical approach for the treatment of late radiation injury to the bowel.Clinical and follow-up charts of 83 patients operated in our institution for late radiation injury to the bowel were retrospectively reviewed. The type of operation (resection-anastomosis or bypass) mortality, postoperative complications and reoperation rate were recorded. Seventy-six underwent resection with immediate anastomosis. A bypass or viscerolysis was performed in only 7 patients.Postoperative mortality was 2.4%, morbidity was 23. Twenty-seven patients underwent further surgery; early reoperation (within 1 month) was necessary in 12 (morbidity 41%). A late reoperation has been performed in 15 patients (no mortality, morbidity 53.5%).From the results of our study it can be concluded that resection with immediate anastomosis for late radiation injury to the bowel is safe and should be the first option for these patients.

The Authors have reported a case of retroperitoneal leiomyosarcoma. The retroperitoneal localization is quite unusual and early diagnosis is difficult. Only surgery operation and radio-chemotherapy can improve the prognosis. Tumor size is the major prognostic factor.

The Authors report a case of Vater's ampulla apudoma and after having examined the characteristics of these neoplasms they discuss clinical presentation, diagnostic and treatment problems of islet cell adenomas. They review the literature and make some remarks.

Surgery remains the preferred therapy for renal cell carcinoma. The various adjunctive or complementary therapies currently yield disappointing results. Identifying reliable prognostic factors could help in selecting patients most likely to benefit from postoperative adjuvant therapies. We reviewed the surgical records of 78 patients who had undergone radical nephrectomy with lymphadenectomy for renal cell carcinoma, matched for type of operation and histology. According to staging (TNM), 5.1% of the patients were classified as stage I, 51.3% as stage II, 29.5% as stage III and 14.5% as stage IV. Of the 78 patients 40 were T2N0 and 21 T3aN0. Tumor grading showed that 39.7% of the patients had well-differentiated tumors(G1), 41.1% moderately-differentiated (G2), and 19.2% poorly-differentiated tumors (G3). Overall actuarial survival at 5 and 10 years was 100% for stage 1; 91.3% at 5 years and 83.1% at 10 years for stage II; 45.5% and 34.1% for stage III; and 29.1% and nil for stage IV (stage II vs stage III p = 0.0001). Patients with tumors confined to the kidney (pT2N0) had better 5- and 10-year survival rates than patients with tumors infiltrating the perirenal fat (pT3aN0) (p = 0.000006). Survival differed according to nuclear grading (G1 vs G3 ; p = 0.000005; G2 vs G3; p = 0.0009). In conclusion our review identified tumor stage, primary-tumor extension, and the grade of nuclear differentiation as reliable prognostic factors in patients with renal cell carcinomas.

Thyroglossal duct cysts are the most common congenital disorder of the neck. One percent of cases may degenerate and give rise to a cancer, mainly arising in the pericystic thyroid tissue. Some 250 cases have been reported in the literature to date. We report here on a 39-year-old man with a midline mass in the neck measuring 4 cm max. The patient was examined preoperatively by ultrasonography of the neck and assay of thyroid hormones, which yielded a diagnosis of a thyroglossal duct cyst. On the basis of these findings, the patient underwent surgery to remove the mass and, after an extempore histopathological examination, was submitted to total thyroidectomy owing to the presence of papillary carcinoma of the thyroid arising on the thyroglossal duct cyst with multiple foci in the context of the thyroid gland. Most thyroid cancers at the time of surgery are confined to the thyroid gland, infiltrating the adjacent structures in approximately 20% of cases and the local-regional lymph nodes in 8 to 11.5%. Thyroid papillary adenocarcinoma is multifocal in 21% of cases. The multifocal nature of the cancer makes total thyroidectomy mandatory at the same time as surgery is performed to remove the cyst.

The echinococcosis represents a common condition in many parts of the world with maximum incidence in Uruguay (32 cases/100,000/year), in Argentina (21 cases/100,000/year), and in Morocco (7.2 cases/100,000/year). Italy is among the middle-high risk countries with beyond 1000 annual surgeries for hydatid cyst. Liver (45-75%) and lung (10-50%) are the most frequent localizations of echinococcosis. The other localizations represents the 13% of total. The hydatid cyst of pancreas constitutes the 1%. The Authors report the clinical case of a 28 years old woman, admitted for abdominal pain. Abdominal ultrasound, angio-CT and angiography of celiac trunk and superior mesenteric artery have been undertaken and the presence of a 10 x 10 cm lesion in the body-tail of pancreas has been showed, and the diagnosis of pseudocyst or cystadeno-carcinoma of pancreas has been formulated. The patient underwent surgery with body-tail pancreatectomy plus splenectomy. The histopathological examination showed the presence of hydatid cyst contained clear fluid and daughter cysts. The treatment of this infrequent localization of hydatid cyst is exclusively surgical. The tactic and surgical technique must aim to radical cyst's removal, with the maximum saving of the stricken organ, maintaining a good pancreatic function, either exocrine and endocrine.

The aim of this study was to describe the clinico-pathological characteristics of malignant biliary papillomatosis and the diagnostic and therapeutic approach adopted in this case, which extended from the left hepatic biliary duct to the bifurcation of the 2nd and 3rd segments. The patient was studied with ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), CT scan and MRI cholangiography, which showed the morphological characteristics and the extent of the disease in the biliary tract. The malignancy of the disease was confirmed by preoperative cytological analysis of bile collected via a nasobiliary probe. The surgical treatment, preceded by intraoperative ultrasonography, consisted in a left hepatectomy, sparing the 1st segment, and a right intrahepatic jejunostomy. The final pathological analysis revealed a malignant biliary papillomatosis. Preoperative ERCP clearly documented the exact distribution of the biliary tract lesions and allowed both treatment of the cholestasis and diagnosis of the nature of the lesion through cytological analysis of the bile. Surgical treatment must be carried out and guided not only by the preoperative diagnosis, but also by perioperative ultrasonography. Finally, owing to the rarity of such cases and consequently our very limited knowledge of the disease, an intensive follow-up is recommended.

Soft tissue sarcomas account for less than 1% of all malignancies and 10% of them arise in the retroperitoneal tissues 1,2 . The prognosis for patients with retroperitoneal sarcoma varies widely but is usually poor, with reported five-year survival rates ranging between 12% and 70% 1-6 . Complete surgical resection is the treatment of choice 7 . An accurate preoperative diagnosis is necessary to enable the most radical surgical excision of the mass. A 53-year-old woman was admitted to our hospital because of a six-month history of a painless but growing palpable mass of hard consistency located in the right upper quadrant of the abdomen. The patient’s medical history was unremarkable except for iron deficiency anemia. Physical examination revealed a solid, palpable mass occupying the right upper abdomen. There was no palpable lymphadenopathy. Plain X-ray of the abdomen showed a vast, ill-marginated calcified radiopacity projecting over the right upper quadrant (Figure 1). Ultrasound examination detected a large multilobated, mixed echogenic mass extending from the right iliac wing to the lower surface of the liver, inseparable from the medial aspect of the ipsilateral kidney, which appeared invaded and displaced medially. Spiral CT of the abdomen revealed a single, large mass characterized by heterogeneous soft-tissue density with some areas of fatty density on non-contrast images. The upper part of the mass was completely calcified and the mass appeared to originate from the retroperitoneal space. After administration of intravenous contrast medium the mass showed heterogeneous enhancement (Figure 2). The patient underwent radical surgical excision of the lesion with resection of the right kidney. Histological examination showed predominant features of myxoid and round cell liposarcoma. These areas were juxtaposed to high-grade leiomyosarcoma cells, with some areas of lipoma-like type; malignant fibrous histiocytoma-like areas with malignant cells arranged in whorls were also detected. Metaplastic bone and cartilage formation was also observed, especially in the upper portion of the mass. The final pathological diagnosis was mixed retroperitoneal sarcoma with metaplastic bone and cartilage formation. The patient is free of disease at one year from diagnosis. Retroperitoneal sarcomas are often very large at diagnosis because they become symptomatic only when they reach the size of a huge mass or when there is as

The aim of our study was to retrospectively evaluate the results of 2 groups of patients admitted and treated for rectal cancer.One hundred and fifty-one patients were available for evaluation. Eighty (group A) were radically operated with the standard technique; 71 (group B) underwent total mesorectal excision (TME). Groups were similar according to demographics, staging, and pathological data. Mean follow-up was 73.5 months.No operative mortality was observed. Complications were 15% in group A and 32% in group B. Local recurrence rates were 41.2% in group A and 12.6% in group B. Distant metastases occurred in 21.2% and 7.6%, respectively, in groups A and B. Cancer-related mortality was 62.5% in the non-TME group and 19.5% in the TME group. Overall 5-year survival rates were 32.4% in group A and 70.5% in group B. Disease-free survival rates were 25% in group A and 62.3% in group B.TME appears to lower the incidence of cancer-related mortality, with a higher incidence of postoperative complications. Further studies need to be done to assess the real benefits of TME in the surgical treatment of rectal cancer.