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The actual benefit of extended lymphadenectomy in terms of survival in the surgical treatment of gastric cancer is still a debated issue. The aim of this non-randomized prospective multicentre study was to evaluate long-term survival in a group of patients with involvement of the second level lymph nodes, which would not have been removed with a limited lymphadenectomy. From 1991 to 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy in three italian surgical departments. Lymph node stations were removed and classified according to the rules of the Japanese Research Society for Gastric Cancer; in all cases, retrieval of the lymph nodes was performed by the surgeon on the fresh specimen. Metastases to lymph node stations 7-12 were found in 126 patients out of 451 (27.9%). A mean number of 13 +/- 9 positive lymph nodes (range: 1-42) was found in these cases. Lymph node stations 7 and 8 showed the highest incidence of metastases (61.1% and 44.4%, respectively). Morbidity and mortality rates were 17.1% and 2% in 451 cases treated by extended lymphadenectomy, and 21.4% and 3.2%, respectively, in 126 cases with involvement of second level lymph nodes. In this group of patients, the five-year survival rate was 32 +/- 4%. Multivariate analysis, identified depth of invasion (P < 0.0001, relative risk (RR) 2.4) and the number of positive lymph nodes (P < 0.001, RR 1.6) as significant predictors of a poor prognosis. Japanese-type extended lymphadenectomy is associated with low morbidity and mortality rates if performed in specialised centres. The incidence of metastases in lymph node stations removed with this technique is by no means negligible. This procedure could be beneficial as regards long-term survival even in patients with involvement of regional lymph nodes. more...

Aims: Since the Japanese Society for Gastroenterology and Endoscopy (JSGE) introduced the definition of Early Gastric Cancer (EGC), much more and deeper studies were done, which demonstrated that EGC was a more complex phase of the neoplastic disease with different morphologic characteristics, tightly linked to the prognosis. We evaluated the clinical impact of some prognostic factors, known being important in the advanced lesions, in a series of EGC patients with special reference to the clinicomorphological features., Methods and Results: We analysed the mitotic (MI) and apoptotic (AI) indices and the immunohistochemical expression of p27 and MIB-1 in 83 EGC cases consecutively recruited in the hospitals of Forlì, Verona, Siena and Milan (IRGGC) in the period 1994-95. The classifications of JSGE, Lauren and Kodama were used to define the macroscopic, microscopic and growth pattern types, respectively. Decreased p27 expression correlated with the macroscopic escavated lesions and diffused mixed histotypes; the increase of MIB-1 detection with tumour size larger than 2 cm, but lesser than 4 cm; MI with intestinal histologic types and AI with mucosal and penetrating lesions, according to Kodama. Statistical analysis showed significative correlations among MIB-1, MI and AI, but not with p27 and the other variables. All these factors did not influence the prognosis of our patients., Conclusions: In our series, p27, MIB-1, MI, and AI did not add any useful clinical. So, in EGC patients the morphological features have still the most important role in influencing the prognosis and treatment of patients. more...

Background: The prognostic significance of the histological type in gastric cancer is still debated. The correlation between intestinal-diffuse type and tumor recurrence was investigated in a prospective multicentric study which collects the cases from three surgical Departments of Italy., Patients and Methods: Four-hundred and twelve patients who underwent a potentially curative resection between 1988 and 1995 were considered; 273 cases were classified as intestinal type (group A), and 139 cases as diffuse type (group B). Mixed cases were excluded from the study. All patients were included in a complete follow-up program for the early diagnosis of recurrence. Clinical, histopathological and surgical factors were examined for their influence on tumor recurrence by univariate and multivariate analysis., Results: Recurrence rate was 41.4% in intestinal type, and 65.5% in diffuse type cases (p < 0.0001). In group A, multivariate analysis identified nodal status (p < 0.0001), depth of invasion (p < 0.005), lymph node dissection (D1 vs. D2-D4, p < 0.01), advanced age (p < 0.01) and male sex (p < 0.05) as significant prognostic factors. In group B, depth of invasion (p < 0.0005), lymph node dissection (p < 0.005), tumor size (p < 0.01) and nodal status (p < 0.05) resulted as significant variables; no preventive effect on tumor recurrence was found for D2 vs. D1 lymphadenectomy. Multivariate analysis performed on the totality of the cases demonstrated diffuse type as an independent predictor of poor prognosis (relative risk: 1.67, p < 0.001)., Conclusions: Diffuse type of gastric cancer is an independent risk factor for tumor recurrence as compared with intestinal type; clinical and pathological variables play a different role as prognostic factors in the two histotypes. more...

Postoperative morbidity and mortality were correlated with the preoperative results of three widely used pulmonary function tests (FVC, FEV1, FEV1/FVC) in 100 consecutive patients who underwent pneumonectomy for lung carcinoma. Factor analyzed following operation included thirty-day mortality, incidence of cardiovascular and respiratory complications, number of individuals requiring prolonged mechanical ventilation. Nineteen patients had a forced vital capacity (FVC) of 70% or less of the normal value, seven had a one-second forced expiratory volume (FEV1) of 1.5 liters or less, and thirty-three had a FEV1 of less than 2 liters. Fourteen patients had a FEV1/FVC ratio of 65% or less. There were no differences in morbidity or mortality between these patients and those presenting higher test scores. As a general rule, decisions regarding operability and extent of resection cannot be made solely on the basis of the three spirometry tests reviewed. more...