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Presentazione Tesi di Specialità : Trattamento chirurgico del carcinoma gastrico. Analisi di una casistica quarantennale e confronto tra periodi
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Conferenza Magistrale su : Tracheal sleeve Pneumonectomy for T3 Lung Cancer with invasion of Carina
No full textImpact of routine videothoracoscopy as the first step of the planned resectiona for lung cancer. Experience of 1306 cases
Full text linkWe have analyzed our experience of 1306 patients with NSCLC, submitted from November 1991 to December 2007 to routine videothoracoscopy exploration, as the first step of the planned procedure, in order to evaluate its validity in obtaining precise assessment of tumor extension, verifying thoracoscopic resectability and in decreasing the rate of unnecessary thoracotomies.
Thoracoscopy revealed inoperability in 58 patients (4.4%) mostly due to pleural dissemination (2.4%) or mediastinal infiltration (1.7%). Of the remaining 1248 (95.6%), 449 (34.4%) had thoracoscopic resection (230 lobectomies, 6 pneumonectomies, 230 wedge resections), 767 (58.7%) underwent open resection (592 lobectomies, 175 pneumonectomies), and 32 (2.4%) had an exploratory thoracotomy (ET). Among the 32 ETs, thoracoscopy had suspected unresectability in 7 (0.5%), had been incompletely carried out in 4 early cases (0.3%) and had been unfeasible in 21 (1.6%). In our previous series from 1980 to 1991 the E.T. rate had been 11.6%. In the present series, after the introduction of routine thoracoscopy, the E.T. rate is 2.4% and the global rate of patients correctly staged, by thoracoscopy is 73.3%, significantly better than by CT. Video exploration resulted highly reliable in excluding conditions of unresectability with a negative predictive value (NPV) of 0.97.
We conclude that preliminary thoracoscopy is useful in obtaining correct staging, reliably evaluates resectability of the lesion and helps in decreasing unnecessary thoracotomies
Il trattamento chirurgico del carcinoma gastrico. Analisi di un'esperienza quarantennale : confronto tra periodi
No full textIntroduzione Presso la nostra Scuola dal 1972 al 2007 sono stati operati per ca. gastrico 479 pazienti. Scopo del lavoro è l’analisi dell’esperienza mediante il confronto tra due casistiche differenti, raccolte dal 1972 al 1990 e dal 1992 al 2007. Materiali e Metodi La serie più recente comprende 255 pazienti (55% età>65 aa., 55% maschi). 224 interventi resettivi e 24 palliativi; complicanze 8%, mortalità 3,5%. L’esperienza di confronto, maturata tra il 1972 e il 1990, è composta da 240 pazienti (62% età65aa; i T1 hanno una sopravvivenza del’83,4±7,9% contro il 31,3±5,18% dei T2. Gli N0 dimostrano una sopravvivenza del’68,13±6,6% e gli N1 del 36,41±7,9%, nessun N2 risulta vivo a 5 anni. Lo stadio I sopravvive a 5 anni nel 67,53±6,7% contro il 38,14±8,7% del II. Non si sono riscontrate differenze statisticamente significative per il tipo di intervento. La serie di confronto non evidenziava risultati significativi riguardo l’età e il tipo di intervento; era invece significativa la differenza in funzione di T (T1 83±29%,T2 57,5±11%), di N (N0 67±11%, N1 35±14%, N2 17±15%) e dello stadio (I 75±12%, II 34,5±17%). Discussione Nella serie recente è aumentato il numero dei ca. in situ e dei tumori operati ai primi stadi ed è aumentata la tendenza a eseguire interventi più conservativi. Le complicanze sono risultate significativamente inferiori (dal13% all’8%) ed è diminuita la mortalità (dal 5,4% al 3,5%). Il confronto specifico, seppur indebolito dalla relativa disomogeneità delle due popolazioni, mostra differenze di sopravvivenza significative per stadio, ma non per tipo di intervento. L’età è nella serie recente un fattore prognostico fortemente significativo, dato il notevole aumento della quota di grandi anziani operati per cancro gastrico
Surgical treatment of gastric cancer. Comparison between periods in a forty-year clinical experience
No full textSurgical treatment of gastric cancer. Comparison between periods in a forty-year clinical experience.
Contardo Vergani,MD, FACS Luca Despini,MD, Marco Pagani,MD, and Giancarlo Roviaro MD, FACS
Dipartimento di Scienze Chirurgiche, Università degli Studi di Milano – U.O.C. Chirurgia Generale Ospedale Maggiore Policlinico, IRCCS – Milano.
Via Francesco Sforza, 35 20122 Milano Italy
From 1972 through 2007, 479 patients have been submitted to surgery for gastric cancer at our School. Aim of this paper is to analyse this forty-year experience by comparing two different clinical series collected from 1972 through 1992 and from 1992 through 2207, respectively.
The more recent series includes 255 patients (55% older than 65 years), 224 resections with curative intention and 24 palliative procedures. In this series we recorded an 8% complication rate and a 3.5% mortality rate. The previous series, collected between 1972 and 1992, included 240 patients (62% older than 65 years), 209 resections, 11 palliations and 20 exploratory laparotomies. The complication rate was 13% and mortality was 5.4%. The two series have been separately analyzed and then compared in respect of age, operation, T and N descriptors and Stage IA-IB, II. Five-year survival has been calculated by Kaplan Meier method and compared with the log-rank test. The largest series in the literature have been considered and the results compared.
In the recent series differences in survival related to age, T and N (N0-N1-N2) descriptors and stage resulted highly significant (p<0.001). Patients younger than 65 have a survival of 56.3% vs. 28.9% of those older than 65. T1 have a survival rate of 83.4% and T2 31.3. N0 patients have 68% survival rate and N1 36.4% and no N2 patient is alive after five years. Stage I five-year survival rate is 67.5% and Stage II survival is 38.1%. No differences in survivalo have been recorded for different types of resection.
Among the control series (1972-1992) non significant differences in survival have been found regarding age and type of resection. A significant difference in survival has been found for T (T1 83% vs. T2 57.5%), for N (N0 67%, N1 35%, N2 17%) and for stage (stage I 75% and stage II 34.5%).
In the more recent series we found an increased number of cancer in situ and of early stage tumors, with an increased number of partial gastrectomies. Complications have been significantly decreased (8% vs 13%) as did mortality rate (3.5% vs 5.4%)
Specific comparison, even though weakened by the relative disomogeneity of the populations considered, shows significant differences in survival for stage but not for different type o f resection. The age is, in the recent series, a highly significant prognostic factor, due to the increased rate of very old patients operated on for gastric cancer.
REFERENCES
Koovor PA, Hwang J. Treatment of resectable gastric cancer: current standard of care. Expert Rev Anticancer Ther. 2009;9(1):135-42.
Ly QP, Sasson AR. Modern Surgical considerations for gastric cancer. J Natl Compr Canc Netw. 2008, 6(8) 885-94.
Deng J. Liang H et al- prognosis of gastric cancer patients with node metastasis following curative resection: outcomes of the survival and recurrence. Can J gastroeneterol. 2008;22(10):835-9
Trans-obturator colonic suspension during Altemeier’s operation for full-thickness rectal prolapse : preliminary results with a new technique
No full textAIM:
With the aim of reducing recurrence after perineal surgery for full-thickness rectal prolapse, a new operation consisting of a trans-obturator colonic suspension during Altemeier's operation has been developed.
METHOD:
Eighteen women with full-thickness rectal prolapse were examined clinically, with validated quality of life and continence scores, colonoscopy, anorectal manometry, anal EMG and sacral reflex latency. Ten had a newly diagnosed and eight a recurrent prolapse. The Altemeier operation was combined with a levatorplasty in all cases using two porcine collagen prostheses sutured to the descending colon and passed through the trans-obturator space bilaterally. The operation was completed by a manual or stapled colo-anal anastomosis. Clinical examination, with quality of life and continence scores, anorectal manometry, EMG and sacral reflex latency, was scheduled during follow up, with the recurrence of prolapse as the primary outcome measure.
RESULTS:
There were no recurrences at 30 months. There was no mortality and no complications. All patients experienced significant improvement in quality of life and faecal continence scores (P<0.01). Surgery did not affect anorectal pressures or sacral reflex latencies.
CONCLUSION:
The new technique appears to be relatively easy to perform and is complication free with no recurrence after a short period of follow up. A larger study with appropriate controls and longer follow up is now needed to assess its real effectiveness in reducing the risk of recurrenc
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