32 research outputs found
Accuracy of transrectal ultrasound after preoperative radiochemotherapy compared to computed tomography and magnetic resonance in locally advanced rectal cancer.
No full textINTRODUCTION:
The aim of the present study was to compare the restaging results obtained by transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) performed after preoperative chemoradiation with pathologic staging of the operative specimen.
METHODS:
From January 2008 to December 2009, all the consecutive patients with locally advanced rectal cancer that underwent neoadjuvant therapy at our department were evaluated. The results of diagnostic examinations and the definitive pathological examination were considered and compared.
RESULTS:
Thirty-seven patients were included in the study (27 males, 73%), mean age was 65.5 years (range 45-82 years). In all the patients TRUS and CT and in 20 patients MRI were performed before and after the treatment. Concerning the depth of invasion after treatment TRUS agreed with histopathology in 25/37 patients (67.5%), CT agreed in 22/37 cases (59.5%), and MRI in 12/20 cases (60%). Considering only neoplasia with stage T3, TRUS agreed in 23/24 cases (96%), CT in 19 cases (79%), and MRI in 10/12 cases (83.5%). Considering the tumors that did not exceed the rectal wall (T0, T1, and T2), TRUS agreed with histology in 2/13 cases (15.5%), CT in 3/13 cases (23%), and MRI 2/8 cases (25%). Concerning the presence of positive lymph nodes TRUS agreed with histology in 28/37 cases (75.5%), while CT agreed in 21/37 cases (56.5%) and MRI in 11/20 cases (55%). The concordance between the techniques was found to be low.
CONCLUSIONS:
Transrectal ultrasonography resulted as the most accurate method to determine neoplastic wall infiltration and lymph node involvement even after radiochemotherapy. In most cases, considering the poor correlation between the diagnostic procedures and the disagreement of the results, a restaging performed only with TRUS could be proposed, limiting the use of the other imaging methods to selected cases
Laparoscopy Versus Robotic Surgery for Colorectal Cancer: A Single-Center Initial Experience
No full textBackground. Minimally invasive approach has gained interest in the treatment of patients with colorectal cancer. The purpose of this study is to analyze the differences between laparoscopy and robotics for colorectal cancer in terms of oncologic and clinical outcomes in an initial experience of a single center. Materials and Methods. Clinico-pathological data of 100 patients surgically treated for colorectal cancer from March 2008 to April 2014 with laparoscopy and robotics were analyzed. The procedures were right colonic, left colonic, and rectal resections. A comparison between the laparoscopic and robotic resections was made and an analysis of the first and the last procedures in the 2 groups was performed. Results. Forty-two patients underwent robotic resection and 58 underwent laparoscopic resection. The postoperative mortality was 1%. The number of harvested lymph nodes was higher in robotics. The conversion rate was 7.1% for robotics and 3.4% for laparoscopy. The operative time was lower in laparoscopy for all the procedures. No differences were found between the first and the last procedures in the 2 groups. Conclusions. This initial experience has shown that robotic surgery for the treatment of colorectal adenocarcinoma is a feasible and safe procedure in terms of oncologic and clinical outcomes, although an appropriate learning curve is necessary. Further investigation is needed to demonstrate real advantages of robotics over laparoscopy
Porcelain gallbladder and its relationship to cancer
No full textBackground: Porcelain gallbladder (PGB) is defined as calcium deposits encrusting the internal visceral layer, which becomes hard, brittle, and bluish. Porcelain gallbladder is rare and has been found in less than 1% of routine cholecystectomy specimens. Several studies report an incidence of gallbladder carcinoma (GBC) associated with gallbladder calcification varying between 12.5 and 61%, data which have been known for 60 years. There is a lack of information concerning PGB and its association with GBC, and the aim of this study is to better define this relationship. Methods: A total of 10 patients were found to have PGB in 1050 consecutive routine surgical cholecystectomies. Clinical and laboratory findings, gallbladder histologic examination, bile culture, and bile pH were related to stone composition analysis performed by X‐ray diffraction using Perkin–Elmer (Perkin Elmer Corp. Norwalk, CT, US) 1625 FTIR. Results: Among the 10 patients with PGB, complete calcification of the entire gallbladder wall was present in six cases, while four patients had partial calcification. Gallstones were present in all cases of PGB, multiple stones in nine cases and a single stone in one case. Bile culture was performed in all patients of the series. Among the 10 cases with PGB, culture was positive in two cases. Conclusion: PGB is a disease as rare as it is subtle. Moreover, the chronic stimulation by stones can generate an initial dysplasia that will subsequently turn into a neoplasm: the cancerization risk is probably no different from long-standing cholesterol or combined stones, but as risk factor for cancer it requires early cholecystectomy
Assessing the feasibility of full robotic interaortocaval nodal dissection for locally advanced gastric cancer
No full textBackground: The clinical value of super-extended lymph node dissection (D2+) is still debated. This procedure has not been reported using the laparoscopic or robotic approach. Although this technique, in low-volume centres, could lead to an increased risk of morbidity, in high-volume centres morbidity and mortality are similar to those of the standard D2 lymphadenectomy. Robotic surgery could overcome the limitations of laparoscopic surgery, especially in the removal of posterior nodal stations. In this report we describe the feasibility of fully robotic interaortocaval lymphadenectomy, following similar steps to those of the traditional open approach. Methods: The procedure was a total gastrectomy with oesophago-jejunal Roux-en-Y reconstruction in a 73 year-old male patient with clinically advanced (cT3) gastric adenocarcinoma, located in the lesser curvature (middle-upper third). The da Vinci® Si HD with a double-docking robot set-up was employed. Results: The histological specimen examination showed a pT4aN3bM0, Borrmann type III, intestinal histotype, G3 gastric adenocarcinoma. No involvement of resection margins was found (R0 resection). The numbers of total harvested and positive nodes were 57 and 41, respectively; the number of harvested interaortocaval nodes was 14, and all of them were negative for tumour involvement. Operative time for lymphadenectomy was comparable with that of the traditional open approach. The postoperative period was uneventful and hospital stay was 11 days. Conclusions: Robotic-assisted interaortocaval lymphadenectomy is a feasible technique in high-volume centres for gastric cancer surgery, and should be considered in curative surgery for selected advanced cases, especially for the high-risk group of lymph node metastases in the posterior area
Robotic single docking total colectomy for ulcerative colitis: First experience with a novel technique
No full textIntroduction: We describe a novel technique that could aid the surgeon to perform a total proctocolectomy with a single docking position of the da Vinci Si HD System. Methods: Patients were positioned in 20° Trendelenburg lithotomy split legs position. A 12-mm trocar was for camera and 3 more trocars were placed: two robotics on left and right flanks and one laparoscopic in left iliac fossa. The robot was docked between the legs of the patients. Results: Four proctocolectomies were performed. Mean operative time was 235 min (range 215-255); mean blood loss was 100 cc (range 50-200). Median post-operative stay was 6 days. Overall morbidity was 75%, whereas major complications occurred in 25%. Post-operative mortality was null. Conclusions: The robotic single docking approach to perform total proctocolectomy for ulcerative colitis is a time-saving technique respect to the multiple docking approach
Malignant rhabdoid tumor of the small intestine in adults: a brief review of the literature and report of a case
No full textA malignant rhabdoid tumor was first described as a subtype of Wilms tumor in 1978. The most frequent location of these tumors is the kidney, and they are common in childhood. The extrarenal localization of these tumors has been described mainly in the central nervous system (called atypical teratoid–rhabdoid tumors), liver, soft tissues and colon. Localization in the small intestine is uncommon and since the 1990s, only a few cases of malignant rhabdoid tumors in the small intestine have been reported. This tumor is very aggressive and the prognosis is poor. We herein present our personal experience with a rhabdoid tumor of the jejunum in a 76-year-old male, and also provide an analysis of the cases of malignant rhabdoid tumor of the small intestine previously described in the literature as for a brief review. We also compared the previous reports and our present case to try to identify prognostic factors
Long-term outcomes in ypT0 rectal cancers: An international multi-centric investigation on behalf of Italian Society of Surgical Oncology Young Board (YSICO)
No full textTo investigate the outcome and pattern of survivals of rectal cancer patients presenting a complete or nearly complete tumor response after neo-adjuvant treatment
The Potential of Plantain Residues for the Ghanaian Bioeconomy—Assessing the Current Fiber Value Web
No full textAn essential part in the concept of any emerging bioeconomy includes the sustainable use of biomass as a resource for industrial raw materials. Focusing on the increasing demand for natural fibers, it will be necessary to identify alternative sources without compromising food security. Here, untapped potential lies in the use of plantain residues. Yet, it is unclear how or whether this can be activated. This article investigates the current situation in Ghana as a major plantain producer in Africa. Based on data collected with participatory tools, expert interviews, and group discussions, we (i) assess predominant plantain production structures, (ii) derive a stakeholder network map identifying institutional challenges, and (iii) discuss the potential starting points for linking the supply side with the national or international fiber market. Results indicate that there is substantial interest of private enterprises for high quality fibers. Despite traditional knowledge, after fruit harvest the fiber rich plantain pseudostems usually remain in the field. From an institutional point of view, key stakeholders and structures exist that could boost the establishment of a sustainable plantain based fiber value web. Key to such an endeavor, however, would be to pilot activities, including technology transfer of suitable innovations from other countries
Long-term outcomes in ypT0 rectal cancers: An international multi-centric investigation on behalf of Italian Society of Surgical Oncology Young Board (YSICO)
No full textAim To investigate the outcome and pattern of survivals of rectal cancer patients presenting a complete or nearly complete tumor response after neo-adjuvant treatment. Methods Young surgeons <40 years old affiliated to the Italian Society of Surgical Oncology (YSICO) from 13 referral centers for colorectal cancer treatment, were invited to participate a retrospective study. Records from patients treated from 2005 to 2015 with a pathological diagnosis of ypT0/ypTis were retrieved and pooled in a common data-base for statistical purposes. All clinical and pathological variables were reviewed. Univariate and multivariate analyses were conducted with the end-point of survivals. Results Two hundreds and sixty-one patients were analyzed including 237 ypT0 and 24 ypTis. Nodal positive patients were 8.7%. More than sixty-six percent of the patients did not perform adjuvant chemotherapy, with a statistical difference comparing N0 versus N+ patients (66.8% vs 40.9%, p 0.02). Mean follow-up was of 47.6 months. Twenty-two relapses were observed, 91.6% at a distant site. The mean time to recurrence was of 35.3 months. On univariate analysis, the use of adjuvant chemotherapy correlated with better OS exclusively in ypT0N + patients and not in ypT0N0. Univariate and multivariate analyses documented nodal positivity as the only prognostic factor correlated with a worse OS. Conclusion Recurrences were mostly diagnosed at a distant site and within the third year of follow-up. Nodal positivity was the only variable independently correlated with a worse OS. Univariate analysis documented a benefit for the use of adjuvant chemotherapy treatment exclusively in ypT0N + rectal cancers
Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members (World Journal of Emergency Surgery, (2022), 17, 1, (34), 10.1186/s13017-022-00424-0)
No full textFollowing the publication of the original article [1], the author name “Dragos Serban” under The WSES COVID-19 emergency surgery survey collaboration group was incorrectly written as “Dragos Seban” instead of “Dragos Serban”. The original article has been corrected
