1,721,002 research outputs found
EAES (European Association for Endoscopic Surgery) Travel Grant
No full textBackground: The sentinel lymph node (SLN) mapping is widely used, during oncological surgery, for several type of tumors (Head and Neck, Breast and Melanoma).
This procedure can be performed by using both blue dyes and gamma ray-emitting radiotracers. However, both have disadvantages like the involvement of a nuclear medicine physician, or difficulty to identify nodes through fatty tissue.
The SLN procedure has been proposed to improve nodal staging even in colorectal cancer patients.
Occult tumor cells and micrometastases are easily missed by conventional histopathologic examination. Various retrospective studies have shown poor prognosis for patients with micrometastases compared with patients without metastases.
Aim: The aim of this ongoing prospective study was to assess the value of near-infrared (NIR) fluorescence imaging for ex vivo SLN mapping in conventional surgical resection for colorectal tumors and the detection of micrometastases.
Materials and Methods: We enrolled 5 consecutive patients undergoing surgery with curative intent for colorectal cancer.
All patients underwent a standard oncological laparoscopic resection.
After specimen extraction, we submucosally injected a premixed cocktail of the near-infrared lymphatic tracer around the tumor for detection of SLN. Each SLN was investigated with ultrastaging techniques for the detection of micrometastases using serial sectioning and additional immunohistochemistry or reverse transcriptasepolymerase chain reaction.
We used the Quest SpectrumTM Platform imaging system for fluorescence imaging.
Results: In 100% of patients, we identified at least one sentinel lymph node. Overall, from the specimens were found 64 lymph nodes. A total of 13 SLN were identified. Alfter ultrastaging anatomopathological investigations, no tumor cells nor micrometastases were present in SLN, nor in the remaining nodes.
SLN located deeper in the mesenteric fat could easily be identified by NIR fluorescence.
Conclusions: We reported our preliminary data of this ongoing prospective study about the use and value of the NIR fluorescence guided surgery to identify the ex vivo SLN in colorectal cancer and micrometastases research.
In our series, the histological sentinel lymph nodes’ asset rightly predicts the status of loco-regional nodes
Mappatura ex vivo dei linfonodi sentinella nei tumori colo-rettali tramite la fluorescenza vicino all'infrarosso con colorante vitale verde di indocianina e sviluppo di nuovi fluorofori
Full text linkIntroduzione
I tumori colo-rettali sono attualmente la seconda causa oncologica di morte per entrambi i sessi. La stadiazione linfonodale è elemento dirimente la stadiazione oncologica e la prognosi dei pazienti, con la conseguente indicazione a trattamenti chemioterapici adiuvanti.
Infatti pazienti con malattia linfonodale negativa (N0) hanno una Overall Survival a 5 anni del 70-80%, contro una percentuale del 30-60% nei pazienti N+ (va precisato però che la sopravvivenza in questo gruppo è migliorata dal trattamento chemioterapico adiuvanti).
Nel 20-30% dei pazienti che presentano recidiva di malattia numerosi autori ipotizzano che questa possa essere dovuta a metastasi linfonodali occulte.
Inoltre nella chirurgia oncologica colorettale, l’identificazione dei linfonodi sentinella permette la ricerca delle micrometastasi tramite la cosiddetta “ultrastadiazione” dei linfonodi campionati con sezioni seriate ed indagini immunoistochimiche o reverse transcriptase-polymerase chain reaction (procedure, per i cui costi e tempi, non applicabili su tutti i linfonodi).
Dai dati riportati in letteratura, è stata evidenziata una prognosi peggiore nei pazienti pN0 affetti da micrometastasi ed è tuttora oggetto di dibattito la chemioterapia adiuvante in questi pazienti.
Il verde indocianina è stato proposto nell’identificazione intraoperatoria dei linfonodi sentinella tramite Fluorescenza vicina all’infrarosso, come già validato nei tumori della mammella e del compartimento testa/collo e nel melanoma cutaneo.
Materiali e metodi
Sono stati inseriti nello studio i pazienti sottoposti a chirurgia colorettale per neoplasia presso il Dipartimento di Chirurgia Generale “P. Stefanini” dell’AOU Policlinico “Umberto I” di Roma e Dipartimento di Chirurgia Generale dell’Ospedale di Fidenza (AUSL di Parma).
Come da protocollo, sul pezzo operatorio a fresco appena resecato, dopo apertura del viscere e identificazione del tumore, viene iniettato 1ml di colorante, su mucosa sana, equidistribuito sui quattro punti cardinali peritumorali. Dopo circa 5-7 minuti vengono identificate e prelevate le sedi di maggior fluorescenza sul tessuto linfoadiposo mesenteriale per essere sottoposte ad esami di ultrastadiazione.
Per ogni paziente inoltre sono stati rilevati i dati dell’esame istologico, in particolare la correlazione con la stadiazione linfonodale in riferimento al linfonodo sentinella
Risultati
Nel corso di questo periodo 58 pazienti sono stati sottoposti a resezioni oncologiche colorettali VLS standard. In ogni paziente è stato identificato almeno 1 SLN. Dal campionamento di tutti pezzi operatori sono stati repertati 1085 linfonodi (117 SLN, media 2.01).
Nei pazienti N0 sono stati trovati trovati 54 SLN (media 1,9).
La detection rate e la sensitivity rate sono state del 94,8% (55/58 pts) e del 100% (30 SLN+ / 30 N+ pts) rispettivamente. La false negative rate è stata dello 0%. In questa serie preliminare, l’assetto istologico dei SLN (sia negli N+ che negli N0) ha correttamente predetto lo stato dei linfonodi loco-regionale.
Dopo gli esami di ultrastadiazione, sono state riscontrate micrometastasi nei SLN N0 in 4 pazienti (14%, 4/28 NND pts) che sono stati così ri-stadiati come N1 ed inviati a trattamento chemioterapico adiuvante.
Conclusioni
Nella nostra serie preliminare, la mappatura NIRF dei SLN con tecnica ex-vivo ha predetto correttamente lo stato linfonodale loco-regionale, come confermato all’esame istologico. L’identificazione delle micrometastasi ha permesso a 4 pazienti precedentemente stadiati come N0 di beneficiare del trattamento chemioterapico adiuvante con l’obiettivo di ridurre il rischio di recidiva. Il colorante vitale verde di indocianina però risulta non ottimale per la ricerca dei linfonodi sentinella e vi è la necessità di sviluppare e testare nuovi fluorofori, nuovi software e hardware per migliorare, nel futuro, le mappature linfonodali
Synchronous signet-ring cell carcinoma of the duodenum and ampullary intestinal-type carcinoma
No full text[No abstract available
Quality of Life in Rectal Cancer Treated by Endoluminal Loco-Regional Resection by Tem Vs Laparoscopic Total Mesorectal Excision: Long Term Results
No full textBackground:
Endoluminal loco-regional resection (ELRR) by transanal endoscopic
microsurgery (TEM) may be an alternative treatment option to laparoscopic total
mesorectal excision (LTME), in selected patients with N0 rectal cancer. Post-operative
Quality of Life (QoL) evaluation is an important parameter of outcomes related to high
percentage of functional sequelae. We reported, in a previous published paper, the short and
medium term results of QoL in patients underwent ELRR by TEM or LTME.
Aim:
The aim is to evaluate the 3y QoL in patients with iT2-T3 N0/
+
rectal cancer
underwent ELRR by TEM or LTME after neoadjuvant radio-chemotherapy (n-RCT) in a
retrospective analysis of prospectively collected data.
Materials and Methods:
We enrolled in this study 39 patients with iT2–iT3 rectal cancer
who underwent ELRR by TEM (n=19) or LTME (n=20), according to predefined criteria.
QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires at admission,
after n-RCT and 1, 6, 12 and 36 months after surgery.
Results:
No statistically significant differences in QoL evaluation were observed between
the two groups, both at admission and after n-RCT.
In short term (1–6 months) period, significantly better results were observed in ELRR group
by QLQ-C30 in: Global Health Status (p=0.003), Physical Functioning (p=0.004), Role
Functioning (p=0.004), Emotional Functioning (p=0.004), Cognitive Functioning, Fatigue
(p=0.005), Dyspnoea (p=0.005), Insomnia (p=0.05), Appetite loss (p=0.05), Constipation
(p=0.05); and by QLQ-CR38 in: Body Image (p=0.03) and Defecation (p=0.025).
At 1 year, the two groups were homogenous as assessed by QLQ-C30, whereas the
QLQCR38 still showed better results of ELRR vs. LTME in Body Image (p=0.006),
Defecation Problems (p=0.01), and Weight Loss (p=0.005).
At 3 years no statistically significant differences were observed between the two groups.
Conclusions:
In selected patient with rectal cancer, underwent ELRR by TEM or LTME,
QoL testes at 3 years don’t show any statistical difference on examined items
Use of Fluorescence Angiography for the Identification of Point of Transection in Colorectal Surgery
No full textBackground: Anastomotic leakage still remains the most important surgical complication after colorectal surgery. The reported rate of anastomotic leak ranges from 3 to 20% and morbidity can be substantial, with an increased associated mortality of 6–22%.
Nowadays no intraoperative tests (as the hydropneumatic assessment) predictive of anastomotic continence are validated. Some factors influencing anastomotic leakage are reported in literature like colonic tension, vascularization and the execution of the proper anastomotic technique.
Fluorescence angiography has been shown to be an accurate tool for assessing microperfusion and has been associated with improved outcomes in hepatobiliary, foregut, transplant, and plastic surgery.
Aim: The aim of this prospective study was to describe the vascular pattern in colorectal surgery to assess the proximal colonic point of transection (PoT) by near-infrared (NIR) fluorescence perfusion.
Materials and Methods: We enrolled 5 consecutive patients undergoing surgery with curative intent for colonic (4 patients) and rectal cancer.
All patients underwent a standard oncological laparoscopic resection.
After inferior mesenteric artery and vein ligation, wide left colonic mobilization, transection of the rectum, before specimen extraction anesthesiologist administered a bolus of 3.5 mg ICG intravenously.
Perfusion of the colon was visualized and evaluated via fluorescence angiography and the line of demarcation between perfused and nonperfused tissue was compared with the initial planned PoT and assessed as inadequate, adequate, or optimal. We used the Quest SpectrumTM Platform imaging system for fluorescence angiography.
Results: In four patients, the fluorescence angiography confirmed as optimal the planned PoT otherwise in a patient with ultralow rectal cancer, it was considered inadequate and the correct PoT was re-assessed by the fluorescence angiography.
On 30 POD, patients underwent endoscopy and/or barium enema and no anastomotic leakage was reported.
Conclusions: We reported our preliminary data of this ongoing prospective study about the use and value of the NIR fluorescence angiography guided surgery to identify the optimal Point of Transection in order to prevent anastomotic leakage
Extracapsular lymph node spread: not-so-well known but important prognostic factor in gastric cancer.
No full text[No abstract available
Transanal Endoscopic Microsurgery - Endoscopy assisted treatment of colorectal anastomotic stenosis
No full textTransanal Endoscopic Microsurgery (TEM) is a type of NOTES, developed for rectal tumors and used also to treat other rectal diseases. Anastomotic complications after colorectal surgery, including stenosis, represent a challenging problem. We present the case of a 36 year-old woman with a diagnosis of Hirschsprung Disease that was submitted to a modified Duhamel operation. A postoperative barium enema showed a complete stricture of the anastomosis that was impossible to resolve by flexible endoscopic approach. Then an intraoperative endoscopic approach to facilitate the localization of pre-anastomotic colon was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM, under fluoroscopic-endoscopic control. The patient underwent a control barium enema showing regular retrograde transit of contrast medium without evidence of stenosis. In our experience, transanal approach by TEM -Colonoscopy assisted is safe and feasible and represents a model of combined minimally invasive technique
Ex vivo Sentinel Lymph Node Mapping in Colorectal Cancer Using Invisible Near-Infrared Fluorescence Light
No full textIs the research of extracapsular lymph nodal invasion mandatory in histological examination of gastric carcinoma?
No full text[No abstract available
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