1,721,023 research outputs found
Gastrectomia e strategie multimodali nel trattamento del cancro gastrico in stadio IV: risultati oncologici di 16596 pazienti
Full text linkObjectives
This population-based study aimed to investigate the survival benefit of treatment strategies in metastatic gastric cancer (GC) patients, focusing on role and timing of gastrectomy.
Methods
We included eligible stage IV GC patients in the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2015. Overall (OS) and Cancer Specific Survival (CSS) rates were calculated by Kaplan–Meier analysis and log-rank test. Multivariate Cox analysis was performed to analyze the effect of gastrectomy performed alone, before (Primary gastrectomy, PG) or after (Secondary Gastrectomy, SG) chemotherapy. Finally, we performed a propensity score matching (PSM) to reduce the potential selection bias.
Results
A total of 16596 patients were extracted, including 6819 (41.1%) underwent chemotherapy, 1244 (7.5%) gastrectomy, 1031 (6.2%) PG and 220 (1.3%) SG.
The median OS time was significantly higher (P<0.001) in SG patients (15 months) than in PG (13 months), G (6 months) and chemotherapy (6 months) group, respectively.
In the multivariate Cox analysis, SG was associated with better OS (HR=0.27; 95%CI=0.22-0.34; P<0.001) and CSS (0.28, 95%CI=0.23-0.35, P<0.001) compared to PG (OS: HR=0.31; 95%CI=0.27-0.36; P<0.001; CSS: HR= 0.31, 95%CI=0.27-0.36, P<0.001), gastrectomy (OS: HR=0.50; 95%CI=0.43-0.57, P<0.001; CSS: HR 0.49, 95%CI=0.43-0.57, P<0.001) and chemotherapy (OS: HR=0.41; 95%CI=0.39-0.44, P<0.001; CSS: HR= 0.41, 95%CI=0.39-0.44, P<0.001), respectively. The survival benefits of SG persisted even after the PSM analysis (OS: HR=0.74, 95%CI=0.59-0.93, P=0.009; CSS: HR=0.75, IC95%0.59-0.94, p=0.012).
Conclusions
Based on population-based study, we demonstrated that there was a survival advantage of gastrectomy in stage IV GC patients, especially after chemotherapy. Our findings needs to be investigate in further prospective studies
Surgical management and prognostic factors of hilar cholongiocarcinoma: experience with 68 patients at the Ghent university Hospital
No full textFrom may 1992 to december 2006, 68 patients with Klatskin tumor were evaluated in our institution. Clinicopathological data were analyzed and univariate and multivariate analyses carriede out to determine significant prognostic factors affecting morbidity and mortality. Mean age was of 53,4+/-12 years. M/F ratio was of 46/22. After a median FU of 28 months (1-84), 11/68 (16%) of patients were non respectable (group A) and treated with palliative transtumoral stenting. The others 57 patients (group B) underwent surgery : n=5 for BYsmuth type II; n=20 for type IIIa; n=23 for type IIIb and n=9 for type IV. Median survival was of 6 months in non resected patients vs. 32 months in group B (p = 0,001). R0 resection was achived in 41/57 (72%) patients. Median survival was of 48 m in R0 vs. 10 m in R1-2 resection (p = 0,003). In-hospital mortality was of 3.5%. Overall morbidity rate was of 3.5%. Factors related to a shorter survival were identified as: Lymphatic and perineural invasiveness, R1-2 resection, AJCC stage, overall 3 & 5 y patient survival was of 45% and 22% respectively. Surgical approach for Klatskin tumor is the only chance for long-term survival with acceptable surgical mortality rate. In our experience, radical oncological surgery was possible in more than 70% of cases leading to a significant survival. Perineural and lymphatic involvement combined to a R1-R2 resection correlated with shorter survival
Giant extraluminal leiomyoma of the colon: rare cause of symptomatic pelvic mass
No full textLeiomyomas (LMs) may appear throughout the entire gastrointestinal tract but are rarely seen in the colon-rectum and only 5 of those measured greater than 15 cm in diameter. Pain and palpable abdominal mass are the most common symptoms. Surgical resection is the treatment of choice for most LMs. We here describe a case of a 46-year-old woman who presented with a 3-month history of abdominal pain associated with worsening constipation and abdominal distension. A pelvic solid, polylobulate, left-sided mass was noted on examination. Preoperative findings revealed a dishomogeneous sigmoid mass with calcified spots compressing small intestine and bladder. At laparotomy, a large polylobulate and well-circumscribed mass arising from the descending colon mesentery and displacing small intestine, uterus, and ovaries. A segmental colon resection was performed. An extraluminal 18- × 12- × 5-cm paucicellular sigmoid colon leiomyoma was histologically diagnosed. Our case is one of the few giant (>15 cm) sigmoid colon LMs reported in the literature. Although rare and benign in nature, LMs of the colon can cause life-threatening complications that could require emergency treatment and they should be included in the differential diagnosis of large abdominopelvic masses. Follow-up after surgery is necessary for tumors with any atypia or mitotic activity
Primary adenocarcinoma of the renal pelvis: histologic features of a stepwise process from intestinal hyperplasia to dysplasia in a patient with chronic renal abscess.
No full textPure adenocarcinomas of the urothelium are very rare and their location in the pelvis is uncommon. Although their pathogenesis is not well defined, adenocarcinomas are likely to originate from neoplastic transformation of the glandular cells of the urothelial intestinal metaplasia usually arising in response to chronic irritating stimuli, such as long-duration inflammation, urolithiasis, and hydronephrosis. We report a case of an 81-year-old woman who underwent right nephrectomy for relapsing renal abscess due to a staghorn calculus. Histological examination disclosed an infiltrating adenocarcinoma arising from a tubulovillous adenoma with the surrounding pelvic mucosa showing a sequence of intestinal metaplasia, low- and high-grade villous adenoma, and invasive adenocarcinoma, supporting the hypothesis of cancer progression due to chronic inflammation from the urothelium through the metaplasia step
An unusual case of exclusive liver metastases from adenoid cystic carcinoma of the submandibular gland: a role for surgery? Report of a case
No full textPreoperative Brain Natriuretic Peptide (BNP) is a better predictor of adverse cardiac events compared to preoperative scoring system in patients who underwent abdominal surgery
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Surgical management, morbidity and prognostic factors of survival in 70 consecutive patients with hilar cholangiocarcinoma
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