I supplementi di Tumori : official journal of Societa italiana di cancerologia ... [et al.]最新文献

Xanthogranulomatous pyelonephritis is a rare disease of the kidney; renal parenchyma is replaced by lesions radiologically simulating clear cell carcinoma. We present a case of a 62-year-old diabetic woman observed at our institution for the appearance of back pain and dysuria. A CT scan revealed a large lesion of left kidney with psoas muscle infiltration and the patient undrwent a nephrectomy. Histology surprisingly showed a xanthogranulomatous pyelonephritis. Though recent reports demonstrated the feasibility of conservative management of XGP with antibiotics, the use of pre-operative biopsy is still limited by the risk of seeding and the high false-negative results. How to distinguish xanthogranulomatous pyelonephritis from renal cancer?

Much recent data have been published on the risk of local recurrence (LR) following curative surgery for rectal cancer and the impact of adjuvant therapy. On the other hand, improvements in surgical techniques, as the total mesorectal excision, have apparently reduced the risk of LR. Furthermore, in selected cases, neoadjuvant therapy seems to reduce much more the incidence of LR. A list of prognostic factors which affect the onset of LR, other than the different procedures, was considered. To investigate such evidences a retrospective analysis was undertaken in our series, focusing on examination of the employed techniques as potential predictors of local recurrence. Thus, in a 18-yr-period (1986-2003), two hundred and ninety-five patients who had undergone elective curative surgical resection of rectal cancer were included in the study. The demographic, operative and follow-up data were collected retrospectively. All patients underwent total mesorectal excision, whereas neoadjuvant therapy was performed in a selected series of patients, according to defined entry criteria patterns. Results evidenced LR in 7.1% of patients and occurred between 6 months to 8 year following surgery. Comparisons were made between patients who had different surgical procedures; indeed sphyncter saving procedures correlated with a higher incidence of LR rather than abdomino-perineal resection. Pelvic recurrences were observed more frequently compared to the anastomotic ones. A limited number of patients with LR underwent surgery due to the associated condition of metastatic lesions; the follow-up related to such series evidenced a mortality rate of 57% within 3 year from reoperation. A low local recurrence rate can be achieved after total mesorectal excision (TME) without preoperative radiotherapy. Our results suggest that preoperative radiotherapy may be employed only for those patients who are at a higher risk for local recurrence.

The study analyses the results of surgical treatment and intraperitoneal hyperthermic chemotherapy on a group of 22 patients, affected by peritoneal carcinomatosis of different origins, and treated at Policlinico Multimedica (Milan) between June 2001 and December 2004. Surgical major complications were present in the 23% of the patients, and post-operative mortality rate was 13%. None of the patients presented chemotherapy related toxicity. Six patients died within 2 and 40 months after surgery, while 13 are alive within 4 and 40 months after operation.

Objective: Laparoscopic adrenalectomy is unanimously recognised as the gold standard for the surgical treatment of adrenal lesion. Also the role of laparoscopic adrenalectomy (LA) for metastasis is controversial. This study, in according with literature dates, aimed to confirm that patients are most likely to have prolonged survival after resection of adrenal metastases and confirms that oncological outcome of laparoscopic adrenalectomy are similar with open adrenalectomy.

Patient and methods: The study included patients who underwent LA from 2000 to 2005. Indications for LA were adrenal masses with no radiological evidence of involvement of the surrounding structure, or solitary metastases with well-controlled primary cancer. The variable evaluated were port-site and intra-addominal recurrence, distant metastasis and survival time. Primary tumors were the followings: lymphoma non-Hodgkin, lung cancer. Patients age was mean 69 (range, 62-77), the lesions were at right adrenal gland. No conversion to open surgery occurred. No complication were observed. Mean operative time was 100 minutes (range, 90-110). No postoperative complication occurred. Mean diameter of the tumor was 4.5 cm (range, 4.2-4.8 cm). Tumor free margins were obtained. Mean hospital stay was 3 day. At follow-up mean of ten months (eight-twelve months) there was any sight of distant metastases and the patient was alive.

Conclusion: LA seems to be a feasible option if the principles of oncological surgery are respected. Adrenalectomy for metastasis, with intent to prolong survival, should be offered to patient with favourable tumor biology, such as those with significant DFI.

Isolated recurrence of rectal carcinoma have been reported from 7% to 33% with a median of 15. Increasing recurrence is associated with increasing Dukes's stage. Patient who have recurrence after a low-anterior resection are more likely to present with non fixed, surgically correctable lesion versus recurrences after abdominoperineal resection. The most common symptom related to pelvic recurrence is pain, which may be perineal or radiate to the lower extremities. The diagnosis of a locally recurrent rectal cancer was obtained with CT; imaging is the first step to estimate the extent and location of the local tumor growth and the presence or absence of distant metastases. The most common location is at or around the anastomosis and the presacral region. Apart from distant metastases locoregional recurrence is the most important factor determining prognosis and survival. If an R0 resection can be performed, a 5-year survival rate of 20-30% can be achieved. Local or locoregional recurrence implies the reappearance of carcinoma after an intended complete removal of the tumor. For rectal cancer, the adjacent organs include the perineum, bladder and vagina, and LR failure includes perineal or pelvic lesions. Total pelvic exenteration is performed in patients with local recurrence of rectal cancer and a 5-year suvival rate of 30-40% was achieved. For patient with unresectable recurrence, chemotherapy and radiation contribute to a better quality of life and prolong survival. While radiotherapy may reduce recurrence, it is now apparent that total mesorectal excision is the most effective modality, with rates as low as 5%. The anastomotic recurrence that can be locally resected, the best approach for long-term survival is an extensive surgical procedure requiring en bloc removal of adjacent organs and pelvic structures so called composite resection. Intraoperative radiotherapy and brachytherapy, and/or preoperative chemoradiation may provide better results in future. While radioterapy remains the most common antineoplastic modality used for palliation of symptoms, surgical resection remains the mainstay of curative treatment for carcinoma of colon and rectum.

The gastrointestinal stromal tumors (GISTs) represent 1% among bowel diseases. Their clinical history is unknown, and it seems to develop from muscolar or nervous tissue in the bowel wall. The grade of malignancy is directly correlate to the dimension of tumor and the number of mythosis for field. We report our experience in diagnosis and treatment.

Colorectal cancer with peritoneal carcinomatosis is usually considered incurable. Intraperitoneal carcinomatosis accounts for 25-35% of recurrences of colorectal cancer. Studies demonstrate that peritoneal carcinomatosis is not necessarily a terminal condition with no options for treatment or cure. Encouraging results were obtained in many studies by cytoreductive surgery followed by hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Oxaliplatin is a new agent whose clinical use with intraperitoneal administration has been pioneered by Elias et al. Eight patients with peritoneal carcinomatosis (PC) of colo-rectal origin underwent complete cytoreductive surgery from March 2004 to January 2005. Six of them were submitted to HIIC with semi-closed technique; in one patient mitomycin C (2 mg/m2/l) was used for intraperitoneal perfusion at 41.5-42 degrees for 60 minutes; in five patients IPCH was carried out for 30 minutes at 41.5-42 degrees with intraperitoneal oxaliplatin (460 mg/m2). Patients received intravenous leucovorin (10 mg/m2) and 5-fluorouracil (400 mg/m2) just before HIIC to maximize the effect of oxaliplatin. Preliminary results are reported.

Breast reconstruction can be accomplished with implants, autologous tissue or both. Thanks to the widespread of microsurgical techniques autologous tissue reconstruction has become a frequent option in many departments although it is mostly considered a second choice. The aim of this study was to review our experience covering the past five years in immediate breast reconstruction with tissue expanders. From January 2000 to January 2005 279 patients underwent immediate breast reconstruction with submuscular tissue expanders. Tissue expander was chosen according to dimension, shape and volume of the healthy breast. Operating time, early and late complications, interference with neo-adjuvant therapies as well as timing and surgical techniques of second-step reconstruction were also considered. No major complications occurred. Tissue expander, beyond proving itself a valid and safe option in immediate breast reconstruction, also decreased the psychological distress following a mastectomy.