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

Sentinel lymph node biopsy allows enhanced pathology through serial sections and immunohistochemical analysis of the retrieved node, with detection of micrometastases and isolated tumor cells not otherwise recognized. We present our experience with a simple, effective, pathology protocol requiring six couples of sections at three different sentinel lymph node levels. Additional micrometastases or ITC were diagnosed in 51/416 patients (14.6%).

Aim: The aim of our study was to identify clinicopathological predictors of survival among patients undergoing potentially curative resections for gastric carcinoma.

Patients and methods: From January 1987-March 2004, 1074 patients have been submitted to curative gastric resection for gastric cancer (647 males and 427 females, mean age, 65 +/- 12, min 22, max 92). The surgical procedure consisted of 289 (27%) total and 785 (63%) subtotal gastrectomies. The extent of lymph node dissection was limited D1 (n = 376, 35%) or extended D2 (n = 578, 54%) and D3 (n = 12, 1%); no lymphadenectomy was performed in 108 (10%) cases. The pathological nodal status has been defined based on the number of involved lymph nodes (N1: 1 to 6 positive nodes; N2: 7 to 15 positive nodes; N3: more than 15 positive nodes). The distribution of N stage was: N0 = 278 (26%), N1 = 344 (32%); N2 = 215 (20%); N3 = 129 (12%). Univariate analyses were performed for gender, age, pT stage, pN stage, tumor site, tumor size, and extent of lymphadenectomy. Significant factors were then entered into a Cox regression analysis.

Results: The median number of examined lymph nodes was 17 (mean, 18). Overall, 688 (64%) of patients had lymph node metastases. Of these patients, the median number of involved nodes was 2 (mean, 6). In the univariate analysis age, pT stage, pN stage, tumor size, and extent of lymphadenectomy were found to be significant factors. In the multivariate analysis T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival. The median and mean survival time were 69 and 87 months, respectively. Overall survival was 80%, 51% and 40% at 1, 5, and 10 years, respectively.

Conclusions: T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival in patients submitted to curative gastric resections.

Composite pelvic resection with sacrectomy may provide good local control in case of locally advanced rectal cancer infiltrating the sacral bone. A combined multidisciplinary approach including chemotherapy and radiotherapy is here presented for a case of rectal tumor invading the sacrum.

Local recurrence (LR) is a major problem following curative resection of rectal cancer. Intraoperative radiation therapy (IORT) is considered an ideal boost technique for increasing the dose of radiation therapy within a restricted area without introducing a significant toxicity. The aim of this study is to present the results of a multimodality treatment containing external beam irradiation, chemotherapy, surgical resection, and IORT delivered by a movable linear accelerator (NOVAC7, Hitesys SpA, Italia), employed in a "traditional" operating room.

Sentinel node biopsy has been widely adopted in the treatment of cutaneous melanoma and breast cancer. The ongoing controversy concerning the extension of lymphatic dissection in gastric cancer demonstrate that the optimal extent of lymphadenectomy has yet to be established, and underlines that the research in this area is needed to refine our knowledge and consequently our treatment of gastric tumors. In this paper the authors describe a multicentric protocol concerning the sentinel node research in early and advanced T1-T2 gastric cancer employing the blue dye method and lymphoscintigraphy by means of the endoscopic injection of Tc99m labeled nanocolloids. The aim of this protocol is to assess the clinical relevance of the sentinel node biopsy in selecting N+ patients in early gastric cancer, and the role of the same technique in detecting N2 positive patients in case of advanced gastric cancer. Assuming a confidence interval of +/- 5%, a sample of 100 recruited cases over three years is previewed.

In this work we report our experience on multiorgan resections (MOR) for local advanced gastric cancer. From 1998 to 2004 in our Department 79 patient underwent total or partial resection of stomach associated with removal of various other organs. The results we report come from the evaluation of perioperative mortality and morbidity rates and further analysis of median survival time and quality of residual life. In conclusion, we affirm the utility of major surgery in advanced gastric cancer only in conditions that guarantee an acceptable rate of major complications.

Gastric stromal tumors give diagnostic and therapeutic problems, especially with regard to histopathologic identification and biological behavior. These tumors are very rare in all case reports. These ones are the most frequent of all alimentary tract. They are often incidentally found; because of their potential transformation, they have to be treated by respecting oncologic eradication standards and observing prognostic criteria based on a correct histopathologic evaluation (neoplasm localization and dimension, its structure, presence of cytological atypisms, mitotic index, ploidia, surgical resection). Then there has to be a good follow-up program.

The Von-Hippel Lindau (VHL) disease is a rare genetically determined syndrome. Clinical course depends on the occurrence of multiple tumors as central nervous system tumors, phaeochromocytoma and renal cell carcinoma. We describe the second case in the literature reporting about a patient affected by a pancreatic neuroendocrine tumor as the first clinical sign of VHL disease. It has been showed that only a strict follow-up can effectively improve survival. Based on the present case, the follow-up of patients affected by VHL syndrome should routinely include functional tests and imaging exams of the pancreas.

From 1980 to 2004, out of 109 patients who underwent surgery for neuroendocrine pancreatic tumor, 33 had a simple tumor excision. Seventy-two percent of cases were insulinomas. Age, sex, site and size of the tumor, associated diseases, hospital stay and complications were retrospectively reviewed by the clinical records. Patients (12 males and 21 females) averaged 56.8 years, range 20-86. Mean size of the tumor was 1.7 cm and 54.5% were in the pancreatic head; 78.8% of cases had medical associated diseases. Hospital stay was 12 days (median; range, 6-81 days) and mean period of gastric suction was 4 days. Forty-eight percent had a uneventful postoperative course. Complications were divided in early (related to pancreatic surgery, related to general open surgery and medical) and late events. Complication related to pancreatic surgery were 6/33 (18%); 5 pancreatic fistulas (4 low output) and 1 acute pancreatitis, while 5/33 had a general surgery complication (2 leacking due to gastric and duodenal associated operations). Medical complications were recorded in 13 cases. Late complications occurred in 4 cases (2 incisional hernias, 1 pseudocyst and 1 keloid). No patient was re-operated for pancreatic complications; 1 was reoperated for evisceration and 1 for hyper-parathyroidism in the early post-operative period. No mortality occurred. Re-evaluation of the clinical records in order to be submitted to laparoscopic surgery excluded 17/33 cases (51%) as candidate to laparoscopic approach.

Pancreatic carcinoma remains a letal disease with an overall 5-year survival of less than 5%. Recent reports of increases in actuarial survival after resection have determined some optimism. Our objective was to identify the actual 5-year survival rate of patients with pancreatic carcinoma who underwent a resection with curative intent, analyzing those factors associated with a more favorable prognosis.