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

Background: Advances in laparoscopic techniques, refinements of instruments and growth of practical experience in liver surgery during the last decade have prompted some surgeons to develop the laparoscopic approach for hepatic metastases of colorectal cancer (MCRC).

Aims: Primary end points of this clinical study were safety and effectiveness of laparoscopic hepatectomy for MCRC, including early postoperative results and long-term outcomes (overall survival and disease-free survival).

Design: Retrospective analysis of data (clinicopathologic, operative, perioperative ad late results) collected in a prospective database.

Patients: Between January 1997 and December 2004, 37 non-consecutive (selected) patients underwent curative laparoscopic hepatic resection (n = 42) for MCRC at Montsouris Institut of Paris. Resection was considered when all liver metastases can be totally removed with clear margins, and in absence of nonresectable extrahepatic diseases. Among them were 24 males and 13 females with average ages of 63.4 years (range, 42-78).

Results: Metastases were metachronous in 18, multiple in 21, bilateral in 12, and <5 cm in diameter in 30. There were 21 major hepatectomies (n = 3 Couinaud's segments or more), 4 anatomical minor resections, and 12 wedge resections. Mean operative time was 324 +/- 105 mins. Conversion to laparotomy was necessary in 6 patients (16%), due to massive intractable bleeding in 3 patients, multiples adhesions in 1 patient, technical reasons (location of the lesion) in 1 patient, and for presence of localized carcinosis in 1 patient. Portal triad clamping was performed in 6 patients. Mean operative blood loss was 797 +/- 645 ml, and transfusions were required in 4 patients (11%). Clear resection margins (> 5 mm) were observed in 94%. Postoperative mortality was nil. The overall morbidity rate was 35%, with 2 early reoperations due to hemorrhage and postoperative ileus. Overall and disease free survival at 36 months were 87% and 55%, respectively. Five patients who had a recurrence of metastatic liver disease were referred to a second laparoscopic resection.

Conclusion: This clinical study suggests that laparoscopic liver surgery for metastatic colorectal cancer can be accomplished safely, in selected patients and by experienced surgeons, with good early results and without detrimental consequences on survival.

The authors analyze a consecutive series of 219 patients affected by complicated colorectal cancer who underwent surgery in emergency. In hospital mortality, 5-year survival and recurrence's incidence in 104 of these patients who underwent curative treatment are calculated and compared with a series of 701 patients who underwent elective surgical treatment. There was no significative statistical difference between emergency and elective group. At the multivariate analysis only the stage of the tumor was an independent prognostic factor.

Recent reports from US and Japan have established that mutations in the tyrosine kinase (TK) domain of the epidermal growth factor receptor (Egfr) occur in a subset of patients with lung cancer that respond to therapy with gefitinib, a TK inhibitor. To gain further insights into the role of Egfr in carcinogenesis of lung and tumors of diverse histology, that are currently under investigation with drugs of the same class, we have taken in examination a panel of tumors consisting in 110 pulmonary adenocarcinomas, 40 pulmonary squamous carcinomas, 40 gastric adenocarcinomas and 40 colorectal adenocarcinomas. The sequence analysis of exon 19 and 21 of the Egfr has allowed the identification of 10 cases exhibiting specific deletions in exon 19 and 1 case with point mutation in a conserved residue in exon 21. All Egfr mutations occur specifically in lung adenocarcinomas while tumors of different histology result unaffected. The rate of mutation affecting these other tumors is either very rare, involves different domains of the receptor or other tyrosine kinases. The molecular analysis of the Egfr gene can help identify patients that will benefit from gefitinib therapy.

Surgical resection is still the first therapeutic option in patients with resectable colorectal cancer metastatic to the liver. Application of radiofrequency energy has been used in patients who did not meet the criteria for resectability and yet were candidates for a liver-directed procedure based upon the presence of liver-only disease. Hepatic resection has evolved in the last two or three decades from a procedure with associated mortality rate of up to 20% in the early 80s to usually less than 5% in patients undergoing liver resection thereafter. This improvement in morbidity and mortality is multifactorial; despite the increased safety of liver operations, hepatic resection still remains a complex surgical procedure with serious potential morbidity. The experience with liver resections and/or radiofrequency ablations, for colorectal cancer metastatic to the liver, performed at a medium-volume center (15 cases in 4 years) is presented. Some features of the metastatic disease, including the number, size and location of metastases are identified. The perioperative mortality is 0, morbidity for non surgical complications is 40%. In this series the reported overall 1-yr survival is 80%, 2-yr is 67%. This paper reviews the experienced factors that have defined the morbidity and mortality associated with liver surgery.

Anal cancer is a rare neoplasm, representing 1-2% of all large bowel cancers. Surgical excision by abdominoperineal resection has been the standard treatment. In the 1920s and 1930s inguinal node dissection was included in the surgical management of these patients. In the 1950s it was evident that the morbidity associated with lymphnode dissection was much greater than any survival benefit and this procedure was abandoned. Since 1974 "multimodality treatment" with a combination of radiation and chemotherapy has become the standard treatment. Synchronous inguinal lymph node metastases occur in 10-25% of patients and metachronous metastases have been reported in 5-25% of cases. Inguinal lymph node metastases are an independent prognostic factor for local failure and overall mortality by a multivariate analysis of EORTC. In order to assess inguinal lymph node status we applied the sentinel node technique to patients affected by anal cancer. Fifteen patients were studied with a lymphoscintigraphy after peritumoral injection of 37 MBq of Tc-99m colloid. A surgical biopsy of sentinel node was performed in all patients with a detection rate of 100%. Inguinal metastases occurred in 4 patients (26.6%), and in 2 cases metastases were located bilaterally. Twelve patients (80%) were treated in local anesthesia and they were dismissed the same day of surgical procedure. No major complication occurred. Considering the strong correlation between prognosis and node involvement, we consider this technique an important and simple method for evaluating the lymph node status and for an adequate pre-treatment staging of anal carcinoma. fundamental in the choice of radiation plane. In particular inguinal radiotherapy could be reserved for N1 patients only. avoiding the morbidity related to this procedure in N0 patients. Further studies are required to confirm these results and a consistent follow-up will be necessary to evaluate long-term results particularly in those patients (N0) who have not been treated with prophylactic inguinal radiotherapy.

This paper reports six patients with perianal Crohn's disease (CD), who developed anal cancer in chronic anal fistulas. Tumors have been often diagnosed at an advanced stage and had a worse prognosis than cancers arising in the general population as tumor symptoms may mimic symptoms of CD, resulting in delay in diagnosis. Patients with perianal CD should undergo a careful surveillance program for ano-rectal carcinoma, including routine biopsy of any suspected lesion. When malignancy is found, an aggressive surgical approach and complementary therapy are mandatory.

The authors report their experience on the treatment of GIST. They point out the importance of classification of the disease in low, medium and high risk neoplasms based on the characteristic of the tumour: site, volume and mytotic index as the Consensus Conference of Bethesda recently established. Surgical procedure remains the most important treatment in localized disease, while patients with advanced disease can benefit from imatinib, a chemotherapeutic agent recently introduced, as an adjuvant therapy.

New approach in treatment of peritoneal carcinomatosis combining cytoreductive surgery and intraperitoneal chemotherapy suggests improved survival when it is possible to achieve a complete cytoreduction. In this study we consider the carcinomatosis from colorectal and appendiceal adenocarcinoma. In all cases, patients in whom cytoreductive surgery was complete had a median survival much longer compared with patients in whom was not possible and, as perfusion works on minimal residual disease, peritonectomy is the only surgical technique that aim at total removal of parietal and visceral peritoneal lesions.

Cutaneous squamous cell carcinoma (SCC) is, in its most frequent presentation, a moderately aggressive neoplastic disease. It can, however, present in a moltitude of clinico-pathological variants, some of which are characterized by a more malignant attitude. It is important to determine which tumors, among the various histophenotypes, are high risk in order to establish the appropriate treatment and follow-up. Histologic subtype has been considered as a possible variable in determining the prognosis of cutaneous SCC. We report our experience with 3 cases of peculiar variants of cutaneous SCC.