Pelvic exenteration represents a radical intervention performed on highly selected cases for locally advanced pelvic (gynecologic and digestive) tumours. Due to the high complexity of the intervention and of the impact of the neoplastic disease on the patient this intervention is accompanied by a high degree of postoperative morbidity. We hereby present the case of a patient with recurrent rectal cancer involving the bladder, small bowel and anterior abdominal wall in which a supralevatorial pelvectomy was performed. Although it was performed on a patient with infected tumour, the postoperative course of the patient was uneventful; the patient is disease-free at 6 months after pelvectomy. Although pelvic exenteration is associated with increased morbidity, many patients with recurrence after rectal resection that undergo this intervention can have increased disease-free survival.
Abstract): Peritoneal carcinomatosis due to gastrointestinal malignancies has been considered a poor prognosis entity. Few prospective studies have shown 6 to 12 months suvirval period for peritoneal carcinomatosis of colorectal cancer (CR) treated with systemic chemotherapy. New chemotherapeutic agents and monoclonal antibodies increased survival to 16-22 months. Despite this new systemic treatment most patients will die due to cachexia, peritonitis and/or intestinal occlusion. Normothermic or hyperthermic intraperitoneal chemotherapy, intraoperative or early postoperative became in the last three decades the standard treatment for several malignancies of peritoneum and it has proven effective in peritoneal carcinomatosis of colorectal and ovarian origin. The main drawbacks of this method is lack of studies to confirm the benefits. A long learning curve, high morbidity and mortality, lack of studies on quality of life and the high cost of this procedure appears to be the most important disadvantages of this method. Recent studies including carreful selected patients show a five year suvirval rate of 40%, median survirval period of 30 months, high morbidity (up to 60%) and a mortality up to 8%. Phase III trials on patients with peritoneal carcinomatosis from colorectal cancer treated with HlPEC are still ongoing. We present and review the latest results from the literature regarding the value of HIPEC in peritoneal carcinomatosis from colorectal origin.
BACKGROUND: Surgical resection can offer the best curative treatment for oesophageal cancer but is associated with high postoperative morbidity rates. Most common surgical approaches are transthoracic (TT) and transhiatal (TH) techniques. Transhiatal approach has the advantage of reducing the pulmonary morbidity in patients with impaired pulmonary function. AIM: The aim of this study is to compare the TT and TH approach, in terms of preoperative assessment and short term outcomes. MATERIALS AND METHODS: We performed an observational study on a prospective collected database which included all the patients diagnosed with oesophageal cancer in which surgery was performed. A detailed assessment of comorbidities was performed using several scales: Charlson and age adjusted Charlson score, physiological score of POSSUM. Postoperative complications were graded according to the Dindo-Clavien classification. RESULTS: During a 9 years period surgery was performed in 50 cases, 33 by TT approach and 17 by TH approach respectively. The mean age was 58.7 ± 2.21 years old (95% CI 56.3-61.2). Patients in the TH group had a higher Charlson score (3 vs 2, P = 0.01), age adjusted Charlson score (5 vs 4, P = 0.03) and physiological score (17 vs 15, P = 0.04). TT techniques were mainly used for middle oesophageal cancers (69.7%) and TH for lower oesophageal tumors (82.4%). The overall operative morbidity was 60% with no difference between the two groups even for minor and major complications. Pulmonary complications occurred in 23 cases (46%), cardiac complications in 5 cases (10%), anastomotic leakage in 6 cases (12%) and recurrent nerve paralysis in 6 cases (12%). Multivariate analysis showed that age adjusted Charlson score (OR = 2.77; 95%CI 1.114-6.9236) and physiological score (OR = 1.7601; 95% CI 1.2067-2.5674) were predictors for complications. CONCLUSION: In our study mortality and morbidity showed no statistical difference in relation to the surgical approach. An accurate preoperative assessment and tailoring an adequate surgical approach can limit the percentage of postoperative complications.
Gastroenteropancreatic neuroendocrine carcinomas (GEP-NENs) represent a heterogeneous group of rare tumors. The incidence of GEP-NENs has increased worldwide over the past decades, with the small intestine, rectum, and pancreas as the most common tumor locations. The epidemiological characteristics, pathogenesis and treatment have raised many questions, and some of them are still being debated. Here, we report a case of gastric collision tumor with large-cell neuroendocrine carcinoma and adenocarcinoma. A 73year-old male patient with a history of gastric resection performed 30 years ago, with no medical records revealing the type of resection or the reconstructive way, presented with epigastric pain. The endoscopy revealed a solid, ulcerated mass at the gastrojejunal anastomosis site from which a tissue biopsy was taken, which was reported as adenocarcinoma. For staging, the patient underwent an abdominal CT scan, which showed the thickening of the gastric wall adjacent to anastomosis and perilesional adenopathy. The patient underwent a subtotal gastrectomy and regional lymphadenectomy. A diagnosis of large-cell neuroendocrine carcinoma developed on the gastric stump associated with isolated foci of moderately differentiated tubular adenocarcinoma pT3N1G3 was made. Immunohistochemical analysis is essential for the diagnosis and classification of the lesion. To confirm the diagnosis, Chromogranin A and Synaptophysin are needed, and for prognostic evaluation the identification of Ki-67 and mitotic figure count are required.
Introduction: Neuroendocrine tumors of the gastro-entero-pancreatic system have a variety of components, clinical manifestations and prognostic indices according to their anatomical site. Therefore, their diagnostic and management strategies differ a great deal. Prognosis concerning NETs can be poor due to the degree of differentiation, early metastasizing and the high degree of invasiveness. Material and Methods: For the present study, the patient files were evaluated and the parameters of interest were followed. Results: Over the course of 6 years there were 37 patients diagnosed with and treated for NETs, regardless of primary tumor site. There were 9 patients with NETs of the primite mid-and hindgut thusly: 5 cases with colorectal NETs and 4 cases of small bowel NETs. 6 patients benefited from radical surgical treatment, 2 cases with palliative procedures and only one patient with tumor biopsy. The tumors were evaluated according to the 2010 WHO classification based on the number of mitoses and the Ki67 proliferation index. Adjuvant treatment was adapted according to staging and histopathological parameters. Conclusions: Despite recent progress in managing NETs, there are still many controversial aspects regarding the management of these cases, mainly about timing the right sequence of therapy.
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