Lymphomas represent common hematological malignancies with increasing incidence in recent years. The major site of extranodal non-Hodgkin lymphoma is the gastrointestinal tract. Involvement of the large intestine is rare in comparison to the stomach or small bowel. The disease appears later in life, predominantly in the male population. Complaints are nonspecific, requiring a high index of suspicion in order to establish the diagnosis. The treatment varies from chemotherapy alone to multimodal therapies combining surgery, chemotherapy and radiotherapy. The small number of patients with various histological subtypes and different stage at presentation results in unclear protocol for the treatment of primary colorectal lymphoma. The purpose of this paper is to review current data on primary lymphoma of the colon and rectum while analyzing reported case series and published material on the subject.
Angioleiomyoma represents a benign stromal tumor, which usually occurs in the subcutaneous tissue of the extremities, although its occurrence in the gastrointestinal tract is very rare. A case of rectal angioleiomyoma in a 40 year-old female patient is described here. Six months earlier, the patient suffered from periodical prolapse of an oval tumor from the anus, along with difficulties in bowel movement. A transanal extirpation of the tumor was performed. This is the first reported case in the English literature of a patient presenting with prolapsed angioleiomyoma of the rectum. During the immediate postoperative period, as well as 6 mo later, the patient had an unremarkable postoperative recovery.
Introduction/Objective. The elderly (age ? 65 years) comprise an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The objective of the paper was to determine the intra-hospital mortality rate in elderly patients undergoing emergency gastrointestinal surgical procedures. Methods. 914 elderly patients (> 65 years old) were examined, divided into two groups: emergency and elective surgery patients, treated for diseases (benign and malignant) of the stomach, duodenum, small intestine and colon. The patients were divided into four age groups and five American Society of Anesthesiologists (ASA) groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administering transfusion, and the occurrence of surgical complications during hospitalization. Results. The mortality rate among elderly patients was 17.8%. The univariate analysis in EGS patients revealed that gastro-duodenal surgical interventions (p < 0.001), ASA ? 3 score (p < 0.001), heart, lung, kidney diseases, and postoperative complications (p < 0.001), as well as the white cell count > 10,000/mm3 (p = 0.043) were independent risk factors for mortality. In the multivariate analysis, in EGS patients, the significant risk factors for mortality were gastric surgical interventions (p = 0.001), ASA score of 4 (p < 0.001), heart and kidney disease (p ? 0.001), and white cell count > 10,000/mm3 (p = 0.039). Conclusion. The characterization of independent validated risk indicators for mortality in those patients is essential and may lead to an efficient specific workup, which constitutes a necessary step towards developing a dedicated score for elderly patients.
The shorter length of hospitalization and the lower morbidity of the studied patients were considered to be the result of the correct treatment using modern principles of thoracic drainage, a suitable surgical technique, and a careful follow-up of the patients.
Patients with advanced gastric cancer generally have poor overall prognosis as well as survival rate. Unfortunately, in the West, gastric cancer typically occurs at an advanced stage and many of these patients have tumor invasion into adjacent structures (International Union Against Cancer [UICC]/American Joint Committee on Cancer [AJCC] Stage T4). Although T4 gastric cancer patients often have peritoneal dissemination or distant metastasis, many do not have M1 disease and are therefore candidates for surgery with the curative intent. A multivisceral resection (MVR) or gastrectomy with resection of adjacent organs is needed in T4 gastric cancer patients to achieve an R0 resection that is one of the most powerful forecasters of gastric cancer surgery results. Spleen, distal pancreas, liver, and large intestine (mostly transverse colon) were the most commonly resected organs. The therapeutic choice with acceptable postoperative morbidity and mortality rates in locally advanced patients with gastric cancer should be gastrectomy with MVR, where complete resection could be realistically obtained and where metastatic involvement of the lymph node is not evident. MVR is done with a curative R0 resection to provide advanced gastric cancer patients with the best survival chance. It was found that resections involving the pancreas, transverse colon and liver were associated with increased survival rate in comparison to MVR with resection of other structures. It was shown that survival rate significantly decreased in patients who had undergone MVR without complete resection compared to those who had an R0 resection. Nevertheless, the extent of the surgical resection required and further advantages of MVR are disputable.
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