We found a specifically subset of patients where the combination of prognostic factors, in particular, negative surgical margins R0, tumour size ≤ 30 mm and the absence of lymph node metastasis independently reduced the mortality indicating that earlier tumour detection and histologically curative resection are important factors contributing to long term survival and healing of ductal adenocarcinoma of the head of the pancreas.

Based on current evidence, we spare well-informed and consenting patients from further axillary surgery when the SLN is minimally involved in early breast cancer within an agreed protocol, whilst scheduling adjuvant treatment based on the patients' primary tumour characteristics.

Annular pancreas is an uncommon congenital anomaly which usually presents itself in infants and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.

We suggest to perform in every patients undergone to pancreatic surgery an intraoperative ultrasound exam, to detect unresecable and unpredicted lesions.

IntroductionTransanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention.Patients and MethodsDuring the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months.ResultsThe pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies.DiscussionThe significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy.ConclusionIn selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results.

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Articolo presente su PubMed Central. Surcerecord id Scopus 28558\ud http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194378/\ud Introduction.Transanal endoscopic microsurgery is a useful technique of minimally invasive surgery that allows the realization of complex interventions, from transanal excisions to full thickness resections with anastomotic reconstructions.\ud TEM can have a diagnostic and therapeutic value in the elderly for the treatment of primary rectal cancer as well as for recurrences.\ud Materials and methods.During the period between January 2002 and December 2009 six patients, average age of 66 years, four men and two women, with early diagnosed rectal cancer recurrence were selected to undergo this palliative surgical procedure. 3 men and 1 woman underwent "ultra-low anterior resection”, followed by chemo / radio therapy (T3N1M0); in one woman a TEM (T1NxM0) and in one old man the local escission was performed after neoadiuvant chemo/radio therapy (T2NxM0). The selection of the patients was made by: rigid sigmoidoscope, transrectal us, colonoscopy, abdominal us to rule out liver metastases, CT and MRI abdomen and pelvis with and without contrast agents, PET CT. In all patients the lesions were superficial, smaller than 2 cm and located at the posterior wall of the rectum.\ud Results.Follow-up was approximately 12-28 months; the pathologic staging confirmed the complete excision of recurrences. Patients were then referred for more complementary therapies. Only one patient presented a retro rectal abscess treated with conservative techniques, too.\ud Conclusions.The alternative to conservative surgery is an abdomino-perineal resection sec. Miles, but also this really invasive procedure can be considered palliative in the most part of recurrences. So, based on equal oncological results, the reduction of surgical trauma and preservation of anatomical integrity are really important goals