The role of baseline inflammatory-based scores and serum tumor markers to risk stratify pseudomyxoma peritonei patients treated with cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

AIMS: Inflammation-based scores such as neutrophil-lymphocyte ratio (NLR) and Onodera nutritional index (ONI) have been identified as new prognosticators in several tumors. We conducted a prognostic analysis of these markers and performed a risk stratification of PMP patients submitted to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: 226 patients from two peritoneal surface malignancies centers participated in this study. Cox proportional modeling was used to select predictors of overall survival (OS) among baseline inflammation-based scores, serum tumor markers, clinical and surgical variables. Risk stratification was done using conditional inference tree model. RESULTS: One hundred eighty-two cases had diffuse peritoneal adenomucinosis subtype. Fifty-four cases had received previous systemic chemotherapy. The means of ONI and NLR were 51.4 (SD = 9.8) and 3.2 (SD = 2.3), respectively. Two hundred ten cases were optimally cytoreduced. Cox analysis identified completeness of cytoreduction, histological subtype, previous systemic chemotherapy, NLR, and CA 19-9 as independent prognosticators. Conditional inference tree method identified two poor prognostic subsets: NLR ≤2.7 and CA 19-9>336 (5yr-OS = 15%) and NLR >2.7 and ONI ≤42 (5yr-OS = 30%). CONCLUSIONS: NLR, ONI, and CA 19-9 are new prognosticators that contributed to improve prediction of OS in PMP patients treated by CRS and HIPEC. These markers allowed a risk stratification that could optimize therapeutic management of PMP patients.

Class II versus Class III radical hysterectomy in early cervical cancer: an observational study in a tertiary center.

AIMS: The purpose of this observational study was to evaluate disease free survival (DFS), overall survival (OS), and local recurrence rate (LRR) in patients submitted to Class II RH compared with Class III RH in early FIGO stage cervical cancer (ECC). MATERIALS AND METHODS: We investigated 127 patients with CC admitted to the National Cancer Institute of Milan from June 2001 to October 2011 treated with Class II RH, and compared them with 202 patients operated with Class III RH between March 1980 and March 2001. A total of 329 patients were collected. RESULTS: Median follow-up time was 91 months (IQ range:58-196). Five-year OS and DFS estimates were 89.5% (95%CI: 86.0-93.2%) and 85.6% (95%CI: 81.6-89.7%), respectively. Estimates of effect of surgical treatment (Class III RH versus Class II RH) on OS showed a HR of death = 3.38 (95%CI: 1.18-9.63, P = 0.0228), at univariable Cox analysis, and a HR = 3.08 (95%CI: 0.96-9.93; P = 0.0595) at multivariable analysis. For DFS, a HR of relapse = 2.51 (95%CI 1.10-5.72; P = 0.0290) comparing Class III vs Class II was found at multivariable analysis. Overall recurrence rate was 12.8%, whilst it was 16.3% for Class III and 7.1% for Class II respectively. CONCLUSIONS: The present data suggest that the outcomes of Class II RH are comparable in terms of LRR and OS to those of Class III RH, according to literature data. The opportunity of extending the indication to all women with ECC needs further investigations. Clearer data are warranted by prospective controlled studies.

Thoracic paravertebral anaesthesia for awake video-assisted thoracoscopic surgery daily.

Thoracic paravertebral blockade has been described as an effective alternative to epidural blockade for the management of postoperative pain after thoracic surgery. Here we present what we believe is the first description of the use of thoracic paravertebral block as the sole anaesthetic for video-assisted thoracoscopy. Two oncology patients with severe respiratory disease presented for video-assisted thoracoscopic surgery. Thoracic paravertebral block provided excellent surgical conditions and postoperative pain relief for these patients and allowed an optimal assessment of the anaesthetic impact on respiratory function.

Ventilator associated pneumonia (VAP): an impossible diagnosis? Call for a pragmatic approach.

Many years after the introduction of the protected specimen brush (PSB) by Wimberley et al. as a tool to diagnose ventilator associated pneumonia (VAP), new sampling techniques have increased the controversy concerning the diagnosis of VAP. Agreement exists only on the high sensibility and low specificity of the clinical symptoms combined with imaging data. However, sampling methods, qualitative/quantitative microbiological evaluation and the value of ''markers'' still appear to be unresolved issues. Because a proven diagnosis is very rare, a more pragmatic approach to VAP diagnosis seems necessary. More specifically, the questions we must focus on include the following: ''Which patients with possible pneumonia or lower respiratory infection require antibiotic treatment ?'' and ''In which patients with possible/suspected VAP is empiric treatment not immediately necessary and for which of these patients can empiric treatment be limited or discontinued?''

Prognostic factors of posterior cervical disc surgery: a prospective, consecutive study of 54 patients.

OBJECTIVE: To our knowledge, there is no prospective study to date about the prognostic factors of dorsal foraminotomy. The aim of this prospective study was to provide further information in this field. METHODS: From January 1994 to January 1995, we performed a prospective, consecutive study of 54 patients, each of whose lateral herniated cervical disc was operated on via a dorsal foraminotomy. We analyzed the general data, the case history, the neurological examination at admission, and all data from imaging examinations and therapy. Most of the patients (93%) were followed up at 1 year, postoperatively. The patients were divided into one group with good results and another group with bad results, according to their ratings on a pain scale. The groups were analyzed in relation to the patients' initial condition. RESULTS: At follow-up, 94% of the patients had completely recovered or their condition had improved. CONCLUSION: A long duration of preoperative complaints and a long-standing neurological deficit seem to be important prognostic factors for a bad outcome after dorsal foraminotomy.