RESUMO
COVID-19 pandemic had an impact on surgical activities. The aim of this multi-centric, retrospective study was to evaluate the impact of the COVID-19 pandemic on breast surgery. The patients who operated during the pre-pandemic year 2019 were compared to those operated in 2020. Fourteen Breast Care Units provided data on breast surgical procedures performed in 2020 and 2019: total number of breast-conserving surgery (BCS), number of 1st level oncoplastic breast surgery (OBS), number of 2nd level OBS; total number of mastectomies, mastectomies without reconstruction, mastectomies with a tissue expander, mastectomies with direct to implant (DTI) reconstruction, mastectomies with immediate flap reconstruction; total number of delayed reconstructions, number of expanders to implant reconstructions, number of delayed flap reconstructions. Overall 20.684 patients were included: 10.850 (52.5%) operated during 2019, and 9.834 (47.5%) during 2020. The overall number of breast oncologic surgical procedures in all centers in 2020 was 8.509, compared to 9.383 in 2019 (- 9%). BCS decreased by 744 cases (- 13%), the overall number of mastectomies decreased by 130 cases (- 3.5%); mastectomy-BCS ratio was 39-61% in 2019, and 42-58% in 2020. Regarding immediate reconstructive procedures mastectomies with DTI reconstruction increased by 166 cases (+ 15%) and mastectomies with immediate expander reconstruction decreased by 297 cases (- 20%). Breast-delayed reconstructive procedures in all centers in 2020 were 142 less than in 2019 (- 10%). The outburst of the COVID-19 pandemic in 2020 determined an implemented number of mastectomies compared to BCS, an implemented number of immediate breast reconstructions, mainly DTI, and a reduction of expander reconstruction.
Assuntos
Neoplasias da Mama , COVID-19 , Mamoplastia , Humanos , Feminino , Mastectomia , Estudos Retrospectivos , Pandemias , Neoplasias da Mama/cirurgia , Mamoplastia/métodosRESUMO
BACKGROUND: A subsets of ovarian carcinomas (OCs) are related to inherited conditions including Hereditary Breast and Ovarian Cancers (HBOC) and Lynch Syndrome (LS). The identification of inherited conditions using genetic testing might be a strategic model for cancer prevention that include benefits for the ovarian cancer patients and for their family members. METHODS: We describe a retrospective Italian experience for the identification of inherited conditions in 232 patients affected by OCs using both somatic and germline analyses. RESULTS: Immunohistochemical and microsatellite analyses performed on OCs identified 20 out of 101 MMR defective cancers and 15 of these were from patients carriers of the MMR germline pathogenetic variants. BRCA1 and BRCA2 testing offered to 198 OC patients revealed 67 (34%) pathogenetic variant carriers of BRCA1/2 genes. Interestingly LS patients revealed a mean age of OC onset of 45.4 years, which was significantly lower than the mean age of OCs onset of HBOC patients. CONCLUSIONS: Somatic and germline analyses offered to OC patients has proved to be an efficient strategy for the identification of inherited conditions involving OC also in absence of suggestive family histories. The identification of LS and HBOC syndromes through OC patients is an effective tool for OC prevention.
Assuntos
Síndromes Neoplásicas Hereditárias/genética , Neoplasias Ovarianas/genética , Feminino , Genes BRCA1 , Genes BRCA2 , Testes Genéticos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , LinhagemRESUMO
BACKGROUND: Breast angiosarcoma is a malignant mesenchymal neoplasm, which accounts for approximately 2% of all soft tissue sarcomas. Secondary breast angiosarcoma (SBA) may be related to chronic lymphedema after a mastectomy with lymph node dissection (Stewart Treves syndrome) and previous radiotherapy for complications from breast radiation treatment. It is a very rare condition; therefore, diagnosis and management are still a challenge. METHODS: The ANISC collected SBA data by means of a survey sent to all Italian breast centres in the ANISC. The clinicopathological characteristics and the management of this disease were analysed. RESULTS: Twenty-four centres participated in this survey in which 112 cases of SBA were analysed. The median age of the women with SBA was 68.9 years and it appeared approximately 90 months after the first irradiation for breast cancer. In 92% of cases, a mastectomy was performed without axillary dissection for those patients having a high grade of SBA (74.2%). The prognosis was worse in the high-grade cases (overall survival-OS: 36 months) as compared with the low-grade cases (OS: 48 months). After a follow-up of 5 years, 50.5% of the patients were still alive. Disease-free survival (DFS) was 35 months, and there were no differences between the groups of patients with either high- or low-grade histology. CONCLUSIONS: Secondary breast angiosarcoma is a very aggressive disease associated with a short survival outcome. The surgical approach still remains an important step in the course of treatment; furthermore, an accurate histological examination is helpful in establishing the prognosis of the patient. A mastectomy is mandatory. A longer OS was observed in patients with low-grade angiosarcoma as compared to high-grade angiosarcoma (C.I. 40-57 vs. 31-41 months).
Assuntos
Neoplasias da Mama/mortalidade , Hemangiossarcoma/mortalidade , Segunda Neoplasia Primária/mortalidade , Complicações Pós-Operatórias/mortalidade , Idoso , Neoplasias da Mama/etiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Hemangiossarcoma/complicações , Hemangiossarcoma/etiologia , Hemangiossarcoma/cirurgia , Humanos , Itália/epidemiologia , Excisão de Linfonodo/efeitos adversos , Linfangiossarcoma/complicações , Mastectomia/mortalidade , Segunda Neoplasia Primária/etiologia , Segunda Neoplasia Primária/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Cirurgiões/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: The aim of this study was to evaluate the association of breast cancer with thyroid diseases. Many authors have already studied the possible relationship between these two diseases, but the results are nowadays conflicting. MATERIALS AND METHODS: Our study examining 867 patients with breast cancer (862 women and 5 men, average age = 61 years old) of whom 141 also had thyroid disease evaluated the recurrence of thyroid diseases and their association with different types of breast cancer. Statistical analyses were performed using SPSS software for Windows; we used nonparametric tests (Chi-square and Mann-Whitney), and the level of significance was set at p < 0.05. RESULTS: We found a significant association between breast cancer diagnosed after menopause and thyroid disease (p < 0.003). Moreover, we analyzed the role of thyroid autoimmunity identifying an association between chronic autoimmune thyroiditis and breast cancer diagnosed before menopause (p < 0.05). Regarding receptor profile of breast carcinoma, we have found an increased expression of estrogen receptors in patients with autoimmune thyroiditis compared to patients with any other thyroid diseases (p < 0.03). Contrariwise, we do not have found any difference between the group with every thyroid disease and the group without thyroid disease (p < 1.00). We did not find other statistically significant associations with breast cancer's parameters like family history, tumor size, lymph node metastasis, distant metastasis, cancer clinical and pathological stage, differentiation grade and expression of Ki67, p53 and Her2 in the two main groups with or without thyroid disease. Likewise, we did not found other statistically significant association between hypothyroidism or hyperthyroidism and breast cancer.
Assuntos
Neoplasias da Mama/etiologia , Carcinoma Ductal de Mama/etiologia , Carcinoma Lobular/etiologia , Doenças da Glândula Tireoide/complicações , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/metabolismo , Carcinoma Lobular/secundário , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prognóstico , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismoRESUMO
The p53 transcription factor has a critical role in cell stress response and in tumor suppression. Wild-type p53 protein is a growth modulator and its inactivation is a critical event in malignant transformation. It has been recently demonstrated that wild-type p53 has developmental and differentiation functions. Indeed an over-expression of p53 in tumor cells induces asymmetrical division avoiding self-renewal of cancer stem cells (CSCs) and instead promoting their differentiation. In this study, 28 human breast carcinomas have been analyzed for expression of wild-type p53 and of a pool of non-clustered homeobox genes. We demonstrated that orthodenticle homolog 1 gene (OTX1) is transcribed in breast cancer. We established that the p53 protein directly induces OTX1 expression by acting on its promoter. OTX1 has been described as a critical molecule for axon refinement in the developing cerebral cortex of mice, and its activity in breast cancer suggests a synergistic function with p53 in CSC differentiation. Wild-type p53 may regulate cellular differentiation by an alternative pathway controlling OTX1 signaling only in breast cancer cells and not in physiological conditions.
Assuntos
Neoplasias da Mama/metabolismo , Regulação Neoplásica da Expressão Gênica/fisiologia , Fatores de Transcrição Otx/genética , Proteína Supressora de Tumor p53/fisiologia , Neoplasias da Mama/genética , Feminino , HumanosRESUMO
Day-surgery setting allows to combine patients' satisfaction to cost-saving policies that seems to be more and more important for a modern hospital management. Minimally invasive surgery seems to be the ideal surgical approach for day-case procedures since, reducing trauma to a minimal level, allows patients to return quick to a normal life with minimal nursing assistance. Extensive review of the most recent article has been performed in this article in order to define the current evidences that support the use of laparoscopic surgery in a day-case setting. Laparoscopic cholecystectomy, anti-reflux procedure and hernia repair seems to be justified according to the results of the published data. Patients' selection and hospital organization seem to be mandatory in order to obtain successful results.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Tomada de Decisões , Laparoscopia/métodos , Seleção de Pacientes , HumanosRESUMO
BACKGROUND AND AIM: Different studies underline the importance of hospital stay on the development of infectious complications. We performed an audit of surgical site infections (SSI) after thyroidectomy was performed in a one-day surgery setting. MATERIALS AND METHODS: One hundred and twelve consecutive patients admitted between April 2007 and discharged before May 2008 were studied. Patient selection criteria for one-day surgery were specific medical and social-logistic status. The technique of thyroidectomy was standardized. RESULTS: SSI affect 2.6% of patients undergoing thyroid surgery with short hospitalization. The incidence of SSI was 3.2% following thyroidectomy, 2% for lobectomy. Mean time interval to symptom onset was 3 days (range 2-6). Most likely organism was Staphylococcus aureus. WI was associated with prolonged ambulatory medications. CONCLUSIONS: Rates of SSI are similar to those described in the literature with longer hospitalization. All SSI become evident only after patient discharge. Prevention of SSI is very much the responsibility of the persons working in the operating theater. Effort should be made to improve sterile technique. Appropriate antibiotic coverage is indicated when infection develops postoperatively.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Infecções Estafilocócicas/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Tireoidectomia/métodos , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Adulto JovemRESUMO
BACKGROUND AND AIM: Enteric fistulas are defined by their sites of origin, communication and flow. We evaluate the treatment of complex patients with entero-cutaneous fistulae with large abdominal wall defects. MATERIALS AND METHODS: Retrospective case note review of 19 patients (15 males, median age 46 years) treated at the Department of Surgical Sciences, University of Insubria, Varese, Italy. These were distinguished by multiple/wide gastrointestinal fistula orifices, with total discontinuity of bowel. Fistulas were not covered by abdominal wall thus presenting with a giant abdominal wall defects. Surgery was planned once adequate nutritional status was present. RESULTS: All fistulas resulted from previous surgery for IBD in 7 cases (37%), abdominal trauma 4 (21%), acute necrotic infected pancreatitis 3 (16%), intra-abdominal malignancy 3 (16%), and diverticular disease 2 (10%). The most common site of presentation was ileum (80%). Median fistula output was 800ml/day (range 400-1600ml/day). Seltzer's prognostic index identified malnutrition in 70% of patients at the time of presentation. The elapsed mean time from onset of fistula and elective time of surgical management were 184 days (range 20-2190 days). The VAC system was used in the last 7 patients preoperatively and in 6 patients with postoperative abdominal wound dehiscences that could not be closed immediately and who were at high risk for healing complications. There were no complications from the VAC therapy. Surgery was successful in 69% of cases. Mortality rate was 21%. Factors related to mortality were persistent malignancy, malnutrition and sepsis. CONCLUSIONS: After optimization of nutritional status surgery with en bloc resection of fistula offers best results. In this series, cancer and sepsis were unfavourable factors for outcome. These fistulas may be successfully managed with a multidisciplinary approach.
Assuntos
Fístula Intestinal/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Deiscência da Ferida Operatória/cirurgia , Adulto , Idoso , Feminino , Humanos , Fístula Intestinal/complicações , Fístula Intestinal/etiologia , Fístula Intestinal/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Transplante de Pele , Telas Cirúrgicas , Deiscência da Ferida Operatória/complicaçõesRESUMO
AIM OF THE STUDY: To review the current indications, to establish predictive factors of success and the safety of LC as a day-surgery procedure. METHODS: Randomized clinical trials were searched on PubMed between January 2000 and June 2008 using "laparoscopic cholecystectomy", "day-surgery" as keywords. RESULTS: A total of 20 trials was identified and analyzed. The indications for LC in day-surgery unit were symptomatic and chronic cholelitiasis without evidence of common bile duct stones; acute cholecystitis and pancreatitis cases were excluded. The trials considered as inclusion criteria: ASA score, BMI, social aspect and the preoperative workout included: abdominal US, liver function tests and routine preoperative tests, while the results considered the reasons for hospital stays and for readmission and measured patient satisfaction; some trials included analyze of costs of LC as day-surgery procedure the role of the surgeon's experience. DISCUSSION: The present study confirms that day-surgery LC is safe and feasibility in selected patients; serious complications are rare and most frequently prolonged hospital stay and the readmission are connected with minor and more easily controlled complications or social reasons. Outpatient surgery requires careful planning and preparation in order to reach acceptable patients' satisfaction: preoperative workout is extremely imports allowing to reduce errors selection. Considering surgical training, it has been demonstrated that in the centres in which the trainees are involved in day-surgery LC there not significant difference in terms of number of complications, patient outcomes, prolonged stay and readmission. The adequate control of pain, nausea or vomiting is essential component in day-case LC service and it is possible at home after LC. CONCLUSION: Day-case laparoscopic cholecystectomy is feasible with an acceptable discharge rate and level of patient satisfaction. The success depends on appropriate patient selection and on well-trained staff and skilful operative technique together with safe anaesthesia.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Colecistectomia Laparoscópica/métodos , Doenças da Vesícula Biliar/cirurgia , Seleção de Pacientes , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Evidence base data have demonstrated that video-assisted thyroidectomy (VAT) has good results regarding safety, morbidity, patient cure rate, pain and cosmesis. Aim of this study was to evaluate the performance of VAT in an ambulatory setting (i.e. one-day surgery, <24-h stay). MATERIALS AND METHODS: Between September 2007 and July 2008, 43 patients underwent VAT in a one-day surgery division. Patient selection criteria for VAT were: thyroid nodules <30 mm, gland volume <20 ml, no history of thyroiditis or neck surgery or irradiation, "low risk" papillary carcinoma and absence of enlarged lymph nodes. One-day surgery patient selection criteria were medical and social logistic (Materazzi G, et al. Eur Surg Res 2007;39:182-8). Intraoperative neuromonitoring (IONM) was used for RLN identification. Intact parathyroid hormone (iPTH) levels were determined early postoperatively at +6-h. Postoperative complications, conversion rate were analyzed. RESULTS: No cases required conversion to open surgery or ordinary recovery (i.e. >24h). Incidence of temporary hypoparathyroidism was 11.6% (5/43) with no case of symptomatic hypocalcemia. Incidence of temporary RLN injury was 2.3% (1 patient) with no case of permanent or bilateral RLN injury. All patients were satisfied with the type of recovery. CONCLUSIONS: This preliminary report is an example of the safe incorporation between new technologies (IONM, early iPTH measurement) with improvement of the quality and safety of VAT performed in a one-day surgery setting.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Cirurgia Vídeoassistida/métodos , Adulto , Feminino , Humanos , Incidência , Itália , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto JovemRESUMO
The number of outpatient surgical procedures performed in hospitals increases daily. In some countries, outpatient operations outnumber inpatient operations. The incidence of thyroid disorders and in particular, the cancer forms, has been increasing sharply for many years in several countries. Even if thyroid surgery is performed with low morbidity, no mortality, and short operation time, some potentially lethal complications are strong arguments against shortening of hospital stay. The purpose of this review is to examine the relevant updated published results on selection criteria measures that can be used to assess patients referred to short-stay surgery for thyroid disease.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Seleção de Pacientes , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/tendências , Humanos , Tireoidectomia/estatística & dados numéricos , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. Amyloidosis is a rare occurrence in thyroid gland. METHODS: A systematic review of the published data on amyloid goiter was carried out by searching Medline and other online databases (such as Scopus and Endnote) for the period from 1951 to March 2008. A total of 127 publications (case series, single case reports and reviews) was found, of which 31 were case series published from February 1995 to March 2008. Six articles have been considered for our review because they regard amyloid goiter as a manifestation of both primary and secondary amyloidosis (a total of 30 cases have been analyzed). Exclusion criterion was the presence of primary thyroid cancer. RESULTS: The preoperative diagnosis of amyloid goiter should be considered in patients with known systemic amyloidosis or with a long-standing predisposing disease who present a rapidly growing thyroid volume in association with a euthyroid state. Fine-needle aspiration biopsy can be performed to exclude primary malignant lesions of thyroid gland and immunohistochemical studies can identify and characterize the amyloid deposits. CONCLUSION: Amyloid goiter has to be suspected in all patients with a progressive, rapidly growing, bilateral thyroid enlargement and a concomitant history of chronic inflammatory processes. Moreover, this should be suspected in patients who are known to have disease predisposing to amyloid deposition.
Assuntos
Amiloidose/complicações , Bócio/etiologia , Glândula Tireoide/patologia , Amiloidose/diagnóstico , Biópsia por Agulha Fina , Diagnóstico Diferencial , Bócio/diagnóstico , Humanos , Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
All over the World laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis; use of local long lasting anesthetics reduces post-operative pain. Levobupivacaine is one of the most effective local anesthetics. The aim of our study is to test the effectiveness of local anesthetics comparing pre- versus post-operative trocar site's infiltration. 50 patients were enrolled in our study and 25 five patients were randomized into pre-I group (pre-incisional infiltration) and 25 into post-I group (post-operative infiltration); all the operations were performed with the same technique (Anglo-Saxon with 4 accesses) by 4 expert laparoscopic surgeons; our results showed different analgesic consumption between the 2 groups of patients; in the pre-I group the mean intravenous dose of Ketorolac post-operative used was 124 mg while in the post-I group was 339 mg: this difference was statistically significant.; the mean VAS was 10.7 in the post-I group while in the pre-I group was 5.1, also the i-VAS score's difference was statistically significant: in fact in the post-I group i-VAS was 8.8 while in the post-I group 14.8. Our study demonstrated that infiltration of the trocar site with long lasting local anesthetic is extremely effective for the treatment of post-operative pain after laparoscopic cholecystectomy; pre-incisional local infiltration seems to be better in term of pain perception and intravenous post-operative analgesic consumption.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Bupivacaína/administração & dosagem , Bupivacaína/análogos & derivados , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Injeções Subcutâneas , Levobupivacaína , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Thyroid operations are increasingly performed in the outpatient setting. In general the essential objectives for thyroidectomy are: sparing the parathyroid glands, avoidance of injury to the laryngeal nerves, an accurate hemostasis and an excellent cosmesis. In the last 10 years major improvements and new technologies have been proposed and applied in thyroid surgery; among these mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, intraoperative neuromonitoring, and PTH assay technology. This paper reviews relevant medical literature published on the influence of these new technologies on quality of thyroid surgery as well as prevention of postoperative morbidity and mortality. Searches were last updated April 2008.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Tireoidectomia/tendências , Perda Sanguínea Cirúrgica/prevenção & controle , Eletrocoagulação/métodos , Humanos , Monitorização Intraoperatória/métodos , Resultado do Tratamento , Cirurgia Vídeoassistida/métodosRESUMO
BACKGROUND: The study describes the initial experience and learning curve of intraoperative neuromonitoring (IONM) during thyroidectomy. We describe the prevalence and patterns of IONM technical problems. METHODS: Prospective series of 152 consecutive thyroid operations (304 nerves at risk) were analyzed. Standard technique consists of monitoring vagal and RLNs before, during and after resection. Personal gain of experience was defined by the preceding number of thyroid operations. To establish the number of thyroidectomies required before achieving an effective and safe IONM technique, all of the procedures were divided into three chronological groups of about 50 cases (groups 1, 2, and 3). RESULTS: Patients (90%) had successful IONM with initial endotracheal tube position. Fifteen patients (10%) needed further tube adjustment. Out of 15 patients 14 (93%) were due to non-optimal contact of endotracheal surface electrodes to vocal cords. Tube malrotation was the main reason for initial failure (53%). The success rates of prompt IONM technique were 80% in group 1, 92% in group 2, and 98% in group 3 (p<0.05). Mean operating time was low in group 3 (p<0.03). Vagus and RLNs were localized and monitored in all the cases (100%). The incidence of temporary RLN injury was 2.6%. No permanent complications occurred. Negative EMG response indicated an altered function of RLN and stage thyroidectomies were scheduled. Transient RLN palsies were seen without changes during the entire study period. CONCLUSIONS: This is the first series of thyroidectomies with standardized IONM technique performed in Italy. Neuromonitoring was effective in providing identification and function of laryngeal nerves. IONM successful rates were affected considerably by the extent of surgical and anaesthesiological experiences, starting with relatively low rates in the beginner group and then increasing. We assessed the learning curve: improved operative variables and safe technique were seen in about 50 patients.
Assuntos
Sistema Nervoso Central/fisiologia , Competência Clínica/normas , Monitorização Intraoperatória/métodos , Nervo Laríngeo Recorrente/fisiopatologia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/educação , Nervo Vago/fisiopatologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND AND AIM: Several studies have demonstrated that endoscopic thyroidectomy is a safe technique. Aim of the study is to evaluate the feasibility of video-assisted thyroidectomy (VAT) performed by a junior surgeon. MATERIALS AND METHODS: We consider 67 consecutive standard VAT gasless approaches. VAT was performed by an under 35-years-old surgeon trained in basic laparoscopy tutored by an experienced surgeon. Outcome measures were operative and hospitalization times, incision length, and complications. Conversion to open surgery was defined as the need to perform a longer incision. To establish the number of procedures required before achieving a safe VAT technique, procedures were divided into three chronological groups of about 30 lobectomies (Groups 1, 2, and 3). RESULTS: Success rates of VAT were 90% in group 1, 97% group 2, 100% group 3 respectively (P<0.05). Most conversions were due to bleeding. In group 1, the overall mean operative time was 111 min, group 2, 93 min, group 3, 86 min (P<0.03). Mean length of incision significantly increased from the initial incision: group 1, +1.3 cm, group 2, +0.9, group 3, +0.5 cm (P>0.05). Group 3 had a faster recovery after surgery. The incidences of temporary hypoparathyroidism were 8.9%. The incidences of temporary RLN injury were 2.9%. CONCLUSIONS: To date there are no recommendations regarding the amount of endoscopic training required to safely perform VAT, but our experience demonstrated that surgeon's age cannot be considered having a negative effects on results. Success of VAT technique was considerably associated with experience: improved operative variables and safe technique were seen after 30 lobectomies.
Assuntos
Competência Clínica/normas , Educação Médica Continuada/métodos , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/educação , Cirurgia Vídeoassistida/educação , Adolescente , Adulto , Idoso , Avaliação Educacional , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Tireoidectomia/métodos , Fatores de Tempo , Cirurgia Vídeoassistida/métodos , Adulto JovemRESUMO
INTRODUCTION: Colorectal cancer is still one of the many factors of death both in males and in females. To date, the most important prognostic factors are mainly related to the pathological stage of the disease. AIM OF THE STUDY: The purpose of this study was to analyze the possible role of tumor circumferential localization on the colonic wall (mesenteric (M) or antimesenteric (AM)) as a possible prognostic factor. In this study, we compare the localization of the tumor with patient's survival. The hypothesis of this study is that M tumors, closer to blood and lymphatic vessels, should be more aggressive in terms of hematogenous and lymphatic spread compared to the AM tumors. PATIENTS AND METHODS: All patients undergoing curative resection for colorectal cancer were enrolled in this study; there was no statistical difference for age, sex and co-morbidity. The histopathological examination was carried out in the standard manner. Next, we have taken care to survival of neoplastic patients by examining of our 5-year follow-up archive: we divided patients in different groups concerning the different tumor stage and we compare these results with the different localizations of tumor at the operation. RESULTS: In 45% of cases, we were able to distinguish the different localizations M (160 patients) or AM (47 patients) and this difference is statistically significant (P<0.0001, Pearson Chi-Square-test (PCS-t)). The number of metastatic nodes is statistically higher in the M group compared to the AM group one (P=0.003949). Medium time of follow-up was 36.54 months; AM and M patients have a rather similar survival, only at the end the two curves seem to change but not in a significant manner. Only if we consider the difference between the two groups comparing T3 tumor can we observe a statistically significant difference (P<0.005). CONCLUSIONS: In conclusion, the localization of M or AM colorectal cancer is feasible in 45% of cases. M tumors have significantly more lymph nodes metastases but a better 5-year survival than AM tumors. A possible explanation for such results might be the different pattern of diffusion of cancer cells.
Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Linfonodos/cirurgia , Mesentério/cirurgia , Neoplasias Colorretais/terapia , Seguimentos , Humanos , Linfonodos/patologia , Metástase Linfática , Mesentério/patologia , Terapia Neoadjuvante , PrognósticoRESUMO
Postoperative infectious complications still represent a relevant problem in colorectal surgery. They always results in suffering for the patients and often prolonged hospitalization. Furthermore, they result in additional expenses to cover the cost of antibiotics, blood derivates, total parenteral nutrition, nursing and additional surgical procedures. Prevention and control of hospital infections start with surveillance, which is an important means to constantly evaluate the local bacterial epidemiology. An infection surveillance program finalized to minimize the incidence of postoperative infections through the respect of available techniques leads to a better quality of work in each surgical unit, to a decrease in postoperative hospital stay and to cost reduction.
Assuntos
Colo/cirurgia , Reto/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Antibioticoprofilaxia , Proteína C-Reativa/metabolismo , Humanos , Interleucina-6/metabolismo , Laparoscopia , Neutrófilos/metabolismo , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Linfócitos T/metabolismoRESUMO
Rectal cancer continues to be one of the most common tumors worldwide. Its prognosis mainly depends on early diagnosis and precise stage evaluation in order to choose the most effective treatment. In recent years, new and promising technologies have been proposed and are now available in daily practice. Each rectal cancer patient should be considered individually, choosing the diagnostic pretreatment exams that are appropriate for that single clinical case mainly related to the tumor and the available instruments. Clinicians must be informed about the efficacy of these technologies and be aware of any cause of mistake in tumor staging in order to reduce the risk of both improper use and inaccurate staging.