[Carcinoma of the gastric stump. Our experience in 28 treated cases]. / Carcinoma del moncone gastrico. Nostra esperienza su 28 casi trattati.

A chart review was conducted on 28 patients with gastric stump cancer who were radically treated at the First Department of Surgery of University "La Sapienza" of Rome between 1978 and 1990. The data obtained were compared with those of 401 patients radically treated, in the same period, for primary cancer of the proximal third of the stomach. There were no significant differences between the two groups in terms of stage and nodal involvement. Surgical treatment was total gastrectomy in 86% of cases, and an extended procedure in 57% of patients. The morbidity rate was similar to patients treated for primary gastric cancer, as well the 5-year survival, which depend on the stage of disease. We can conclude that gastric stump cancer must be treated surgically with radical intent as the prognosis is similar to that of primary gastric cancer.

[The role of colonoscopy in early diagnosis of intraluminal recurrences in patients already treated for colorectal cancer]. / Ruolo della colonscopia nella diagnosi precoce delle recidive intraluminali nei pazienti già trattati per carcinoma colorettale.

It is a common opinion that the more often and the more rigorously the colon is examined, the more lesions will be discovered and diagnosed. However it has not been shown which methods of colonic examination and which regimen of surveillance should be used. Chart review was conducted on 481 patients who underwent curative resection for colorectal cancer between 1980 and 1990. Colonoscopy was performed preoperatively, after 12-15 months from surgical treatment, and then at an interval of 12-24 months, or when symptoms appeared. About ten percent of patients developed intraluminal recurrences, and more than 25% adenomatous polyps. More than one half of the metachronous lesions arise within the first 24 months. The median time to diagnosis was 25 months for intraluminal recurrences and 22 months for adenomatous polyps. Patients with left sited tumor at an advanced stage run a higher risk of developing recurrent intraluminal disease, and patients who presented associated polyps at the time of the operation for the index cancer have a higher risk of developing new polyps. About 50% of recurrences were detected when patients were asymptomatic. Colonoscopy must be performed within the first 12-15 months after operation, while an interval of 24 months between each examination seems sufficient to guarantee an early detection of metachronous lesion. Asymptomatic patients are more frequently reoperated for cure and thus have a better survival rate.

[Video-laparoscopic cholecystectomy. Results of 281 treated cases]. / Colecistectomia per via videolaparoscopica. Risultati su 281 casi trattati.

From March 1992 to September 1994, 281 patients were submitted to laparoscopic cholecystectomy for cholelithiasis. 27 patients were admitted with diagnosis of acute cholecystitis and in 17 patients common duct stones were discovered and managed by ERCP before laparoscopic procedure. Surgical procedure was the standard one described by Cox. The mean duration of the operation was 60 minutes and was significantly related to the surgeon's experience; the incedence of conversion to open procedure was 5.7%. There was no postoperative mortality; the total morbility rate was 2.8%, with 3 major complications, and 5 minor complications.

[Effectiveness of quarterly assessment of CEA, TPA and GICA serum levels in gastric and colorectal carcinomas: Prospective study of 174 patients undergoing radical surgery]. / Efficacia della valutazione trimestrale dei livelli sierici del CEA TPA e GICA nei carcinomi gastrici e colorettali. Studio prospettico su 174 pazienti operati radicalmente.

One-hundred seventy four consecutive patients who underwent curative resection for gastric and colorectal cancer between 1983 and 1985, were studied prospectively to evaluate the roles of sequential CEA, TPA and GICA determinations and independent clinical examinations, in the early diagnosis of resectable recurrences. Sixty-six recurrences (33 from gastric and 33 from colorectal cancer) were detected between 6 and 42 months after primary surgery. In gastric cancer CEA, TPA and GICA showed a sensitivity of 64%, 73%, and 60%, and a specificity of 67%, 65% and 54% respectively. Nine patients (27%) underwent surgical treatment for the recurrent disease, and 4 of them (44.4%) had resectable recurrence, for a total resectability rate of 12%. Out of these four patients, three patients are still living after 12, 36 and 44 months respectively from re-operation without evidence of neoplastic disease. In one of these patients re-operation was performed on the basis of the elevation of the three markers, without any other clinical sign of disease, this patient had a resectable solitary hepatic recurrence. In colorectal cancer CEA, TPA and GICA showed a sensitivity of 73%, 73%, and 49%, and a specificity of 77%, 87%, and 97% respectively. Fourteen patients (42.4%) underwent surgical treatment for the recurrent disease, and 8 of them (57%) showed a resectable recurrence, for a total resectability rate of 24.2%. Six patients are still living after 9, 16, 21, 31, 41 and 53 months respectively from reoperation without evidence of neoplastic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Localized pleural mesotheliomas. Clinicopathological considerations on a case report]. / Mesoteliomi pleurici localizzati. Considerazioni clinicopatologiche su di un caso osservato.

Pleural mesotheliomas are rare, and their diagnosis and treatment not clear. The case observed in our Department leads us to an analysis of the literature. This showed that differential diagnosis with pulmonary carcinoma is very difficult, even in cases of parietal mesothelioma; however local treatment may be performed even in malignant mesothelioma.