[Integrated multidisciplinary treatment of colorectal neoplasms]. / Trattamento multidisciplinare integrato delle neoplasie colo-rettali.

In this retrospective study, the modality and advantages of the multidisciplinary diagnostic work-up and therapy regarding colorectal neoplasm were analysed. Over the period 2004-2008, 63 patients underwent multidisciplinary treatment for colorectal cancer. All patients underwent surgery (laparoscopic/open). Exeresis was supplemented by adjuvant chemotherapy in those cases beyond IIA stage; all cases of extraperitoneal rectal and anal canal neoplasms plus one case of carcinoma of the transverse colon, initially inoperable, underwent neoadjuvant radiotherapy plus chemotherapy. The treatment was initiated approximately 3 weeks after the diagnosis. Fifty-four percent of patients with colonic and upper rectal neoplasms were given adjuvant chemotherapy, starting around 4 weeks after surgery. Exeresis was performed in those patients with extraperitoneal rectal and anal canal neoplasms (12.7%) about 6-8 weeks after they had completed neoadjuvant therapy. At the end of the treatment, 76% of the overall total numbers of patients were in good condition (follow-up 4-50 months). The remaining 24% suffered recurrences about 13 months after the treatment for colonic and upper rectal neoplasm, and 8 1/2 months after treatment for extraperitoneal rectal/anal canal neoplasms. Seventy-five percent of the recurring cases underwent treatment again, with 50% success; the others are still undergoing treatment. The best therapeutic results were obtained by programmed integration of the various diagnostic-therapeutic steps according to an algorithm which we elaborated to evaluate all types of neoplasm at any stage of illness.

[Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy]. / Complicanze maggiori postoperatorie nella chirurgia colo-rettale per cancro. Incidenza in rapporto alla tecnica utilizzata: open versus laparoscopica.

In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique. No mortality occurred with either technique. None of the cases submitted to laparoscopy presented anastomotic dehiscence or severe intraoperative bleeding. In the group submitted to open surgery, 3 cases of severe complications occurred (10.3%), consisting in acute faecal peritonitis due to immediate dehiscence of the colorectal anastomosis; angulation of the intestinal loop with microdehiscence of the ileo-colic anastomosis; and pulmonary embolism. In the group submitted to laparoscopic surgery, 2 cases of severe complications occurred (9.5%), consisting in enterorrhagia due to haemoperitoneum; and intrafascial haematoma due to haemorrhage of the epigastric artery. The overall complication rate was 10%, corresponding to the minimum values reported in the literature. No statistically significant difference was observed in the incidence of these complications with the two methods employed. A very low incidence of minor complications was observed, limited to repercussions on the postoperative course. Furthermore, the laparoscopic technique led to early canalisation, a reduction in hospital stay, less need of drugs (antibiotics and pain killers) and better aesthetic results. The advantages obtained with the laparoscopic technique, with no significant differences in severe complications, indicate that this approach is preferable to the traditional technique in colorectal surgery for cancer.

Improvement in the fertility rate after placement of microsurgical shunts in men with recurrent varicocele.

OBJECTIVE: To evaluate the effectiveness of microsurgical shunts for secondary varicocele repair after ligation-like procedures, focusing on long-term functional outcomes. DESIGN: Long-term survey (mean follow-up, 8.5 years) of infertile men after secondary microsurgical reconstructive varicocelectomy. SETTING: University-based medical center. PATIENT(S): Thirty-four infertile men (group A, <30 years of age; and group B, >30 years) with recurrent palpable varicocele after varicocelectomy, according to Ivanissevich (n = 28), or after angiographic vein occlusion (n = 6). Ten patients presented bilateral recurrence. INTERVENTION(S): Microsurgical shunts between spermatic vein and inferior epigastric vein. MAIN OUTCOME MEASURE(S): Sperm count, pregnancy rate, and ultrasound evaluation of varicosity. RESULT(S): Complete disappearance of varicosity was achieved in 97.06% of patients, while in 2.94%, a consistent reduction in size was observed. In patients with severe infertility, a significant postoperative increase in seminal parameters was observed. Pregnancy rates were 43.75% in group A and 22.22% in group B. CONCLUSION(S): Microsurgical drainage in patients with recurrent varicocele after ligation-like procedures was shown to be an effective minimally invasive treatment, with immediate hemodynamic recovery of testicular venous outflow and excellent long-term results in patients with left or bilateral recurrences.