[A COMPARATIVE STUDY OF THE PATHOLOGICAL CHARACTERISTICS OF RIGHT SIDED VERSUS LEFT SIDED COLON CANCER].

AIMS: This study aimed to investigate the pathologic differences between right and left sided colonic cancer. BACKGROUND: The incidence of right sided colon cancer during the past several decades is increasing as compared to left sided colon cancer. There are cumulative publications describing epidemiological, pathological and genetic differences between right and left sided colon cancer. A few studies have also shown a lower survival rate in patients with right sided colon cancer as compared to patients with left sided colon cancer. METHODS: A retrospective study based on the accumulated data on right and left sided colonic cancer. RESULTS: Data on 823 patients was collected; 426 patients (52.8%) had colon cancer located on the right side and in 397 patients (48.2%) it was located on the left side. There were no statistically significant differences between right and left colon cancer regarding sex, lymph node metastases and lymphovascular invasion. However, there was a significantly higher proportion of poorly differentiated adenocarcinomas (19%vs.8.7%; p<.001) and a trend to higher T stage (T3-4:87.7%vs.82.8%; p<.049) in right sided tumors as compared to left sided tumors. The incidence of mucinous tumors and mucinous components was also significantly higher in right sided tumors (7.3%vs.2%; p<.001, 13.1%vs.7%; p<.001). CONCLUSIONS: We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage and mucinous tumors. The reasons are unclear, either the existence of two distinct molecular pathways or simply a delay in the diagnosis of right sided colon cancer. Future studies are needed to better understand the true nature of these differences.

When Should Abdominal Computed Tomography Be Considered in Patients with Lower Rib Fractures?

BACKGROUND: Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%-40%. OBJECTIVE: The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures. METHODS: Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI. RESULTS: Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1-16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1-13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2-4.8; p = 0.016) as independent risk factors for the presence of IAI. CONCLUSIONS: Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission.

Re-Examining Distal Resection in Colon Cancer.

BACKGROUND: In colon cancer, data regarding proximal and distal metastasis to lymph nodes remains scarce. OBJECTIVES: To evaluate lymph node distribution along the longitudinal axis of the colon as related to a tumor to re-examine the common practice of 5 cm proximal and 2 cm distal resection margins. METHODS: We studied 106 patients (53 males and 53 females, mean age 67.9 ± 10 years) who had undergone left hemicolectomy or sigmoidectomy. Colonic cancer specimens were divided into five zones proximally and distally to the tumor. For each zone, overall lymph node evaluation and ratio was performed. RESULTS: The mean number of retrieved lymph nodes per patient was 24.3 ± 12, with 54.9% of the nodes concentrated in zone I, 22.1% in zone II, 9.5% in zone III, 10.3% in zone IV, and 3% in zone V. While most positive nodes were found in zone I, significant numbers were also detected in both directions proximally and distally to the tumor. CONCLUSIONS: It seems that longer colonic segments proximally, and especially distally, should be considered for resection to significantly reduce the chances of finding involved lymph node.

Incidence and Trends of Gastrointestinal Malignancies in Jewish and Arab Populations in Israel over 32 Years.

BACKGROUND: Gastrointestinal malignancies comprise a broad spectrum of neoplasms and have a high overall incidence. The incidence rates in Israel vary among ethnic groups due to different risk factors. OBJECTIVES: To investigate incidence trends of these cancers in Israel in both Jewish and Arab ethnic groups in order to better understand the risks in those groups. METHODS: This study is based on data published by the Israel National Cancer Registry and the Central Bureau of Statistics. We compared statistics between ethnicities and genders. We examined the eight most common gastrointestinal cancers, focusing on colon, rectal and gastric cancers. RESULTS: Between 1980 and 2012 there was a decline in the incidence of gastric cancer in the Jewish population; in contrast, a significant increase occurred in Arab women, but there was no significant change in Arab men. Colon cancer showed a relative decrease in incidence in the Jewish population, but an increase in the Arab population. A decrease in the incidence of rectal cancer in the Jewish population and an increase in the Arab population was observed. CONCLUSIONS: Gastric, colon and rectal cancers exhibit differences in incidence and outcome between Jewish and Arab populations in Israel. These differences were not observed in the other five types of less common gastrointestinal cancers.

Interval Laparoscopic Cholecystectomy: What is the Best Timing for Surgery?

BACKGROUND: The timing of interval laparoscopic cholecystectomy continues to be a matter of debate. OBJECTIVES: To evaluate the best timing for performing this procedure after an episode of acute cholecystitis. METHODS: In this retrospective analysis, we divided 213 patients into three groups based on the time that elapsed from an episode of acute cholecystitis to surgery: Group 1: 1-6 weeks, Group II: 6-12 weeks, Group III: > 12 weeks. RESULTS: The mean operative time ranged from 51 to 59 minutes, complication rate 2.6%-5.9%, conversion rate 2.6%-10.8%, length of hospitalization 1.55-2.2 days, and the 30 day readmission rate 2.7%-7.9%. There were no statistically significant differences between the study groups in the primary outcome parameters. CONCLUSIONS: Due to the lack of statistically significant differences between the groups, interval laparoscopic cholecystectomy can be performed safely and without increasing the complication rate within 6 weeks after the acute episode as well as 12 weeks after. However, a trend towards higher conversion and complication rates was observed in Group II (6-12 weeks).

D1 versus D2 Gastrectomy for Gastric Adenocarcinoma.

BACKGROUND: Despite the ongoing decrease in the incidence of gastric cancer, this disease is still a major cause of death. It is still debatable whether D2 lymphadenectomy improves survival and whether this procedure should be performed routinely or selectively. OBJECTIVES: To compare the pathological and short-term results following radical D2-type gastric resection and lymphadenectomy versus the more limited D1 type resection and lymphadenectomy. METHODS: We conducted a retrospective study on 4 years experience treating 164 patients suffering from gastric cancer. We compared the results between the group of patients who underwent a radical D2 type gastric resection and lymphadenectomy (n = 100) and those of a relatively small group of patients who intentionally underwent the more limited D1 type (n = 34). RESULTS: The overall number of harvested lymph nodes was 9 ± 4 in the D1 group compared to 30 ± 12 (range 16-69) in the D2 group (P = 0.001). Of the 100 patients undergoing a D2 lymphadenectomy, 57% had positive nodes compared to 38% of the 34 patients in the D1 group (P = 0.045). CONCLUSIONS: We showed statistically significant differences between D1 and D2 procedures in the overall number of harvested lymph nodes and the proportion of positive nodes to the overall number. Our results support the fact that D2 resection should be recommended as the standard approach of treatment for gastric cancer patients, ensuring a larger number of retrieved lymph nodes and a comparable rate of complications and mortality.

Diagnostic Use of Endoscopic Retrograde Cholangiopancreatectography for Pancreatic Duct Injury in Trauma Patients.

BACKGROUND: Trauma patients diagnosed with pancreatic duct injury (PDI) have a high complication rate and prolonged hospital stay. The role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of PDI remains unclear. During the last decade, our trauma unit incorporated ERCP into the management protocol for suspected PDI cases. OBJECTIVES: To determine whether ERCP is a sensitive tool to detect PDI. METHODS: This retrospective trauma patient series study assessed the diagnostic yield of ERCP in trauma cases with suspected PDI on computed tomography (CT) or intraoperatively. Between 1 January 2004 and 31 December 2011, 13 patients admitted to our medical center underwent ERCP for suspected PDI. Patient demographics, mechanism of injury, Injury Severity Score (ISS), time from injury to ERCP, and ERCP-related complications were documented and assessed. RESULTS: Of the 13 patients included in the analysis, 8 stable patients with suspected PDI on CT had no leak from the main pancreatic duct on ERCP. Two of them underwent surgery for suspected pancreatic transection. ERCP confirmed a main pancreatic duct leak in three patients. Two patients underwent ERCP for suspected PDI after "damage control" surgery. No leak from the pancreatic ducts was diagnosed. No pancreas-related complications or ERCP-related complications were observed. CONCLUSIONS: ERCP is a sensitive and relatively safe tool for the diagnosis of PDI, and its use might prevent unnecessary surgical interventions in selected trauma cases.

Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury.

OBJECTIVE: Computed tomography (CT) has become an important tool for the diagnosis of intra-abdominal and chest injuries in patients with blunt trauma. The role of CT in conscious asymptomatic patients with a suspicious mechanism of injury remains controversial. This controversy intensifies in the management of pediatric blunt trauma patients, who are much more susceptible to radiation exposure. The objective of this study was to evaluate the role of abdominal and chest CT imaging in asymptomatic pediatric patients with a suspicious mechanism of injury. METHODS: Forty-two pediatric patients up to 15 years old were prospectively enrolled. All patients presented with a suspicious mechanism of blunt trauma and multisystem injury. They were neurologically intact and had no signs of injury to the abdomen or chest. Patients underwent CT imaging of the chest and abdomen as part of the initial evaluation. RESULTS: Thirty-one patients (74%) had a normal CT scan. Two patients of 11 with an abnormal CT scan required a change in management and were referred for observation in the Intensive Care Unit. None of the patients required surgical intervention. CONCLUSION: The routine use of CT in asymptomatic pediatric patients with a suspicious mechanism of blunt trauma injury is not justified.

Does selective use of computed tomography scan reduce the rate of "white" (negative) appendectomy?

BACKGROUND: Appendectomies are the most common operations performed on an emergency basis. The accepted rate of "white" appendectomies is around 20%. In recent years, computed tomography (CT) scanning has been recognized as a valuable tool with high sensitivity and specificity in the diagnosis of acute appendicitis. The use of CT scans in the management of patients with suspected acute appendicitis is increasing worldwide. OBJECTIVES: To assess whether introducing more liberal use of CT in the management of patients presenting to the emergency room with right lower quadrant pain or suspected acute appendicitis would reduce the rate of "white" appendectomies. METHODS: We conducted a retrospective study of the pathology reports and CT scans of all patients who underwent appendectomy during a 3 year period. We examined the correlation between the rate of CT scans performed and the rate of "white" appendectomies. RESULTS: Overall, we performed 797 appendectomies during the study period. In 2004, we performed 272 appendectomies and CT in 34 patients (12.5%). In 2005, we performed 275 appendectomies and CT in 83 patients (30.2%). In 2006, we performed 250 appendectomies and CT in 88 patients (35.2%). The percentage of "white" appendectomies decreased from 29% in 2004 to 21.1% in 2005 and to 18.8% in 2006. CONCLUSIONS: It appears that a more selective use of CT scans in the management of suspected appendicitis could reduce the rate of "white" appendectomies.

Incidence trends and mortality rates of gastric cancer in Israel.

BACKGROUND: Gastric cancer is the fourth most common malignancy worldwide. The incidence trends and mortality rates of gastric cancer in Israel have not been studied in depth. The aim of our study was to try and investigate the aforementioned issues in Israel in different ethnic groups. METHODS: This retrospective study is based on the data of The Israel National Cancer Registry and The Central Bureau of Statistics. Published data from these two institutes were collected, summarized, and analyzed in this study. RESULTS: Around 650 new cases of gastric cancer are diagnosed yearly in Israel. While we noticed a decline during the period 1990-2007 in the incidence in the Jewish population (13.6-8.9 and 6.75-5.42 cases per 100,000 in Jewish men and women, respectively), an increase in the Arab population was noticed (7.7-10.2 and 3.7-4.2 cases per 100,000 in men and women, respectively). Age-adjusted mortality rates per 10,000 cases of gastric cancer decreased significantly, from 7.21 in 1990 to 5.46 in 2007, in the total population. The 5-year relative survival showed a slight increase for both men and women. CONCLUSION: There is a difference in the incidence and outcome of gastric cancer between the Jewish and Arab populations in Israel. The grim prognosis of gastric cancer patients in Israel is probably due to the advanced stage at which gastric cancer is diagnosed in Israel.

Indication for relumpectomy--a useful scoring system in cases of invasive breast cancer.

BACKGROUND AND OBJECTIVES: In two-thirds of breast cancer patients undergoing reoperation no residual tumor will be found. A scoring system for selection of patients who might benefit from relumpectomy is proposed. METHODS: This study is based on 293 patients with invasive breast cancer undergoing reoperation due to margins of <2 mm. Eighteen parameters were evaluated by univariate and multivariate stepwise logistic regression. RESULTS: Univariate analysis identified nine parameters associated with a residual invasive tumor: surgical margins; lobular histological type; grade 3; multifocality; positive lymph modes; non-fine needle localization (FNL) versus FNL lumpectomy; vascular/lymphatic invasion; age <50 years; and tumor size ≥3 cm. Multivariate stepwise logistic regression study identified six out of nine parameters associated with a higher probability of finding a residual invasive tumor: margins <1 mm, multifocality, tumor size ≥3 cm, positive lymph nodes, age <50 years, and lumpectomy without previous FNL. Odds of these factors were used for scoring. CONCLUSIONS: For patients with surgical margins <2 mm and a score of <4, the probability of finding a residual invasive tumor is 0%, while the probability of finding a microfocus of <2 mm of invasive carcinoma is 3.2% and of finding residual DCIS is up to 10%.

Comparative study of the pathological characteristics of gastric stump carcinoma and carcinoma of the upper third of the stomach.

BACKGROUND: Gastric stump cancer is often described as a tumor with a poor prognosis and low resectability rates. OBJECTIVES: To compare the pathological characteristics of gastric stump cancer patients with those of patients with proximal gastric cancer. METHODS: This retrospective study was based on the demographic and pathological data of patients diagnosed with gastric cancer and treated at Assaf Harofeh Medical Center during an 11 year period. The patients were divided into two groups: those undergoing proximal gastrectomy for proximal gastric cancer and those undergoing total gastrectomy for gastric stump cancer. RESULTS: Patients with gastric stump cancer were predominantly male, older (P = 0.202, not significant), and had a lower T stage with less signet-ring type histology, fewer harvested and fewer involved lymph nodes (P = 0.03, statistically significant) and less vascular/lymphatic involvement than patients with proximal gastric cancer. CONCLUSIONS: The lower incidence of involved lymph nodes and lymphovascular invasion in gastric stump cancer as compared to proximal gastric cancer in this study may imply that the prognosis of gastric stump cancer may be better than that of proximal gastric cancer. However, to verify this assumption a study comparing patient survival is required.

PET/CT in breast cancer staging is useful for evaluation of axillary lymph node and distant metastases.

INTRODUCTION: Breast cancer outcome is dependent on disease stage. The aim of the study was to assess the role of PET/CT in the evaluation of axillary lymph node and distant metastases in women with newly diagnosed primary breast cancer. MATERIALS AND METHODS: We assessed, among patients with newly diagnosed primary breast cancer, associations of [18F] fluorodeoxyglucose (FDG) uptake (maximum standardized uptake value [SUVmax]) with clinical variables of the primary tumor, including regional nodal status and the presence of distant metastases. RESULTS: Of 324 patients, 265 (81.8%) had focal uptake of FDG that corresponded with the cancerous lesion, and 21 (6.5%) had no FDG-avid findings. The remaining 38 patients had diffuse or nonspecific uptake of FDG. Among patients with a focal uptake of FDG (n = 265), the mean tumor size was 2.6 ± 1.9 (range 0.5-13.5), and the mean SUVmax was 5.3 ± 4.9 (range 1.2-25.0). In 83 patients (25.6%), PET/CT demonstrated additional suspected foci in the same breast. FDG-avid lymphadenopathy was observed in 156 patients (48.1%). Further assessment of lymph node involvement was available for 55/156 patients (axillary lymph node dissection [n = 21]; core needle biopsy [n = 34]) and confirmed axillary lymph node metastases in 47 (85.5%)). Thirteen patients (4.0%) had FDG-avid supraclavicular lymph nodes and six (1.9%) had FDG-avid internal mammary lymph nodes. Distant FDG-avid lesions were detected in 33 patients (10.2%). CONCLUSION: PET/CT is a useful diagnostic tool for staging breast cancer patients, but its use should be limited to specific clinical situations; further evaluation is needed.

The accuracy of sentinel node mapping according to T stage in patients with gastric cancer.

BACKGROUND: Sentinel lymph node (SLN) mapping has been recently introduced to the field of gastric cancer. To the best of our knowledge, no study has dealt with the accuracy of SLN mapping according to the T stage of the primary tumor. The aim of the present study was to evaluate SLN status according to the T stage of the primary tumors. METHODS: Eighty patients with gastric cancer underwent SLN mapping with patent blue dye during gastric resection. RESULTS: Forty-seven patients underwent distal subtotal gastrectomy; 17 patients, proximal gastrectomy; 14, total gastrectomy; and 2, gastric stump resection. SLNs were stained in 61/80 patients (76.3%). The number of stained SLNs varied from 1 to 16 (mean, 3.3). Patients undergoing proximal gastrectomy had a mean of 3 stained SLNs, whereas patients undergoing distal subtotal gastrectomy had a mean of 2.8 stained SLNs. In 55/61 patients (90.2%) with stained SLNs a positive correlation was found between the presence of metastases and stained or non-stained SLNs. Ten out of 11 patients (90.9%) with T1 tumors (mean, 3.27 SLNs per patient) and 15/17 patients with T2 tumors (88.2%; mean, 3 SLNs per patient) had stained SLNs as compared to only 33/48 (68.8%) of patients with T3 tumors (mean, 3.3 SLNs per patient). The positive predictive value of the SLN mapping was 100%, the negative predictive value was 76.9%, and sensitivity was 85.4%. CONCLUSION: While in T1 and T2 tumors sentinel node mapping may be of assistance in the decision-making process regarding the extent of lymphadenectomy (sensitivity, 100%; negative predictive value, 90%-100%), SLN mapping in patients with T3 tumors will be misleading in a third of the patients and should not be attempted.

Posterior thoracic esophagostomy as an esophageal sparing procedure.

A diverting (posterior) thoracic esophagostomy is a rare, but acceptable, surgical option in some cases. The goal is to save as much esophageal length as possible with a view to future reconstructive surgery. We herein report a 41-year-old woman, in whom a posterior thoracic esophagostomy was successfully created and used for reestablishing further physiological alimentary continuity in a second stage.

Preoperative staging using transrectal ultrasound in high and low rectal cancer.

BACKGROUND: An accurate preoperative definition of tumor and lymph node status is needed for reaching the correct decision regarding rectal cancer treatment. Transrectal ultrasonography is the most commonly used diagnostic modality for the local staging of rectal cancer. OBJECTIVES: To determine the accuracy of TRUS in the staging of rectal cancer. METHODS: We conducted a retrospective study on 95 patients evaluated by TRUS. The rectum was subdivided into two parts (lower and upper). RESULTS: Sixty patients underwent radical surgery. Of these, 34 received no preoperative chemo-irradiation owing to microT1, was suggested to patients with adenocarcinoma that proved to be microT3). The overall accuracy rate was 80% for T stage. Overstaging was found in 13.3% and understaging in 6.7%. The N-stage was correctly assessed in 70%. The overall accuracy rate for tumors was 73.9% in the lower part and 90.9% in the upper. A trend towards a lower accuracy rate for low-lying tumors compared to high-located rectal tumors was found (P = 0.532), which did not reach statistical significance. CONCLUSIONS: TRUS gave better results for T1 and T3 stage rectal tumors but was inaccurate for stage T2, indicating the possible need for local excision in order to base the final treatment for T2 tumors on pathologic staging.

Intraoperative parathormone measurements and postoperative hypocalcemia.

BACKGROUND: Hypocalcemia following thyroid and parathyroid surgery is a well-recognized potential complication. OBJECTIVES: To determine the utility of intraoperative quick parathormone assay in predicting severe hypocalcemia development following parathyroidectomy for a single-gland adenoma causing primary hyperparathyroidism. METHODS: A retrospective cohort study was performed. IO-QPTH values were measured at time 0 (T0) before incision, and 10 (T10) and 30 minutes (T30) following excision of the hyperfunctioning gland. Percent decrease in IO-QPTH at 10 minutes (T10), maximum percent decrease of IO-QPTH value, and lowest actual IO-QPTH value obtained at surgery were used to determine any correlation with the development of postoperative hypocalcemia requiring treatment. RESULTS: Percent decrease in IO-QPTH at 10 minutes, maximum percent decrease in IO-QPTH and lowest IO-QPTH value did not correlate with the lowest postoperative calcium levels measured 18 hours after surgery (r = 0.017, P = 0.860; r = 0.018, P = 0.850; and r = 0.002, P= 0.985 respectively). For the purposes of our analysis, patients were subdivided into three groups. Group 1 comprised 68 patients with normal calcium levels (serum Ca 8.6-10.3 mg/dl), group 2 had 28 patients with hypocalcemia (8.1-8.6 mg/dl), and group 3 included 12 patients with severe hypocalcemia (calcium level < or = 8.0 mg/dl) requiring calcium supplementation due to symptoms of hypocalcemia. There was no difference between the three groups in the lowest IO-QPTH value (P = 0.378), percent decrease in IO-QPTH (P = 0.305) and maximum percent dercrease in IO-QPTH (P = 0.142). CONCLUSIONS: IO-QPTH evaluation was not useful in predicting the group of patients susceptible to develop severe postoperative hypocalcemia.

The role of upper gastrointestinal swallow study in patients undergoing proximal or total gastrectomy.

BACKGROUND: One of the ominous complications following proximal gastrectomy or total gastrectomy is a leak from the esophagogastric or esophagojejunal anastomosis. An upper gastrointestinal swallow study is traditionally performed to confirm the anastomotic patency and lack of any leak before oral feeding can be initiated. OBJECTIVES: To challenge the routine use of UGISs following proximal or total gastrectomy in order to check the integrity of the gastroesophageal or jejunoesophageal anastomosis. METHODS: The charts of 99 patients who underwent PG or TG for malignant pathology were retrospectively reviewed. UGISs were performed on day 6 following surgery using a water-soluble material. RESULTS: The UGISs were normal in 95 patients, with none displaying any complication related to the gastroesophageal or jejunoesophageal anastomosis. All four patients who experienced a leak from the anastomosis had an early stormy postoperative course. CONCLUSIONS: Routine use of an UGIS to detect a leak following PG orTG is not justified. UGIS should be performed whenever signs of abdominal sepsis develop following this type or surgery.

Factors affecting rise in the incidence of infiltrating lobular carcinoma of the breast.

BACKGROUND: Infiltrating ductal carcinoma and infiltrating lobular carcinoma account for more than 90% of all invrasive breast cancer histological types. The rate of lLC is reported to be increasing steadily in the United States and Europe. OBJECTIVES: To describe the trend in the incidence of ILC in a large cohort of patients who underwent surgery in a single institution over an 18 year period. METHODS Our comprehensive database of 2175 consecutive patients with invasive breast cancer diagnosed during the period 1992-2009 served for the analysis. Several potential factors associated with lobular carcinoma as compared with ductal carcinoma were evaluated. RESULTS: During this period, a 2.4-fold increase in the incidence of pure ILC was noted, from 4.6% in theyears 1992-1994 to 10.9% in 2004-2006, followed by a modest decrease to 8.7% in 2007-2009. A significant association of lobular malignancies with external hormonal use was noted, including hormone replacement therapy exposure in patients diagnosed at age 50-64, and ovarian overstimulation during in vitro fertilization in those diagnosed at age 50 or less CONCLUSIONS: Better diagnostic tools - such as the liberal use of ultrasound and magnetic resonance imaging- and more accurate pathological definition for ILC type appear to influence the changes in the incidence of ILC in the subgroups of invasive breast cancer.

The role of diagnostic laparoscopy in the management of patients with gastric cancer.

BACKGROUND: Gastric cancer continues to be a leading cause of cancer death. The treatment approach varies, and preoperative staging is therefore crucial since an exploratory laparotomy for unresectable gastric cancer will be followed by an unacceptably high morbidity and mortality rate. OBJECTIVES: To assess the added value of diagnostic laparoscopy to conventional methods of diagnosis such as computed tomography in avoiding unnecessary laparotomies. METHODS: We conducted a retrospective study on 78 patients scheduled for curative gastrectomy based on CT staging. DL was performed prior to exploratory laparotomy. RESULTS: In 23 of 78 patients (29.5%) unexpected peritoneal spread not detected on preoperative CT was found. Fifty-five patients underwent radical gastrectomy, 15 patients were referred for downstaging and 8 patients underwent a palliative procedure. CONCLUSIONS: Based on our results, DL should be considered in all gastric cancer patients scheduled for curative gastrectomy.