[Quadrantectomy and removal of the sentinel lymph node under local anaesthesia in the day hospital setting]. / Quadrantectomia e asportazione del linfonodo sentinella in anestesia locale in day hospital.

In recent years, breast carcinoma diagnostics and therapy have evolved very considerably, allowing conservative surgery in most cases. These kinds of major operations have been greatly simplified since the introduction of the sentinel lymph node approach, with the possibility of a day surgery operation under local anaesthesia. The aim of this study, after thorough analysis of the axillary lymph nodes with ultrasound and cytological examinations, was to assess whether it would be possible to distinguish between negative and metastatic lymph nodes and whether the operation could be performed under local anaesthesia without hospitalisation. From January 2005 to January 2007, 54 breast carcinoma patients with negative axillary lymph nodes (after ultrasound examination) had a quadrantectomy and sentinel lymph node removal under local anaesthesia together with sedation where appropriate. Eight patients who presented micrometastases or isolated tumour cells in the sentinel lymph node underwent a subsequent lymphadenectomy. Our data show that, thanks to thorough analysis of the axillary cavity, it may be possible to use the sentinel lymph node approach with a good chance of the patient remaining free of distant metastases and of operating under local anaesthesia.

[Diagnosis and treatment of fibroadenoma of the breast: 20 years' experience]. / Diagnosi e trattamento del fibroadenoma della mammella: 20 anni di esperienza.

The diagnostic differentiation of breast lesions is very important because of the frequency with which they occur. Though fibroadenoma is easy to diagnose, some cases prove really hard to distinguish. Therefore, various methods have been suggested both for diagnosis and therapy, but no common approach has been achieved to date. We report our experience with 1350 cases diagnosed over a twenty-year period. The diagnosis was made on the basis of a diagnostic protocol drawn up over the years where cytology is of primary importance. With regard to therapy, we decide to operate when the cytological findings prompt the need for a histological examination of the lesion. Moreover, we operate on those cases where either an increase in size or a morphological change of the lesion has taken place. Histological examinations were carried out in 420 cases out of 1350 and only one of these cases turned out to be a carcinoma. As a result, the 0.24% error in the diagnosis can be considered irrelevant. In spite of the different therapies suggested (cryoablation, laser hyperthermia, i.a.), we believe that surgical treatment with local anaesthetic is the most suitable solution in those cases requiring treatment. Obviously, the diagnosis has to be accurate and made by surgeons with appropriate expertise. When the diagnosis is certain and the conditions of the lesion are stable, the best policy seems to be periodic follow-up.

Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer.

BACKGROUND: Because of scarce data from larger series and nonhomogeneous selection criteria, further information is needed on peritonectomy with hyperthermic intraperitoneal chemotherapy (HIPEC) in managing patients with ovarian peritoneal carcinomatosis. METHODS: In an open, prospective, single-center nonrandomized phase 2 study conducted from November 2000 to April 2007, 47 patients with primary advanced or recurrent ovarian cancer and diffuse peritoneal carcinomatosis were enrolled; 22 underwent primary and 25 secondary cytoreduction plus immediate HIPEC followed by systemic chemotherapy. RESULTS: The overall mean Sugarbaker peritoneal cancer index was 14.9 (range, 6-28). A mean of 6 surgical procedures were required per patient (range, 4-10). In 87.3% of the patients debulking achieved optimal cytoreduction (Sugarbaker completeness of cytoreduction [CC] score 0-1), whereas in 12.7% it left macroscopic residual disease (CC-2 or CC-3). Major complications developed in 21.3% of the patients and the in-hospital mortality rate was 4.2%. The mean overall survival was 30.4 months, median survival was 24 months, and mean disease-free survival was 27.4 months. Five-year survival was 16.7%. Univariate (log-rank test and analysis of variance) and multivariate analyses (Cox proportional-hazard model) identified the CC score as the main factor capable of independently influencing survival. CONCLUSIONS: Peritonectomy procedures combined with HIPEC offer promising long-term survival in patients with diffuse peritoneal ovarian carcinomatosis. They achieve high adequate primary and secondary surgical cytoreduction rates with acceptable morbidity and mortality.