Laparoscopic colectomy in colon cancer. A single-center clinical experience.

INTRODUCTION: Aim of our study was to compare the results of the laparoscopic technique to those obtained by traditional open approach in patients with colon cancer. The advantages, disadvantages, and the contraindications (real and presumptive) of this mini-invasive approach are described, by comparing the data obtained from the international literature with our clinical experience. PATIENTS AND METHODS: From February 2000 to May 2006, we performed 73 laparoscopic colectomies for cancer in the Operative Unit of General and Laparoscopic Surgery, Department of Surgical Sciences of the University of Chieti, Italy. The data of these patients were compared with the data obtained from 141 other patients who underwent open procedure for the same pathology in the same period and in the same Unit. Factors such as obesity, previous major abdominal surgery, T4 cancers, perforation and obstruction of the colon, tumor located in the transverse colon or in the left flexure of the colon were considered contraindications to laparoscopic approach. RESULTS: The length of surgical specimens and the number of lymph nodes removed did not show significant differences in the two groups. Two patients in the open procedure group died in the postoperative period. No postoperative death was noted in the group of patients operated by laparoscopic method. Postoperative complications requiring re-operation were observed in 9 patients in the open group and in 3 patients of laparoscopic group. Postoperative complications not requiring re-operation were observed in 16 patients in the open group and in 4 patients in laparoscopic group. Hospital stay was shorter for laparoscopic right or left colectomy compared to corresponding open procedures. At the follow-up (a mean 30 months), the overall survival was 78% for open colectomies and 82.1% for laparoscopic colectomies. Disease-free survival, excluding patients with stage IV tumor and patients died in the postoperative period, was 77.6% for open colectomies and 82.5% for laparoscopic colectomies. In the group of laparoscopic patients, we observed 1 case of port-site recurrence. CONCLUSIONS: Our clinical experience, even if limited by the number of patients and by the duration of follow-up period, contributes in confirming the reliability of laparoscopic procedures in the treatment of tumours of the colon and the safety of oncological results.

[Pseudosarcomatous lesions: report of two cases]. / In tema di lesioni "pseudosarcomatose".

Of unknown etiology, mainly located on the upper limbs, the nodular fasciitis nowadays is considered as a reactive inflammatory lesion more than a neoplastic one. With very few symptoms, it can be diagnosed through histology and the extent of the excision is related to the report of the pathological examination.

[Antibiotic prophylaxis in the implantation of permanent pacemakers]. / Profilassi antibiotica nell'impianto di pace-makers permanenti.

Prophylactic antibiotics are prescribed frequently at pacemaker placements despite a paucity of data indicating effectiveness. Battery pack replacement procedures usually are not followed by infections and prophylactic antibiotics in this setting are controversial. Pacing wire and battery pack placement have higher infection rate (about 5%), thus antibiotics may be useful in the prevention of serious infections. In this study three different schemes of antibiotics prophylaxis (local prophylaxis, Short term prophylaxis, conventional postoperative prophylaxis) were compared in 72 patients receiving permanent transvenous cardiac pacemakers. No significant differences were found among these three groups also if S.T.P. showed a greatest simplicity.

[Diagnosis of cerebrovascular diseases. International multicentric study]. / Diagnosi delle malattie cerebrovascolari. Studio policentrico internazionale.

A Polycentric International Study was performed to evaluate the diagnostic methods in patients with cerebrovascular diseases. New tools and new non-invasive methods were proposed by the 15 centers collaborating in this study. The difficulty of defining a standard method to investigate not invasively and invasively these patients still remains.

[Breast cancer. Epidemiology and other factors related to incidence in various populations]. / Carcinoma della mammella. Epidemiologia ed altri fattori connessi alla incidenza in varie popolazioni.

An extensive review of epidemiology, etiology, age, genetic factors, race, alimentary habits and hormonal patterns have been analysed in studies concerning patients with breast cancer. The role of other factors (the age of menopause, the geographic distribution, the action of reserpine and many possible causes) are also discussed. The evidences observed in many studies performed in the last years in different countries are compared but definitive data cannot be reached. The material reported in these studies is not homogeneous and this review can only indicate the problems still present in this field and the subjects we need to investigate in the next years.

[Current diagnosis of venous diseases of the lower limbs]. / Diagnostica attuale della patologia venosa degli arti inferiori.

The haemodynamic of venous circulation of lower limbs seems to be not yet fully understood and different methods are available to study clinical patterns of venous insufficiency, deep venous incompetence or venous occlusion. Simple and common methods as venography, venous doppler and plethysmography are frequently used but other method as impedance plethysmography, ambulatory venous pressure, photoplethysmography, isotopes and thermography can be used for research or clinical investigation. The techniques and the indications of these tests are reviewed and critically analyzed to evaluate the best approach to the patients with venous pathology.

Encapsulated liquid crystal (ELC) thermography in peripheral arterial disease.

The correlation between peripheral pressures and skin temperatures was studied by encapsulated liquid crystal (ELC) plates in 66 patients with peripheral arterial disease. The study was also performed to evaluate the correlation between symptoms and temperature in four symptomatic groups of patients (with claudication, rest pain, ischemic ulcerations or gangrene and chronic ulcerations in diabetic patients). The correlation with temperature and pressure was positive (0.99) and so it was that one between symptoms and temperature. This method may be easily used in patients with peripheral arterial disease to evaluate the perfusion of the extremities and to compare bordering areas. Considering these data different new applications of this technique in peripheral vascular disease diagnosis can be suggested. The elevate velocity of the method (about 5 seconds) reveal also very fast variations of the perfusion and this may be useful to study functional decreases of blood pressure.

[The prevention of venous thromboembolism in Italy]. / Indagine sulla profilassi della tromboembolia venosa in Italia.

A questionnaire concerning the prophylaxis of venous thromboembolism was filled in by 326 surgical departments in Italy. In 58% the prophylaxis was routinely used and in 29% more than one method was used. The most used method of prevention was subcutaneous heparin followed by elastic compression. In 51% of the centers the prophylaxis was used only in high risk patients and in 22% it was not used at all. The most relevant risk factors in the development of thrombosis were considered age, tumors and obesity. Finally in a questionnaire sent to 350 vascular laboratories it was found that--according to the operators--76% of all documented thromboses were possibly consequent to surgical procedures (in 86% no prophylaxis had been used).

[Carcinoma of the male breast. Our experience]. / Il carcinoma della mammella maschile. Nostra esperienza.

A case series of 5 male patients afflicted with breast carcinoma is reported. The Authors describe symptomatology, diagnostic iter, principles of surgical treatment and results. Underlined is the wider surgical demolition in male breast cancer in comparison with females, even if natural history and biological conduct are comparable. This is because in male breast carcinoma the local and remote infiltration is more rapid than female for the less development of breast gland. Finally, indications for radiochemotherapy are comparable to female breast cancer.

[Our experience with duodenal tumors]. / La nostra esperienza in tema di tumori duodenali.

The authors report 3 cases of benign duodenal tumors and one case of duodenal cancer. In two cases the benign tumors were adenomatous polyps, in one case with signs of dysplasia. One case of benign tumor was a lipoma. All the three benign tumors were removed through a duodenotomy, in one case associated with a sphincteroplasty. The case of duodenal cancer, arisen in a patient operated since 24 years with a gastric resection, was treated with a Whipple technique but for the very old age and the bad health conditions, the patient died in 11th post-operative day for myocardium infarct.

[Our experience with pheochromocytoma]. / La nostra esperienza in tema di feocromocitoma.

The authors report cases of pheocromocytomas operated in the period 1991-1997. 16 of these patients presented a monolateral pheocromocytoma, 1 a bilateral. A patient had a malignant evolution, one patient presented an extrasurrenal para-aortic localization. All the patients were operated by a middle longitudinal laparotomy. There was no mortality, neither significant morbility. In all the patients, who presented pre-operatory arterial hypertension, there was a regression of the symptomatology.

[Juvenile papillomatosis of the breast]. / La papillomatosi giovanile (PJ) della mammella.

The PJ, introduced by Rosen in the 1980, is a benign and localized mammary lesion in female under 30 years old. The most important clinical and histological features are: Diagnosis in juvenile age. A mass clinically localized. A nodule with histologic features of cyst, benign hyperplasia of ductal epithelium and galactophorus ducts dilatation (Swiss cheese disease). There is a correlation between patients with PJ and breast cancer there is an increment of breast cancer in familirs of patients with PJ. There is an increment of the risk to develop a K in situ in patients with PJ and apocrine metaplasia and/or adenomatosis and/or atypical mastoplasia. We describe the diffuse PJ in a girl of 23 years old from the 1996 to 2002.

[Goiter recurrences after surgical resection]. / Le recidive del gozzo dopo resezione chirurgica.

A personal experience about 135 pz. with non-toxic goitre treated by mono o bilateral thyroidectomy and followed during 5 years (2-8) to evaluate the incidence of recurrences is reported. The recurrences were 10.5%, especially after monolateral thyroidectomy (9 pz.). Therefore the authors stress the importance of a more accurate surgical indication, a wider resection of the gland and a careful follow-up to undertake opotherapy when hypofunction appears.

[A case of colonic multiple lipoma]. / Un caso di lipomi multipli del colon.

The Authors, after a review of the literature, report a case of multiple lipomas of the left colon. They analyse the diagnostic, pathogenetic and therapeutic features of this rare pathology.

[Clinical study of aortic co-involvement in lumbo-aortic lymph node metastasis of testicular carcinoma]. / Studio clinico sul coinvolgimento aortico nelle metastasi linfonodali lombo-aortiche da carcinoma testicolare.

The Authors review the international literature about the frequency of vascular involvement (inferior vena cava and aorta) in the lymph node lumbo-aortic metastases of the testicular neoplasm. They report a case of a patient with an aortic involvement from lymph node metastases of a mixed (seminoma and germ cell) cancer of the left testis. They performed en bloc resection of the bulky metastases including the aorta involved. The literature data as well as the outcome of the operated case show a moderate survival also in patients with advanced disease.

[Diagnosis and therapy of severe acute colitis, still an open issue. Our experience]. / Diagnosi e terapia delle coliti acute severe, un problema ancora aperto. Nostra esperienza.

From a review of a series of 12 cases of whom 52 operated and of the literature, the Authors discuss about aetiology, pathogenesis and diagnosis of severe colitis. Clinical and laboratory findings, CT and plain films of the abdomen and at last colonoscopy should be evaluated very carefully for certainty diagnosis of a severe acute colitis or toxic megacolon. They suggest a multidisciplinary approach as fundamental for medical management, for indications and correct timing of surgical procedures and to decrease postoperative morbility and mortality. Total colectomy with ileostomy is recommended in emergency surgical treatment of this colonic acute diseases, whereas for urgency operation, performed not later than 48-72 hour of adequate medical treatment, colectomy is suggested with ileorectal or ileoanal anastomosis and ileostomy.

[Medullary carcinoma of the thyroid]. / II carcinoma midollare della tiroide.

Medullary thyroid carcinoma represents 4-8% of thyroid malignancies; regional nodal involvement is commonly found, even at the time of first surgical approach. In these patients after surgical resection, other therapeutic choices are really limited. The Authors evaluated their experience in the period 1981-1994, concerning 14 patients, 9 females and 5 males, all affected with sporadic MTC. Diagnosis was preoperative in 10 patients and intraoperative in 4; as for the staging: in 8 patients the tumor resulted confined to the thyroid, while in the remaining 6 patients it was extra-thyroidal. In 5 patients a total thyroidectomy with regional lymphadenectomy was performed, with in 6 patients a total thyroidectomy with cervico-mediastinic total lymphadenectomy was achieved. Survival was evaluated with a short, follow-up (3 months) and calculated using the K-Mayer method. Average survival was: 5 years in patients undergoing only total thyroidectomy; 3 years and 1 month in patients undergoing total thyroidectomy and lymphadenectomy; 6 months in patients undergoing no treatment at all. Among the factors negatively affecting patients survival, the Authors pointed out: metastasis occurrence; incomplete resection and mediastinal metastasis. In conclusion surgical resection (total thyroidectomy) associated with radical lymphadenectomy resulted to be a good approach. However, prognostic factors require further investigation.