[Incidental gallbladder carcinoma]. / Il carcinoma incidentale della colecisti.

Carcinoma detected at histological examination of the gallbladder is defined as incidental. It is a fairly rare event, but the increase in the number of cholecystectomies performed has led to a rise in detection of incidental gallbladder carcinoma. Histologically, in most cases, these are pT1 and pT2 carcinomas. Up until the 'nineties it was believed that these carcinomas could be adequately treated by simple cholecystectomy, whereas today the treatment of choice entails a second operation. This study constitutes a review of 20 years' experience. The database consists of 3012 cholecystectomies. Survival data are calculated in relation to the evolution of surgical treatment, thus making it possible to correlate tumour staging, patient survival and surgical therapy. The incidence of IGC was about 0.66% (20 cases). The survival rates of patients operated on by extended cholecystectomy, compared with those achieved previously with simple cholecystectomy, have risen from 92% to 100% at 1 year and from 26% to 66% at 5 years, respectively. The contributions made by literature reports since the 'nineties have prompted hepatobiliary surgeons to modify their attitudes towards incidental gallbladder carcinoma. Detection of previously unrecognised microinfiltrations of the serosa and of neoplastic involvement of distant lymph-node stations has led to the introduction of the concept of extended cholecystectomy. Comparison between our historical survival curve of patients treated with simple cholecystectomy and the distinctly better curve of those treated with a radical second operation accounts for the evolution of surgical treatment over the past two decades.

Outcome of radical surgery for carcinoma of the gallbladder according to the tumor node metastasis and Japanese Society of Biliary Surgery stages.

Primary carcinoma of the gallbladder is a progressive, lethal disease. Survival of patients with this neoplasm depends strictly on lymph node involvement and depth of tumor invasion. The aim of the study was to evaluate the results of our surgical series according to the tumor node metastasis and Japanese Society of Biliary Surgery classification systems. A retrospective analysis of our 15-year experience was performed. Of the 79 patients with gallbladder carcinoma observed at our institution between 1984 and 2001, a radical resection was carried out in 20 patients. Patients with stage I-II disease represent a minority of the cases of gallbladder carcinoma; the disease is localized in these patients, and surgical treatment provides the opportunity for good survival. Survival rates for patients with stage III-IV disease demonstrates that radical extended surgery offers the only chance for a relatively prolonged survival.

[Indications and results of the first 100 liver resections in Bolzano]. / Indicazioni e risultati delle prime 100 resezioni epatiche a Bolzano.

The aim of the study was to report on a survey of 100 liver resections performed over an 8-year period. Seventy-four patients underwent surgery for primary or secondary liver tumours, 15 for benign diseases, and 11 for traumas. The overall operative mortality rate was 3.0%, while the operative mortality rate in elective resections was 2.3%. Five-year survival was 22% for colorectal metastases and 25% for hepatocarcinomas. The expanding role of liver surgery in the treatment of hepato-biliary diseases is emphasized and the importance of anatomical surgery, guided by intraoperative ultrasonography, with limited blood loss and transfusion, is stressed.

[Liver resection after downstaging with neoadjuvant chemotherapy for "unresectable" colorectal metastases]. / Resezione epatica dopo downstaging con chemioterapia neoadiuvante per metastasi colo-rettali "irresecabili".

Hepatic resection is the only treatment that offers a chance of long-term survival in patients with metastases from colorectal cancer. Nevertheless, a curative resection can be performed in only 10-20 per cent of patients: multiple bilobar metastases or "unresectable" disease are the greatest obstacles to surgical radicality. Techniques such as preoperative portal embolisation, preoperative portal ligation, two-stage hepatectomy, and neoadjuvant chemotherapy, have extended the possibility of liver surgery to patients with advanced metastatic colorectal cancer. The outcomes of two patients treated successfully with neoadjuvant chemotherapy (one case with FOL-F-OX, and one with FOL-F-IRI) followed by liver resection were analyzed. In both patients neoadjuvant chemotherapy enabled a curative liver resection to be performed without significant complications. In some patients, neoadjuvant chemotherapy permits the "downsizing" of metastatic disease to such an extent that a surgical approach proves feasible. This advance can dramatically improve the prognosis of patients with multiple or unresectable liver metastases from colorectal cancer.