Oncological monitoring after transanal total mesorectal excision (TaTME) for rectal neoplasia.

BACKGROUND: The surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME). METHODS: This was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up ≥ 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed. RESULTS: One hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%. CONCLUSIONS: TaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.

Ripretinib in gastrointestinal stromal tumor: the long-awaited step forward.

Gastrointestinal stromal tumor (GIST) represents a paradigm for clinically effective targeted inhibition of oncogenic driver mutations in cancer. Five drugs are currently positioned as the standard of care for the treatment of advanced or metastatic GIST patients. This is the result of continuous, deep understanding of KIT and PDGFRA GIST oncogenic drivers as well as the resistance mechanisms associated to tumor progression. However, the complexity of GIST molecular heterogeneity is an evolving field, and critical questions remain open. Specifically, the clinical benefit of approved and/or investigated targeted agents is strikingly modest at advanced stages of the disease when compared with the activity of first-line imatinib. Ripretinib is a novel switch-pocket inhibitor with broad activity against KIT and PDGFRA oncoproteins and has recently demonstrated antitumoral activity across phase I to phase III clinical trials. Therefore, ripretinib has emerged as a new standard of care for advanced, multi-resistant GIST patients. Based on this data, the Food and Drug Administration has granted in 2020 the approval of ripretinib for GIST patients after progression to imatinib, sunitinib and regorafenib. This, in turn, constitutes a major breakthrough in sarcoma drug development, as there have not been new treatment approvals in GIST for nearly a decade. Herein, we provide a critical review on the preclinical and clinical development of ripretinib in GIST. Furthermore, we seek to assess the biological and clinical impact of this new standard of care on the course of the disease, aiming to provide an insight on future treatments strategies for the next coming years.

Gold(I) and silver(I) complexes containing a tripodal tetraphosphine ligand: influence of the halogen and stoichiometry on the properties. The X-ray crystal structure of two gold(I) dimeric aggregates.

Complexes of the type [Au2(micro-PP3)2]X2 [X=Cl (), Br (), I ()], [Ag2(micro-PP3)2](NO3)2 (), Ag(PP3)Cl (), M3(micro-PP3)X3 [M=Au, X=Cl (), Br (), I (); M=Ag, X=NO3 ()] and Au4(micro-PP3)X4 [X=Cl (), Br (), I ()] have been prepared by interaction between gold(I) or silver(I) salts and the ligand tris[2-(diphenylphosphino)ethyl]phosphine (PP3) in the appropriate molar ratio. Microanalysis, mass spectrometry, IR and NMR spectroscopies and conductivity measurements were used for characterization. and are ionic dinuclear species containing four-coordinate gold(i) and four/three coordinate silver(i), respectively. Solutions of behave as mixtures of complexes in a 2:1 [Au2(micro-PP3)X2; X=Cl(), Br(), I()] and 4:1 () metal to ligand ratio. and react with free PP(3) in solution to generate the ionic compounds and , respectively. Complexes and , with four linear PAuX fragments per molecule, were shown by X-ray diffraction to consist of dimeric aggregates via close intermolecular gold(I)gold(I) contacts of 3.270 A () and 3.184 A (). The resultant octanuclear systems have an inversion center with two symmetry-related gold(I) atoms being totally out of the aurophilic area and represent a new form of aggregation compared to that found in other halo complexes of gold(I) containing polyphosphines. The luminescence properties of the ligand and complexes, in the solid state, have been studied. Most of the gold systems display intense luminescent emission at room and low temperature. The influence of the halogen on the aurophilic contacts of compounds with a 4:1 metal to ligand ratio results in different photophysical properties, while and are luminescent complex is nonemissive. The luminescence increases with increasing the phosphine/metal ratio affording for complexes , without aurophilic contacts, the stronger emissions. Silver complexes and are nonemissive at room temperature and show weaker emissions than gold(I) species at 77 K.

Cutaneous metastatic adenocarcinoma of gallbladder origin: report of a case and review of the literature.

In the English literature, there have only been seven reports of metastasis from cancer of the gallbladder to the skin. This is the report of a 75-year-old woman who developed cutaneous metastasis from an adenocarcinoma of the gallbladder which was confirmed histologically. We report the uncommon metastatic potential of gallbladder carcinoma to the skin.

Symptomatic colonic lipoma: differential diagnosis of large bowel tumors.

Symptomatic colonic lipomas, although unusual, continue to present difficulties in the preoperative differential diagnosis between malignant and benign colonic neoplasm. Although new imaging techniques are available, they are frequently diagnosed at laparotomy, and definitive histology is required. Local excision is adequate treatment, but segmental excision may be necessary when there is doubt about the diagnosis, or when a complication occurs.