Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients.

BACKGROUND/AIM: Extraordinary restrictions aimed to limit Sars-CoV-2 spreading; they imposed a total reorganization of the health-system. Oncological treatments experienced a significant slowdown. The aim of our multicentric retrospective study was to evaluate screening suspension and surgical treatment delay during COVID-19 and the impact on breast cancer presentation. PATIENTS AND METHODS: All patients who underwent breast surgery from March 11, 2020 to May 30, 2020 were evaluated and considered as the Lockdown group. These patients were compared with similar patients of the previous year, the Pre-Lockdown group. RESULTS: A total of 432 patients were evaluated; n=223 and n=209 in the Lockdown and Pre-lockdown-groups, respectively. At univariate analysis, waiting times, lymph-nodes involvement and cancer grading, showed a statistically significant difference (p<0.05). Multivariate analysis identified waiting-time on list (OR=1.07) as a statistically significant predictive factor of lymph node involvement. CONCLUSION: Although we did not observe a clinically evident difference in breast cancer presentation, we reported an increase in lymph node involvement.

Laparoscopic sleeve gastrectomy for morbid obesity. Our initial experience.

AIM OF THE STUDY: The outcomes and initial results of laparoscopic sleeve gastrectomy (LSG) were evaluated at our Institution. METHODS: A retrospective analysis of the initial 6 patients who underwent laparoscopic sleeve gastrectomy (LSG), between November 2006 and May 2008, was performed. The aim of this study was to assess the safety and short-term efficacy of LSG as a treatment option for weight reduction. Data collected included operative time, postoperative complications, length of hospital stay and degree of weight reduction. RESULTS: Our 6 morbidly obese patients, who underwent LSG had an average preoperative BMI 58.2 kg/m2. There were 2 women and 4 men, with mean age 45 (range 41 to 55 years). Indication for LSG was related to BMI, high perioperative risk, and body habitus for five patients. One patient underwent LSG as an alternative to laparoscopic adjustable gastric banding (LAGB). Mean operative time was 2 hours (range 1.5-2.5). We had no conversion to open procedure. There were neither postoperative complications nor mortality. Median hospital stay was 2 days. For our first 4 patients Average %EWL and BMI were 24% and 44.5 kg/m2 at 6 months and % 31.2 and 41.2 kg/m2 at 1 year respectively. No patients have subsequently undergone a second-stage procedure. CONCLUSIONS: In our initial experience, LSG is a safe and effective treatment option for the high-risk and super super-obese patient. Follow-up will be necessary to evaluate long-term results when performed as single stage operation for morbid obesity.

Rare complication after anterior resection of the rectum and colon reconstruction: severe constipation with obstructed defecation. Report of a case.

OBJECTIVE: The aim of this manuscript is to verify the impact that some recanalization procedures for intestinal continuity could have in bowel function and quality of life. STUDY MATERIAL: We describe a clinical case of a rectal cancer patient who underwent anterior resection of the rectum with colo-anal anastomosis, colo-plasty and diverting ileostomy. RESULTS: After the diverting ileostomy closure, suffered of severe bowel function problems. The establishment of a colo-plasty caused a syndrome of such severe obstructed defecation to necessitate the reestablishment of a diverting ileostomy. DISCUSSION: Anterior resection with total mesorectal excision and colo-anal anastomosis is the gold standard surgical treatment of rectal carcinoma. The so called "anterior resection syndrome" is well known after such surgical procedures. The establishment of a reservoir such as the J-pouch and more recently the transverse pouch (colo-plasty) are procedures used to improve the quality of life after anterior resection of the rectum. CONCLUSIONS: The presence of bowel obstruction without mechanical causes makes us consider the colo-plasty as its cause with a Hirschprung like mechanism or similar to the "obstructed defecation". The peristalsis stops at the colo-plasty level impeding the progression of feces. The colo-plasty or the pouch do not function as a reservoir to accommodate feces, but because they stop the peristalsis.