Extending indication for radiofrequency ablation (RFA) in cancer surgery.

Radiofrequency ablation (RFA) represents one of the successful methods for the thermal ablation of unresectable tumors. The tumoricidal effect of this method consists in the tissular conversion of electromagnetic energy into thermal energy. The term refers to the electric current, whose frequencies reach high values, 480 KHz on average. The method involves the insertion of bipolar needles in parenchymal tumors. The thermal tissue damage depends on both the temperature reached and the duration. The most frequent use is for unresectable hepatic tumors (metastases, hepatoma) or for those with a contraindication for surgery, visible on ultrasound. We have also widened the indications to other tumoral locations: cervical cancer (stages II, III, IV) accompanied by metrorrhagia, RFA being used hemostatically and with the purpose of reducing the size of the tumor, genital tumors, lateral-aortic lymph blocks to reduce the tumoral mass, metastases (the psoas muscle, the sacrum), retroperitoneal sarcoma, with a hemostatic role and also to reduce the size of the tumor. The paper aims to present a preliminary situation based on 24 cases. The results have shown the usefulness of the application of RFA with the purpose of reducing the tumoral mass and the hemostatic role of the method. No complications were recorded.

Intraoperative laparoscopic renal ultrasonography: use in advanced laparoscopic renal surgery.

OBJECTIVES: To highlight the use of intraoperative laparoscopic ultrasonography (ILUS) in complex renal surgery, as well its impact on management. ILUS has been used to facilitate advanced laparoscopic surgery, but only limited descriptions of the indications for its use have been published. METHODS: All patients undergoing laparoscopic renal procedures requiring ILUS from October 2001 to March 2005 were reviewed. A total of 50 cases, including 35 partial nephrectomies, cryoablation of 6 renal tumors, 6 radical nephrectomies, 2 perinephric explorations, and 1 resection of a renal artery aneurysm were assessed by ILUS. RESULTS: The average tumor size in the patients undergoing laparoscopic partial nephrectomy was 3.1 cm (range 1.4 to 8.0), and all margins were negative. Also, a previously unidentified satellite lesion was found in 1 patient. ILUS was essential in assessing iceball formation during laparoscopic renal cryotherapy. ILUS also proved useful in defining the anatomy during laparoscopic perinephric exploration, assessing renal vein thrombi during laparoscopic nephrectomy, and evaluating renal perfusion during laparoscopic renal artery aneurysm repair. CONCLUSIONS: ILUS can be extremely useful in advanced laparoscopic renal surgery. In a number of situations, it is an essential surgical tool. With expanding indications for laparoscopic surgery, the indications for ILUS continue to grow.

[Percutaneous cervical cordotomy in intractable cancer pain]. / Perkutan cervikal kordotomi ved intraktable kreftsmerter.

Percutaneous cordotomy by the lateral high cervical approach may be indicated in the treatment of intractable nociceptive or neuropathic cancer pain below the C5 dermatome. A description of the technique and two case studies are presented.

[Neoplastic involvement of the inferior vena cava]. / L'interessamento neoplastico della vena cava inferiore.

Inferior caval vein invasion not infrequently complicates advanced neoplastic lesions. Primitive caval neoplasms (leiomyosarcomas) or other tumors such as renal carcinomas, pheochromocytoma, as well as liver, testis, and retroperitoneal tumors most likely cause caval invasion. In the past, caval invasion was a clear index of non operability, while today, a modern multidisciplinary approach allows to treat successfully even so advanced diseases. In the present report the Authors analyze the cases treated at the Dept. of Surgery of the University of Perugia, and review the most important international reports on this subject illustrating the new possibilities offered by IVC substitution with biological or artificial grafts.

[Surgical stress in pediatric oncology]. / Operatsionnyi stress v detskoi onkologii.

Hormonal-metabolic examination was performed in 150 children suffering nephroblastoma and retroperitoneal tumors to outline features of surgical stress in pediatric cancer patients. Surgical trauma causes hyperglycemia associated with relatively low level of insulin and elevated concentration of somatotropin in blood. A reverse correlation was established between pre- and intraoperative values of many hormonal-metabolic parameters. Surgical stress results in cytolysis, protein catabolism and an increase in endogenous intoxication. Retabolil, eleuterococcus, gordox and preoperative infusion of glucose and neohemodes can be used for prevention of surgical stress.

Is age alone a contraindication to major cancer surgery?

The question of whether major cancer operations are worthwhile in elderly patients is becoming more important, as we are faced with a progressively aging population. From Jan. 1, 1978 to Dec. 31, 1983, 268 elderly patients underwent major operations for esophageal, gastric, intestinal, pancreatic and retroperitoneal cancer. The patients were divided into three age groups: group A, 65 to 74 years (163 patients), group B, 75 to 84 years (81 patients) and group C, 85 to 92 years (24 patients). The overall operative mortality was 11.2%, 8.6% in group A, 13.6% in group B and 20.8% in group C. The higher rates in groups B and C resulted from two major factors: (a) the presence of serious cardiopulmonary disease preoperatively and (b) the development of one or more serious complications postoperatively. When these two factors were compensated for, the rates became comparable at 6.1%, 6.6% and 8.3%, respectively. The effect of preexisting cardiorespiratory compromise was approximately equal in each group. The effect of postoperative surgical complications became more pronounced with advancing age. Most patients enjoyed substantial palliation of symptoms. The average length of hospital stay was not unduly prolonged. Major cancer surgery can be safe and beneficial for elderly patients, but concerted attempts must be made to improve their status preoperatively. The minimum effective operation should be performed and postoperative care should be intensified.