Risk factors for conversion in laparoscopic and robotic rectal cancer surgery.

BACKGROUND: The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery. METHODS: A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m2 or more) was performed. RESULTS: A total of 600 patients were included in the analysis. The overall conversion rate was 9·2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0·28, 95 per cent c.i. 0·15 to 0·52). Obese patients experienced a threefold higher risk of conversion compared with non-obese patients (47 versus 24·4 per cent respectively; P < 0·001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0·22, 0·07 to 0·71). CONCLUSION: Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non-obese patients.

ANTECEDENTES: El objetivo del estudio era revisar los factores de riesgo para la conversión en una cohorte de pacientes con cáncer de recto sometidos a cirugía abdominal mínimamente invasiva. MÉTODOS: Se realizó un análisis retrospectivo de pacientes consecutivos operados desde febrero de 2005 hasta abril de 2018. Se incluyeron pacientes adultos sometidos a resección anterior baja o resección abdominoperineal por adenocarcinoma primario de recto mediante abordaje mínimamente invasivo. Los criterios de exclusión fueron falta del consentimiento informado, cáncer de recto en estadio IV o recidivado y cirugía urgente. Los factores de riesgo para la conversión se determinaron mediante regresión logística. Se realizó un análisis de subgrupo en pacientes obesos (índice de masa corporal, IMC ≥ 30 kg/m2 ). RESULTADOS: Se incluyeron en el análisis un total de 600 pacientes. La tasa global de conversión fue del 9,2%. El modelo multivariado mostró un riesgo 72% menor de conversión cuando los pacientes fueron tratados mediante cirugía robótica (razón de oportunidades, odds ratio, OR 0,28, i.c. del 95% 0,15-0,52). Los pacientes obesos presentaron un riesgo de conversión tres veces mayor en comparación con los pacientes no obesos (47,3% versus 24,5%, P < 0,001). La cirugía robótica se asoció con una menor probabilidad de conversión en los pacientes obesos (OR 0,22; i.c. del 95% 0,07-0,71). CONCLUSIÓN: La cirugía robótica se asoció con un menor riesgo de conversión en pacientes sometidos a cirugía mínimamente invasiva de cáncer de recto, tanto en pacientes obesos como no obesos.

[Long-term clinical assessment of single-lead VDD electric stimulation]. / Valutazione clinica a lungo termine dell'elettrostimolazione VDD monocatetere.

BACKGROUND: During the last decade single lead VDD pacing has been progressively affirmed as an electrotherapy of choice in patients with advanced atrioventricular block without alterations of the sinus function. It combines the benefits of P-synchronous ventricular pacing with an easy implant procedure when compared to the conventional DDD approach. The aim of this study was to evaluate the validity of such an approach in a large population of patients, all implanted in a single center. METHODS: From 1987 up to now, 317 patients, all affected by advanced atrioventricular block and without sinus node dysfunction, were implanted in our center with a single lead VDD pacemaker. During follow-up the persistence of a proper atrioventricular synchronization was assessed and evaluated. RESULTS: The mean follow-up was 3.9 +/- 2.7 years/patient (range 6-138 months). The 94.6% of implanted systems maintained the normal VDD pacing function. Permanent reprogramming in VVI mode was necessary in 17 patients (5.36%); in 12 (3.78%) because of chronic atrial fibrillation and in 5 (1.63%) for loss of atrial sensing. The percentage of atrial synchronization was optimal (> 98%) and acceptable (> 95%) in 81% and 19% of patients, respectively. Episodes of paroxysmal atrial fibrillation occurred in 3 patients. Neither inhibition by myopotentials nor occurrence of sinus node disease was observed during follow-up. These results are in accordance with those reported by previous studies, performed on a smaller population or on a multicenter basis, and are comparable with the results reported for conventional DDD pacemaker. CONCLUSIONS: Our results confirm the high reliability of the single lead VDD pacing system concerning the long-term persistence of a proper atrioventricular synchronization. Data showed above enforce our opinion that this pacing approach should be considered the treatment of choice in patients with advanced atrioventricular block and preserved sinus node function.

[Surgical therapy in high-risk patients with endometrial adenocarcinoma]. / Terapia chirurgica in pazienti ad alto rischio affette da adenocarcinoma dell'endometrio.

Personal experience with 100 cases of endometrial adenocarcinoma surgically treated in 1983-87 revealed a significant link between grading, myometrial infiltration and lymph node involvement. This finding forms the basis for the creation of a special classification system used in selecting the therapeutic approach, the aim being to avoid radical surgery in those patients considered "high risk" due to their poor cardiovascular or metabolic condition or obesity, while ensuring that the appropriate treatment is given.