The effect of preoperative chemoradiotherapy on lymph nodes harvested in TME for rectal cancer.

BACKGROUND: Adequate lymph nodes resection in rectal cancer is important for staging and local control. This retrospective analysis single center study evaluated the effect of neoadjuvant chemoradiation on the number of lymph nodes in rectal carcinoma, considering some clinicopathological parameters. METHODS: A total of 111 patients undergone total mesorectal excision for rectal adenocarcinoma from July 2005 to May 2012 in our center were included. No patient underwent any prior pelvic surgery or radiotherapy. Chemoradiotherapy was indicated in patients with rectal cancer stage II or III before chemoradiation. RESULTS: One-hundred and eleven patients were considered. The mean age was 67.6 yrs (range 36 - 84, SD 10.8). Fifty (45.0%) received neoadjuvant therapy before resection. The mean number of removed lymph nodes was 13.6 (range 0-39, SD 7.3). In the patients who received neoadjuvant therapy the number of nodes detected was lower (11.5, SD 6.5 vs. 15.3, SD 7.5, p = 0.006). 37.4% of patients with preoperative chemoradiotherapy had 12 or more lymph nodes in the specimen compared to the 63.6% of those who had surgery at the first step (p: 0.006).Other factors associated in univariate analysis with lower lymph nodes yield included stage (p 0.005) and grade (p 0.0003) of the tumour. Age, sex, tumor site, type of operation, surgeons and pathologists did not weight upon the number of the removed lymph nodes. CONCLUSION: In TME surgery for rectal cancer, preoperative CRT results into a reduction of lymph nodes yield in univariate analisys and linear regression.

Colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial.

BACKGROUND: Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. METHODS: Patients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications. RESULTS: Two hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery. CONCLUSIONS: These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.

Factors that influence 12 or more harvested lymph nodes in resective R0 colorectal cancer.

BACKGROUND/AIMS: The number of lymph nodes required for accurate staging is a critical component in colorectal cancer (CRC). Current guidelines demand at least 12 lymph nodes to be retrieved. Results of previous studies were contradictory in factors, which influenced the number of harvested lymph nodes. This study was designed to determine the factors that influence the number of harvested lymph nodes (> or = 12) in resective R0 early-stage CRC in a single institution. METHODOLOGY: Between July 2005 and December 2008, data on 225 patients who underwent surgery for CRC were retrospectively evaluated. Data for a total of 139 R0-surgery patients were collected and all the tumor-bearing specimens were fixed with node identification performed. Several possible factors that influence 12 or more harvested lymph nodes were investigated and classified into four aspects: (1) operating surgeon, (2) examining pathologist, (3) patient (age, sex, and body mass index) and (4) disease (tumor localization, tumor cell differentiation, tumor stage, type of resection). RESULTS: A total of 100 patients (71.9%) with 12 or more harvested lymph nodes and 39 patients (28.1%) with < 12 lymph nodes were analyzed. The results demonstrate that within a single institution, tumor localization, depth of tumor invasion according to Dukes stage and grading were independent influencing factors of 12 or more harvested lymph nodes. Neither the operating surgeon nor the examining pathologist had significant influence on the number of harvested lymph nodes. CONCLUSIONS: The number of harvested lymph nodes was highly variable in patients who underwent resection of R0 CRC. Neither the operating surgeon nor the examining pathologist had significant influence over the number of harvested lymph nodes. Therefore, from the viewpoint of the surgeons, disease itself is the most important factor influencing the number of harvested lymph nodes.

Urachal tumour: case report of a poorly understood carcinoma.

BACKGROUND: Urachal carcinoma is an uncommon neoplasm associated with poor prognosis. CASE PRESENTATION: A 45-year-old man was admitted with complaints of abdominal pain and pollakisuria. A soft mass was palpable under his navel. TC-scan revealed a 11 x 6 cm tumor, which was composed of a cystic lesion arising from the urachus and a solid mass component at the urinary bladder dome. The tumor was removed surgically. Histological examination detected poor-differentiated adenocarcinoma, which had invaded the urinary bladder. The patient has been followed up without recurrence for 6 months. CONCLUSION: The urachus is the embryological remnant of urogenital sinus and allantois. Involution usually happens before birth and urachus is present as a median umbilical ligament. The pathogenesis of urachal tumours is not fully understood. Surgery is the treatment of choice and role of adjuvant treatment is not clearly understood.

Small bowel metastasis from primary neuroendocrine small cell lung carcinoma.

Small bowel metastases from a primary lung carcinoma are rare. We report a case of a 76-year-old male with a primary neuroendocrine small cell carcinoma of the lung, treated by chemotherapy, who developed fever and bowel symptoms (subocclusion and pain). On CT examination, he was found to have a tumour in the small bowel. The patient then underwent abdominal surgery. At operation we found small bowel occlusion by neoplasia and we therefore resected 15 cm of ileum with a side-to-side anastomosis. Early recognition of this rare condition is important due to the fact that complicated intestinal metastases from lung carcinoma can lead to high mortality rates and poor short-term outcomes. With advances in chemotherapy and palliative care, patients with metastatic lung carcinoma can sometimes survive more than a year with a reasonable quality of life.

Complicated small-bowel diverticulosis: a case report and review of the literature.

Here we report a case of a 60 years old woman who came to the Emergency Department of San Martino Hospital suffering from abdominal pain for about a week with high fever in the last 24 hours. The final histological examination led to the diagnosis of ileal diverticulosis associated with perforation and peritonitis with a fibrotic reaction involving the last ileal loop, the caecum and the appendix.

Low- and high-grade non-invasive gastric neoplasia (formerly dysplasia): cytological differentiation (gastro-entero-pancreatic antigens) in association with p53 pattern expression.

BACKGROUND/AIMS: In order to better define the evolutive potentiality of non-invasive neoplasia (formerly dysplasia) a study of the cytological differentiation and of the behavior of p53 in relation to the clinical progress has been performed. METHODOLOGY: Gastro-entero-pancreatic antigens, p53 and Ki-67 expression were evaluated in 120 cases of epithelial gastric dysplasia: 70 cases of low-grade dysplasia (LGD) and 50 cases of high-grade dysplasia (HGD). For the cytological study four antigens were studied: two of them gastric (pepsinogen C, gastric foveolar M1), one enteric (CAR-5) and one pancreatic (DU-PAN-2). Routinely processed tissue sections of a colon carcinoma known to contain mutant p53 were used as positive controls for p53 immunohistochemistry. For Ki-67 immunohistochemistry, routinely processed tissue sections of normal lymph node and tonsil were used as staining controls. RESULTS: The study of the coexpression of the gastro-entero-pancreatic antigens showed how all cases of non-invasive neoplasia associated with or progressed to gastric carcinoma (GC) were characterized by entero-pancreatic markers and, in particular, in case of LGD p53 expression positivity was evidenced in 66.6% of cases. Ki-67 hyperproliferation is present in 100% of cases. CONCLUSIONS: The cytological study, only if confirmed by wider casuistries, could represent further information in order to better define the follow-up and the therapeutical decisions in case of non-invasive gastric neoplasia therefore, the immunophenotypic study in association with p53 could lead to more personalized therapeutical choices.

Number of lymph nodes after neoadjuvant therapy for rectal cancer: How many are needed?

Neoadjuvant chemoradiation is the standard treatment for advanced rectal tumor, providing better local control of disease and potentially increasing sphincter preservation surgery. Neoadjuvant radiation may affect the number of lymph nodes harvested after resection or alter their prognostic value. Over the past 10 years, standards for lymph node harvests in colorectal cancer have been proposed. Several studies have recommend examination of at least 12 lymph nodes (LNs) in the specimen and this number is now used as a reflection of surgical quality. Nevertheless, recent reports have identified significantly decreased LN harvests in patients treated with neoadjuvant radiation. And preoperative chemoradiation has a significant effect on the number of nodes harvested in rectal specimens and this should be considered in staging of the tumor. In the near future, the total number of nodes will be less important than specific biologic markers in detecting high-risk patients and improving their prognosis with adjuvant therapy tailored.

On biomarkers and pathways in rectal cancer: What's the target?

In spite of tremendous progresses in surgical and chemo-radiotherapeutic regimens, rectal cancer still suffers from high relapse and mortality rates, and metastatic disease is incurable. Here we assess some of the most recent and validated biomarkers and potential targets studied in rectal cancer, and provide comments to a recent monographic topic covering several aspects of colorectal cancer, published in Current Cancer Drug Targets.

Primary omental torsion: A case report.

A patient presented with an acute abdomen at the Emergency Department. The patient, a 69-year-old man, was admitted and underwent surgery with a provisional diagnosis of acute appendicitis. During surgery, omental torsion was diagnosed and the involved omentum was removed. The patient had no previous surgical history. Omental torsion is a rare cause of acute abdomen in children and adults who may present with various signs and symptoms; a preoperative diagnosis may therefore be difficult and can usually only be established during surgery.