[Locally advanced and recurrent pelvic colorectal carcinoma: results of aggressive surgical treatment]. / Carcinoma colorettale pelvico localmente avanzato e recidivo: risultati di un trattamento chirurgico aggressivo.

Pelvic exenteration has been described as a formidable procedure in cases of advanced or recurrent pelvic cancers for a variety of primary tumors, including colorectal, gynaecologic and urologic. We report our 14-year experience in a community hospital with 37 cases who underwent pelvic exenteration for recurrent (n = 15) or locally advanced (n = 22) colorectal cancers. At a median follow-up of 36 months, the median survival was 24 and 36 months, respectively, and the 5-year actuarial survival was 18% and 44%.

Pelvic exenterative procedures for locally advanced or recurrent colorectal carcinoma in a community hospital.

BACKGROUND: We describe our experience with exenterative pelvic surgery for colorectal cancer in a small community hospital. METHODS: We retrospectively evaluated 26 consecutive patients (14 women) with locally advanced (n=16) or recurrent (n=10) colorectal adenocarcinomas who underwent pelvic exenterations between August 1990 and December 2001 in our service. RESULTS: Seventeen patients had posterior pelvic exenteration (PPE), eight had total pelvic exenteration (TPE) and one had TPE with internal hemipelvectomy. Major morbidity occurred in 12 patients (46%), causing 3 deaths (11%) in the immediate postoperative period. Fourteen of 23 patients who survived the immediate postoperative period have relapsed (61%). At a median follow-up of 42 months, the 5-year survival is 38%. CONCLUSION: Pelvic exenterative procedures can be offered to patients with bulky or recurrent colorectal carcinomas with adequate results and satisfactory palliation, even in a community setting.

[Sentinel lymph node for breast cancer: remove less to know more]. / Il linfonodo sentinella nel cancro della mammella: rimuovere di meno per sapere di più.

BACKGROUND: Our aim was to study the value of sentinel lymph node (SLN) biopsy in patients with breast cancer seen at a community hospital. METHODS: Consecutive cases receiving primary treatment for unicentric breast cancer less than 3 cm in diameter were prospectively studied from January 1999 to July 2000. All patients signed a detailed informed consent. The majority of patients (89%) underwent a combined technique of intradermal injection of 0.3-1.2 mCi of (99)Tc and 1-3 cc of Patent Blue at the biopsy site. Intraoperative localization was performed with a hand-held gamma probe. The first 15 patients underwent routine back-up lymphadenectomy. Thereafter, only patients with positive SLN, suspicious findings, or personal preference underwent formal axillary dissection. RESULTS: One hundred eight cases were included in the study with a median age of 61 years and a median diameter of the breast tumor of 1.5 cm. Success rate for identification of SLN was 94% (101/108 cases). A total of 917 additional lymph nodes were removed after SLN biopsy (median 6.5 lymph nodes/patient). Correlation between SLN and the final axillary status was 98%. In 20/36 patients (61%) with positive axillary status the sentinel lymph node was the only positive one. Ten patients had only microscopic foci of cancer found in the SLN. Sixty-seven patients (62%) could have avoided axillary dissection becouse the SLN was found, it was negative, and there were no other intraoperative suspicious findings. CONCLUSIONS: SLN biopsy is accurate and easily reproduced. Our data confirms that the majority of breast cancer patients may no longer need routine axillary lymphadenectomy.