A nationwide audit of the use of radiotherapy for rectal cancer in Italy.

BACKGROUND: There is good evidence that radiotherapy is beneficial in advanced rectal cancer, but its application in Italy has not been investigated. METHODS: We conducted a nationwide survey among members of the Italian Society of Colo-Rectal Surgery (SICCR) on the use of radiation therapy for rectal cancer in the year 2005. Demographic, clinical and pathologic data were retrospectively collected with an online database. Italy was geographically divided into 3 regions: north, center and south which included the islands. Hospitals performing 30 or more surgeries per year were considered high volume. Factors related to radiotherapy delivery were identified with multivariate analysis. RESULTS: Of 108 centers, 44 (41%) responded to the audit. We collected data on 682 rectal cancer patients corresponding to 58% of rectal cancers operated by SICCR members in 2005. Radiotherapy was used in 307/682 (45.0%) patients. Preoperative radiotherapy was used in 236/682 (34.6%), postoperative radiotherapy in 71/682 (10.4%) cases and no radiotherapy in 375 (55.0%) cases. Of the 236 patients who underwent preoperative radiotherapy, only 24 (10.2%) received short-course radiotherapy, while 212 (89.8%) received long-course radiotherapy. Of the 339 stage II-III patients, 159 (47%) did not receive any radiotherapy. Radiotherapy was more frequently used in younger patients (P < 0.0001), in patients undergoing abdominoperineal resection (APR) (P < 0.01) and in the north and center of Italy (P < 0.001). Preoperative radiotherapy was more frequently used in younger patients (P < 0.001), in large volume centers (P < 0.05), in patients undergoing APR (P < 0.005) and in the north-center of Italy (P < 0.05). CONCLUSION: Our study first identified a treatment disparity among different geographic Italian regions. A more systematic audit is needed to confirm these results and plan adequate interventions.

[The surgery of pulmonary metastases. The surgical indications and technical aspects of lung resections for metastases]. / La chirurgia delle metastasi polmonari. Indicazioni operatorie e aspetti tecnici delle resezioni polmonari per metastasi.

Surgery for pulmonary metastases is an accepted method of treatment for many kinds of malignant neoplasms, because of favorable results in five-year and ten-year survival. At present several technical aspects are being debate (operative indications, method of thoracic access, procedure of lung resection, approach of bilateral lesions), with the aim of improving the number of patients undergoing radical excision of all pulmonary metastatic foci. The present paper summarizes a recent experience (1989-1992) in the treatment of pulmonary metastases in 55 patients, with special reference to tactical and technical problems related to metastasectomies. The primary tumor was an osteogenic sarcoma in 28 cases (51%), other musculoskeletal and soft tissue sarcoma in 20 (36%), and epithelial neoplasms in 7 (13%). In 47 patients (85%) the discovery of pulmonary metastases was metachronous regarding primary malignancy, with a range of between 3 months and 17 years; in the other 8, lung disease was simultaneous with diagnosis of neoplasm. All patients underwent preoperative standard chest X-ray, thoracic computerized tomography and lung function assessment; the radical control of primary neoplasm and the absence of any extrapulmonary metastases were required for thoracotomy. Pulmonary nodules were single in 21 patients (38%), multiple ipsilateral in 16 (29) and bilateral in 18 (33%). The thoracic approach was a muscle-sparing thoracotomy (axillary vertical thoracotomy) in 51 patients, other thoracotomies in 3 and a median sternotomy in 1 patient. The operative procedures were 19 single wedge resections (35%), 27 multiple wedge resections (49%), 1 lobectomy (2%), 1 lingulectomy (2%) and finally 7 exploratory thoracotomies (12%) for different reasons. In patients with bilateral disease, a bilateral synchronous thoracotomy and multiple wedge resection was performed 13 times, while staged thoracotomy was necessary in 2 and a median sternotomy was preferred in 1 case; 2 patients received a monolateral axillary exploratory thoracotomy. A total of 186 lung nodules were excised, but only in 161 (86%) the histologic examination confirm the metastasis. There was no operative mortality and the postoperative complications were few. Based on this experience, the authors believe that every neoplastic patient with pulmonary metastases, certain or suspected, should be considered for thoracotomy, since metastasectomy is a very safe procedure today.(ABSTRACT TRUNCATED AT 400 WORDS)

[Axillary thoracotomy: a simple and conservative approach to the thoracic cavity]. / La toracotomia ascellare: un accesso semplice e conservativo al cavo toracico.

Morelli and Di Paola's thoracotomy allows to approach the pleural space with the only osteo-muscular sparing without any section of chest wall structures. With this kind of approach that we have been employing since twenty years, we report our experience about 82 cases recently operated on for both pulmonary and mediastinal disease. Unlike who don't consider this approach to allow adequate exposure of all endothoracic anatomic structures, it is our opinion that this thoracotomy not only allows every kind of operation in thoracic surgery, but is easy to perform and fast to repair. Moreover, postoperative pain is decreased, functional recovery is improved and patient can frequently be discharged earlier from the hospital with a very satisfactory aesthetic result.

[Adenocarcinoma of the distal ileal loop: a rare disease at the typical site for Crohn's disease]. / L'adenocarcinoma dell'ultima ansa ileale: una malattia rara nella sede tipica del morbo di Crohn.

The authors report their recent experience in the treatment of two patients respectively affected by Crohn's disease and adenocarcinoma of the terminal ileum. Although with some differences, they presented with radiological, pathological and gross morphological findings quite similar so that the authors concluded for a different clinical stage of Crohn's disease in both cases. Frozen-section examination carried out in one of the two cases, established the correct diagnosis and indicated a wide resection instead of a very limited one. An extremely rare case of primitive adenocarcinoma of the terminal ileum is presented and the literature is reviewed. Features which could help the differential diagnosis between malignant lesions and regional enteritis are therefore focused.

Surgical treatment of chronic idiopathic thrombocytopenic purpura: results in 107 cases.

Between 1972 and 1985, 107 patients with chronic Idiopathic Thrombocytopenic Purpura underwent splenectomy. Platelet life span and sites of sequestration were studied with labelled platelets and external scanning. Medical treatment was always of scarce and transient effectiveness and had considerable side effects. Splenectomy had minimal complications and mortality and caused no hazard of overwhelming sepsis in adults. The results of splenectomy were very satisfying, especially when platelet sequestration was mainly splenic (remission in about 90% of patients). Surgical treatment is at present the most effective in patients with chronic ITP.