Quality of life in patients with loco-regional rectal cancer after ELRR by TEM versus VLS TME after nChRT: long-term results.

BACKGROUND: Endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to Laparoscopic total mesorectal excision (LTME), in selected patients with N0 rectal cancer. Post-operative quality of life (QoL) evaluation is an important parameter of outcomes related to high percentage of functional sequelae. We reported, in a previous paper, the short and medium term results of QoL in patients who underwent ELRR or LTME. The aim is to evaluate the 3 year QoL in patients with iT2-T3 N0/+ rectal cancer who underwent ELRR by TEM or LTME after neoadjuvant radio-chemotherapy (nChRT) in a retrospective analysis of prospectively collected data. METHODS: We enrolled in this study, 39 patients with iT2-T3 rectal cancer who underwent ELRR (n = 19) or LTME (n = 20), according to predefined criteria. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires at admission, after n-RCT and 1, 6, 12, and 36 months after surgery. RESULTS: No statistically significant differences in QoL evaluation were observed between the two groups, both at admission and after n-RCT. In short term (1-6 months) period, significantly better results were observed in ELRR group by QLQ-C30 in global health status (p = 0.03), physical functioning (p = 0.026), role functioning (p = 0.04), emotional functioning (p = 0.04), cognitive functioning, fatigue (p < 0.05), dyspnoea (p < 0.001), insomnia (p < 0.05), appetite loss (p < 0.05), constipation (≤ 0.05), and by QLQ-CR38 in: body image (p = 0.03) and defecation (p = 0.025). At 1 year, the two groups were homogenous as assessed by QLQ-C30, whereas the QLQCR38 still showed better results of ELRR versus LTME in body image (p = 0.006), defecation problems (p = 0.01), and weight loss (p = 0.005). At 3 years, no statistically significant differences were observed between the two groups. CONCLUSIONS: In selected patients with rectal cancer, who underwent ELRR by TEM or LTME, QoL tests at 3 years do not show any statistical differences on examined items.

Recto-Urinary Fistula (RUF) treated by Transanal Endoscopic Microsurgery (TEM) Review of the literature and surgical technique.

AIM: Recto-Urinary Fistula (RUF) is a rare complication of pelvic surgery. Different approaches are reported in literature but a gold standard treatment has not yet been achieved. Transanal Endoscopic Microsurgery (TEM) is a miniinvasive approach with well known advantages as magnification, 3D view and lighting of the operative field. Aim of the present review is to report the current evidence in literature about technique and results of RUF treatment by TEM and to suggest some key points for its correct management. MATERIALS OF STUDY: After a medline in Pubmed and Scopus databases, seven papers were eligible for the present study. Data were reviewed on the basis of the cases reported, patient's characteristics, surgical techniques and results. RESULTS: Eighteen cases have been reported in the literature from 1996 to 2005. The healing success rate was 77.8%. Fecal and urinary diversion were performed before TEM-assisted procedure in the 83% and 94% of cases, respectively. Recurrence was observed in four patients (22%). DISCUSSION: A gold standard treatment of RUF should ensure the complete removal of scar tissue around the fistula, in order to perform a tension free suture on healthy margins with adequate vascularization. Preoperative stoma improves the healing of the fistula, reducing local inflammation and infections. CONCLUSIONS: There is not common view of this topic in literature and clarify which could be the best treatment is a key condition due to high failure rate of the surgical proposed techniques. Recurrences treatment has a lower cure rate if compared to primary lesions, nevertheless more studies are required to confirm this data. KEY WORDS: Recto-Urinary Fistula (RUF), Transanal Endoscopic Microsurgery (TEM), Transanal approach.

Spleen preserving laparoscopic distal pancreatectomy for treatment of pancreatic lesions.

AIM: Aim of this study is to evaluate the feasibility and safety of the laparoscopic approach in the treatment of distal pancreas tumors, from prospectively collected data. MATERIAL OF STUDY: From January 2003 to July 2013, 20 patients were treated by laparoscopic approach for distal pancreatic lesions. Nine patients underwent laparoscopic pancreatic tumorectomy (LPT) (Group A) for insulinoma (mean lesion diameter 1.2 cm, range, 0.5-2) and 11 patients underwent spleen preserving laparoscopic distal pancreatectomy (SP-LDP) (Group B) for ductal adenocarcinoma (pT1N0R0) (1), cystic mucinous neoplasm (5), serous cystadenoma (4) and lymphoepithelial cysts (1). RESULTS: Mean operative time was 94.3 minutes (range 80-110) for Group A and 164 minutes (range 90-240) for Group B. Intraoperative bleeding occurred in 4 cases (20%) and was easily controlled by laparoscopy. Conversion to open surgery was not required in any case. Morbidity was observed in 2 patients (18%) in Group A: pancreatic fistula (1) and peritoneal fluid collection (1); and a peritoneal fluid collection occurred in one patients (11%) in Group B. Mean hospital stay was 6.8 days (range 3-11) in Group A and 6.5 days (range 3-10) in Group B. Mortality was nil. At a mean follow-up of 82 months (range 15-141) local recurrence and distant metastases were not observed. DISCUSSION: LDP is a valid treatment showing the same rate of complication to open surgery but allowing the advantages of a minimally invasive procedure. CONCLUSIONS: SP-LDP is feasible and safe for benign and malignant pancreatic lesions.

Quality of Life after Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM).

AIM: Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM) may be considered a valid alternative surgical treatment in patients with rectal cancer. Aim of this study is to evaluate the short and medium term Quality of Life (QoL) from prospectively collected data in patients who underwent ELRR by TEM. MATERIAL OF STUDY: From May 2010 to June 2013, 31 patients with iT1-iT2-iT3N0 rectal cancer were enrolled in this study. Patients with T1 rectal cancer underwent ELRR by TEM. Patients with iT2-iT3 rectal cancer underwent neoadjuvant radio-chemoterapy (n-RCT) before surgery. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires before surgery and 1, 6, and 12 months after surgery. RESULTS: Mean distance from the anal verge was 5.4 cm (range 1-10). Mean operative time was 145.8 minutes (range 60-300). Pathological staging was as follows: pT0N0 (6), pT1N0 (18), pT2N0 (7). At 1 month after surgery, in QLQC30 questionnaire, significant worsening was observed in Global Health Status (p=0.0028), Physical Functioning (p=0.0016), Role Functioning (p=0.0004), Fatigue (p=0.0024), Pain (p=0.0003) and Dyspnoea (p=0.0192). In QLQCR38 questionnaire significant worsening at 1 month was observed in Defecation Problems (p=0.0005) and Weight Loss (p=0.0008). At six and twelve months after surgery, no significant differences were observed in QLQ-C30 and in QLQCR38 questionnaires. DISCUSSION: QoL evaluation showed worsening results at 1 month after ELRR by TEM, in QLQ-C30 and in QLQCR38 questionnaires. CONCLUSIONS: At 6 and 12 months after surgery, no significant differences in QoL as compared to preoperative status were observed.

Breast myofibroblastoma in a young woman: a case report.

Myofibroblastoma (MFB) is an uncommon benign mesenchymal tumor that may arise in several organs and tissue. Although most of reported cases were located in the breast, it is extremely rare, representing less than 1% of breast tumor. MFB has predominantly seen in elderly men, but some cases have been described in menopausal women. This lesion is a stromal tumor which has many morphologic variants including cellular, collagenized, epithelioid, palisaded, lipomatous, hemangiopericytoma-like, and infiltrant features. Even if its incidence has recently increased due to the mammary screening, only few cases have been reported in Literature and even less in young women. Physical examination discloses a solitary, unilateral, painless, freely movable, usual firm in consistency, non-tender nodule. Imaging investigations usually are not specific to establish the right diagnosis. Furthermore, findings from Fine-Needle Aspiration (FNA) may be confusing and nonspecific, making diagnosis of MFB possible only after surgical operation. Not evidence of malignant transformation, recurrence or distant metastasis after a follow-up period of 15 years have been reported in Literature when resection margins are free. Hereby the authors describe a rare case of breast MFB in a young woman.