Impact of Underlying Disease and Preoperative Factors on Postoperative Outcomes After Laparoscopic Splenectomy: A Bicentric Retrospective Analysis.

BACKGROUND: Although the laparoscopic approach is considered the gold standard for elective splenectomy, it is still debated whether the underlying disease affects postoperative outcomes. Given the importance of good patient selection in the early stages of the learning curve for laparoscopic splenectomy (LS), this study aimed to compare the postoperative outcomes following LS for malignant diseases and benign diseases (MDs and BDs). MATERIALS AND METHODS: A retrospective review of patients who underwent LS was performed at 2 different institutions between January 2013 and September 2020. Patients were classified into 2 groups based on the underlying BDs or MDs, and the 30 days postoperative outcomes were compared. Risk factors for overall complications were determined using logistic regression analysis. RESULTS: LS was performed for BDs and MDs in 51 (67%) and 25 (33%) patients, respectively. The overall morbidity rate and the intraoperative and postoperative complication rates were significantly higher in the MD group ( P <0.05). In the univariate analysis, the underlying MD, age above 49.5 years, body mass index >24.9, the long axis of the spleen >16 cm, and spleen weight >600 g were significantly associated with increased postoperative morbidity. CONCLUSION: In addition to the underlying disease, preoperative conditions may also affect the complication rates after LS. These findings may be helpful in patient selection, especially in the early stages of the learning curve for minimally invasive splenectomies.

Mycosis fungoides (CTCL) associated with colorectal adenocarcinoma. A rare case of combined response to neoadjuvant therapy.

Mycosis fungoides (MF) is a well-known and common form of cutaneous T-cell lymphoma (CTCL), composed of malignant proliferation of CD4+CD45Ro+helper memory T cells. In the patient with MF, the incidence of secondary malignancies is higher than general population but very few cases with both MF and colorectal adenocarcinoma have been reported. Herein we describe a case of MF occurring in a 64-year-old man and followed, five months later, by a diagnosis of colorectal adenocarcinoma. Of notice, simultaneous regression of both rectal mass and cutaneous MF manifestations was observed after administration of chemioradiation therapy prior to rectal surgery. The patient is alive and in stable clinical remission at eight years from the diagnosis. KEY WORDS: CTCL, Colorectal adenocarcinoma, Mycosis fungoides, PUVA.

Obstructing left sided colorectal cancer. A retrospective single Center study.

BACKGROUND: In recent years, with population aging, there has been an increased number of colorectal cancer cases with severe occlusion symptoms. About 75% of obstructions due to malignant colorectal cancer (10-30%) occur distal to splenic flexure. METHODS: The authors evaluated the best surgical therapeutic strategy to be used in cases of left-sided colorectal carcinoma in patients over 65 years old, especially considering the emergency condition, age of patients and efficacy in terms of postoperative morbidity, mortality and 5 years survival rate. RESULTS: The management of left-sided obstructing colorectal carcinoma is controversial. Hartmann's procedure is the best therapeutic choice in elderly patients. However, resection with intraoperative colonic wash-out and primary anastomosis has favorable outcome in low risk patients. CONCLUSIONS: A review of the literature reveals that primary resection and anastomosis for left-sided obstructing CRC is the correct therapeutic strategy in low risk patients with localized, resectable carcinoma, without peritonitis; Hartmann's procedure should be adopted in doubtful cases and in high risk patients.