A Prospective Study Evaluating Health-Related Quality of Life Following a Multimodal Treatment for Colorectal Cancer.

PURPOSE: The major improvements in the diagnosis and treatment of colorectal cancer (CRC) over the past decades increased the patients' survival rates. Despite this, patients and clinicians still need to address the long-term physical and psychosocial effects over time. This paper aims to prospectively assess CRC patients' HR-QoL psychological distress and sexual functioning and identify clinical, demographic, and psychological predictors. METHODS: In total, 55 patients were evaluated from diagnosis to 5-year follow-up with the following instruments: EORTC QLQ-C30 and QLQ-C38 for QoL and sexuality; HADS for psychological distress; and specific questions to detect psychological variables. RESULTS: QoL worsened after diagnosis and returned to baseline values after 5 years. Sexual function significantly deteriorated over time (with no recovery, especially in women), while borderline/severe anxiety and depression decreased. A better HR-QoL at baseline was associated with better physical, social and sexual functioning, positive body image and sexual pleasure after 5 years. CONCLUSION: HR-QoL allows the early detection of patients at risk, favoring prompt patient-centered interventions.

Diagnostic Accuracy of Contrast-Enhanced, Spectral Mammography (CESM) and 3T Magnetic Resonance Compared to Full-Field Digital Mammography plus Ultrasound in Breast Lesions: Results of a (Pilot) Open-Label, Single-Centre Prospective Study.

Introduction: To assess the diagnostic accuracy of CESM and 3T MRI compared to full-field digital mammography (FFDM), plus US, in the evaluation of advanced breast lesions. Materials and Methods: Consenting women with suspicious findings underwent FFDM, US, CESM and 3T MRI. Breast lesions were histologically assessed, with histology being the gold standard. Two experienced breast radiologists, blinded to cancer status, read the images. Diagnostic accuracy of (1) CESM as an adjunct to FFDM and US, and (2) 3T MRI as an adjunct to CESM compared to FFDM and US, was assessed. Measures of accuracy were sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results: There were 118 patients included along with 142 histologically characterized lesions. K agreement values were 0.69, 0.68, 0.63 and 0.56 for concordance between the gold standard and FFDM, FFDM + US, CESM and MRI, respectively (p < 0.001, for all). K concordance for CESM was 0.81 with FFDM + US and 0.73 with MRI (p value < 0.001 for all). Conclusions: CESM may represent a valuable alternative and/or an integrating technique to MRI in the evaluation of breast cancer patients.

Breast cancer surgery during the Covid-19 pandemic: a monocentre experience from the Regina Elena National Cancer Institute of Rome.

The Covid-19 pandemic has challenged hard the national health systems worldwide. According to the national policy issued in March 2020 in response to the evolving Covid-19 pandemic, several hospitals were re-configured as Covid-19 centers and elective surgery procedures were rescheduled according to the most recent recommendations. In addition, Covid-19 protected cancer hubs were established, including the Regina Elena National Cancer Institute of Rome, Central Italy. At our Institute, the Breast Surgery Department continued working under the sign of a multidisciplinary approach. The number of professional figures involved in case evaluation was reduced to a minimum and interactions took place in the full respect of the required safety measures. Treatments for benign disease, pure prophylactic surgery and elective reconstructive procedures were all postponed and priority was assigned to the histologically-proven malignant breast tumors and highly suspicious lesions. From March 15th though April 30th 2020, we treated a total of 79 patients. This number is fully consistent with the average quantitative standards reached by our Department under ordinary circumstances. Patients were mostly discharged the day after surgery and none was readmitted due to surgery-related late complications. More generally, post-operative complications rates were unexpectedly low, particularly in light of the relatively high number of reconstructive procedures performed in this emergency situation. A strict follow up was performed based on the close contact with the surgical staff by telephone, messaging apps and telemedicine.Patients ascertainment for their Covid-19 status prior to hospital admission and hospital discharge allowed to maintain the "no-Covid-19" status at our Institution. In addition, during the aforementioned time window, none of the care providers developed SARS-CoV-2 infection or disease, as shown by the results of anti-SARS-CoV-2 immunoglobulin M and G profiling. In conclusions, elective breast cancer surgery procedures were successfully performed in a lockdown situation due to a novel viral pandemic. The well-coordinated regional and hospital efforts in terms of medical resource re-allocation and definition of clinical priorities allowed to maintain high quality standards of breast cancer care while ensuring safety to the cancer patients and care providers involved.

Prevention of complications following pelvic exenteration with the use of mammary implants in the pelvic cavity: Technique and results of 28 cases.

BACKGROUND: With the evolution of neo-adjuvant therapy and the introduction of peritonectomy with chemotherapy in surgical practice, pelvic exenteration has taken second place in the treatment of advanced pelvic tumors. This surgery remains the first of choice for the treatment of T4 superior and medium rectal tumors that are not susceptible to neo-adjuvant radiochemotherapy, for uterine tumors and cervical FIGO IV T4, for pelvic recurrence and for T4 bladder tumors. After a pelvic exenteration the pelvic cavity becomes occupied by the intestinal loops, causing an increase in the risk of short and long-term complications such as radiation enteritis in the case of post-operative radiotherapy, occlusions, and enteric fistulas that could be avoided by isolating the small intestine in the pelvic cavity. METHODS: With this aim we positioned a mammary prosthesis (implant) in the cavity of the last 28 cases we treated, and did not observe complications related to the prosthetic implant. RESULTS: No early or delayed complications, such as occlusions or fistulas, were observed. All the patients treated underwent adjuvant radiotherapy with no evidence of radiation enteritis. Ten patients were recanalized with removal of the implant, ultra-low rectal anastomosis was performed in six cases and colo-anal anastomosis was performed in four cases. Eight patients were not recanalized, six distance due to recurrence and two local recurrence. Nine patients are currently in follow-up, disease free between 1 and 12 months. CONCLUSIONS: We retain the encouraging results observed that the use of mammary implants in the pelvic cavity after pelvic exenteration should be part of the cultural patrimony of the surgeon who approaches this type of major radical surgery.

Prognostic value of soluble P-selectin levels in colorectal cancer.

Measurement of soluble (s) P-selectin levels has been proposed as a diagnostic tool for monitoring the clinical course of human neoplasms. Thus, our study was aimed at analyzing the role of sP-selectin in association with clinicopathological variables in 181 patients with primary (n =149) or metastatic (n = 32) colorectal cancer (CRC), 34 patients with benign diseases and 181 control subjects. The results obtained showed that sP-selectin levels were higher in patients with CRC compared either to patients with benign disease (p = 0.006) or controls (p = 0.003). No differences were observed between the latter and patients with benign diseases. Increased median sP-selectin levels were significantly associated with the presence of distant metastasis (68.2 ng/ml vs. 48.6 ng/ml, p = 0.002). Of interest, carcinoembryonic antigen (CEA) levels were independently associated to sP-selectin (regression coefficient = 0.28, p < 0.002). Cox's proportional hazards survival analysis of primary CRC patients demonstrated that beside the stage of disease sP-selectin levels had an independent prognostic role in predicting recurrent disease (HR = 2.22, p = 0.019) and mortality from CRC (HR = 3.44, p= 0.017). These results suggest that measurement of plasma sP-selectin might represent a prognostic indicator in the management of patients with CRC.

[Anatomico-surgical contribution to the knowledge of the lymphatic spread of gastric adenocarcinoma]. / Contributo anatomochirurgico alla conoscenza della diffusione linfatica dell'adenocarcinoma gastrico.

Following the researches performed on lymphatic spread of gastric carcinoma, our study aimed to add useful informations to establish the extension of exeresis with radical intent on the basis of recent studies on sentinel node mapping. The study includes 120 consecutive cases of gastric cancer operated between 1996 and 2000. Sixty-nine (57.5%) males and 51 (42.5%) females, with age ranging between 29 and 84 years, were evaluated. Cancer location was in 17 patients upper third, in 35 middle third, in 59 distal third and in 9 cases gastric stump. Early cases (T1-2) were 65 and advanced cases (T3-4) were 55. Sixty-eight STG and 52 TG were performed with 21 D1, 73 D2 and 26 D3 lymphoadenectomy. Overall 3501 lymph-nodes were examined. Eighty-two cases (68%) showed lymph-nodal metastases, while 38 (32%) were negative. The lymphatic spread of gastric cancer resulted related to the depth of wall invasion (T): 25% of T1, 75% of T2, 85% of T3 and 95% of T4 were node positive (N+). The correlation between T and N+ was also significative concerning the diffusion to the first, second and third level stations, increasing with the depth of wall invasion. The possibility of extension to one single lymphnodal station was inversely related to the T. When the first level stations were negative the second and third were never positive. This study seems to confirm the complex but systematic and predictable lymphatic gastric flow. The skip metastases, rare but described in other retrospective studies, were never observed. Our study shows that sentinel node mapping could be reliable also for gastric cancer surgery, allowing tailored and less aggressive resections. Meanwhile, from this analysis it appears that nodal stations 7-8 should be included in the first level lymphoadenectomy, widening D1 exeresis considered until now sufficient in less advanced cases. In conclusion, studies of lymphatic spread and sentinel node mapping seems to require a different therapeutic approach to gastric cancer concerning D1 lymphoadenectomy, tailoring the exeresis on the basis of sentinel node mapping in negative T1-2 cases, but systematically widening the lymphoadenectomy from the perigastric only, to 7 and 8 stations.