[Low rectal cancer: therapeutic options and clinical experience of a single center]. / Il carcinoma del retto basso: possibilità terapeutiche ed esperienza clinica di un singolo centro.

INTRODUCTION: Currently the therapeutic gold standard for medium and low rectal tumours is the "en-bloc" excision of the rectum and total mesorectal excision (TME) preserving the autonomous nerve plexus. In very distal tumours, complex procedures such as very low anterior resections and intersphincteric resections are used where possible. These procedures can avoid incapacitating operations such as abdominoperineal amputation. The possibilities to perform these procedures even by laparoscopic means, with regard to it's advantages, are still under evaluation. The authors describe their own clinical experiences using such methods. PATIENTS AND METHODS: From 2005 to 2010, we performed by laparoscopic procedure 3 anterior resections and 3 inter-sphincteric resections for cancer of the low rectum . Medium age of patients was 70 years (range 52-80 years) and male to female ratio was 4/2. Mean operative time was 260 min ( range 220 - 360 min). No laparoscopic procedure was converted to the traditional open surgery. We noted 2 anastomotic leakages of which one required re-operation. Two patients were classified T2 (1 N0 and 1 N1); four patients T3 (3 N0 and 1 N2). In all the cases, resection margins were free. The mean distance from the anal verge was 3,8 cm (range 2,8 - 6 cm). In a mean followup of 48 months ( range 6-54 months), 1 patient developed hepatic metastasis and no local recurrence was noted. Two patients had urinary retention, resolved spontaneously. One patient presented erectile dysfunction. At 12 months from the operation, one patient had slight incontinence for gas and liquids. CONCLUSIONS: We believe that total mesorectal resection, even associated with sphincter preserving procedures, such as intersphincteric resection, in case of very low rectal tumours, can also be performed by laparoscopic approach with the same oncological and surgical principles of open surgery. However it is necessary to have broad based studies and randomised clinical trials in order to confirm the safety of such procedure and the results obtained.

[Laparoscopic surgery of adrenal tumours: indications and techniques]. / Chirurgia laparoscopica dei tumori del surrene: indicazioni e tecniche.

Laparoscopic adrenalectomy is a gold standard in the treatment of the majority of adrenal lesions. In fact, laparoscopic technique reduces post-operative morbidity, hospital stay, the necessity of blood transfusions, post-operative pain and complications. We examined the data of patients who were operated by laparoscopic technique from April 2000 to April 2010. The following data were evaluated: demographic data of the patients, type of operation, the operative time, the rate of conversion to laparotomic procedure, post-operative complications, histologic diagnosis and the dimensions of the lesions. A total of 41 patients underwent to laparoscopic procedure. Two patients developed complications which got resolved through medical treatment. No patient died after surgery. The time of laparoscopic procedure was 95 min in average. No patient was converted to laparotomy. The total average hospital stay was 4.18 days. Average diameter of the lesions was 4.43 cm (range 1.2-8.5 cm). The data we obtained from our studies confirm the safety and the feasibility of laparoscopic adrenalectomy and it's application can be considered even in case of malignant lesions. The only contraindication to laparoscopic procedure is the involvement of surrounding tissue and vascular invasion by tumour cells.