[Retrospective study of 266 patients with differentiated thyroid cancer. Current surgical options]. / Analisi di 266 casi di carcinoma differenziato della tiroide. Attuali opzioni chirurgiche.

INTRODUCTION: Total thyroidectomy (TT) is considered to be more efficient and more widely used than conservative thyroidectomy (CT) in patients with differenziated thyroid cancer (DTC). Anyway recently CT has been reevaluated in the treatment of DTC sharing favorable prognostic factors, due to the introduction of mini-invasive neck surgery. Such technique are indeed more feasibly applicable to CT than to TT. In this retrospective study we report the results of these surgical approaches in a series of patients with DTC. PATIENTS AND METHODS: Since 1985 up to 2002, 329 patients with thyroid neoplasm (134 female, aged between 13 and 88) underwent to surgery in our Department. Sixty-three were diagnosed as non-DTC and therefore excluded from this study. The remaining 266 were divided into two groups according with the surgical treatment: the I group (82 patients) underwent to CT, the II group (184 patients) had TT. Several clinical/pathological parameters were analyzed in comparison in the two groups. RESULTS: 60.3% of TT and 80.4% of CT had a single node presentation (p < 0.001 chi-square), whereas multinodular presentation was found in 28.4% of TT and in only case of CT. The mean size of the node was 2.9 +/- 0.8 cm in TT and 1.3 +/- 0.5 in CT (p = < 0.001 t-test). The follicular hystotype was more frequent in TT (37%) than in CT (13%) (p = 0.006 chi-square), whereas papillary form and capsule invading tumors were equally distributed. There was a lymphatic involvement in 20% of TT. Peri-operative mortality is absent; transitory and definitive recurrent nerve lesions were more frequent in TT then n CT (2.1% vs 1.2%); 2.2% of TT and no case in CT had hypoparatiroidism. Ten TT patients (5.5%) and 3 CT cancer (3.6%) died for thyroid cancer. Out of the latter 2 had a capsule-infiltrating form. Finally 4 CT patients had controlateral recurrence (4.8%): two of them had a follicular form and two a papillar one, with mean size of 2.5 cm. CONCLUSIONS: Although TT is currently considered as the approach of choice for the oncologic accuracy and the correct follow-up, CT is having increasing application for low-risk patients in open and video-assisted surgery especially in the case of an incidental post-operative diagnosis of malignancy. The increasing use of modern technology such as high resolution ultrasounds and nuclear imaging (PET) will allow a more accurate follow-up of CT patients, with an early recognition of either lymphatic or local recurrences.

[Surgical strategy in the treatment of adrenal cortex cancer. Expanded and repeated interventions]. / La strategia chirurgica nel trattamento del carcinoma cortico surrenalico. Gli interventi allargati ed iterativi.

AIM OF THE STUDY: To analyze our patients affected by adreno-cortical carcinoma (ACC) considering in particular the therapeutical approach in case of local recurrence or metastasis, and to compare our results with those from literature. PATIENTS AND METHODS: Since 1975 up to 2001, 35 patients with ACC were observed, 27 female and 8 male, aged between 3 and 76 year. All patients were surgically treated, 3 out of which laparoscopically. Thirty patients underwent radical and 5 palliative surgery. Twenty-two patients had extended resections to surrounding infiltrated organs, such as spleen, pancreatic taIl, vena cava, left colon and liver. The intervention was always completed by regional lymphadenectomy. Adjuvant treatment was administered in 17 patients, 4 out of which were re-operated. RESULTS: Only one patient died in the perioperative period for hyperacute adrenal failure. The survival rate was 85.7% at one year, 76.5% at two years, 70.8% at three and 28.3% at five years. Out of the 30 patients radically treated, only 3 are disease-free up to now. Local recurrence or metastatic disease was observed in 27 patients, out of which only 9 were eventually surgically treated, once or more times. All non-operated patients died between 1 and 6 months from the recurrence. The survival rate of the 9 re-operated patients was 51% at 2 years, and 22.1% at 5 years. Interestingly, one patient who has been re-operated three times, is still alive and disease-free after 7 years from the first recurrence. No significant difference was observed between Mitotane-treated and non-treated patients. CONCLUSIONS: According with data from literature, we conclude that surgical therapy of recurring local or metastatic ACC is up to now the best treatment, independently from the original stage of the disease. Controversies still remain about the utility of adjuvant chemotherapy in the primary and the recurrent disease.

[Videolaparoscopic adrenalectomy in Conn syndrome. Analysis of 39 case observations]. / La videolaparosurrenectomia nella sindrome di Conn. Analisi di 39 casi osservati.

The authors retrospectively analyse 39 patients affected by Conn's syndrome, which have been observed since 1985, and discuss the results of surgical approach using the new technologies. In particular, the introduction of laparoscopy, technique that has been applied almost exclusively since the last seven years, has revealed being the "gold standard" for the surgical treatment of this disease. The adrenal underlying lesions are indeed almost always monolateral, small in size and present very rarely malignancy in their biological behaviour. Furthermore, the authors, although lacking of personal experience, propose the possibility of a more conservative treatment of the adrenal lesions with a simple "enucleation", whose feasibility also in laparoscopy has recently been shown by some authors. Anyway, the Authors believe that this technique of a partial adrenalectomy could be chosen in selective cases of bilateral adenomas or hyperplasia or in those lesions which are placed in an easily accessible peripheral site.

[Current indications of bilateral adrenalectomy in Cushing's syndrome: discussion of personal experience]. / Indicazioni attuali alla bisurrenectomia nella sindrome di Cushing: discussione della casistica personale.

Since 1975 we have observed 68 patients with Cushing syndrome, 48 out of which with an ACTH-independent disease and 20 with an ACTH-dependent one, due to hypophisary adenoma. Out of the latter group of patients, which had a relapse of the disease after a previous trans-sfenoidal procedure, 16 underwent an open bilateral adrenalectomy and 4 a laparoscopic monolateral or bilateral adrenalectomy. Patients from the former group had an open or laparoscopic adrenalectomy, or a bilateral adrenalectomy in case of the rare bilateral diseases, as McCune-Albright syndrome. All patients had a complete healing, except for 2 patients affected by McCune-Albright syndrome who died for cardiopulmonary complications. We conclude that bilateral adrenalectomy plays a fundamental role in the treatment of Cushing disease, after the failure of the trans-sfenoidal procedures. This surgical therapy has been certainly improved by the introduction of the laparoscopic techniques, which allowed us to exert bilateral adrenalectomies in two times with a significant reduction of perioperative morbidity and mortality because of the less severe traumatism and the absence of addisonian complications.

Clinicopathologic findings and results of surgical treatment in cardiac adenocarcinoma.

BACKGROUND AND OBJECTIVES: There is a great deal of controversy regarding the definition, classification, and staging of cardiac adenocarcinoma (CA). Recently, a shift from distal to proximal lesions has been documented in gastric cancer. We have stratified our cases of gastric cancer as CA, distal gastric cancer (DGC), and stump cancer (SC). METHODS: Between 1986 and 1998, 450 patients with gastric cancer were operated on at our institute. The resectability rate was 81.6%. Of 367 patients, 48 were CA, 298 DGC, and 21 SC. These 3 groups were compared in terms of clinicopathologic factors and survival rates. RESULTS: CA was significantly higher in male patients and showed a prevalence of the Lauren intestinal type. Regarding staging parameters, CA showed a higher rate of T3 tumors and of resection line involvement. Five-year survival rates were 23. 2% for CA, 45.0% for DGC, and 17.4% for SC. CONCLUSIONS: A possible cause of the poor outcome of CA is presentation at a more advanced stage. CA was similar to SC as far as epidemiology, pathologic factors, and survival rates.