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ABSTRACT: BACKGROUND: The objective of this study was to evaluate pretreatment clinical parameters as predictive factors for complete pathological response after long-term chemoradiotherapy (RCT) for rectal cancer. Tumor downstaging after RCT for rectal cancer can be obtained in half of cases, whereas a complete pathological response (CPR) is reported to range between 15 and 30 %. It is not possible to foresee before therapies who will respond. METHODS: Patients with stage II-III rectal cancer that had undergone RCT and rectal resection between January 1995 and October 2010 were considered. Patients were divided in those who achieved a CPR, "CR" group, and those who did not achieve a CPR, "NCR" group. Univariate and multivariate analyses between groups were performed considering the clinical parameters: gender, age, ASA score, preoperative hematic CEA, tumor grading; distance of the tumor from the anal verge, maximum tumor diameter, TNM stage, and neoadjuvant treatment details. RESULTS: Among 260 patients, 43 (16.5 %) achieved a CPR. The two groups resulted homogeneous for age, sex, pretreatment status, and tumor stage. A CEA <5 ng/dl and distance from anal verge >5 cm were correlated with CPR at multivariate analysis. Patients with both these conditions presented a significantly higher CPR rate (30.6 %) as well as improved 5-year survival. CPR was also correlated with improved survival. CONCLUSIONS: Very low tumors with a high serum CEA are very unlikely to reach a CPR. The predictive value of these easily available clinical factors should not be underestimated, and better therapeutic strategies for these tumors are needed.
Annals of Surgical Oncology 09/2012; · 4.17 Impact Factor
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ABSTRACT: BackgroundAccurate preoperative staging is the key to correct selection of rectal tumors for local excision. This study aims to assess
the accuracy of endorectal ultrasound (ERUS) at our institution.
Patients and methodsRetrospective analysis was carried out of patients treated by transanal endoscopic microsurgery (TEM) from 1996 to 2008. TEM
was considered the treatment of choice for uT0-1/N0 lesions located between 2 and 12cm from the anal verge. It was also proposed
in selected uT2-3 patients. Preoperative staging was compared with histopathologic findings.
ResultsEighty-one patients (46 males, mean age 66years) underwent TEM. Mean distance of the tumor from the anal verge was 6.6cm
(range 2–12cm). ERUS staged 15 of 27 adenomas (55%) as uT1. Of 54 carcinomas, 5 were pT0 because TEM was performed to remove
resection margins of a malign polyp already snared. Five of 19 pTis (26%) were overstaged uT1, while 7 of 17 pT1 (41%) were
understaged. Overall, ERUS enabled distinction between early and advanced rectal lesion with 96% sensitivity and 85% specificity,
giving accuracy of 94% (65/67). Thirteen patients had advanced lesions (eight pT2 and five pT3). Only in two of them (15%)
was depth of invasion underestimated by ERUS (one uT0, one uT1) and thus was subsequent salvage surgery necessary.
ConclusionsERUS is useful to confirm the diagnosis of adenoma and predict depth of mural invasion in early rectal cancer. Differentiation
between T0/is and T1 lesions remains challenging, however this does not usually influence surgical strategy.
Surgical Endoscopy 04/2012; 23(6):1384-1389. · 4.01 Impact Factor
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ABSTRACT: Accurate preoperative staging is the key to correct selection of rectal tumors for local excision. This study aims to assess the accuracy of endorectal ultrasound (ERUS) at our institution.
Retrospective analysis was carried out of patients treated by transanal endoscopic microsurgery (TEM) from 1996 to 2008. TEM was considered the treatment of choice for uT0-1/N0 lesions located between 2 and 12 cm from the anal verge. It was also proposed in selected uT2-3 patients. Preoperative staging was compared with histopathologic findings.
Eighty-one patients (46 males, mean age 66 years) underwent TEM. Mean distance of the tumor from the anal verge was 6.6 cm (range 2-12 cm). ERUS staged 15 of 27 adenomas (55%) as uT1. Of 54 carcinomas, 5 were pT0 because TEM was performed to remove resection margins of a malign polyp already snared. Five of 19 pTis (26%) were overstaged uT1, while 7 of 17 pT1 (41%) were understaged. Overall, ERUS enabled distinction between early and advanced rectal lesion with 96% sensitivity and 85% specificity, giving accuracy of 94% (65/67). Thirteen patients had advanced lesions (eight pT2 and five pT3). Only in two of them (15%) was depth of invasion underestimated by ERUS (one uT0, one uT1) and thus was subsequent salvage surgery necessary.
ERUS is useful to confirm the diagnosis of adenoma and predict depth of mural invasion in early rectal cancer. Differentiation between T0/is and T1 lesions remains challenging, however this does not usually influence surgical strategy.
Surgical Endoscopy 04/2009; 23(6):1384-9. · 4.01 Impact Factor
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ABSTRACT: Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in muscle is not common, accounting for 2-3% of all sites; even rarer is the development of multiple cysts.
The patient presented with a painless abdominal mass which gradually increased in size to a diameter of approximately 16 cm. Organ imaging scan revealed multiple hydatid cysts within the right psoas muscle. Because of the proximity of the lesions to the iliac vessels, ureter and nerves to the lower limb, percutaneous drainage and alcoholization under local anaesthesia were -performed with the aim of reducing the size of the cysts and sterilizing them prior to definitive surgery. This procedure was not effective. Two weeks after percutaneous treatment the patient underwent surgery.
At operation the cysts were localized and successfully removed under ultrasound guidance. Postoperative stay was -uneventful. Two years after surgery the patient has no evidence of recurrent hydatid disease.
Ultrasonography is the preferred method for detecting muscular hydatid cyst and for guiding the surgeon during resection.
ANZ Journal of Surgery 07/2002; 72(6):443-5. · 1.25 Impact Factor
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Diseases of the Colon & Rectum 05/2002; 45(4):562-3. · 3.13 Impact Factor
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ABSTRACT: Solitary necrotic nodule is a rare benign lesion of the liver of unknown aetiology, which as a result of its radiological features can be misdiagnosed as a necrotic tumour. We believe that surgical exploration with a limited liver resection and an extemporary examination of the specimen is the best strategy for this rare type of lesion.
Chirurgia italiana 56(4):567-70.
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ABSTRACT: The aim of the study was to assess the frequency of synchronous colorectal and renal cancers among our patients. To this end we reviewed 781 consecutive patients operated on for colorectal carcinoma in our institution. Three patients (0.4%) had diagnosis of synchronous renal-cell cancer during the work-up for their colorectal primary tumours. The colon and rectum are frequently affected by multiple malignant tumours. Second primaries are not frequently associated with colorectal cancer. On the other hand, renal cell carcinoma has been described as being associated with other synchronous malignancies in up to 27.4% of cases. A recent report has described a 4.8% incidence of synchronous colorectal and renal carcinomas, which is much higher than that previously reported in the literature (0.03-0.5%). We found a 0.4% incidence of simultaneous colorectal cancer and renal cell carcinoma. The latter was invariably asymptomatic and diagnosed during the work-up for the colorectal cancer. We are unable to confirm the observation of a higher than expected incidence of synchronous colorectal and renal neoplasms. Nevertheless, the surgeon should be conscious of this association, when considering renal lesions detected during the work-up for colorectal cancer.
Chirurgia italiana 55(6):903-6.
