[Show abstract][Hide abstract] ABSTRACT: Introduction. Our objective was to identify mutations in the K-RAS gene in cases of pulmonary metastases from colorectal cancer (CRC) and determine whether their presence was a prognostic factor for survival. Methods. We included all patients with pulmonary metastases from CRC operated on between 1998 and 2010. K-RAS mutations were investigated by direct sequencing of DNA. Differences in survival were explored with the Kaplan-Meier method log-rank tests and multivariate Cox regression analysis. Results. 110 surgical interventions were performed on 90 patients. Factors significantly associated with survival were disease-free interval (P = 0.002), age (P = 0.007), number of metastases (P = 0.001), lymph node involvement (P = 0.007), size of the metastases (P = 0.013), and previous liver metastasis (P = 0.003). Searching in 79 patients, K-RAS mutations were found in 30 cases. We did not find statistically significant differences in survival (P = 0.913) comparing native and mutated K-RAS. We found a higher rate of lung recurrence (P = 0.040) and shorter time to recurrence (P = 0.015) in patients with K-RAS mutations. Gly12Asp mutation was associated with higher recurrence (P = 0.022) and lower survival (P = 0.389). Conclusions. The presence of K-RAS mutations in pulmonary metastases does not affect overall survival but is associated with higher rates of pulmonary recurrence.
[Show abstract][Hide abstract] ABSTRACT: We report a case of a 37-year-old man with an asymptomatic extraparenchymal mass in the left hemithorax. Complete surgical removal of the tumour was achieved through a minithoracotomy and histological analysis confirmed the diagnosis of myxoid neurofibro-ma. Given this histological diagnosis, the patient was re-examined and many café au lait spots (more than 6, larger than 15 mm in diameter) and neurofibromas (elastic tissue) were observed and the patient was diagnosed with neurofibromatosis (NF) type 1 (von Recklinghausen's disease). We have found only eight case reports of neurogenic tumours originating from an intercostal nerve; only two of these corresponded to neurofibromas. Among these two patients, only one was a case of NF type 1 and, in contrast to our case, the diagnosis was reached prior to surgery. We present a very rare case of intercostal nerve neurofibroma leading to a definitive diagnosis of NF type 1.
[Show abstract][Hide abstract] ABSTRACT: To analyse patient survival after the resection of lung metastases from colorectal carcinoma and specifically to verify whether presence of liver metastasis prior to lung metastasectomy affects survival.
All patients who, between 1998 and 2008, underwent lung metastasectomy due to colorectal cancer were included in the study. Kaplan-Meier survival analysis was performed with the log-rank test and Cox regression multivariate analysis.
During this period, 101 metastasectomies were performed on 84 patients. The median age of patients was 65.4 years, and 60% of patients were male. The 30-day mortality rate was 2%, and incidence of complications was 7%. The overall survival was 72 months, with 3-and 5-year survival rates of 70% and 54%, respectively. A total of 17 patients (20%) had previously undergone resection of liver metastasis. No significant differences were found in the distribution of what were supposed to be the main variables between patients with and without previous hepatic metastases. Multivariate analysis identified the following statistically significant factors affecting survival: previous liver metastasectomy (p = 0.03), tumour-infiltrated pulmonary lymph nodes (p = 0.04), disease-free interval ≥ 48 months (p = 0.03), and presence of more than one lung metastasis (p < 0.01). In patients with previous liver metastasis, the shorter the time between primary colorectal surgery and the hepatectomy, the lower the survival rate after pulmonary metastasectomy (p = 0.048).
A previous history of liver metastasis shortens survival after lung metastasectomy. The time between hepatic resection and lung metastasectomy does not affect survival; however, patients with synchronous liver metastasis and colorectal neoplasia have poorer survival rates than those with metachronous disease.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 06/2011; 37(9):786-90. DOI:10.1016/j.ejso.2011.05.014 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute mediastinitis is a life-threatening sit-uation that is associated with high rates of morbidity and mortality. The most common causes of mediastinitis are: oesophageal per-foration, acute necrotising mediastinitis (ANM) and post-sternotomy mediastinitis. The aim of this study was to analyze prognostic fac-tors and the differences between mediastinitis from various origins. A retrospective analysis was carried out on all patients operated on for acute mediastinitis between 2000 and 2009. Surgical interventions were performed on 33 patients (69.7% male), the majority as a conse-quence of oesophageal perforation (21 cases). The overall mortality rate was 30%. Better sur-vival was seen in subjects less than 60 years of age, subjects with no comorbidities, and sub-jects who had undergone early tracheotomy. Patients with ANM were younger, had less comorbidities, diagnosed later and required more repeat interventions compared to those patients who had mediastinitis caused by oesophageal perforations. Mortality was lower in the ANM group, but this was not statistical-ly significant. Protective factors in mediastini-tis are: early diagnostic and treatment, age under 60 years, absence of major comorbidity and early tracheotomy.
[Show abstract][Hide abstract] ABSTRACT: In the treatment of primary spontaneous pneumothorax (PSP) the latest guidelines rec-ommend video-assisted thoracoscopy, but do not specify the best technique for performing pleurodesis. Indeed, there are no clinical trials comparing the effectiveness of talc pleurode-sis, mechanical pleurodesis and pleurectomy. Our objective was to compare outcomes in patients who underwent surgery for primary pneumothorax with the talc procedure or with pleural abrasion using dry gauze. Patients undergoing video-assisted thoracoscopic sur-gery for PSP in two hospitals were retrospec-tively recruited between 2007 and 2008, and followed-up until December 2010. The vari-ables measured to compare the outcomes were: recurrence, complications, and mortality, as well as the duration of air leaks and of drainage and the length of postoperative hos-pital stay (in days). Statistical analysis: The two groups were compared using the Chi square test for qualitative variables and non-parametric tests for continuous variables. A total of 106 interventions were carried out in 104 patients (74 in group A: pleural abrasion with dry gauze; 32 in group B: chemical pleu-rodesis with talc), with a mean age of 28 years (median 25) and 85.6% were male. Complications were observed in nine patients (8.5%) and there were no deaths in the 30 days after surgery; there were, however, four cases of recurrence (3.8%). The mean air leak dura-tion was 0.78 days (median 0), the mean drainage duration 1.95 days (median 1) and the mean length of postoperative hospital stay 2.68 days (median 2). In 74 cases (69.8%), mechanical pleurodesis was performed, while 32 cases were treated with talc (30.2%). Comparing the two groups, we did not find sta-tistically significant differences in recurrence (4.1% vs 3.1%, P=0.82), complications (6.8% vs 12.5%, P=0.45) or mortality (no cases of death). On the other hand, the mean postoper-ative hospital stay was lower in the mechanical pleurodesis group than in the talc group (2.2 vs 3.8 days, P=0.005). Video-assisted surgery in the treatment of PSP is a safe technique. In the mechanical pleurodesis group, we observed the same rate of recurrence, half the number of complications and a shorter hospital stay. We consider it necessary that well-designed multicentre clinical trials be carried out to compare these techniques and determine which produces the best outcomes, providing stronger scientific evidence given that the data available to date are not conclusive.
[Show abstract][Hide abstract] ABSTRACT: Spontaneous pneumothorax is an extremely frequent pathology. Despite this, there is still no clear consensus on managing these patients. Therefore, we perform a systematic review and meta-analysis of the effectiveness of percutaneous aspiration compared with tube drainage for treating idiopathic spontaneous pneumothorax. Controlled, randomised clinical trials were selected, in which the effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. Relevant articles were identified by searching electronic databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as the references of the papers found in this manner, with a cut-off date of April 2009. Quality was assessed by two independent evaluators, using the CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2010; 37(5):1129-35. DOI:10.1016/j.ejcts.2009.12.008 · 3.30 Impact Factor