[Show abstract][Hide abstract] ABSTRACT: Surgical treatment of rectal cancer is still controversial as regards the type of operation and the extent of lymphadenectomy. Four hundred and fifty-eight patients with rectal cancer operated on at two different hospitals (206 patients, Surgical Department, S. Martino General Hospital and 252 patients, Surgical Department, Galliera General Hospital) in the decade 1980-1989 were studied. None of the patients were submitted to adjuvant or neoadjuvant therapy. The operations opted for were anterior resection for carcinoma of the upper rectum, anterior resection or abdominoperineal resection for carcinoma of the middle rectum, and abdominoperineal resection for lower rectal cancer. At the S. Martino General Hospital, anterior resection comprised ligation of the inferior mesenteric artery at its origin, with subsequent preaortic lymphadenectomy. In abdominoperineal resection, the pelvis was left open and was closed later. At the Galliera General Hospital, preaortic lymph node dissection was not performed, and abdominoperineal resection comprised a one-stage pelvic floor closure. Survival was no different in the two patient populations. Extended lymphadenectomy was of no benefit in terms of survival in operated rectal cancer patients. Abdominoperineal resection may still be useful for selected patients.
No preview · Article · Jan 2004 · Chirurgia italiana
[Show abstract][Hide abstract] ABSTRACT: Of great interest today is the debate regarding the benefits and limitations of extended lymphadenectomy in rectal cancer, particularly with regard to patient survival. In the present report we review the experience of two different surgical departments: a total of 458 patients with rectal cancer were operated on in the 1st Surgical Department of S. Martino Hospital, Genoa, and in the 1st Surgical Department of Galliera Hospital, Genoa over the period from 1980 to 1989. Anterior rectal resection was performed in 137 rectal tumours at the S. Martino Hospital and in 146 at the Galliera Hospital. The mean follow-up was 48 months (range: 24-120 months). In the first group of patients, ligation at the origin of the mesenteric vessels (with subsequent peri-aortic lymphadenectomy) (D2-D3) was performed, while in the second group the mesenteric vessel ligation was done at the level of the origin of the left colic vessels (D1). There were no complementary therapies (radio or chemotherapy) either before or after surgery, because these were only introduced later. The data obtained from analysis of the long-term survival curves showed that there were no statistical differences between the two surgical experiences. The execution of extended lymphadenectomy would not appear to afford any additional benefit in terms of the survival of patients with rectal cancer. The well-matched starting conditions in the two groups allowed effective comparison between the two experiences and evaluation of the "pure" surgical aspect.
No preview · Article · Sep 2002 · Chirurgia italiana
[Show abstract][Hide abstract] ABSTRACT: Cyproterone acetate (CPA), a synthetic steroid used in human therapy, has recently been shown to cause DNA damage in cultured rat hepatocytes and in rat liver. In the present study we have investigated whether CPA also induces genotoxic effects in human hepatocytes. Genotoxicity of CPA was determined by measuring the capability of the compound for inducing DNA repair synthesis and for causing the formation of DNA single-strand breaks. Autoradiography and alkaline elution were used to quantitate DNA repair and DNA fragmentation, respectively. Exposure of hepatocytes to CPA for 20 h induced DNA repair synthesis in two hepatocyte preparations derived from males and in four of the five preparations derived from females. In cultures from some donors, induction of repair was detected at 1 microM CPA, the lowest concentration tested. The maximum effect generally occurred at 10-20 microM. Only a very slight increase in the frequency of DNA single-strand breaks was found following exposure of the hepatocytes to 50 microM CPA for 20 h. For comparative purposes, the effects of CPA on DNA repair and DNA fragmentation were also determined in cultured rat hepatocytes. A strong induction of DNA repair synthesis, but only a slight enhancement in DNA fragmentation was observed in CPA-treated hepatocytes derived from female rats. These results indicate that the measurement of repair is a more sensitive indicator for the genotoxicity of CPA than the measurement of DNA fragmentation. No genotoxic effects of CPA were detectable in hepatocyte cultures derived from male rats. The present findings show that CPA is genotoxic in human hepatocytes and that the striking sex difference in the genotoxicity of CPA in rat cells is not observed with human cells.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate the clinical, morphological and functional results obtained in a group of patients previously submitted to Traverso-Longmire pylorus-preserving duodeno-pancreatectomy (PPDP). The study was performed as a clinical, endoscopic, radioisotopic and electro-manometric evaluation. An analysis of the results allowed us to conclude that: 1) most patients show good clinical features, and this becomes more evident as post-operative time progresses; 2) bile reflux gastritis is an infrequent event; 3) gastric emptying times in patients overlap those seen in control subjects, and progressive normalization occurs postoperatively. The best clinical results coexist with normal gastric emptying times; 4) gastrojejunal interdigestive motor activity shows a reduction in phase 3 and a relative increase in phase 2. We argue that the motor activity of the upper gastrointestinal tract can restore, from a functional point of view, the new anatomical situation. On the basis of the good clinical and functional results, pyloric preservation seems to be the most physiological procedure for the restoration of alimentary continuity following duodenopancreatic resection.
No preview · Article · Mar 1995 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: Few cases of repeated hepatic resection for recurrent metastasis have been in literature. This paper focuses on metastatic recurrences and their surgical treatment, comparing the outcome of resective therapy with the natural history of metastases. Results of alternative methods (alcoholization and trans-arterial chemo-embolization), are evaluated through the analysis of indications, complications and real benefit.
Between January 1980 and Jan 1995, 163 patients with hepatic metastases were operated on in our Department. In 132 cases, metastases originated from colorectal cancer: 105 were submitted to hepatic resection, 3 were treated by selective ischemia, 5 by chemotherapy through an infusaid catheter, 5 by alcoholization under ultrasonographic control, 14 by a new phase II trial of schedule oriented biochemical modulation of FUra bolus by MTX and B interferon and FUra continuous infusion by leucovorin.
Out of 76 metachronous metastases operated on, 10 were metastatic hepatic recurrences surgically treated by second resection. The average time-interval intercurring between the two hepatic resections was 15 months. The average follow-up and survival period after repeated resection was 27 months (range 2-129).
Through the analysis of these ten cases, we sorted out the segmentary localization of hepatic metastases, the type of operation performed, the disease free interval, serum CEA patterns, morbidity and survival.
No preview · Article · Jan 1995 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: One hundred ten cases of primitive hepatic hilum neoplasms (Klatskin tumor) observed from January 1970 to June 1992 are reviewed and the variations occurring in the diagnostic back-up and treatment policy are considered. The importance of careful preoperative staging is stressed. Preoperative tests should be limited to investigations supplying most informations about endo- and esobiliary diffusion of the tumoral mass (ultrasound, direct cholangiography, portography). This paper demonstrates that a surgical approach with both palliative or resective aims is suitable for all patients with no local or general contraindications. Other cases are treated with percutaneous or endoscopic biliary stenting. The authors conclude by pointing out that tumoral resection with biliodigestive anastomosis is in any case the treatment of choice in these patients as it gives a better quality of life (improved "comfort index").
No preview · Article · Jan 1993 · Journal of surgical oncology. Supplement
[Show abstract][Hide abstract] ABSTRACT: Pancreatoduodenectomy is the most used resective operation in the treatment of cephalopancreatic pathology; nevertheless it is a severely demolitive operation, especially if performed according to the traditional technique. It can induce early as well as late complications in a high percentage of cases. A number of technical improvements have been proposed so far in order to reduce or avoid such complications; duodenopancreatectomy with gastric and pyloric preservation (PPDP) is the most representative one. The Authors analyze technical and functional features of PPDP in 22 patients operated on; results are compared with the traditional technique. In conclusion, among all the techniques proposed, PPDP assures the best improvement in the quality of life of these patients.
No preview · Article · Apr 1991 · Il Giornale di chirurgia
[Show abstract][Hide abstract] ABSTRACT: The Authors, on the basis of ten cases of gallstone-ileus personally observed, examine the clinical diagnostic and therapeutic aspects of this very serious and rare affection. They underline the importance of early diagnosis and surgical treatment in order to reduce the still high mortality rate.
No preview · Article · · Archivio per le scienze mediche