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Updates on abdominal desmoid tumors

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World Journal of Gastroenterology 2007年第45期13卷 5985-5988页

作者： Bernardino Rampone Corrado Pedrazzani Daniele Marrelli Enrico Pinto Franco Roviello Department of General Surgery and surgical oncology Unit of Surgical Oncology University of Siena Italy

Desmoid tumor is a monoclonal, f ibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia inf iltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations diff icult. This distinct pathological entity is reviewed with a specif ic focus on aetiology and management.

关键词： Desmoid Abdomen Fibromatosis Familialadenomatous polyposis Gardner's syndrome

Giant appendiceal mucocele: Report of a case and brief review

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World Journal of Gastroenterology 2005年第30期11卷 4761-4763页

作者： Bernardino Rampone Franco Roviello Daniele Marrelli Enrico Pinto Department of General Surgery and surgical oncology

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucoid substance. This disease is often asymptomatic and pre-operative diagnosis is rare. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and to histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadenocarcinoma. In this paper, we report a case of a 51-year-old woman with a mobile, painless mass in the right lower quadrant of abdomen caused by a giant appendiceal mucocele. Imaging showed a larger tubular, cystic structure extending below from the inferior wall of the cecum. Surgery revealed a giant retro-cecal appendix measuring 17 cm in length and 4 cm in diameter. The final pathologic diagnosis was mucocele caused by mucinous cystadenoma.

关键词： Appendix Mucocele Pseudomyxoma peritonei surgical treatment

Hypertriglyceridemia is positively correlated with the development of colorectal tubular adenoma in Japanese men

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World Journal of Gastroenterology 2006年第8期12卷 1261-1264页

作者： Masafumi Tabuchi Joji Kitayama Hirokazu Nagawa Nakameguro Gastrointestinal Clinic Department of Surgical Oncology.The University of TokyoJapan Department of surgical oncology The University of TokyoJapan

AIM： To determine the real association between serum lipid levels and colonic polyp formation. METHODS： We performed a large scale retrospective study to analyze the correlation between the incidence of colorectal adenoma or carcinoma and the fasting serum levels of total cholesterol （TC） and triglycerides （TG） in patients who underwent total colonoscopy for screening for colon cancer. RESULTS： Both levels were significantly elevated in patients with adenomas as compared with patients without any neoplastic lesion （TC 207.6 ± 29.5 vs 199.5 ±34.3, n= 4883, p〈 0.001; TG 135.0 ± 82.2 vs 108.7± 71.5, n= 4874, p〈 0.001）. The difference was significant in patients with tubular adenoma but not in those with villous or serrated adenoma. Multiple logistic regression analysis including age and sex revealed that TG was an independent correlation factor in male （p〈0.01）, but not in female patients. The level of TG in patients with invasive carcinoma did not show a significant elevation from that in patients with adenoma. These findings suggest that hypertriglyceridemia is an independent risk factor for colonic adenoma in men. CONCLUSION： Although a high level of serum triglyceride does not appear to be mechanically involved in the development of carcinoma, reduction of serum TG and intensive surveillance with total colonoscopy may have benefit in men with hypertriglyceridemia.

关键词： Triglyceride, Hyperlipidemi Colorectal Adenoma Colonoscopy

Breakthrough therapy for peritoneal carcinomatosis of gastric cancer:Intraperitoneal chemotherapy with taxanes

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World Journal of Gastrointestinal oncology 2015年第11期7卷 285-291页

作者： Hironori Yamaguchi Joji Kitayama Hironori Ishigami Shinsuke Kazama Hiroaki Nozawa Kazushige Kawai Keisuke Hata Tomomichi Kiyomatsu Toshiaki Tanaka Junichiro Tanaka Takeshi Nishikawa Kensuke Otani Koji Yasuda Soichiro Ishihara Eiji Sunami Toshiaki Watanabe Department of surgical oncology the University of Tokyo

The effect of chemotherapy on peritoneal carcinomatosis(PC) of gastric cancer remains ***,the intraperitoneal(IP) administration of taxanes [e.g.,paclitaxel(PTX) and docetaxel(DOC)] during the perioperative period has shown promising ***,we summarized the rationale and methodology for using IP chemotherapy with taxanes and reviewed the clinical *** administered taxanes remain in the IP space at an extremely high concentration for 48-72 *** drug directly infiltrates peritoneal metastatic nodules from the surface and then produces antitumor effects,making it ideal for IP *** are two types of perioperative IP chemotherapy with taxanes: neoadjuvant intraperitoneal and systemic chemotherapy and sequential perioperative intraperitoneal chemotherapy(SPIC).In SPIC,patients receive neoadjuvant IP chemotherapy and the same regimen of IP chemotherapy after cytoreductive surgery(CRS) until disease ***,a taxane dissolved in 500-1000 m L of saline at ordinary temperature is administered through an IP access port on an outpatient *** to phase Ⅰ?studies,the recommended doses(RD) are as follows: IP DOC,45-60 mg/m2; IP PTX [without intravenous(IV) PTX],80 mg/m2; and IP PTX(with IV PTX),20 mg/*** Ⅱ studies have reported a median survival time of 14.4-24.6 mo with a 1-year overall survival of 67%-78%.A phase Ⅲ study comparing S-1 in combination with IP and IV PTX to S-1 with IV cisplatin started in *** prognosis of patients who underwent CRS was better than that of those who did not; however,this was partly due to selection *** several phase Ⅱ studies have shown promising results,a randomized controlled study is needed to validate the effectiveness of IP chemotherapy with taxanes for PC of gastric cancer.

关键词： Taxane Paclitaxel Docetaxel Carcinoma Gastric canc

Impact of jejunostomy during esophagectomy for cancer on health related quality of life

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Chinese Journal of Cancer Research 2014年第6期26卷 678-684页

作者： Marco Scarpa Francesco Cavallin Giulia Noaro Eleonora Pinto Rita Alfieri Matteo Cagol Carlo Castoro surgical oncology Unit Veneto Institute of Oncology (IOV-IRCCS) Padua 35128 Italy

Background： The aim of this study was to evaluate the impact of jejunostomy during esophagectomy for cancer on postoperative health-related quality of life（HRQL）.Methods： We evaluate all consecutive patients who underwent esophagectomy for cancer at the surgical oncology unit of the Veneto Institute of oncology（IOV-IRCCS） between January 2008 and March 2014. The primary outcome was HRQL, which was assessed using nine scales of EORTC C30 and OES18 questionnaires. General linear models were estimated to evaluate mean score difference（MD） of each selected scale in patients with and without jejunostomy, adjusting for clinically relevant confounders. The secondary outcomes were morbidity, hospital stay, postoperative weight loss and postoperative albumin impairment. Results： Jejunostomy was performed in 40 on 109 patients（41.3%） who participated in quality of life investigation. A clinically and statistically significantly worse eating at admission（P=0.009） became not clinically significant at 3 months after surgery（MD =9.1）. Jejunostomy was associated to clinically and statistically significantly poorer emotional function（EF） at 3 months after surgery（MD =-15.6; P=0.04）. Hospital stay was longer in jejunostomy group（median, 20 vs. 17 days, P=0.02）.Conclusions： In our series patients who had a jejunostomy during esophagectomy had been selected for their risk for postoperative complication. However, their postoperative outcome was actually similar compared to those without jejunostomy. Nevertheless, jejunostomy was associated to clinically and statistically significantly poorer EF at 3 months after surgery. Therefore, patient candidate to esophagectomy and feeding jejunostomy should receive additional psychological support.

关键词： Health-related quality of life(HRQL) jejunostomy esophagectomy esophageal cancer

Minimally invasive surgical approach to pancreatic malignancies

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World Journal of Gastrointestinal oncology 2015年第12期7卷 411-421页

作者： Lapo Bencini Mario Annecchiarico Marco Farsi Ilenia Bartolini Vita Mirasolo Francesco Guerra Andrea Coratti Department of oncology Division of Surgical Oncology and Robotics Careggi University Hospital

Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patientsdue to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci® robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer(and less aggressive tumors), w

关键词： Pancreatic cancer Pancreatic adenocarcinoma Neuroe

Impact of age-related comorbidity on results of colorectal cancer surgery

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World Journal of Gastroenterology 2009年第45期15卷 5706-5711页

作者： Corrado Pedrazzani Guido Cerullo Giovanni De Marco Daniele Marrelli Alessandro Neri Alfonso De Stefano Enrico Pinto Franco Roviello Department of Human Pathology and oncology Unit of Surgical OncologyUniversity of Siena 53100 SienaItaly

AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: According to age, 403 patients operated on for CRC in our department were divided into group A (< 70 years old) and group B (≥ 70 years old) and analyzed statistically. RESULTS: Rectal localization prevailed in group A (31.6% vs 19.7%, P = 0.027), whereas the percentage of R0 resections was 77% in the two groups. Comorbidity rate was 46.2% and 69.1% for group A and B, respectively (P < 0.001), with a huge difference as regards cardiovascular diseases. Overall, postoperative morbidity was 16.9% and 20.8% in group A and B, respectively (P = 0.367), whereas mortality was limited to group B (4.5%, P = 0.001). In both groups, patients who suffered from postoperative complications had a higher overall comorbidity rate, with preexisting cardiovascular diseases prevailing in group B (P = 0.003). Overall 5-year survival rate was significantly betterfor group A (75.2% vs 55%, P = 0.006), whereas no signif icant difference was observed considering disease-specif ic survival (76.3% vs 76.9%, P = 0.674). CONCLUSION: In spite of an increase in postoperative mortality and a lower overall long-term survival for patients aged ≥ 70 years old, it should be considered that, even in the elderly group, a signif icant number of patients is alive 5 years after CRC resection.

关键词： Colorectal cancer Elderly Post-operative complications Co-morbidity Aged

Precision surgical approach with lymph-node dissection in early gastric cancer

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World Journal of Gastroenterology 2019年第14期25卷 1640-1652页

作者： Shinichi Kinami Naohiko Nakamura Yasuto Tomita Takashi Miyata Hideto Fujita Nobuhiko Ueda Takeo Kosaka Department of surgical oncology Kanazawa Medical University

The gravest prognostic factor in early gastric cancer is lymph-node metastasis,with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy,functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this *** on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative *** the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.

关键词： Stomach neoplasms surgery Gastrectomy methods Recovery of function Sentinel lymph node surgery Gastric cancer

Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution

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World Journal of Gastroenterology 2014年第7期20卷 1777-1789页

作者： Lapo Bencini Marco Bernini Marco Farsi Division of surgical oncology Department of OncologyCareggi University Hospital50134 FlorenceItaly

After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts,some surgeons started to treat malignancies by the same ***,if the limits of laparoscopy for benign diseases are mainly represented by technical issues,oncologic outcomes remain the foundation of any procedures to cure *** patients represent an important group with peculiar aspects including reduced survival expectancy,worsened quality of life due to surgery itself and adjuvant therapies,and challenging psychological *** these issues could,potentially,receive a better management with a laparoscopic surgical *** order to confirm such aspects,similarly to testing the newest weapons(surgical or pharmacologic)against cancer,long-term follow-up is always recommendable to assess the real benefits in terms of overall survival,cancer-free survival and quality of ***,it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive ***,laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences,as compared to those achieved for inflammatory bowel diseases,gastroesophageal reflux disease or diverticular *** review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.

关键词： Gastrointestinal cancer Laparoscopic oncology Laparoscopic surgery Robotic surgery surgical outcomes Oncologic outcomes