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L Sarli

Publications and source records attributed to L Sarli.

At least 55 records · Page 3Linked to original sources
PubMed1998

Curative surgery for colorectal cancer: long-term results and life expectancy in the elderly.

PURPOSE: The long-term prognosis after curative surgery for colorectal cancer was evaluated in relation to age and life expectancy as a possible basis for assessing the risk to benefit ratios in the elderly. METHODS: Data relating to 1,256 patients operated on from 1976 to 1994 were stored in a computer database prospectively from 1987. Patients were subdivided into four age groups (A = <60 years; B = 60-69; C = 70-79; D = > or =80). Distribution of general contraindications to curative surgery was examined. In the 869 patients who underwent curative treatment (A = 206; B = 256; C = 289; D = 118), distribution of tumor stage and elective/emergency surgery and the operative mortality rate were evaluated. Crude and age-corrected survival curves were calculated in 794 patients. The median crude survival of each group was related by gender and tumor stage to demographic life expectancy, assuming as "relative median survival index" the ratio between the two values. RESULTS: General contraindications to curative surgery increased significantly with age. The operative mortality rate was higher in Group D than in Groups A, B, plus C over the total series (P < 0.001) and in both elective (P < 0.001) and emergency surgery (P < 0.05). Intergroup analysis of long-term survival rates showed significant differences between "crude" (P = 0.0057) but not age-corrected (P = 0.66) curves. The relative median survival index increased with age, up to approximately 1 in the local stages of Groups C and D. CONCLUSIONS: To evaluate long-term results, elderly patients should be compared with unaffected, same-age subjects. Because the risks may be very high, the surgical policy in the elderly should be carefully weighed and related to life expectancy and actual results.

Adult↗
PubMed1998

Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study.

PURPOSE: This prospective, randomized, single-center study was designed to evaluate the influence of follow-up on detection and resectability of local recurrences and on survival after radical surgery for colorectal cancer. METHODS: Between 1987 and 1990, 207 consecutive patients who underwent curative resections for primary untreated large-bowel carcinoma were randomly assigned to a conventional follow-up group (Group A; n = 103) and to an intense follow-up group (Group B; n = 104). All the patients were followed up prospectively, and the outcome was known for all of them at five years. Patients in Group A were seen at six-month intervals for one year, and once a year thereafter. Patients in Group B were checked every three months during the first two years, at six-month intervals for the next three years, and once a year thereafter. RESULTS: Of the 103 patients in Group A, local recurrence was detected in 20; 9 (13 percent) of these patients had colon cancer, and 11 (29 percent) had rectal cancer. Of the 104 patients in Group B, local recurrence was detected in 26; 12 (16 percent) of these patients had colon cancer, and 14 (45 percent) had rectal cancer. Twelve cases (60 percent) of local recurrence in Group A and 24 cases (92 percent) in Group B were detected at scheduled visits (P < 0.05). Local recurrences were detected earlier in patients of Group B (10.3 +/- 2.7 vs. 20.2 +/- 6.1 months; P < 0.0003). Curative re-resection was possible in 2 patients (10 percent) in Group A, 1 with colon cancer and 1 with rectal cancer, and in 17 patients (65 percent) in Group B, 6 with colon cancer and 11 with rectal cancer (P < 0.01). Of the Group B patients who had curative re-resections of local recurrence, 8 (47 percent) were disease-free and long-term survivors as of the last follow-up, and 2 (11.7 percent) were alive, but with a new recurrence. The 2 patients in Group A who had curative re-resections died as a result of cancer. The five-year survival rate in Group A was 58.3 percent and in Group B was 73.1 percent. The difference is statistically significant (P < 0.02). CONCLUSIONS: Our data support use of an intense follow-up plan after primary resection of large-bowel cancer, at least in patients with rectal cancer.

Adult↗
PubMed1998

A randomized, controlled, clinical study of laparoscopic vs open tension-free inguinal hernia repair.

BACKGROUND: The aim of this prospective, randomized, controlled clinical study was to compare laparoscopic transabdominal preperitoneal (TAPP) hernia repair with a standard tension-free open mesh repair (open). METHODS: A total of 108 low-risk patients with unilateral (primary or recurrent) or bilateral hernias were randomized to TAPP (group 1 = 52 cases) or open (group 2 = 56 cases). The outcome measures included operating time, complications, postoperative pain, return to normal activity, operating theater costs, and recurrences. RESULTS: The mean operative time was longer for the TAPP than for the open group only in unilateral primary hernias. At rest, the median Visual Analog Scale (VAS) score was higher for group 1 than group 2 at 48 h postoperatively. Mild to discomforting pain in the inguinal region after 7 days, night pain after 30 days, and inguinal hardening after 3 months were more frequent in group 2 than group 1. No significant differences were observed in return to normal activities between the groups. One hernia recurrence was observed after 1 month in group 1. TAPP was significantly more expensive than open. CONCLUSIONS: TAPP was associated with less postoperative pain than open. The increase in operating theater costs, however, was dramatic and was not compensated by shorter time away from work. TAPP should not be adopted routinely unless its costs can be drastically reduced.

Adolescent↗
PubMed1998

Adenocarcinoma of the colon and rectum: some reflections on the immediate and long-term results of surgery.

Colorectal cancer continues to be a major public health problem in western countries. Although some studies have reported an improvement in disease-free and overall survival, few of the diagnostic and therapeutic procedures proposed have found unanimous consent. We report some reflections on both the immediate and the long-term results of colorectal cancer surgery on the basis of our experience, represented by 1164 patients with histologically proven colorectal carcinoma, admitted to the Institute of General Surgery of Parma University between 1976 and 1993 and operated on by the same surgical team, in order to provide data for scientific discussion. A curative resection was possible in 67.9% of the cases. Our experience shows that many colorectal cancer patients will be cured with aggressive surgery, although, in recent years, adjuvant therapy for colorectal cancer has advanced considerably. Statistical analyses reveal that an unfavourable prognosis is correlated with variables indicative of advanced disease. Concerning the problem of local recurrences, our results demonstrate that surgery is the only therapeutic option providing tangible results, and that intense follow-up leads to a greater number of resections carried out for local recurrence and to improved 5-year survival. Comparison of studies and scientific discussions can prove useful, above all regarding secondary prevention and, in particular, the identification of patients at risk who should undergo screening for early diagnosis and early surgical treatment.

Adenocarcinoma↗
PubMed1997

Reduced postoperative morbidity after elective laparoscopic cholecystectomy: stratified matched case-control study.

To answer the question whether laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) is safer in terms of complications and to what extent the "learning curve" influences the frequency of complications after LC, we conducted a matched case-control study. First, 200 patients undergoing LC (LC group A), and two groups of 200 patients undergoing LC at two different periods of the learning curve (LC groups B and C) were matched, taking into account sex, age, anesthesiologic risk, and surgical difficulties. We evaluated the frequency and grade of postoperative complications of these patients and of the last 200 patients undergoing OC before the introduction of LC, retrospectively matched with the LC groups. The total rate of complications in the OC group was 16.0% compared with 5.5% in the LC groups (p < 0.003); the difference was particularly significant for complications classified as grade I, in female patients, those younger than 70, those with low anesthesiologic risk (ASA), and those after cholecystectomy without surgical difficulties. Matched case-control analysis revealed that the complication rate in the LC group significantly decreases with experience (P < 0.01). We conclude that LC is today the treatment of choice for symptomatic cholelithiasis and is replacing OC as the gold standard against which new therapies should be compared.

Adult↗
PubMed1997

Laparoscopic hernia repair: a prospective comparison of TAPP and IPOM techniques.

The aim of the study was to evaluate the safety and efficacy of two techniques of laparoscopic hernia repair: the transabdominal preperitoneal technique (TAPP) and the intraperitoneal onlay mesh technique (IPOM). In May 1992 a prospective randomized trial was initiated to compare TAPP and IPOM. Until October 1994, 115 patients with 148 hernias took part in the trial (59 TAPP and 56 IPOM). The TAPP took significantly longer than did the IPOM. There were no intraoperative complications, conversions to open repair, or postoperative deaths in either group. There were 10 (16.9% of patients) postoperative complications in the TAPP group and 14 (25%) in the IPOM group. The difference was not statistically significant. Neuralgias occurred in 3 cases of TAPP and 11 cases of IPOM (p < 0.05), local hematoma in 6 cases of TAPP and 3 cases of IPOM (NS), and urinary retention in 1 case of TAPP and in no case of IPOM (NS). Recurrences occurred in no cases of TAPP and in 8 cases (11.1% of hernias) of IPOM (p < 0.01). The results of the present report suggest that the IPOM technique for laparoscopic hernia repair should be avoided, whereas TAPP appears to be an excellent technique with no early recurrences.

Adult↗
PubMed1997

[Prospective randomized comparative study of laparoscopic hernioplasty and Lichtenstein tension-free hernioplasty].

To compare the laparoscopic transabdominal preperitoneal inguinal hernioplasty (TAPP) and the open Lichtenstein technique, in 1992 a prospective randomized trial was initiated. Until 1995 108 patients with 130 hernias took part in the trial: 64 TAPP (group A) and 66 Lichtenstein (group B). 22 patients had simultaneous bilateral repairs. Laparoscopic approach (group A) was able to expose otherwise-occult controlateral hernias in 3 cases and discovered a complex hernia (a hernia with more than one defect in the wall) in 2 patient in whom a direct hernia had been diagnosed before the operation. Mean operating time for monolateral operations was significantly longer in group A (p < 0.05). The corresponding figures for bilateral operations were longer in group B (p < 0.01). No intraoperative complications, conversions from TAPP to open repair, postoperative deaths. There were not less pain quicker mobility and shorter period of disability in the laparoscopic group (group A). Ten (15.6%) postoperative complications occurred in group A: local hematoma (6 cases, 9.3%), neuralgias (3 cases, 4.7%), urinary retention (1 case, 1.6%). Eight (12.1%) postoperative complications: hematomas (3 cases, 4.5%), urinary retention (3 cases, 4.5%), neuralgias (2 cases, 3%) occurred in group B. Differences were not significant. The current follow-up period is 36 months (15-54) in median. In both groups no recurrences occurred, but 3 patients in group B who were operated on for monolateral hernia (6.5%) discovered to be affected by contralateral hernia. The results of the present report suggest that TAPP does not appear to be associated with better results in terms of complications, pain or period of disability as compared to open tension free hernia repair, but the ability of the laparoscopic approach to expose otherwise-occult defects eliminated the risk of recurrences due to missed hernias.

Adult↗
PubMed1996

Prognostic value of ploidy, cell proliferation kinetics, and conventional clinicopathologic criteria in patients with colorectal carcinoma: a prospective study.

PURPOSE: The aim of this study was to obtain additional biologic determinants that may be of use in segregating into subgroups with different prognosis patients with similarly staged colorectal cancers. METHODS: Between 1989 and 1991, a prospective study of prognostic factors has been performed in a group of 98 consecutive, unselected patients who underwent curative resections for primary untreated large bowel carcinoma. The fate of all patients is known at three years after operation. Clinical and pathologic data were recorded at the time of presentation and operation, and patients have been the subjects of regular follow-up. Tumor DNA content was determined by flow cytometry, and cell proliferative activity was determined by autoradiography with tritiated thymidine labeling index (LI). RESULTS: Univariate analysis revealed that the most important predictors of survival (P < 0.001) were the presence of positive lymph nodes, the presence of preoperative complications, Dukes stage, and LI. The multivariate analysis showed that Dukes stage (P < 0.002) and LI (P < 0.0001) were the only factors significantly related to survival. Disease-free survival was influenced significantly by Dukes stage (P < 0.001), LI, according to the classification in the two groups of high and low proliferative activity, respectively, (P < 0.0001), LI, calculated as a continuous variable (P < 0.0002), and the presence of lymph node metastases (P < 0.003). Outcome (favorable/unfavorable) was influenced significantly by Dukes stage (P < 0.0001) and LI (P < 0.0001). Concordance for each patient between Dukes stage and outcome was 73.1 percent and between LI, calculated as a continuous variable, and outcome was 74.1 percent. If, on the other hand, Dukes stage and LI are used together, concordance with outcome reaches 89.2 percent. CONCLUSION: We can conclude that, from a practical point of view, LI is an essential factor that must be combined with pathologic variables for a better prediction of patient outcome.

Adult↗
PubMed1995

Laparoscopic cholecystectomy and endoscopic sphincterotomy under a single anesthetic: a case report.

Several options have been described for the management of unsuspected common bile duct stones diagnosed for the first time by transcystic cholangiography during laparoscopic surgery. These include immediate conversion to open laparotomy and formal common bile duct exploration, laparoscopic bile duct exploration, or postoperative biliary endoscopy (i.e., ERCP with sphincterotomy and stone extraction). Herein we describe a fourth option which allows the surgeon to manage both cholelithiasis and choledocholithiasis at the time of laparoscopic intervention: endoscopic sphincterotomy performed immediately after laparoscopic cholecystectomy under one anesthetic. This option seems the most logical when the surgeon wishes to preserve the minimally invasive approach.

Anesthetics↗
PubMed1992

[A critical review of the history of the systems for staging colorectal cancer].

A great debate is still open in literature about the available staging systems of colorectal cancer. Therefore, an historical analysis of the several systems suggested in the last decades was performed; pathological, clinicopathological and more recent score clinicopathological staging systems were evaluated. From this historical review it appears that subsequent modifications of various classifications allowed only for a poor improvement in predictivity. A more careful histopathological examination of surgical specimen and more exact information about involvement of other organs and tissues allow a correct classification of patients affected by colorectal cancer independently of the staging system used.

Colorectal Neoplasms↗
PubMed1992

Today's treatment of cholelithiasis: laparoscopic surgery.

The speed at which laparoscopic biliary tract surgery has been introduced to such a large number of surgeons is without precedent in modern surgical history. At least 4 factors work together to explain such a rapid success: 1) Laparoscopic cholecystectomy removes the diseased gallbladder and ensures permanent cure; 2) Laparoscopic approach allows a telescopic vision and dissections are very precise; 3) Laparoscopic cholecystectomy allows minimal wound pain with complete resolution within a few days, a short hospital stay and the ability of many patients to return to work within a week of operation; 4) There are economic advantages to the patient, his community and the healthcare provider. The procedure proved to be as safe and feasible to use as conventional surgery. Obviously adequate training and credentialing are important processes to faster good patient outcomes. There are some contraindications to laparoscopic surgery, the most part of them are depending upon the experience of the surgeon. The successful application of therapeutic laparoscopy changed the diagnostic approach to lithiasic biliary disease. Whereas the most popular method of documenting gallbladder abnormalities before performing conventional surgery is ultrasonography, most surgeons who have embraced laparoscopic surgery argue for routine cholangiography because of the necessity to document duct anatomy besides minimizing the incidence of retained GBDS.

Cholecystectomy, Laparoscopic↗
PubMed1992

[Laparoscopic surgery: planning program].

Performing laparoscopic surgery requires an initial training program. A well-planned organization is essential and the surgeon has to become first familiar with the new procedures; the choice of the necessary equipment is the second step. Upkeep of surgical instruments and a careful consideration of legal aspects are the next important steps. Several areas of a planning program are evaluated on the basis of the authors' experience.

Female↗
PubMed1992

[Anesthesia for laparoscopic cholecystectomy].

Alterations in the serological, pulmonary and cardiocirculatory parameters, potentially determined by CO2 pneumo-peritoneum during laparoscopic cholecystectomy, require careful intraoperative evaluation. With the aim of verifying the real entity of these alterations, an experience is reported relating to 76 of the 303 patients undergoing laparoscopic cholecystectomy during 14 months. During surgery, besides an obvious increase in pO2, a slight hypercarbia and a slight decrease in pH were observed, which required pharmacological intervention in only 5 cases. In no case did the respiratory and haemodynamic alterations observed necessitate the conversion into laparotomy. This initial experience gives us reason to conclude that careful monitoring of the respiratory parameters leads to an adequate anaesthesiological conduct, and thus facilitates the completion of laparoscopic procedures.

Adult↗
PubMed1992

[Reflection on 19 months of laparoscopic cholecystectomy].

The introduction of laparoscopic cholecystectomy (LC) has aroused enthusiasm on the part of the mass media and perplexity on the part of many medical workers. In an attempt to reconcile the two points of view, the video-laparoscopic activity in a surgical ambient was audited over 19 months. 450 LC were carried out during this period. The number of cholecystectomies performed by this method has risen significantly in the recent past thanks to the high esteem in which it is held by the public in general and by gastroenterologists in particular. The average age of patients is lower since young people accept more readily a type of surgery involving a lesser degree of traumatism, a relatively short convalescence and less aesthetic damage. After a brief initial period of scepticism, the method has also been received favourably by anaesthetist, and by operating theatre and ward nursing staff. Morbidity and mortality rates are not different from those noted after traditional cholecystectomy, which confirms the method as being safe and thus meriting the success it has widely achieved.

Cholecystectomy, Laparoscopic↗
PubMed1992

[The importance of preoperative study of cholelithiasis during the laparoscopic era].

Preoperative x-ray examination of the biliary tree has in the last decade been entrusted to ultrasonography. The diagnostic procedure was completed with an accurate evaluation of the main biliary tract by means of intra-operative cholangiography. However, recently-developed methods such as operative endoscopy and laparoscopic surgery require essential pre-operative information about the state of the biliary tract which ultrasonography is not able to provide. In our view, the most useful examination for this purpose is i.v. cholangiography; the results of this study, relating to 303 patients undergoing laparoscopic cholecystectomy, of whom 39 affected by cholecysto-choledochal lithiasis, would seem to confirm these view.

Bile Duct Diseases↗
PubMed1992

[Interaction between laparoscopic surgery and operative endoscopy. Results of an experience].

Nowadays it is possible to treat complex biliary disease such as cholecysto-choledochal stones with mini-invasive methods. In this field, laparoscopic surgeons and gastroenterologic endoscopists can collaborate not only in the planning of endo-laparoscopic sequential treatment of biliary stones but also in the successful treatment of complex cases having either surgical or endoscopic complications. Here are presented the results which 14 months of collaboration between laparoscopists and endoscopists have brought about in the diagnostic and therapeutic fields. In particular, the results are documented of the sequential endo-laparoscopic treatment of cholecysto-choledochal calculi proposed for 39 patients, of inverse laparo-endoscopy carried out in 2 cases, and of therapeutic procedure used to treat an iatrogenic perforation of the biliary tree by mini-invasive methods. The experience reported is an example of how technological progress is gradually pushing aside the barriers still existing between medicine and surgery.

Cholecystectomy↗