Biomedical subjects
Publications and source records attributed to L Sarli.
Sigmoid volvulus is a pathology which can be treated with beneficial effect using the fully laparoscopic or laparoscopic-assisted approach. We describe a technique which, although it does not qualify as a true laparoscopic operation, it also does not require advanced laparoscopic skills or prolonged operating time.
There have been several reports claiming that there is a risk that laparoscopic cholecystectomy might worsen the prognosis of unexpected gallbladder cancer. The objective of this study was to evaluate which factors influence the prognosis of such cancers. A clinicopathological study was conducted in 25 patients with unexpected gallbladder cancer. The results of 10 patients undergoing laparoscopic cholecystectomy were compared with those of 15 patients undergoing open cholecystectomy. Correlations were evaluated between cumulative survival rates and seven prognostic factors, namely, age, sex, histopathological grade, pathological stage, occurrence of bile spillage, type of cholecystectomy (laparoscopic or open) and additional surgical treatments. Seven patients after laparoscopic cholecystectomy (70%) and 9 patients after open cholecystectomy (64%) had cancer recurrence: the difference was not statistically significant. There was a statistically significant correlation between survival rate and tumour stage (P < 0.01) and occurrence of bile spillage (P < 0.05). There was no difference in survival depending on whether cholecystectomy was carried out using laparoscopic or traditional techniques. Laparoscopic cholecystectomy does not adversely affect the prognosis of unexpected gallbladder cancer. Once the histological findings have been examined, the surgeon will decide whether it is necessary to extend surgery, regardless of whether laparoscopic or open cholecystectomy is carried out.
This report updates an experience with local recurrences of rectal cancer after curative surgery. Overall 13 year period (1976-1988) 254 patients were operated on in the II Surgical Clinic of Parma University for rectal cancer. Only 122 patients who underwent potentially curative resection were examined. Approximate recurrence rates according to patients age, site, type and stage of primitive tumour, tumour complications and surgical procedures were evaluated. The overall local failure rate was 17.2% with 12 patients having local failure alone and 9 patients having concurrent local failure and distant metastasis. Local failure occurred predominantly in tumour bed, involving the anastomosis in 2 cases. Relapse developed primarily at colo-rectal anastomosis in only 1 patients, 20% of recurrences were diagnosed within the first postoperative year; 65% within the second and 90% within the third. Stage of primary tumour was the most predictive factor for eventual relapse. Minute foci of tumour not encompassed by the first operation led to local recurrences in most of the cases, but relapses were independent of operative procedures adopted. The authors conclude that surgery, even if correctly performed, is not sufficient to prevent the risk of local recurrence of rectal cancer. They believe that routine adjuvant radiation therapy after surgical treatment of rectal cancer should improve survival rate.
This study explores the patterns of local recurrence after curative operations for colonic cancer. Over a 13 year period (1976-1988) 486 patients were operated on in the Surgical Clinic of Parma University for colonic cancer, but only 296 patients who underwent potentially curative resection were examined. The influence of patients' age, disease stage, site and grade, presence of obstruction or perforation and type of surgical procedures were examined as prognostic factors for local cancer recurrence. A total of 28 patients (14%) relapsed after surgery and 19 were found to have simultaneous distant metastasis. 86% of recurrences were evident within the first 2 years. Local recurrence rate increased with more advanced Duke's stage and stage of the primary tumour was most predictive for eventual relapse. The recurrences occurred within the operative resection site involving the anastomosis by inward growth at the suture line. Minute foci of adenocarcinoma not encompassed by the first operation might lead to local recurrences; the authors do not rule out, however, the rare possibility of the implantation of exfoliated malignant cells. Despite the attempt to carry out an intensive followup in terms of early diagnosis of recurrence in colonic surgery, the presence of local recurrences is associated with extremely poor prognosis independent of operative procedure performed. The authors believe that routine adjuvant radiation therapy after surgical treatment of locally advanced colonic cancer could improve survival rate.
Our recent studies have shown a significant association between lithiasic biliary disease and colorectal cancer. This could be due to the existence of risk factors common to both disease or to a cause-effect correlation between them. This latter hypothesis is supported by the observation in gallstone patients of the increase of biliary and fecal concentrations in secondary biliary acids. These could have co-carcinogenic effect on the colon. With a view to singling out further elements which might help us to understand more clearly the possible cause-effect correlation between cholelithiasis and colon cancer, we examined 12 patients affected by both diseases. In these, we evaluated the composition of the gallbladder stones, by means of spectrophotometry and diffractometry. Bile samples were taken from the gallbladder and used to examine the lipidic composition and the cholesterol saturation index according to Carey. In addition bacteriological examinations were carried out. The results were compared with those of 10 patients with cholelithiasis but not cancer, 10 with cancer but not cholelithiasis and 10 with neither. Analysis of the results did not reveal significant differences in gallstone and bile composition between colon cancer patients with concomitant gallstones and control groups. However, in cancer patients with gallstones a higher incidence of bile bacteria (35.7%) was observed than in the other groups. Bile bacteria were observed more frequently in right colon cancer patients who had pigment stones in 75% of the cases. The results seem to evidence peculiarities in patients with a cancer of right colon.(ABSTRACT TRUNCATED AT 250 WORDS)
A recent study put forward the hypothesis that microlithiasis may represent an early stage in the development of biliary calculi. It is an established fact that cholesterol crystals are the product of an inevitable stage in the sequence leading to gallstone formation. To test the hypothesis stated above ten patients affected by gallbladder cholesterol microlithiasis (CM) were examined in the lipid composition of the bile, the cholesterol saturation index and the presence of cholesterol crystals being calculated. The results were compared with those of 14 patients affected by pigment microliths, 24 with larger stones (LS) and ten control patients. The cholesterol saturation index was above one in all CM patients, whereas in some LS patients the gall-bladder bile was not supersaturated. Cholesterol crystals were observed in the gallbladders of all CM patients and seven LS patients. These results would seem to provide support for the hypothesis of microcalculi as being "young stones", with the bile of CM patients maintaining the conditions leading to gallstone formation.
The aim of the research was to verify the existence of an association between neoplasms in the colon and cholelithiasis, treated surgically or non-surgically. The case-control study was carried out on 109 patients operated on for cancer of the colon, and on 109 control patients operated on for benign pathology. Matching was carried out according to sex, age, region of origin and dietary habits of the patients. Results showed a significant association of cancer of the colon with concomitant cholelithiasis (odds ratio = 2.42) but not with previous cholecystectomy. This correlation was more evident in female patients (odds ratio = 3.2), over 65 years of age (odds ratio = 3.6), with neoplasms in the right colon (odds ratio = 5). Observations suggest cholecystectomy has a protective role as regards an increased risk of cancer of the colon in cholelithiasic patients. A confirmation of this association might also be beneficial in terms of early diagnosis of cancer of the colon, thereby allowing identification of a large population of risk patients to be submitted to monitored screening.
By the term of local recurrence (LR), after apparently curative resection of a colorectal cancer, we mean the recurrence of the disease at the site of the original tumor, in correspondence to the regional lymph nodes or to intestinal anastomosis. The frequency of LR, which differs widely from one case to another because of the unhomogenity of the samples under examination, is on average around 16%, although this figure is to be considered an underestimation since it is not supported by routine autopsies. The authors analyse, together with the data in the literature, the results of their personal experience relating to 1164 patients undergoing surgery for colorectal cancer in the space of 18 years, in order to evaluate the true effectiveness of surgery on patients affected by LR. Surgery on the original tumor had a curative aim in 791 (68%) of these cases, 33 patients died during the postoperative period and 37 were lost to follow-up. Among the remaining 721 patients, recurrence was observed in 218 cases (30.2%): in 81 of these was confirmed a LR, with simultaneous distant metastasis in 45. During the same time span, 15 patients were admitted who were affected by LR from colorectal cancers treated surgically in other hospitals. Of these, only 2 had concomitant distant metastasis. 58 of these 96 patients (60.4%) underwent surgery, which had a curative aim in 22 cases (37.9%)/ Up to present, 12 patients undergoing curative surgery are still alive, 4 (33.3%) being affected by further relapse. The data reported demonstrate that in patients with proven LR surgical intervention is widely indicated, being the only therapeutic approach able to provide tangible results. However, the choice of exeresis must be carefully weighed: surgery of LR can be said to be truly curative in few cases, and thus the operative risks may not be acceptable in situations where limited results, in terms of duration and quality, are foreseen.
At the moment of surgical intervention, colorectal cancer involves adjacent tissues or organs in a percentage of cases ranging between 5% and 12%. "En bloc" resection of these tumors, when not associated with distant metastasis, allows survival at 5 years in from 32% to 79% of cases. The authors discuss their personal experience on the subject of extended resection for carcinoma of the large intestine, in order to evaluate not only the possible anatomico-clinical peculiarities but also both short and long term results. In the period from 1976 to 1993 1164 patients underwent surgery for colorectal cancer, in 791 cases (68%) with a curative aim. 71 patients underwent extended resection, in 59 cases for the curative treatment of a primary tumor and in 12 for the treatment of a local recurrence (LR). Pathologic examination revealed neoplastic infiltration into at least one of the organs removed with the tumor in 43 cases (61%). It must, however, be pointed out that the above frequency was considerably higher (92%) when extended resection was carried out for LR than in cases of exeresis of primary cancers (54%). The reported results show that extended resection leads to potentially higher morbidity and mortality than can be observed after standard resection, but that, at the same time, it proves to be the only treatment able to provide these patients with good prospects for fairly long-term survival. Recourse to this procedure must therefore always be out of necessity, furthermore the extension of demolition must be adapted to the operative finding.(ABSTRACT TRUNCATED AT 250 WORDS)
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BACKGROUND/AIMS: Duke's staging is still the most widely used parameter in the estimation of risk for local recurrence in patients with colorectal neoplasia. The aim of this study is to identify biological determinants that may be of use in segregating patients with similarly staged tumors into groups with different risk of local recurrence. METHODOLOGY: Ninety-eight patients who had undergone curative resection for colorectal cancer between 1989 and 1991 were prospectively studied. Statistical analysis of clinical and pathologic variables was carried out using a Cox multivariate proportional hazard model. RESULTS: Dukes stage and DNA ploidy were the only significantly predictive variables for local recurrence. In particular, the factors increasing local recurrence risk were seen to be the presence of lymph node metastases and aneuploid status. In the absence of both of these negative prognostic factors the risk of local recurrence is practically nil, in the presence of just one it reaches 16% and in the presence of both it rises to over 40%. CONCLUSIONS: The results of this study indicate that the presence of an aneuploid tumor with positive lymph nodes places patients at a higher risk of local recurrence, and calls for post-operative adjuvant therapy and intensive follow-up.