Biomedical subjects

P Bignami

Publications and source records attributed to P Bignami.

46 records · Page 3Linked to original sources

PubMedDate not supplied

Surgical strategies in colorectal cancer metastatic to the liver.

Surgical resection remains a milestone in the treatment of colorectal metastases to the liver. There is a distinct subset of patients who benefit from surgical resection in terms of longer survival or definitive cure. The main effort of the surgical oncological regards the safety of the procedure and the adequacy of the recommendation. Many studies, some of them including multivariate analysis, have shown the presence of prognostic determinants of long-term survival and prognostic indexes of the outcome after hepatectomy. It is now accepted that liver resection should be done when the complete excision of all demonstrable tumor with clear resection margins is feasible. Major contra-indication is represented by the presence of extra-hepatic intra-abdominal disease or of unresectable lung metastatic deposits. There is a wide literature indicating that in very selected patients liver reresection and multiorgan synchronous or metachronous resections are beneficial. The role of neoadjuvant chemotherapy and especially postoperative adjuvant local (intra-hepatic) and systemic chemotherapy is promising and supported by recent multicenter randomised clinical trials.

Chemotherapy, Adjuvant↗

PubMedDate not supplied

Prognostic effects of lymph node micrometastases in patients undergoing curative gastrectomy for cancer.

AIMS & BACKGROUND: It is not known whether the presence of micrometastases in the regional lymph nodes has an impact on the oncologic outcome of patients undergoing a curative (R0) gastrectomy for cancer. The aim of the study was to assess the effects of the presence of micrometastases on survival. METHODS: We reviewed 29 patients operated on for curative (R0) gastrectomy, with a final diagnosis of pN0, 16 or more lymph nodes in the specimen, and a follow-up of at least 4 years. The original hemotoxylin and eosin slides were reviewed, and a new section was cut from the lymph nodes and immunostained with a pool of antibodies against different types of cytokeratins. Micrometastases were detected in 5 patients (27.5% of the series) and 11 lymph nodes (1.51% of all removed lymph nodes). RESULTS: Mortality due to cancer progression occurred in 3 patients from the pN0 group (14.2%) and 1 patient from the pN1 group (12.5%). CONCLUSIONS: There was no suggestion from the data that the presence of micrometastases carries an ominous prognosis in terms of survival.

Disease Progression↗

PubMedDate not supplied

Feasibility of intraportal chemotherapy with fluorouracil and folinic acid immediately after hepatic resection for colorectal metastases.

BACKGROUND: About 50% of recurrence after resection of hepatic metastases from colorectal cancer remain confined to the liver. Adjuvant locoregional treatments could reduce the failure rate, but these treatments have been scantily investigated. Experimental models have shown that both intra-arterial chemotherapy (IAC) and intraportal chemotherapy (IPC) in adjuvant setting were able to reduce metastatic growth, but IPC should be initiated in the immediate postoperative period. AIMS: To evaluate the feasibility of immediate postoperative IPC of fluorouracil (5-FU) plus folinic acid (FA) in a consecutive series of patients undergoing hepatic resection for metastatic colorectal cancer. METHODS: Forty-three consecutive patients underwent hepatic resection. The first 25 (Control Group = CG) received only surgery; the latter 18 (Treated Group = TG) were candidate to postoperative IPC of 5-FU 750 mg/m2 plus FA 20 mg/m2/day continuous infusion for 8 days. One patient was not treated owing to bleeding, thus only 17 received the treatment. RESULTS: Postoperative morbidity was 14%, equally distributed in both groups. Biochemical hepatic parameters of TG were not statistically different from those of CG. Five patients (29%) developed systemic toxicity: one hematologic grade 4; 3 mucositis grade 3 and one allergic erythema. Three of these patients had been treated by systemic chemotherapy less than one year before. DISCUSSION: IPC of 5-FU plus FA in the immediate postoperative period has not yet been tested. The schedule we have investigated neither affected the postoperative outcome, nor influenced hepatic function and regeneration. Systemic toxicity was evident and severe mainly in patients already pretreated by systemic chemotherapy. In these patients, however, toxicity did not affect further outcome. This study confirms the feasibility of immediate intraportal chemotherapy after hepatic resection.

Adult↗

PubMedDate not supplied

[Principles of oncologic radicality in the surgical treatment of gastric carcinoma].

To date the basic guidelines in surgical oncology of the stomach may be summarized in the correct definition of "R0" exeresis (curative operation), but there is still much debate on which should practically be the extension of the gastric resection and which the kind of lymphatic dissection in order to fulfill all the criteria for a correct definition of "curative surgery". As regards the T factor, almost all Authors agree on the fact the a correct R0 gastric resection must include a tumor-free distal margin at least 6 cm from the superior edge of the neoplasm; a safe distal margin should be at least at 1 cm. below the pylorus. Provided that these principles are thoroughly observed, there is no oncologic advantage in performing a total gastrectomy instead of a sub-total gastric resection. Differently, as regards the N factor, there is no agreement on which kind of lymph nodal dissection shoul be routinely adopted: published reports on this subject are somewhat controversial and also whereas a systematic extended lymphadenectomy showed a possible statistical benefit in long term-survival, unacceptable morbidity rates discourage a diffuse application of extended lymphatic dissection out of dedicated; institutions. Anyhow, at the moment it is almost universally accepted that a minimum of 25 removed nodes are necessary for a correct and comparable staging of gastric cancer. At last, literature data do not support the routine use of splenectomy, with the only exception of those cases with documented lymph nodal enlargement at the splenic hilum.

Gastrectomy↗

PubMedDate not supplied

[D2 gastrectomy in the surgical treatment of gastric cancer].

The study is conducted on a series of 57 patients treated with D2 gastrectomy with curative intent for gastric cancer between January 2000 and December 2004, at Policlinico Multimedica (Milan). Postoperative mortality was 2%. Recurrence rate was 10%. The overall survival of the series is 36% at 4 years follow-up. Negative prognostic factors were: high grade tumor, locally advanced primary disease, presence of lymph node metastases, advanced stage of disease and recurrent disease at follow-up. The data of the study are comparable to those in the literature.

Adult↗

PubMedDate not supplied

[Intraperitoneal hyperthermic chemotherapy. Preliminary experience with 22 consecutive patients].

The study analyses the results of surgical treatment and intraperitoneal hyperthermic chemotherapy on a group of 22 patients, affected by peritoneal carcinomatosis of different origins, and treated at Policlinico Multimedica (Milan) between June 2001 and December 2004. Surgical major complications were present in the 23% of the patients, and post-operative mortality rate was 13%. None of the patients presented chemotherapy related toxicity. Six patients died within 2 and 40 months after surgery, while 13 are alive within 4 and 40 months after operation.

Adult↗

PubMedDate not supplied

Prognostic factors for survival and disease-free survival in hepatic metastases from colorectal cancer treated by resection.

The prognostic factors of 219 patients submitted to Ro hepatic resection for colorectal metastases have been statistically analyzed. The overall 5-year actuarial survival rate was 24% and the 5-year disease-free survival rate was 18%. At univariate analysis four variables resulted significant: 1) The stage of primary colorectal cancer: if the meserentic lymph nodes were metastatic (Dukes C) or uninvolved (Dukes B) 5-year survival was respectively 16 and 38% (p < 0.001). 2) The percentage of hepatic replacement: the 5-year survival rate of patients with H1 (< 25%), H2 (25-50%) and H3 (> 50%) was 27, 16 and 8% respectively (p < 0.001). 3) The number of metastases: the 5-year survival of patients with 1, 2-3, > 3 hepatic nodules was 29, 21 and 17% respectively (p < 0.05). 4) The extent of surgical resection: 5-year survival after minor and major resection was 28 and 18% respectively (p < 0.05). At multivariate analysis only stage of primary and percentage of hepatic replacement retained statistical significance. In 60% of 154 patients with recurrent disease the liver was again involved.

Analysis of Variance↗

PubMedDate not supplied

[Liver metastasis. Clinico-pathological prognostic factors in metastasis from colorectal cancer].

Hepatic Metastases (HM) from colorectal cancer represents one of the main problems of oncologic treatment: from 80 to 90 percent of patients undergo chemotherapy and a minority hepatic resection. The natural history of patients with unresectable HM has been recently investigated by uni and multivariate analyses; the percentage of hepatic replacement, the stage and grade of primary colorectal tumours, alkaline phosphatase and the presence of extrahepatic disease proved to be the most important independent prognostic factors. Albumin and carcino-embryonic antigen (CEA) levels, age and weight loss of patients were also prognostic. The groups of patients with more favourable factors had a median survival ranging from 21 to 35 months, in contrast to a median survival of 4 to 8 months for those with adverse factors. The outcome of more than 3400 patients submitted to hepatic resection, has been investigated. At multivariate analysis twelve variables resulted independently related to prognosis: stage of primary tumour, extent of liver involvement and presence of extrahepatic metastases were considered to be the most important. The knowledge of prognostic factors is extremely important in selecting patients candidated to various treatments, to interpret the results and to plan new therapeutic strategies.

Colorectal Neoplasms↗

PubMedDate not supplied

[Liver metastasis: therapeutic strategy].

The liver is one of the most frequent sites of metastatic growth, in particular from digestive malignancies (DM). The first goal is to reduce the incidence of metastases. Adjuvant systemic chemotherapies have been demonstrated to reduce the recurrence rate and to improve survival in Dukes C colon cancer. Fluorouracil is the pivot of adjuvant treatment modulated by Leucovorin or Levamisol. A short postoperative administration of fluorouracil by intraportal route has been tested, but the results are controversial. Adjuvant treatments for different DM are under investigation. When hepatic metastases are clinically evident, therapeutic decisions depend on several factors: site and nature of primary, extent of hepatic and extrahepatic disease, patient characteristics, efficacy of treatments. A staging system should be adopted to allow a rational approach. In selected cases a locoregional treatment can achieve consistent results. Hepatic Intrarterial Chemotherapy (HIAC) for colorectal metastases achieves objective responses in more than 50% of patients. Survival seems positively affected. When feasible, Ro hepatic resection is the most effective treatment, five-year survival rate being about 30% when metastases are from colorectal cancer. Since the liver is the most frequent site of recurrence after resection, repeat resection have been successfully performed.

Humans↗

PubMedDate not supplied

[Function and complications of diverse totally implantable systems for continuous intra-arterial infusion of FUdR in colorectal hepatic metastases].

Different totally implantable arterial infusion systems were compared in patients with liver metastases from colorectal cancer undergoing continuous intra-arterial infusion. Seventy-eight patients received continuous FUdR infusion using either totally implantable pumps (group a = 44 pts.) or ports fed by external portable pumps (group b = 34 pts.), and 57 patients received bolus infusion of Cisplatin (group c). Devices were cared for patency even after interruption of treatment, commonly caused by disease progression. Pocket problems most frequently occurred in group a (30%) compared to groups b (9%) and c (7%), whereas a higher incidence of catheter and infusion related problems was observed in group b (109%). System failure was recorded as a cause of interruption of treatment in two, 9, and 6 cases in groups a to c, respectively. The 12-months patency rate was 92% in group a, 24% in group b (median 9 months), and 65% in group c (median 17 months). Though implantable ports allow adequate infusion periods in most cases they seem more adequate for bolus infusions.

Aged↗