Avoiding early postoperative complications in liver surgery. A multivariate analysis of 254 patients consecutively observed.

Background: The number of hepatic resections for benign and malignant lesions has constantly increased over the past 20 years, as a consequence, surgical experience acquired over the past few years has decreased post-operative morbidity and mortality rates.

Aims: Analysing the relation between potential preoperative risk factors and the occurrence of severe post-operative complications, an attempt is made to identify the variables determining surgical risk in elective hepatic surgery both in normal and cirrhotic liver.

Patients And Methods: The hospital records of 254 patients who underwent elective liver surgical procedures for hepatic lesions in our department, between 1984 and 1999, were reviewed.

Surgery: independent prognostic factor in curable and far advanced gastric cancer.

The hospital records of 639 patients affected by primary gastric cancer who were consecutively admitted to our unit during the period 1981-1995 were reviewed. Overall 220 underwent total gastrectomy (38 palliative), 12 had resection of the gastric stump, 195 had distal subtotal gastrectomy (55 palliative), 78 had bypass procedures, 72 had explorative laparotomy, and 62 had no operation. Univariate and multivariate analyses were used to evaluate 5-year survival with respect to the main clinical, pathologic, and treatment variables after both curative and palliative treatments.

Primary retroperitoneal soft tissue sarcomas: results of aggressive surgical treatment.

A retrospective study was undertaken to evaluate the results of surgical treatment in a series of patients with primary retroperitoneal sarcomas consecutively treated by the same surgical team. The hospital records of 42 patients with primary retroperitoneal sarcomas who underwent surgical exploration at our unit from 1984 to 1995 were reviewed. A univariate analysis was used to identify the main clinical, pathologic, and treatment-related factors affecting long-term survival.

Survival in early gastric cancer: multivariate analysis on 72 consecutive cases.

Background/aims: Few reports from the Western hemisphere have investigated the impact of pathological features and surgical modalities on the prognosis of patients affected by early gastric cancer (EGC). In particular, the extent of lymphadenectomy (limited vs. extended) and the type of gastric resection (subtotal vs.

Structured versus long-chain triglycerides: a safety, tolerance, and efficacy randomized study in colorectal surgical patients.

Background: After trauma or surgery, researchers have suggested that medium-chain triglycerides have metabolic advantages, although they are toxic in large doses. To try to reduce this potential toxicity, structured lipids, which provide a higher oxidation rate, faster clearance from blood, improved nitrogen balance, and less accumulation in the reticuloendothelial system, could be used. Therefore, we evaluated, through a blind randomized study, the safety, tolerance, and efficacy of structured triglycerides, compared with long-chain triglycerides (LCT), in patients undergoing colorectal surgery.

Accurate lymph-node detection in colorectal specimens resected for cancer is of prognostic significance.

Purpose: Lymph-node involvement is the most important prognostic factor in colorectal cancers. Many staging systems adopted node status as a parameter of tumor classification. However, the number of identified and positive glands varies across articles, depending on specimen examination.

Palliative surgery for far-advanced gastric cancer: a retrospective study on 305 consecutive patients.

Few reports of the Western countries have investigated the value of palliative surgery for stomach cancer. The aim of this study was to evaluate the results of palliative surgery in a large series of patients affected by gastric carcinoma, consecutively treated by the same surgical team. The hospital records of 305 patients affected by gastric cancer who did not undergo surgical treatment or who underwent a palliative surgical procedure at our unit between 1981 and 1995 were reviewed.

Radiotherapy, local control and survival in carcinomas of the exocrine pancreas.

Local recurrence affects approximately 50% of patients undergoing surgery for pancreatic adenocarcinoma. To lower the incidence of locoregional recurrence, the combination with surgery of adjuvant radiotherapy has been proposed. The latter is based on external radiotherapy (ERT), intraoperative radiotherapy (IORT) or their combination.

Extensive resection in pancreatic cancer: review of the literature and personal experience.

Background/aims: The surgical treatment of pancreatic carcinoma, and particularly the decision to resect locally advanced non-metastatic cancer is extremely controversial. The aim of this study is to report our experience in extensive pancreatectomy and draw conclusions regarding its effectiveness in treating locally advanced pancreatic cancer.

Methodology: In our Department of Surgery, 12 patients underwent pancreatic resective surgery extended to the portal vein (6 cases), to the superior mesenteric vein (1 case) or to other peripancreatic organs (5 cases).

Transfusion timing and postoperative septic complications after gastric cancer surgery: a retrospective study of 179 consecutive patients.

Background: Immunosuppression associated with homologous blood transfusion was first observed in renal allograft transplantation. Clinical effects of transfusion-induced immunosuppression in surgical patients have been debated in the literature for more than a decade with contradictory results.

Objective: To investigate whether homologous blood transfusions significantly affect postoperative septic morbidity and mortality in patients undergoing elective surgery for gastric cancer.

Quantitative analysis of basic fibroblast growth factor and vascular endothelial growth factor in human colorectal cancer.

Tumour growth is angiogenesis dependent. Some authors suggest a prognostic role of microvessel count in colorectal cancer. We tested the role of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) in the switch to the angiogenic phenotype in 35 patients with colorectal cancer at different stages of disease.

Prognostic factors in differentiated thyroid carcinoma: a multivariate analysis of 234 consecutive patients.

Background And Objectives: The clinical characteristics and patient outcome of a group of patients treated for differentiated thyroid carcinoma (DTC) were analyzed in order to assess the relative influence of different prognostic factors.

Materials And Methods: We retrospectively reviewed data about sex, age, size and histologic behavior of the tumor, extrathyroid extension of the tumor, lymph node status, distant metastasis at diagnosis, surgical procedures, and overall survival from 234 patients treated for DTC. Data were submitted to a statistical analysis.

Prognostic factors in colorectal cancer. Literature review for clinical application.

Purpose: Identification of prognostic factors is a primary basis for planning the treatment and predicting the outcome of patients with colorectal cancer. Reviewing studies from the literature performed using univariate and multivariate analyses and their own study, the authors critically discuss the prognostic value of the clinicopathologic parameters of the tumor.

Methods: Among 853 patients with colorectal tumors seen at the Department of Clinical Surgery of the Catholic University of Rome, Italy, 690 cases that were curatively resected the study.

CMF + radiotherapy in the primary treatment of operable breast cancer: preliminary results of a phase II pilot study.

Background And Objectives: Chemotherapy and radiotherapy have been investigated in several studies about their role in primary (neoadjuvant) treatment before surgery in breast cancer. We proposed a pilot study to evaluate a primary scheme of alternate radio-chemotherapy in the treatment of operable (T2- small T3) breast cancer.

Methods: 14 patients were recruited.

Adrenal cystic lesions: report of 12 surgically treated cases and review of the literature.

Adrenal cysts are rare (0,064%-0,18% in autopsy series) and less than 500 cases have been reported in the western literature. Incidental diagnosis of adrenal cysts, however, is reported with increasing rates. We observed 12 patients with adrenal cyst.

Assessment of risk factors for pancreatic resection for cancer.

A series of 101 consecutive patients undergoing pancreatic resection for cancer was retrospectively analyzed to define factors that may affect the immediate postoperative outcome. Overall morbidity and mortality were 28.7% and 10.

Integrated radiosurgical treatment of resectable pancreatic head carcinoma.

Thirty-six patients with pancreatic head carcinoma entered a protocol, but only 20 were suitable for resection and evaluation of long-term survival. They were nine males and 11 females, with a mean age of 64.3 years.

Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma.

Background: Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series.

Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: immediate and medium-term results.

Background: Obstruction of the main pancreatic duct with upstream hypertension and dilation is a cause of pain in patients with chronic pancreatitis. Pancreatic ductal drainage can be achieved endoscopically by intraductal stone removal after endoscopic pancreatic sphincterotomy and/or by insertion of a pancreatic stent. Extracorporeal shock wave lithotripsy may be needed whenever stones cannot be removed by endoscopic procedures.

Solitary necrotic nodule of the liver: diagnosis and treatment.

In 1983, Shepherd and Lee described the solitary necrotic nodule of the liver, an uncommon non-malignant lesion with a characteristic histological appearance. This nodule can often be misinterpreted as a necrotic secondary tumour. Limited liver resection can make differential diagnosis and cure the lesion.

Tension-free hernioplasty: technical remarks and personal experience.

The authors report their experience with 463 tension free hernioplasty procedures for inguinal and femoral hernias. The surgical technique included the insertion of both a polypropylene plug and a polypropylene mesh, and was carried out mostly in local anesthesia (84.2%) using bupivacaine 0.

Radical surgery for liver hydatid disease: a study of 89 consecutive patients.

Background/aims: This study was designed to evaluate the effectiveness of radical surgery for liver hydatid disease.

Materials And Methods: Hospital charts of 104 consecutive patients with liver hydatidosis observed in our unit during the period 1982-1994 were reviewed. A total of 121 cysts in 89 patients were treated surgically: with cystopericystectomy in 66 and liver resection in 23.

Modified Hill operation vs. Nissen fundoplication in the surgical treatment of gastro-esophageal reflux disease.

Background/aims: The authors compared the results of the Nissen fundoplication technique with the results of the Hill procedure, by using a 10-year history of patients with gastro-esophageal reflux disease.

Materials And Methods: Seventy two consecutive patients entered the study, 32 of whom underwent a 360 degrees fundoplication according to Nissen and 40 with a modified Hill operation. In the Nissen Group, intraoperative manometry (IOM) was carried out in all patients; in the Hill Group, the patients were randomized in two sub-groups (A and B), before operation; in 20 of them (group A), the procedure was randomly associated to IOM.