Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis

BACKGROUND AND OBJECTIVES

Anterior rectal resection (ARR) represents one of the most frequently performed methods in colorectal surgery, mainly carried out for rectal cancer (RC) treatment. Defunctioning ileostomy (DI) has long been chosen as a method to "protect" colorectal or coloanal anastomosis after ARR. However, DI does not rule out risks of more or less serious complications. A proximal intra-abdominal closed-loop ileostomy, the so-called virtual/ghost ileostomy (VI/GI), could limit the number of DIs and the associated morbidity.

MATERIALS AND METHODS

We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Meta-analysis was performed by use of RevMan [Computer program] Version 5.4.

RESULTS

The five included comparative studies (VI/GI or DI) covering an approximately 20-year study period (2008-2021). All included studies were observational ones and originated from European countries. Meta-analysis indicated VI/GI as significantly associated with lower short-term morbidity rates related to VI/GI or DI after primary surgery (RR: 0.21, 95% CI: 0.07-0.64, p = 0.006), fewer dehydration (RR: 0.17, 95% CI: 0.04-0.75, p = 0.02) and ileus episodes after primary surgery (RR: 0.20, 95% CI: 0.05-0.77, p = 0.02), fewer readmissions after primary surgery (RR: 0.17, 95% CI: 0.07-0.43, p = 0.0002) and readmissions after primary surgery plus stoma closure surgery (RR: 0.14, 95% CI: 0.06-0.30, p < 0.00001) than the DI group. On the contrary, no differences were identified in terms of AL after primary surgery, short-term morbidity after primary surgery, major complications (CD ≥ III) after primary surgery and length of hospital stay after primary surgery. Conclusions: Given the significant biases among meta-analyzed studies (small overall sample size and the small number of events analyzed, in particular), our results require careful interpretation. Further randomized, possibly multi-center trials may be of paramount importance in confirming our results.

Treatment of postoperative jejunal intussusception in adult with oral gastrografin after laparoscopic low rectal resection. A case report

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Intussusception is a rare cause of postoperative small bowel obstruction in adult and the treatment is still debated.

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Bowel Intussusception should be kept in mind in a post operative patient who develops obstructive symptoms.

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The time of diagnosis makes the difference between surgical treatment and others.

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Abdominal CT have a good accuracy in diagnosis.

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Surgery is necessary if peritoneal irritation is present. Otherwise, conservative treatment is considered.

Introduction

Postoperative intussusception is a rare cause of intestinal obstruction in adults. Intussusception refers to a condition in which a segment of the intestine invaginates into the lumen of an adjacent segment of the intestine.

Presentation of case

We report a case of postoperative jejunojejunal intussusception in a 42-year-old male following a laparoscopic low anterior resection for rectal cancer. In post-operative day (POD) 2 the patient showed intermittent bowel obstruction and fever. Diagnosis was established with abdominal computed tomography (CT) and enteroclysis, which led to a spontaneous reduction of the invagination.

Discussion

The incidence of intussusception in adults is rare condition. It represents less than 5% of all cases. In adults, transient asymptomatic enteric intussusception often resolves spontaneously without any treatment. When bowel obstruction is complete and persistent, surgery is need. Intussusception as cause of intestinal obstruction should be kept in mind in a post operative patient who develops obstructive symptoms. Early diagnosis makes the difference between surgical and others treatment. The pathogenesis and diagnosis of postoperative intussusception in the adult is discussed in the case report.

Conclusion

The authors presented a rare cause of postoperative small bowel obstruction treated without surgery. The peculiarity of this case report is that the authors have successfully used, in an adult, conservative treatment with gastrografin, which is the treatment of choice used in children. The use of gastrografin was decisive and there were no recurrences in the follow up.

Next-generation sequencing analysis of receptor-type tyrosine kinase genes in surgically resected colon cancer: identification of gain-of-function mutations in the RET proto-oncogene

BACKGROUND

Improvement in genetic characterization of Colon Cancer (CC) patients is required to propose new potential targets, since surgical resection coupled to chemotherapy, presents several limits such as cancer recurrence and drug resistance. Targeted therapies have more efficacy and less toxicity than standard treatments. One of the most relevant cancer-specific actionable targets are receptor tyrosine kinases (RTKs) whose role in CC need to be better investigated.

METHODS

We have analysed 37 CC patients using the Ion AmpliSeq™ Comprehensive Cancer Panel (CCP). We have confirmed the somatic nature of RET variants through Sanger sequencing and assessed RET activation status and protein expression by immunofluorescence and western-blot analyses. We have used RET mutant expression vectors to evaluate the effect of selected mutations in HEK293 cells by performing proliferation, migration and clonogenic assays.

RESULTS

Among the 409 cancer-related genes included in the CCP we have focused on the RTKs. Overall, we have observed 101 different potentially damaging variants distributed across 31 RTK genes in 28 patients. The most frequently mutated RTKs were FLT4, ROS1, EPH7, ERBB2, EGFR, RET, FGFR3 and FGFR4. In particular, we have identified 4 different somatic variants in 10% of CC patients in RET proto-oncogene. Among them, we have demonstrated that the G533C variant was able to activate RET by promoting dimer formation and enhancing Y1062 phosphorylation. Moreover, we have demonstrated that RET G533C variant was able to stimulate anchorage-dependent proliferation, migration and clonogenic cell survival. Notably, the effects induced by the RET G533C variant were abolished by vandetanib.

CONCLUSIONS

The discovery of pathogenic variants across RTK genes in 75% of the CC patients under analysis, suggests a previously underestimated role for RTKs in CC development. The identification of a gain-of-function RET mutation in CC highlights the potential use of RET in targeted therapy.

Solid pancreatic pseudopapillary tumor managed laparoscopically: A case report and review of the literature

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Solid pancreatic pseudopapillary tumors are a rare neoplasms with not well known pathogenesis.

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Imaging is not able to provide a precise diagnostic orientation. The essential role is played by surgery and histological examination.

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Immunohistochemistry shows a possible correlation between the Beta-catenin mutations or alteration of the E-cadherin and tumor development.

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Laparoscopic technique has proven to be the gold standard for the countless advantages found compared to the open technique.

Background

Solid pancreatic pseudopapillary tumors are a rare neoplasms, about 1–3% of all pancreatic neoplasms. This cancer mainly affects women between the third and fourth decade of life.

They are not well known; the molecular origins represent a low degree of malignancy, in which the complete resection is curative. We report our experience with a case report of SPT in a young man.

Presentation of case

Thirty-six years old male patient with a mass about 10 cm in the pancreatic tail and splenic ilum. After following CT and MR, the patient was subjected to surgery. Histophatological result was solid tumor pseudopapillary of pancreas with no pathological lymph nodes.

Discussion and conclusion

Solid pseudopapillary neoplasm shows histological characteristic solid and pseudopapillary proliferation. Immunohistochemistry detects, among the causes of tumor development, a correlation between the Beta-catenin mutations, alteration of the E-cadherin. In the most cases, therapy is surgical treatment with laparoscopic.

Irreversible electroporation for locally advanced pancreatic cancer through a minimally invasive surgery supported by laparoscopic ultrasound

INTRODUCTION

Pancreatic cancer is one of the most lethal cancers worldwide, with 5-years survival rate as low as 6%. The majority of pancreatic cancer patients present locally advanced or metastatic disease at diagnosis. Typically, patients affected by locally advanced pancreatic cancer (LAPC) do not undergo radical surgery but are treated with focal ablative therapies. However, a high rate of morbidity due to the heat sink effect has limited the application of ablative techniques on a routine basis in LAPC patients. Irreversible electroporation (IRE) has proved to be a new method of LAPC ablation.

PRESENTATION OF THE CASE

A 69-year-old woman affected by LAPC with good response to systemic chemotherapy with FOLFIRINOX and residual 35 mm mass in the neck of the pancreas underwent to IRE through a minimally invasive surgical approach under laparoscopic ultrasound guide. The post-operative course was uneventful and the patient was discharged after 5 days. Six months after surgery she had no evidence of distant or recurrent disease.

DISCUSSION

IRE has previously shown promising results in the treatment of LAPC, with relatively acceptable morbidity rates and improvement of survival. We report on the application of IRE through a minimally invasive surgical approach supported by laparoscopic ultrasound.

CONCLUSION

In conclusion, we propose a novel technical approach that combines the benefits of IRE on the treatment of patients affected by LAPC with the advantages of laparoscopic surgery.

Surgical approach to right colon cancer: From open technique to robot. State of art

This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical, oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary. Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.

Preoperative Predictive Factors of Successful Weight Loss and Glycaemic Control 1 Year After Gastric Bypass for Morbid Obesity

BACKGROUND

Gastric bypass (GBP) is one of the most effective surgical procedures to treat morbid obesity and the related comorbidities. This study aimed at identifying preoperative predictors of successful weight loss and type 2 diabetes mellitus (T2DM) remission 1 year after GBP.

METHODS

Prospective longitudinal study of 771 patients who underwent GBP was performed at four Italian centres between November 2011 and May 2013 with 1-year follow-up. Preoperative anthropometric, metabolic and social parameters, the surgical technique and the previous failed bariatric procedures were analyzed. Weight, the body mass index (BMI), the percentage of excess weight lost (% EWL), the percentage of excess BMI lost (% BMIL) and glycated haemoglobin (HbA1c) were recorded at follow-up.

RESULTS

Univariate and multivariate analysis showed that BMI <50 kg/m(2) (p = 0.006) and dyslipidaemia (p = 0.05) were predictive factors of successful weight loss. Multivariate analysis of surgical technique showed significant weight loss in patients with a small gastric pouch (p < 0.001); the lengths of alimentary and biliary loops showed no statistical significance. All diabetic patients had a significant reduction of HbA1c (p < 0.001) after surgery. BMI ≥ 50 kg/m(2) (p = 0.02) and low level of preoperative HbA1c (p < 0.01) were independent risk factors of T2DM remission after surgery.

CONCLUSIONS

This study provides a useful tool for making more accurate predictions of best results in terms of weight loss and metabolic improvement.

Intestinal infarction by internal hernia in Petersen’s space after laparoscopic gastric bypass

Intestinal occlusion by internal hernia is not a rare complication (0.2%-5%) after Laparoscopic Roux-en-Y-GBP (LGBP) with higher morbidity and mortality related to mesenteric vessels involvement. In our Center, from October 2009 to April 2013 we have had 17 pts treated for internal hernia on 412 LGBP (4.12%). Clinical case: 28-year-old woman, operated of LGBP (BMI = 49; co-morbidity: diabetes mellitus and arthropathy) about 10 mo before, was affected by recurrent abdominal pain with alvus alteration lasting for a week. After vomiting, she went to first aid Unit of a peripheric hospital where she made blood tests, RX and US of abdomen that resulted normal so she was discharged with flu like syndrome diagnosis. After 3 d the patient contacted our Center since her symptoms got worse and was hospitalized. Blood tests showed an alteration of hepatic enzymes and amylases. The abdominal computed tomography (CT) showed the presence of fluid in peri-splenic, peri-hepatic areas and in pelvis and a “target like imagine” of “clustered ileal loops” with a superior mesenteric vein (SMV) thrombosis involving the Portal Vein. During the operation, we found a necrosis of 80 cm of ileus (about 50 cm downstream the jejuno-jejunal anastomosis) due to an internal hernia through Petersen’s space causing a SMV thrombosis. The necrotic bowel was removed, the internal hernia was reduced and Petersen’ space was sutured by not-absorbable running suture. An anticoagulant therapy was begun in the post-operative time and the patient was discharged after 28 d. Conclusions: The internal hernia diagnosis is rarely confirmed by preoperative exams and it is obtained in most cases by laparoscopy but the improvement of technologies and the discover of “new” CT signs interpretation can address to an early laparoscopic treatment for high suspicion cases.

Laparoscopic total mesorectal excision for extraperitoneal rectal cancer: long-term results of a 18-year single-centre experience

BACKGROUND AND OBJECTIVES

The oncologic efficacy of laparoscopic total mesorectal excision (TME) for middle-low rectal cancer is still under discussion because of the few long-term data. This study reports the results arising from a single-institution experience during a 18-year period.

METHODS

Data about 132 consecutive laparoscopic TME performed between January 1994 and January 2012 were analysed with Kaplan-Meier method and a uni- and multi-variate analysis was conducted to define independent survival predictors.

RESULTS

A total of 116 sphincter-preserving operations and 16 abdominoperineal resections were performed. Postoperative mortality and morbidity were 0.8 and 18.2%, with a rate of anastomotic leakage of 13.8%. Average follow-up was 85.9 months (range 13-210). Actuarial local recurrence rate was 4.13% at 5 years (any pelvic recurrence developed after 3 years from surgery). Overall and disease-free survival was respectively 83 and 79.8% at 5 years, 71 and 73% at 10 years and then remained constant until 18 years. Survival was correlated only to tumour stage and the type of surgery.

CONCLUSIONS

Laparoscopic TME for extraperitoneal rectal cancer shows long-term oncologic outcomes similar to open rectal resections.

Laparoscopic surgery for colon cancer

Colon cancer is a major problem in Western countries and complete surgical resection is the main treatment. Since its introduction the laparoscopic approach has been used to achieve bowel resection with a better postoperative course and better aesthetic outcomes. Initial concerns about the radicality of the resection and the oncologic outcomes have been overcome in the last decade. All over the world large trials have been conducted to compare the laparoscopic approach and the traditional laparotomic one. A review of literature has been conducted to find evidence about this issue, revealing 24 relevant trials. The laparoscopic approach showed short-term benefits without compromising oncological safety. However intraoperative complication rates during laparoscopic colon resections seem to be increased, mainly due to the increased rate of intraoperative bowel injury. This finding confirms a great need for training and a wide learning curve for the surgeon. Our review supports the continued use of laparoscopic surgery in patients with colon cancer.

Laparoscopic gastrectomy for treatment of advanced gastric cancer: preliminary experience on 38 cases

AIM

In the last 20 years the laparoscopic surgery rapidly and successfully diffused for the treatment of benign diseases and recently also for the treatment of malignancy; newerteless, the laparoscopic gastrectomy for gastric cancer is still controversial, in relation to extreme difficulty of a radical surgical resection performing with an accurate lymphadectomy. The authors present a surgical experience of patients affected by advanced gastric cancer who underwent total or subtotal gastrectomy with videoassisted or entirely laparoscopic technique in order to evaluate the safety, feasibility, advantages and limits of this surgical approach.

METHODS

between January 2002 and August 2007 we performed 40 laparoscopic procedure for advanced gastric cancer; of these, 38 (95%) patients underwent a laparoscopic gastric resection and 2 (5%) patients underwent a palliative surgical treatment (laparoscopic gastro-entero-anastomosis). In the 38 patients which underwent laparoscopic gastrectomy, the anatomical localization of cancer, ASA score, pTNM classification, type of surgical laparoscopic technique (videoassisted or entirey laparoscopic technique), mean number of lymph nodes harvested, mean operative time, rate of conversion, postoperative morbidity and mortality and rate of local recurrence at 24 mounths follow-up were retrospectively analyzed.

RESULTS

Thirty-eight laparoscopic gastrectomies for gastric cancer were performed: in relation to surgical technique, 4 (10.5%) of these were video-assisted gastric resection (left subcostal minilaparotomy and extracorporeal anastomosis) and 34 (89.5%) were entirely laparoscopic gastrectomy; regarding to extension of surgical resection, there were 16 (42%) total D2 gastrectomies and 22 (58%) subtotal gastrectomies, of which 19 D2 gastrectomy and 3 D1 gastrectomy. Regarding the ASA score, 23% of patients were in ASA I, 52% in ASA II, 25% in ASA III. The mean operative time was 225 minutes (range 160-285) for total gastrectomy and 183 minutes (range 70-270) for subtotal gastrectomy. Overall, on 38 laparoscopic gastric resection, the conversion rate was 7.8% (3 patients). The number of lymph nodes harvested was 28 (range 5-53). No major intraoperative complications were observed. Overall morbidity was 31.5% (12 patients); the rate of postoperative surgical complications was 8% (3 patients). One patient (2.6%) dead for a sepsis subsequent to leak of esophagojejunal anastomosis. Mean hospital stay was 16 days for total gastrectomies and 12 days for subtotal gastrectomies. Three cases (7.9%) of cancer recurrence were observed in 3 patients (2 patiens UICC IIIa, one patient UICC IIIb) at 20th, 23th, 24th postoperative month and one case (2.6%) of peritoneal carcinosis at 18th month. No port-site metastasis were observed at 24-month follow-up.

CONCLUSIONS

On the basis of this surgical preliminary experience, laparoscopic gastrectomy for malignancy resulted a technically safe surgical procedure if performed by an advanced laparoscopic surgical team, with additional benefits, time to resumption of oral intake, morbidity rate, and acceptance from patients. A radical laparoscopic gastrectomy via laparoscopic approach is advisable until UICC stage II, in patients with ASA score I-III and minimal endoabdominal adhesion. The safe and efficacy of laparoscopic treatment in locoregional limph nodes dissection is still controversial. However, long-term results of prospective and comparative trials will be necessary to show the real oncologically benefits of laparoscopic approach.

Laparoscopic resection of duodenal gangliocytic paraganglioma. A case report

Paraganglioma is an exceedingly rare tumour of the duodenum that arises in close proximity to the ampulla of Vater. To date a total of 133 cases of duodenal paraganglioma have been reported in the literature; of these, 27 (20%) were histologically gangliocytic paragangliomas. This neoplasm generally behaves in a benign fashion, although instances of recurrence and/or lymph node metastasis have been described. The treatment consists in endoscopic polypectomy or surgical resection in relation to the histological features and the macroscopic extent of the neoplasm. We present a case of a benign duodenal gangliocytic paraganglioma treated by a laparo-endoscopic approach. We report a case of gangliocytic paraganglioma in a 75-year-old woman admitted to the General Surgery Division of Aosta Regional Hospital (Aosta-Italy), complaining of melaena and anaemia. Upper gastrointestinal endoscopy followed by enteroscopy with a video-capsula, revealed a pedunculated neoplasm in the second portion of the duodenum, with ulceration of the overlying mucosa. Multiple biopsies were performed during the endoscopic examination and showed the cellular pattern of benign paraganglioma. After stabilisation of the patient's clinical status, we performed a resection of the neoplasm via a laparoscopic transduodenal approach and a concomitant intraoperative duodenoscopy. The histological features showed a gangliocytic paraganglioma without a malignant cell pattern. The size of the neoplasm was 4 cm. The resection margins were free of neoplastic infiltration. The postoperative stay was 9 days and there were no intraoperative or postoperative complications. The patient is currently in good health without any tumour recurrence. Transduodenal laparoscopic resection with intraoperative duodenoscopy is a valuable treatment for benign gangliocytic paraganglioma of the duodenum which is unresectable by upper gastrointestinal endoscopy. This approach affords the advantages of the minimally invasive technique and fulfils the surgical tenets of the open transduodenal approach, if en bloc resection of the neoplasm with the adjacent duodenal wall is performed.

Laparoscopic approach to morbid obesity: personal experience of 250 gastric bypasses. Analysis of different techniques and results

AIM

Severe obesity is a major health problem affecting more than 1,000,000 people in Italy, with a 95% failure rate of nonsurgical treatments. We report our over five-years experience with laparoscopic Roux-en-Y gastric bypass (LRYGBP), evaluating the postoperative course of the patients undergoing 3 different gastro-esophageal anastomosis technique: Gagner procedure (87 cases) (34.8%), the purse-string approach (93 cases) (37.2%), robotic-assisted gastric bypass (68 cases) (27.2%) and by laparoscopic hand sewn anastomosis (2 cases) (0.8%).

METHODS

Between October 2000 and February 2006, we performed LRYGBP on 250 patients (77 male and 173 female aged from 16 to 65 years [mean age 43.1 years] and with an average body mass index of 51.1 kg/m(2) [35-99]). Comorbidities were: hypertension, type II diabetes, hyperlipemia, osteoarthritis, chronic restrictive pulmonary insufficiency, sleep apnea, deep venous thrombosis.

RESULTS

The mean operative time was 142.3 min (80-420) with a mean hospitalization of 9.8 days (5-44). Eighteen major complications were recorded. There were no deaths. The mean percent excess body weight loss was 47.2+/-18.2% after 1 year (212 patients), 66.2+/- 19.4% after 2 years (178 patients), 78.2+/-12.4% after 3 years (139 patients), 80.6+/-11.7% after 4 years (101 patients), and 82.5+/-10.2% after 5 years (67 patients). Nearly all of the comorbidities were solved or improved. Bariatric analysis and reporting outcome system results after 5 years were excellent, good or fair in 100% of the subject evaluated.

CONCLUSIONS

Although requiring the skill of an expert surgeon, LRYGBP is one of the most effective procedure available today to induce long-term weight loss, with limited nutritional risks and better prospects for improved quality of life.

Laparoscopic gastric bypass performed with the Da Vinci Intuitive Robotic System: preliminary experience

BACKGROUND

This study aimed to analyze retrospectively the authors' preliminary experience using the Da Vinci Intuitive Robotic System for gastric bypass in managing morbid obesity, and to determine its efficacy and safety in relation to other standardized laparoscopic surgical techniques.

METHODS

From October 2000 to March 2004 the authors performed 146 laparoscopic gastric bypasses, 17 of which were robot assisted using the Da Vinci Intuitive Robotic System. The last patients were 7 men and 10 women with a mean age of 44 years. The mean weight was 139 kg, and the mean body mass index (BMI) was 49.8 kg/m at first postoperative recovery. The mean excess body weight (EBW) was 131%. Follow-up assessment, performed at months 1, 3, 6, and 12, then yearly thereafter, included evaluation of the variations in BMI and the percentage of excess body weight loss (EBWL%). All the patients were informed of the risks inherent with each surgical procedure as well as the potential benefits.

RESULTS

The mean operative time was 201 min (range, 90-300 min). No intraoperative complications and no conversion occurred in this series. The mean hospital stay was 9 days (range, 6-18 days). The patients in this series experienced a normal postoperative course without anastomotic complications. The mortality rate was zero. No robot-related complications were noted. The analysis of follow-up assessment at months 1, 3, 6, and 12 showed a progressive decrease in BMI and an increment of EBWL%.

CONCLUSIONS

The authors' early experience with robotic surgery suggests that it is safe and could be an effective alternative to conventional laparoscopic surgery. The authors believe that robotic surgery, with its ability to restore the hand-eye coordination and three-dimensional view lost in laparoscopic surgery, could allow complex procedures to be performed with greater precision and better results.

[Antithrombotic prophylaxis in day surgery: proposal of a clinical protocol]

The considerable diffusion of the day surgery has new problems such as the use of antithrombotic prophylaxis, now carried out systematically in major surgery. An the basis of the poor data present in the literature, a protocol of study is proposed to evaluate the real effectiveness of this type of prophylaxis in DS, dividing the patients into 3 groups, according to the patient's risk factors to the intervention and to the disease.

[The timing in differential diagnosis of cystic tumors of the pancreas: clinical report of three cases of cystadenocarcinoma]

The Authors analyze their own twelve-years experience about the Cystic Tumors of the Pancreas, considering the data existing in the literature. In particular, after a description of anatomo-pathological and clinical characteristics, they set out the problems in the differential diagnosis between the Cystadenocarcinomas and the other benign cystic lesions of the Pancreas. The solution of this problem is often reached only during the operation with multiple biopsies. Moreover they pay attention to the therapeutic choices, determined by the symptomatology of the patients and the localization and the histological kind of the lesions.

[A case of anaplastic thyroid carcinoma]

The Authors report a case of anaplastic thyroid carcinoma surviving more than 20 months from the time of diagnosis and still living. The patient underwent surgery (total thyroidectomy), chemotherapy (cisplatin and doxorubicin according to Schlumberger), and radiotherapy (5000 Gy).