1
|
Brandl A, Lundon D, Lorenzon L, Schrage Y, Caballero C, Holmberg CJ, Santrac N, Smith H, Vasileva-Slaveva M, Montagna G, Bonci EA, Sgarbura O, Sayyed R, Ben-Yaacov A, Herrera Kok JH, Suppan I, Kaul P, Sochorova D, Vassos N, Carrico M, Mohan H, Ceelen W, Arends J, Sandrucci S. Current practice in assessment and management of malnutrition in surgical oncology practice - An ESSO-EYSAC snapshot analysis. Eur J Surg Oncol 2023:S0748-7983(23)00542-5. [PMID: 37429796 DOI: 10.1016/j.ejso.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Malnutrition is common in patients suffering from malignant diseases and has a major impact on patient outcomes. Prevention and early detection are crucial for effective treatment. This study aimed to investigate current international practice in the assessment and management of malnutrition in surgical oncology departments. MATERIAL AND METHODS The survey was designed by European Society of Surgical Oncology (ESSO) and ESSO Young Surgeons and Alumni Club (EYSAC) Research Academy as an online questionnaire with 41 questions addressing three main areas: participant demographics, malnutrition assessment, and perioperative nutritional standards. The survey was distributed from October to November 2021 via emails, social media and the ESSO website to surgical networks focussing on surgical oncologists. Results were collected and analysed by an independent team. RESULTS A total of 156 participants from 39 different countries answered the survey, reflecting a response rate of 1.4%. Surgeons reported treating a mean of 22.4 patients per month. 38% of all patients treated in surgical oncology departments were routinely screened for malnutrition. 52% of patients were perceived as being at risk for malnutrition. The most used screening tool was the "Malnutrition Universal Screening Tool" (MUST). 68% of participants agreed that the surgeon is responsible for assessing preoperative nutritional status. 49% of patients were routinely seen by dieticians. In cases of severe malnutrition, 56% considered postponing the operation. CONCLUSIONS The reported rate of malnutrition screening by surgical oncologists is lower than expected (38%). This indicates a need for improved awareness of malnutrition in surgical oncology, and nutritional screening.
Collapse
Affiliation(s)
- Andreas Brandl
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany.
| | - Dara Lundon
- Mount Sinai Department of Urology, New York, United States
| | - Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Carl Jacob Holmberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Nada Santrac
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Henry Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Denmark
| | | | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduard-Alexandru Bonci
- Surgical Oncology and Gynecologic Oncology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Olivia Sgarbura
- Department of Surgical Oncology, Institut du Cancer Montpellier, University of Montpellier, France
| | - Raza Sayyed
- Department of Surgical Oncology, Patel Hospital, Karachi, Pakistan
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Ina Suppan
- Breast Center, Department of Gynaecology, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - Pallvi Kaul
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Dana Sochorova
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marta Carrico
- Nutrition Department - Champalimaud Foundation, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Helen Mohan
- Peter MacCallum Cancer Centre in Melbourne, Australia
| | - Wim Ceelen
- Department of GI Surgery and Cancer Research Institute Ghent (CRIG), Ghent University Hospital, Belgium
| | - Jann Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | |
Collapse
|
2
|
Braga M, Sandrucci S. The evolution of nutritional care in surgical oncology. Eur J Surg Oncol 2023:S0748-7983(23)00376-1. [PMID: 36935224 DOI: 10.1016/j.ejso.2023.03.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Affiliation(s)
- Marco Braga
- Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy.
| | | |
Collapse
|
3
|
Sandrucci S. Frailty: How to assess, prognostic role. Eur J Surg Oncol 2023:S0748-7983(23)00173-7. [PMID: 36922252 DOI: 10.1016/j.ejso.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature. A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery. This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition. Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative care should include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.
Collapse
Affiliation(s)
- Sergio Sandrucci
- General Surgery Department, CDSS University of Turin, Torino, Italy.
| |
Collapse
|
4
|
Brandl A, Lundon D, Lorenzon L, Schrage Y, Caballero C, Holmberg CJ, Santrac N, Vasileva-Slaveva M, Montagna G, Mohan H, Sgarbura O, Sayyed R, Ben-Yaacov A, Carriço M, Henry Hererra Kok J, Smith HG, Suppan I, Sandrucci S, Ceelen W. The assessment and treatment strategies of malnutrition in patients with cancer treated by surgical oncologist – an EYSAC snapshot analysis. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
5
|
Bellino R, Giaccone M, Bertot L, Rosati S, Balestra G, Sandrucci S. OC-017 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIA IN DAY SURGERY REGIME. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
IPOM technique is a well-established technique for the repair of primary and incisional ventral hernia; and outpatient regime is considered a cost-effective strategy without compromising the quality of care. In this retrospective observational study, we evaluated the application of IPOM technique through outpatient setting, with the use of a non-absorbable, transparent, light prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent polypropylene film.
179 consecutive procedures of primary and incisional hernia repair from 2011 to 2022 have been included in this study (149 with the above-mentioned composite meshes and 30 with other meshes, semi-absorbable and non-absorbable). All the procedures were performed through 3 abdominal trocars executing cold adhesiolysis to release the contents of the hernial sac without dissecting the latter. The abdominal wall was then prepared by blunt dissection to create the space for the mesh and to favor a prompt cell colonization. Mesh fixation was achieved using transparietal points and resorbable tackers.
The primary outcomes of the study were the evaluation of any risk factors for conversion from outpatient regime to standard hospitalisation, and the hernia recurrence, in two subgroups: primitive hernias (n=72) and incisional hernias (n=107).
Our clinical experience showed that IPOM technique through outpatient setting is a safe and effective approach. No statistically significant difference in the recurrence rate between the primitive and incisional hernias groups (5.9% vs 5.0%, p=0.80) was found. Moreover, we found a relationship between the rate of unexpected hospitalization and age of the patients, number of defects and hernia dimension.
Collapse
Affiliation(s)
- R Bellino
- surgery, University of Turin , Turin , Italy
| | - M Giaccone
- surgery, University of Turin , Turin , Italy
| | - L Bertot
- surgery, University of Turin , Turin , Italy
| | - S Rosati
- PolitoBIOMed Lab, Biolab - Department of Electronics and Telecommunications , Politecnico di Torino, Turin , Italy
| | - G Balestra
- PolitoBIOMed Lab, Biolab - Department of Electronics and Telecommunications , Politecnico di Torino, Turin , Italy
| | - S Sandrucci
- surgery, University of Turin , Turin , Italy
| |
Collapse
|
6
|
Bellino R, Giaccone M, Sandrucci S. V-057 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF INGUINAL HERNIA. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Laparoscopic treatment of inguinal hernia is a widely accepted technique, especially in the case of bilateral or recurrent inguinal hernias. The evolution of materials has led to the successful use of double layer prostheses for the intraperitoneal treatment of wall defects, significantly reducing the mesh-related complications.
In this regard, the literature data and the availability of non-absorbable, transparent, light surgical prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent film, have led to the re-proposal of the IPOM technique also for the treatment of primary inguinal hernias.
After the laparoscopic access in the abdomen using a 10 mm trocar in the umbilical region and two 5 mm trocars operating in the Iliac fossae, the hernia is reduced by returning the hernial contents to their original compartments and the hernial sac is closed with the possible lipoma using purse-string suture. Subsequently, a polypropylene composite prosthesis is then inserted into the abdomen, centered on the defect and fixed to the wall by tack and chemical glue.
To date we have performed 10 procedures on 6 patients (4 with bilateral hernia). The longest follow-up is one year. The patients were all discharged the day after the surgery, reporting a mean postoperative pain score (assessed with EHS QoL scale) equal to 2 (range: 0–4), and the work resumption after a week in average.
This technique, which is easy to perform and reproducible, can significantly reduce operating times and minimize complications related to the preparation of the peritoneal pocket.
Collapse
Affiliation(s)
- R Bellino
- General surgery, University of Turin , Turin , Italy
| | - M Giaccone
- General surgery, University of Turin , Turin , Italy
| | - S Sandrucci
- General surgery, University of Turin , Turin , Italy
| |
Collapse
|
7
|
Bellino R, Giaccone M, Peirano E, Rosati S, Balestra G, Sandrucci S. P-101 EVALUATION OF PATIENTS’ QUALITY OF LIFE AFTER LAPAROSCOPIC INTRAPERITONEAL ONLAY MESH (IPOM) TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIA. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
IPOM technique is a well-established technique for the repair of primary and incisional allowing a less invasive treatment compared to open approach and improving patient satisfaction. In this retrospective observational study, we evaluated the application of IPOM technique with the use of a non-absorbable, transparent, light surgical prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent film. 82 procedures of primary and incisional hernia repair from January 2018 to January 2022 have been included in this study. All the procedures were performed through 3 abdominal trocars without dissecting the hernia sac. Mesh fixation was achieved using transparietal points and resorbable tackers. The primary outcome of the study was the evaluation of patients’ Quality of Life (QoL assessed with EHS QoL scale) in two subgroups: primitive hernias (n=34) and incisional hernias (n=48). The secondary outcomes of the study were the evaluation of recurrence rate and postoperative complications rate. In both groups we recorded a significative improvement in patients’ QoL related to pain at rest, pain during physical activity and aesthetic discomfort (p <0.01). In the included cohort population, the hernia recurrence was recorded in 4 cases (4.9%, at 10, 18, 24 and 24 moths, respectively), and 3 patients experienced postoperative complications (3.7%). The recorded postoperative complications included pain (n=1, 1.2%), seroma infection (n=1, 1.2%) and intestinal obstruction (n=1, 1.2%). Our clinical experience showed that IPOM technique is a safe and effective approach, and it allows to significantly improve the patients’ QoL after surgery.
Collapse
Affiliation(s)
- R Bellino
- surgery, University of Turin , Turin , Italy
| | - M Giaccone
- surgery, University of Turin , Turin , Italy
| | - E Peirano
- surgery, University of Turin , Turin , Italy
| | - S Rosati
- PolitoBIOMed Lab, Biolab - department of Electronics and Telecommunications, Politecnico di Torino , Turin , Italy
| | - G Balestra
- PolitoBIOMed Lab, Biolab - department of Electronics and Telecommunications, Politecnico di Torino , Turin , Italy
| | - S Sandrucci
- surgery, University of Turin , Turin , Italy
| |
Collapse
|
8
|
Pavlidis N, Madry R, Peeters M, Sandrucci S, Markowska J, Peccatori F, Costa A, Eriksen JG, Ricardi U, Poetter R, Schrijvers D, Vermorken JB. ESO-ESSO-ESTRO Multidisciplinary Course in Oncology for Medical Students: 4 Years of Experience (2016-2019). J Cancer Educ 2022; 37:1239-1244. [PMID: 33387267 DOI: 10.1007/s13187-020-01947-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 05/13/2023]
Abstract
The ESO-ESSO-ESTRO Multidisciplinary Course in Oncology is intended to fill the gap of the undergraduate fragmented oncology education, to provide insight into all theoretical and practical aspects of oncology, and to encourage future professional choices towards an oncology discipline. Students are exposed to (a) preclinical cancer topics; (b) natural history of the disease; (c) laboratory diagnostic tests; (d) medical, radiation, surgical, and palliative treatment; and (e) direct or through multidisciplinary patients' approach. Students are obliged to attend (i) all theoretical lectures, (ii) clinical case presentations, (iii) laboratories and ward visits, and (iv) to prepare and present a specific project under supervision. Participation is limited to 24 medical students who are selected through a competitive application process. Between 2016 and 2019, 96 students from 29 countries have attended. Data analysis derived from a given questionnaire demonstrates that most of the participants have declared that (1) they have achieved their expectations and objectives, (2) they have highly rated both clinical and non-clinical teaching oncological topics, and (3) they have been stimulated in developing a professional career in the field of oncology.
Collapse
Affiliation(s)
- Nicholas Pavlidis
- Medical School, University of Ioannina, Ioannina, Greece.
- European School of Oncology, Milan, Italy.
| | - Radoslaw Madry
- Medical University K. Marcinkowski and Clinical Hospital of the Transfiguration, Poznan, Poland
| | - Marc Peeters
- Oncology, Antwerp University Hospital, Edegem, Belgium
| | | | - Janina Markowska
- Department of Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Fedro Peccatori
- European School of Oncology, Milan, Italy
- Fertility and Procreation Unit, Gynecologic Oncology Programme, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Richard Poetter
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | | | | |
Collapse
|
9
|
Brandl A, Lundon D, Lorenzon L, Schrage Y, Caballero C, Holmberg CJ, Santrac N, Vasileva-Slaveva M, Montagna G, Sgarbura O, Sayyed R, Ben-Yaacov A, Hererra Kok JH, Suppan I, Mohan H, Ceelen W, Brandl A, Holmberg CJ, Schrage Y, Lundon D, Lorenzon L, Sayyed R, Sgarbura O, Ceelen W, Mohan H, Lundon D, Ben-Yaacov A, Vasileva-Slaveva M, Herrera Kok JH, Kovacs T, DUgo D, Sandrucci S. Standards in surgical training in advanced pelvic malignancy across Europe and beyond – A Snapshot analysis. Eur J Surg Oncol 2022; 48:2338-2345. [DOI: 10.1016/j.ejso.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 10/19/2022] Open
|
10
|
van der Hage J, Sandrucci S, Audisio R, Wyld L, Søreide K, Amaral T, Audisio R, Bahadoer V, Beets G, Benstead K, Berge Nilsen E, Bol K, Brandl A, Braun J, Cufer T, Dopazo C, Edhemovic I, Eriksen JG, Fiore M, van Ginhoven T, Gonzalez-Moreno S, van der Hage J, Hutteman M, Masannat Y, Onesti EC, Rau B, De Reijke T, Rubio I, Ruurda J, Sandrucci S, Soreide K, Stattner S, Trapani D, D'Ugo D, Vriens M, Wyld L, Zahl Eriksson AG. The ESSO core curriculum committee update on surgical oncology. Eur J Surg Oncol 2021; 47:e1-e30. [PMID: 34657781 DOI: 10.1016/j.ejso.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Surgical oncology is a defined specialty within the European Board of Surgery within the European Union of Medical Specialists (UEMS). Variation in training and specialization still occurs across Europe. There is a need to align the core knowledge needed to fulfil the criteria across subspecialities in surgical oncology. MATERIAL AND METHODS The core curriculum, established in 2013, was developed with contributions from expert advisors from within the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy and Oncology (ESTRO) and European Society of Medical Oncology (ESMO) and related subspeciality experts. RESULTS The current version reiterates and updates the core curriculum structure needed for current and future candidates who plans to train for and eventually sit the European fellowship exam for the European Board of Surgery in Surgical Oncology. The content included is not intended to be exhaustive but, rather to give the candidate an idea of expectations and areas for in depth study, in addition to the practical requirements. The five elements included are: Basic principles of oncology; Disease site specific oncology; Generic clinical skills; Training recommendations, and, lastly; Eligibility for the EBSQ exam in Surgical Oncology. CONCLUSIONS As evidence-based care for cancer patients evolves through research into basic science, translational research and clinical trials, the core curriculum will evolve, mature and adapt to deliver continual improvements in cancer outcomes for patients.
Collapse
Affiliation(s)
- Jos van der Hage
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Sergio Sandrucci
- Surgical Oncology Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Riccardo Audisio
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Lynda Wyld
- Department of Oncology and Metabolism, Sheffield University, Sheffield, United Kingdom
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, HPB unit, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Teresa Amaral
- Dermatology, Eberhard Karls Universitat Tubingen, Tubingen, Germany
| | | | - Viren Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Geerard Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kim Benstead
- Gloucestershire Oncology Centre, Cheltenham General Hospital, United Kingdom
| | - Elisabeth Berge Nilsen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Kalijn Bol
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Brandl
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany; Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Jerry Braun
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Tanja Cufer
- University Clinic Golnik, University of Ljubljana, 4204 Ljubljana, Slovenia
| | - Cristina Dopazo
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Edhemovic
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tessa van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Jos van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Merlijn Hutteman
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Yazan Masannat
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - Elisa Concetta Onesti
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Beate Rau
- Department of General Surgery, Charité University of Berlin, Berlin, Germany
| | - Theo De Reijke
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Isabel Rubio
- Breast Surgical Oncology, Clínica Universidad de Navarra, Madrid, Universidad de Navarra, Spain
| | - Jelle Ruurda
- Visceral Sarcoma Surgery Unit, Città della Salute e della Scienza, Turin, Italy
| | - Sergio Sandrucci
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Soreide
- Department of Surgery, Salzkammergutklinikum, Standort Vöcklabruck, Oberösterreich, Austria
| | - Stefan Stattner
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria; New drugs development for innovative therapies, European Institute of Oncology, IRCCS, Milano, Italy
| | - Dario Trapani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, 00168 Rome, Italy
| | - Domenico D'Ugo
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Menno Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | |
Collapse
|
11
|
Lorenzon L, Brandl A, Guiral DC, Hoogwater F, Lundon D, Marano L, Montagna G, Polom K, Primavesi F, Schrage Y, Gonzalez-Moreno S, Kovacs T, D'Ugo D, Sandrucci S. Nutritional assessment in surgical oncology: An ESSO-EYSAC global survey. Eur J Surg Oncol 2020; 46:2074-2082. [PMID: 32938568 DOI: 10.1016/j.ejso.2020.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The majority of cancer patients report malnutrition, with a significant impact on patient's outcome. This study aimed to compare how nutritional assessment is conducted across different surgical oncology sub-specialties. METHODS Survey modules were designed for breast, hepato-pancreato-biliary (HPB), upper-gastrointestinal (UGI), sarcoma, peritoneal and surface malignancies (PSM) and colorectal cancer (CRC) surgeries to describe 4 domains: participants' setting, evaluation of clinical factors, use of screening tools and clinical practice. Results were compared among sub-specialties and according to human development index (HDI) in the largest cohorts. RESULTS Out of 457 answers from 377 global participants (62% European), 35.0% were from breast and 28.9% were from CRC surgeons. Although MDTs management is consistently reported (64-88%), the presence of a nutritionist/dietician ranges from 14.1% to 44.2%. Breast surgeons seldom evaluate albumin (25.6%) and weight loss (30.6%), opposite to HPB, PSM and UGI groups (>70%, p 0.044). Overall, responders declared that the use of screening tools is largely neglected, that nutritional status is often assessed by the surgeons and that nutrition is not consistently modified according to risk factors (range among groups respectively: 1.9%-25.6%, 33.1%-51.4%, 33.1%-60.5%). Less than 20% of breast surgeons assess patients before/after surgery, comparing to >60% of PSM surgeons. However, no statistical differences were documented comparing groups for the majority of the items of the 4 domains. Nutritional evaluation is more often conducted by breast surgeons in medium/low HDI countries comparing very high/high HDI (p 0.04). CONCLUSIONS Nutritional assessment is largely neglected. These results identify target-issues for the implementation of clinical practice.
Collapse
Affiliation(s)
- Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy.
| | - Andreas Brandl
- Champalimaud Centre for the Unknown, Digestive Unit, Lisbon, Portugal
| | - Delia Cortes Guiral
- Universitary Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Frederik Hoogwater
- University Medical Center, Department of Surgery, Groningen, Netherlands
| | - Dara Lundon
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - Luigi Marano
- University of Siena, Department of Medicine, Surgery, and Neurosciences, Siena, Italy
| | - Giacomo Montagna
- Universitätsspital Basel Switzerland, Department of Surgery, Basel, Switzerland
| | - Karol Polom
- Medical University of Gdansk, Department of Surgical Oncology, Gdansk, Poland
| | - Florian Primavesi
- Medical University of Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck, Austria
| | - Yvonne Schrage
- Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
| | | | - Tibor Kovacs
- Breast Surgery Unit, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Domenico D'Ugo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | |
Collapse
|
12
|
Forget P, Aguirre JA, Bencic I, Borgeat A, Cama A, Condron C, Eintrei C, Eroles P, Gupta A, Hales TG, Ionescu D, Johnson M, Kabata P, Kirac I, Ma D, Mokini Z, Guerrero Orriach JL, Retsky M, Sandrucci S, Siekmann W, Štefančić L, Votta-Vellis G, Connolly C, Buggy D. How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence. Cancers (Basel) 2019; 11:cancers11050592. [PMID: 31035321 PMCID: PMC6563034 DOI: 10.3390/cancers11050592] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 01/04/2023] Open
Abstract
The question of whether anesthetic, analgesic or other perioperative intervention during cancer resection surgery might influence long-term oncologic outcomes has generated much attention over the past 13 years. A wealth of experimental and observational clinical data have been published, but the results of prospective, randomized clinical trials are awaited. The European Union supports a pan-European network of researchers, clinicians and industry partners engaged in this question (COST Action 15204: Euro-Periscope). In this narrative review, members of the Euro-Periscope network briefly summarize the current state of evidence pertaining to the potential effects of the most commonly deployed anesthetic and analgesic techniques and other non-surgical interventions during cancer resection surgery on tumor recurrence or metastasis.
Collapse
Affiliation(s)
- Patrice Forget
- Anesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Jose A Aguirre
- Anesthesiology, Balgrist University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Ivanka Bencic
- University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia.
| | - Alain Borgeat
- Anesthesiology, Balgrist University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Allessandro Cama
- Department of Pharmacy, Unit of General Pathology, Center on Aging Sciences and Translational Medicine (CeSI-MeT), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Claire Condron
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, 9 Dublin, Ireland.
| | - Christina Eintrei
- Department of Anesthesiology and Intensive Care, University of Linköping, 581 83 Linköping, Sweden.
| | - Pilar Eroles
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
- Biomedical Research, Network in Breast Cancer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Anil Gupta
- Physiology and Pharmacology, Karolinska Institutet, Perioperative Medicine and Intensive Care, Karolinska Hospital, 171 76 Stockholm, Sweden.
| | - Tim G Hales
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, UK.
| | - Daniela Ionescu
- Head Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Outcome Research Consortium, Cleveland, OH 44195, USA.
| | - Mark Johnson
- Department of Anesthesia, Fiona Stanley Hospital, Perth, Western Australia. University College Dublin School of Medicine and Medical Science, 4 Dublin, Ireland.
| | - Pawel Kabata
- Department of Surgical Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
| | - Iva Kirac
- Surgical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia.
| | - Daqing Ma
- Anesthetics, Pain Medicine & Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK.
| | - Zhirajr Mokini
- San Gerardo University Hospital, Monza, Italy. Clinique Saint Francois, 36000 Chateauroux, France.
| | - Jose Luis Guerrero Orriach
- Institute of Biomedical Research in Malaga [IBIMA], Department of Cardio-Anaesthesiology, Virgen de la Victoria University Hospital, 2010 Malaga, Spain.
- Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, 29071 Malaga, Spain.
| | - Michael Retsky
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Sergio Sandrucci
- Visceral Sarcoma Unit, CDSS-University of Turin, 10124 Turin, Italy.
| | - Wiebke Siekmann
- Department of Anesthesiology and Intensive Care, Örebro University, 702 81 Örebro, Sweden.
| | - Ljilja Štefančić
- Intensive Care Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia.
| | - Gina Votta-Vellis
- Departments of Anesthesiology and Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL 60607, USA.
| | - Cara Connolly
- Mater Misericordiae University Hospital, Eccles st., D07 R2WY Dublin, Ireland.
| | - Donal Buggy
- Mater University Hospital, School of Medicine, University College Dublin, 4 Dublin, Ireland.
- Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Ireland and Outcomes Research Consortium, Cleveland Clinic, OH 44195, USA.
| |
Collapse
|
13
|
Barrera V, Currado F, Evangelista A, Galassi C, Sandrucci S. Pelvic exenteration for primary and recurrent rectal or gynecological malignancies: a meta-analysis. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
14
|
Bonomo LD, Giaccone M, Caltagirone A, Bellocchia AB, Grasso M, Nicotera A, Lano N, Sandrucci S. Patient selection criteria for an effective laparoscopic intraperitoneal ventral hernia repair in day surgery. Updates Surg 2018; 71:549-553. [PMID: 30569347 DOI: 10.1007/s13304-018-00616-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
The laparoscopic treatment of abdominal wall defects is currently a valid alternative to the open technique, given the possibility to significantly reduce the length of hospital stay and, consequently, to allow its carrying out in a day surgery setting. The comparison between the two methods has also been the subject of a Cochrane meta-analysis performed by Sauerland et al. (Cochrane Database Syst Rev 3: CD007781, 2011), which pointed out how, in spite of many clinical trials indicating the superiority of laparoscopy in terms of invasiveness and postoperative pain control, the quality of evidence is low due to the excessive variability among the different series in terms of reported complications. Moreover, what should be the selection criteria of patients fit for laparoscopic treatment in day surgery is not yet defined. This retrospective study considered 94 patients with primary or recurrent incisional wall hernias treated with laparoscopic technique over a 7-year period of time, from 2011 to 2018. The aim was to define the selection criteria for an effective day surgery laparoscopic treatment, considering as outcome the rate of conversion to ordinary hospitalization (discharge > POD1). Discharge > POD 1 was necessary in 15 cases out of 94 (16%). Concerning this outcome, statistically significant risk factors were ASA score > I (p = 0.022), number of hernia orifices > 1 (p = 0.001), recurrent hernias (p = 0.002) and hernia diameter > 10 cm (p < 0.0001). These factors were confirmed by univariate binary logistic analysis. A stepwise model of multivariate analysis showed as determinants for adverse events ASA score > 1 (OR 5.2, 95% CI 1.1-25.6, p = 0.043) and hernias > 10 cm (OR 7.0, 95% CI 1.1-46.4, p = 0.045). This work highlighted some useful criteria for preoperative selection of patients fit for laparoscopic abdominal wall defects repair in a day surgery setting. In particular, criteria related to a favorable clinical outcome were ASA score < II and a hernia diameter < 10 cm.
Collapse
Affiliation(s)
- Luca Domenico Bonomo
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy
| | - Michele Giaccone
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy
| | - Alice Caltagirone
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy
| | - Alex Bruno Bellocchia
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy
| | - Mariateresa Grasso
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy
| | - Antonella Nicotera
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy
| | - Nicolò Lano
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy
| | - Sergio Sandrucci
- Visceral Sarcoma Unit, Città della Salute e della Scienza di Torino, Cso Bramante 88, 10126, Turin, Italy.
| |
Collapse
|
15
|
Ponzetti A, Grignani G, Di Cuonzo D, Ciccone G, Sandrucci S. Different quality of treatment in retroperitoneal sarcomas according to hospital-case volume and surgeon-case volume: A retrospective regional analysis in Italy. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
16
|
|
17
|
Pelosi E, Arena V, Bellò M, Cesana P, Lamberti L, Spandonari T, Ropolo R, Sandrucci S, Bisi G. Radiolabeled Localization of the Sentinel Lymph Node: Dosimetric Evaluation in Personnel Involved in the Procedure. Tumori 2018; 88:S7-8. [PMID: 12365392 DOI: 10.1177/030089160208800321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Peritumoral injection of 99mTc-labeled colloids for lymphoscintigraphy and radioguided surgery does not entail any relevant radiation burden to the patients. The real issue about radiation protection concerns the personnel involved in the procedure besides the nuclear medicine personnel. The aim of our study was to evaluate the cumulative doses to personnel involved during the injection of radiolabeled compounds under ultrasound or stereotactic guidance and the radiation burden to the personnel involved in the surgical incision of the tumor 24 hours after the administration of 99mTc-labeled colloids. Methods and Study Design We performed environmental contamination tests (SMEAR TEST) and exposure evaluation in the operating room. Results In the operating room the removed activity in the analyzed samples was less than 0.5Bq/g and exposure to the personnel was less than 6μSv/h. The evaluations made during ultrasound guidance demonstrated an equivalent and effective dose less than 20μSv. Conclusions Our results show that during ultrasound or stereotactic administration of radiolabeled compounds the radiation burden to the personnel involved in the procedure is virtually negligible. The surgeons too are exposed to a negligible radiation dose.
Collapse
Affiliation(s)
- E Pelosi
- Servizio Universitario de Medicina Nucleare, Azienda Ospedaliera San Giovanni Battista, Turin, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Aims and Background Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases. Methods and Study Design To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous anal carcinoma. Results Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases. Conclusions We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.
Collapse
Affiliation(s)
- M Mistrangelo
- Sugical Oncology Department, University of Turin, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Sandrucci S, Casalegno PS, Percivale P, Mistrangelo M, Bombardieri E, Bertoglio S. Sentinel Lymph Node Mapping and Biopsy for Breast Cancer: A Review of the Literature Relative to 4791 Procedures. Tumori 2018; 85:425-34. [PMID: 10774561 DOI: 10.1177/030089169908500602] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The status of axillary nodes is the most important prognostic factor in breast cancer to select patient subgroups for adjuvant chemotherapy; the current standard of care for surgical management of invasive breast cancer is complete removal of the tumor by either mastectomy or lumpectomy followed by axillary lymph node dissection (ALND). The recent introduction of intraoperative lymphatic mapping and sentinel lymph node biopsy (SLND) represents a major new opportunity for appropriate and less invasive surgical management of many tumors. There is an almost uniformly enthusiasm concerning the potential of this technique in breast carcinoma management, shown by published data. A peculiar attention to the so-called “sentinel node debate” in breast cancer surgery is a constant in the last years issues of the major medical journals. Even patients have become more aware about medical enthusiasm and their request of concise information on the topic and the possibilities of this approach is an increasing reality in medical practice. The aim of this paper is to review recent literature to offer an overview about the main controversial methodological aspects and a wide analysis of reported results. The most significative international literature papers from Medline were retrieved from 1993 to September 1999, and 4782 procedures were analysed. This extensive review of the literature has confirmed accuracy, feasibility and reliability of the SN detecting technique in axillary mapping. Provided a good proficiency in SN localisation and pathological evaluation, human resources and efforts should be mainly focused on its clinical validation as an alternative to ALND instead of on further phase I–-II clinical studies.
Collapse
Affiliation(s)
- S Sandrucci
- Dipartimento di Oncologia, Unità Operativa di Chirurgia Esofagea ed Oncologica, ASO San Giovanni Battista, Turin, Italy
| | | | | | | | | | | |
Collapse
|
20
|
Casalegno PS, Sandrucci S, Bellò M, Durando A, Danese S, Silvestro L, Pellerito R, Testori O, Roagna R, Giai M, Giani R, Bussone R, Favero A, Bisi G, Massobrio M, Giardina G, Mussa GC, Sismondi P, Mussa A. Sentinel Lymph Node and Breast Cancer Staging: Final Results of the Turin Multicenter Study. Tumori 2018; 86:300-3. [PMID: 11016708 DOI: 10.1177/030089160008600409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim of the study Validation of the sentinel node (SN) technique in breast cancer by means of lymphoscintigraphy. Materials and methods From December 1996 to January 1999 102 T1-T2 breast carcinoma cases were recruited in Turin. 99mTc-human serum albumin colloids were injected subdermally the day before surgery (mean activity, 5.2 ± 2.5 MBq). Scintigraphic imaging was performed after injection. After identification of the SN during surgery by a hand-held gamma probe, the SN was excised and sent for histologic examination. SN histology was compared with that of other axillary nodes. Results The SN detection rate was 86.3%; among 88 cases with an identified SN, 37 (42%) had axillary metastases; the SN was metastatic in 35 cases (sensitivity, 94.6%); in 51.3% of pN+ cases (19/37) the SN was the only metastatic site. In two of the 53 negative SNs, SN histology did not match with that of the remaining axilla (negative predictive value, 96.2%; staging accuracy, 97.7%). Conclusions Our results agree with those reported in the literature; however, except in clinical trials and experienced structures axillary lymph node dissection should not be abandoned when mandatory for prognostic purposes, considering that at present SN biopsy alone is not completely accurate for axillary staging, especially in the absence of an adequate learning period.
Collapse
Affiliation(s)
- P S Casalegno
- Unità Operativa di Chirurgia Oncologica, Università di Torino, Turin, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Sandrucci S, Ponzetti A, Gianotti C, Mussa B, Lista P, Grignani G, Mistrangelo M, Bertetto O, Di Cuonzo D, Ciccone G. Different quality of treatment in retroperitoneal sarcomas (RPS) according to hospital-case volume and surgeon-case volume: a retrospective regional analysis in Italy. Clin Sarcoma Res 2018; 8:3. [PMID: 29507712 PMCID: PMC5830336 DOI: 10.1186/s13569-018-0091-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Retroperitoneal sarcomas (RPS) should be surgically managed in specialized sarcoma centers. However, it is not clearly demonstrated if clinical outcome is more influenced by Center Case Volume (CCV) or by Surgeon Case Volume (SCV). The aim of this study is to retrospectively explore the relationship between CCV and SCV and the quality of surgery in a wide region of Northern Italy. Methods We retrospectively collected data about patients M0 surgically treated for RPSs in 22 different hospitals from 2006 to 2011, dividing them in two hospital groups according to sarcoma clinical activity volume (HCV, high case volume or LCV, low case volume hospitals). The HCV group (> 100 sarcomas observed per year) included a Comprehensive Cancer Center (HVCCC) with a high sarcoma SCV (> 20 cases/year), and a Tertiary Academic Hospital (HVTCA) with multiple surgeon teams and a low sarcoma SCV (≤ 5 cases/year for each involved surgeon). All other hospitals were included in the LCV group (< 100 sarcomas observed per year). Results Data regarding 138 patients were collected. Patients coming from LCV hospitals (66) were excluded from the analysis as prognostic data were frequently not available. Among the 72 remaining cases of HCV hospitals 60% of cases had R0/R1 margins, with a more favorable distribution of R0/R1 versus R2 in HVCCC compared to HVTCA. Conclusions In HCV hospitals, sarcoma SCV may significantly influence RPS treatment quality. In low-volume centers surgical reports can often miss important prognostic issues and surgical quality is generally poor.
Collapse
Affiliation(s)
- Sergio Sandrucci
- 1Visceral Sarcoma Unit, University of Turin, Cso Dogliotti 14, 10126 Turin, Italy
| | - Agostino Ponzetti
- Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Claudio Gianotti
- 1Visceral Sarcoma Unit, University of Turin, Cso Dogliotti 14, 10126 Turin, Italy
| | - Baudolino Mussa
- 3Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Patrizia Lista
- Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Giovanni Grignani
- 4Department of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | | | - Daniela Di Cuonzo
- Cancer Epidemiology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Giovannino Ciccone
- Cancer Epidemiology Unit, Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
22
|
Silvestri S, Deiro G, Sandrucci S, Comandone A, Molinaro L, Chiusa L, Fronda GR, Franchello A. Solitary pancreatic head metastasis from tibial adamantinoma: a rare indication to pancreaticoduodenectomy. J Surg Case Rep 2018; 2018:rjy012. [PMID: 29479415 PMCID: PMC5810439 DOI: 10.1093/jscr/rjy012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/16/2018] [Indexed: 01/12/2023] Open
Abstract
Pancreatic metastases are rare, <2% of all pancreatic neoplasia. This is the first case of pancreatic metastasis from adamantinoma, a rare, low grade and slow growing tumor which is frequently localized in long bones. We describe a case of a 45-year-old woman presenting with increased bilirubin level. Computed tomography and ecoendoscopic ultra sonography revealed a pancreatic head mass. Fine-needle aspiration biopsy was consistent with metastatic adamantinoma. The patient was submitted to a standard pancreaticoduodenectomy. As in the case presented, standard pancreatic resections are safe and feasible options to treat non-pancreatic primary tumor improving patient’s survival and quality of life.
Collapse
Affiliation(s)
- S Silvestri
- Department of Surgery, S.Spirito Hospital, Casale Monferrato, Alessandria, Italy
| | - G Deiro
- Department of General Surgery, University of Eastern Piemont-AOU Maggiore della Carità Hospital, Novara, Italy
| | - S Sandrucci
- Department of Sarcoma and Rare Visceral Cancers Surgery, City of Health and Science-Molinette Hospital, Turin, Italy
| | - A Comandone
- Department of Oncology, Humanitas Cancer Center-Gradenigo Hospital, Turin, Italy
| | - L Molinaro
- 2nd Department of Pathological Anatomy, City of Health and Science-Molinette Hospital, Turin, Italy
| | - L Chiusa
- 2nd Department of Pathological Anatomy, City of Health and Science-Molinette Hospital, Turin, Italy
| | - G R Fronda
- Department of Surgery, Humanitas Cancer Center-Gradenigo Hospital, Turin, Italy
| | - A Franchello
- 4th Department of General Surgery, City of Health and Science-Molinette Hospital, Turin, Italy
| |
Collapse
|
23
|
Mistrangelo M, Cassoni P, Mistrangelo M, Castellano I, Codognotto E, Sapino A, Lamanna G, Cravero F, Bianco L, Fora G, Sandrucci S. Obstructive Colon Metastases from Lobular Breast Cancer: Report of a Case and Review of the Literature. Tumori 2018; 97:800-4. [DOI: 10.1177/030089161109700619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Gastrointestinal metastases from breast cancer are rare. One large series reported a rate of 0.7% of gastrointestinal metastatic manifestations from breast cancer, but its true incidence could be underestimated. Here we report a case of bowel obstruction caused by sigmoid metastases from breast cancer and describe its relevance to histological origin and clinical practice. Methods The clinical course and histopathology of the case are reviewed and compared with reports of similar cases in the literature. Results An 80-year-old woman presented with bowel obstruction. Her medical history included infiltrating lobular breast cancer treated with left radical mastectomy 25 years before the current presentation; 13 years later bone metastases developed and were treated with hormone therapy. In 2003 the patient came to our emergency department because of symptoms of bowel obstruction. A computed tomography (CT) scan revealed a mass in the distal sigmoid causing the obstruction. A colostomy was performed, followed by a second operation completed with Hartmann's procedure. Histological examination revealed metastases from invasive lobular carcinoma. The patient was discharged 45 days postoperatively and died 9 months later because of disease progression. Conclusions Although gastrointestinal metastases from breast cancer are rare, patients with diagnosed breast cancer, particularly invasive lobular carcinoma, should be regularly followed up with endoscopy, CT, endosonography and PET-CT when abdominal symptoms are present. This could permit early diagnosis of gastrointestinal metastases and improve treatment planning.
Collapse
Affiliation(s)
- Massimiliano Mistrangelo
- Department of Digestive and Colorectal Surgery, Center of Minimally Invasive Surgery, University of Turin, Molinette Hospital, Turin
| | - Paola Cassoni
- Department of Biomedical Sciences and Human Oncology, University of Turin, Molinette Hospital, Turin
| | | | - Isabella Castellano
- Department of Biomedical Sciences and Human Oncology, University of Turin, Molinette Hospital, Turin
| | - Elena Codognotto
- Department of Digestive and Colorectal Surgery, Center of Minimally Invasive Surgery, University of Turin, Molinette Hospital, Turin
| | - Anna Sapino
- Department of Biomedical Sciences and Human Oncology, University of Turin, Molinette Hospital, Turin
| | - Ginevra Lamanna
- Department of Oncological Surgery, University of Turin, Molinette Hospital, Turin, Italy
| | - Francesca Cravero
- Department of Digestive and Colorectal Surgery, Center of Minimally Invasive Surgery, University of Turin, Molinette Hospital, Turin
| | - Lavinia Bianco
- Department of Oncological Surgery, University of Turin, Molinette Hospital, Turin, Italy
| | | | - Sergio Sandrucci
- Department of Oncological Surgery, University of Turin, Molinette Hospital, Turin, Italy
| |
Collapse
|
24
|
Fava P, Astrua C, Sanlorenzo M, Ribero S, Brizio M, Filippi AR, Marra E, Picciotto F, Sangiolo D, Carnevale-Schianca F, Aglietta M, Sandrucci S, Ricardi U, Caliendo V, Quaglino P, Fierro MT. Treatment of metastatic melanoma: a multidisciplinary approach. Ital J Dermatol Venerol 2017; 152:241-261. [PMID: 28290625 DOI: 10.23736/s0392-0488.17.05633-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prognosis of stage IV metastatic melanoma is poor. An overall 1-year survival of 25.5% and a median survival of 6.2 months were reported without any significant improvement during the last 30 years before the introduction of new drugs (immune checkpoint inhibitors and targeted therapies) which completely modified the therapeutic approach and induced an overwhelming improvement on the survival rates of these patients. This review will analyze the therapeutic tools available for the treatment of patients with metastatic melanoma, including adjuvant interferon and locoregional therapies (surgery, radiotherapy and electrochemotherapy) and will mainly focus on the presentation of results obtained by the new treatments (checkpoint inhibitors and targeted therapies).
Collapse
Affiliation(s)
- Paolo Fava
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Chiara Astrua
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Martina Sanlorenzo
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy.,Department of Dermatology, Mt. Zion Cancer Research Center, University of California, San Francisco, CA, USA
| | - Simone Ribero
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Matteo Brizio
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Andrea R Filippi
- Department of Oncology, University of Turin, Turin, Italy.,Radiation Oncology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Elena Marra
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Franco Picciotto
- Section of Surgical Dermatology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Dario Sangiolo
- Medical Oncology Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | | | - Massimo Aglietta
- Department of Oncology, University of Turin, Turin, Italy.,Medical Oncology Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Sergio Sandrucci
- Sarcoma Unit, Department of Surgery, University of Turin, Turin, Italy
| | | | - Virginia Caliendo
- Section of Surgical Dermatology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Pietro Quaglino
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy -
| | - Maria T Fierro
- Clinic of Dermatology, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| |
Collapse
|
25
|
Sandrucci S, Ponzetti A, Gianotti C, Grignani G, Di Cuonzo D, Ciccone G. Different quality of treatment in retroperitoneal sarcomas according to hospital-case volume and surgeon-case volume: a retrospective regional analysis in Italy. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Sandrucci S, Merlo M, Grignani G, Lista P, Verri A, Pau R. 756. Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: A case series. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
27
|
Gronchi A, Delrio P, Quagliuolo V, Sandrucci S. The Italian Society of Surgical Oncology (SICO) survey on the minimum requirements of rare cancers referral centers. Updates Surg 2016; 68:321-323. [PMID: 27312931 DOI: 10.1007/s13304-016-0376-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Alessandro Gronchi
- Department of Cancer Medicine and Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Delrio
- Department of Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | | | - Sergio Sandrucci
- Sarcoma Unit, Department of Surgery, Universiy of Turin, Turin, Italy.
| |
Collapse
|
28
|
Sandrucci S, Gatta G, Trama A, Dei Tos AP, Casali PG. Specialized teams or specialist networks for rare cancers? Eur J Surg Oncol 2015; 41:1115-7. [PMID: 25936223 DOI: 10.1016/j.ejso.2015.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- S Sandrucci
- Visceral Sarcoma Unit, S. Giovanni Battista Hospital, University of Turin, Turin, Italy.
| | - G Gatta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, IRCCS National Cancer Institute, Milan, Italy
| | - A Trama
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, IRCCS National Cancer Institute, Milan, Italy
| | - A P Dei Tos
- Department of Anatomic Pathology, General Hospital of Treviso, Treviso, Italy
| | - P G Casali
- Adult Mesenchymal Tumor Medical Oncology Unit, Department of Cancer Medicine, IRCCS National Cancer Institute, Milan, Italy
| |
Collapse
|
29
|
Sandrucci S, Gibin E, Esposito L, Mussa B. 453. Office-based Denver peritoneovenous shunt for malignant ascites: A feasibility study. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
30
|
Pau R, Merlo M, Piana R, Sandrucci S. 469. Oncovascular surgery: A new perspective facing advanced retroperitoneal and pelvic malignancies. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
31
|
Sandrucci S, Comandone S, Boglione A. Primary surgical treatment of pelvic aggressive angiomyxoma is not always advisable in ER positive patients. Eur J Surg Oncol 2014; 40:592-593. [PMID: 24630771 DOI: 10.1016/j.ejso.2013.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- S Sandrucci
- Sarcoma and Rare Visceral Cancers Surgical Unit, Department of Surgical Sciences, S. Giovanni Battista Hospital, University of Turin, Cso Dogliotti 14, 10126 Turin, Italy.
| | - S Comandone
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin, Italy
| | - A Boglione
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin, Italy
| |
Collapse
|
32
|
D'Amico L, Satolli MA, Mecca C, Castiglione A, Ceccarelli M, D'Amelio P, Garino M, De Giuli M, Sandrucci S, Ferracini R, Roato I. Bone metastases in gastric cancer follow a RANKL-independent mechanism. Oncol Rep 2013; 29:1453-8. [PMID: 23404437 DOI: 10.3892/or.2013.2280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 12/27/2012] [Indexed: 01/06/2023] Open
Abstract
Gastric cancer is one of the most common and lethal malignancies worldwide. Bone metastases in gastric cancer are less common than in other solid tumors, but when they occur the prognosis is generally poor. Increased osteoclastogenesis and osteoclast activity are common features in bone metastases caused by different osteotropic cancer. We investigated osteoclastogenesis and its mechanisms in gastric cancer by enrolling 31 newly diagnosed gastric cancer patients and 45 healthy controls. We studied in vitro osteoclastogenesis in the peripheral blood mononuclear cell cultures of patients and controls, showing spontaneous osteoclastogenesis for half of the patients. This osteoclastogenesis was RANKL- and TNF-α-independent. We analyzed primary tumor and bone metastatic tissues of gastric cancer for the expression of genes involved in osteoclastogenesis. The expression of transforming growth factor-β (TGF-β), osteoprotegerin (OPG), IL-7 and dickkopf-1 (DKK-1) was higher in primary tumors than in bone metastases. RANKL was not detectable in primary tumor or in bone metastatic tissue. The serum RANKL level was significantly higher in healthy controls than in patients, and it was not related to osteoclastogenesis, thereby suggesting that RANKL is not involved in the bone metastatic mechanisms in gastric cancer. We hypothesized a role of RANKL in angiogenesis, thus we compared the serum levels of RANKL to those of VEGF, since VEGF is directly related to angiogenesis. Different from RANKL, the VEGF serum levels were higher in gastric patients than in controls, suggesting a block of the angiogenesis inhibition due to RANKL. RANKL and VEGF serum levels were not predictive of overall survival in our cohort of gastric patients.
Collapse
Affiliation(s)
- Lucia D'Amico
- CeRMS (Center for Experimental Research and Medical Studies), Department of Medical Oncology, San Giovanni Battista Hospital, and Department of Surgical and Medical Discplines, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Forchino F, Marano A, Ostuni E, Sandrucci S, Degiuli M. Low and ultra-low anastomosis in colorectal cancer: Open versus laparoscopic approach. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
34
|
Cianflocca D, Balbo G, Reddavid R, Mussa B, Sandrucci S. Office-based Denver peritoneovenous shunt for malignant ascites: A feasibility study. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
35
|
Mistrangelo M, Cassoni P, Mistrangelo M, Castellano I, Codognotto E, Sapino A, Lamanna G, Cravero F, Bianco L, Fora G, Sandrucci S. Obstructive colon metastases from lobular breast cancer: report of a case and review of the literature. Tumori 2012. [PMID: 22322849 DOI: 10.1700/1018.11099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Gastrointestinal metastases from breast cancer are rare. One large series reported a rate of 0.7% of gastrointestinal metastatic manifestations from breast cancer, but its true incidence could be underestimated. Here we report a case of bowel obstruction caused by sigmoid metastases from breast cancer and describe its relevance to histological origin and clinical practice. METHODS The clinical course and histopathology of the case are reviewed and compared with reports of similar cases in the literature. RESULTS An 80-year-old woman presented with bowel obstruction. Her medical history included infiltrating lobular breast cancer treated with left radical mastectomy 25 years before the current presentation; 13 years later bone metastases developed and were treated with hormone therapy. In 2003 the patient came to our emergency department because of symptoms of bowel obstruction. A computed tomography (CT) scan revealed a mass in the distal sigmoid causing the obstruction. A colostomy was performed, followed by a second operation completed with Hartmann's procedure. Histological examination revealed metastases from invasive lobular carcinoma. The patient was discharged 45 days postoperatively and died 9 months later because of disease progression. CONCLUSIONS Although gastrointestinal metastases from breast cancer are rare, patients with diagnosed breast cancer, particularly invasive lobular carcinoma, should be regularly followed up with endoscopy, CT, endosonography and PET-CT when abdominal symptoms are present. This could permit early diagnosis of gastrointestinal metastases and improve treatment planning.
Collapse
Affiliation(s)
- Massimiliano Mistrangelo
- Department of Digestive and Colorectal Surgery, Center of Minimally Invasive Surgery, University of Turin, Molinette Hospital, Corso A.M. Dogliotti 14, Turin, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Degiuli M, Borasi A, Forchino F, Marano A, Vendrame A, Casella D, Ponti A, Mussa B, Sandrucci S. Lymph-nodal ratio in gastric cancer staging system. MINERVA CHIR 2011; 66:177-182. [PMID: 21666553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Many studies have indicated that lymph node metastases and the depth of invasion of the primary tumor are the most reliable prognostic factors for patients with radically resected gastric cancer. Recently the ratio between metastatic and examined lymph nodes (n ratio) has been proposed as a new prognostic indicator. The aim of this study was to evaluate the prognostic value of n ratio in patients with gastric cancer. METHODS We retrospectively reviewed the data of 399 patients who had undergone radical resection for gastric carcinoma. RESULTS N ratio was significantly greater in patients with large and undifferentiated tumors. Moreover, it was significantly related to both the number and location of lymph node metastases. Survival curves showed that n ratio was strictly related to patients' survival. Multivariate analysis confirmed that it was an important independent prognostic indicator. CONCLUSION N ratio is useful to better evaluate the status of lymph node metastases in patients with gastric cancer submitted to radical surgery. Moreover it is a very important independent prognostic factor for gastric cancer.
Collapse
Affiliation(s)
- M Degiuli
- Department of Surgery University of Turin, San Giovanni Battista Hospital, Turin, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Matera L, Sandrucci S, Mussa A, Boffa C, Castellano I, Cassoni P. Low Foxp3 expression in negative sentinel lymph nodes is associated with node metastases in colorectal cancer. Gut 2010; 59:419-20. [PMID: 20207654 DOI: 10.1136/gut.2009.203422] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
|
38
|
Mistrangelo M, Bellò M, Mobiglia A, Beltramo G, Cassoni P, Milanesi E, Cornaglia S, Pelosi E, Giunta F, Sandrucci S, Mussa A. Feasibility of the sentinel node biopsy in anal cancer. Q J Nucl Med Mol Imaging 2009; 53:3-8. [PMID: 18337684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM Anal cancer is a rare neoplasm. According to a European Organization for Research and Treatment of Cancer multivariate analysis, synchronous inguinal lymph node metastasis occurs in 10-25% of patients and constitutes an independent prognostic factor for local failure and overall mortality. METHODS Inguinal lymph node status was assessed using the sentinel node technique in 35 patients with anal cancer. RESULTS Histology revealed 23 squamous carcinomas, 10 basaloid carcinomas, 1 squamous carcinoma with basaloid areas and 1 spinocellular epithelioma associated with areas of Bowen's disease. Disease stage was T1 in 5 patients, T2 in 18, T3 in 11 and T4 in 1 patient. Lympho-scintigraphy using a GE Millennium gamma camera was performed after peritumoral injection of 37 MBq of 99mTc colloid. Surgical sentinel node biopsy with a portable Scintiprobe MR 100 (Politech, Carsoli, Italy) had a detection rate of 97.1%. Inguinal metastases were detected in 7 (20%) patients, in 2 of which metastasis was bilateral. CONCLUSIONS Given the correlation between prognosis and node involvement, sentinel node biopsy can be considered a simple method for adequate pretreatment staging of anal carcinoma. Use of the technique could avert the need for prophylactic inguinal radiotherapy in N0-N1 patients, thus reducing the morbidity associated with inguinal radiotherapy. Consistent follow-up is required to evaluate long-term results:
Collapse
Affiliation(s)
- M Mistrangelo
- Surgical and Oncological Department, University of Turin, Molinette Hospital, Turin, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Sandrucci S, Mussa B, Goss M, Mistrangelo M, Satolli MA, Sapino A, Bellò M, Bisi G, Mussa A. Lymphoscintigraphic localization of sentinel node in early colorectal cancer: results of a monocentric study. J Surg Oncol 2007; 96:464-9. [PMID: 17929257 DOI: 10.1002/jso.20848] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Evaluation of the feasibility of the sentinel node technique in early colorectal neoplasms and its overall accuracy in predicting nodal metastases. METHODS Thirty-five patients with colon or rectal lesions or degenerate polyps not radically excised by endoscopy were included. Lymphatic mapping was performed with 99mTc labeled albumin colloid injected submucosally by an endoscopic route the afternoon before the surgical procedure. The day of the intervention, 2.5% patent blue V dye (S.A.L.F: Italy) was injected circumferentially around the tumor. A hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect "hot" nodes, in vivo and ex vivo. All sentinel nodes were embedded separately for haematoxylin and eosin staining. No IHC or PCR techniques were employed. RESULTS Sentinel lymph nodes (SLN) were successfully identified in 35 out of 35 patients. Concordance between SLN and nodal status was observed in 32 out of 35 cases (91.4%); four patients (11.4%) were upstaged. Three skip nodal metastases were observed (false-negative rate: 8.5%). CONCLUSIONS The sentinel node technique with blue dye and radiotracer seems valuable in early colorectal cancers detected by screening programs: a good organization and a learning curve are needed, as further multicentric studies.
Collapse
Affiliation(s)
- Sergio Sandrucci
- Oncologic Surgery, S. Giovanni Battista Hospital, University of Turin, Turin, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Matera L, Galetto A, Bello M, Baiocco C, Chiappino I, Castellano G, Stacchini A, Satolli MA, Mele M, Sandrucci S, Mussa A, Bisi G, Whiteside TL. In vivo migration of labeled autologous natural killer cells to liver metastases in patients with colon carcinoma. J Transl Med 2006; 4:49. [PMID: 17105663 PMCID: PMC1681349 DOI: 10.1186/1479-5876-4-49] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 11/14/2006] [Indexed: 11/17/2022] Open
Abstract
Background Besides being the effectors of native anti-tumor cytotoxicity, NK cells participate in T-lymphocyte responses by promoting the maturation of dendritic cells (DC). Adherent NK (A-NK) cells constitute a subset of IL-2-stimulated NK cells which show increased expression of integrins and the ability to adhere to solid surface and to migrate, infiltrate, and destroy cancer. A critical issue in therapy of metastatic disease is the optimization of NK cell migration to tumor tissues and their persistence therein. This study compares localization to liver metastases of autologous A-NK cells administered via the systemic (intravenous, i.v.) versus locoregional (intraarterial, i.a.) routes. Patients and methods A-NK cells expanded ex-vivo with IL-2 and labeled with 111In-oxine were injected i.a. in the liver of three colon carcinoma patients. After 30 days, each patient had a new preparation of 111In-A-NK cells injected i.v. Migration of these cells to various organs was evaluated by SPET and their differential localization to normal and neoplastic liver was demonstrated after i.v. injection of 99mTc-phytate. Results A-NK cells expressed a donor-dependent CD56+CD16+CD3- (NK) or CD56+CD16+CD3+ (NKT) phenotype. When injected i.v., these cells localized to the lung before being visible in the spleen and liver. By contrast, localization of i.a. injected A-NK cells was virtually confined to the spleen and liver. Binding of A-NK cells to liver neoplastic tissues was observed only after i.a. injections. Conclusion This unique study design demonstrates that A-NK cells adoptively transferred to the liver via the intraarterial route have preferential access and substantial accumulation to the tumor site.
Collapse
Affiliation(s)
- Lina Matera
- Dept. of Internal Medicine, University of Turin, Italy
| | | | - Marilena Bello
- S.C.D.U. of Nuclear Medicine 2, Molinette Hospital, Turin, Italy
| | - Cinzia Baiocco
- S.C.D.U. of Nuclear Medicine 2, Molinette Hospital, Turin, Italy
| | | | | | | | - Maria A Satolli
- Dept. of Biological and Clinical Science, S. Luigi's Hospital, Orbassano, Italy
| | - Michele Mele
- Dept of Surgical and Medical Disciplines, University of Turin, Italy
| | | | - Antonio Mussa
- S.C.D.U. of Surgical Oncology, University of Turin, Italy
| | - Gianni Bisi
- S.C.D.U. of Nuclear Medicine 2, Molinette Hospital, Turin, Italy
| | | |
Collapse
|
41
|
Rubello D, Pelizzo M, Al-Nahhas A, Salvatori M, O'Doherty M, Giuliano A, Gross M, Fanti S, Sandrucci S, Casara D, Mariani G. The role of sentinel lymph node biopsy in patients with differentiated thyroid carcinoma. Eur J Surg Oncol 2006; 32:917-21. [DOI: 10.1016/j.ejso.2006.03.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 03/06/2006] [Indexed: 11/16/2022] Open
|
42
|
Rubello D, Fig LM, Casara D, Piotto A, Boni G, Pelizzo MR, Shapiro B, Sandrucci S, Gross MD, Mariani G. Radioguided Surgery of Parathyroid Adenomas and Recurrent Thyroid Cancer Using the "Low Sestamibi Dose" Protocol. Cancer Biother Radiopharm 2006; 21:194-205. [PMID: 16918295 DOI: 10.1089/cbr.2006.21.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to establish the clinical efficacy of the "low sestamibi dose" (LSD) protocol to perform thyroid and parathyroid radioguided surgery in a large series of patients homogeneously studied and operated on by the same surgeon. The LSD protocol was initially developed in our center to cure primary hyperparathyroid (PHPT) patients with a high likelihood of a solitary parathyroid adenoma (PA) by minimally invasive radioguided surgery (MIRS). Since then, the same protocol has been applied to differentiated thyroid cancer (DTC) patients with 131I-negative, but sestamibi-positive, locoregional recurrent disease in order to obtain radical radioguided extirpation of tumoral lesions at reoperation. STUDY DESIGN We reviewed the clinical charts of 453 consecutive patients referred at the surgical department at Padova University (Padova, Italy) to investigate a PHPT or a DTC recurrence: 336 patients (74.2%) met the inclusion criteria for radioguided surgery, and these patients were analyzed for the aim of this study. There were 298 patients affected by PHPT with a high likelihood of a solitary sestamibipositive PA and 38 DTC patients affected by 131I-negative, but sestamibi-positive, locoregional recurrence. All patients underwent a preoperative imaging work-up, including sestamibi scintigraphy (doubletracer subtraction scan in PHPT patients and single-tracer, wash-out scan in DTC patients) and high-resolution neck ultrasonography (US). The LSD protocol we developed consists of the intravenous injection of a very low (1 mCi) sestamibi dose in the operating theater just 10 minutes before commencing intervention for the purpose of radioguided surgery only. At variance with the traditional "high (20-25 mCi) sestamibi dose (HSD)" protocol in which imaging and radioguided surgery are obtained in the same day, in the LSD protocol, imaging and radioguided surgery are performed in different days. The LSD protocol allows some advantages over the HSD protocol: (1) more time for acquiring and interpreting preoperative imaging (planar scintigraphy, single-photon emission computed tomography [SPECT], US); (2) an accurate selection of patients to whom MIRS is offered, especially in countries where the prevalence of nodular goiter with sestamibi-avid thyroid nodules (exclusion criteria for MIRS) is relatively high, as in mid-south-European countries; (3) it facilitates the work planning in the operating theater (bilateral neck exploration requires an operating time of at least double to that of MIRS); and (4) the radiation exposure dose to operating theater personnel is very low-substantially negligible, using the LSD protocol: This aspect assumes great importance in countries where radioproteximetric rules are stringent, as in Europe. RESULTS PHPT patients. MIRS was successfully performed by a 1.5-2-cm skin incision in 287 of 298 PHPT patients (96.3%) in whom such an approach was scheduled on the basis of preoperative imaging, including 41 of 57 patients (71.9%) who had previously received thyroid or unsuccessful parathyroid surgery in another center. No case of major intraoperative complication was recorded. No case of persistent or recurrent PHPT was observed during postsurgical follow-up. DTC patients. A total of 79 metastatic lesions were intraoperatively detected by the gamma probe and successfully removed (68 of them had been correctly visualized at preoperative sestamibi scintigraphy). During subsequent follow-up, 18 patients (72%) were considered disease-free, whereas 7 had persistent disease (increased serum thyroglobulin levels). The radiation exposure dose to the surgeon using the LSD protocol was 1.2 uSi/hour, that is, 20-30-fold lower than that delivered with the HSD protocol used for PHPT patients and with the 131I protocol used for DTC patients with recurrence. CONCLUSIONS On the basis of our data, it can be concluded that the LSD protocol is a safe and effective protocol to perform in both MIRS in PHPT patients and radioguided reoperation in DTC patients with 131I-negative recurrence. Furthermore, from a radioproteximetric point of view, in comparison with other radioguided protocols used for the same purposes, the LSD protocol minimizes the radiation-exposure dose to the surgeon and operating theater personnel.
Collapse
Affiliation(s)
- Domenico Rubello
- Nuclear Medicine Service, S. Maria della Misericordia Hospital, Rovigo, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Sandrucci S, Luccisano E, Filomena A, Verdecchia G, Mussa A. [Lymph node sentinel in gastric carcinoma: proposal of a multicenter GISCRIS (Gruppo Italiano per lo Studio della Chirurgia Radioguidata e dell'immunoscintigrafia) protocol]. Suppl Tumori 2005; 4:S90-1. [PMID: 16437924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Sentinel node biopsy has been widely adopted in the treatment of cutaneous melanoma and breast cancer. The ongoing controversy concerning the extension of lymphatic dissection in gastric cancer demonstrate that the optimal extent of lymphadenectomy has yet to be established, and underlines that the research in this area is needed to refine our knowledge and consequently our treatment of gastric tumors. In this paper the authors describe a multicentric protocol concerning the sentinel node research in early and advanced T1-T2 gastric cancer employing the blue dye method and lymphoscintigraphy by means of the endoscopic injection of Tc99m labeled nanocolloids. The aim of this protocol is to assess the clinical relevance of the sentinel node biopsy in selecting N+ patients in early gastric cancer, and the role of the same technique in detecting N2 positive patients in case of advanced gastric cancer. Assuming a confidence interval of +/- 5%, a sample of 100 recruited cases over three years is previewed.
Collapse
Affiliation(s)
- S Sandrucci
- SC Chirurgia Oncologica, ASO S Giovanni Battista, Università degli Studi, Torino
| | | | | | | | | |
Collapse
|
44
|
Sandrucci S, Mussa B, Goss M, Repici A, Bellò M, Bisi G, Mussa A. [Lymphoscintigraphic localization of sentinel lymph nodes in colorectal carcinoma in early stage: results of a single center study and proposal of a multicenter protocol]. Suppl Tumori 2005; 4:S26-7. [PMID: 16437882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In colorectal cancer the sentinel node dissection may help to identify any unusual mesenteric lymphatic drainage pattern from the primary tumor site (ex/skip metastases); assuming that accurate pathological staging is critical for therapeutic decisions we are conducing a study to evaluate the feasibility of the sentinel node technique in colorectal neoplasms and its overall accuracy in predicting regional lymph nodes metastases for appropriate staging. From February 2001 to September 2004 we included in this study 30 patients with rectal lesions or degenerate colonic polyps not radically excised by endoscopy. Lymphatic mapping was performed with low molecular weight albumin colloid labelled with 500Mci of 99mTc in a 2 ml volume and injected submucosally by an endoscopic route at the four cardinal points around the tumor, the afternoon before the surgical procedure, both in case of colonic or rectal lesions. Scintigraphic images were obtained with a gamma camera fitted with a general purpose collimator. The day of the intervention, a hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect the "hot" nodes, in vivo and ex vivo. These lymph nodes were tagged with a stitch in vivo; the specimen was removed by a standard resection and SLN were dissected ex vivo and sent separately for pathological examination. In case of rectal lesions, the sentinel nodes were searched ex vivo into mesorectal fat in case. All lymph nodes, including blue or hot ones, were embedded separately for preparation of paraffin sections and haematoxylin and eosin staining. Sentinel lymph node were submitted to multi-seriate sections in order to look for micrometastases. Using the radioactive tracer, sentinel lymph nodes were successfully identified in 27 out of 30 patients. Concordance between SLNs and nodal status was observed in 23 out of 27 cases (85%); two patients (7.4%) were upstaged, as SLN was the only site of metastases. In another two cases we observed no concordance between negative sentinel node and non sentinel nodes (false negative rate, 7.4%). Starting from this experience we are proposing a multicentric trial concerning the value of sentinel node technique in rectal cancer and in early colorectal cancers detected by screening programs.
Collapse
Affiliation(s)
- S Sandrucci
- SC Chirurgia Oncologica, Università degli Studi, Torino
| | | | | | | | | | | | | |
Collapse
|
45
|
Rubello D, Pelizzo MR, Boni G, Schiavo R, Vaggelli L, Villa G, Sandrucci S, Piotto A, Manca G, Marini P, Mariani G. Radioguided surgery of primary hyperparathyroidism using the low-dose 99mTc-sestamibi protocol: multiinstitutional experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS). J Nucl Med 2005; 46:220-6. [PMID: 15695779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
UNLABELLED This study evaluated the accuracy of (99m)Tc-sestamibi scintigraphy and neck ultrasonography in patients with primary hyperparathyroidism (PHPT) and the role of intraoperative hand-held gamma-probes in minimally invasive radioguided surgery (MIRS) of patients with a high likelihood of a solitary parathyroid adenoma (PA). The study was undertaken under the aegis of the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS). METHODS Clinical records were reviewed for 384 consecutive PHPT patients undergoing radioguided surgery using a low dose of (99m)Tc-sestamibi. Selection of patients for MIRS instead of traditional bilateral neck exploration was based on preoperative imaging indicating a solitary PA. (99m)Tc-Sestamibi (37-110 MBq, or 1-3 mCi) was injected in the operating theater 10-30 min before the start of the intervention. Either 11-mm collimated (309 patients) or 14-mm collimated (75 patients) gamma-probes were used. Intraoperative quick parathyroid hormone (IQPTH) assay was used on 308 patients (80.2%). RESULTS MIRS was successfully performed on 268 (96.8%) of 277 patients. Conversion to bilateral neck exploration was necessary in 9 patients (3.3%) because of either persistently high IQPTH levels after removal of the preoperatively visualized PA (4 patients), intraoperative frozen-section diagnosis of parathyroid carcinoma (2 patients), or hard-to-remove PA (3 patients). MIRS, which was performed under locoregional anesthesia in 72 patients, required a mean operating time of 37 min and a mean hospital stay of 1.2 d. MIRS was successfully performed also on 32 (78.0%) of 41 patients who had previously undergone thyroid or parathyroid surgery. No major surgical complications were observed in the MIRS group, and there were only 24 cases (11%) of transient postoperative hypocalcemia. The probe was of little help in patients with concomitant (99m)Tc-sestamibi-avid thyroid nodules and not helpful at all in patients with negative scan findings preoperatively. IQPTH measurement helped to disclose some cases of multigland parathyroid disease. CONCLUSION (99m)Tc-Sestamibi scintigraphy, especially if combined with neck ultrasonography, is highly accurate in selecting PHPT candidates for MIRS. The low-dose (99m)Tc-sestamibi protocol (which entails a low-to-negligible radiation exposure to the surgical team) is safe and effective for MIRS. MIRS plays a limited role in patients with concomitant (99m)Tc-sestamibi-avid thyroid nodules and should be discouraged in patients with negative (99m)Tc-sestamibi finding preoperatively. IQPTH can be recommended during MIRS to facilitate intraoperative identification of previously undiagnosed multigland parathyroid disease.
Collapse
Affiliation(s)
- Domenico Rubello
- Nuclear Medicine Service, S. Maria della Misericordia Hospital, Rovigo, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Cserni G, Gregori D, Merletti F, Sapino A, Mano MP, Ponti A, Sandrucci S, Baltás B, Bussolati G. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg 2004; 91:1245-52. [PMID: 15376203 DOI: 10.1002/bjs.4725] [Citation(s) in RCA: 229] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The need for further axillary treatment in patients with breast cancer with low-volume sentinel node (SN) involvement (micrometastases or smaller) is controversial. METHODS Twenty-five studies reporting on non-SN involvement associated with low-volume SN involvement were identified using Medline and a meta-analysis was performed. RESULTS The weighted mean estimate for the incidence of non-SN metastases after low-volume SN involvement is around 20 per cent, whereas this incidence is around 9 per cent if the SN involvement is detected by immunohistochemistry (IHC) alone. Subset analyses suggest that studies with axillary dissection after any type of SN involvement result in somewhat higher estimates than studies allowing omission of axillary clearance, as do studies with more detailed histological evaluation of the SN compared with those with a less intensive histological protocol. Higher-quality papers yield lower pooled estimates than lower-quality papers. CONCLUSION The risk of non-SN metastasis with a low-volume metastasis in the SN is around 10-15 per cent, depending on the method of detection of SN involvement. This should be taken into account when assessing the risk of omission of axillary dissection after a positive SN biopsy yielding micrometastatic or immunohistochemically positive SNs.
Collapse
Affiliation(s)
- G Cserni
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Bertoglio S, Sandrucci S, Percivale P, Goss M, Gipponi M, Moresco L, Mussa B, Mussa A. Prognostic value of sentinel lymph node biopsy in the pathologic staging of colorectal cancer patients. J Surg Oncol 2004; 85:166-70. [PMID: 14991889 DOI: 10.1002/jso.20030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Over the last decade, lymphatic mapping and sentinel lymph node (sN) biopsy have greatly increased the possibility of identifying nodal metastasis in clinically node-negative patients with melanoma and breast cancer, thus improving the accuracy of pathologic staging. Recently, sN biopsy has been applied also in colorectal cancer. This prospective study aimed to assess its feasibility and accuracy in predicting regional lymph nodes metastases in colorectal cancer patients as well as the impact on treatment decision-making. MATERIALS AND METHODS Lymphatic mapping was accomplished by means of blue dye, which was intraoperatively injected into the subserosa overlying the tumor site in 26 patients undergoing colorectal cancer surgery. Following bowel resection, the operative specimen was inspected to identify each blue-stained node, the sN, which was sent separately to the pathologist. One half of each sN was examined by multiple 200 microm sections, while the second half was examined by standard bi-valving technique with hematoxylin-eosin (H and E) staining; all the other regional non-sentinel nodes were routinely examined by standard bi-valving technique and H and E staining. RESULTS At least one sN was detected in 24 of 26 patients (92.3%); two patients with rectal cancer had no sN identified. Overall, 70 sN were retrieved into the operative specimens, with a mean of 2.9 sNs/patient, and 19 sNs were tumor-positive. An agreement between sN and regional lymph-node status was observed in 20 of 24 patients (83.4%). The sN was histologically negative in two of nine patients with positive regional nodes (sensitivity = 77.8%; false-negative rate of 22.2%); in two of seven patients with tumor-positive sN (28.6%), the sN was the exclusive site of regional nodal metastasis. The negative predictive value was 88.2% (15 of 17 patients), and the overall accuracy was 91.7% (22 of 24 patients). As regards the contribution to the detection of nodal metastasis according to the pathologic technique, standard H and E bi-valving technique detected 16 of 19 tumor-positive sNs (84.2%) while, by means of serial sectioning, metastases were detected in the remaining 3 of 19 sNs (15.8%). CONCLUSIONS The sN biopsy proved feasible, with a rather short learning curve. The focused analysis of the sN by means of serial sectioning improved the detection rate of nodal metastasis compared to standard bi-valving examination, so that a more accurate nodal staging should be expected; finally, an elective localization of metastasis within the sN was observed in almost one third of regional node-positive patients.
Collapse
Affiliation(s)
- Sergio Bertoglio
- Gastrointestinal Surgery Unit, Department of Oncology, Biology and Genetics, University of Genoa, School of Medicine, Genoa, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Evangelista W, Satolli MA, Malossi A, Mussa B, Sandrucci S. Sentinel lymph node mapping in colorectal cancer: a feasibility study. Tumori 2002; 88:37-40. [PMID: 12004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AIMS AND BACKGROUND Sentinel lymph node (SLN) biopsy is currently used and investigated in melanoma and in breast cancer. Its utility in gastrointestinal malignancies is still under debate. The prognosis of colorectal cancer patients is strongly related to the lymphatic involvement. The aim of this study was to evaluate the feasibility of SLN mapping in colorectal cancer and to assess its impact on pathological staging and treatment. METHODS AND STUDY DESIGN We injected blue dye in 11 colorectal cancer patients during surgery. After resection the tumor specimen was examined to identify blue-stained lymph nodes and these lymph nodes were sent separately to the pathologist. Routine hematoxylin-eosin examination was performed on all nodes (including blue ones). No other techniques (eg immunohistochemistry or PCR) were performed. RESULTS Sentinel lymph nodes were successfully identified in 10 of the 11 patients. We observed only one false negative result (10%) and the agreement between SLN and other lymph node status was 80% (8/10). One patient was upstaged: SLN was positive for metastases while the other lymph nodes were negative. CONCLUSIONS Lymphatic mapping using patent blue dye is feasible in colorectal cancer. The identification of lymph nodal metastases by this technique led to upstaging of one patient, who may benefit from adjuvant therapy. These initial results prompt further investigation of this procedure as an accurate, minimally invasive staging approach in early colorectal cancer. We proceed with our study to evaluate the role of SLN mapping in colorectal cancer management.
Collapse
Affiliation(s)
- Walter Evangelista
- Department of Oncology, Medical Oncology Service, Azienda Ospedaliera San Giovanni Battista, Turin, Italy. walterev.@tin.it
| | | | | | | | | |
Collapse
|
49
|
Mussa A, Sandrucci S, Zanon C. Intraoperative chemohyperthermia for advanced gastric cancer: a new procedure with closed abdomen and previously constructed anastomosis. Tumori 2001; 87:S18-20. [PMID: 11693812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- A Mussa
- Surgical Oncology Division, San Giovanni Battista Hospital, University of Turin, Italy
| | | | | |
Collapse
|
50
|
Zanon C, Bortolini M, Bo P, Sandrucci S, Trombetta F, Deandrea M, Mussa A. [A case of presacral myelolipoma]. MINERVA CHIR 2000; 55:559-63. [PMID: 11140113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Myelolipoma is a rare benign pathology whose pathogenesis is still unclear. It is most frequently localised in the adrenal gland, followed by the presacral region, mediastinum, and perirenal and hepatic region. It varies in size from a few millimetres to several centimetres. The lesion is usually capsulated, detachable from the surrounding tissues and hypovascularised. In histological terms, it is composed of lipomatous and hematopoietic tissues. A 65-year-old female patient was referred to our unit after the finding of a nonbiopsied, pelvic mass during earlier surgery. The patient was in considerable pain owing to the extrinsic compression of the mass on abdominal and pelvic organs. Preoperative tests confirmed the presence of a voluminous presacral neoformation that appeared to have a possible medullary origin (chordoma or schwannoma). During surgery, the lesion was found to be capsulated and mainly adherent to the rectum. Histological analysis confirmed the myelolipomatous nature of the lesion. A review of 21 cases reported in the literature is presented.
Collapse
Affiliation(s)
- C Zanon
- Dipartimento di Oncologia dell'Università, Divisione di Chirurgia Oncologica, Ospedale San Giovanni Battista, Molinette, Corso A. Dogliotti, 14-10126 Torino
| | | | | | | | | | | | | |
Collapse
|