- Email: [email protected]
Office-based Denver peritoneovenous shunt for malignant ascites: A feasibility study
1008 calcitonin; this protein represents the biochemical activity of MTC and it is a sensitive and specific marker in preoperative screening, diagnosis and postoperative follow-up. To date, only five cases of serum calcitonin-negative MTC have been reported. Methods: In a series of 74 patients with MTC in follow-up at the Services of Endocrinology and Oncological Endocrinology, 64 of which underwent surgical treatment at our Surgical Service, 3 patients with sporadic MTC were calcitonin negative. The preoperative findings, surgical approach and long-term outcome are reported. Conclusions: MTC with negative serum calcitonin is not so rare as might be expected. In our experience, such cases account for 4% of the affected population. Diagnosis and postoperative monitoring for recurrent disease in such patients are difficult. Alternative neuroendocrine markers (Cr A and NSE) and CEA become important for proper preand postoperative management associated with periodic neck ultrasound scans. Keywords. Medullary thyroid carcinoma; negative serum calcitonin
Co-existing chronic lymphocytic thyroiditis and papillary thyroid carcinoma. Impact on presentation, management, and outcome P. Makovaca, C. Dobrinjab,* , J. Guerrinic, N. de Manzinid a Department of General Surgery, Hospital of Cattinara, University of Trieste, Italy b Department of General Surgery, Hospital of Cattinara, of Trieste, Italy c Department of General Surgery, Hospital of Cattinara, of Trieste, Italy d Department of General Surgery, Hospital of Cattinara, of Trieste, Italy * Corresponding author. Chiara Dobrinja, M.D., ADDRESS: Department of General Surgery, Hospital of Cattinara, Universita degli Studi di Trieste, Strada di Fiume 447, 34149 Trieste, Italy. Tel.: +39-040-3994445; fax: +39-040-3994373. E-mail address: [email protected] (C. Dobrinja). Background: The association between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC) has been investigated for several years from different perspectives. Nonetheless, few attempts have been made to design a common reference frame to understand the complex mutual interactions between inflammatory response pathways and thyroid tumor induction and progression. The aim of this study was to determine the frequency and the prognostic significance of CLT in patients with PTC by comparing two groups of patients. Methods: From January 2005 to January 2012 we conducted a retrospective study on 114 patients with PTC who underwent thyroidectomy. CLT was diagnosed histopathologically. Age, sex, tumor features (dimension, angioinvasion, capsular infiltration, mono/multifocality and lymph node metastases), pathologic findings, and outcome were considered. The mean duration of follow-up (metastasis, completeness-of-resection, serum thyroglobulin levels, tumor recurrence) was 40 months (range, 284). A P <0.05 was considered statistically significant. Results: Out of 114 patients, 39 (34.2%) with PTC had co-existing CLT. Two groups were formed. Group A included 75 patients (26 males and 50 females; mean age, 52 years) with PTC alone; 72 underwent total thyroidectomy (TT) and 5 hemithyroidectomy. Group B was composed of 39 patients (5 males and 34 females; mean age, 51 years) with PTC and CLT. The median major diameter of the nodule was 16 mm (range, 0.6-65) in group A and 12 mm (range, 1.20-30) in group B. Concomitant CLT correlated with a lower grade of PTC (P <0.05). There was no statistically significant correlation between patient age (<45 years vs. 45 years) and CLT (P <0.26). There was a statistically significant correlation between patient sex and CLT co-existing with PTC (P <0.009), particularly for the female patients. There was no statistically significant correlation between mono/multifocal PTC and patient sex (P <0.08 for females and P <0.53 for males) or CLT (P <0.52). Lymphadenectomy was performed in 24 (32%) patients in group A and in 19 (48.7%) in group B. After surgery 62 (82%) patients underwent radioiodine therapy in group A, and 28 (71.8%) in group B. One (1.33%) patient in group A developed a local recurrence 7 months after surgery. Two (5.1%) patients in group B had a recurrence, one died 15 months after surgery, which was R1.
ABSTRACTS Conclusions: Concurrent CLT in patients with PTC correlated with a lower grade of PTC, disease-free survival and overall survival, but it did not affect the diagnostic evaluation or the management of papillary thyroid cancers. Sternal resection for metastatic thyroid carcinoma S. Silvestri1,*, N. Palestini2, C. Mossetti3, M.C. Bruna3, M. Freddi2, G. Sisto2, G. Gasparri2 1 School of Specialization in Surgery, University of Turin, Italy 2 General Surgery III, , Turin, Italy 3 Thoracic Surgery, AOU San Giovanni Battista, Turin, Italy * Corresponding author: Name: Silvestri Stefano, Address: Corso Re Umberto 11 e Torino, Italy. Phone number: 0039 340 5765010; Fax 011 7807762 - 0116335788. E-mail address: [email protected] (S. Silvestri). Background: Skeletal metastases (MTS) from thyroid carcinoma (TC) are resistant to radioiodine therapy. Sternal localizations are rare; in such cases surgical resection may offer not only the chance of a cure but also effective palliation for patients with MTS in other sites. Methods: From 1994 to 2011, 6 patients (4 males; mean age, 66 years; range, 56-78) underwent sternal resection for synchronous or metachronous sternal metastases from TC. Four patients had sternal involvement at initial diagnosis of TC and two had metachronous MTS. Three patients had single skeletal localizations at partial sternal resection and three others had synchronous bony MTS. Four patients had concurrent lung MTS. Results: All MTS were localized to the cranial sternum. Partial sternal resection including the internal parts of the clavicle and the adjacent ribs was performed, with tracheal resection in one case. The primary tumor was follicular carcinoma (n¼3), poorly differentiated carcinoma (n¼2), and papillary carcinoma (n¼1). The chest wall defect was reconstructed with GoretexÒ mesh in the first case and with resorbable material (VicrylÒ) in the second; in the other four patients a polypropylene (ProleneÒ) mesh was used. A seroma developed in the first case; no other complications occurred. Radioiodine was administered to all patients as complementary therapy. No local recurrence was observed; the 5-year actuarial survival is 78% (51-105 months, 95% confidence interval). Conclusions: Sternal resection for MTS from TC is a safe procedure and should be performed in selected patients. It is indicated not only as curative treatment for single skeletal MTS, but also with palliative intent to control symptoms and to make radioiodine treatment more effective. Reconstruction of the sternum with polypropylene mesh is a simple and effective method to restore chest wall defects and yields satisfactory functional and cosmetic results. Office-based Denver peritoneovenous shunt for malignant ascites: A feasibility study D. Cianflocca*, G. Balbo, R. Reddavid, B. Mussa, S. Sandrucci Surgical Oncology unit, University of Turin, Italy * Corresponding Author: Desiree Cianflocca, Surgical Oncology Unit, San Giovanni Battista Hospital, Cso Dogliotti 14 10126 Torino Italy. E-mail address: [email protected] (D. Cianflocca). Background: Management of refractory malignant ascites is part of palliative care to improve the patient’s quality of life. In patients with malignant ascites, peritoneovenous shunts can control ascites, but the potential risks of the procedure need to be weighed against the requirement of hospital stay and operatory room utilization. We report our experience in peritoneovenous shunt placement as an outpatient procedure. Methods: From 2006 to 2011, 148 patients with symptomatic malignant ascites, more than 30 days life expectation, unresponsive to diuretic treatment, and requiring paracentesis at least twice a week were evaluated for shunt placement. Of these, 98 patients (8 with breast cancer carcinomatosis, 5 with pancreatic cancer carcinomatosis, 30 with ovarian cancer carcinomatosis, 15 with gastric cancer carcinomatosis, 30 with
ABSTRACTS colorectal cancer carcinomatosis, 5 with abdominal mesothelioma, 5 with carcinomatosis of other origin) with a cardiac ejection fraction >40 and Karnofsky Performance Status >80 received a Denver peritoneojugular shunt as an outpatient procedure under local anesthesia and mild sedation. Jugular vascular access was achieved via ultrasound-guided venipuncture. Results: The average operating time was 30 minutes. Vascular access was through the right jugular vein in 87 patients and the left jugular vein in 11. The success rate of venipuncture and the operation was 100%. The mean postprocedural observation period was 180 minutes. Hemorrhagic suffusion occurred in 12 patients; no other major complications were observed. The waist circumference decreased within 3 hours of shunt placement; 4 patients required mild abdominal compression. The percentage of patent shunts at 30 days postimplantation was 75% (74/98) and 70% at 60 days. In 20 patients the shunt was removed due to valve failure or peritoneal catheter occlusion, with subsequent conversion to open percutaneous drainage. No thrombotic complications occurred in the district of the superior vena cava. Conclusions: Our experience demonstrates the feasibility of performing peritoneovenous shunt placement on an outpatient basis in selected patients and with use of ultrasound-guided venipuncture. The high success rate confirms that it is an effective palliative procedure for treating intractable malignant ascites.
Pelvic evisceration for pelvic neoplastic disease: Our results D. Siatis, A. Mellano*, M. Robella, M. Barbera, G. Maucioni, M. De Simone Surgical Oncology Unit, IRCC Candiolo, Turin, Italy * Corresponding author: Alfredo Mellano, Chirurgia Oncologica IRCC, Candiolo (TO), Italy. Strada Provinciale no. 142, Km 3,95, Candiolo (TO), Italy. Tel.: 0119933445/0119933630/3383824104; fax: 0119933440. E-mail address: [email protected] (A. Mellano). Background: Oncologic surgeons face the challenging problem of patients with locally advanced neoplastic (primary or recurrent) pelvic disease recalcitrant to cancer therapies and tending to be locally bulky and highly symptomatic. Methods: Between May 2010 and March 2012, 8 patients (5 females and 3 males; mean age, 50.5 years) underwent pelvic evisceration with curative intent (complete in 7 patients, posterior in 1 patient) for neoplastic disease (recurrent rectal adenocarcinoma [n¼3], primary locally advanced rectal adenocarcinoma [n¼1], squamous cell cervical carcinoma [n¼1], endometrial cancer [n¼1], ovarian cancer [n¼1], squamous cell keratinizing perianal carcinoma [n¼1]) by the same skilled surgical team. Four patients were treated with neoadjuvant chemotherapy. Results: All 8 patients underwent anterior resection (rectum, neorectum or rectal stump), with sphincter resection in 3, cystectomy in 7 with monolateral nefrectomy in 2, resection of the vagina in 4 females, and hysteroannessiectomy in 1, prostatectomy in all 3 male patients associated with resection of the external genitalia in 1. Lymph node dissection (iliac and obturator node groups) was performed in 6 patients. Moreover, resection of the coccyx, the sacrum (from S2 downwards), or the left pyriform muscles with incision of the left coxofemoral joint capsule was performed in 3 patients, respectively. Digestive tract reconstruction was a terminal colostomy in 7 patients and a low colorectal straight anastomosis in 1 patient. Urinary tract reconstruction was performed using a Bricker ileal loop in 2 patients, ureterocutaneostomy in 4 (2 bilateral, 2 monolateral), ureterocolostomy in 1 patient, uretero-ureteral T-T anastomosis in 1 patient, and uretero-vescical anastomosis in 1. The mean operating time was 300 minutes (5 hours). The mean length of stay was 14.6 days. Blood transfusions were needed in 4 patients. No patient died. Morbidity was 37.5% (3/8). Two patients required a relaparotomy for hemoperitoneum and partial intestinal necrosis, respectively. One patient had a pelvic collection that was drained through the perineal wound. Two late complications occurred: one Bricker fistula treated with replacement of a double J stent and one rectovaginal fistula. At a median
1009 follow-up of 7 months, 5/8 (62.5%) patients are alive and 3/8 (37.5%) alive and disease free, 2/5 patients are alive with recurrence: 1 distant (hepatic) and 1 local (head of femur). Recurrence of disease was observed in 5/8 (62.5%) patients: local in 3/5 (60%), isolated distant in 1/5 (liver) (20%), and distant diffuse and local in 1/5 (20%). Conclusions: Pelvic evisceration resolves troublesome symptoms in patients with pelvic neoplastic disease not controlled by therapy, increasing their quality of life, with zero mortality and acceptable morbidity. The survival benefit doesn’t seem to be high, but more data and studies are needed. Reliability and safety of the echo-guided procedure of mid- and longterm totally implantable system positioning in the path to learning the techniques M.C. Cucchi, R. Ferrarini, V. Galluzzo* U.O. of General and Oncologic Surgery, Bellaria Hospital, Bologna, Italy * Corresponding author: Valentina Galluzzo, U.O. of General and Oncologic Surgery, Bellaria Hospital e Bologna Italy. via Altura 3, 40139 Bologna, Italy. Tel. 051 6225021/22 3385226586; fax 051 6225033. E-mail address: [email protected] (V. Galluzzo). Background: The authors analyze their experience with the positioning of totally implantable central venous access, stressing the importance of the systematic use of ultrasound for vascular assessment and venipuncture in learning the methods to be used and in order to control immediate complications. Methods: From 1January 2007 to 31 December 2011 we placed 312 Port-a-Cath devices under ultrasound guidance (185 women, 127 men). The use of ultrasound allowed us to perform venous cannulation with a single venipuncture in 82% of cases. Surgical isolation of the vessel was required in only 1 case due to an unfavorable position of the vein. There was only 1 case of an early complication (formation of a layer of pneumothorax) but it did not require chest drainage aspiration. The catheter had to be removed in 8 cases because of late onset of infection in 6 and skin necrosis in the pocket of the reservoir in 2. Results: The procedure was ordinarily performed under local anesthesia in day surgery, except in patients whose port placement had been planned for oncologic operations under general anesthesia. The technique involves cannulation of the vein under ultrasound guidance using a 10 MHz linear transducer. A preoperative ultrasound of the neck allows direct visualization of the vein and its exact location and morphology. The most often used access was the right internal jugular vein at the right supraclavicular level. Device implantation is carried out under fluoroscopy control in the operating room in order to assess correct positioning of the catheter tip after cannulation, which must be pre-atrial. The pocket for positioning the reservoir is generally located at a right subcutaneous subclavicular level in the parasternal area. Subsequent chest radiographs in 2 projections are obtained to rule out pneumothorax. Conclusions: The steady increase in the use of port-like systems can be attributed to greater attention to patient compliance with respect to the various procedures necessary for proper planning of therapeutic strategies for cancer. The use in operating room environment, the ultrasound monitoring of the cannulation via the central vein, the fluoroscopy control of the catheter and of the position of its tip at the pre-atrial level, and the port inserted by the surgeon under the skin, all reduce complications to a limited number of cases. In our view, ultrasound is particularly useful as a tool for operational safety: in our series we have noted no increase in the complications rate from the early stages of the learning curve for operators. Feasibility, efficacy and advantages of an early diagnosis and treatment of PICC-related thrombosis in cancer patients C. Garrino*, C. Gennaro, G. Monasterolo, F. Pischedda, B. Mussa Surgical Oncology Unit, University of Turin, Italy * Corresponding author: Cristina Garrino, Surgica Oncology Unit, University of Turin, Italy. Cso Dogliotti 14 10126 Torino, Italy. Tel.: +39 0116334530; fax +39 0116336652. E-mail address: [email protected] (C. Garrino).
Co-existing chronic lymphocytic thyroiditis and papillary thyroid carcinoma. Impact on presentation, management, and outcome P. Makovaca, C. Dobrinjab,* , J. Guerrinic, N. de Manzinid a Department of General Surgery, Hospital of Cattinara, University of Trieste, Italy b Department of General Surgery, Hospital of Cattinara, of Trieste, Italy c Department of General Surgery, Hospital of Cattinara, of Trieste, Italy d Department of General Surgery, Hospital of Cattinara, of Trieste, Italy * Corresponding author. Chiara Dobrinja, M.D., ADDRESS: Department of General Surgery, Hospital of Cattinara, Universita degli Studi di Trieste, Strada di Fiume 447, 34149 Trieste, Italy. Tel.: +39-040-3994445; fax: +39-040-3994373. E-mail address: [email protected] (C. Dobrinja). Background: The association between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC) has been investigated for several years from different perspectives. Nonetheless, few attempts have been made to design a common reference frame to understand the complex mutual interactions between inflammatory response pathways and thyroid tumor induction and progression. The aim of this study was to determine the frequency and the prognostic significance of CLT in patients with PTC by comparing two groups of patients. Methods: From January 2005 to January 2012 we conducted a retrospective study on 114 patients with PTC who underwent thyroidectomy. CLT was diagnosed histopathologically. Age, sex, tumor features (dimension, angioinvasion, capsular infiltration, mono/multifocality and lymph node metastases), pathologic findings, and outcome were considered. The mean duration of follow-up (metastasis, completeness-of-resection, serum thyroglobulin levels, tumor recurrence) was 40 months (range, 284). A P <0.05 was considered statistically significant. Results: Out of 114 patients, 39 (34.2%) with PTC had co-existing CLT. Two groups were formed. Group A included 75 patients (26 males and 50 females; mean age, 52 years) with PTC alone; 72 underwent total thyroidectomy (TT) and 5 hemithyroidectomy. Group B was composed of 39 patients (5 males and 34 females; mean age, 51 years) with PTC and CLT. The median major diameter of the nodule was 16 mm (range, 0.6-65) in group A and 12 mm (range, 1.20-30) in group B. Concomitant CLT correlated with a lower grade of PTC (P <0.05). There was no statistically significant correlation between patient age (<45 years vs. 45 years) and CLT (P <0.26). There was a statistically significant correlation between patient sex and CLT co-existing with PTC (P <0.009), particularly for the female patients. There was no statistically significant correlation between mono/multifocal PTC and patient sex (P <0.08 for females and P <0.53 for males) or CLT (P <0.52). Lymphadenectomy was performed in 24 (32%) patients in group A and in 19 (48.7%) in group B. After surgery 62 (82%) patients underwent radioiodine therapy in group A, and 28 (71.8%) in group B. One (1.33%) patient in group A developed a local recurrence 7 months after surgery. Two (5.1%) patients in group B had a recurrence, one died 15 months after surgery, which was R1.
ABSTRACTS Conclusions: Concurrent CLT in patients with PTC correlated with a lower grade of PTC, disease-free survival and overall survival, but it did not affect the diagnostic evaluation or the management of papillary thyroid cancers. Sternal resection for metastatic thyroid carcinoma S. Silvestri1,*, N. Palestini2, C. Mossetti3, M.C. Bruna3, M. Freddi2, G. Sisto2, G. Gasparri2 1 School of Specialization in Surgery, University of Turin, Italy 2 General Surgery III, , Turin, Italy 3 Thoracic Surgery, AOU San Giovanni Battista, Turin, Italy * Corresponding author: Name: Silvestri Stefano, Address: Corso Re Umberto 11 e Torino, Italy. Phone number: 0039 340 5765010; Fax 011 7807762 - 0116335788. E-mail address: [email protected] (S. Silvestri). Background: Skeletal metastases (MTS) from thyroid carcinoma (TC) are resistant to radioiodine therapy. Sternal localizations are rare; in such cases surgical resection may offer not only the chance of a cure but also effective palliation for patients with MTS in other sites. Methods: From 1994 to 2011, 6 patients (4 males; mean age, 66 years; range, 56-78) underwent sternal resection for synchronous or metachronous sternal metastases from TC. Four patients had sternal involvement at initial diagnosis of TC and two had metachronous MTS. Three patients had single skeletal localizations at partial sternal resection and three others had synchronous bony MTS. Four patients had concurrent lung MTS. Results: All MTS were localized to the cranial sternum. Partial sternal resection including the internal parts of the clavicle and the adjacent ribs was performed, with tracheal resection in one case. The primary tumor was follicular carcinoma (n¼3), poorly differentiated carcinoma (n¼2), and papillary carcinoma (n¼1). The chest wall defect was reconstructed with GoretexÒ mesh in the first case and with resorbable material (VicrylÒ) in the second; in the other four patients a polypropylene (ProleneÒ) mesh was used. A seroma developed in the first case; no other complications occurred. Radioiodine was administered to all patients as complementary therapy. No local recurrence was observed; the 5-year actuarial survival is 78% (51-105 months, 95% confidence interval). Conclusions: Sternal resection for MTS from TC is a safe procedure and should be performed in selected patients. It is indicated not only as curative treatment for single skeletal MTS, but also with palliative intent to control symptoms and to make radioiodine treatment more effective. Reconstruction of the sternum with polypropylene mesh is a simple and effective method to restore chest wall defects and yields satisfactory functional and cosmetic results. Office-based Denver peritoneovenous shunt for malignant ascites: A feasibility study D. Cianflocca*, G. Balbo, R. Reddavid, B. Mussa, S. Sandrucci Surgical Oncology unit, University of Turin, Italy * Corresponding Author: Desiree Cianflocca, Surgical Oncology Unit, San Giovanni Battista Hospital, Cso Dogliotti 14 10126 Torino Italy. E-mail address: [email protected] (D. Cianflocca). Background: Management of refractory malignant ascites is part of palliative care to improve the patient’s quality of life. In patients with malignant ascites, peritoneovenous shunts can control ascites, but the potential risks of the procedure need to be weighed against the requirement of hospital stay and operatory room utilization. We report our experience in peritoneovenous shunt placement as an outpatient procedure. Methods: From 2006 to 2011, 148 patients with symptomatic malignant ascites, more than 30 days life expectation, unresponsive to diuretic treatment, and requiring paracentesis at least twice a week were evaluated for shunt placement. Of these, 98 patients (8 with breast cancer carcinomatosis, 5 with pancreatic cancer carcinomatosis, 30 with ovarian cancer carcinomatosis, 15 with gastric cancer carcinomatosis, 30 with
ABSTRACTS colorectal cancer carcinomatosis, 5 with abdominal mesothelioma, 5 with carcinomatosis of other origin) with a cardiac ejection fraction >40 and Karnofsky Performance Status >80 received a Denver peritoneojugular shunt as an outpatient procedure under local anesthesia and mild sedation. Jugular vascular access was achieved via ultrasound-guided venipuncture. Results: The average operating time was 30 minutes. Vascular access was through the right jugular vein in 87 patients and the left jugular vein in 11. The success rate of venipuncture and the operation was 100%. The mean postprocedural observation period was 180 minutes. Hemorrhagic suffusion occurred in 12 patients; no other major complications were observed. The waist circumference decreased within 3 hours of shunt placement; 4 patients required mild abdominal compression. The percentage of patent shunts at 30 days postimplantation was 75% (74/98) and 70% at 60 days. In 20 patients the shunt was removed due to valve failure or peritoneal catheter occlusion, with subsequent conversion to open percutaneous drainage. No thrombotic complications occurred in the district of the superior vena cava. Conclusions: Our experience demonstrates the feasibility of performing peritoneovenous shunt placement on an outpatient basis in selected patients and with use of ultrasound-guided venipuncture. The high success rate confirms that it is an effective palliative procedure for treating intractable malignant ascites.
Pelvic evisceration for pelvic neoplastic disease: Our results D. Siatis, A. Mellano*, M. Robella, M. Barbera, G. Maucioni, M. De Simone Surgical Oncology Unit, IRCC Candiolo, Turin, Italy * Corresponding author: Alfredo Mellano, Chirurgia Oncologica IRCC, Candiolo (TO), Italy. Strada Provinciale no. 142, Km 3,95, Candiolo (TO), Italy. Tel.: 0119933445/0119933630/3383824104; fax: 0119933440. E-mail address: [email protected] (A. Mellano). Background: Oncologic surgeons face the challenging problem of patients with locally advanced neoplastic (primary or recurrent) pelvic disease recalcitrant to cancer therapies and tending to be locally bulky and highly symptomatic. Methods: Between May 2010 and March 2012, 8 patients (5 females and 3 males; mean age, 50.5 years) underwent pelvic evisceration with curative intent (complete in 7 patients, posterior in 1 patient) for neoplastic disease (recurrent rectal adenocarcinoma [n¼3], primary locally advanced rectal adenocarcinoma [n¼1], squamous cell cervical carcinoma [n¼1], endometrial cancer [n¼1], ovarian cancer [n¼1], squamous cell keratinizing perianal carcinoma [n¼1]) by the same skilled surgical team. Four patients were treated with neoadjuvant chemotherapy. Results: All 8 patients underwent anterior resection (rectum, neorectum or rectal stump), with sphincter resection in 3, cystectomy in 7 with monolateral nefrectomy in 2, resection of the vagina in 4 females, and hysteroannessiectomy in 1, prostatectomy in all 3 male patients associated with resection of the external genitalia in 1. Lymph node dissection (iliac and obturator node groups) was performed in 6 patients. Moreover, resection of the coccyx, the sacrum (from S2 downwards), or the left pyriform muscles with incision of the left coxofemoral joint capsule was performed in 3 patients, respectively. Digestive tract reconstruction was a terminal colostomy in 7 patients and a low colorectal straight anastomosis in 1 patient. Urinary tract reconstruction was performed using a Bricker ileal loop in 2 patients, ureterocutaneostomy in 4 (2 bilateral, 2 monolateral), ureterocolostomy in 1 patient, uretero-ureteral T-T anastomosis in 1 patient, and uretero-vescical anastomosis in 1. The mean operating time was 300 minutes (5 hours). The mean length of stay was 14.6 days. Blood transfusions were needed in 4 patients. No patient died. Morbidity was 37.5% (3/8). Two patients required a relaparotomy for hemoperitoneum and partial intestinal necrosis, respectively. One patient had a pelvic collection that was drained through the perineal wound. Two late complications occurred: one Bricker fistula treated with replacement of a double J stent and one rectovaginal fistula. At a median
1009 follow-up of 7 months, 5/8 (62.5%) patients are alive and 3/8 (37.5%) alive and disease free, 2/5 patients are alive with recurrence: 1 distant (hepatic) and 1 local (head of femur). Recurrence of disease was observed in 5/8 (62.5%) patients: local in 3/5 (60%), isolated distant in 1/5 (liver) (20%), and distant diffuse and local in 1/5 (20%). Conclusions: Pelvic evisceration resolves troublesome symptoms in patients with pelvic neoplastic disease not controlled by therapy, increasing their quality of life, with zero mortality and acceptable morbidity. The survival benefit doesn’t seem to be high, but more data and studies are needed. Reliability and safety of the echo-guided procedure of mid- and longterm totally implantable system positioning in the path to learning the techniques M.C. Cucchi, R. Ferrarini, V. Galluzzo* U.O. of General and Oncologic Surgery, Bellaria Hospital, Bologna, Italy * Corresponding author: Valentina Galluzzo, U.O. of General and Oncologic Surgery, Bellaria Hospital e Bologna Italy. via Altura 3, 40139 Bologna, Italy. Tel. 051 6225021/22 3385226586; fax 051 6225033. E-mail address: [email protected] (V. Galluzzo). Background: The authors analyze their experience with the positioning of totally implantable central venous access, stressing the importance of the systematic use of ultrasound for vascular assessment and venipuncture in learning the methods to be used and in order to control immediate complications. Methods: From 1January 2007 to 31 December 2011 we placed 312 Port-a-Cath devices under ultrasound guidance (185 women, 127 men). The use of ultrasound allowed us to perform venous cannulation with a single venipuncture in 82% of cases. Surgical isolation of the vessel was required in only 1 case due to an unfavorable position of the vein. There was only 1 case of an early complication (formation of a layer of pneumothorax) but it did not require chest drainage aspiration. The catheter had to be removed in 8 cases because of late onset of infection in 6 and skin necrosis in the pocket of the reservoir in 2. Results: The procedure was ordinarily performed under local anesthesia in day surgery, except in patients whose port placement had been planned for oncologic operations under general anesthesia. The technique involves cannulation of the vein under ultrasound guidance using a 10 MHz linear transducer. A preoperative ultrasound of the neck allows direct visualization of the vein and its exact location and morphology. The most often used access was the right internal jugular vein at the right supraclavicular level. Device implantation is carried out under fluoroscopy control in the operating room in order to assess correct positioning of the catheter tip after cannulation, which must be pre-atrial. The pocket for positioning the reservoir is generally located at a right subcutaneous subclavicular level in the parasternal area. Subsequent chest radiographs in 2 projections are obtained to rule out pneumothorax. Conclusions: The steady increase in the use of port-like systems can be attributed to greater attention to patient compliance with respect to the various procedures necessary for proper planning of therapeutic strategies for cancer. The use in operating room environment, the ultrasound monitoring of the cannulation via the central vein, the fluoroscopy control of the catheter and of the position of its tip at the pre-atrial level, and the port inserted by the surgeon under the skin, all reduce complications to a limited number of cases. In our view, ultrasound is particularly useful as a tool for operational safety: in our series we have noted no increase in the complications rate from the early stages of the learning curve for operators. Feasibility, efficacy and advantages of an early diagnosis and treatment of PICC-related thrombosis in cancer patients C. Garrino*, C. Gennaro, G. Monasterolo, F. Pischedda, B. Mussa Surgical Oncology Unit, University of Turin, Italy * Corresponding author: Cristina Garrino, Surgica Oncology Unit, University of Turin, Italy. Cso Dogliotti 14 10126 Torino, Italy. Tel.: +39 0116334530; fax +39 0116336652. E-mail address: [email protected] (C. Garrino).