- Email: [email protected]
Results of Surgical Salvage Treatment of Anal Canal Cancer
ABSTRACTS determinated by long rank test. A P value of < 0.05 was considered statistically significant. Results: 48 (19.7%) patients had a complete response and 67 (27.2%) patient were not responders. Sphincter preservation, anteroposterior resection and endoscopic surgery were performed in 46 patients (95.8%). A patient refused rectal surgery. Mean number of examinated lymphnodes was 14,3. Median follow up was 60 months. In pCR patients no locoregional recurrence occurred and distant metastases was found in 2 patients (4.1%). In the no responder group we found 13/67 (19.4%) local recurrence and 27/67 (40.3%) patients developed distant metastases. The pCR group 5-years overall and disease free survival were 100% and 95.2% respectively, During the follow up one patient died at 61 months. 2 pCR patients (4.1%) showed positive limph-nodes. In the pNC group the overall and disease free survival was respectively 36% and 31.2%. In our study overall and disease free survival were significantly improved in patients with pCR versus patient pNC (p <0.001). Conclusions: The improved oncological outcome in patients with rectal cancer who achieve a pCR appears related to their significantly decreased rate of distant failure when compared with no downstaged patients. To further improve the oncological outcomes and sphincter preservation rates in patients with locally advanced rectal cancer, the molecular mechanism governing the rectal cancer response to preoperative CRT need to be explored Results of Surgical Salvage Treatment of Anal Canal Cancer Benedetta Pesi, MD*, Stefano Scaringi, MD, Carmela Di Martino, MD, Giacomo Batignani, MD, Francesco Tonelli, MD Digestive Surgery Unit, Careggi University Hospital, Florence * Corresponding author: Benedetta Pesi. Tel. (+39) 3292283666 E-mail address: [email protected] (B. Pesi). Background and aim: Until thirty years ago, radical surgery with abdominoperineal resection (APR) was the most frequently recommended treatment. Today chemoradiotherapy or radiotherapy alone are the gold standard treatment for anal canal cancer, because they offer a similar or a superior survival rate than surgery and they permit to conserve the anal function. However, about 33% of patients develop disease progression and surgery represents the only salvage therapy. The aim of this study is to evaluate survival and morbidity rate in patients underwent surgical salvage treatment of anal canal cancer. Material and methods: A retrospective study was carried out on patients who underwent surgical treatment of anal canal cancer, after failure of radiochemiotheraphy, at the Gastro-Intestinal Surgery Unit of Careggi University Hospital from December 1988 to May 2010. We evaluated overall survival at 1, 3 and 5 years and post-operative morbidity rate. Statistical analysis was performed using SPSS (version 17.0). Results: Twenty-one patients were included in the study. Seventeen (81%) patients underwent radical surgery with APR and 4 (19%) patients mucosectomy. Survival rates were 80.2%, 70.2% and 45.1% at 1, 3, and 5 years respectively, the median of survival was 57.3 months (follow up 6 years, range 4-200). In patients underwent APR the 1, 3 and 5 years survival rates were 76.5%, 70.6% and 47.1% respectively, with a median of survival of 57.3 months. In patients underwent mucosectomy the 1, 3 and 5 years survival rates were 66.7%, 33.3% and 33.3% respectively and the median of survival was 46.1 months (p¼0.2). There was not post-operative mortality. Seven (33%) patients, 6 APR (86%) and 1 mucosectomy (14%), had post-operative complications: 5 (71.4%) had perineal surgical site complications (4 APR, 1 mucosectomy), 1 (14.3%) had postoperative anemia and 1 (14.3%) had iatrogenic urinary fistula. The morbidity rate was 33.3% and the 1, 3 and 5 years survival rates were 71.4%, 57.1% and 28.6%, the median of survival was 45.1 months. The patients without complications had 1, 3, and 5 years survival rates of 84.6%, 76.9% and 53.8%, and the median of survival was 62.8 months (p¼0.8). Conclusion: Surgery represents the recommended salvage therapy in the management of persistent or recurrent anal canal cancer after radiochemotherapy with a good survival rate and an acceptable morbidity. Furthermore, the post-operative complications do not influence the prognosis.
S9 Frantz’s Tumor of the Pancreas in Males. Report of Two Cases. C. Pasquali1,*, M.L. Polizzi1, C. Sperti1, V. Vincenzi2, R. Alaggio3, S. Pedrazzoli1 1 Clinica Chirurgica 4, University of Padua, Italy 2 S. Martino Hospital, Belluno, Italy 3 Pathyology, University of Padua, Italy * Corresponding author: Claudio Pasquali, Clinica Chirurgica IV, Via Giustiniani 2 Padova. Tel 049 8218845, fax 0498218821 E-mail address: [email protected] (C. Pasquali). Background: Frantz’s tumor is a rare neoplasm of young females (averaging 25 years; ratio 10F:M1) of the pancreatic body/tail. About 1300 cases are described in the literature. They have usually low malignant potential and mostly behave benign. We report 2 cases of solid-pseudopapillary tumor of the pancreas occurring in 2 adult men. Materials and Methods: We review the clinical data of 2 patients observed in January 2007 and March 2010. Results: Case 1: In December 2006, due to dyspepsia and palpable mass in left hypochondrium, a male 58 years old underwent abdominal ultrasound that showed a cystic neoplasm with irregular wall and unhomogeneous liquid content and septa (size: 12.3cm), close to pancreatic tail. A CT confirmed a 12cm cyst of pancreatic tail, with thin wall and few solid parietal nodules and dense septa. CEA and CA 19-9 were normal. A FDGPET showed uptake in an area of 2cm around the cyst with a high SUV (3.4 n.v.<2). The clinical diagnosis suggested a mucinous cystadenocarcinoma. On January 2007 the patient underwent left pancreatectomy. Pathologic examination showed a solid-pseudopapillary tumor of the pancreatic tail (size: 11.5cm) with haematic content and 2 solid nodules (max size: 2.5cm). Mitotic index was 3x10 HPF and Ki-67¼4,5%. Margin was free. Patient was discharged in 10th p.o. day and developed later a fluid collection and then a symptomatic pseudocyst of 6.3cm so underwent in December 2007 a cyst-jejunostomy. Since then the patient is alive and without disease at follow-up 41 months after resection. Case 2: Male 75 years old. In February 2010, incidental finding at ultrasound of oval solid lesion close to spleen hilum. CT showed a solid, hypodense lesion with septa 4.5cm in the pancreatic tail. At MRI intensity was partially cystic with peripheral enhancement and with septa within the cyst. FDG-PET was negative. CA 19-9 was negative. The clinical diagnosis suggested a serous cystadenoma and indication for surgery was location close to the splenic hilum and large size of the lesion. In May 2010 the patient underwent a left pancreatectomy. Pathology showed a 4.5cm solidpseudopapillary tumor with central haemorragic area, completely resected. Mitosis were absent, and immunocytochemistry was positive to B-catenin. The course was uneventful and the patient was discharged in 8th p.o. day. Conclusion: Frantz’s tumor is an uncommon pancreatic neoplasm. Advanced age and male sex do not exclude the occurrence of this tumor, although rare. Robotic Oncological Colon and Rectal Surgery: A Series of 105 Cases A. Coratti, A. Lombardi*, G. Caravaglios, G. Calamati, L. Bianco, G. Baldoni, R. Piagnerelli, S. Tumbiolo, P.C. Giulianotti* Dpt of Surgery, “Misericordia” Hospital - Grosseto, Italy. * Antonella Lombardi, Cell: 338/4608580, Tel: þ0564485354. E-mail address: [email protected] (A. Lombardi). Background: Today, laparoscopic colorectal surgery has become a main stay also in the treatment of oncological colorectal disease. The role of robotic technology in oncologic colorectal surgery still has to be defined. We show our ten years of experience with 105 cases of robotic and robotic-assisted colon and rectal resections for oncological disease. Methods: From November 2000 through april 2011, we performed a total of 115 robotic and robot-assisted colorectal procedures; these included 105 procedures for oncological colorectal disease: 12 abdominal-perineal amputations (APR), 32 rectal anterior resection (AR), 14 * Dpt of Surgery, University of Illinois at Chicago, USA.
S9 Frantz’s Tumor of the Pancreas in Males. Report of Two Cases. C. Pasquali1,*, M.L. Polizzi1, C. Sperti1, V. Vincenzi2, R. Alaggio3, S. Pedrazzoli1 1 Clinica Chirurgica 4, University of Padua, Italy 2 S. Martino Hospital, Belluno, Italy 3 Pathyology, University of Padua, Italy * Corresponding author: Claudio Pasquali, Clinica Chirurgica IV, Via Giustiniani 2 Padova. Tel 049 8218845, fax 0498218821 E-mail address: [email protected] (C. Pasquali). Background: Frantz’s tumor is a rare neoplasm of young females (averaging 25 years; ratio 10F:M1) of the pancreatic body/tail. About 1300 cases are described in the literature. They have usually low malignant potential and mostly behave benign. We report 2 cases of solid-pseudopapillary tumor of the pancreas occurring in 2 adult men. Materials and Methods: We review the clinical data of 2 patients observed in January 2007 and March 2010. Results: Case 1: In December 2006, due to dyspepsia and palpable mass in left hypochondrium, a male 58 years old underwent abdominal ultrasound that showed a cystic neoplasm with irregular wall and unhomogeneous liquid content and septa (size: 12.3cm), close to pancreatic tail. A CT confirmed a 12cm cyst of pancreatic tail, with thin wall and few solid parietal nodules and dense septa. CEA and CA 19-9 were normal. A FDGPET showed uptake in an area of 2cm around the cyst with a high SUV (3.4 n.v.<2). The clinical diagnosis suggested a mucinous cystadenocarcinoma. On January 2007 the patient underwent left pancreatectomy. Pathologic examination showed a solid-pseudopapillary tumor of the pancreatic tail (size: 11.5cm) with haematic content and 2 solid nodules (max size: 2.5cm). Mitotic index was 3x10 HPF and Ki-67¼4,5%. Margin was free. Patient was discharged in 10th p.o. day and developed later a fluid collection and then a symptomatic pseudocyst of 6.3cm so underwent in December 2007 a cyst-jejunostomy. Since then the patient is alive and without disease at follow-up 41 months after resection. Case 2: Male 75 years old. In February 2010, incidental finding at ultrasound of oval solid lesion close to spleen hilum. CT showed a solid, hypodense lesion with septa 4.5cm in the pancreatic tail. At MRI intensity was partially cystic with peripheral enhancement and with septa within the cyst. FDG-PET was negative. CA 19-9 was negative. The clinical diagnosis suggested a serous cystadenoma and indication for surgery was location close to the splenic hilum and large size of the lesion. In May 2010 the patient underwent a left pancreatectomy. Pathology showed a 4.5cm solidpseudopapillary tumor with central haemorragic area, completely resected. Mitosis were absent, and immunocytochemistry was positive to B-catenin. The course was uneventful and the patient was discharged in 8th p.o. day. Conclusion: Frantz’s tumor is an uncommon pancreatic neoplasm. Advanced age and male sex do not exclude the occurrence of this tumor, although rare. Robotic Oncological Colon and Rectal Surgery: A Series of 105 Cases A. Coratti, A. Lombardi*, G. Caravaglios, G. Calamati, L. Bianco, G. Baldoni, R. Piagnerelli, S. Tumbiolo, P.C. Giulianotti* Dpt of Surgery, “Misericordia” Hospital - Grosseto, Italy. * Antonella Lombardi, Cell: 338/4608580, Tel: þ0564485354. E-mail address: [email protected] (A. Lombardi). Background: Today, laparoscopic colorectal surgery has become a main stay also in the treatment of oncological colorectal disease. The role of robotic technology in oncologic colorectal surgery still has to be defined. We show our ten years of experience with 105 cases of robotic and robotic-assisted colon and rectal resections for oncological disease. Methods: From November 2000 through april 2011, we performed a total of 115 robotic and robot-assisted colorectal procedures; these included 105 procedures for oncological colorectal disease: 12 abdominal-perineal amputations (APR), 32 rectal anterior resection (AR), 14 * Dpt of Surgery, University of Illinois at Chicago, USA.