Surgery today
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Multicenter Study Comparative Study Clinical Trial
Laparoscopic versus open colectomy for TNM stage III colon cancer: results of a prospective multicenter study in Italy.
There is still debate about the practicality of performing laparoscopic colectomy instead of open colectomy for patients with curable cancer, although laparoscopic surgery is now being performed even for patients with advanced colon cancer. We compared the long-term results of laparoscopic versus open colectomy for TNM stage III carcinoma of the colon in a large series of patients followed up for at least 3 years. ⋯ These findings support that LS is safe and effective for advanced carcinoma of the colon. Although the LS group in this study had a significantly better long-term outcome than the OS group, further investigations are needed to draw a definitive conclusion.
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The use of adjuvant chemotherapy for stage II colon cancer remains controversial. The accurate assessment of the risk factors associated with recurrence in patients with stage II disease is the key to identifying the patients that are most likely to benefit from adjuvant chemotherapy. Recent guidelines advocate that adjuvant chemotherapy for high-risk stage II colon cancer should take into account factors such as the T stage, number of lymph nodes examined, tumor differentiation, and tumor perforation. ⋯ Recent advances in the field of molecular genetics have led to the identification of specific biomarkers involved in colorectal cancer progression, whereas gene expression microarray technology has led to the identification of molecular profiles able to predict recurrence or benefit from adjuvant chemotherapy. However, none of these has yet been validated in large prospective clinical trials. In this article, we review the current status of prognostic and predictive biomarkers for stage II colon cancer and provide an update on the most recent developments.
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Case Reports
Management of acute portomesenteric venous thrombosis induced by protein S deficiency: report of a case.
Hereditary protein S deficiency is a risk factor which may predispose patients to venous thrombosis. Deep venous thrombosis of the lower extremities can result in painful congestion, while the presence of mesenteric venous thrombosis (MVT) can cause abdominal emergencies. We herein report a protein S-deficient patient presenting with acute portomesenteric venous thrombosis. ⋯ The treatment strategy for MVT with bowel ischemia has evolved from aggressive portomesenteric thrombectomy with resection of the involved bowel, to conservative anticoagulation to recanalize thrombotic mesenteric veins with bowel preservation. Surgical intervention is reserved for transmural necrosis or bowel perforation. The perioperative thrombophylaxis of inherited thrombophilic patients is also important for preventing further thromboembolic events.
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Gastric rupture with necrosis following acute gastric dilatation (AGD) is a rare and potentially fatal event; usually seen in patients with eating disorders such as anorexia nervosa or bulimia. A 12-year-old lean boy with no remarkable medical history was brought to our Emergency Department suffering acute abdominal symptoms. ⋯ We performed partial gastrectomy and the patient recovered uneventfully. We report this case to demonstrate that AGD and subsequent gastric rupture can occur in patients without any underlying disorders and that just a low body mass index is a risk factor for this potentially fatal condition.
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An 80-year-old man was transferred to our hospital for surgical treatment of a ruptured aortic arch aneurysm. Based on a history of severe heart failure and coronary artery bypass, we considered him unsuitable for conventional open repair. ⋯ After additional endovascular repair for recurrent hemosputum, the patient recovered without complications. Although continued follow-up is necessary, acute hybrid arch repair seems feasible for treating ruptured aortic arch aneurysms, even in the setting of severe heart failure and a previous coronary artery bypass.