Sphincter saving surgeries for locally advanced low rectal cancer after neoadjuvant chemoradiation

Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of primary rectal cancer is curative surgical resection; however, affine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. Forty nine [49] patients with low rectal carcinoma were included in a prospective study, between Jan 2007 and Jan 2012. Preoperative chemoradiation was administrated to all patients and subjected to different techniques of sphincter saving surgery. Stage I and Stage IV disease at diagnosis were excluded from the study. Forty nine patients were included in the study. 27 [55%] patients were male and 22 [45%] were female the age range from 23 years to 70 years with the median age 46 years. The main presenting symptoms were bleeding per rectum and tenesmus. Stage II 18 patients [36.7%,], stage III 31 patients [63.3%. Complete clinical and pathological response in 3 patients [6%], and complete clinical response with only microscopically residual carcinoma in 20 patients [41%], partial response in 18 patients [36.7%], and no significant response in 8 patients [16%] 7 from 8 were mucoid carcinoma. Low anterior resection [LAR] in 22 patients [44.9%], Hartman 's procedure in 4 patients [8.1%], Coloanal pull-through [COP] was done in 19 patients [38.9%] and perineal colostomy in 4 patients [8.1%]. For patients with cola-anal pull-through technique complete dehiscent and retraction observed in 2 cases, Major leakage in one case, stenosis in 4 cases. There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter saving surgery. Coloanal pull- through technique is not wide spread technique for low rectal cancer with good oncological safety and acceptable functional outcome

Expression of c-met in malignant pleural mesothelioma: an immunohistochemical study

Most patients with malignant pleural mesothelioma present in advanced stages of disease. Response rates and survival with currently available therapies are poor. Therefore, it is critical to identify the molecular markers of mesothelioma which would provide a way of understanding this neoplasm and targeting these markers in therapy. To assess the immunoreactivity of c-Met in malignant pleural mesothelioma and to analyze the potential link of the c-MET expression to some clincopathological parameters such as tumor subtype, TNM stage and patients' survival. A total of 20 patients [7 females and 13 males] with pathologically confirmed MPM; age range, [35 to 63 years] were included in the study. The patient records for the clinical, radiological and laboratory investigations and the results of closed pleura biopsies were analyzed. Pleura biopsies were stained for c-Met using immunohistochemical technique applied to paraffin sections. Of the studied tumors 18 [90%] were immunoreactive for c-Met. There were no significant relations between c-Met and patient age [p=0.569] or gender [0.755]. Also there was no relation between c-Met expression and clinical symptoms. All tumors that showed distant metastasis were c-Met positive. While all c-Met negative tumors showed no metastasis. However, the difference was statistically insignificant. There was also no relation between c-Met and tumor subtype [p=0.40] or tumor stage [p=0.257]. However, all T3 and T4 tumors were c-Met positive and the two c-Met negative tumors were T[2]. The 2 c-Met negative patients showed one-year survival. Whereas [7/18] of patients with positive c-Met died. However, again the difference was statistically insignificant [p=0.755]. c-Met receptor was expressed in a high proportion of MPM. It may have a significant role in the development of MPM and could be a beneficial target for therapy. Though there was no statistically significant relation between c-Met expression and one-year survival or with different prognostic factors in MPM, we observed more c-met expression in more extensive cases and more deaths in c-Met positive cases. Additional larger-scale studies of MPM are needed to confirm the prognostic role of c-Met expression

Surgical management of adenocarcinoma of the esophagogastric AEG junction

This study was performed to analyze the surgical results of 66 patients with adenocarcinoma of the esophagogastric AEG Junction subjected to curative resection. Between Sep. 2000 and Sep 2003, 66 patients with AEG including 20 type I, 16 type II and 30 type Ill were subjected to surgical resection in NCI Cairo University, South Egypt Cancer Institute [SECI] Assiut University, Nasser institute and Aswan Cancer Center. Patients with type I tumors [distal esophagus] underwent total esophagogastric transhiatal transthoracic or through three fields approach [abdominal, thoracic and cervical] or .subtotal esophagectomy with thoracic reconstruction. Patients with type Ill [gastric cardia] anderwent total or proximal gastrectomy with either transhiatal or transthoracic reconstruction For type II tumors [true cardia], total esophagectomy, subtotal esophagectomy, proximal gastrectomy with distal esophagectomy or total gastrectomy with distal esophagectomy were done with transhiatal, transthoracic or three field approach. Pathology, TNM stage, surgical approach, morbidity, mortality and survival were studied among the 3 groups. There were 54 male patients and 12 females with a median age 53 teams twenty patients [30.3%] had type I tumors, 16 [24.2%] had type II tumors and 30 [45.5%] had type Ill tumors twenty seven [41%] [20 type is 7 type II] underwent total esophagectomy or subtotal distal through transhiatal, trans thoracic or abdominal, thoracic and cervical approach Thirty nine patients [59%]. including thirty patients with type III and 7 patients with type II underwent gastrectomy 27 [41%] total and 12 [18%] proximal gastrectomy. Postoperative mortality was 9% and morbidity was 228.7% Overall survival [OS] was 88% at 12 months and 44.6% at 24 months while disease free survival [DFS] was 69.4% and 20.7% respectively. Lymph nodes [+ve vs-ve] and stage [I+II vs Ill+IV] grade percent of ve abdominal lymph nodes and total abdominal and mediastinal lymph nodes had prognostic significance while type of tumour, surgical approach, type of R resection, surgical margin size of the tumour and mediastinal lymph nodes were non significant on univariate analysis. while the abdominal lymph nodes were the only significant variable on multivariate analysis. Adenocarcinoma of the cardia is associated with poor survival. Early diagnosis remains the prerequisite for curative treatment. The classification of AEG into type I, II and III provides a useful tool for selecting the surgical approach