Oncologic outcomes of neoadjuvant chemoradiation for locally advanced rectal cancer: a single-institution experience

<p><b>INTRODUCTION</b>This study reports the outcomes of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by surgery in a local population of Singapore.</p><p><b>MATERIALS AND METHODS</b>The records of 85 patients who underwent neoadjuvant chemoradiation for locally advanced rectal cancer followed by surgery at the Tan Tock Seng Hospital (TTSH) between November 2002 and January 2012 were reviewed. The treatment protocol comprised radiotherapy to a total dose of 50.4 Gy concurrent with 5-fluorouracil-based chemotherapy. Patients underwent total mesorectal excision surgery following the completion of neoadjuvant chemoradiation. Local control, disease-free survival and overall survival were analysed using Kaplan-Meier methods.</p><p><b>RESULTS</b>Median age of the patients was 61 years. All of them completed radiotherapy. One patient did not complete neoadjuvant chemotherapy. The median time to surgery was 52 days. Fifty-five percent (47 of 85) of patients achieved pathological downstaging and 13% (11 of 85) of patients had a pathologic complete response to preoperative treatment. The neoadjuvant chemoradiation was well tolerated. Four percent of patients had grade 3 diarrhoea and 4% of them had grade 3 dermatitis. There were no grade 4 toxicities. With a median follow-up of 41 months, the 5-year actuarial local recurrence, disease-free survival and overall survival rates were 7%, 71.9%, and 83.2% respectively. Univariate analysis showed that patients with positive surgical margins had significantly worse disease-free survival and overall survival (P=0.012 and P<0.001 respectively) and a trend towards a higher rate of local recurrence (P=0.08).</p><p><b>CONCLUSION</b>Our study provides evidence that neoadjuvant chemoradiation is an effective treatment for locally advanced rectal cancer. Our outcomes are comparable with internationally published data and demonstrate the reproducibility of the neoadjuvant approach in an Asian population.</p>

Prótese intracava provisória no tratamento de lesão da veia cava retro-hepática / Temporary intracaval prothesis in treatment of retrohepatic vena cava injury

One of the most difficult challenges to surgeons is the treatment of wounds on the retro hepatic vena cava. The anatomic particularities of this venous segment make its approach and treatment difficult, contributing to a high morbidity and mortality. Several techniques have been described for the treatment of these types of lesions. In this particular case, authors have chosen the introduction of a fastened provisory intra caval prothesis, without primary suturing of the wounds. The provisory intra caval prothesis can be an option for the treatment of retro hepatic vena cava lesions.

Contribuiçäo ao estudo dos elementos vasculares arteriais e venosos do hilo renal em suínos (Sus scrofa domestica - Linnaeus - 1758) da raça Large White / Contribution to the study of the arterial and venous vessels at the renal hilus in Large White swines (Sus scrofa domestica - Linnaeus, 1758)

Estudou-se, em 30 pares de rins de suínos da raça Large White, 15 machos e 15 fêmeas, com aproximadamente quatro meses de idade, procedentes do Matadouro e Frigorífico "Eder", em Itapecerica da Serra, Estado de Säo Paulo, a distribuiçäo arterial e venosa do hilo deste órgäo, mediante dissecçäo dos elementos vasculares do pedículo renal, após a fixaçäo do material em soluçäo aquosa de formol a 10,0//. Nestes animais, a artéria renal direita fornece de seis (10,0//) a vinte (3,3//) ramos, com maior freqüência de dez (20,0//) e a esquerda de quatro (3,3//) a dezoito (3,3//), com maior incidência de dez (16,7//) e demonstrou uma maior concentraçäo no quadrante craniodorsal, seguido dos quadrantes cranioventral, caudoventral e caudodorsal. No que tange ao número de raízes venosas, a veia renal direita apresenta uma variaçäo de uma (10,0//) a cinco (33,8//) raízes, com maior freqüência de cinco (33,8//), a esquerda de duas (13,3//) e sete (3,3//), com maior concentraçäo de três e quatro (53,4//), situadas com maior incidência no quadrante cranioventral, seguido dos quadrantes caudoventral, craniodorsal e caudodorsal. Quanto à situaçäo global, os ramos das artérias renais direita e esquerda se apresentam em maior número de vezes preponderantemente periféricos (43,3//), enquanto as raízes venosas se mostram exclusivamente periféricas (16,7//). Há igualdade no número de ramos das artérias renais e raízes das veias renais, direitas e esquerdas, apenas 1 vez (3,3//), com distribuiçäo desigual nos quadrantes. Näo existem diferenças estatisticamente significantes quanto ao sexo