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1.
BMJ Open ; 11(2): e044692, 2021 02 19.
Article in English | MEDLINE | ID: mdl-33608405

ABSTRACT

INTRODUCTION: Temporary ileostomy is a valuable aid in reducing the severity of complications related to rectal cancer surgery. However, it is still unclear what is the best timing of its closure in relation to the feasibility of an adjuvant treatment, especially considering patient-reported outcomes and health system costs. The aim of the study is to compare the results of an early versus late closure strategy in patients with indication to adjuvant chemotherapy after resection for rectal cancer. METHODS AND ANALYSIS: This is a prospective multicentre randomised trial, sponsored by Rete Oncologica Piemonte e Valle d'Aosta (Oncology Network of Piedmont and Aosta Valley-Italy). Patients undergone to rectal cancer surgery with temporary ileostomy, aged >18 years, without evidence of anastomotic leak and with indication to adjuvant chemotherapy will be enrolled in 28 Network centres. An early closure strategy (between 30 and 40 days from rectal surgery) will be compared with a late one (after the end of adjuvant therapy). Primary endpoint will be the compliance to adjuvant chemotherapy with and without ileostomy. Complications associated with stoma closure as well as quality of life, costs and oncological outcomes will be assessed as secondary endpoints. ETHICS AND DISSEMINATION: The trial will engage the Network professional teams in a common effort to improve the treatment of rectal cancer by ensuring the best results in relation to the most correct use of resources. It will take into consideration both the patients' point of view (patient-reported outcome) and the health system perspective (costs analysis). The study has been approved by the Ethical Review Board of Città della Salute e della Scienza Hospital in Turin (Italy). The results of the study will be disseminated by the Network website, medical conferences and peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT04372992.


Subject(s)
Ileostomy , Rectal Neoplasms , Aged , Chemotherapy, Adjuvant , Humans , Italy , Postoperative Complications , Prospective Studies , Quality of Life , Rectal Neoplasms/drug therapy , Rectal Neoplasms/surgery , Time Factors
2.
Ann Ital Chir ; 86(ePub)2015 Jun 15.
Article in English | MEDLINE | ID: mdl-26098121

ABSTRACT

AIM: Bronchogenic cysts are congenital lesions deriving from the primitive foregut, and are usually located in close relation to tracheobronchial tree or oesophagus. We report a case of an oesophageal bronchogenic cyst appearing at preoperative examinations as a benign fibromuscular tumour (leiomyoma). CASE REPORT: A 62 years old male patient in good general conditions, was admitted to our Institution because of moderate dysphagia and upper post-prandial abdominal pain. Conventional imaging, endoscopy and echo endoscopy detected a parietal oesophageal wall mass looking like a solid formation, determining extrinsic compression and narrowing of the lumen. RESULTS: The mass has been radically removed with thoracoscopic approach. Postoperative stay was uneventful and the patient was discharged three days after the operation. At histological examination the mass appeared as a cystic formation with fibromuscular wall and ciliated epithelium (so-called disembriogenetic bronchogenic cyst). CONCLUSION: The case we have reported describes a very unusual case of a voluminous symptomatic intramural oesophageal disembriogenetic cyst whose characteristics had not been defined at preoperative examinations. Surgical removal of the mass has been achieved with a minimally invasive approach.


Subject(s)
Bronchogenic Cyst/surgery , Esophageal Cyst/surgery , Thoracoscopy/methods , Abdominal Pain/etiology , Bronchogenic Cyst/diagnosis , Bronchogenic Cyst/embryology , Bronchogenic Cyst/pathology , Deglutition Disorders/etiology , Diagnosis, Differential , Esophageal Cyst/diagnosis , Esophageal Cyst/embryology , Esophageal Cyst/pathology , Humans , Leiomyoma/diagnosis , Male , Middle Aged , Minimally Invasive Surgical Procedures
3.
Ann Ital Chir ; 85(ePub)2014 Nov 21.
Article in English | MEDLINE | ID: mdl-25425601

ABSTRACT

AIM: To describe the case of a thymic carcinoma with atypical clinical behavior that has arisen with a voluminous metastasis at the right hemidiaphragm while the primitive thymic neoplasm was initially occult. CASE REPORT: A 42 years female patient came to clinical observation for a voluminous thoraco-abdominal mass located in right side, infiltrating the diaphragm. The patient was submitted to surgical excision of the mass; definitive histological examination: non-keratinizing spinocellular carcinoma suggestive for neoplasia on ectopic thymic tissue or metastasis from carcinoma of the thymus. Three 3 months after surgery MR and CT-scan restaging identified the presence of anterior mediastinal mass of about 3 cm of diameter, compatible with thymical origin; thymectomy was performed (histology: Lymphoepithelial thymoma). Eight months after the first surgical procedure a restaging by CT, MR and PET CT showed the presence of disease recurrence at the right diaphragmatic level. The patient underwent surgical exploration, with right thoracotomic approach: a metastasis in the hepatic segment VII was found and radically removed. Six months after liver metastasis resection, CT scan showed disease progression in mediastinum, with involvement of pericardium and aorta; the patient died for disease recurrence five months later, 22 months after the first surgical procedure. CONCLUSION: Thymic neoplasms are the most common tumors of the mediastinum; a small percentage of these tumors are however extremely aggressive carcinomas. Rare but not exceptional findings are also cancers arising from ectopic thymic tissue.


Subject(s)
Diaphragm , Muscle Neoplasms/secondary , Thymoma/secondary , Thymus Neoplasms/pathology , Adult , Female , Humans
4.
Chir Ital ; 60(1): 147-52, 2008.
Article in Italian | MEDLINE | ID: mdl-18389760

ABSTRACT

Aorto-oesophageal fistula is a rare and often fatal condition due to pathologies of the aorta and oesophagus. Recently, a new aetiology for aorto-oesophageal fistulas has been detected, namely, decubitus of an aortic endovascular prosthesis positioned in the presence of aneurysms. The symptoms are those of Chiari's triad: (1) chest pain and/or dysphagia (2) haematemesis (3) massive haematemesis. If the patient is haemodynamically stable the gold standard diagnostic examination is a CT scan with contrast medium. Aorto-oesophageal fistulas are characterised by a rapidly worsening acute clinical presentation and high postoperative morbidity and mortality. The treatment of aorto-oesophageal fistula is divided into three progressive steps: (1) control of bleeding; (2) prevention of mediastinitis; (3) oesophageal repair. We report a case of a 59-year-old male patient with an aorto-oesophageal fistula due to the decubitus of an endovascular aortic prosthesis previously positioned for a traumatic aneurysm of the descending aorta. We controlled the bleeding in emergency with a Sengstaken-Blakemore tube. Since the cardiovascular surgeons excluded any intervention, we executed a bipolar oesophageal exclusion in our department of general surgery and subsequently positioned a self-expanding oesophageal prosthesis by a retrograde route. The patient survived for 7 months, the cause of death being septic shock.


Subject(s)
Aortic Diseases/etiology , Blood Vessel Prosthesis/adverse effects , Esophageal Fistula/etiology , Fistula/etiology , Postoperative Complications/etiology , Aorta, Thoracic/injuries , Aortic Aneurysm/etiology , Aortic Aneurysm/surgery , Aortic Diseases/surgery , Aortic Diseases/therapy , Chest Pain/etiology , Combined Modality Therapy , Digestive System Surgical Procedures , Esophageal Fistula/surgery , Esophageal Fistula/therapy , Fatal Outcome , Fistula/surgery , Fistula/therapy , Hematemesis/etiology , Humans , Male , Mediastinitis/etiology , Middle Aged , Postoperative Complications/surgery , Prosthesis Implantation , Shock, Septic/etiology , Tomography, X-Ray Computed
5.
Chir Ital ; 59(4): 507-12, 2007.
Article in Italian | MEDLINE | ID: mdl-17966772

ABSTRACT

The need for a protection of a colo-colonic or colorectal anastomosis (by a colostomy or ileostomy) does not always encounter a general consensus except in selected clinical settings such as a low or ultra-low colorectal anastomosis or a colo-colonic or colorectal anastomosis after resection for acute disease. Commonly, a protective stoma is closed within 3-6 months after x-ray or endoscopic monitoring of the anastomosis. We believe in the importance of an open debate on the timing of bowel reconstruction and on the ways of monitoring the anastomosis. The aim of our study was to confirm the feasibility of early closure of stomas without specific increased risks, and especially to demonstrate the usefulness of early endoscopic monitoring of the anastomosis. We present 26 consecutive patients who underwent a left colonic resection or a colorectal resection with a stoma constructed for protection. In these patients the early restoration of bowel continuity was achieved between postoperative days 8 and 15 after endoscopic monitoring. There have been no specific complications related to the endoscopic manoeuvre. The morbidity rate after early bowel continuity restoration was 4.1%, which is lower than the rates encountered in the literature (6-8.6%). We consider as innovative the concept of early endoscopic monitoring, which is commonly not indicated in the presence of a recent anastomosis. We believe that in selected conditions the risk of perforation due to this manoeuvre can be eliminated.


Subject(s)
Colonoscopy , Colostomy/methods , Ileostomy/methods , Monitoring, Intraoperative , Surgical Wound Dehiscence/prevention & control , Aged , Aged, 80 and over , Anastomosis, Surgical/methods , Colorectal Neoplasms/surgery , Diverticulitis, Colonic/surgery , Feasibility Studies , Female , Humans , Intestinal Obstruction/surgery , Male , Middle Aged , Monitoring, Intraoperative/methods , Treatment Outcome
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