Publisher Correction: Feasibility and effects of enhanced recovery vs. conventional care after emergency colon surgery for patients with left colon perforation.

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Feasibility and effects of enhanced recovery vs. conventional care after emergency colon surgery for patients with left colon perforation.

The impact of an enhanced recovery after surgery (ERAS) programme in emergency colorectal surgery has not yet been reported. The objective of this study was to evaluate the feasibility and the results of patients included in an ERAS protocol following emergency colon surgery for left colon perforation. For this purpose, patients with a low to moderate risk of mortality, according to a Peritonitis Severity Score (PSS), and treated with an ERAS protocol (ERAS group) after emergency surgery for left colon perforation were compared for a period of 40 months (March 2014-June 2017) with a control group of patients treated with conventional care (CC group) during the 38 months prior to implementation of the new ERAS protocol (January 2011-February 2014). The main endpoint was 90-day postoperative morbidity according to the Clavien-Dindo classification. Secondary endpoints included length of postoperative hospital stay, 90-day readmission rate, protocol compliance and mortality. Fifty patients were included in the study, 29 in the ERAS group and 21 in the CC group. There were no significant differences between the groups in the demographic data or in the operative characteristics. A reduction in the incidence of postoperative complications (20.7% vs. 38%; p > 0.05) and in the postoperative hospital stay (7.7 + /- 3.85 vs. 10.9 + /- 5.6 days; p = 0.009) were observed in the ERAS group. The 90-day readmission rate did not differ significantly between the two groups (2 vs. 1). No 90-day mortality was observed in either group. The ERAS group showed better results than the CC group in protocol compliance. We conclude that ERAS protocols are feasible and help to reduce morbidity and length of hospital stay without adversely affecting the rate of readmission or mortality.

[Merkel cell carcinoma: an uncommon neuroendocrine cancer]. / Il carcinoma a cellule di Merkel: una rara neoplasia neuroendocrina.

Merkel cell carcinoma (MCC), firstly described by Torker in 1972, is an uncommon and aggressive neuroendocrine cancer of the skin. MCC tends to recur and precociously spread to lymph nodes. Five-year survival rate is between 35 and 75%. In literature there are not univocal criteria regarding the diagnosis and therapy of MCC, probably due to its rarity. Surgery plays an important role in the therapeutic strategy of this cancer. Surgical excision must be wide and guarantee at least 2-3 cm of free tumor margins. Sentinel lymph node biopsy is useful to identify those patients in which extensive lymph node dissection and/or adjuvant therapies (radio- and/or chemotherapy) are advisable. We hereby report a case of MCC of the left arm in a 48 year-old male. A wide excision was performed with sentinel lymph node biopsy that did not show any metastasis. Adjuvant radio therapy was administered. The patient was healthy at one year follow-up.

The new classification of hemorrhoids: PATE 2000-Sorrento. History of the scientific debate.

BACKGROUND: The history of our proposal for a new classification of hemorrhoids is very old: 7 years of scientific debate had a big impact for the study and the definition of hemorrhoids. METHODS: Nowadays many things have changed mainly in the field of treatment of hemorrhoids. New medical and surgical tools are available for the modern proctologist. RESULTS: The new classification of the disease seems to fit the necessity of introducing these modern opportunities. Many authors recognize the fundamental role and claim for the routine use of a new classification, named PATE 2000 Sorrento. Nevertheless many problems are on debate. Their resolution needs the cooperation of all the experts in order to choose the best version of the classification. CONCLUSIONS: For these reasons the authors analyse all the work carried out till now in order to see what we still need to introduce a new classification of the disease.