Primary tumour resection may improve survival in functional well-differentiated neuroendocrine tumours metastatic to the liver.

BACKGROUND: Functional well-differentiated neuroendocrine tumours (NET) with liver metastases represent a therapeutic challenge with few alternative options in guidelines. In these patients, the role of surgical resection of the primary tumour is controversial. PATIENTS AND METHODS: From a regional registry collecting somatostatin analogue (SSA)-treated tumours from 1979 to 2005, a series of 139 patients presenting with symptomatic, liver-metastatic, well-differentiated NET (G1-G2, mitoses: ≤20, Ki-67: ≤20%) was prospectively collected and retrospectively analysed. Surgery on either the primary tumour or liver metastases was chosen: 1) when low perioperative risk was predictable; 2) in presence of an impending risk of obstruction, bleeding, or perforation; or 3) if liver metastases were suitable of curative or subtotal (>90%) tumour removal. Impact of the most relevant clinico-pathological parameters on survival was studied. RESULTS: Median follow-up was 127 months and median survival was 94 months, with 138 vs. 37 months in resected vs. non-resected primary NET (p < 0.001), respectively. In the univariate analysis, prolonged survival was significantly associated with primary tumour resection (p < 0.001), resection of liver metastases (p = 0.002), site of primary (carcinoid vs. pancreatic, p = 0.018), basal chromogranin-A (CgA) <200 ng/mL (p = 0.001), and absence of diarrhea (p = 0.012). Multivariate analysis showed that primary tumour resection was an independent positive prognostic factor (HR = 3.17; 95% CI: 1.77-5.69, p < 0.001), whereas diarrhea, basal CgA ≥200 ng/mL, and high tumour load were independent negative prognostic factors. Also, in 103 patients with non-resectable liver metastases, primary tumour resection was significantly associated with prolonged survival (median 137 vs. 32 months, p < 0.0001). CONCLUSIONS: Primary tumour resection may improve survival in functional well-differentiated NET with liver metastases.

Effect of age on survival in patients undergoing resection of hepatocellular carcinoma.

BACKGROUND: The benefit of surgical intervention for cancer should be estimated in relation to the life expectancy of the general population. The aim of this study was to provide a measure of relative survival after hepatectomy for hepatocellular carcinoma (HCC). METHODS: Consecutive patients with liver cirrhosis and HCC who underwent hepatectomy were divided into age quartiles for analysis. Short- and mid-term survival rates were used to estimate survival until death for all patients, in relation to age and other co-variables. Years of life lost (YLL) were estimated using a reference cohort, derived from the general population matched for sex, age and year of diagnosis. RESULTS: Some 919 patients were included in the study. The following age quartiles were identified: less than 60 years (229 patients), 60-66 years (230), 67-70 years (231) and over 70 years (229). Postoperative mortality rates were similar between age quartiles, as were survival rates up to 3 years (P = 0·404). A statistically significant reduction in 5-10-year survival rates was observed with ageing (P = 0·001). Relative survival calculation showed that the youngest age quartile (less than 60 years) experienced the longest entire postoperative lifespan (15·6 years) but also the greatest number of YLL (11·0 years). Patients aged over 70 years had the shortest entire postoperative lifespan (6·4 years) but also the smallest number of YLL (3·7 years). CONCLUSION: Although survival after liver resection for HCC is shortest in elderly patients, relative survival estimates suggest that hepatectomy can be of benefit in these patients, with a small loss of the entire individual lifespan.

Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures.

AIMS: Despite laparoscopic surgery for gastric cancer has gained worldwide acceptance, long term results and survival are seldom reported. This study was designed to assess long term outcomes after laparoscopic gastrectomy with D2 dissection. The short term results of conventional and robot-assisted minimally invasive procedures were also examined. PATIENTS AND METHODS: The charts of 65 patients who underwent laparoscopic surgery for non-metastatic adenocarcinoma were reviewed retrospectively. This series included 35 patients with early gastric cancer (EGC) and 30 with advanced gastric cancer (AGC). A 4/5 laparoscopic subtotal gastrectomy (LSG) with D2 nodal clearance was the procedure of choice for distal cancers. Laparoscopic total gastrectomy (LTG) with modified D1 lymphadenectomy was performed for mid-proximal EGC. RESULTS: Sixty gastrectomies were carried out laparoscopically, 56 LSG and 4 LTG. Conversion to laparotomy was required in 5 patients with distal cancer. No intraoperative complication was registered. Morbidity included 2 duodenal leaks that healed conservatively. Two postoperative deaths were registered. An average number 31.3+/-8.8 lymph nodes were collected. The mean hospital stay was 10 days (range 7-24). The mean follow up was 30 months (range 2-86) and the cumulative overall 5 year survival rate was 78%. Survival at 5 years for EGC was 94% and survival at 4 years for AGC was 53% (57% for non-converted patients). CONCLUSIONS: Laparoscopic gastrectomy for cancer represents a valid alternative to open surgery with minimal morbidity and acceptable long term survival. Considering the risk of preoperative under diagnoses a D2 lymphadenectomy is suggested also for EGC. This study validated the effectiveness of minimally invasive technique in the management of gastric cancer.

Organic tin compounds combined with anionic additives-an ionophore system leading to a phosphate ion-selective electrode?

The potentiometric response characteristics of electrodes based on organic trialkyl/aryl-tin compounds combined with various amounts of anionic additive (NaTFPB) were investigated in 0.1M bis-Tris-H(2)SO(4) buffer solution at pH 7.0. The best result for phosphate sensing was obtained for the electrode membrane containing tributyltin chloride and 25mol% NaTFPB, where the electrode exhibits high selectivity towards phosphate anions with a slope of -60mV per decade. It was demonstrated that the interference from more lipophilic anions is drastically suppressed (log K (ij)(pot ), i=H(2)PO(4)(-): salicylate, 0.5; SCN(-), -0.8; ClO(4)(-), -2.3) under this optimized measurement conditions.

Optical determination of low-level water concentrations in organic solvents using fluorescent acridinyl dyes and dye-immobilized polymer membranes.

The fluorescent acridinyl indicators 4-(9-acridinyl)-N-(5-hexenyl)-N-methylaniline (KD-F0011), 6-(9-acridinyl)-1,2,2,3-tetramethyl-2,3-dihydro- 1H-perimidine (KD-F0021), and 6-(9-acridinyl)-2-(3-butenyl)-1,2,3-trimethyl-2,3-dihydro-1H-perimidine (KD-F0022) were designed, synthesized, and applied for highly sensitive optical determination of low-level water in organic solvents. All these dyes were found useful as fluorescence indicators for the detection of water below 1% (v/v) in different solvent media with a low detection limit of 0.002% (v/v) or 20 mg/L (22 ppm by weight) for KD-F0021 in THF solution. Sensing membranes made from poly(ethylene glycol) dimethacrylate by photocopolymerization with the indicator KD-F0011 were also prepared. Using the membrane sensor, the lowest detection limit of 0.001% (v/v) or 14 mg/L (20 ppm) water was achieved in diethyl ether samples. This system enables the continuous monitoring of the water content in a flow-through arrangement, where single-wavelength excitation (404 nm) and single-wavelength detection (532 mm) can be used for the fluorescence determination, allowing a simple measurement setup. In a continuous-flow experiment using THF samples, fully reversible and fast signal changes with t95% = 1-2 min for water concentrations up to 0.50% (v/v) were observed. A detection limit of 0.004% (v/v) or 40 mg/L (45 ppm) water in THF was achieved. These characteristics make this type of sensor a useful tool for the online continuous monitoring of water present as an impurity in organic media, which is difficult to achieve using a Karl Fischer instrument.

Development of new dyes for use in integrated optical sensors.

New chromoionophores have been developed, focused on NIR applications so that optode membranes may be used in monolithically integrated optical sensors. The wavelength of maximum absorbance has been estimated for a new model compound by the Pariser-Parr-Pople (PPP) method. Several cyanine type dyes have been tested as membrane chromoionophores. Membrane composition has been altered to overcome solubility problems. In this way, simple pH-sensitive optode membranes have been produced.