Evaluation of extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced epithelial ovarian cancer.

OBJECTIVE: Although standard treatment for advanced epithelial ovarian cancer (EOC) consists of surgical debulking and intravenous platinum- and taxane-based chemotherapy, favorable oncological outcomes have been recently reported with the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of the study was to analyze feasibility and results of CRS and HIPEC in patients with advanced EOC. MATERIALS/METHODS: This is an open, prospective phase 2 study including patients with primary or recurrent peritoneal carcinomatosis due to EOC. Thirty-nine patients with a mean (SD) age of 57.3 (9.7) years (range, 34-74 years) were included between September 2005 and December 2009. Thirty patients (77%) had recurrent EOC and 9 (23%) had primary EOC. RESULTS: For HIPEC, cisplatin and paclitaxel were used for 11 patients (28%), cisplatin and doxorubicin for 26 patients (66%), paclitaxel and doxorubicin for 1 patient (3%), and doxorubicin alone for 1 patient (3%). The median intra-abdominal outflow temperature was 41.5°C. The mean peritoneal cancer index (PCI) was 11.1 (range, 1-28); and according to the intraoperative tumor extent, the tumor volume was classified as low (PCI <15) or high (PCI ≥15) in 27 patients (69%) and 12 patients (31%), respectively. Microscopically complete cytoreduction was achieved for 35 patients (90%), macroscopic cytoreduction was achieved for 3 patients (7%), and a gross tumor debulking was performed for 1 patient (3%). Mean hospital stay was 23.8 days. Postoperative complications occurred in 7 patients (18%), and reoperations in 3 patients (8%). There was one postoperative death. Recurrence was seen in 23 patients (59%) with a mean recurrence time of 14.4 months (range, 1-49 months). CONCLUSIONS: Hyperthermic intraperitoneal chemotherapy after extensive CRS for advanced EOC is feasible with acceptable morbidity and mortality. Complete cytoreduction may improve survival in highly selected patients. Additional follow-up and further studies are needed to determine the effects of HIPEC on survival.

An innovative abdominal wall repair technique for infected prosthesis: the Eskimo technique.

The use of meshes to repair incisional hernias has been shown to reduce the recurrence rate, though it may increase the risk of surgical site infection. This is one of the most feared and devastating complications of surgical abdominal wall repair. The aim of this work is to describe a new surgical technique that was used to treat two patients suffering from chronic prosthesis infection. Additionally, the outcome of this procedure will be analyzed in terms of its safety, subsequent site infection and recurrence prevention. Two case reports are presented. The procedure was based on a wide surgical excision of the infected prosthesis and the surrounding tissues, plus abdominal wall repair with biological prosthesis. Both patients experienced an uneventful postoperative course. Infection of the surgical site resolved following the procedure and, after a mean follow-up of 36 months, no recurrences of the incisional hernia had occurred. This unique surgical technique not only proved to be safe, but it also solved the chronic prosthesis infection through its use of radical excision, without any postoperative complications or recurrence. This technique confirmed that biological prostheses can be used safely and effectively for implantation in sites of infection.

Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND/AIMS: Although standard treatment typically consists of an early appendectomy, there has recently been an increase in the use of antibiotic therapy as primary treatment for acute appendicitis (AA). The aim of this analysis is to systematically evaluate the evidence available in relevant literature in order to compare the relative effectiveness of antibiotic therapy as a viable alternative to appendectomies in the treatment of AA. METHODS: Literature was searched for randomized clinical trials (RCTs) comparing the efficacy of surgery versus antibiotic therapy. Differences in pooled odds ratios (OR) for outcomes within 95% confidence intervals (CI) were calculated. RESULTS: Four RCTs were identified including 741 patients. Efficacy was significantly higher for surgery (OR = 6.01, 95% CI = 4.27-8.46). No differences were found in the numbers of perforated appendices (OR = 0.73, 95% CI = 0.29-1.84) and patients treated with antibiotics (OR = 0.04, 95% CI = 0.00-3.27). Complication rates were significantly higher for surgery (OR = 1.92, 95% CI = 1.30-2.85). CONCLUSION: Although a nonsurgical approach in AA can reduce the complications rate, the lower efficacy prevents antibiotic treatment from being a viable alternative to surgery. Since only a small number of RCTs of poor methodological quality are available, well-designed RCTs are needed for further investigation.

A prospective, multi centre, randomized clinical study to compare the efficacy and safety of Ertapenem 3 days versus Ampicillin-Sulbactam 3 days in the treatment of localized community acquired intra-abdominal infection. (T.E.A. Study: Three days Ertapenem vs three days Ampicillin-sulbactam).

BACKGROUND: The recommendations outlined in the latest guidelines published by the Surgical Infection Society (SIS) and the Infectious Disease Society of America (IDSA) regarding the proper duration of antibiotic therapy in patients with intra-abdominal infections are limited and non-specific. This ambiguity is due mainly to the lack of clinical trials on the topic of optimal duration of therapy. It is well known that the overuse of antibiotics has several important consequences such as increased treatment costs, reduced clinical efficacy, and above all, the increased emergence of antibiotic-resistant pathogens. Ampicillin-Sulbactam is a commonly used "first line" antibiotic for intra-abdominal infections. Ertapenem and Ampicillin-sulbactam are recommended as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. METHODS/DESIGN: This study is a prospective multi-center randomized investigation. The study will be performed in the Departments of General, Emergency, and Transplant Surgery of Sant'Orsola-Malpighi University Hospital in Bologna, Italy, in the General Surgery Department of the Ospedali Riuniti of Bergamo, Italy, and in the Trauma and Emergency Surgery Department of Maggiore Hospital in Bologna, Italy, and will be conducted by all surgeons willing to participate in the study. The inclusion period of the study will take approximately two years before the planned number of 142 enrolled patients is reached. DISCUSSION: Ertapenem and Ampicillin-sulbactam are recommended both as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. As one of the discussed topic is the optimal duration of the antibiotic therapy and this ambiguity is due mainly to the lack of clinical trials on the topic, the present study aims for obtain precise data. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00630513.

Bizarre behaviour, bizarre intruder and bizarre bowel obstruction.

An 82-year-old woman, with previous history of hiatal hernia, cholecystectomy and depression, has been admitted for worsening diffuse abdominal pain with constipation and vomiting for 4 days. She lived alone, without signs of dementia or cognitive impairment. The abdomen was distended and tender in middle quadrants. Abdominal x-ray revealed concentric distension of bowel loops. CT scan confirmed mechanical small bowel obstruction with a transition point in the right iliac fossa. At laparotomy, the obstruction was caused by an intraluminal mass. After enterotomy, a 5.5 cm large phytobezoar was extracted; immediately after, a small live insect jumped out from the vegetable mass crawling onto the surgical area. The specimen was sent for parasitology and identified as a crustacean isopod, terrestrial arthropod, classified in the phylum Arthropoda, subphylum Crustacea and order Isopoda. They usually live in humid, moist conditions, obtaining their nourishment from decomposing vegetable matter. They often colonise in greenhouse pot plants. No cases of parasitisation in vertebrate species have been reported to date.

Prospective analysis of 101 consecutive cases of laparoscopic cholecystectomy for acute cholecystitis operated with harmonic scalpel.

BACKGROUND: Videolaparocholecystectomy (VLC) for acute cholecystitis (AC) is a technically demanding procedure, feasible by experienced surgeons, still affected by high conversion rate. Aim of this study was to prospectively evaluate whether the use of harmonic scalpel (HA) during VLC for AC, allowing a potentially better hemostasis and biliostasis, can decrease the conversion rate. METHODS: Hundred and one patients, with the mean age of 61.2+/-8.2 years (range: 39 to 81 y), admitted for AC, have been submitted to early VLC with HA within 6 years (from January 1, 2003 to December 31, 2008) at the Department of General, Emergency, and Transplant Surgery of St Orsola-Malpighi University Hospital in Bologna, Italy. The design of the study was prospective observational non-randomized. The control group consisted of 100 patients who underwent VLC for AC without HA at the same department in the same period. RESULTS: Mean operative time in VLC group with HA has been 71.4+/-14.3 minutes (range: 42 to 112 min) versus 87.4+/-10.8 minutes in the control group (P<0.001). Blood losses were significantly lower with the use of HA. Conversion rate has been 4.9%, mortality was 1%, and postoperative morbidity 7.9% in HA treated group, versus 12% conversion rate, 1% and 9% mortality and morbidity, respectively in the control group (P value not significant). CONCLUSIONS: The use of HA seems to be associated with lower conversion rate in VLC for AC, without any significant increase of morbidity. HA might be even more useful in the most technically demanding cases but further investigations are required. A prospective randomized trial comparing harmonic versus monopolar diathermy in laparoscopic cholecystectomy for AC in adults (Harmonic for Acute Cholecystitis Trial, NCT00746850) is currently enrolling patients and will clarify these observations.

Peritoneal adhesions to prosthetic materials: an experimental comparative study of treated and untreated polypropylene meshes placed in the abdominal cavity.

BACKGROUND: Frequently, hernia repair requires polypropylene (PP) meshes, which carry a well-known adhesiogenic risk when placed in contact to the intestine. The aim of this experimental study in a rat model was to assess the role of some materials, when combined with PP, in preventing the adhesions' formation. MATERIALS AND METHODS: Sixty male Sprague-Dawley rats were assigned to five groups for intraperitoneal mesh placement: untreated PP, PP+polyurethane (PP+PU), PP+Surgisis (PP+SIS), PP+expanded polytetrafluoroethylene (PP+ePTFE), and a control group without mesh. Twenty-one days and 3 and 6 months after the operation, an assessment of adhesion formation was performed, scoring adhesions in terms of extent and type and the adhesion index (AI; product of adhesions' extent and type). RESULTS: No significant difference was seen between PP+SIS, PP+PU, and control groups in adhesions extent/quality and in AI. The PP+SIS group had significantly lower adhesions' quality value and AI than PP+ePTFE. PP+PU had significantly lower adhesions' extent/quality value and AI than PP+ePTFE. The control group had adhesions with significantly lower extent/quality and AI than PP+ePTFE. The PP group had significantly more and denser adhesions, compared to PP+ePTFE, as well as a significantly higher AI. CONCLUSIONS: Adhesions' incidence is reduced by using treated PP meshes. PP+PU and PP+SIS were superior to PP+ePTFE in adhesion prevention.

The HAC Trial (Harmonic for Acute Cholecystitis) Study. Randomized, double-blind, controlled trial of Harmonic(H) versus Monopolar Diathermy (M) for laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in adults.

BACKGROUND: In the developmental stage of laparoscopic cholecystectomy (LC) it was considered 'unsafe' or 'technically difficult' to perform laparoscopic cholecystectomy for acute cholecystitis (AC). With increasing experience in laparoscopic surgery, a number of centers have reported on the use of laparoscopic cholecystectomy for acute cholecystitis, suggesting that it is technically feasible but at the expense of a high conversion rate, which can be up to 35 per cent and common bile duct lesions.The HARMONIC SCALPEL (H) is the leading ultrasonic cutting and coagulating surgical device, offering surgeons important benefits including: minimal lateral thermal tissue damage, minimal charring and desiccation.Harmonic Scalpel technology reduces the need for ligatures with simultaneous cutting and coagulation: moreover there is not electricity to or through the patient Harmonic Scalpel has a greater precision near vital structures and it produces minimal smoke with improved visibility in the surgical field.In retrospective series LC performed with H was demonstrated feasible and effective with minimal operating time and blood loss: it was reported also a low conversion rate (3.9%).However there are not prospective randomized controlled trials showing the advantages of H compared to MD (the commonly used electrical scalpel) in LC. METHODS/DESIGN: Aim of this RCT is to demonstrate that H can decrease the conversion rate compared to MD in LC for AC, without a significant increase of morbidity.The patients will be allocated in two groups: in the first group the patient will be submitted to early LC within 72 hours after the diagnosis with H while in the second group will be submitted to early LC within 72 hours with MD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00746850.

Inguinal hernia repair with porcine small intestine submucosa: 3-year follow-up results of a randomized controlled trial of Lichtenstein's repair with polypropylene mesh versus Surgisis Inguinal Hernia Matrix.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of Lichtenstein's hernioplasty using Surgisis Inguinal Hernia Matrix (SIHM; Cook, Bloomington, Indiana) compared with polypropylene (PP; Angiologica, Pavia, Italy). METHODS: This was a prospective, randomized, double-blind trial comparing Lichtenstein's inguinal hernioplasty using SIHM versus PP. RESULTS: Seventy male patients underwent Lichtenstein's hernioplasty (n = 35 in the SIHM group and n = 35 in the PP group). At 3 years after surgery, there were 2 deaths (5.7%) in the PP group and 1 death (2.9%) in the SIHM group (not significant [NS]). Although the study was underpowered to evaluate the recurrence rate, only 1 recurrence (2.9%) was seen in the PP group (NS). Although a significant decrease in postsurgical pain incidence was never observed among patients in the SIHM group, a significantly lower degree of pain was detected at rest and on coughing at 1, 3, and 6 months and on movement at 1, 3, and 6 months and 1, 2, and 3 years. A significant decrease in postsurgical incidence and degree of discomfort when coughing and moving were observed among patients in the SIHM group at 3 and 6 months and at 1, 2, and 3 years after surgery. COMMENTS: SIHM hernioplasty seems to be a safe and effective procedure.

The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study: multicenter randomized, double-blind, controlled trial of laparoscopic (LC) versus open (LTC) surgery for acute cholecystitis (AC) in adults.

BACKGROUND: In some randomized trials successful laparoscopic cholecystectomy for cholecystitis is associated with an earlier recovery and shorter hospital stay when compared with open cholecystectomy. Other studies did not confirm these results and showed that the potential advantages of laparoscopic cholecystectomy for cholecystitis can be offset by a high conversion rate to open surgery. Moreover in these studies a similar postoperative programme to optimize recovery comparing laparoscopic and open approaches was not standardized. These studies also do not report all eligible patients and are not double blinded. DESIGN: The present study project is a prospective, randomized investigation. The study will be performed in the Department of General, Emergency and Transplant Surgery St Orsola-Malpighi University Hospital (Bologna, Italy), a large teaching institutions, with the participation of all surgeons who accept to be involved in (and together with other selected centers). The patients will be divided in two groups: in the first group the patient will be submitted to laparoscopic cholecystectomy within 72 hours after the diagnosis while in the second group will be submitted to laparotomic cholecystectomy within 72 hours after the diagnosis. TRIAL REGISTRATION: TRIAL REGISTRATION NUMBER ISRCTN27929536 - The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study. A multicentre randomised, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis in adults.

259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up.

BACKGROUND: The Van Nuys Prognostic Index (VNPI) is a simple score for predicting the risk of local recurrence (LR) in patients with Ductal Carcinoma In Situ (DCIS) conservatively treated. This score combines three independent predictors of Local Recurrence. The VNPI has recently been updated with the addition of age as a fourth parameter into the scoring system (University of Southern California/ VNPI). PATIENTS AND METHODS: Our database consisted of 408 women with DCIS. Applying the USC/VNPI we reviewed retrospectively 259 patients who were treated with breast conserving surgery with or without radiotherapy (RT). Of these patients 63.5% had a low VNPI score, 32% intermediate and 4.5% a high score. In the low score group, the majority of the patients underwent Conservative Surgery (CS) without RT while in the intermediate group, almost half of the patients received RT. Eighty-three percent (83%) of the patients with high VNPI were treated with Conservative Surgery plus RT. Nodal assessment by Sentinel Lymph Node Biopsy was obtained in 32 patients since 2002. RESULTS: Twenty-one Local Recurrences were observed (8%) with a mean follow up of 130 months: sixteen were invasive. No statistically significant differences in Disease Free Survival were reached in all groups of VNPI score between patients treated with Conservative Surgery or Conservative Surgery plus RT. However it was noted that the higher the VNPI score, the lower was the risk of local recurrence in the group treated additionally with RT, even though it was not statistically significant. Further analysis included those patients treated with Conservative Surgery alone and followed up. Disease-free survival (DFS) at 10 years was 94% with low VNPI and 83% in both intermediate and high score (P < 0.05). No significant differences were observed in the subgroups of VNPI. The Local Relapse rate after Conservative Surgery alone, increased with tumor size, margin width, and pathology classification (P < 0,05), while age was not found to be a significant factor. Lesions with only mammographic appearances are associated with lower DFS but it did not reach significance (P = ns), while assumption of estrogenic hormones and familial history of breast cancer are significant factors associated with a higher risk of local recurrence. After multivariate analysis including seven clinical and pathological factors, the only significant predictors of local recurrence remained margin width of surgical excision, previous therapy with estrogens (contraceptives or Hormone Replacement Therapy) and the Van Nuys pathologic classification. The overall survival breast cancer specific was 99% and no differences were observed between groups (P = ns). The comparison of patients treated with a total mastectomy and those conservatively treated showed a significantly better local relapse free survival rate obtained with mastectomy (98.2% vs. 89.7% at 10 years P = 0.02). However, the overall cause-specific survival did not prove any better outcome (98.7% in both groups). Of the 32 patients who underwent a Sentinel Lymph Node Biopsy, four were found to have micrometastases and all of them had a previous Directional Vacuum Assisted Biopsy. CONCLUSIONS: Although in our series there is not a significant difference in LR rates by the parameter of age, the new USC/VNPI is still a simple and reliable scoring system for therapeutic management of DCIS. We did not find any statistically significant advantage in groups treated with the addition of RT. Obtaining wide surgical margins appears to be the strongest prognostic factor for local recurrence, regardless of other pathological factors or the addition of adjuvant radiation therapy. However, only prospective randomized studies can precisely predict the risk of LR of conservatively treated DCIS. The clinical significance of Sentinel Lymph Nodes micrometastases Immuno-Histo-Chemistry-detected found in DCIS patients remains uncertain. However, we hypothesize that the anatomical disruption after preoperative biopsy procedures increases the likelihood of epithelial cell displacement and the frequency of IHC-positive Sentinel Lymph Nodes, both of which are directly proportional to the degree of manipulation.

Immune response to small intestinal submucosa (surgisis) implant in humans: preliminary observations.

Surgisis IHM is an acellular biomaterial derived from porcine small intestinal submucosa (SIS) that induces site-specific remodeling in the organ or tissue into which it is placed. Previous animal studies have shown that the graft recipient mounts a helper T type 2-restricted immune response to the SIS xenograft without signs of rejection. The aims of this study were to evaluate the immune response to the SIS implant in a small series of humans and to examine the long-term clinical acceptance of the xenograft in these patients. Five consecutive male patients (mean age 56 years, range 34-68) who underwent inguinal hernioplasty with Surgisis IHM were assessed at 2 weeks, 6 weeks, and 6 months after implant for SIS-specific, alpha-1,3-galactose (alpha-gal) epitope and type I collagen specific antibodies. All five patients were also clinically assessed up to 2 years for signs of clinical rejection, hernia recurrence, and other complications. All 5 patients implanted with Surgisis IHM produced antibodies specific for SIS and alpha -gal with a peak between 2 and 6 weeks after implantation. By 6 months, all patients showed decreasing levels of anti-SIS antibodies. Two patients developed a transient, mild local seroma that resolved spontaneously. None of the patients showed any clinical signs of rejection, wound infection, hernia recurrence, or other complications in the follow-up out to 2 years. Thus, this study showed that in a small series of patients the SIS elicits an antibody response without clinical rejection of the xenograft and minimal postoperative complications.

Hernioplasty with Surgisis Inguinal Hernia Matrix (IHM).

Although at present nonabsorbable meshes are the preferred material for tension-free hernioplasty, some problems with their use are still to be addressed (i.e., chronic pain and infections). To address these disadvantages, a collagen-based material, the porcine small intestinal submucosa mesh, has recently been developed for hernia repair. The technique to use this material in performing an hernioplasty is described. A preshaped Surgisis Inguinal Hernia Matrix (IHM) is fashioned as appropriate, with a slit 2 cm from its inferior edge to accommodate the spermatic cord, placed for at least 10 min into a dish with room-temperature normosaline to be rehydrated and then transferred to the already prepared and dissected inguinal region. After drawing its tails around the cord, the mesh is sutured to the inguinal ligament with a continuous suture of PDS II 2/0, starting from the pubic tubercle laterally up to the deep orifice. The fixation of the mesh to the internal oblique abdominal muscle and the rectus sheath is accomplished with interrupted stitches. An extra stitch is placed between the two tails to close the new deep orifice. We conclude that an hernioplasty using Surgisis IHM is feasible with promising results.

Skin angiosarcoma arising in an irradiated breast: case-report and literature review.

BACKGROUND: Angiosarcoma (AS) is a rare, invasive malignancy originating from endothelial cells caused by many different clinical situations. AS following radiotherapy for breast cancer after conservative surgery is a rare but well-known association. OBJECTIVE: The aim of this article is to describe a case of AS after breast conserving surgery and to review the literature to date. RESULTS: We report the case of an 84-year-old woman who developed AS four years after she was subjected to quadrantectomy for invasive ductal cancer, followed by 30 tangent field radiotherapy sessions. She presented with a one-month history or red papular skin eruptions on the operated breast. Skin lesions were submitted for biopsy, and they were positive for AS. The patients was subjected to surgical excision of the remaining breast including all AS lesions. She is alive with no evidence of disease after 10 months follow-up. CONCLUSION: Post-radiotherapy AS is rare neoplasm, but it should be considered in the case of patients with red lesions after breast conserving surgery and adjuvant radiotherapy.

Small bowel tumours in emergency surgery: specificity of clinical presentation.

BACKGROUND: Despite advances in diagnostic modalities, small bowel tumours are notoriously difficult to diagnose and are often advanced at the time of definitive treatment. These malignancies can cause insidious abdominal pain and weight loss, or create surgical emergencies including haemorrhage, obstruction or perforation. The aim of the present study was to describe the clinical presentation, diagnostic work-up, surgical therapy and short-term outcome of 34 patients with primary and secondary small bowel tumours submitted for surgical procedures in an emergency setting and to look for a correlation between clinical presentation and the type of tumours. METHODS: From 1995 to 2005, 34 consecutive surgical cases of small bowel tumours were treated at the Department of Emergency Surgery of St Orsola-Malpighi University Hospital, Bologna, Italy. Clinical and radiological charts of these patients were reviewed retrospectively from the department database. RESULTS: All patients presented as surgical emergencies: intestinal obstruction was the most common clinical presentation (15 cases), followed by perforation (11 cases) and gastrointestinal bleeding (eight cases). Lymphoma was the most frequent histologic type (nine patients), followed by stromal tumours (eight patients), carcinoids (seven patients), adenocarcinoma (seven patients) and metastasis (three patients). Of the nine patients with lymphoma, eight were perforated, all patients with stromal tumours had bleeding, and all carcinoids patients had bowel obstruction. There were two patients with melanoma metastasis, both had bowel intussusception. Resection of the neoplasm was carried out in 32 patients and two patients were deemed unresectable and received a palliative procedure. CONCLUSIONS: The present study shows that there is a correlation between small bowel tumours and clinical emergency presentation: gastrointestinal stromal tumours (GIST) mostly bleed; carcinoids make an obstruction; lymphomas cause a perforation; and melanoma metastasis causes intussusception.

Emergency surgery for recurrent intraabdominal cancer.

BACKGROUND: Recurrent abdominal cancer can manifest in many ways but there are certain situations that are a great challenge to clinicians. Emergency presentation is one such situation. Surgeons are faced with a therapeutic dilemma that on the one hand most of these patients have a limited life expectancy, and on the other surgical procedures are unavoidable. We reviewed our experience of recurrent abdominal cancers presenting with acute abdominal symptoms requiring emergency. PATIENTS AND METHODS: Over the last 10 years, 81 patients with recurrent abdominal cancer presented with an abdominal emergency. Case records, operative notes and histology were reviewed. Frequency distributions were prepared for clinical, hematological, biochemical parameters, treatment and complications. Surgical analysis was carried out by the Kaplan Meier method and groups were compared using a log-rank test. RESULTS: The mean age of the patients was 70.1 years with a female to male ratio of 1.25. An overall postoperative mortality of 11.1% and morbidity of 27.1% was observed. Postoperative infections and respiratory complications were the most common causes of morbidity and mortality. Emergency resections carried the same risk of mortality and morbidity as the other surgical procedures (p > 0.05). Patients who underwent radical or palliative resections had a better survival than patients undergoing other procedures (p < 0.05). Preoperative Apache II score was found to be single most important predictor of postoperative mortality and morbidity. CONCLUSIONS: We conclude that surgical resection offers the best chance for improvement in survival after emergency surgery for recurrent abdominal cancer. If resection is not feasible, the possibility of creating a bypass or enterostomies should be considered to improve the patients' quality of life.