Management of advanced abdominopelvic tumors with combined radiofrequency ablation and surgical debulking.

AIM: Advanced abdominopelvic tumors due to rectal cancer, gynecological cancer or sarcomas are often unresectable using surgery alone. This study presents the combination of radiofrequency ablation (RFA) and surgical debulking for such tumors. METHODS: Between November 2005 and June 2007 we treated 4 patients with tumor fixation to the pelvic side wall and to the sacroiliac joint. Two of these patients had recurrent gynecological cancer while the other 2 had rectal cancer. All 4 of them had received prior treatment. The radiofrequency probe was placed in the center of the tumor. A 5- to 8-cm tissue core was ablated and aspirated or curetted out. This was repeated centrifugally out to the tumor capsule. RESULTS: Control of the tumor for more than 12 months was achieved in 3 patients. One patient died 14 months after the procedure due to tumor progression. Two patients are still alive 12 and 14 months after the operation without symptoms. The other patient is alive 6 months after the operation in a disease-free condition. CONCLUSIONS: Combined RFA and surgical debulking is beneficial as an alternative palliative method in patients with inoperable abdominopelvic tumors.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal carcinomatosis. Preliminary results and cost from two centers in Greece.

PURPOSE: To report our preliminary experience in the combined treatment of peritoneal carcinomatosis (PC) using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). PATIENTS AND METHODS: This prospective study included patients with PC from gynaecological, gastric and colon cancer, treated in two centers. Cytoreductive surgery included the peritonectomy procedures described by Jacquet and Sugarbaker as well as multivisceral resections in order to achieve a complete macroscopical cancer eradication. The HIPEC that followed was performed via the open abdomen technique. RESULTS: Twenty-four patients (3 men and 21 women, mean age 60 years) were treated. Twelve patients had PC from ovarian cancer, 7 from colon, 3 from gastric and 2 from uterine cancer. The mean duration of the procedure was 7.83 h (range 5 -12.30). Macroscopically, complete cytoreduction (CC) was achieved in 18 (75%) patients. Two (8.3%) patients died in the first 30 days. The overall morbidity was 42% and 2 patients were reoperated. The mean follow up was 22 months (range 3-36). The overall 1-year survival was 59.1%; concerning the gynaecological cancers it was 53.8% (mean survival 11.7 months) and for gastrointestinal cancers it was 44.4% (mean survival 9.5 months). CONCLUSION: Our preliminary data suggest that the combined treatment of cytoreduction plus HIPEC for PC is associated with acceptable mortality and morbidity and offers an improved survival in these patients. An optimal patient selection and establishment of experienced centres are of paramount importance.

Colorectal carcinoma: contribution of growth pattern on prognosis.

BACKGROUND: Recent studies have reported poor prognosis in colorectal carcinomas with non-polypoid growth pattern. The aim of the present study is to investigate this issue in the patients referred to "Hatzikostas" General Hospital of Messolonghi, Greece. MATERIALS AND METHODS: A total of 13 patients who were treated for primary colorectal adenocarcinoma in a one-year period were studied. Colorectal carcinomas were classified into two types based on the presence or absence of elevation of tumour as compared with adjacent mucosa: polypoid growth (PG-type) and non-polypoid growth (NPG-type) carcinomas. Clinical and tumour histopathologic parameters were analysed. RESULTS: Unlike PG-type carcinomas, NPG-type carcinomas had a high proportion of poorly differentiated adenocarcinoma cells, a high likelihood of being advanced, and a high frequency of lymph node as well as distant metastases at the time of diagnosis. CONCLUSIONS: Colorectal carcinomas with NPG pattern tend to show more malignant characteristics than those with PG pattern, explaining their poorer outcome.

The presence and significance of iron in neoplasia of the colorectum.

BACKGROUND: To investigate the presence and distribution of tissue iron in colon adenomas of all grades of dysplasia as well as colorectal carcinomas of all grades of differentiation. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tissue blocks from 8 biopsies of colon adenomas and 13 surgical specimens of colorectal carcinoma were studied. Consecutive sections were stained using Perls' stain that demonstrates the presence of ferric iron by staining it blue. RESULTS: Iron was absent in all cases of colon adenoma. On the other hand, iron was present in 9 of the 13 cases of colorectal carcinoma (69.23%), regardless of the degree of differentiation, the location and the stage of development. The iron was stored in mesenchymal cells in the stroma and various types of inflammatory cells. CONCLUSIONS: Our results suggest association of iron presence in the environment of malignant cells. Thus, iron may be a carcinogenic factor, possibly facilitating tumour growth and modulating local immune response.

Simple closure of chronic duodenal ulcer perforation in the era of Helicobacter pylori: an old procedure, today's solution.

BACKGROUND/AIMS: To evaluate the risk of recurrence in our patients with chronic duodenal ulcer perforation, who underwent a simple closure and postoperative Helicobacter pylori eradication therapy. METHODOLOGY: Within 4.5 years (3/1996 to 7/2000), 21 patients with chronic duodenal ulcer perforation, were operated in our hospital. All of them underwent simple closure with omental patch repair plus Helicobacter pylori eradication with omeprazole, clarithromycin and amoxycillin for two weeks. On December 2000, in 14 (66.6%) of these patients, urea breath test for Helicobacter pylori was performed, followed by endoscopy. RESULTS: The mean age of our 14 patients is 55 years. The urea breath test was positive for Helicobacter pylori in 3 (21.4%) patients. Two of them had endoscopically gastritis, confirmed by pathological examination. None of our patients had ulcer relapse. The three patients with positive urea breath test received another course of the same eradication therapy. CONCLUSIONS: Simple closure of perforated chronic duodenal ulcer in combination with postoperative Helicobacter pylori eradication, seems to be an accepted treatment, so the immediate acid-reduction surgery (vagotomy) in the contaminated environment caused by perforation, is probably unnecessary.