Thrombocytosis as a predictor of distant recurrence in patients with rectal cancer.

BACKGROUND AND AIMS: Thrombocytosis is frequently observed in patients with malignancy. We undertook this study to determine the prognostic value of thrombocytosis in patients with rectal cancer. METHODS: We performed a retrospective study of patients undergoing low anterior resection for rectal cancer between January 2000 and March 2007. Preoperative platelet count was measured before surgery. Postoperative platelets were determined 1 month after surgery. Two-tailed p values <0.05 were considered statistically significant. RESULTS: One hundred sixty three patients with rectal cancer were included in the study. Preoperative platelet count >350,000 was found in 8% of patients. Postoperative platelet count >350,000 was found in 6% of patients. Distant metastases were found in 17 patients (10.4%). Significant variables in the multivariate analyses were preoperative platelets >350,000 (p = 0.001), postoperative platelets >350,000 (p = 0.002), carcinoembryonic antigen >13 ng/dL (p = 0.003). Patients with preoperative platelet count <350,000 showed a 5-year survival rate of 81%, whereas patients with platelet count >350,000 had a 25-month survival [95% confidence interval (CI): 20-26]; p <0.001. Patients with postoperative platelets <350,000 showed a 5-year survival rate of 80%, whereas patients with platelets >350,000 showed a 3-year survival rate of 37.5% (p <0.05). CONCLUSIONS: Pre- or postoperative platelet count >350,000 is associated with poor survival in patients with rectal cancer. The measurement of platelets is a clinical marker useful to define the prognosis for patients with rectal cancer.

[Breast cancer in Mexican women under 40]. / Cancer de mama en mujeres mexicanas menores de 40 años.

BACKGROUND: Breast cancer is the leading cause of death from malignancy in women. The incidence increases with age, but the relationship between age and survival of breast cancer patients is not well defined. It is observed that young women with breast cancer have patterns more aggressive biological. OBJECTIVE: To determine the frequency, sociodemographic, clinical and histopathological features of breast cancer in women under 40 years attending a specialist breast unit in Mexico City. PATIENTS AND METHOD: Transversal, descriptive and retrospective study of patients under 40 years of age with breast cancer treated between 2005 and 2010. RESULTS: 1430 cases were diagnosed with breast cancer five years with a mean age of 53.64 +/- 11.87 years (range 23 to 93 years), 142 cases were women under 40 years of age (10%). The auto-detection of a breast lump was the most frequent clinical manifestation (50%). CONCLUSION: The prevalence of clinical stage III in this age group suggests the difficulty of diagnosis, the high breast density, which is one factor limiting studies of screening with mammography, it diminishes their effectiveness in early detection of breast cancer.

[Laparoscopic radical hysterectomy with lymphatic mapping and sentinel lymph node biopsy in early cervical cancer]. / Histerectomía radical laparoscópica con mapeo linfático y biopsia del ganglio centinela en cáncer cervicouterino temprano.

BACKGROUND: in patients with early-stage cervical cancer (FIGO IA, IB2 and IIA), the incidence of lymph node metastases is up to 15%; the majority of early cervical cancer patients with pelvic and para-aortic lymphadenectomy does not benefit with the procedure and are at risk of associated morbidity (linfocyst, lymphedema, vascular or nerve damage). OBJECTIVE: To describe the experience and usefulness of lymphatic mapping and sentinel lymph node with total laparoscopic radical hysterectomy in early stage cervical cancer. PATIENTS AND METHOD: Retrospective study in patients with diagnosis of cervical cancer in early stage, submitted to laparoscopic radical hysterectomy with lymphatic mapping and sentinel lymph node biopsy. We analyzed sentinel lymph node identification, false negative rate and surgical variables. RESULTS: in 36 months 15 patients were included, two in IA2 FIGO stage, twelve IB1 and one IIA; thirteen patients were mapping with combined technique and two only with dye. The sentinel lymph node identification rate was 87% (two failures in the patients using only blue dye); the false negative rate was 0%. CONCLUSION: Laparoscopic radical hysterectomy with lymphatic mapping is a secure technique for patients with early stage cervical cancer; it allows the correct identification of lymph node status as the principal prognostic factor. We recommend the use of combined technique (radiocolloid tracer and blue dye) for best rate sentinel lymph node identification.

[Laparoscopy for staging and treatment of cervical cancer]. / Laparoscopia para la etapificación y el tratamiento del cáncer cervicouterino.

BACKGROUND: Laparoscopic surgery for cervical cancer (CC) study and treatment is one of the main achievements in last years. OBJECTIVE: Describe the feasibility and experience of laparoscopic procedures for CC staging and treatment. PATIENTS AND METHOD: A retrospective analysis of 75 patients with CC in different stages was done, group I included CC in situ patients treated with type I Piver hysterectomy, in group 2, patients with early CC treated with type II or III radical hysterectomy with pelvic lymphadenectomy and para-aortic lymph node sampling, and group 3 patients with locally advanced CC submitted to pelvic and para-aortic lymphadenectomy. We analyzed operating time, bleeding, hospital stay, conversion to laparotomy, late complications and tumor recurrence. RESULTS: Thirty patients were included in group 1, 31 in group 2 and 14 in group 3, mean operating time was 143, 270 and 136 minutes, bleeding 170, 460 and 80 mL, hospital stay was 1.6, 3.6 and 1.5 days and conversion to laparotomy was 3%, 9.7% and 0%, respectively for each group. CONCLUSION: Laparoscopy is a safe procedure for the staging and treatment of cervical cancer in its different stages.

Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection.

INTRODUCTION: Histologic examination of circumferential margins is an important predictor of local and distant relapse in non-radiated rectal cancer. However, for patients who received preoperative chemoradiotherapy this role has not yet been addressed. METHODS: From January 1995 to December 1997, 61 patients with rectal adenocarcinoma located between 0 and 10 cm from anal verge with invasion into perirectal fat assessed by rectal ultrasound were included. All patients received 45 Gy + bolus infusion of 5-FU (450 mg/m(2)/days 1-5, 28-33 of RT); 4-6 weeks later, surgery was performed. Circumferential margin was assessed (<2 mm was considered as positive). Five-year survival was calculated by Kaplan-Meier method and comparison of groups with log-rank test. Multivariate Cox regression analysis was performed to find risk factors affecting local control and survival. RESULTS: There were 35 males and 26 females, mean age 60.3 years. Twelve patients (19.7%) had circumferential margin involvement. Median follow-up was 44 months. Overall local recurrence was observed in 6 of 61 patients (9.8%); in patients without circumferential margin involvement this was 8%, whereas it was 16% in those with circumferential margin involvement (P = 0.33). Distant recurrence was observed in 22% of patients without circumferential margin involvement; conversely, it was 58.3% in those with involvement (P = 0.02). Five-year survival of patients without circumferential resection involvement margin was 81%, while it was 42% in patients with circumferential involvement (P = 0.006). CONCLUSIONS: In patients with rectal cancer treated by preoperative chemoradiation plus total mesorectal excision (TME) and sphincter saving surgery, circumferential margin involvement is associated with high incidence of distant recurrence and cancer-related death.

[Transverse glossectomy for tongue cancer treatment]. / Glosectomía transversa para el tratamiento del cáncer de lengua.

INTRODUCTION: Standard care of patients with oral tongue-invasive squamous cell carcinoma in early stages is local resection and neck dissection. Traditionally, tumor resection was performed with hemiglossectomy (tongue resection in lingual long axis), which implied morbidity for deglutition and speech. Although surgical margins are sufficient, they are usually larger than necessary. OBJECTIVE: To know functional results and surgical margins in patients with T1-T2 oral tongue cancer submitted to transverse glossectomy (TG). MATERIAL AND METHODS: We analyzed charts of patients with T1-T2 oral tongue squamous cell carcinoma treated by TG during a 2-year period. We studied surgical margins, deglutition, speech intangibility, performance status and patient satisfaction. RESULTS: We included 20 patients: 12 women and eight men, with mean age of 45 years. Tumor-thickness mean was 8 mm; 19 patients showed free tumor margins in definitive histology study with mean of 1.8 cm three-dimensionally. In one patient, frozen sections were free-of-tumor, but definitive study showed a microscopic area of squamous cell carcinoma in surgical margin. All patients preserved > 50% of oral tongue and all showed lingual tip deviation and short tongue. None required nasogastric tube for feeding and speech was intelligible in all patients. CONCLUSIONS: TG provided sufficient surgical margin in all patients in this series without important morbidity and with good functional result; thus, TG is an alternative to classic vertical hemiglossectomy for patients in early stages of tongue mobile cancer.