Axillary lymphectomy in breast cancer.

BACKGROUND: The aim of the study was to demonstrate the prognostic value of sentinel node biopsy compared to the sampling of clinically suspected nodes and lymphectomy of the 3 axillary levels. METHODS. From October 1996 to January 1999, 60 patients with breast cancer with a diameter of 4 cm or under using different procedures of axillary lymphadenectomy. Sentinel node biopsy was performed using Giuliano's technique, followed by lymph nodes larger than 5 cm (lymph node sampling) and lastly all axillary lymph nodes (axillary lymphectomy at 3 levels). RESULTS: Sentinel nodes were identified in all patients and a mean of 3 sentinel nodes (range 1-5) were removed during the procedure. Histological analysis showed metastatic sentinel nodes in 21 cases. Lymph node sampling was possible in 43 patients who presented enlarged nodes. The mean number of lymph nodes removed was 6 (range 3-10). Lymph node metastasis was found in 10 patients and of these 7 had a metastatic sentinel node, whereas 3 had presented negative results. Histological tests in all 60 cases of complete axillary lymphectomy showed positive results in 4 cases confirming metastasis present in sentinel nodes. CONCLUSIONS: The results show that the association of lymph node sampling can improve the efficacy of sentinel node dissection, highlighting the rare cases of false negatives. In our study, total axillary lymphectomy did not add any information to the N parameter and was resolutive in a small percentage of cases.

[Ambulatory surgical treatment for breast carcinoma]. / Trattamento ambulatoriale del carcinoma della mammella.

BACKGROUND: The aim of the study is to demonstrate the feasibility and the oncologic effectiveness of quadrantectomy plus sentinel node biopsy performed under local anesthesia, and to demonstrate the economic and psychologic advantages. METHODS: From October 1996 to March 2000, 71 patients affected with clinical T1 N0 breast cancer, underwent quadrantectomy or tumor resection plus sentinel node biopsy and clinically suspicion axillary nodes biopsy, under local anesthesia at the Casa di Cura "Villa Mafalda" in Rome. RESULTS: Twenty tumors were T1a, 26 T1b e 25 T1c. A mean of 2 sentinel nodes (range 1-4) and a mean of 8 axillary nodes were removed during the procedure. In 2 cases sentinel nodes were not identified. Intraoperative histologic examination showed metastatic sentinel nodes in 11 cases. An axillary node dissection was performed in all cases (>12 nodes) and no other metastatic nodes were found. In all patients clinically suspected nodes were removed. In two cases no evidence of metastasis was found in sentinel nodes, while histologic examination revealed in a patient micrometastasis in one node, and in another patient two metastatic nodes. CONCLUSIONS: Fifty-three patients rated the overall surgical, anesthetic and recovery experience as "very satisfactory", 13 "satisfactory" and 5 "unsatisfactory". Patients typically expressed their pleasure at the possibility to return home and stressed the ease of recovery.

[Carcinoma of the gastric stump. Our experience in 28 treated cases]. / Carcinoma del moncone gastrico. Nostra esperienza su 28 casi trattati.

A chart review was conducted on 28 patients with gastric stump cancer who were radically treated at the First Department of Surgery of University "La Sapienza" of Rome between 1978 and 1990. The data obtained were compared with those of 401 patients radically treated, in the same period, for primary cancer of the proximal third of the stomach. There were no significant differences between the two groups in terms of stage and nodal involvement. Surgical treatment was total gastrectomy in 86% of cases, and an extended procedure in 57% of patients. The morbidity rate was similar to patients treated for primary gastric cancer, as well the 5-year survival, which depend on the stage of disease. We can conclude that gastric stump cancer must be treated surgically with radical intent as the prognosis is similar to that of primary gastric cancer.

Correlation between lowered PgE2 levels and alkaline reflux gastritis in patients subjected to Billroth II. Pylorogastrectomy: possible improvement with sulglycotide.

In patients subjected to pylorogastrectomy with anterior gastroenterostomy (Billroth's operation II) the remaining gastric mucosa is exposed to the damaging action of bile with consequent reduction of locally generated prostaglandins. The purpose of the present study was to explore the correlation between PgE2 levels in such postgastrectomy patients before and after treatment with sulglycotide. Twelve patients with clinical, endoscopic and histological evidence of alkaline reflux gastritis were treated with sulglycotide in daily doses of 1600 mg for 30 days. At termination there was a definite clinical, endoscopic and histological improvement with significant (p less than 0.001) increase of PgE2 levels.

Lung cancer: long-term survival after surgical treatment.

The authors have carried out an analysis on a series of 1802 patients with lung cancer. 1254 patients were considered operable (69.5%) and 828 were resected. Overall 5-year survival rate was 28.3%. Results of surgical treatment were analysed in relation to the specific features both of primary tumour and the host organism. Although patients affected with epidermoid carcinoma showed a better survival as compared to those affected with tumours of other histotypes. Conversely long-term results were significantly related to post-surgical stage. Patients treated for stage I tumour showed a significantly better long-term survival (5-year survival rate 48.2%) as compared to those undergone resection for stage II and III neoplasms (22.8% and 12%, respectively; p: less than 0.001). From the prognostic standpoint female patients undergone resection showed markedly lower long-term survival (5-year survival rate 12.5%) as compared to male patients (5-year survival rate 29.5%), but the numerical differences between the two groups of patients does not permit to detect statistically significant differences (P: less than 0.05). Type and intensity of the immune response affect significantly long-term survival.

Results of surgical treatment for small cell carcinoma of the lung.

The records of 288 patients treated for small cell carcinomas of the lung are reviewed. Resectional surgery was performed in 150 cases (147 apparently curative and 3 palliative procedures), 73 patients were submitted to exploratory thoracotomy and 65 were deemed unsuitable for surgical treatment. Overall postoperative mortality after resection was 14,6% and 5-year survival rate 20,7%. Long term prognosis was significantly correlated to p-TNM (p less than 0,002) and host's immune response as evidenced by circulating peripheral lymphocytes/cumm (p less than 0,003), primary tumor lymphocytic infiltration (L.I.) (p less than 0.03), regional lymph-node reactivity (P.C.A., S.H. and C.A. development) (p less than 0,0001). Patients treated for Stage I disease and showing enhanced immune reactivity had a significantly better long term prognosis than Stage II, III and non reactive patients. Oat cell subtype had worse 5-year survival rates (10,7%) than intermediate cell subtype (25,4%), this difference however is devoid of statistical significance (p: not significant).

Segmental and wedge resections for lung cancer: a palliative or curative procedure?

Among 1000 consecutive patients submitted to surgery for lung carcinoma, 24 underwent minimal resections. Minimal resections although occasionally curative are, as a rule, palliative procedures to be used in patients with limited cardio-pulmonary reserve or previously submitted to lung resection. Whenever possible lateral, muscle-sparing thoracotomy and wedge resections should be performed.