[Second tumours in patients with malignant neoplasms of the digestive apparatus. A retrospective study on 2406 cases]. / Secondi tumori in pazienti con neoplasie maligne dell'apparato digerente. Studio retrospettivo su 2406 casi.

BACKGROUND: Incidence of a second tumor is elevated, between 2-10%, in patients previously affected by another tumor. Second tumor may concern the same organ, as a synchronous or metachronous way, or different organs. The present work is based on 4286 patients who underwent surgical treatment for gastric, small bowel, colorectal or pancreatic cancer at Surgical Unit 1- Minni- Bologna University and regards multiple primitive malignant tumor (T.M.M.P) of the II type (Möertel classification), such as different organs or tissues based second tumors; it also analyses overall incidence, sites, lesion number, latency period, and main association in our series. PATIENTS AND METHODS: 1742 patients with colorectal carcinoma, 1418 patients with gastric cancer, 91 patients with malignant tumour of the small bowel, 867 patients with pancreatic cancer and 68 with hepatocellular carcinoma have been included in the present study. A careful history, aimed at checking the presence of a previous tumor in a different site, was taken. One hundred eighty one patients (82 male and 99 female) reported tumor of a second type. Eleven cases of synchronous tumor and 170 cases of metachronous tumors were found, at a distance of 1-39 years. Moreover 7 patients reported more than one second tumor. Female genital tract tumors (37 cases), hematopoietic system tumors (34 cases), breast cancer (29 cases), and cutaneous tumor (20 cases) 9 were the most observed previous tumor. Incidence of a second tumor was more elevated in patients with small bowel neoplasms (18/91, 19.8%) than in patients with others tumors of gastrointestinal tract. CONCLUSIONS: Present study, although win part retrospective, point out an overall incidence of 4.3% of second tumors of the II type. Incidence of second tumours in patients with small bowel neoplasm, is particularly high; this confirm that small bowel plays a possible immunoprotective role and the immunodepression characterise patients with tumors in this site.

Inflammatory pseudotumor of the pancreas resembling pancreatic cancer: clinical, diagnostic and therapeutic considerations.

Pancreatic masses could be malignant or benign. Among these latter inflammatory pseudotumor is an uncommon mass rarely located in the pancreas and it must be considered in differential diagnosis with pancreatic cancer. A case report and literature review of inflammatory pseudotumor were recognized to well known this rare pathology regarding its clinical, diagnostic, therapeutic and histopathological feature. Twenty-one cases of inflammatory pseudotumor in the adult were reviewed from the literature; 10 (47.6%) were female, 11 (52.3%) male; mean age 53.3 years (range 23-73). They were solid single mass in 18 cases, with median size of 5.1 cm (range 1.5-13), cystic mass in one case; 18 were located in the head, 1 in the body. In 2 cases it appeared as a volumetric increase of the pancreas. Diagnosis was possible only histologically and surgical treatment was mandatory in 20 cases; only in one patient a corticosteroid treatment was performed. Pancreatic inflammatory pseudotumor is a rare lesion of the pancreas but it must be distinguished from pancreatic cancer. Pancreatic resectioning is mainly due to the preoperative diagnostic difficulties that must be resolved surely only with histopathological examination of the specimen.

Usefulness of the ultrasonically activated shears in total thyroidectomy.

Surgical technique of total thyroidectomy is nowadays well known. Technology could determine some improvement of this kind of surgery. Two groups of patients that underwent total thyroidectomy were compared retrospectively. In group 1 we described 105 total thyroidectomies performed with ultrasonically activated shears; in group 2, 76 performed with conventional methods of haemostasis. Comparing the two groups for several parameters, it results that in the total thyroidectomies performed with ultrasonically actived shears, operative time is shorter of 24 minutes compared with conventional method (81 vs 105 minutes), the mean amount of intraoperative blood loss is smaller (70 ml vs 125 ml), the postoperative pain is less, the cosmetic result is better (length of incision 6 cm vs 10 cm) and the costs is not more expensive. Complications of thyroid surgery are similar between the two methods. The use of ultrasonically actived shears in total thyroidectomy is safe (no increase of complications) and useful because it reduces operative time, improves the recovery of the patient (less pain, better cosmetic results) and, finally, is not more expensive than conventional method of haemostasis.