Is It Possible a Conservative Approach After Radiochemotherapy in Locally Advanced Rectal Cancer (LARC)? A Systematic Review of the Literature and Meta-analysis.

BACKGROUND: Locally advanced rectal cancer is usually treated with a preoperative approach with radiochemotherapy followed by surgery. Patients obtaining a pathologic complete response have a very favorable long-term prognosis. This study was intended to assess whether major surgery can reduce tumor recurrences and prolong survival of patients with a complete response after radiochemotherapy. METHODS: Computerized literature search was performed to identify relevant articles. Comparative studies reporting the outcomes of non-operative and operative management in patients after neoadjuvant treatment were reviewed. Data synthesis was performed using Review Manager 5.0 software. RESULTS: Twelve non-randomized comparative studies with a total of 1812 patients were suitable for analysis. There was no significant difference in overall survival at 3 and 5 years (odds ratio [OR] 1.31; 95% CI 0.64-2.69; p = 0.46 and 1.48; 95% CI 1.00-2.20; p = 0.50) and in disease-free survival at 3 and 5 years (odds ratio [OR] 1.20; 95% CI 0.68-2.14; p = 0.53 and 1.22; 95% CI 0.86-1.74; p = 0.26, respectively) between locally advanced rectal cancer patients treated with and without operative approach. CONCLUSIONS: Major surgery does not seem to improve prognosis in patients obtaining a complete response after radiochemotherapy. Clinical trials, using clear criteria to identify complete response patients, are needed to recommend non-operative approach.

Laparoscopic treatment of colo-colic intussusception secondary to a lipomatous polyp.

INTRODUCTION: Colo-colic intussusception is extremely rare in adults and few cases have been described secondary to a lypomatous polyp. CASE REPORT: We present the case of a 50-year old man with chronic abdominal pain who was diagnosed a colo-colic intussusception secondary to a lipoma of the left colon. The patient underwent laparoscopic resection of the splenic flexure without reduction, which occurred spontaneously after induction of the pneumoperitoneum, and final histology confirmed a submucosal lipoma with no evidence of malignancy. CONCLUSION: The traditional treatment of choice for adult intussusception is bowel resection without reduction. More recently, however, preoperative reduction of the invaginated bowel segment has been reconsidered in order to: 1) avoid emergency surgery, 2) allow radical surgery for cancer, and 3) reduce the extent of the intestinal resection. To the best of our knowledge, this is the first case of adult colonic intussusception secondary to a lipoma treated by laparoscopy. KEY WORDS: Colon, Intussusception, Laparoscopy, Lipoma.

Gastrointestinal stromal tumours: evaluation of biological and clinical current opinions.

The discovery of c-kit gene mutations and the positivity of its transcription products in gastrointestinal stromal tumours (GISTs) suggest a possible origin from Cajal interstitial cells. The study population consisted of 12 patients with GIST, with a mean age of 67.6 years. Preoperative biopsy was performed in 4 cases and in only 1 case did it prove correct. Mesenchymal tumours were regarded as myogenic when they were positive for desmin, and as neurogenic when they were positive for S-100 protein or specific neural enolase (SNE). Seven out of 12 patients underwent simple tumour excision, while in 2 cases ileal resection was performed; gastric resection, total gastrectomy with D2 lymphadenectomy and left colectomy were carried out in one case each. There were two deaths, both unrelated to the primitive diagnosis. Immunohistochemical studies were positive for CD34 in 58% of the cases, and for CD117 in 83%. The mitotic count was higher than 5/10 HPF in 3 cases. The mean survival was 57 months. The overall survival rate was 66%. We found that good tumour differentiation, small size and a low mitotic index correlate with benign behaviour and a better prognosis. Positivity for CD117, evaluated in all malignant lesions, was slightly lower (83% vs 89%) as compared to the data reported in the literature. Tumours with a high mitotic index (> 5 mitoses/10 HPF) and measuring more than 5 cm in diameter are to be considered malignant.