What is the role of nodal ratio as a prognostic factor for gastric cancer nowadays? Comparison with new TNM staging system and analysis according to the number of resected nodes.

Nodal ratio (NR) has been demonstrated to be an important prognostic factor in patients with gastric cancer. The aim of this study is to evaluate the prognostic role of nodal ratio comparing it with the new TNM (2010) classification. One hundred forty-two patients were submitted to potentially curative gastrectomy for cancer. Patients with low performance status underwent D1.5 lymphadenectomy, whereas the other patients underwent D2-D2.5 lymphadenectomy. Nodal staging was classified according to 2010 International Union Against Cancer/American Joint Committee on Cancer classification. Kaplan-Meier method was used to evaluate survival, stratified for nodal classes and nodal status. Total gastrectomy was performed in 39 per cent of cases and distal gastrectomy in 61 per cent. Mean number of resected nodes was 25.5. Whereas N status was strictly related to the number of resected nodes, the NR was independent from the extension of the lymphadenectomy. Overall five-year survival was 81 per cent for N0 patients, 72 per cent for N1, and 26 and 23 per cent for N2 and N3, respectively. Patients with NR0 had 81 per cent five-year survival, whereas NR1 67 per cent, NR2 51 per cent, and NR3 22 per cent. NR seems to be a simple method to predict the prognosis of patients with gastric cancer; unlike N status, it is independent from the number of resected nodes, and therefore it is particularly useful in case of inadequate lymphadenectomy.

[Adult ileocaecal and colic invagination: a case report]. / Invaginazione ileo-colica nell'adulto: a proposito di un caso clinico.

Intestinal invagination or intussusception is the telescoping of a segment of the intestinal tract into an adjacent one. In most cases the invagination is ileocolic, consisting of the small intestine penetrating into the colon through the ileocaecal valve; in other cases it could be ileoileal or colocolic. It is a common entity in paediatric subjects, especially in the first two years of life (90-95% of cases), but is a rare condition in the adult where it accounts for only 5-10% of all intestinal invaginations and around 1% of all intestinal occlusions. We report a case observed in a 65-year-old patient. The patient underwent ileo-caeco-colic resection. Histological examination of the specimen showed an ulcerated submucosal intestinal lipoma. Computed tomography is the most accurate imaging technique for intestinal invagination. The recommended treatment of adult intestinal invagination is surgical resection of the intestinal segments involved.

Gallstone ileus: a case report and review of the literature.

Gallstone ileus is a rare complication of gallstone disease, accounting for 1-4% of all bowel obstructions. The phisiopathology is related to the presence of a bilio-enteric fistula. Cholecistoenteric fistulae occur in fewer than 1% of patients with gallstone. We present the case of an 83-years-old woman, complaining of acute abdominal pain, vomiting and mechanical obstruction at admission. She reported a past history of hypertension, recent miocardial ischaemia, diverticular disease and cholelithiasis. A CT scan revealed aerobilia, gastric and duodenal dilatation and a gallstone impacted just beyond the duodeno-jejunal junction. An exploratory supraumbilical laparotomy was performed: revealing a 4-cm gallstone impacted just caudal to the Treitz ligament. We then performed an enterolithotomy. According to the literature, enterolithotomy is the most commonly used surgical technique, whereas enterolithotomy combined with cholecistectomy and fistulectomy is indicated only in selected cases. The clinical presentation depends on impaction site and generally includes abdominal pain, nausea and vomiting. Some cases may present haematemesis due to mucosal erosion. The gold-standard investigation technique is CT scan.