Correlation between obesity and prognostic/predictive parameters with emphasis on the importance of lymph node metastases in patients with invasive breast carcinoma.

We aimed to evaluate whether obese women experience more advanced invasive breast carcinoma (IBC) with a higher number of involved lymph nodes, higher range of axillary lymph node ratio (LNR) and presence and size of extracapsular extension as it may have an impact on prognosis and management. 245 patients diagnosed with IBC were divided into normal weight (NW), overweight (OW) and obese (OB) groups. Patients were divided into high range of LNR (LNR over or equal to 0.2) and low LNR (LNR less than 0.2). The extracapsular extension dimensions were measured on the original slides of each case and grouped into ≤ 1 mm and > 1 mm. 84 patients (33.07%) were OW, 72 (29.38%) OB and 91 (37.14%) NW. 45.7% of cases had macrometastasis in the axillary lymph nodes. NW patients had significantly fewer metastatic lymph nodes (p = 0.05) than in the OW/OB groups. There was no statistically significant difference between BMI groups according to the LNR (p = 0.66). Out of 111 cases with macrometastasis, 58 cases (52.25%) had extracapsular extension (ECE) (11.7% NW, 24.32% OW and 16.22% OB). Significantly more OW patients presented extranodal invasion (p = 0.04). We found no statistically significant relationship between the extracapsular extension diameter and BMI groups (p = 0.1).

Indications of a Defunctioning Stoma in Colorectal Anastomosis--Our Experience and Review of the Literature.

BACKGROUND: Defunctioning stomas can prevent consequences of anastomotic leakage, but they are not free of complications. OBJECTIVES: The identification of high-risk patients to establish criteria for strong and relative indications for the formation of a defunctioning stoma. METHODS: Two hundred fifty consecutive colorectal anastomoses were performed between 2004 and 2015; 95.2% of these were for colorectal cancer. In 130 cases, mechanical anastomosis was used. A protective stoma was performed in only 15 cases. The incidence of anastomotic leakage was evaluated according to multiple parameters, as were the postoperative complications related to protective stomas. The outcomes were compared to those reported in the literature. RESULTS: Symptomatic anastomotic leakage occurred in six patients (2.4%) and resulted in four deaths. None of the patients with a protective stoma developed serious complications related to the colorectal anastomosis. However, serious ileostomy-related complications occurred in two cases (15.38%). CONCLUSIONS: Protective stomas should be used only according to the risk criteria of the patients. Strong indications are: anastomotic imperfections, anastomosis under tension, previous pelvic irradiation, ultralow anastomosis in patients older than 70 years, patients over 80 years, and significant co-morbidities.