Our experience in the management of obstructing colorectal cancer.

AIM: Comparing the different possible surgical procedures and the results in urgent/emergency and in elective surgery for obstructing colorectal cancer. MATERIAL OF STUDY: From 2008 we operated on 238 patients affected by colorectal cancer, 136 complicated tumours, 115 obstructing and 19 perforated. 23 patients had right-sided and 92 left-sided obstructing colonic tumour, divided retrospectively in 4 groups. 18 decompressive colostomy; 32 two-stages procedures: 25 Hartmann's operations and 7 total colectomies with terminal ileostomy; 7 one-stage procedures, with defunctioning ileostomy: 4 total colectomies and 3 colonic resections with wash-out; 35 one-stage procedures with primary anastomosis+wash-out or milking. RESULTS: Operative mortality is 7% in urgent/emergency versus 1% in elective surgery and anastomotic leakage affected 6 /58 cases, 5 requiring additional surgery. Overall, about 2/3 of the perioperative deaths were related to general complications and 1/3 to anastomotic failure. The local recurrence rate was 7% in elective and 11% in urgent/emergency surgery. DISCUSSION AND CONCLUSIONS: Obstructing colorectal cancer is associated with a high operative mortality and a worse prognosis, in terms of recurrence and survival. Actually, immediate resection with primary anastomosis represents the goldstandard in selected patients with a low anaesthetic risk, performing either as a typical resection with wash-out, or a subtotal colectomy; a temporary defunctioning colostomy or ileostomy could be proposed for patients with an intermediate risk; in high-risk cases, advanced obstruction, simultaneous colonic perforation, metastatic or locally advanced disease, Hartmann's operation should be used, as a safer procedure. Colon stenting can be an useful palliative or bridge-to-surgery option. KEY WORDS: Bowel obstruction, Colorectal cancer, Primary anastomosis.

[Retroperitoneal schwannoma: a case report]. / Un caso di schwannoma retroperitoneale.

Schwannomas are degenerate peripheral nerve sheath tumors that very rarely occur in the retroperitoneum. They are usually benign than malignancy is very rare and is usually observed in patients with von Recklinghausen disease. We report a case of female adult patient who presented with vague abdominal discomfort. The preoperative diagnosis was difficult and the treatment was complete surgical excision. The patient is with no evidence of recurrence more than four years after surgery.

Phase II study of neoadjuvant concurrent chemioradiotherapy with oxaliplatin-containing regimen in locally advanced rectal cancer.

UNLABELLED: The purpose of this phase II trial was to assess tolerance and efficacy of the combination of radiation, fluorouracil and oxaliplatin as neoadjuvant treatment in locally advanced rectal cancer. Between March 2001 and August 2004 , 28 patients M/18 F/10 with locally advanced rectal cancer were entered in our study. All the patients underwent to the Radiotherapy with a total dose was 45 Gy and concurrent chemotherapy with Oxaliplatin 80 mg/mq G1 on weeks 1,3,5 followed by five day continuous infusion of 5-Fluorouracile 300 mg/mq on five consecutive weeks. Surgery was planned 5 weeks later. Surgery was performed in all patients after a mean interval time of 5 weeks. Side effects and toxicity included grade II sec WHO diarrhea and grade II mucositis , grade I-II dysuria and skin reaction Downstaging to T0-2N0 was achieved in 18 patients (65%) with 4 (15%) achieving a pathologically complete response. CONCLUSIONS: Such a combined preoperative chemioradiotherapy and oxaliplatin-containing regimen is well tolerated with non increase in surgical toxicity. The good response rate observed warrants its use in further clinical trials.