Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients.

BACKGROUND: The purpose of this multicentric prospective study was to evaluate postoperative HRQL and satisfaction with care after laparoscopic colonic resection for colorectal cancer in elderly patients. METHODS: A total of 116 patients were enrolled in this study: 33 patients older than age 70 years had laparoscopic colectomy, whereas 24 had open colectomy; 44 patients younger than age 70 years had laparoscopic colectomy and 15 of them had open colectomy. The patients answered to three questionnaires about generic (EORTC QLQ C30) and disease-specific quality of life (EORTC CR29) and about treatment satisfaction (EORTC IN-PATSAT32). Nonparametric tests and forward stepwise multiple regression analysis were used for statistical analysis. RESULTS: One month after surgery, global quality of life (QL2 item) was significantly impaired in elderly patients who had laparoscopic colectomy compared with younger patients who had the same operation (p = 0.003). Similarly, role function (RF), physical function (PF), emotional function (EF), cognitive function (CF), and social function (SF) were impaired in elderly patients who had laparoscopic colectomy compared with younger patients (p < 0.001, p < 0.001, p = 0.013, p < 0.001, p = 0.01, respectively). Fatigue (FA), sleep disturbances (SL), appetite loss (AP), and dyspnea (DY) affected the quality of life of these patients more than younger patients (p < 0.001, p = 0.055, p = 0.051, and p = 0.003, respectively). CONCLUSIONS: Elderly patients undergoing laparoscopic colectomy for cancer experience less postoperative local complications than elderly patients undergoing open colectomy. Nevertheless, in the first postoperative month, these patients experience a worse global quality of life than younger patients undergoing the same operation with impairment of all the functions and the presence of fatigue, sleep disturbances, appetite loss, and dyspnea.

Relationship between oral contraceptive therapy and estrogen receptor status in patients with breast cancer.

BACKGROUND: Breast cancer (BC) is the most common cancer in women, and the hormone receptor status is one of the most important prognostic factors in patients with BC. The aim of this study was to establish whether a relationship exists between the hormone receptor rate and the main classic risk factors in patients with BC. PATIENTS AND METHODS: The data regarding a series of 351 consecutive women (median age 57 years, range 26-85 years) who had undergone curative surgery for primary BC was retrospectively reviewed. Eighty-seven (24.8%) patients used oral contraceptives. According to the duration of OC therapy, the patients were dichotomized into two Groups. Group A: less than 22 months (47 patients, 54%) and Group B: 22 months or more (40 patients, 46%). RESULTS: Final pathology showed 15 (4.3%) pT1a, 62 (17.7%) pT1b, 133 (37.9%) pT1c, 125 (35.6%) pT2, and 16 (4.5%) pT3 BC. There were 286 (81.5%) infiltrating ductal, and 24 (6.8%) infiltrating lobular breast carcinomas. The average estrogen receptor (ER) and progesterone receptor (PgR) rate was 59.7 +/- 32.8 and 54.2 +/- 33.9, respectively. There was no relationship (p = NS) between either ER or PgR and the age of the patients, age at menarche and menopause, number of pregnancies, age at first pregnancy, number of spontaneous abortions, months of breastfeeding and the use of estrogen replacement therapy. As expected, ER and PgR rates correlated significantly (R = 0.78, p < 0.01). The ER rates of groups A and B were 51.7 +/- 35.6% and 68.2 +/- 23.6%, respectively (p = 0.014). No other differences (p = NS) between the groups were found. CONCLUSION: The prolonged use of oral contraceptives may increase the ER rate within the tumor tissue, and thus such therapy should be considered an indirect positive prognostic factor in patients with BC.

Intima-media thickness measurement of the carotid artery in patients with primary hyperparathyroidism. A prospective case-control study and long-term follow-up.

BACKGROUND: The intima-media thickness (IMT) measurement of the common carotid artery is recognized as a reliable marker of systemic atherosclerosis and may be useful in predicting the likelihood of cardiovascular events, since it is related to the extent and severity of coronary artery disease. The aims of this study were to analyze whether correlations exist between the IMT of the common carotid artery and the main clinical and biochemical parameters in patients with primary hyperparathyroidism (PHPT), and to evaluate the possible improvement of the IMT values following parathyroidectomy at long-term follow-up. PATIENTS AND METHODS: Twenty-seven patients (5 men, 22 women; median age 59 years, range 36-82 years) with biochemically confirmed PHPT (Group A, cases), and 27 gender- and age-matched healthy volunteers (Group B, controls) were prospectively enrolled in the study. All patients underwent ultrasound examination and the IMT of each carotid artery were recorded, averaging all values. The measurements were repeated 18-22 months (median 20) later in all patients. RESULTS: A significant (p < 0.05) correlation between age and both systolic BP and IMT, and between IMT and fasting glycaemia was found in each Group. There was an inverse relationship between IMT and serum parathyroid hormone (R = -0.56, p < 0.01), but no correlation (p=NS) was found between IMT and serum calcium (R = -0.14) or serum phosphate (R = 0.07). At follow-up a slight (10.4%) improvement in the mean IMT was observed among Group A patients (0.86 +/- 0.18 vs. 0.77 +/- 0.24; p = 0.12), but the difference was not significant. CONCLUSION: At long term follow-up, the IMT values did not improve significantly and no correlation was found between serum calcium and IMT. These results suggest that hypercalcemia does not represent a reliable risk of carotid atherosclerosis in patients with PHPT.

Morphological and functional modifications of the aneurysm-endograft complex following endoluminal exclusion in 30 consecutive cases.

Data from 30 consecutive excluded abdominal aortic aneurysms (AAA) have been analysed, to verify whether important morphological changes take place after exclusion, and whether these can be considered as risk factors for functional (leaks, flow alterations) and clinical complications (rupture, obstruction). All AAAs have been initially successfully excluded and patients have been followed up by clinical examinations and ct scan controls post-operatively, at the third and sixth month, then yearly. At a mean follow-up of 17 months, dimension of the proximal neck increased significantly (> 2 mm in diameter) in five pts and graft was distally dislodged in two. Maximum aneurysm diameter reduced significantly (at east 10% than originally) in half of the case and more than 25% in 10% of cases. Four AAAs presented an initial increase, that reduced only in two. Calculation of length of the AAA was unreliable due to tortuosity. Two secondary type II leaks and one secondary type III leak were observed associated to stable or slightly increased AAA diameter (the latter patient suddenly died probably for miocardial infarction, but a rupture could not be formally excluded). Marked tortuosity of the graft was seen in five patients, all associated with frank shrinkage of the aneurysmal sac. Parietal thrombosis without explanation was observed in five, and in one progressed to obstruction of an iliac branch. Two pts needed anticoagulation. These data indicate that endoluminal aneurysm exclusion can not be considered as a definitive solution, for long-term outcome is unforeseeable in a number of patients.