A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG.

Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.

Diagnostic Accuracy of Pleural Fluid Cytology, Carcinoembryonic Antigen and C-Reactive Protein Together in Patients With Pulmonary Metastases and Malignant Pleural Effusion.

BACKGROUND/AIM: Pleural effusion (PE) has a heterogeneous aetiology, and differential diagnosis between benign and malignant disease may require invasive procedures in up to 60% of cases. The sensitivity of pleural cytology is limited, and several strategies have been tested to reduce the need of invasive diagnostic approaches. The aim of this study was to evaluate the usefulness of pleural fluid cytology, compared to, and combined with, carcinoembryonic antigen (CEA), C reactive protein (CRP), and lactate dehydrogenase (LDH) assay of pleural fluid (PF) in patients with a history of cancer, exudative non-purulent PE, and suspicion of malignant PE on imaging studies. PATIENTS AND METHODS: The medical records of 40 patients with pulmonary metastases and malignant PE, and 57 controls with benign exudative PE were reviewed. All the patients underwent pleural cytology and CEA, CRP, and LDH assay before VATS-guided biopsy. RESULTS: The sensitivity and specificity were 55.0% and 98.2% (cytology), 35.0% and 98.2% (CEA), 92.5% and 71.9% (CRP), 70.0% and 54.4% (LDH). The multivariate analysis excluded LDH, and the final AUC (cytology+CEA+CRP) was 0.894. CONCLUSION: In all patients with a history of cancer and PE of uncertain origin, the combination of PF cytology plus pleural CEA and CRP assay together should be suggested to recognize malignant plural effusion (MPE), minimising the use of unnecessary invasive investigations.

Diagnosis of Malignant Pleural Effusion Using CT Scan and Pleural-Fluid Cytology Together. A Preliminary Case-Control Study.

BACKGROUND/AIM: The purposes of this study were to evaluate the usefulness of chest computed tomographic (CT) scan plus pleural fluid cytology (PFC) together in patients with malignant pleural effusion (PE), and to compare the results of these diagnostic tools in patients with malignant PE due to non-small-cell lung cancer and pulmonary metastases from other malignancies. PATIENTS AND METHODS: The medical records of 185 patients with PE, who underwent chest CT, PFC and video-assisted thoracoscopy (VATS) thoracentesis followed by VATS-guided biopsy for diagnostic purpose, were reviewed. At the final diagnosis, 123 (66.5%) patients had malignant PE (cases), and 62 (33.5%) had benign PE (controls). RESULTS: Overall, the sensitivity, specificity, and accuracy of CT and PFC were 65.0% vs. 67.5% 98.4% vs. 98.4%, and 76.2% vs. 77.8%, respectively. The combination of CT plus PFC significantly improved sensitivity (86.2%, p=0.003) and accuracy (90.8%, p=0.02). CONCLUSION: CT and PFC used together may lead to approximately 100% specificity and >90% sensitivity in distinguishing between benign and malignant PE.

Analysis of Factors Affecting Short-term Results in Elderly Patients Undergoing Elective Surgical Resection for Stage I-II Colon Cancer.

AIM: The aim of this study was to analyze the influence of comorbidities and to compare the short-term results of elective surgical resection of stage I-II colon adenocarcinoma in elderly (≥65 years) versus younger patients. PATIENTS AND METHODS: Two groups of sex-matched younger and older patients were compared: Group A: N=36, median age 58 (range=43-65) years; and group B: N=67, median age 73 (range=66-86) years. RESULTS: Overall, 71 out of 103 (68.9%) patients had one or more comorbidities. A greater number of older patients had an American Society of Anesthesiologists (ASA) score >2 (p=0.004) and were on multiple medications (polypharmacy) (p=0.016), but the distribution of the other parameters was similar (p≥0.05). Intra- and postoperative complications in group A vs. B occurred in 25.0% vs. 26.9%, and 47.2% vs. 64.2%, respectively (p≥0.05). CONCLUSION: Elderly patients with colon cancer scheduled to elective surgical resection should not be considered at increased risk of intra- or short-term postoperative complications with respect to younger patients. However, they require careful individual preoperative evaluation because they are usually polypharmacy users and have a higher ASA score.

Short-term cyclosporine therapy and cotransplantation of donor splenocytes: effects on graft rejection and survival rates in pigs subjected to renal transplantation.

BACKGROUND: Donor-specific allogeneic loading can prolong the survival of solid organ transplants by inducing a state known as acceptance. Several populations of cells are known to be involved in this process, but their exact roles have yet to be defined. The aim of this study was to assess the effects of portal-vein transfusion of donor-specific splenocytes (DST) after short-term cyclosporine A (CyA) therapy in pigs subjected to renal transplantation. METHODS: Four groups of unrelated swine underwent renal transplantation with removal of the native kidneys. Antirejection protocols consisted in portal-vein DST (3 x 10(8) cells/kg) (Group 2, n = 7); intravenous CyA (9 mg/kg/d) on postoperative days 1-12 (Group 3, n = 14); and DST + CyA (as described above) (Group 4, n = 13). Results (through postoperative day 90) were compared with those obtained in untreated control recipients (Group 1, n = 7). RESULTS: Compared with animals of Groups 1, 2, and 3, Group 4 recipients presented significantly longer survival (mean: 90 days, P < 0.01 in Kaplan-Meier analysis) and better renal function (P < 0.05). Graft histology revealed preserved parenchyma. CONCLUSION: The role of spleen cells in the immune response has probably been underestimated. Cotransplantation of donor splenocytes seems to induce a certain degree of acceptance toward the renal allograft. The route of administration (portal-vein infusion in this study) may be crucial for developing favorable mechanisms of recognition.