Surgical management protocol during the COVID-19 pandemic in an Italian non-referral center.

BACKGROUND: In the surgical scenario, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion worldwide entails on the one hand the need to continue to perform surgery at least in case of emergency or oncologic surgery, in patients with or without COronaVIrus Disease 2019 (COVID-19); and on the other hand, to avoid the pandemic diffusion both between patients and medical and nursing team. The aim of this study was to report our surgical management protocol during the COVID-19 pandemic in an Italian non-referral center. METHODS: Data retrieved during the outbreak for the COVID-19 pandemic, from March 8 to May 4, 2020 (study period) were analyzed and compared to data obtained during the same period in 2019 (control period). RESULTS: During the study period, 41 surgical procedures (24 electives, 17 emergency surgical procedures) underwent surgery in comparison to 99 procedures in the control period. Stratifying the procedures in elective and emergency surgery, and based on the indication for surgery, the only statistically significant difference was observed in the elective surgery regarding the abdominal wall surgery (0 vs. 13 procedures, P=0.0339). Statistically significant differences were not observed regarding the colorectal and the breast oncologic surgery. All stuff members were COVID-19 free. CONCLUSIONS: The present protocol proved to be safe and useful to prevent SARS-CoV-2 infection before and after surgery for both patients and stuff. The pandemic was responsible for the reduction in number of procedures performed, anyway for the oncologic surgery a statistically significant volume reduction in comparison to 2019 was not observed.

Paratesticular leiomyosarcoma: a case report.

Leiomyosarcomas of the spermatic cord are extremely rare. This article reviews the pathophysiology of spermatic cord leiomyosarcomas and the reasons for recurrence, and discusses the management options. Radical inguinal orchiectomy and high ligation of the cord is the standard primary surgical procedure.

Gastric metastasis 14 years after mastectomy for breast lobular carcinoma: case report and literature review.

In planning treatment of a gastric neoplasm in a patient previously treated for lobular breast carcinoma, it is important to differentiate a primary gastrointestinal tract tumor from a metastatic form. We report a case of a breast lobular carcinoma metastatic to the stomach. The patient underwent a subtotal gastrectomy for symptomatic disease. Although gastric symptoms appeared 14 years after the breast carcinoma, immunohistochemical analysis of the surgical specimen helped to establish that the gastric lesion, thought to be primary, was effectively a metastatic repetition of the breast neoplasm. To better define treatment in a gastric neoplasm patient previously treated for breast carcinoma, the preoperative diagnosis should rule out a metastatic disease. The patient described received an adjuvant chemotherapy according to breast cancer protocol after gastric resection for symptomatic disease. The patient is still alive and undergoing chemotherapy for peritoneal carcinosis.

Male breast cancer: a case report and review of the literature.

Breast cancer in men is an uncommon disease. Because of its rarity little is known about its aetiology, clinical behaviour and treatment. Retrospective studies show that when age- and stage-matched breast cancer in men and women are compared, there is no difference in survival between the two groups. Nevertheless, because of the absence of screening protocols and the limited amount of mammary tissue in men, allowing rapid local infiltration, a late diagnosis is often made, with a poor survival rate. Most of our current knowledge about the biology, natural history, surgical therapeutic strategies, adjuvant radiotherapy and chemotherapy protocols of male breast carcinoma has been extrapolated from its female counterpart. The Authors report the case of a male patient with breast cancer and pagetoid diffusion in the nipple region, and, on the basis of a review of the literature, summarise what is currently known about this rare neoplasm in terms of prognostic factors, therapy and survival.

[Benign cystic mesothelioma with multiple recurrences: a clinical case]. / Mesotelioma cistico benigno plurirecidivo: caso clinico.

Benign multicystic mesothelioma is a rare disease with a high tendency to local recurrence, but with no tendency to malignancy. The correct diagnosis can be made by histopathological examination in conjunction with immunohistochemical and ultrastructural evaluations. A case of benign cystic mesothelioma recurring three times in a 48-year-old woman is reported, and the management of this disease and the importance of radical surgery are discussed.

Adrenal metastatic placental site trophoblastic tumor. Case report.

Placental site trophoblastic tumor is a rare disease. Since its first description in the literature only about 100 cases have been reported. Initially considered a benign pathology, its malignant potential with metastases was later recognized. About 30% of the cases described metastatised, thereby aggravating the prognosis. The therapy is surgical and in cases of metastatised disease has to be supplemented by chemotherapy. A case of placental site trophoblastic tumour with a single metastasis to the left adrenal gland treated with adrenalectomy and chemotherapy is reported.

Laparoscopic adrenalectomy: a worthwhile procedure performed in a general surgery department.

A laparoscopic procedure is considered the treatment of choice for adrenalectomy. We report the experience of a nonreferring unit for adrenal pathology; we have evaluated its safety and feasibility in a series of 40 patients. From 1994 to 2001, forty consecutive patients underwent laparoscopic adrenalectomy, 37 with transperitoneal and 3 with retroperitoneal approach. The mean operative time was 129 +/- 51.7 minutes (range 60-300): 107 +/- 29 minutes (range 60-100) for the right-sided transperitoneal adrenalectomy and 144 +/- 62 minutes (range 90-300) for the left-sided transperitoneal adrenalectomy. The mean intraoperative blood loss was 90 mL (range 40-200). The procedure laparoscopic was converted to open in one case for the presence of a voluminous angiolipoma arising from the retroperitoneal fat strictly adherent to the adrenal gland. The postoperative morbidity rate was 5.1 per cent. Pain medication was required for a mean period of 1.6 +/- 0.6 days (range 1-3). The patients were able to resume solid food after an average time of 1.8 +/- 0.7 days (range 1-4). Postoperative hospital stay was 3 +/- 1.4 days (range 2-8). We believe that laparoscopic adrenalectomy is safe and effective in removing benign functioning or nonfunctioning adrenal masses and also in a general surgery department.

Intermittent small bowel obstruction by jejunal enteroliths in a patient with a Crohn's disease stricture.

Small bowel obstruction is most frequently due to postoperative or inflammatory adhesions, intestinal neoplasms, hernias, or bezoars. Intermittent small bowel obstruction may be secondary to a Crohn's disease stricture or to chronic adhesive peritonitis. Enterolithiasis, usually associated with jejunal diverticulosis or with a Meckel diverticulum, should be considered in patients who have not previously undergone abdominal surgical procedures. X-ray evidence of stones in the abdominal field, outside the common sites, i.e. gallbladder, kidney, bladder, should suggest a diagnosis of enterolithiasis. The authors report a case of multiple enteroliths in a patient with a segmental ileal stricture and ulcerations (diagnosed as Crohn's disease) causing frequent, intermittent occlusive symptoms, treated by segmental ileal resection.