[Colorectal reconversion after Hartmann procedure. Apropos of 26 cases]. / Riconversione colo-rettale dopo intervento di Hartmann. A proposito di 26 casi.

The authors report the RCR results executed on 26 patients submitted to Hartmann operation for colo-rectal emergency at the Surgical Department of S. Giovanni Hospital during the period 1986-1995. The reconversion index (46.4%), the morbidity (42.3%) and the operation mortality (3.8%) agree with those reported in the writings. Therefore, the tactical, technical and prognostic aspect related to RCR are examined, a heavy operation fully justified by the patient quality of life expectations.

[The Hartmann procedure in colorectal emergencies. Report of 76 cases]. / L'intervento di Hartmann nelle urgenze colo-rettali. Riflessioni su 76 casi.

The Hartmann procedure has, in emergency colo-rectal surgery, many implications. The decision is based on clinical, radiological, instrumental and pathological findings. The authors report the results of 76 Hartmann's procedures performed between 1986 and 1995 and compare their results with those found in the current medical literature on the topic. In particular, they draw attention to an increased use of this procedures in colo-rectal emergencies; the morbility and mortality rates confirm the severity of the clinical cases that can be treated with this operation. To improve results the authors propose a therapeutic plan that uses a score for stratification of the risk (MPI, APA-CHE II, SSI, Hinchey); so the surgeon can choose the best surgical operation. Finally, the authors underline the importance of the principles of oncology surgery in colo-rectal cancer.

[Age as a prognostic factor following excisional surgery for colorectal cancer]. / L'età come fattore prognostico dopo chirurgia di exeresi per cancro del colon retto.

On a series of 369 patients with colorectal cancer who underwent curative resections at the I Instituto di Clinica Chirurgica della Università "La Sapienza" of Rome between 1960 and 1980, age was related to survival. All patients were followed for a minimum of ten years; 79 of them were aged over 65 years and 290 under at the time of the operation. The survival was correlated to the age and to other prognostic parameters: post surgical stage (TNM UICC classification) degree of differentiation of the tumour (NG--Black classification), degree of lymphocytic infiltration of neoplasm (LI Black classification) as expression of immunological immune-response of the host. Patients less than 65 years old had a better survival than patients greater than = 65 years old (median survival 72 months and 44 months respectively) (p = 0.006). These differences where true in subgroups with stage 2 of disease (p TNM UICC) and a favourable immunological reactivity (LI greater than = 2). These results suggest a possible independent role of age in defining the outcome of patients with colorectal cancer.

[Tracheobronchial carcinoids: current therapeutic trends]. / Carcinoidi tracheo-bronchiali: attuali orientamenti terapeutici.

Tracheobronchial carcinoids are relatively uncommon neoplasms potentially curable with surgery. However, the extent of excision which results in the best long term local and distant tumour control is still controversial. A series of 522 patients who underwent surgical treatment for tracheobronchial carcinoids reported by the literature which included 52 cases of tracheobronchial neuroendocrine tumours observed between 1960 and december 1983 at the Institute of I Clinica Chirurgica of Università "La Sapienza" Rome was reviewed. Local recurrence rate range between 1% and 1.8% after major surgery and between 11.8% and 16.7%, after bronchial wall resection and endoscopic treatment respectively. Local recurrences were detected after a mean period of 110.2 month (median = 9 years). 15 years survival rate was above 70%. Long term prognosis was related to the degree of malignancy (typical or atypical forms) and locoregional (N) and distant metastases (M). Factors related to the possibility to obtain free margins by the surgical procedure (pneumonectomy/lobectomy or sleeve resections vs simple bronchial wall resection or endoscopic resection), the degree of bronchial wall involvement (endobronchial, iceberg, peripheral), the biology of primary tumour (atypical vs typical) and the presence of regional and/or distant metastases are of prognostic importance for both local and distant tumour control. The Authors describe their strategy for managing this disease: endoscopic treatment or simple bronchial wall resection are available for endobronchial typical carcinoid tumours. Atypical carcinoid neoplasms or tumours involving bronchial wall or peripheral lung parenchyma need more extended resection and lymphadenectomy.

[Radical surgery and loco-regional chemotherapy in the treatment of liver metastases of stomach and colorectal cancer]. / Chirurgia di exeresi e chemioterapia loco-regionale nel trattamento delle metastasi epatiche da cancro dello stomaco e del colon retto.

The results of surgical treatment of hepatic metastasis from stomach and colo-rectal cancer in a series of 28 patients have been assessed. 21 cases were subjected to hepatic resection (stomach cancer: 7 cases; colorectal: 14 cases) and 7 underwent locoregional chemotherapy through the gastroduodenal artery with fully implantable catheters (stomach ca.: 1 case; colorectal ca.: 6 cases). Of patients who underwent hepatic resection, 3 died postoperatively and 4 are still alive 5 years after the operation. Of the 7 patients treated with locoregional chemotherapy, 4 can be evaluated: 2 responded to treatment, 1 stabilised and 1 progressed. Clinically noteworthy toxicity was observed in one patient only.