Corrado Rispoli

Undertreatment of breast cancer in the elderly

AimsThe effect of undertreatment with adjuvant hormonal therapy, chemotherapy or radiation was studied in elderly women with breast cancer.MethodsA prospectively maintained database was used to identify women undergoing potentially curative surgery between 1997 and 2011. The presentation, pathologic findings, treatment and outcomes of 449 women over 65 were compared to the findings in 1049 younger patients. Moreover, conventionally treated and undertreated elderly patients were identified and their characteristics and outcomes were compared.ResultsBoth young and old patients presented most frequently with mammographic findings, but older patients presented more frequently with mammographic masses while younger patients presented more frequently with mammographic calcifications. Cancers of older patients were signicantly more favorable than cancers in younger patients with more infiltrating lobular, fewer ductal carcinoma in situ and more frequently estrogen receptor positive and fewer were poorly differentiated. Elderly patients had less axillary surgery, less adjuvant radiation therapy and more hormonal therapy. Fourty-six percent of the 449 elderly patients were undertreated by conventional criteria. Undertreated patients were more frequently in situ, better differentiated, smaller, and more often estrogen receptor positive. Forty-four percent of the undertreated patients died during follow-up without disease recurrence.ConclusionsDespite undertreatment, local and distant disease-free survival was comparable to patients who were not undertreated.

Breast reconstruction in older women: a growing request

Results During this time period, 153 (27%) of patients with breast cancer were 60 years or older. Approximately, one third (49 patients) required or elected mastectomy as primary treatment. Of the 49 women evaluated, 17 (28%) elected delayed implant-based breast reconstruction. No patients experienced major complications at the longest follow up. Conclusion Elderly women undergoing with mastectomy should be offered breast reconstruction as part of their treatment. Physicians and patients need to be educated regarding surgical options, the minimal associated morbidity and mortality, and excellent functional and cosmetic outcomes. With extended life expectancy, breast reconstruction enhances these aspects of quality of life. Future management guidelines should include breast reconstruction in the algorithm. from XXI Annual Meeting of The Italian Society of Geriatric Surgery Terni, Italy. 4–6 December 2008

Anorectal avulsion: Management of a rare rectal trauma

INTRODUCTION Traumatic injuries of the rectum are unusual even though their treatment is challenging and often lead to high morbidity and mortality rate. PRESENTATION OF CASE This paper reports a rare case of complete rectal avulsion with multiple fracture and hemoperitoneum treated with a multistep approach in our department. DISCUSSION The anorectal avulsion is a rare rectal trauma; only few reports are available. Treatment key points of rectal trauma are: direct repair, diverting stoma and sacral drainage. CONCLUSION We reported a case of anorectal avulsion with complete detachment of external sphincter muscle. A multidisciplinary approach was mandatory in this kind of lesions.

Axillary masses in a woman with a history of breast cancer: Dermatopathic lymphadenopathy

The presence of axillary enlarged lymph nodes in the follow-up of a woman with a history of breast cancer should always be thoroughly indagated. Dermatopathic lymphadenopathy presents a specific pathologic pattern found within the lymph nodes and is usually associated with cutaneous rashes. Patients with various skin conditions can develop regional lymphadenopathy, which can result in the asymptomatic enlargement of the lymph nodes, especially in the inguinal, axillary and cervical regions. Dermatopathic lymphadenopathy should be considered in the differential diagnosis also in patients with minimal cutaneous findings. Dermatopathic lymphadenopathy is a benign process and management of these patients consists in simple clinical, mammographic and ultrasonographic follow-up.

Role of Mitomycin C in Preventing Capsular Contracture in Implant-Based Reconstructive Breast Surgery: A Randomized Controlled Trial.

Background: Capsular contracture represents the most frequent complication after implant-based breast reconstruction. An experimental study on mice demonstrated that capsule formation around breast implants is considerably diminished after topical application of mitomycin C. The authors conducted a randomized controlled clinical trial investigating the efficacy of mitomycin C in reducing capsular contracture rates following implant-based breast reconstruction after mastectomy for breast cancer. Methods: The authors randomized all women older than 18 years scheduled for the second stage of an implant-based breast reconstruction after mastectomy for breast cancer at the National Cancer Institute in Milan from October of 2005 to February of 2010 to receive or not receive the topical application of mitomycin C during surgery. The authors assessed capsular contracture, major postoperative complications, and aesthetic outcome. Results: The authors randomized 322 patients to receive mitomycin C or not at the second stage of implant-based breast reconstruction. One hundred sixty-two patients were allocated to the mitomycin C group and 160 patients were allocated to the control group. The relative risk of capsular contracture in the mitomycin C group was 0.92 (95 percent CI, 0.60 to 1.41). Major complications leading to reintervention, oncologic outcomes, and aesthetic outcomes were comparable between the two groups. Conclusions: This is the first trial reporting data about the use of mitomycin C in breast reconstructive surgery in a clinical setting. Mitomycin C seems not to significantly affect capsular contracture rate and severity following implant-based reconstructive breast surgery at the tested doses. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Laparoscopic antireflux surgery in the elderly

Laparoscopic antireflux surgery (LARS) has shown excellent results for treatment of gastroesophageal reflux disease (GERD). With success rates between 93% and 97% and a low incidence of complications. Life expectancy in our country is increasing and more patients over 65 years of age are admitted for surgical intervention. The aim of this retrospective study was to compare reflux and five years surgical outcome of laparoscopic antireflux surgery (LARS) in patients younger than 65 years and elderly patients aged 65 years or older.

Assessment of bacterial infection in chronic wounds in the elderly: biopsy versus VERSAJET.

AIM The aim of this study was to evaluate the hydro-surgery VERSAJET system as a suitable alternative to the traditional invasive tissue sampling technique in detecting bacteria and their load in chronic wounds in the elderly. MATERIALS AND METHODS To investigate and evaluate bacterial incidence and load in chronic wounds, we simultaneously performed on 19 affected patients a deep tissue biopsy and tissue collections by the VERSAJET hydro-surgical system. After local cleaning and anesthesia, a deep biopsy was performed with a punch of 3-4 mm in diameter. Subsequently, three tissue samples were collected by the VERSAJET system: one from the first washing in order to investigate the superficial contamination; one from the second washing to investigate deep tissue infection investigation and one from the third washing as a control procedure. After treatment, all tissue samples were cultured in vitro for diagnostic and micro-biological assessment. RESULTS Nineteen patients with chronic wounds of the lower limbs were enrolled from February 2010 to May 2013. Concordance between deep tissue biopsy cultures and tissue cultures collected by the VERSAJET system was examined. The deep tissue biopsy cultures showed complete concordance with the VERSAJET as follows: 2 patients (11%) for the first washing sample; 10 patients (53%) for the second washing sample; 4 patients (21%) for the third washing sample. However, with reference to only aerobic isolated strains, the concordance of the VERSAJET second washing samples cultures with a biopsy of the deep tissue cultures was very high (84%) and fairly high (63%) in the anaerobic isolated strains. The second VERSAJET washing sample cultures seem to have the highest concordance with the biopsy of the deep tissue cultures. CONCLUSIONS Tissue biopsy remains the leading technique for detecting bacteria and their load in chronic wounds. However, this study shows that the hydro-surgery VERSAJET system is sufficiently effective in detecting bacteria and their load in chronic wounds and can be a potential alternative to a biopsy. In particular, the second washing sample culture showed the best correlation with the deep tissue biopsy culture. However, further studies are needed in order to modify techniques of tissue collection in the VERSAJET system before drawing any conclusions.

Complete rectal prolapse in the elderly: systematic review of surgical treatment.

Background Complete rectal prolapse is a disease characterized by the complete protrusion of rectal wall through the anus. This disability affects mostly elderly women (>65 years). Several surgical techniques have been described for the treatment of this condition with both perineal and abdominal approach. Under trial condition none of them have been demonstrated to be the best choice in terms of recurrence, postoperative faecal incontinence or stipsis and cost-effectiveness. The aim of our study was to compare different surgical techniques for complete rectal prolapse in the elderly.

Retraction Note: Undertreatment of breast cancer in the elderly

This article [1] has been retracted by the authors due to significant overlap with a previous publication by Malik et al., 2013 [2]. Gennaro Pagano was not involved in the study and was introduced into the author list in error by the corresponding author. All authors, including Gennaro Pagano, have subsequently agreed that he did not qualify for authorship. The remaining authors apologize for any inconvenience caused.

Retraction Note: breast cancer surgery in elderly patients: postoperative complications and survival

Retraction: Breast cancer surgery in elderly patients: postoperative complications and survival