Giovanni B. Secco

Is intensive follow-up really able to improve prognosis of patients with local recurrence after curative surgery for rectal cancer?

Background: Because more than 90% of local recurrences after curative surgery for rectal cancer appear within the first 36 months after surgery, an intensive and strict follow-up program during this period could improve early diagnosis and, thus, prognosis of patients.Methods: Of the 216 patients who underwent surgery for rectal cancer, 127 entered an intensive follow-up program (median follow-up: 42 months); the clinical outcome of the remaining 89 patients was reconstructed with the help of their general practitioners.Results: Fifty eight (26.8%) of the 216 patients who were treated with curative surgery alone developed a local recurrence; pelvic recurrences were prevalent. Eleven (30.5%) of the 36 patients who had recurrence during follow-up, and 6 of the 22 who had not undergone follow-up, had a reoperation with curative intent; the median survival was 19 months vs. 8 months, respectively (P 5 ns). Four (44.4%) curative reoperations were performed on the 9 asymptomatic patients and in 13 (26.5%) of the 49 cases with symptomatic local recurrences. Median survival was 15 months vs. 14 months, respectively (P 5 n.s). All patients except one (living after 42 months from reoperation) died within 48 months.Conclusions: In our study, adherence to a strict follow-up program unfortunately proved to be ineffective for improving long-term survival for patients who underwent reoperation with curative intent.

Preoperative chemotherapy and radiotherapy in the management of epidermoid carcinoma of the anal canal.

Sixteen patients affected by epidermoid carcinoma of the anal canal were treated preoperatively by means of an i.v. infusion of mitomycin C (15 mg/m2) on day 1 and 5-fluorouracil (750 mg/m2) days 1 to 5, followed by radiotherapy (3000 R in 3 weeks). Four to 6 weeks after the end of radiotherapy the response to the preoperative treatment was evaluated by means of biopsy. A reduction of the neoplastic mass was observed in 13 of the 16 patients. An evident correlation exists between the stage of the tumor and 1) the response to preoperative treatment, 2) local recurrence, and 3) long-term survival. In fact: 3/4 T1 patients reached a complete response (CR), and 1/4 T1, 5/5 T2 and 4/7 T3 patients achieved a partial response (PR); only 3/7 T3 patients never responded to preoperative treatment. After the initial surgery, only T2 (3/5) and T3 (4/7) patients underwent a second operation for a recurrence. Overall survival at 42 months was 62.5 % (T1, 100 %; T2, 80 %; T3, 28.5 2%).

Variables Influencing the Choice and Outcome of Noncurative Surgery for Advanced Gastric Cancer

Of 550 patients with gastric cancer presenting in an 18-year period, 274 (49.8 %) underwent noncurative surgery. Surgery was noncurative due to invasion of adjacent organs (T4) in 19.7% of patients, extensive lymph node involvement (N3) in 4%, unresectable distant metastases in 27.7% or a combination of all three conditions in 48.5% of cases. Resection was carried out in 41.4% of patients with primary situated in the antrum and in only 12.2.% with multicentric primary ( p 70 years old) and tumor stage. Six of the total 274 patients were alive 5 years from noncurative surgery. Subtotal gastric resection is the surgical procedure to be preferred. In the absence of distant metastases, resection should be considered in patients with primary situated in the body or antrum, with T4N0–2 or T3N3 lesions. Resection is also warranted when distant metastases can be excised.

Grading as a prognostic factor: review of 209 primary gastric cancer patients.

Two hundred and nine cases of primary gastric cancer were treated surgically from January 1968 to December 1983 and analyzed retrospectively. All patients were followed up for a minimum of 5 years. There were 25 SI cases (12 %), 22 SII (10.5%), 55 SIII (26.3%) and 107 SIV (51.2%). Tumor grade according to Broders classification showed 50 cases of G1 lesions (23.9%), 44 G2 (21.1 %) and 115 G3 (55%). Patients with well differentiated G1 lesion, compared to G2-G3 patients, presented a greater incidence of T1-T2 tumors and decreased incidence of T4 tumors (p < 0.05). The lymph node involvement rate significantly increased with variation of T (p < 0.001) but not with tumor grade. Survival results correlated with tumor stage (p < 0.01) but not with tumor grade or histological type.

Polytetrafluoroethylene Bifurcation Prosthesis for the Treatment of Aortoiliac Atherosclerotic Occlusive Disease: A 5-Year Clinical Trial

During the period of 1984-1986, the authors have implanted 13 poly tetrafluoroethylene (PTFE) bifurca tion grafts for the treatment of aor toiliac occlusive disease. The patients were 12 men and 1 woman, their mean age being 60.5 ± 6.3 years. The indi cations for aortoiliac reconstruction were limiting claudication in 6 pa tients and rest pain in 7 patients. Follow-up lasted forty-six ± seven months and included physical exami nation, measurement of the ankle- brachial pressure index, and ultra sonography. Arteriography was per formed exclusively in symptomatic patients. No operative deaths or major complications were recorded. Graft limb occlusion occurred in 2 patients, eight and twenty-two months after surgery, respectively. The five-year patency rate was 85 % . During follow-up, there was no evi dence of graft infection, kinking, stenosis, or dilatation. Neither peri- graft seroma nor anastomotic aneu rysm developed.