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C Coco

Publications and source records attributed to C Coco.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

[Adjuvant radiotherapy in rectal cancer and total mesorectal excision].

Local recurrence (LR) after surgical resection for adenocarcinoma of the rectum still remains an unsolved problem. Local relapse often occurs when tumor spreads in perirectal fat (mesorectum) or along the lateral iliac lymph nodes also when surgery is considered radically. There is a close relationship between local recurrence rate and lymphatic involvement, local tumor extension and tumour grading. Total mesorectal excision (TME) appears to be associated with a reduced LR rate when resection of perirectal fat is done "en-bloc" and when a negative radial margins is obtained. TME allows autonomic nerve sparing and sphincter preservation too, but lateral nodes are not treated by TME. Extended lymphadenectomy with lateral dissection for advanced rectal cancer has been often associated with an increase rate of long term morbidity, particularly regarding urinary and sexual function. Concomitant preoperative chemo-radiation for advanced rectal cancer is a relatively safe procedure with an acceptable morbidity and mortality. This approach is associated with a considerable clinical and pathologic tumor downstaging. Tumor resectability is improved and lateral spreading is also better controlled. An improving in survival and a longer disease free period has been reported. More radical sphincter saving operations are also allowed.

Digestive System Surgical Procedures↗
PubMedDate not supplied

[Surgery and radiotherapy in rectal cancer: indications for anal sphincter conservation].

PURPOSE: Aim of this study is to evaluate the possible increase of sphincter preservation rate in locally advanced extraperitoneal rectal cancer after neoadjuvant treatment. METHODS: 123 patients with a T3 or N+ cancer of middle or lower rectum have been included in this study. Accurate measurement of pre-treatment tumor distance from the anal canal and an individual judgment of the surgeon about the technical feasibility of a sphincter saving resection have been recorded. Two different protocols of concomitant preoperative chemoradiation have been adopted. Radiotherapy ranged from 37.8 to 50.4 Gy. Chemotherapy regimens included mitomycin-C 10 mg/m2; 5FU 1000 mg/m2 and c-DDP 60 mg/m2. All patients underwent surgery 4-8 weeks after the end of chemoradiation. RESULTS: 16 out of a total 121 resected patients (13%) had a complete histologically response at surgical specimen examination (pT0). The post-treatment variation of tumor distance from the anal canal was 1 cm. in 50% of cases, 2 cm. in 20% of cases and > 3 cm. in 10% of cases. 80% of patients (97/121) could benefit of a sphincter saving procedure compared to a pre-treatment expected rate of 55%. 69% of 70 patients with a tumor of the distal rectum maintained their sphincter function; in particular, a sphincter saving procedure was made possible in 16 of 37 patients (43%) with a tumor located in the distal 3 cm. of the rectum. No significant difference in sphincter saving rate was observed between the two different protocols of neoadjuvant treatment. DISCUSSION: Decrease of tumor size, post-treatment variation of tumor distance from the anal canal, histological downstaging and decrease of tumor fixity to adjacent structures are the main effects of neoadjuvant treatment which are responsible for an increase of sphincter saving rate. CONCLUSION: According to the presented data, neoadjuvant protocols of concomitant chemoradiation therapy are effective in increasing the rate of sphincter saving procedures in locally advanced cancer of distal rectum.

Adult↗
PubMedDate not supplied

[Surgical treatment of carcinoma of the left colon and rectum as an emergency. A new method for assessing operative risk].

BACKGROUND/AIMS: The surgical treatment of the left colon and rectal cancer emergencies is still controversial. In our opinion the choices to be based on the general health status of the patient. METHODOLOGY: The authors analysed a series of 63 patients submitted to immediate resection and anastomosis. RESULTS: Factors significantly related to short term results were chronic heart disease, low albumin serum levels, and colonic perforation. The presence of a diverting colostomy did not provide a protective factor against anastomotic dehiscence. We constructed a Colorectal Tumours Emergencies Score made of the identified four factors in which the score of each factor is the approximated odds ratio (chronic renal failure 7 points, low albumin serum levels 6 points, heart disease 5 points, colon perforation 4 points). Each patient was classified as Low Risk (CTES < 4), Moderate Risk (CTES 4-12), High Risk (CTES > 12), mortality and morbidity being 4% and 20%, 19.3% and 61.3%, 88.9% and 88.9% respectively. CONCLUSIONS: High risk patients may undergo a staged procedure. Moderate risk patients may be treated by immediate resection of the tumor, without anastomosis. Immediate resection and anastomosis may be reserved to low risk patients.

Adult↗
PubMedDate not supplied

[Prognostic factors of pancreatic carcinoma: analysis of the 5-year-survivor cases].

Pancreatic carcinoma remains a letal disease with an overall 5-year survival of less than 5%. Recent reports of increases in actuarial survival after resection have determined some optimism. Our objective was to identify the actual 5-year survival rate of patients with pancreatic carcinoma who underwent a resection with curative intent, analyzing those factors associated with a more favorable prognosis.

Adenocarcinoma↗
PubMedDate not supplied

[The prognostic role of anatomo-pathological factors in colorectal cancer: an univariate analysis].

An univariate analysis of pathologic data of 987 patients with primary colorectal carcinoma treated over a period of 22 years was performed. Six variables such as tumor site, histologic type, depth of invasion, nodal involvement, distant metastases, histologic grade and tumor stage were tested for their prognostic value. 5-year survival rate was investigated. Patients with tumors in the left colon and rectum have shown a better prognosis than patients with tumors in the right colon (53-51% vs. 38% p = 0.0007). As regard histologic type non significant differences between mucinous and non-mucinous carcinoma was observed (44% vs 48% respectively p = 0.4). The depth of tumor invasion was an important prognostic factor; according to tumor infiltration patients can be divided in four groups (T1, T2, T3, T4) with 5-year survival rates of 80%, 74%, 39% and 16% respectively (p = 0.0000). Highly significant decrements in survival occurred when lymph node metastases were demonstrable (20% vs. 67% p = 0.0000). Prognosis was still strongly related to histologic grade, with significant difference in survival rates between G1 and G2-G3 tumors (71% vs. 48%-42% p = 0.0000). Finally prognosis was closely related to the stage of spread at the time of diagnosis.

Adenocarcinoma↗
PubMedDate not supplied

[Hartmann's procedure in emergency surgery of the colorectum].

The authors report their experience with Hartmann procedure. 28 patients were treated: 21 males and 7 females. The mean age was 58 years. Perforative diverticulitis was the commonest indication (14 patients), followed by carcinoma (11 patients). Miscellaneous causes accounted for 3 patients. This procedure was primarily performed as an emergency operation (71%). One patient died post-operatively (3.5%); post-operative morbidity was 10.7%. A second operation was not planned if the first operation had been performed for palliation of metastatic or locally advanced cancer (7 patients). Restoration of colonic continuity was achieved successfully in 14 patients with no mortality and morbidity. According to their experience, authors believe Hartmann procedure to be the most suitable operation facing a left colon emergency. It is usually easy to perform and well tolerated by poor risk patients.

Anastomosis, Surgical↗
PubMedDate not supplied

Combined modality therapy in low risk (T2N0) rectal cancer.

The authors' experience with local excision (LE) and adjuvant radiotherapy in the treatment of selected cases of rectal cancer, is reported. 41 patients with distal rectal cancer underwent elective LE for cure. Selection criteria were: the site of tumor in the lower rectum, exophytic growth, maximum diameter equal to or lower than 4 cm, tumor "freely" mobile on the rectal wall, clinical staging T1-2 N0M0, histological grading G1-2. Patients shown to be T2 on definitive histology underwent adjuvant radiotherapy to the site of tumor and to pelvic lymph nodes. LE was performed via transanal route under general anesthesia. Operative mortality was 0% and morbidity 7.3%. In 37 cases (90%) surgery was considered radical and curative. The incidence of local recurrence was 5.4%, overall evidence of disease 8.1%, cancer-specific mortality 5.4% and 5-year actuarial survival 90%. The combination with radiotherapy has achieved similar results in T1 (22 cases) and T2 (15 cases) tumors. It is concluded that LE combined with radiotherapy in T2 tumors in selected cases represent a valid therapeutic alternative to more demolitive surgery.

Adenocarcinoma↗
PubMedDate not supplied

Combined modality therapy of resectable high risk rectal cancer.

Aim of this phase I-II study was to evaluate the efficacy of preoperative concomitant radiochemotherapy in resectable high risk (TNM stage: II and III) rectal tumors, 64 patients entered the study: 37 had low rectal cancer, 27 mid-rectal cancer. 50 patients were clinically staged as stage III (Dukes C) and 14 as stage II (Dukes B). Treatment protocol included bolus mitomycin C at the dose of 10 mg/m2 on day 1 and 5FU continuous infusion at the daily dose of 1000 mg/m2 on day 1, 2, 3, 4. Concomitant external radiotherapy up to a dose of 3780 cGy was delivered at the daily dose of 180 cGy. Surgery was performed 4 to 5 weeks after radiation therapy (RT). Before surgery all patients were clinically restaged to evaluate the response to concomitant radiochemotherapy. Treatment compliance was 97%. Toxicity was 27% prevalently shown as bone marrow depletion and radiodermatitis. In 37 patients (61%) there was 50% reduction (partial response) of neoplastic volume. In 5 patients (8%) no neoplastic cells were evidenced in the surgical specimen on histology (complete response). The distance between the lower margin of the tumor and the internal anal orifice increased in 72% of cases. Postoperative morbidity was 28%. The incidence of anastomotic dehiscences was 8.7% over 46 anterior resections. Postoperative mortality was nil. Definitive staging evidenced 24 patients (39%) stage I or with no evidence of tumor. The incidence of local recurrence was 5% and that of distant metastasis 8%.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

Combined modality follow-up and postoperative recurrence in rectal cancer.

Rectal cancer patients are at high risk for disease progression even after radical surgery for cure. Prognosis depends on a timely diagnosis for effective, curative therapies. In resected patients, an accurate follow-up especially within the first two years of surgery, is required. Clinical and radiologic follow-up is based on periodical, timed physical and instrumental exams (rectal exploration, neoplastic markers, rectoscopy, colonic enema, CT MRI, TRUS) which supply information on locoregional (liver, lymph nodes, peritoneum, chest) recurrence. Rectal exploration, endoscopy, colonic enema and TRUS enable the control of anastomosis and the identification of possible metachronous tumors. CT and MRI as liver US and chest X-ray, detect recurrence in other sites (pelvic perianastomotic recurrence, peritoneal carcinomatosis, lymph node or liver locations). A diagnostic problem is represented by the difficult differentiation of local recurrence from postoperative fibrosis. In this case, surveillance in the course of time with exams more reliable in tissue differentiation (MRI, though with some limitations) and US- or CT-guided biopsy, is required.

Biopsy↗
PubMedDate not supplied

Surgery of rectal cancer (technical observations).

The evolution of the surgical management of rectal cancer is briefly reviewed. Factors which influence the choice of the surgical procedure relatively to the tumor characteristics, are examined. The role played by preoperative staging as the basis of a correct therapeutic approach is underlined. Most common surgical procedures in rectal cancer treatment are reported, and emphasis is put on aspects of particular interest for radiodiagnosticians and radiotherapists.

Humans↗
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Rectal exploration in rectal cancer. Double contrast enema vs rectoscopy: a comparison of present diagnostic accuracy.

The present role of rectal exploration in rectal cancer is defined. Indications and limitations of endoscopy and radiology in the study of colon relatively to the diagnosis and pre-treatment approach to rectal cancer, are reviewed. The need to establish definite parameters of tumor morphology indispensable to a correct surgical management, to a possible neoadjuvant therapy and to a precise assessment of the response to therapy, is emphasized. Compared results about the lengthwise tumor extent, the circumferential involvement of rectal walls and the distance from the internal anal sphincter, are reported. It is concluded that the two diagnostic examinations are complementary and that both represent excellent methods for the diagnosis and assessment of the extent of the disease.

Barium Sulfate↗