Surveillance strategies following curative resection and nonoperative approach of rectal cancer:How and how long?Review of current recommendations

Different follow-up strategies are available for patients with rectal cancer following curative treatment.A combination of biochemical testing and imaging investigation,associated with physical examination are commonly used.However,there is currently no consensus about the types of tests to perform,the timing of the testing,and even the need for follow-up at all has been questioned.The aim of this study was to review the evidence of the impact of different followup tests and programs in patients with non-metastatic disease after definitive treatment of the primary.A literature review was performed of studies published on MEDLINE,EMBASE,the Cochrane Library and Web of Science up to November 2022.Current published guidelines from the most authoritative specialty societies were also reviewed.According to the follow-up strategies available,the office visit is not efficient but represents the only way to maintain direct contact with the patient and is recommended by all authoritative specialty societies.In colorectal cancer surveillance,carcinoembryonic antigen represents the only established tumor marker.Abdominal and chest computed tomography scan is recommended considering that the liver and lungs are the most common sites of recurrence.Since local relapse in rectal cancer is higher than in colon cancer,endoscopic surveillance is mandatory.Different follow-up regimens have been published but randomized comparisons and meta-analyses do not allow to determine whether intensive or less intensive follow-up had any significant influence on survival and recurrence detection rate.The available data do not allow the drawing of final conclusions on the ideal surveillance methods and the frequency with which they should be applied.It is very useful and urgent for clinicians to identify a cost-effective strategy that allows early identification of recurrence with a special focus for highrisk patients and patients undergoing a“watch and wait”approach.

Advanced gastric cancer:what we know and what we stillhave to learn

Gastric cancer is a common neoplastic disease and, more precisely, is the third leading cause of cancer death in the world, with differences amongst geographic areas. The definition of advanced gastric cancer is still debated. Different stadiating systems lead to slightly different stadiation of the disease, thus leading to variations between the single countries in the treatment and outcomes. In the present review all the possibilities of treatment for advanced gastric cancer have been analyzed. Surgery, the cornerstone of treatment for advanced gastric cancer, is analyzed first, followed by an investigation of the different forms and drugs of chemotherapy and radiotherapy. New frontiers in treatment suggest the growing consideration for intraperitoneal administration of chemotherapeutics and combination of traditional drugs with new ones. Moreover, the necessity to prevent the relapse of the disease leads to the consideration of administering intraperitoneal chemotherapy earlier in the therapeutical algorithm.

Acute appendicitis: Epidemiology, treatment and outcomesanalysis of 16544 consecutive cases

AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.

Laparoscopic management of intra-abdominal infections:Systematic review of the literature

AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.

Value of neoadjuvant chemotherapy in advanced ovarian cancer

Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy(HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.