Minerva chirurgica
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Neoadjuvant chemoradiotherapy followed by total mesorectal excision is currently the standard of care for locally advanced rectal cancers. However, this therapeutic approach does not take into account response to neoadjuvant treatment, which can go up to a pathologic complete response in 10-20% of the patients. Moreover, despite its efficacy in terms of local control and survival, radical surgery is associated with a significant risk of postoperative morbidity, anastomotic leakage, permanent stoma, impaired quality of life, bowel and genitourinary dysfunction. ⋯ But few high-quality studies are available and fears remain regarding oncologic results and reproducibility of published results. Before these strategies can be recommended, large prospective randomized studies are still needed. The aim of this review is to discuss these two options for organ preservation, based on the current literature, with a special focus on oncologic outcomes.
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Ductal carcinoma in situ (DCIS) is a non-invasive breast carcinoma that remains in the milk ducts. It is a poorly understood disease and its natural history is not well known. This is because once diagnosed, DCIS is usually treated. ⋯ Each group requires a different treatment, respectively: local excision of the tumor; local excision and radiotherapy; and mastectomy. The use of tamoxifen in the treatment of DCIS is still controversial, but research so far has encouraging results. Interesting developments have been made in the use of Her-2 pulsed dendritic cell vaccination before DCIS surgery.
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Comparative Study
Prevention of hernia incision in laparoscopic left colon resection.
Aim of this study was to assess the rate of incisional hernia in laparoscopic left colectomy comparing two different sites of mini-laparotomy: midline and oblique left iliac fossa. ⋯ This study summarizes our experience in the effort to reduce incisional hernia in laparoscopic left colectomy. There was a significant difference in rate of hernia comparing midline and oblique left iliac fossa incision. We postulate anatomy of abdominal wall, dynamics and the higher rate of infection of umbilicus to be the key.
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Comparative Study
Role of TachoSil® in distal pancreatectomy: a single center experience.
Distal pancreatectomies (DP) are associated with high risk of postoperative complications, and in many series higher morbidity rate than duodenopancreatectomies has been reported. To evaluate the role of a collagen sponge with human fibrinogen and thrombin film (TachoSil®) in limiting the incidence of complications after DP. ⋯ The use of TachoSil® seems to be associated with lower incidence of grade C POPF but larger controlled trials are needed to surely assess the usefulness of TachoSil® in pancreatic surgery in order to reduce pancreatic specific complications and their severity.
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Randomized Controlled Trial Comparative Study
Comparison of postoperative short-term complications after laparoscopic transabdominal preperitoneal (TAPP) versus Lichtenstein tension free inguinal hernia repair: a randomized trial study.
The aim of this randomized trial was to compare short-term postoperative complications of laparoscopic transabdominal preperitoneal (TAPP) and Lichtenstein tension free hernia repair. ⋯ The laparoscopic TAPP repair is safer and less complicated approach to inguinal hernia repair. The two main short-term advantages of the laparoscopic TAPP repair with the tension free Lichtenstein repair were less postoperative pain and earlier return to the normal life activities. No difference was seen in overall complications.