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The aim of our study was to assess if there were any differences in clinical presentation, management, and outcome, between younger and elderly patients with acute diverticulitis (AD).279 patients with diagnosis of AD treated at the General Surgery Department of Trieste from January 2007 to December 2015 were retrospectively examined and then followed for a minimum of 4 years. We divided patients in two categories: young ≤ 50 years and elderly50. Gender, American Society of Anesthesiologists status (ASA score), Hinchey's stage, type and timing of surgery, morbidity, length of hospital stay, recurrence, and overall mortality were retrospectively analyzed.There were 279 patients, 64 (22,9 %) were young and 215 (77,1%) were elderly. Female gender was more frequent in elderly cohort (150 pts 69,7 % F vs 65 pts 30,3 % M) than in the young (16 pts, 25% F vs 48 pts, 75% M), (p0,001). Higher ASA scores were registered in elderly patients with statistically significant correlation with Hinchey's stage. 229 patients ( 82,07 %) received as initial treatment antibiotic therapy (conservative treatment), 50 (17,93 %) pts underwent EM-S, and 11 underwent to DEL-S.In our experience, none significant differences were recorded about Hinchey's stage, timing of surgery, morbidity, length of hospital stay, and recurrence; whereas, regarding the type of surgery (resection-anastomosis (R-A), Hartmann's procedures, and Lavage/Drainage) there were a significant difference (p=0,04).Hartmann's procedures have been effectuated more frequently in the elderly than in the young with recanalization in less than half of elderly. These data seems to confirm that there is no significant difference in incidence or the natural course of acute and complicated colonic diverticulitis among the young or the elderly. The best surgical treatment, with the least morbidity, may be resection with primary anastomosis.Diverticular Disease, Elderly Patients, Sigmoidectomy, Young Patients.Lo scopo del nostro studio è stato quello di valutare se ci fossero delle differenze nella presentazione clinica e nell’outcome, tra i pazienti più giovani e quelli più anziani affetti da diverticolite acuta (DA). 279 pazienti con diagnosi di DA trattati presso il Dipartimento di Chirurgia Generale di Trieste da gennaio 2007 a dicembre 2015 sono stati esaminati retrospettivamente e seguiti per un minimo di 4 anni. Abbiamo suddiviso i pazienti in due categorie: giovani ≤ 50 anni e anziani50. Sono state analizzate retrospettivamente le seguenti variabili: sesso, American Society of Anesthesiologists (punteggio ASA) score, stadio di Hinchey, tipo e tempistica di intervento, morbilità, durata della degenza ospedaliera, tasso di recidiva e mortalità. Sono stati presi in considerazione 279 pazienti, 64 (22,9%) erano giovani e 215 (77,1%) erano anziani. Il sesso femminile era predominante nella coorte dei pazienti anziani (150 pz 69,7% F vs 65 pz 30,3% M) rispetto ai giovani (16 pz, 25% F vs 48 pz, 75% M), (p0,001). I punteggi ASA più alti sono stati registrati nei pazienti anziani con correlazione statisticamente significativa con lo stadio di Hinchey. 229 pazienti (82,07%) sono stati sottoposti a terapia antibiotica come trattamento iniziale (trattamento conservativo), 50 pazienti (17,93%) sono stati sottoposti a un intervento chirurgico in emergenza e 11 sono stati sottoposti ad un intervento chirurgico differito. Nella nostra esperienza, non è stata registrata nessuna differenza statisticamente significativa riguardo a stadio di Hinchey, il tempo operatorio, la morbilità, la durata della degenza ospedaliera ed il tasso di recidiva; mentre, per quanto riguarda il tipo di intervento chirurgico effettuato (resezione-anastomosi (R-A), procedure di Hartmann e Lavaggio / Drenaggio addominale) ci sono state differenze statisticamente significative (p = 0,04). In conclusione, le procedure di Hartmann sono state eseguite più frequentemente negli anziani rispetto ai giovani con ricanalizzazione in meno della metà degli anziani. Questi dati sembrano confermare che non vi sia alcuna differenza significativa nell’incidenza o nel decorso naturale della diverticolite del colon acuta e complicata tra i giovani e gli anziani. Il miglior trattamento chirurgico, seguito dal minor tasso di morbilità, potrebbe essere la resezione con anastomosi primaria.

PURPOSE: The study aimed to evaluate the QoL in patients who underwent elective surgery for uncomplicated diverticulitis using a recently developed diverticulitis quality of life questionnaire (DV-QoL). METHODS: All consecutive patients who underwent surgery for uncomplicated diverticulitis or who were hospitalized and treated conservatively for acute uncomplicated diverticulitis episodes in three referral centers, in a 5-year period, were included in the study. The 36-Item Short Form Survey and the DV-QoL were administered to the patients to assess their QoL before and after treatment of diverticular disease. RESULTS: Ninety-seven patients who underwent surgery, 44 patients who were treated conservatively, and 44 healthy volunteers were included in the study. DV-QoL scores correlated with SF-36 scores (p

The purpose of our study was to estimate in elderly patients with a colorectal and sigmoid cancer the frequency of the histopathological exam and to analyze the prognostic/therapeutic value of central LN examination. In our experience the histological evaluation of the central LN has a precise prognostic value. Patients in which the histological evaluation of the central LN was performed had a better prognosis than patients in which the histological evaluation wasn’t possible (tha actuarial survival rate at 5 years was 73,2% in patients in which the central LN status was determinated and 62,7% in thiose in which it wasn’t (p=0.0066). The authors conclude that the histological evaluation of the central LN represents the quality standard of the lymphadenectomy and ensures a precise staging of the tumor which decreases the shifting between tumor stages. From an oncological point of view the therapeutic improvement achieved can be ascribed to metastatic LN dissection.

The development of new blood and lymphatic vessels is a crucial event for cancer growth, metastatic spread and relapse after therapy. In this work, the expression levels of chemokines, angiogenic and angiostatic factors and their receptors were determined in paired mucosal and tumour samples of patients with colorectal carcinoma and correlated with clinical and histological parameters by advanced multivariate analyses. The most important predictors to discriminate between tumour and paired normal mucosa turned out to be the levels of expression of plexin-A1 and stromal cell-derived factor 1 (SDF-1), the former overexpressed and the latter downregulated in tumours. The levels of osteopontin and Tie-2 transcripts discriminated between the presence and absence of lymph node infiltration, the former overexpressed in the presence of infiltration whilst the latter providing a protective role. These results add support to the notion that the expression levels of selected genes involved in new blood and lymphatic vessel formation represent trustable biomarkers of tumour development and invasion and contribute to the identification of novel molecular classifiers for colorectal carcinoma.

Background and Objectives The aim of this retrospective study is to evaluate the results of local excision (LE) for rectal cancer for curative purposes. Methods From 1969 to December 1997, a total of 456 operations were performed for surgical treatment of rectal carcinoma (262 males and 194 females, mean age 66 years). Twenty patients (4.1%) underwent LE (7 males and 13 females, median age 65 years). Patients were selected for LE if they met the following criteria during preoperative staging: tumors staged as T1-T2,N0,M0, grading G1 or G2, and accessible location. Types of LE performed were: 13 transanal excisions (Francillon's technique), 2 Mason surgeries, 2 endoscopic excisions, and 3 transanal endoscopic microsurgeries. Results There was no in-hospital mortality among LE patients. Thirteen tumors were T1 and 7 were T2; all 20 were adenocarcinoma, 14 G1 and 6 G2. There was no specific morbidity, and aspecific morbidity was minimal (5%). There were no local recurrences, but 2 patients (10%) had secondary lesions. Five-year overall survival following LE was 87.4%. Comparing T1 and T2 tumors treated with abdominoperineal resection (APR) and SSR (17 T1 and 42 T2, all adenocarcinoma), in-hospital mortality and specific morbidity were respectively 1.7% (P = 0.55) and 28% (P = 0.007). There were 5 (8.5%) local recurrences (P = 0.17) and 6 (10.2%) metastatic lesions. Five-year overall survival was similar to LE (88.3%; P = 0.76). Conclusions LE for rectal carcinoma might only be successfully performed in selected patients with correct preoperative staging. In the LE cases reported five-year overall survival, local recurrence, and in-hospital mortality were similar to APR and SSR, while there was a statistically significant difference following LE in terms of specific morbidity. J. Surg. Oncol. 2000;74:158–162. © 2000 Wiley-Liss, Inc.