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Background: Abdominalperineal resection (APR) represents the gold standard for lower third of rectum and anal cancer; after this wide excision, it results a large non-collapsible dead space that tends to collect fluid, increasing the risk of infection and wound dehiscence. Moreover, APR is associated to neoadjuvant/adjuvant radiation therapy with further risk of local complications. In this background, flap reconstruction after APR o eAPR represents the best strategy for minimizing tension in skin closure, providing healthy well vascularized and restoring a good functional local anatomy. Methods: A retrospective study was performed at the Department of Plastic Reconstructive and Aesthetic Surgery at the University Hospital Città della Salute e della Scienza of Turin from March 2013 to November 2016: 11 patients were included in the study: 5 men and 6 women aged 53 to 76 years (mean ± SD age: 66 ± 7 years). All of them received eAPR (extended-APR). Seven patients required a total dose of 20Gy as neoadjuvant radiotherapy treatment and 6 patients needed adjunctive chemotherapy treatment. Skin defects size ranged from 56 to 180 cm2 (mean 114 ± 38 cm2). Skin defect less than 5 cm of maximum width was not included in the study because no major reconstructions were needed. Surgical reconstruction was planned depending on sacrectomy eventually associated to eAPR and defect size too. Planned follow-up was carried out at 1, 3, and 6 months recording clinical data, local and systemic complications, and pain evaluation at sitting position and during normal walking activity. Results: Wound healing was achieved in all patients within a period of 21 days. Only one patient showed partial flap necrosis and required wound surgical revision with simple skin closure. Another one patient suffered from mild venous congestion and partial flap necrosis was observed: a period of 2 weeks of negative pressure wound therapy and dressing led to complete healing of the defect (both these patients received 20Gy neoadjuvant radiotherapy). Esthetic pleasant results, high patient satisfaction, and no significant motor impairment were recorded among all patients, excepting for just one patient who reports mild walking impairment and pain at sitting position, after the 6th month follow-up. None of the patient referred significant life quality impairment and all of them expressed general high satisfaction concerning reconstructive expectations. Conclusions: Many flaps can be harvested to fill and close the large defect after eAPR, with respectively advantages and disadvantages, but we found the use composite gluteal flap technique suitable for most of the patients undergoing eAPR, with good functional results and low rates of morbidity and complications. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Abstract There are several suggestions that centralization of care improves outcome for rare cancers, particularly when optimal treatment requires complex surgery or high-technology radiotherapy equipment. Diagnosis and treatment in reference centers are expected to be more accurate because they benefit from large numbers of cases discussed in a multidisciplinary tumor board with a well-run pathway. However, centralization is sometimes moderately perceived by oncologists as a solution to be endorsed for rare cancer patients; disadvantages of centralization are the need for patients to move and the risk of a longer waiting list, with discomfort and possible negative effects on outcome. It is difficult to find single experts on rare cancers: all the more it will be difficult to find a multidisciplinary panel of experts, and the role of the surgeon is to be a functional part of it. On the other side, from a surgical point of view, the quality of the initial management of many rare cancers directly impacts the final outcome; surgery of rare cancers may not necessarily be more demanding than the average from a technical point of view, but the lack of cultural knowledge about the disease can well lead to inappropriateness even in the lack of major technical challenges. Care for rare cancer patients must be organized in pathways that cover the patient's journey from their point of view rather than that of the healthcare system, and pathways must follow the best evidence on diagnosis, treatment and follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate the “state of art” of clinical role of sentinel lymph node (SLN) biopsy procedure in patients affected by differentiated thyroid carcinoma. Methods: All papers cited on PubMed/MEDLINE until June 2005, published in English, and referred to the key words “sentinel lymph node biopsy” AND “thyroid carcinoma” OR “thyroid cancer” were reviewed for the purpose of the present study. Results: The first method used for SLN biopsy in thyroid carcinoma patients was the vital blue dye technique. This technique had some disadvantages as: (a) risk of disruption of the lymphatic channels deriving from the thyroid cancer; (b) difficulty in disclosing SLN lying outside the central compartment; (c) parathyroid glands can take up blue dye and, thus, can be misinterpreted as lymph nodes. Some of the above cited disadvantages were overcome by using the lymphoscintigraphy and intraoperative gamma probe technique. A combination of the blue dye and gamma probe technique has also been proposed with synergic results. Conclusion: The reported advantages of the SLN biopsy in small differentiated thyroid carcinoma patients can be resumed as follows: (a) better selection of patients who would benefit from compartment oriented nodal dissection; (b) more accurate lymph node staging; (c) better selection of patients who can require 131I treatment after surgery (SLN positive for metastasis); (d) better identification of SLN located out of the central compartment. [Copyright &y& Elsevier]