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Introduzione: Il riconoscimento intra-operatorio delle metastasi nel linfonodo sentinella, in pazienti affetti da cancro della mammella, è utile al fine di procedere ad una linfoadenectomia ascellare immediata nel corso del medesimo intervento. Ciò è fondamentale per evitare una terapia adiuvante tardiva ed un incremento della morbilità e dei costi sanitari. Scopo di tale lavoro è dimostrare che, la metodica citologica “touch-imprint” (TIC), utilizzata presso l’ Azienda Ospedaliero-Universitaria di Trieste, risponde a tale necessità e nel contempo valutarne l’affidabilità. Materiali e metodi: Nel periodo 2009-2012, presso la nostra struttura sono stati operati 690 carcinomi mammari, di cui 479 (69.4%) sono stati selezionati per la ricerca del linfonodo sentinella con radiocolloide. In 347 carcinomi di dimensioni inferiori o uguali a T2 è stata eseguita la metodica citologica TIC; il linfonodo sentinella è stato successivamente sottoposto all’ analisi istologica standard (sezioni seriate ogni 100 micron per ematossilina-eosina e immunoistochimica) che è stato assunta come “gold standard”. Risultati: Su 347 TIC 298 casi erano concordanti con la diagnosi istologica (38 veri positivi e 260 veri negativi). Dei 49 casi risultati falsi negativi, l’analisi definitiva ha dimostrato 28 casi di micrometastasi e 21 casi di macrometastasi, mentre dei 38 casi positivi al TIC, 35 risultavano macrometastasi, 2 micrometastasi e 1 caso di cellule tumorali isolate. La sensibilità e specificità del TIC per macrometastasi sono rispettivamente 64.4% e 100%. Solo 29 casi su 347, pari all’ 8.3%, sono stati sottoposti a radicalizzazione ascellare differita, mentre nel periodo 2005-2008, prima dell’introduzione del TIC,utilizzando l’analisi istologica standard del linfonodo sentinella, tale percentuale era del 18.2%. Discussione e conclusioni: Grazie alla metodica TIC il tasso di dissezioni ascellari in differita è diminuito notevolmente (dal 18.2% all’8.3%). Se gli studi, in corso di validazione definitiva, dimostreranno che la linfoadenectomia ascellare nel trattamento delle micrometastasi non è necessaria, si può ipotizzare che il numero di reinterventi sull’ascella possa ulteriormente ridursi. Nella nostra esperienza, grazie alla discreta sensibilità del TIC per le macrometastasi legata all’ ottima confidenza del patologo con i preparati citologici, è stato possibile migliorare in maniera rilevante l’approccio chirurgico sull’ascella ed il timing oncologico, senza impegno aggiuntivo di risorse economiche.

Pre-operative chemoradiotherapy (CRT) followed by surgical resection is still the standard treatment for locally advanced low rectal cancer. Nowadays new strategies are emerging to treat patients with a complete response to pre-operative treatment, rendering the optimal management still controversial and under debate. The primary aim of this study was to obtain a snapshot of tumor regression grade (TRG) distribution after standard CRT. Second, we aimed to identify a correlation between clinical tumor stage (cT) and TRG, and to define the accuracy of magnetic resonance imaging (MRI) in the restaging setting. Between January 2017 and June 2019, a cross sectional multicentric study was performed in 22 referral centers of colon-rectal surgery including all patients with cT3-4Nx/cTxN1-2 rectal cancer who underwent pre-operative CRT. Shapiro–Wilk test was used for continuous data. Categorical variables were compared with Chi-squared test or Fisher’s exact test, where appropriate. Accuracy of restaging MRI in the identification of pathologic complete response (pCR) was determined evaluating the correspondence with the histopathological examination of surgical specimens.In the present study, 689 patients were enrolled. Complete tumor regression rate was 16.9%. The “watch and wait” strategy was applied in 4.3% of TRG4 patients. A clinical correlation between more advanced tumors and moderate to absent tumor regression was found (p = 0.03). Post-neoadjuvant MRI had low sensibility (55%) and high specificity (83%) with accuracy of 82.8% in identifying TRG4 and pCR.Our data provided a contemporary description of the effects of pre-operative CRT on a large pool of locally advanced low rectal cancer patients treated in different colon-rectal surgical centers.

An intragastric balloon is a non-surgical device enhancing a sensation of early satiety and reducing food intake. The aim of this study is to analyze the results in terms of weight loss and patient satisfaction undergoing intragastric balloon implantation. Air-filled and water-filled devices were used. All patients were participated in strict follow-up programs. Weight, body mass index (BMI), total body weight loss (TWL), percentage of excess weight loss (EWL), and satisfaction degree were taken into account. Eighty-one patients completed a 6-month period with a device in place; 72 of them were then contacted for a follow-up at 12.3 ± 2.4 months post-removal. During treatment period, in 76 cases (93.8 %), a statistically significant reduction in weight was observed. A statistically meaningful linear correlation between a 3-month EWL (or TWL) and a 6-month EWL (or TWL) was found. At the end of endoscopic treatment, a significant link between baseline BMI and EWL >20 % was found. Sixty-three percent of the patients were not satisfied with the procedure, did not deem useful to change their diet, and refused to perform it again. In our study, at device removal and 1 year thereafter, a statistically significant reduction in weight was observed. Most of the patients were found to have a weight loss more than the cut-off of 20 %. The weight reached at the third month appears to be predictive of the effectiveness of endoscopic treatment. Data showed an overall dissatisfaction with procedure.