Search

Despite technical advances in recent decades and a decrease in hospital mortality (<5%), pancreaticoduodenectomy (PD) is still associated with major postoperative complications, even in high-volume centers. The present study aimed to assess the effect of a modified reconstruction technique on postoperative morbidity and mortality. A cohort study of all patients (n=218) undergoing PD between January 2010 and December 2019 was performed at Attikon University Hospital (Athens, Greece). Several variables were studied, including demographic data, past medical history, perioperative parameters, tumor markers and pathology, duration of hospitalization, postoperative complications, 30-day-survival, postoperative mortality and overall survival using multivariate logistic regression and survival analysis techniques. In this cohort, 123 patients [modified PD (mPD) group] underwent a modified reconstruction after a pylorus-preserving pancreaticoduodenectomy, which consisted of gastrojejunostomy and pancreaticojejunostomy on the same loop and an isolated hepaticojejunostomy on another loop. In the standard PD (StPD) group, 95 patients underwent standard reconstruction. The median age was 67 years, ranging from 25 to 89 years. Compared with in the StPD group, the mPD group had significantly lower rates of grade B and C pancreatic fistula (4.9% vs. 28.4%), delayed gastric emptying (7.3% vs. 42.1%), postoperative hemorrhage (3.3% vs. 20%), intensive care unit admission (8.1% vs. 18.9%), overall morbidity (Clavien-Dindo grade III-V: 14.7% vs. 42.0%), perioperative mortality (4.1% vs. 14.7%), and shorter hospitalization stay (11 days vs. 20 days). However, no difference was noted regarding median survival (35 months vs. 30 months). In this single-center series, a modified reconstruction after PD appears to be associated with improved postoperative outcomes. However, further evaluation in larger multi-center trials is required. [ABSTRACT FROM AUTHOR]

Primary anorectal malignant melanoma (ARMM) is a rare, aggressive tumour that accounts for approximately 1.2% of all melanomas. This rare entity represents less than 5% of anorectal malignant tumours and 0.05–1% of all malignant colorectal neoplasms. The incidence increases with age while there is a higher prevalence in Caucasians. ARMM is often asymptomatic or presents with no disease‐specific evidence so that it can mimic other rectal disorders, malignant or benign. Colonoscopy is obligatory as a diagnosing mean for ARMM. Furthermore, endoscopic ultrasonography, computed tomography and magnetic resonance imaging can be utilized for the evaluation of tumour infiltration and lymph node metastases. Moreover, diagnostic establishment of ARMM requires an undeniable demonstration of essential melanocytic features in histology and immunohistochemistry. Even though the standard of treatment remains surgical resection, the choice between wide local excision and abdomino‐perineal resection is still controversial. Recently, there have been recommendations regarding new techniques which could be utilized for the surgical treatment of ARMM. Newer treatments that have been proposed such as immune‐checkpoint inhibitors and targeted therapies need further validation. A multicenter study would allow clarification of the most appropriate therapeutic strategy for this uncommon nosological entity. Anorectal malignant melanoma is a rare clinical entity often characterized by a rapid evolution with metastatic dissemination. Early and correct diagnosis is crucial for improving the prognosis and quality of life of these patients. In non‐metastatic patients, surgical intervention indicates a definite survival benefit. New treatments such as immune‐checkpoint inhibitors and targeted therapies need further exploration. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) remains the most frequently diagnosed malignancy among women worldwide. Recognized predisposing factors may be absent in the majority of affected patients, which has aroused a stronger interest in identifying risk parameters that contribute to BC pathogenesis. Human papilloma virus (HPV) infection is strongly associated with malignancies, such as cervical cancer, oropharyngeal cancer and anal cancer. Various surveys have linked HPV to the development of BC. Relevant variations in HPV identification among BC samples may be attributed to differences in study design, the populations involved and the HPV detection techniques applied, which are still controversial with conflicting opinions and results that deny the causative association between HPV infection and BC development. Furthermore, the role of HPV, a potential cause of human BC, has recently received more attention because of the possible restriction of disease progression using an HPV vaccine. The aim of this review was to evaluate both the aspects supporting and those against the theory of BC related to HPV infection. Recent literature has been also assessed in order to provide an update on the current concepts of relevant association.