Tumors, cold therapy

The new frontier of cryosurgery diseased cells frozen and destroyed

Operation live. Ten hours of operation with the team I dell'Umberto

Ancona there is the only center of Italy where you run this revolutionary method to treat advanced disease

ANCONA - Every year in Italy more than 10,000 people die for primary or secondary liver tumors. So far the only treatment able to offer a long-term survival is surgical resection, however, not always practicable. In combination with surgical therapy and more frequently in cases that can not be operated they were implemented other therapies such as chemotherapy or chemoembolization. Now in addition to these methods are taking an important role cryosurgery, it experienced in the United States and practiced in Europe in just three centers. Only in Italy it is to Umberto I hospital in Ancona, where yesterday the team of Professor Emmanuel Lezoche, director of chair of surgical pathology, has made a long and delicate operation, which lasted ten hours on a patient with 16 tumor lesions liver.

The only center in Ancona

ANCONA - Cryosurgery is a technique born in the US and tati used not only in the liver also in the area of ​​urology and gynecology. In Europe there are only three centers equipped with sophisticated instrumentation, one in Scotland and the other in Germany and the third in Ancona, in the Department of Surgical Pathology headed by Professor Emmanuel Lezoche. In fact the equipment, the only one in Italy, was provided by Dr. Franco Lugnani, specialist in urology, that Trieste has already applied cryosurgery on prostate cancer. With him, the use of Ancona has started a relationship agreement, So Dr. Lugnani part in every session of cryosurgery on liver tumors carried out by Professor Lezoche and his team highly specialized-Zata. A consultancy report and concessions started in February last year and is producing the desired effect quickly. So far they have 12 other action taken, 11 liver and one kidney. For some, it was possible to proceed laparoscopically, or with a less-invasive technique which makes use of the camera and of small incisions, on the part to treat, for surgical instrumentation.

A disease "freeze"

Cryosurgery, the final frontier fought in tumors

ANCONA - Every year in Italy more than 10,000 people die for primary or secondary liver tumors. Figures provided dalrlstat but that experts are underestimated, given that each year 15,000 patients are affected by tu-mori colorectal cancer and that in about 25 percent of these are present at the time of diagnosis liver metastases, while in 40 percent they arise subsequently. So far the only treatment able to offer a long-term survival is surgical resection, however, not always practicable. In combination with surgical therapy and more frequently in cases that can not be operated they were implemented other therapies such as chemioterpia or that-miombolizzazione. Now in addition to these methods are taking an important role cryosurgery, it experienced in the United States and practiced in Europe in just three centers, one of which is to Umberto I hospital of Ancona.

It is a method that has the aim of attacking the tumor directly within the organ from which they originated, or which has been colonized, and cause their destruction. It is based on the princi-ple of freezing and root canal in situ neoplastic tissue in order to bring about its destruction. The everything possible through the use of a highly sophisticated instrumentation, the development of which is derived directly from technological research space. As part of the treatment of liver tumors both primary and secondary, cryosurgery is creating an ever larger role. The advantage of this method is essentially to adhere to the healthy tissue around the tumor, this thing that is not the case if no lesser extent in liver resections, ensuring comuque both the cessation local disease that the certainty of having treated the entire tumor mass. This is possible thanks to the availability of ultrasound intraoperatively that allows surgeons to view directly the mass to be treated in its various dimensions, to point at it with a needle guide and then with the probes by freezing (cryoprebes) which penetrates the center of the lesion allow the otter in seconds freezing temperatures of 200 degrees below zero, forming a ball of ice that encompasses the tumor and a small portion of the surrounding healthy tissue. During surgery, the freezing process is monitored in real time by just intraoperative ultrasound. The problem of the size of the masses treatable is solved by the possibility to use multiple probes for a single lesion of large dimensions, thus permitting the fusion of the ice balls, and the treatment of large amounts of tumor tissue. Instead you can use one or a few probes to hit multiple metastases very close together. After treating this way one or more lesions at the same time, you can be sure of cell death and therefore the root canal of the tumor. The frozen tumors were then followed in their evolution through the MRI every month for the first three months and then with quarterly checks. Of course, no specialist is able to rule out that there may be a recurrence of the disease after some time cryosurgical treatment, but surgery may be repeated up to five times. It should also be added that this method can be performed contextually in addition to traditional surgery, even with minimally invasive techniques, using the approach by laparascopica which can be however carried out in a limited number of cases, or in the presence of a very low number of lesions tumor.

Impressive figures According to Istat die every year in Italy more than 10 thousand people suffering from liver cancer

Caution nelTultimafase operation

"It is a delicate operation especially for the anesthesiologist"

ANCONA - A long and extremely mild one of anesthesiologists in the interventions of cryosurgery. This is because the normal monitoring should be added to a preparation of the patient much more accurate, which requires maximum attention during the thawing of the parties "cooled" to 200 degrees below zero.

We are facing, "says Vito Ciraco, anesthetist ervice in the intensive care unit of the hospital Umberto I in a type of surgery is completely different from the traditional one, which needs a very high monitoring. The patient undergoes in the course of an intervention-raf-cooling huge so you need to monitor the core body temperature. It should also be cannulated the central artery and are administered to the patient particular medications. We oltretuttto in in the presence, for cryosurgery performed open chest, interventions that require very long anesthesia heavy at times, as in the last two cases tratttati, even ten hours. Of course this does not favor the immediate recovery of the patient as is the case in laparoscopic where you make tiny incisions without opening the chest looking all metastases in the liver. " Therefore a maximum level of attention is given by anesthetists to this type of intervention. No coincidence are present in two in the operating room for the entire duration of the intervention. But the situation most at risk, apart from the possible presence of heart failure problems that can still happen in any other more simple case, it has to intervene almost completed. That is, during the process of thawing the cooled parts. In fact at that point they can be im-provvisi bleeding. This is because the liver subjected to treatment of necrosis, not risce to fulfill its task, which is to provide to coagulation factors. Fotoservizio Moreno Boria An effect that doctors say however calculated and thus kept under control, this would explain the presence for the duration of the intervention of two anesthetists. Usually at the end of these long procedures, where is was necessary to refer the patient to long hours of anesthesia, you opt for a gradual awakening, with intubation off only after some hours from the end of the operation.

Early diagnosis the success of therapies

Many cases in which it is difficult to intervene

ANCONA ¡- The waiting lists are quite long. A knock on the door of Professor Emanuele Lezoche, director of the Chair of Surgical pathology at the University of Ancona, are many. But sometimes the wait is long, reaching even to touch the ceiling of six to eight months due to poor availability of operating rooms. For several weeks, they begin to arrive from all over Italy, including many requests for intervention of cryosurgery. But not all can be answered. In many cases, in fact an intervention of criochirugia or even traditional surgery, it would be useless, given the stage of progress of the disease. So you go back to point the finger on the need for early detection. There are still many people, confirmed by doctors of the team of Professor Lezoche, to get you to the hospital when it is in the presence of metastases. At that point a few are the solutions capable of ensuring the lengthening of survival. In short there, beyond the structural problems, a selection of patients for surgery, based solely on the medical condition. A selection that occurs at times when the patient has already walked in the door of the operating room. It can happen, in fact, and even with some frequency, that diagnostic imaging, particularly tomography compiuterizzata, unable to photograph the reality as it appears rather then, once you start working with the scalpel, through ultrasound Intraoperative. Just this exam to start intervention can bring out a greater number of metastasis, such as to advise against going through with it. So is the Tac that MRI may show a sottostimazione extension of the tumor, while the intraoperative ultrasound provides investigative capacity definitely more reliable.

Very close-knit team

ANCONA - Heat, friendship, mutual esteem. This is the glue of a team highly specialized in a technique that at the moment is the last frontier in the fight against liver tumors. A ride is Professor Emanuele Lezoche, director of the Chair of Surgical pathology of the university. With him yesterday in the operating room assistant Alessandro Paganini, the associated Francesco Feliciotti and interns Andrea Tamburini and Mauro Muti. To prepare the patient for surgery and to assist him until the end, the two anesthetists of the intensive care unit of the hospital, Nicholas Venditti and Vito Ciraco. Also present in the room Dr. Franco Lugnani, specialist in urology, by which the Customs and the Department of Pathology have signed an agreement. And 'he, in fact, the owner of sosfisticata instrumentation for cryosurgery, now making available anconentano hospital with his professional advice. And of course in the operating room nurses have come and gone and ferristi, all now prepared to work like that. Are part of the team of Professor Lezoche also doctors Carlo Mariotti, Giovanni Gregorini, Mario Warriors, Marco Di Emiddio, and interns and Pamela Compagnucci Roberto Zenobi. 

Ten hours in the operating room

For the patient, this therapy is the great hope

ANCONA - A sleepless night spent waiting and in fear of an intervention which failed to bind their life expectancies. Then the fateful moment has arrived. The man, 59, from Vasto, Abruzzo, addressed Equipe Professor Lezoche, after a CAT scan to check last April had revealed the presence of multiple liver metastases not amenable to surgical resection. So the only way out and appeared cryosurgery. At 8 the patient was taken to the operating room. Them waiting two anesthetists dell'Umberto I. Since then started the first phase, that of preparation for the subsequent work of the surgeons. A long and delicate process, only to 1O closed. A relay race in which you are then followed the doctors of the team of Professor Lezoche. A very long preoperatively to check their once open with a scalpel first one way and then the other in the chest, the extension and the exact number of injuries. The patient, in fact, had come into the operating room with a CAT scan which revealed the presence of about six to a maximum of seven metastases. In fact since the first contacts with the manuals liver, surgeons have realized that the picture was much more worrying. As it confirmed the intraoperative ultrasound. So were shipped in the first laboratory resections, to understand how deep and how extensive was the tumor. At 12:30, the team decided to go ahead with the surgery as choosing how to resect the tumor smaller parts and surface, leaving it to the task cryosurgery to freeze and destroy cancer cells larger and hidden in hard to reach from scalpel. Seven were removed from the patient's liver metastases from scalpel Professor Lezoche. At 14 began instead cryosurgical treatment. Two cycles of freezing and thawing alternating lasting about 45 minutes, performed with the assistance of Dr. Franco Lugnani, were run on three different tumor metastasis who had a total of nine. Lesions were betting with a 'agoguida. Then he proceeded to the placement of cryosonda the center of the lesions, initiating the process of freezing.A completed this stage around 17.30. Then the probes were removed and the medical team carried the bleeding of the remaining cavity, and then suture the chest wall. At 18:30, the operation a complete success, has ended. The patient is still intubated was taken to intensive care, where he stayed from 36 to 48 hours.

New method and survival times

And Sos comes from all over Italy

"But in many cases you can do nothing"

ANCONA - The Sos comes from every part of Italy. These days the surgical pathology are many requests for help. But in many cases it is impossible to intervene because you and in the presence of cancer in an advanced stage. "We need less resignation," says Professor Emanuele Lezoche "and greater rioconoscimento of their dignity of person. These days have come to us desperate cases. A young mother with pancreatic cancer, asymptomatic in the initial stage, which now has already invaded the uterus and against which little or nothing we can do. And then we will never cease to remind everyone that the main thing is prevention through which, in all cases of the disease, you can get to an early diagnosis and therefore also a good chance to give life to the sick. Prevention is a cultural problem, not cheap. So much so that in short supply everywhere in all social classes.Returning on the specific topic should be said that some of the patients who have contacted us not be subject to intervention of any kind, because often the cancer has spread to several organs. In terms then of this new therapy chiururgica "he concludes Lezoche" we started in February. On the application of cryosurgery to liver results. Of course we can not say with certainty what will happen to these patients. Certainly preliminary studies indicate a lengthening of life compared to other treatments. A result which in itself is satisfactory, as is positive that the early MRI scans performed on patients operated on in recent months do not show the presence of new neoplastic lesions. Moreover, it can be used both in resectable tumors than in those where the scalpel can not reach. "" From the data we have, "adds Dr. Alessandro Paganini" this new treatment certainly less invasive than traditional surgery, allowing patients a prolonged survival. If there are metastases to the liver it is not always possible to exclude the development of new outbreaks, but in the meantime the patient can 'go back to their lives. So far we have made 12 interventions with this method. All patients had a length of stay less than the norm. Then, when we can, in the presence of a few metastases, to perform laparoscopic cryosurgery, then the result is really excellent especially on the timing of recovery of the patient. " So far, the measures have been carried to the liver all except for one performed on a kidney cancer. All are doing well. Difficult for the moment to assume the extension of cryosurgery to other sectors, as already happens in other parts of the world.

The discovery of cancer and therapies to stop it

ANCONA - The patient underwent surgery yesterday to long Cryosurgery is 59 years old and comes from Vasto. His first contact with the tumor was in September 1995 when he was hospitalized with a diagnosis of bowel obstruction of unknown nature. Then he underwent radiography of the abdomen, barium enema and colonoscopy with removal of the colon boioptico that revealed the presence of a tumor lesion located at the level of the valve ileociecale with malignant aspect. At that point the doctors decided to proceed to surgical resection of the lesion and part of the colon which was followed by a course of chemotherapy. A CAT scan of control that last April, however, showed the presence of multiple liver meta stasis not amenable to surgical resection. So the patient has arrived in recent days at Umberto I where yesterday was subjected to the intervention of cryoablation metastasis blood.