Five-year survival was 70.6 percent in patients with no lymph node involvement, 68.2 percent in patients with pararectal lymph nodes N+, 25 percent in patients with involvement of intermediate lymph nodes, and 30 percent in patients with involvement of lumboaortic lymph nodes. In no case was there involvement of the hypogastric lymph nodes. On the basis of our experience and from results in the literature, we consider an upward extended lymphadenectomy with high ligation of the inferior mesenteric artery is warranted since it enables the tumor to be staged accurately and may lead to survival even in cases of advanced lymph node involvement.

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.

In 1989 there were 151,000 new cases of colorectal carcinoma in the United States. Approximately 50% of these patients will be at risk of developing liver metastases together with other sites of recurrence. However, the liver will be the main site of relapse in only 14,000 patients with colorectal cancer. [1,2,12,15,19]. Approximately 25% of patients with colorectal carcinoma have technically resectable hepatic metastases at the time of operation for primary lesion, and an additional 8-25% will develop metachronous hepatic metastases after primary resection [ 15,251. Recent reported experiences with surgical treatment of metastatic colorectal cancer in the liver seem to indicate that hepatic resection has become more acceptable, safe and effective therapy, and offers today when technically possible, the best prospect of survival in a conspicuous number of patients. For these reasons, although a prospective randomized trial has not been done comparing resection with nonresection, resection seems to give the best hope for cure and actually is the treatment of choice for selected patients. In fact in these patients is reported a significant prolongation of survival compared with those patients with unresectable liver metastases treated only with adjuvant therapy in the form of chemotherapy or radiation therapy.Median survival of resected patients with hepatic metastases has been reported to range from 6-12 months, and for patients with single metastases is reported to range from 4.5-6.2 months to 11 and 21 months [16,22,25,27].The benefits of surgical therapy have been emphasized by different experience, with a 5-year overall survival rate ranging from 2MO%. In a recent multicenter survey a 33% 5-year survival rate was demonstrated in 859 patients resected for hepatic metastases.

The method used to identify the SN using vital dye proved to be easy to use both in vivo and ex vivo and allowed to identify the SN in all cases. The preliminary results indicate that there is a risk of false negative findings and therefore further studies are required to improve the sensitivity and the specificity of the technique and to evaluate the role of SN mapping in colorectal cancer management.

Background The results of Phase III of the (SSG)XVIII/AIO clinical study on imatinib (IM) in adjuvant treatment of GIST show that, after five years of follow up, 3 years of treatment lead to 66% of patients free of recurrence compared to 48% who received IM for only one year, with a 18% relative risk reduction. This result will determine the new standard of 3 years of adjuvant IM treatment in GIST patients at high risk of recurrence. Purpose To analyse the budget impact on Piedmont Region, over 3 years, after the approval by the Italian National Regulatory Agency of 3 years’ adjuvant treatment in high-risk GIST. Materials and Methods The analysis was performed considering the estimated incidence of 60 new cases of GIST in Piedmont: 28 patients are at very low/low risk of relapse and don’t need IM; 8 patients are at intermediate risk of recurrence and should receive IM only for 1 year; 12 patients are at very high/high risk and are treated with adjuvant IM for 3 years; 12 patients are metastatic at diagnosis and require lifelong treatment (5–13 years). The price of IM considered in this study was fixed (6–2011) in the regional competition in Piedmont (at 16.7305€/100 mg capsule). Results The annual expenditure for 12 very high/high risk patients is 293,118.6€ which adds up to a total of 879,355.08€ in 3 years. Given the stability of GIST incidence (5 cases/1,000,000 people) and 30% drop off from treatment for intolerance as reported in the SSG/AIO study, the result of our study was: in the first year 12 patients were treated at a total cost of 293,118.36€. The second year for 20 patients (8 from the first year + 12 new) the expenditure was 488,530.6€ (+66.66%). The third year there were 27 patients (7 from the first year, 8 from the second year, 12 new) and a total amount of 659,516.31€ (+35% compared to the second year). The total expenditure on very high/high risk patients at the end of 3 years of observational study was 1,441,165.27€ and the overall incremental cost was +125%. Conclusions The cost of health interventions in rare tumours should be carefully planned with a specific cancer and pharmacological registry. The availability of comprehensive databases or regional registries of these treatments would allow a more accurate analysis that takes into account both the cost of medicines and ambulatory treatment and follow-up cost. Even though data on current costs are alarming it is important to consider that in 2014 IM will lose the Novartis patent and costs will drop about 30–40%. No conflict of interest.