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Balla A, Sartori A, Botteri E, Podda M, Ortenzi M, Silecchia G, Guerrieri M, Agresta F. Augmented reality (AR) in minimally invasive surgery (MIS) training: where are we now in Italy? The Italian Society of Endoscopic Surgery (SICE) ARMIS survey. Updates Surg 2023; 75:85-93. [PMID: 36131182 DOI: 10.1007/s13304-022-01383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/12/2022] [Indexed: 01/19/2023]
Abstract
Minimally invasive surgery (MIS) is a widespread approach in general surgery. Computer guiding software, such as the augmented reality (AR), the virtual reality (VR) and mixed reality (MR), has been proposed to help surgeons during MIS. This study aims to report these technologies' current knowledge and diffusion during surgical training in Italy. A web-based survey was developed under the aegis of the Italian Society of Endoscopic Surgery (SICE). Two hundred and seventeen medical doctors' answers were analyzed. Participants were surgeons (138, 63.6%) and residents in surgery (79, 36.4%). The mean knowledge of the role of the VR, AR and MR in surgery was 4.9 ± 2.4 (range 1-10). Most of the participants (122, 56.2%) did not have experience with any proposed technologies. However, although the lack of experience in this field, the answers about the functioning of the technologies were correct in most cases. Most of the participants answered that VR, AR and MR should be used more frequently for the teaching and training and during the clinical activity (170, 80.3%) and that such technologies would make a significant contribution, especially in training (183, 84.3%) and didactic (156, 71.9%). Finally, the main limitations to the diffusion of these technologies were the insufficient knowledge (182, 83.9%) and costs (175, 80.6%). Based on the present study, in Italy, the knowledge and dissemination of these technologies are still limited. Further studies are required to establish the usefulness of AR, VR and MR in surgical training.
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Affiliation(s)
- Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy.
| | - Alberto Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Via Palmiro Togliatti, 16, 31044, Montebelluna, Treviso, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Via Boccalera 325018, Montichiari, Brescia, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "La Sapienza" University of Rome-Polo Pontino, Bariatric Centre of Excellence IFSO-EC, Rome, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Ferdinando Agresta
- Department of General Surgery, AULSS2 Trevigiana del Veneto, Hospital of Vittorio Veneto, Vittorio Veneto, Treviso, Italy
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Sista F, Carandina S, Andreica A, Zulian V, Pietroletti R, Cappelli S, Balla A, Nedelcu M, Clementi M. Long-term results of laparoscopic gastric sleeve: the importance of follow-up adherence. Eur Rev Med Pharmacol Sci 2022; 26:6691-6699. [PMID: 36196719 DOI: 10.26355/eurrev_202209_29770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study was conducted to assess the long-term results of the Laparoscopic Sleeve Gastrectomy (LSG) in patients not compliant with follow-up, and in patients who completed a postoperative follow-up program. PATIENTS AND METHODS The data concerning LSG patients operated from February 2011 to December 2013 were retrospectively reviewed basing on a single center database. The patients with complete long-term follow-up were scheduled in Group A, while patients who failed to attend controls for more than two years were scheduled in Group B. Long-term results (weight loss, comorbidity improvement and late complications) were compared between the two groups. RESULTS The study population consisted of 285 patients. Of these, 101 had a complete follow-up with a mean duration of 71 ± 7.6 months (Group A). The remaining 184 patients (Group B) were not compliant with follow-up and, consequently, the mean duration of follow-up was 5.5 ± 7.3 months (p < 0.00001). A higher number of patients with insufficient weight loss was recorded in Group B with respect to Group A (78 vs. 23; p = 0.001). The number of patients with results below 25% EWL was significantly higher in Group B than in Group A (24 vs. 5; p = 0.04). In the long-term, the rate of patients with symptomatic reflux requiring medical treatment was two-fold higher in Group B than in Group A. CONCLUSIONS The adherence to a long-term follow-up plan after LSG seems to decrease the number of patients experiencing insufficient weight loss and those at risk for developing a gastro-esophageal reflux disease.
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Affiliation(s)
- F Sista
- San Salvatore Hospital, Department of Surgery, L'Aquila, Italy.
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Clementi M, Pietroletti R, Carletti F, Sista F, Grasso A, Fiasca F, Cappelli S, Balla A, Rizza V, Ciarrocchi A, Guadagni S. Colostomy Reversal following Hartmann’s Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study. J Clin Med 2022; 11:jcm11154388. [PMID: 35956003 PMCID: PMC9369122 DOI: 10.3390/jcm11154388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/23/2022] [Accepted: 07/23/2022] [Indexed: 01/19/2023] Open
Abstract
The restoration of bowel continuity following Hartmann’s Procedure (HP) has been reported hitherto with high morbidity and mortality rates. No clear guidelines exist about timing in Hartmann’s Reversal (HR), the literature data being conflicting. We have sought to investigate the effect of the interval time between HP and HR in short- and long-term HR outcomes through a retrospective study based on consecutive patients undergoing HR between 2009 and 2017 in two regional hospitals in Italy. Demographic characteristics, comorbidities, intra- and post-operative data, as well as early complications, were recorded. Long-term data were collected on the surgical site occurrences of Incisional Ventral Hernia (IVH). One hundred and five patients were recruited for the study. Late HR, female gender, and long operating time were related to the highest incidence of peri-operative complications. Patients who developed IVH had undergone HR at significantly shorter times and had a higher Body Mass Index (BMI). The timing of HR seems to be an important variable linked to the onset of early and late post-operative complications. The patients submitted to early HR show a significantly lower complication rate but, at the same time, a higher rate of IVH incidence after restorative surgery. These data, in our opinion, reflect the need for planning, where possible, an early restoration of bowel continuity after HP.
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Affiliation(s)
- Marco Clementi
- General Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy; (F.C.); (A.G.); (S.G.)
- Correspondence: ; Tel.: +39-33-5538-6225
| | - Renato Pietroletti
- Unit of Proctology and Colorectal Surgery, Val Vibrata-Sant’Omero Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy; (R.P.); (V.R.)
| | - Filippo Carletti
- General Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy; (F.C.); (A.G.); (S.G.)
| | - Federico Sista
- Hepatic Pancreatic and Biliary Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy;
| | - Antonella Grasso
- General Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy; (F.C.); (A.G.); (S.G.)
| | - Fabiana Fiasca
- Public Health Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy;
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Andrea Balla
- General and Minimally Invasive Surgical Unit, San Paolo Hospital, 00053 Civitavecchia, Italy;
| | - Vinicio Rizza
- Unit of Proctology and Colorectal Surgery, Val Vibrata-Sant’Omero Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy; (R.P.); (V.R.)
| | - Andrea Ciarrocchi
- General Surgical Unit, Maria ss. dello Splendore Hospital, 67021 Giulianova, Italy;
| | - Stefano Guadagni
- General Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 Coppito, Italy; (F.C.); (A.G.); (S.G.)
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Cappelli S, Corallino D, Clementi M, Guadagni S, Pelle F, Puccica I, Barba M, Vici P, Sperduti I, Costantini M, Botti C. Surgical site infections in patients undergoing breast oncological surgery during the lockdown: An unexpected lesson from the COVID-19 pandemic. G Chir 2022; 42:e02. [PMID: 35936027 DOI: 10.1097/IA9.0000000000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
Background The present study aims to evaluate how the measures to contain the SARS-CoV-2 spreading affected the surgical site infections (SSIs) rate in patients who underwent nondeferrable breast cancer surgery (BCS). Methods This study is a retrospective analysis of prospectively collected data from a consecutive series of patients underwent nondeferrable BCS in a regional Italian Covid-free hub during two different period: March to April 2020 (pandemic cohort [PC]) and March till April 2019 (control cohort [CC]). SSIs were defined according to the criteria established by the Center for disease control and prevention (CDC) and additional treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation of bacteria, and stay (ASEPSIS) scoring systems. Results One hundred ninety-nine patients were included in the present study: 100 and 99 patients who underwent nondeferrable BCS from March to April 2020 (PC) and from March to April 2019 (CC), respectively. The overall SSIs rate in this series was 9.1% according to CDC criteria and 6.5% according to ASEPSIS criteria. The SSIs incidence decreased during the pandemic period. Moreover, the SSIs rate according to ASEPSIS criteria was statistically lower in the PC than in the CC. We observed significant evidence of higher SSIs, both in terms of CDC and ASEPSIS score, in patients having undergone breast reconstruction compared with patients not undergoing immediate reconstruction. Conclusions The restrictive measures issued during the lockdown period seemed to lower the SSIs rates in patients undergoing nondeferrable BCS.
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Guadagni S, Masedu F, Fiorentini G, Sarti D, Fiorentini C, Guadagni V, Apostolou P, Papasotiriou I, Parsonidis P, Valenti M, Ricevuto E, Bruera G, Farina AR, Mackay AR, Clementi M. Circulating tumour cell gene expression and chemosensitivity analyses: predictive accuracy for response to multidisciplinary treatment of patients with unresectable refractory recurrent rectal cancer or unresectable refractory colorectal cancer liver metastases. BMC Cancer 2022; 22:660. [PMID: 35710393 PMCID: PMC9202660 DOI: 10.1186/s12885-022-09770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Patients with unresectable recurrent rectal cancer (RRC) or colorectal cancer (CRC) with liver metastases, refractory to at least two lines of traditional systemic therapy, may receive third line intraarterial chemotherapy (IC) and targeted therapy (TT) using drugs selected by chemosensitivity and tumor gene expression analyses of liquid biopsy-derived circulating tumor cells (CTCs). Methods In this retrospective study, 36 patients with refractory unresectable RRC or refractory unresectable CRC liver metastases were submitted for IC and TT with agents selected by precision oncotherapy chemosensitivity assays performed on liquid biopsy-derived CTCs, transiently cultured in vitro, and by tumor gene expression in the same CTC population, as a ratio to tumor gene expression in peripheral mononuclear blood cells (PMBCs) from the same individual. The endpoint was to evaluate the predictive accuracy of a specific liquid biopsy precision oncotherapy CTC purification and in vitro culture methodology for a positive RECIST 1.1 response to the therapy selected. Results Our analyses resulted in evaluations of 94.12% (95% CI 0.71–0.99) for sensitivity, 5.26% (95% CI 0.01–0.26) for specificity, a predictive value of 47.06% (95% CI 0.29–0.65) for a positive response, a predictive value of 50% (95% CI 0.01–0.98) for a negative response, with an overall calculated predictive accuracy of 47.22% (95% CI 0.30–0.64). Conclusions This is the first reported estimation of predictive accuracy derived from combining chemosensitivity and tumor gene expression analyses on liquid biopsy-derived CTCs, transiently cultured in vitro which, despite limitations, represents a baseline and benchmark which we envisage will be improve upon by methodological and technological advances and future clinical trials.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Francesco Masedu
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Giammaria Fiorentini
- Department of Oncology and Hematology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Donatella Sarti
- Department of Oncology and Hematology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Caterina Fiorentini
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Veronica Guadagni
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Marco Valenti
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Enrico Ricevuto
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Gemma Bruera
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonietta R Farina
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Andrew R Mackay
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Marco Clementi
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
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Catarci M, Ruffo G, Viola MG, Pirozzi F, Delrio P, Borghi F, Garulli G, Baldazzi G, Marini P, Sica G. ERAS program adherence-institutionalization, major morbidity and anastomotic leakage after elective colorectal surgery: the iCral2 multicenter prospective study. Surg Endosc 2022; 36:3965-3984. [PMID: 34519893 DOI: 10.1007/s00464-021-08717-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs influence morbidity rates and length of stay after colorectal surgery (CRS), and may also impact major complications and anastomotic leakage rates. A prospective multicenter observational study to investigate the interactions between ERAS program adherence and early outcomes after elective CRS was carried out. METHODS Prospective enrolment of patients submitted to elective CRS with anastomosis in 18 months. Adherence to 21 items of ERAS program was measured upon explicit criteria in every case. After univariate analysis, independent predictors of primary endpoints [major morbidity (MM) and anastomotic leakage (AL) rates] were identified through logistic regression analyses including all significant variables, presenting odds ratios (OR). RESULTS Institutional ERAS protocol was declared by 27 out of 38 (71.0%) participating centers. Median overall adherence to ERAS program items was 71.4%. Among 3830 patients included in the study, MM and AL rates were 4.7% and 4.2%, respectively. MM rates were independently influenced by intra- and/or postoperative blood transfusions (OR 7.79, 95% CI 5.46-11.10; p < 0.0001) and standard anesthesia protocol (OR 0.68, 95% CI 0.48-0.96; p = 0.028). AL rates were independently influenced by male gender (OR 1.48, 95% CI 1.06-2.07; p = 0.021), intra- and/or postoperative blood transfusions (OR 4.29, 95% CI 2.93-6.50; p < 0.0001) and non-standard resections (OR 1.49, 95% CI 1.01-2.22; p = 0.049). CONCLUSIONS This study disclosed wide room for improvement in compliance to several ERAS program items. It failed to detect any significant association between institutionalization and/or adherence rates to ERAS program with primary endpoints. These outcomes were independently influenced by gender, intra- and postoperative blood transfusions, non-standard resections, and standard anesthesia protocol.
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Affiliation(s)
- Marco Catarci
- General Surgery Unit, "C. E G. Mazzoni" Hospital, Ascoli Piceno, Italy. .,General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy.
| | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
| | | | - Felice Pirozzi
- General Surgery Unit, ASL Napoli 2 Nord, Pozzuoli, NA, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale IRCCS-Italia", Naples, Italy
| | - Felice Borghi
- General & Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | | | - Pierluigi Marini
- General Surgery Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Sica
- Minimally Invasive Surgery Unit, Policlinico tor Vergata University Hospital, Rome, Italy
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Sista F, Clementi M, Rivkine E, Soprani A, Fiasca F, Cappelli S, Montana L, Nedelcu M, Carandina S. Gastric Bypass after multiple restrictive procedures: Roux-en-Y or One Anastomosis? A retrospective multicentric study. Eur Rev Med Pharmacol Sci 2022; 26:2075-2084. [PMID: 35363357 DOI: 10.26355/eurrev_202203_28355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE When restrictive surgery fails, conversion to more malabsorptive techniques is frequently proposed. The aim of this study is to evaluate the weight loss figures between Roux-en-Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) in patients who have already undergone Multiple Restrictive Procedures (MRP). PATIENTS AND METHODS All patients who underwent conversion of Laparoscopic Sleeve Gastrectomy (LSG) to RYGB or OAGB between 2010 and 2019 were retrospectively analyzed. Only patients who had conversion for Weight Regain (WR) or Insufficient Weight Loss (IWL) after both Laparoscopic Gastric Banding (LGB) and LSG entered the study population. Finally, 44 patients underwent conversion to RYGB, and 24 patients to OAGB. RESULTS Concerning Excess Weight Loss (%EWL) at 3, 6, 12, 24 postoperative months, the results for RYGB were 33.7%, 47.95%, 61.8%, 61.8%, while for OAGB were 38.3%, 51.9%, 63.75%, 79.45%. A significant difference was recorded in favor of OAGB at 3 (p=0.03) and 24 (p=0.046) postoperative months. % EWL at 24 months in the case of IWL was 57.8% for RYGB, while for OAGB was 72.7% (p=0.047). No significant difference was found considering patients with WR (80.9% and 80.5%; p= 0.999). Patients with better results at 24 months after surgery had a significantly longer time between sleeve and bypass than those with a lower % EWL. CONCLUSIONS The results of the present study seem to show that both techniques give good results at 24 months in patients who have undergone MRP. However, OAGB shows overall better results, particularly in patients with IWL.
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Affiliation(s)
- F Sista
- Department of Surgery, Ospedale Civile San Salvatore L'Aquila, UOC di Chirurgia Epato-Bilio-Pancreatica, L'Aquila, Italy.
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Clementi M, Carandina S, Zulian V, Guadagni S, Cianca G, Salvatorelli A, Grasso A, Sista F. The role of antral resection in sleeve gastrectomy. An observational comparative study. Eur Rev Med Pharmacol Sci 2021; 25:7204-7210. [PMID: 34919218 DOI: 10.26355/eurrev_202112_27412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The role of antral resection (AR) in laparoscopic sleeve gastrectomy (LSG) is still a greatly debated topic in the literature. The aim of this study was to evaluate the results and complications of AR in LSG. PATIENTS AND METHODS In this observational comparative study, 101 patients who underwent LSG were divided into two groups based on the extent of antral resection: 1 cm from the pylorus (1-DP group), or 6 cm from the pylorus (6-DP group). The %EWL (%Excess weight loss), resolution of T2D (Type 2 Diabetes Mellitus) and GLP-1 were investigated 48 hours before surgery and 3, 6 and 12 months after LSG. Postoperative complications in the first 30 days after surgery were also compared between the two groups using the Clavien-Dindo (CD) score. RESULTS A significant difference in %EWL was observed at 3 and 6 months in favor of the 1-DP group (38.9% and 57.8%, respectively) compared to the 6-DP group (31.4% and 49.7%, respectively). No difference in T2D resolution was observed between two groups during the follow-up period, with similar changes in GLP-1. Statistically significant differences were found between 1-DP and 6-DP group for the reintervention rate (CD III, 7.7% and 1.9%, respectively; p = 0.02) and life-threatening complications requiring intensive care unit management (CD IV, 3.8% and 0%, respectively, p = 0.03). CONCLUSIONS In LSG, sparing the antrum is associated with a significant reduction in the rate of postoperative complications, but the metabolic and weight results are comparable to those for antrum resection.
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Affiliation(s)
- M Clementi
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie, Ospedale Civile San Salvatore, University of L'Aquila, L'Aquila, Italy.
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Guerra F, Petrelli F, Greco PA, Sisti V, Catarci M, Montalti R, Patriti A. The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group. Eur J Surg Oncol 2021; 47:2873-2879. [PMID: 34119377 DOI: 10.1016/j.ejso.2021.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/29/2021] [Accepted: 05/26/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION how best to manage patients with colorectal cancer and synchronous liver metastasis is still controversial, with specific concerns of increased risk of postoperative complications following combined resection. We aimed at analyzing the influence of combined liver resection on the risk of anastomotic leak (AL) following colorectal resection. METHODS we reviewed the iCral prospectively maintained database to compare the relative risk of AL of patients undergoing colorectal resection for cancer to that of patients receiving simultaneous liver and colorectal resection for cancer with isolated hepatic metastases. The incidence of AL was the primary outcome of the analysis. Perioperative details and postoperative complications were also appraised. RESULTS out of a total of 996 patients who underwent colorectal resection for cancer, 206 receiving isolated colorectal resection were compared with a matched group of 53 patients undergoing simultaneous liver and colorectal resection. Combined surgery had greater operative time and resulted in longer postoperative hospitalization compared to colorectal resection alone. The proportion of overall morbidity following combined resection was significantly higher than after isolated colorectal resection (56.6% vs. 37.9%, p = 0.021). Overall, the two groups of patients did not differ neither on the rate of major postoperative complications, nor in terms of AL (9.4% vs. 6.3%, p = 0.381). At specific multivariate analysis, the duration of surgery was the only risk factor independently associated with the likelihood of AL. CONCLUSIONS combining hepatic with colorectal resection for the treatment of synchronous liver metastasis from colorectal cancer does not increase significantly the incidence of AL.
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Affiliation(s)
- Francesco Guerra
- Division of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy.
| | - Filippo Petrelli
- Division of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Valerio Sisti
- Division of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Marco Catarci
- Division of General Surgery, Sandro Pertini Hospital, Rome, Italy
| | - Roberto Montalti
- Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University, Napoli, Italy
| | - Alberto Patriti
- Division of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
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Guadagni S, Zoras O, Fiorentini G, Masedu F, Lasithiotakis K, Sarti D, Farina AR, Mackay AR, Clementi M. A Prospective Study of Intraarterial Infusion Chemotherapy in Advanced WT BRAF Melanoma Patients. J Surg Res 2021:S0022-4804(21)00381-4. [PMID: 34253376 DOI: 10.1016/j.jss.2021.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/05/2021] [Accepted: 05/28/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Treatment strategies for advanced cutaneous melanoma (CM) patients, resistant or not treatable with novel target and immunotherapeutic drugs, remain a significant challenge, particularly for patients with unresectable stage IIIC/D disease localized to inferior limbs and pelvis, for whom specific outcomes are rarely considered. MATERIALS AND METHODS This is a prospective study of multidisciplinary treatments, including locoregional melphalan chemotherapy, in 62 BRAF wild-type CM patients with locoregional metastases in the inferior limbs and pelvis, including inguinal regions. Patients were either in progression following or ineligible for, or not treatable with novel immunotherapy. For exclusively inferior limb-localised disease, patients received locoregional melphalan chemotherapy performed by hyperthermic isolated limb perfusion (n = 19) or isolated limb infusion (n = 19), and for synchronous lesions localised to inferior limbs and pelvis, received hypoxic pelvic and limb perfusion (n = 24). Additional multidisciplinary therapy included local, locoregional and systemic treatments and the primary endpoint was tumour response. RESULTS The objective response rate following first cycle of locoregional chemotherapy was 37.1% at 3 mo and median progression-free survival was 4-mo, with 12.9% procedure-related complications, 30.6% low-grade haematological toxicity and 11.3% severe limb toxic tissue reactions. Multivariate logistic regression showed that the odds of response were significantly higher for patients ≤ 75 y of age and for patients with locoregional metastases exclusively located in the inferior limbs. CONCLUSION In this subgroup of CM patients with BRAF wild-type status, locoregional metastases localized to inferior limbs and pelvis, in progression following or ineligible for immunotherapy, melphalan locoregional chemotherapy demonstrated a safe and effective profile. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01920516; date of trial registration: August 6, 2013.
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11
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Sista F, De Leonardis M, Carandina S, Pessia B, Clementi M, Vicentini R. Surgical management of rectal GIST. A case report and a review of literature. Ann Ital Chir 2021; 10:S2239253X2103485X. [PMID: 33875627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Rectal GIST is a rare tumor of the gastrointestinal tract. The few literature cases didn't show significant evidence about diagnostic and therapeutic management. We present a rare case of rectal GIST treated with laparoscopic anterior rectal resection (RARLs) preceded by neoadjuvant therapy with Imatinib Mesylate (IM). CASE REPORT A 68-year-old woman with abdominal pain, rectal bleeding and palpable mass on rectal exam has been subjected to computerized tomography (CT) of the abdomen and pelvis and magnetic resonance imaging (MRI) that revealed a rectal GIST of 5x4x2 cm at 3 cm from anal verge. The diagnosis was confirmed with colonoscopy. After 3- mounts neoadjuvant therapy with IM, which allowed to down-stage the neoformation, the patient underwent RARLs without intraoperative or postoperative complications. Immunohistochemistry revealed cluster of differentiation CD 117 positive, HPF 5/50, Ki 67overexpressed. PDGF mutation was detected. The patient was therefore taken in charge by the oncologist. DISCUSSION AND CONCLUSION Resection appear curative for rectal GIST. Extensive resections aren't necessary because of downstaging after IM therapy. However, the appropriate surgical technique is still debated. Further studies are necessary for a correct surgical standardization. KEY WORDS Rectal GIST, Cajal cell, Laparoscopic rectal resection, Imatinib.
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12
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Di Furia M, Della Penna A, Puccica I, Stifini D, Salvatorelli A, Sista F, Guadagni S, Clementi M. Combined approach with negative pressure wound therapy and biological mesh for treatment of enterocutaneous fistula after synthetic mesh repair of incisional hernia. A case report. Ann Ital Chir 2021; 10:S2239253X21035039. [PMID: 33843724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Enterocutaneous fistula is a rare but severe complication of prosthetic incisional hernia repair. Management requires re-exploration with intestinal repair/resection and mesh removal. Repair of the parietal defect in this contaminated field is challenging. MATERIAL OF STUDY A 58-years male patient presented to our department one year after synthetic mesh repair of large incisional hernia with mesh infection and enterocutaneous fistula. The diagnosis was confirmed by ultrasound guided drainage and CT scans with oral contrast. A multiple-step surgical approach has been adopted: first, the mesh was removed, intestinal resection performed and posterior fascial closure obtained by bilateral transversus abdominis release (TAR) and supra-fascial NPWT (negative pressure wound therapy) was positioned and maintained for one week; second, a definitive repair was obtained by a biological prothesis fixed to posterior fascia and covered by anterior fascia closure. Then, new NPWT was positioned and maintained for 6 days on the skin closure. At 18-months follow-up, the patient showed no clinical or radiological signs of recurrence or reinfection. DISCUSSION Surgical strategies to face enterocutaneous fistula after prosthesis ventral hernia repair are not standardized. After bowel fistula treatment and mesh removal, the challenge of abdominal wall closure stay unsolved because of the high rate of complication and failure of a new prosthetic repair. A case-by-case management plan, often with the use of a multi-step strategy, may be an option. CONCLUSION This is a single recovery multiple-step strategy combined approach using NPWT and biological prothesis to manage a case of mesh infection by an enterocutaneous fistula. This unique approach has revealed safe and effective for the treatment of parietal defect in infected field resulting from a mesh removing procedure. KEY WORDS Biological prosthesis, Bowel mesh erosion, Enterocutaneous fistula, Negative Pressure Wound Therapy, Open incisional hernia repair.
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13
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Baiocchi GL, Guercioni G, Vettoretto N, Scabini S, Millo P, Muratore A, Clementi M, Sica G, Delrio P, Longo G, Anania G, Barbieri V, Amodio P, Di Marco C, Baldazzi G, Garulli G, Patriti A, Pirozzi F, De Luca R, Mancini S, Pedrazzani C, Scaramuzzi M, Scatizzi M, Taglietti L, Motter M, Ceccarelli G, Totis M, Gennai A, Frazzini D, Di Mauro G, Capolupo GT, Crafa F, Marini P, Ruffo G, Persiani R, Borghi F, de Manzini N, Catarci M. ICG fluorescence imaging in colorectal surgery: a snapshot from the ICRAL study group. BMC Surg 2021; 21:190. [PMID: 33838677 PMCID: PMC8035779 DOI: 10.1186/s12893-021-01191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background Fluorescence-guided visualization is a recently proposed technology in colorectal surgery. Possible uses include evaluating perfusion, navigating lymph nodes and searching for hepatic metastases and peritoneal spread. Despite the absence of high-level evidence, this technique has gained considerable popularity among colorectal surgeons due to its significant reliability, safety, ease of use and relatively low cost. However, the actual use of this technique in daily clinical practice has not been reported to date. Methods This survey was conducted on April 2020 among 44 centers dealing with colorectal diseases and participating in the Italian ColoRectal Anastomotic Leakage (iCral) study group. Surgeons were approximately equally divided based on geographical criteria from multiple Italian regions, with a large proportion based in public (89.1%) and nonacademic (75.7%) centers. They were invited to answer an online survey to snapshot their current behaviors regarding the use of fluorescence-guided visualization in colorectal surgery. Questions regarding technological availability, indications and techniques, personal approaches and feelings were collected in a 23-item questionnaire. Results Questionnaire replies were received from 37 institutions and partially answered by 8, as this latter group of centers do not implement fluorescence technology (21.6%). Out of the remaining 29 centers (78,4%), fluorescence is utilized in all laparoscopic colorectal resections by 72.4% of surgeons and only for selected cases by the remaining 27.6%, while 62.1% of respondents do not use fluorescence in open surgery (unless the perfusion is macroscopically uncertain with the naked eye, in which case 41.4% of them do). The survey also suggests that there is no agreement on dilution, dosing and timing, as many different practices are adopted based on personal judgment. Only approximately half of the surgeons reported a reduced leak rate with fluorescence perfusion assessment, but 65.5% of them strongly believe that this technique will become a minimum requirement for colorectal surgery in the future. Conclusion The survey confirms that fluorescence is becoming a widely used technique in colorectal surgery. However, both the indications and methods still vary considerably; furthermore, the surgeons' perceptions of the results are insufficient to consider this technology essential. This survey emphasizes the need for further research to reach recommendations based on solid scientific evidence.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy.
| | | | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili, Montichiari, BS, Italy
| | - Stefano Scabini
- General & Oncologic Surgery Unit, National Cancer Center "San Martino", Genova, Italy
| | - Paolo Millo
- General Surgery Unit, Aosta Regional Hospital, Aosta, Italy
| | | | - Marco Clementi
- General Surgery Unit, University Hospital, L'Aquila, Italy
| | - Giuseppe Sica
- General Surgery Unit, Policlinico Tor Vergata University Hospital, Roma, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology Unit, IRCCS G. Pascale Foundation, Napoli, Italy
| | | | | | - Vittoria Barbieri
- General Surgery Unit, Cardinale G. Panico Hospital, Tricase, LE, Italy
| | - Pietro Amodio
- General Surgery Unit, Belcolle Hospital, Viterbo, Italy
| | - Carlo Di Marco
- General Surgery Unit, Conegliano Hospital (TV) ULSS2 Marca Trevigiana, Conegliano, Italy
| | | | | | - Alberto Patriti
- General Surgery Unit, Marche Nord Hospital, Pesaro e Fano, PU, Italy
| | - Felice Pirozzi
- General Surgery Unit, ASL Napoli2 Hospital, Pozzuoli, NA, Italy
| | - Raffaele De Luca
- General Surgery Unit, IRCCS Istituto Giovanni Paolo II, Bari, Italy
| | - Stefano Mancini
- General & Oncologic Surgery Unit, San Filippo Neri Hospital, Roma, Italy
| | | | - Matteo Scaramuzzi
- General Surgery Unit, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | | | - Michele Motter
- General Surgery Unit 1, Santa Chiara Hospital, Trento, Italy
| | | | - Mauro Totis
- General Surgery Unit, San Gerardo Hospital, Monza, Italy
| | - Andrea Gennai
- General Surgery Unit, Sant'Andrea Hospital, La Spezia, Italy
| | - Diletta Frazzini
- General Surgery Unit, Ospedale Civile Di Pescara, Pescara, Italy
| | | | | | - Francesco Crafa
- General & Oncologic Surgery Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | | | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Roberto Persiani
- Minimally Invasive Oncologic Surgery Unit, IRCCS Policlinico Gemelli Foundation, Roma, Italy
| | - Felice Borghi
- General Surgery Unit, Santa Croce E Carle Hospital, Cuneo, Italy
| | | | - Marco Catarci
- General Surgery Unit, CG Mazzoni Hospital, Ascoli Piceno, Italy
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Guadagni S, Farina AR, Cappabianca LA, Sebastiano M, Maccarone R, Zelli V, Clementi M, Chiominto A, Bruera G, Ricevuto E, Fiorentini G, Sarti D, Mackay AR. Multidisciplinary Treatment, Including Locoregional Chemotherapy, for Merkel-Polyomavirus-Positive Merkel Cell Carcinomas: Perspectives for Patients Exhibiting Oncogenic Alternative Δ exon 6-7 TrkAIII Splicing of Neurotrophin Receptor Tropomyosin-Related Kinase A. Int J Mol Sci 2020; 21:ijms21218222. [PMID: 33153070 PMCID: PMC7662965 DOI: 10.3390/ijms21218222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 01/19/2023] Open
Abstract
Merkel cell carcinomas (MCCs) are rare, aggressive, cutaneous neuroendocrine tumours, approximately 80% of which are caused by the genomic integration of Merkel cell polyomavirus (MCPyV). MCPyV-positive MCCs carry poor prognosis in approximately 70% of cases, highlighting the need for greater understanding of the oncogenic mechanisms involved in pathogenesis, progression and post-therapeutic relapse, and translation into novel therapeutic strategies. In a previous pilot study, we reported a potential relationship between MCPyV gene expression and oncogenic alternative Δ exon 6–7 TrkAIII splicing in formalin-fixed paraffin-embedded (FFPE) MCC tissues from a 12-patient cohort of >90% MCPyV-positive MCCs, diagnosed at San Salvatore Hospital, L’Aquila, Italy, characterising a new MCC subgroup and unveiling a novel potential MCPyV oncogenic mechanism and therapeutic target. This, however, could not be fully verified due to poor RNA quality and difficulty in protein extraction from FFPE tissues. Here, therefore, we extend our previous observations to confirm the relationship between MCPyV and oncogenic alternative Δ exon 6–7 TrkAIII splicing in fresh, nonfixed, MCPyV-positive MCC metastasis by detecting sequence-verified RT-PCR products, including full-length Δ exon 6–7 TrkAIII, and by Western blot detection of a 100 kDa TrkA protein isoform of identical size to 100 kDa Δ exon 6–7 TrkAIII expressed by stable transfected SH-SY5Y cells. We also report that in three MCC patients submitted for multidisciplinary treatment, including locoregional chemotherapy, MCPyV large T-antigen mRNA expression, Δ exon 6–7 TrkAIII mRNA expression and intracellular indirect immunofluorescence (IF) TrkA and phosphorylation protein isoform(s) immunoreactivity in FFPE tissues were not reduced in postchemotherapeutic-relapsed MCCs compared to pretherapeutic MCCs, extending the possible roles of this novel potential MCPyV oncogenic mechanism from MCC pathogenesis to post-therapeutic relapse and progression. Detection of alternative Δ exon 6–7 TrkAIII splicing in MCC, therefore, not only characterises a new MCPyV-positive MCC subgroup and unveils a novel potential MCPyV oncogenic mechanism but also identifies patients who may benefit from inhibitors of MCPyV T-antigen and/or TrkAIII expression or clinically approved Trk kinase inhibitors such as larotrectinib or entrectinib, which are known to inhibit activated TrkA oncogenes and to elicit durable responses in TrkA-fusion oncogene-driven cancers, supporting the call for a large-scale multicentre clinical study.
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MESH Headings
- Aged
- Aged, 80 and over
- Alternative Splicing/genetics
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Carcinoma, Merkel Cell/diagnosis
- Carcinoma, Merkel Cell/genetics
- Carcinoma, Merkel Cell/mortality
- Carcinoma, Merkel Cell/therapy
- Cell Transformation, Neoplastic/genetics
- Combined Modality Therapy
- Drug Administration Routes
- Female
- Humans
- Interdisciplinary Communication
- Italy/epidemiology
- Male
- Merkel cell polyomavirus/isolation & purification
- Merkel cell polyomavirus/physiology
- Middle Aged
- Molecular Diagnostic Techniques
- Mutation
- Patient Care Team
- Polyomavirus Infections/diagnosis
- Polyomavirus Infections/genetics
- Polyomavirus Infections/mortality
- Polyomavirus Infections/therapy
- Prognosis
- Receptor, trkA/genetics
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/mortality
- Skin Neoplasms/therapy
- Survival Analysis
- Tumor Virus Infections/diagnosis
- Tumor Virus Infections/genetics
- Tumor Virus Infections/mortality
- Tumor Virus Infections/therapy
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
- Correspondence:
| | - Antonietta Rosella Farina
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Lucia Annamaria Cappabianca
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Michela Sebastiano
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Rita Maccarone
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Veronica Zelli
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Marco Clementi
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Alessandro Chiominto
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Gemma Bruera
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Enrico Ricevuto
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Giammaria Fiorentini
- Department of Onco-Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy; (G.F.); (D.S.)
| | - Donatella Sarti
- Department of Onco-Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy; (G.F.); (D.S.)
| | - Andrew Reay Mackay
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
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Guadagni S, Clementi M, Masedu F, Fiorentini G, Sarti D, Deraco M, Kusamura S, Papasotiriou I, Apostolou P, Aigner KR, Zavattieri G, Farina AR, Vizzielli G, Scambia G, Mackay AR. A Pilot Study of the Predictive Potential of Chemosensitivity and Gene Expression Assays Using Circulating Tumour Cells from Patients with Recurrent Ovarian Cancer. Int J Mol Sci 2020; 21:E4813. [PMID: 32646060 DOI: 10.3390/ijms21134813] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 01/19/2023] Open
Abstract
Circulating tumour cells (CTCs) from liquid biopsies are under current investigation in several cancers, including epithelial ovarian cancer (EOC) but face significant drawbacks in terms of non-standardised methodology, low viable cell numbers and accuracy of CTC identification. In this pilot study, we report that chemosensitivity assays using liquid biopsy-derived metastatic EOC CTCs, from 10 patients, nine with stage IIIC and one with stage IV disease, in progression after systemic chemotherapy, submitted for hypoxic isolated abdominal perfusion (HAP), are both feasible and useful in predicting response to therapy. Viable metastatic EOC CTCs (>5 cells/mL for all 10 blood samples), enriched by transient culture and identified by reverse transcription polymerase chain reaction (RT-PCR) and indirect immunofluorescence (IF), were subjected to flow cytometry-based Annexin V-PE assays for chemosensitivity to several chemotherapeutic agents and by RT-PCR for tumour gene expression profiling. Using a cut-off value of >80% cell death, CTC chemosensitivity tests were predictive of patient RECIST 1.1 responses to HAP therapy associated with 100% sensitivity, 50% specificity, 33% positive predictive, 100% negative predictive and 60% accuracy values. We propose that the methodology employed in this study is feasible and has the potential to predict response to therapy, setting the stage for a larger study.
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16
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Caricato M, Baiocchi GL, Crafa F, Scabini S, Brisinda G, Clementi M, Sica G, Delrio P, Longo G, Anania G, de Manzini N, Amodio P, Lucchi A, Baldazzi G, Garulli G, Patriti A, Pirozzi F, Pavanello M, Carrara A, Campagnacci R, Liverani A, Muratore A, Siquini W, De Luca R, Mancini S, Borghi F, Di Cosmo M, Persiani R, Pedrazzani C, Scaramuzzi M, Scatizzi M, Vettoretto N, Totis M, Gennai A, Marini P, Basti M, Viola M, Ruffo G, Catarci M. Colorectal surgery in Italy during the Covid19 outbreak: a survey from the iCral study group. Updates Surg 2020; 72:249-257. [PMID: 32436016 PMCID: PMC7238958 DOI: 10.1007/s13304-020-00760-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The COVID19 pandemic had a deep impact on healthcare facilities in Italy, with profound reorganization of surgical activities. The Italian ColoRectal Anastomotic Leakage (iCral) study group collecting 43 Italian surgical centers experienced in colorectal surgery from multiple regions performed a quick survey to make a snapshot of the current situation. METHODS A 25-items questionnaire was sent to the 43 principal investigators of the iCral study group, with questions regarding qualitative and quantitative aspects of the surgical activity before and after the COVID19 outbreak. RESULTS Two-thirds of the centers were involved in the treatment of COVID19 cases. Intensive care units (ICU) beds were partially or totally reallocated for the treatment of COVID19 cases in 72% of the hospitals. Elective colorectal surgery for malignancy was stopped or delayed in nearly 30% of the centers, with less than 20% of them still scheduling elective colorectal resections for frail and comorbid patients needing postoperative ICU care. A significant reduction of the number of colorectal resections during the time span from January to March 2020 was recorded, with significant delay in treatment in more than 50% of the centers. DISCUSSION Our survey confirms that COVID19 outbreak is severely affecting the activity of colorectal surgery centers participating to iCral study group. This could impact the activity of surgical centers for many months after the end of the emergency.
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Affiliation(s)
- Marco Caricato
- Colorectal Surgery Unit, Campus BioMedico University Hospital, Rome, Italy
| | | | - Francesco Crafa
- General and Oncologic Surgery Unit, Moscati Hospital, Avellino, Italy
| | - Stefano Scabini
- General and Oncologic Surgery Unit, National Cancer Center "San Martino", Genoa, Italy
| | | | - Marco Clementi
- General Surgery Unit, University Hospital, L'Aquila, Italy
| | - Giuseppe Sica
- General Surgery Unit, Tor Vergata University Hospital, Rome, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology Unit, IRCCS G. Pascale Foundation, Naples, Italy
| | | | | | | | - Pietro Amodio
- General Surgery Unit, Belcolle Hospital, Viterbo, Italy
| | - Andrea Lucchi
- General Surgery Unit, Ceccarini Hospital, Riccione, RN, Italy
| | | | | | - Alberto Patriti
- General Surgery Unit, Marche Nord Hospital, Pesaro e Fano, PU, Italy
| | - Felice Pirozzi
- General Surgery Unit, ASL Napoli2 Hospital, Pozzuoli, NA, Italy
| | | | | | | | - Andrea Liverani
- General Surgery Unit, Regina Apostolorum Hospital, Albano Laziale, RM, Italy
| | - Andrea Muratore
- General Surgery Unit, E. Agnelli Hospital, Pinerolo, TO, Italy
| | - Walter Siquini
- General Surgery Unit, ASUR AV3 Hospital, Macerata, Italy
| | - Raffaele De Luca
- Surgical Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Stefano Mancini
- General and Oncologic Surgery Unit, San Filippo Neri Hospital, Rome, Italy
| | - Felice Borghi
- General Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | | | | | - Matteo Scaramuzzi
- General Surgery Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Nereo Vettoretto
- General Surgery Unit, Spedali Civili of Brescia, Montichiari, BS, Italy
| | - Mauro Totis
- General Surgery Unit, San Gerardo Hospital, Monza, Italy
| | - Andrea Gennai
- General Surgery Unit, Sant'Andrea Hospital, La Spezia, Italy
| | | | - Massimo Basti
- General Surgery Unit, Santo Spirito Hospital, Pescara, Italy
| | - Massimo Viola
- General Surgery Unit, Cardinale Panico Hospital, Tricase, LE, Italy
| | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Marco Catarci
- General Surgery Unit, Ospedale "C. E G. Mazzoni", ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy.
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17
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Patriti A, Baiocchi GL, Catena F, Marini P, Catarci M. Emergency general surgery in Italy during the COVID-19 outbreak: first survey from the real life. World J Emerg Surg 2020; 15:36. [PMID: 32448333 PMCID: PMC7245630 DOI: 10.1186/s13017-020-00314-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has rapidly spread in Italy in late February 2020. Almost all surgical services have been reorganized, with the aim of maintaining an adequate therapeutic path, especially for surgical emergencies. The knowledge of how surgeons dealing with emergency surgery have reacted to the epidemic in the real life can be useful while drafting clinical recommendations. METHODS Surgeons from multiple Italian regions were invited answering to an online survey in order to make a snapshot of their current behaviors towards COVID-19-positive patients bearing urgent surgical diseases. Questions about institutional rules and personal approach for patient treatment and to limit epidemic spread were included in a 37-item questionnaire. RESULTS Seventy-one questionnaires from institutions dealing with emergency surgery were accepted. Participating surgeons were equally subdivided from a geographical point of view, with a large proportion of public (97.2%) and non-academical (91.5%) centers. In 80.3% of cases, the hospitals treated COVID-19 patients; in 69.1% of centers, a change in work plan was necessary, and 33.8% of teams had almost a surgeon infected or in preventive quarantine. The vast majority of surgeons operated only on urgent cases (73.9%), but the number of interventions significantly dropped. Up to 40% of non-traumatic abdominal emergency cases had an unusual delayed treatment. The laparoscopic approach was used in 69.6% of interventions on COVID-19 patients. Strategies to protect health care workers against COVID-19 infection and to identify asymptomatic infected surgeons were suboptimal with respect to the WHO recommendations in 70.4% and 90.2% of centers, respectively. Advanced personal protective equipment for operating room workers was adopted for all surgeries in only 12.7% of centers. DISCUSSION This survey confirms that the COVID-19 outbreak is dramatically changing the practice of emergency surgery centers in Italy. Despite the reduction in number, urgent cases were on average more challenging owing to diagnostic delay. Recommendations from the International Scientific Societies are frequently not complied concerning the use of laparoscopic approach, the availability of personal protective equipment in the operating rooms, and the testing of both asymptomatic physicians and patients scheduled for surgery. A further evaluation of the short-term results of these attitudes is warranted to modulate international recommendations.
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Affiliation(s)
- Alberto Patriti
- Department of Surgery, Azienda Ospedaliera Marche Nord, Ospedale San Salvatore, Piazzale Cinelli 1, Pesaro-Fano, Italy.
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Pierluigi Marini
- General Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Marco Catarci
- General Surgery Unit, Ospedale "C. e G. Mazzoni", ASUR Marche AV5, Ascoli Piceno, Italy
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Guadagni S, Clementi M, Mackay AR, Ricevuto E, Fiorentini G, Sarti D, Palumbo P, Apostolou P, Papasotiriou I, Masedu F, Valenti M, Giordano AV, Bruera G. Real-life multidisciplinary treatment for unresectable colorectal cancer liver metastases including hepatic artery infusion with chemo-filtration and liquid biopsy precision oncotherapy: observational cohort study. J Cancer Res Clin Oncol 2020; 146:1273-1290. [PMID: 32088781 PMCID: PMC7142062 DOI: 10.1007/s00432-020-03156-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatic artery infusion (HAI) and drug selection by liquid biopsy precision oncotherapy are under investigation for the multidisciplinary treatment of unresectable colorectal liver metastases (CRCLM) in progression after systemic therapy. Here, we compare the safety and efficacy of third-line HAI followed by target therapy with drug regimes selected by liquid biopsy precision oncotherapy to third-line systemic therapy with drug regimes selected partly by tissue biopsy precision oncotherapy, in a retrospective real-life study of 106 unresectable CRCLM patients. METHODS Drug regimens for HAI/target therapy were selected by assessing the sensitivity of purified circulating tumor cell (CTCs) to 5-fluorouracil, carboplatin, cisplatin, oxaliplatin, irinotecan, doxorubicin, mitomycin, raltitrexed, and melphalan in-vitro and by real-time qRT-PCR gene expression assays, and for the Systemic therapy cohort were selected by age, comorbidity, performance status, and absence of RAS mutations. Therapeutic responses, adverse events, and quality of life were evaluated by RECIST 1.1, CTCAE 4.03, and ECOG criteria, respectively, and chemo-filtration performed following HAI to reduce systemic toxic effects. RESULTS HAI/target therapy with drugs selected by liquid biopsy precision oncotherapy (44 patients), resulted in 2.27% CRs, 38.63% PRs, 56.81% SD,s and 2.27% PDs; ECOG 2 to 1 improvement, but no infusion-related technical or vascular complications, or deaths. Systemic therapy (62 patients) resulted in 1.6% CRs, 17.74% PRs, 37.09% SDs, and 45.16% PDs; more grade 1-2 adverse events and 4.84% ECOG 1 to 2 worsening. The median 5 month PFS in the HAI/target therapy cohort was significantly longer than 3 months in the systemic cohort (P < 0.007) and the median 14 month survival in the HAI/target therapy cohort was longer than 8.5 months in the systemic therapy cohort but not statistically significant. Multivariate analysis identified ECOG grade 2 as the most unfavourable survival prognostic factor in both cohorts. CONCLUSIONS HAI plus chemo-filtration followed by target therapy, with drug regimens selected by liquid biopsy precision oncotherapy, is a safe and efficacious alternative therapeutic strategy for unresectable CRCLM in progression after two lines of systemic therapy and should be considered for a multicentre prospective phase III study, to fully confirm this potential.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Marco Clementi
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Andrew R Mackay
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Enrico Ricevuto
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
- Oncology Territorial Care S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L'Aquila, Italy
| | - Giammaria Fiorentini
- Department of Oncology and Hematology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Donatella Sarti
- Department of Oncology and Hematology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Paola Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | | | | | - Francesco Masedu
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Marco Valenti
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | | | - Gemma Bruera
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, 67100, L'Aquila, Italy
- Oncology Territorial Care S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L'Aquila, Italy
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Guadagni S, Fiorentini G, Papasotiriou I, Apostolou P, Masedu F, Sarti D, Farina AR, Mackay AR, Clementi M. Circulating tumour cell liquid biopsy in selecting therapy for recurrent cutaneous melanoma with locoregional pelvic metastases: a pilot study. BMC Res Notes 2020; 13:176. [PMID: 32204733 PMCID: PMC7092420 DOI: 10.1186/s13104-020-05021-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/13/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Circulating tumour cells (CTCs) from liquid biopsies provide an exceptional opportunity to obtain real-time tumour information and are under current investigation in several cancers, including cutaneous melanoma, but face significant drawbacks in terms of non-standardised methodology, low viable cell numbers and accuracy of CTC identification. In this pilot study, we report that chemosensitivity assays using liquid biopsy-derived metastatic melanoma (MM) CTCs, from 7 patients with stage IIIC, BRAF wild-type metastatic melanomas, localized exclusively to the pelvic region, un-eligible for immunotherapy and treated with melphalan hypoxic pelvic perfusion (HPP), is both feasible and useful in predicting response to therapy. Viable MM CTCs (> 5 cells/ml for all 7 blood samples), enriched by transient culture, were characterised in flow cytometry-based Annexin V-PE assays for chemosensitivity to several drugs. RESULTS Using melphalan as a standard, chemosensitivity cut-off values of > 60% cell death, were predictive of patient RECIST 1.1 response to melphalan HPP therapy, associated with calculated 100% sensitivity, 66.67% specificity, 33.33% positive predictive, 100% negative predictive, and 71.43% accuracy values. We propose that the methodology in this study is both feasible and has potential value in predicting response to therapy, setting the stage for a larger study. Trial registration Clinical Trials.gov Identifier NCT01920516; date of trial registration: August 6, 2013.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giammaria Fiorentini
- Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | | | | | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Donatella Sarti
- Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Antonietta Rossella Farina
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrew Reay Mackay
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Marco Clementi
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
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Pellegrini C, Cardelli L, Padova MD, Nardo LD, Ciciarelli V, Rocco T, Cipolloni G, Clementi M, Cortellini A, Ventura A, Leocata P, Fargnoli MC. Intra-patient Heterogeneity of BRAF and NRAS Molecular Alterations in Primary Melanoma and Metastases. Acta Derm Venereol 2020; 100:adv00040. [PMID: 31774543 PMCID: PMC9128895 DOI: 10.2340/00015555-3382] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mutations in MAPK signalling genes are driver events in melanoma, and have therapeutic relevance in the metastatic and adjuvant setting. This study evaluated the intra-patient heterogeneity of BRAF, NRAS and c-KIT mutational status between 30 primary melanomas and 39 related metastases, using molecular analysis and immunohistochemistry. BRAF mutations were identified in 46.7% of primary melanomas and 48.7% of metastases and NRAS mutations in 20% and 25.6%, respectively. Intra-patient heterogeneity was detected in 13.3% of patients for both BRAF and NRAS genes and was not associated with clinico-pathological characteristics of melanomas or metastases. High consistency was observed between immunostaining and molecular methods for BRAFV600E (k = 0.90; p < 0.001) and NRASQ61R (k = 0.87; p < 0.001). These findings demonstrate a relevant intra-patient heterogeneity between primary and metastatic lesions that is independent of clinical variables and methodological approach.
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Affiliation(s)
- Cristina Pellegrini
- Dermatology Unit, Department of Biotechnological and Applied Clinical Science , University of L'Aquila, Via Vetoio, Coppito, IT-67100 L'Aquila, Italy
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Clementi M, Di Furia M, Sista F, Mackay AR, Guadagni S. Successful laparoscopic trans-peritoneal repair of an incisional inguinal hernia, resulting from deep lymph node dissection for melanoma: A case report. Int J Surg Case Rep 2020; 67:82-85. [PMID: 32044563 PMCID: PMC7013140 DOI: 10.1016/j.ijscr.2020.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/10/2020] [Accepted: 01/17/2020] [Indexed: 01/19/2023] Open
Abstract
Groin incisional hernia may result like late complication of deep pelvic dissection. When this type of inguinal ventral hernia develops, the surgeon is facing some problems different to the common ventral hernia repair. Most of these difficulties may be overcome using laparoscopic approach. We present a case of successful laparoscopic repair of a giant ventral hernia developed like late complication of deep pelvic dissection for melanoma. To our knowledge, no other laparoscopic repair of this type of ventral hernia has been previously reported.
Introduction Deep pelvic lymph node dissection for cancer may result in incisional inguinal hernias. We present a case report of successful laparoscopic trans-peritoneal repair of a large ventral inguinal hernia that developed following ileo-inguinal lymph node dissection (CLND) for melanoma. Case presentation A successful 3 port laparoscopic trans-peritoneal procedure was performed on a 56-year-old female for the repair of a left inguinal hernia, developed 13 months following CLND for melanoma. The large oval 18 × 14 cm inguinal defect, with superior margins bordering the conjoint tendon and inferior margins bordering the ileo-psoas muscle, femoral vessels and nerve, was not closed in order to avoid excessive tension and was repaired by fixing a 25 × 20 cm intra-peritoneal mesh to abdominal borders at superior and lateral margins with permanent fasteners and at the inferior margin by a cyanoacrylate-glued overlap to protect femoral vessels and nerves from damage. No hernia recurrence was observed 8 months following this procedure. Discussion Incisional inguinal hernias, following CLND, are rare but present a challenge to surgeons due to the difficulty in identifying both anatomical plains and safe sites for stable repair. Conclusions We report a laparoscopic trans-peritoneal approach for the safe, reproducible and efficacious repair of incisional inguinal hernias that result from CLND. In our opinion prevention of hernia recurrence can be achieved by a intraperitoneal large mesh fixed at superior and lateral margin borders with permanent fasteners and using cyanoacrylate glue to overlap inferior margin borders in order to prevent vessels and/or nerve injury.
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Affiliation(s)
- M Clementi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - M Di Furia
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - F Sista
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - A R Mackay
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - S Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
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Anania G, Agresta F, Artioli E, Rubino S, Resta G, Vettoretto N, Petz WL, Bergamini C, Arezzo A, Valpiani G, Morotti C, Silecchia G; SICE CoDIG (Colon Dx Italian Group). Correction to: Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospectivetrial on 1225 cases comparing intra corporeal versus extra corporeal ileo‑colic side‑to‑side anastomosis. Surg Endosc 2020; 34:4801-2. [PMID: 31832859 DOI: 10.1007/s00464-019-07322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Due to an error in production the members of SICE CoDIG (Colon Dx Italian Group) listed in the Acknowledgments were not tagged correctly as authors in the XML of this article. This listing is presented again here.
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Anania G, Agresta F, Artioli E, Rubino S, Resta G, Vettoretto N, Petz WL, Bergamini C, Arezzo A, Valpiani G, Morotti C, Silecchia G. Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis. Surg Endosc 2019; 34:4788-4800. [PMID: 31741153 PMCID: PMC7572335 DOI: 10.1007/s00464-019-07255-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023]
Abstract
Background While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons’ attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients’ characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration Clinical trial (Identifier: NCT03934151).
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Affiliation(s)
- Gabriele Anania
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy. .,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Ferdinando Agresta
- Department of General Surgery, ULSS5 Polesana del Veneto, Adria, RO, Italy
| | - Elena Artioli
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Serena Rubino
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giuseppe Resta
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Nereo Vettoretto
- Montichiari Surgery, ASST Spedali Civili Brescia, Montichiari, BS, Italy
| | - Wanda Luisa Petz
- Division of Gastrointestinal Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Carlo Bergamini
- Department of Emergency Surgery, University Hospital of Careggi, Florence, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Giorgia Valpiani
- MsC in Statistics at Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Morotti
- MsC in Statistics at Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Gianfranco Silecchia
- Department of Medical Surgical Science and Biotechnologies, Faculty Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
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Guadagni S, Fiorentini G, De Simone M, Masedu F, Zoras O, Mackay AR, Sarti D, Papasotiriou I, Apostolou P, Catarci M, Clementi M, Ricevuto E, Bruera G. Precision oncotherapy based on liquid biopsies in multidisciplinary treatment of unresectable recurrent rectal cancer: a retrospective cohort study. J Cancer Res Clin Oncol 2020; 146:205-19. [PMID: 31620896 DOI: 10.1007/s00432-019-03046-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/09/2019] [Indexed: 01/19/2023]
Abstract
Background Third line innovative systemic treatments and loco-regional chemotherapy by hypoxic pelvic perfusion (HPP) have both been proposed for the treatment of unresectable not responsive recurrent rectal cancer (URRC). In the present study, we have compared the safety and efficacy of HPP/target therapy, using drug regimens selected by liquid biopsy precision oncotherapy, to third-line systemic therapy based on tissue specimens precision oncotherapy. Methods HPP/target therapy regimens were selected based on precision oncotherapy, including assays for chemosensitivity and viability, and qRT-PCR for tumor-related gene expression. In the control group, systemic third-line and further lines of therapy were defined according to clinical and biological parameters. Results From 2007 to 2019, 62 URRC patients were enrolled, comprised of 43 patients in the HPP/target-therapy group and 19 patients in the systemic therapy control group. No HPP related complications were reported and the most common adverse events were skin and bone marrow toxicity. In the HPP/target-therapy group, the ORR was 41.8% whereas in the systemic therapy control group was 15.8%. DCR of the HPP/target-therapy group was significantly improved over the systemic therapy group (P = 0.001), associated with a PFS of 8 vs 4 months (P = 0.009), and OS of 20 vs 8 months (P = 0.046). Conclusions The present data indicate that in URCC patients, the integration of HPP/target-therapy and precision oncotherapy based upon liquid biopsy is as effective and efficacious as third-line treatment in local disease control and, therefore, deserves to be further assessed and compared to conventional systemic treatments in future prospective randomized trials.
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Guadagni S, Chiominto A, Mackay AR, Farina AR, Cappabianca L, Puccica I, Valiyeva S, Clementi M. Advanced Merkel cell carcinoma of the lower extremity treated with surgery and isolated pelvic and limb perfusion using Melphalan: A case of unexpected long-term survival. Int J Surg Case Rep 2019; 61:4-8. [PMID: 31302319 PMCID: PMC6626978 DOI: 10.1016/j.ijscr.2019.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/27/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Merkel cell carcinoma (MCC) is a rare, neuroendocrine skin tumor, with high frequency of locoregional recurrence, metastases, and poor prognosis. Locoregional MCC recurrence in the extremities can pose considerable treatment challenges. We report a case of long-term survival in a female patient with recurrent MCC of the leg, treated with surgery and locoregional chemotherapy. PRESENTATION OF CASE A 73-year-old female with cirrhosis and hepatitis C, developed cutaneous MCC in the left inferior limb. This patient initially received surgical treatment, with subsequent negative sentinel lymph-node biopsy in another center, one-month prior recovery in our department, and arrived with 4 new limb nodules, cranially to the previously treated area, without distant metastases or inguinal lymph node recurrence. This patient was not eligible for immunotherapy due to active hepatitis upon treatment with NS5B inhibitors, or eligible for systemic chemotherapy or radiotherapy due to severe neutropenia and was, therefore, subjected to surgical resection combined with Isolated Pelvic and Limb Perfusion (IPLP) with Melphalan. Histological evaluation confirmed MCC diagnosis and during the following 4 months, she developed further locoregional recurrences with homolateral inguinal lymph node involvement and was subjected to two additional rounds of surgery plus IPLP. DISCUSSION All procedures were tolerated, systemic toxicities were temporary and subsequent clinical and radiological follow-up, following the last combined treatment, indicated that this patient was still alive and disease-free, at 56 months. CONCLUSION In this case, surgery combined with locoregional Melphalan chemotherapy was an effective and repeatable treatment for recurrent MMC and resulted in unexpected long-term survival.
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Affiliation(s)
- S Guadagni
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy; Alma Mater Europaea-European Center, Maribor, Slovenia.
| | - A Chiominto
- Department of Pathology, San Salvatore Hospital, L'Aquila, Italy.
| | - A R Mackay
- Department of Applied Clinical Sciences and Biotechnology, Section of Pathology and Clinical Molecular Oncology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - A R Farina
- Department of Applied Clinical Sciences and Biotechnology, Section of Pathology and Clinical Molecular Oncology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - L Cappabianca
- Department of Applied Clinical Sciences and Biotechnology, Section of Pathology and Clinical Molecular Oncology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - I Puccica
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy.
| | - S Valiyeva
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy.
| | - M Clementi
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy.
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Guadagni S, Fiorentini G, Palumbo P, Masedu F, Ricevuto E, Bruera G, Deraco M, Kusamura S, Sarti D, Fiorentini C, Gailhofer S, Clementi M. Hypoxic pelvic perfusion with cisplatin and mitomycin C in multidisciplinary palliative treatment of patients with unresectable recurrent rectal cancer: a retrospective study. MINERVA CHIR 2019; 74:304-312. [PMID: 31062943 DOI: 10.23736/s0026-4733.19.07896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with unresectable recurrent rectal cancer that progresses after systemic chemotherapy and radiotherapy may be candidates for palliation with hypoxic pelvic perfusion (HPP). The aim of this observational retrospective study was to evaluate if a multimodality treatment including HPP and targeted-therapy may be useful to prolong clinical responses and survival of these patients. METHODS Thirty-seven patients with unresectable recurrent rectal cancer in progression after standard treatments underwent repeated HPP with mitomycin C (25 mg/m2) and cisplatin (70 mg/m2). Twenty patients, exhibiting epidermal growth factor receptor (EGFR) overexpression, also received cetuximab targeted-therapy, following the ultimate HPP treatment. RESULTS Following initial HPP treatment, median progression-free survival was 7 months (range: 5-19 months), median time-to-death or termination of follow-up was 13 months (range: 9-18 months), one-year survival-rate was 59.45%, two-year survival rate was 10.81%, and three-year survival rate was 2.7%. Survival was significantly influenced by cetuximab targeted-therapy post-HPP and the presence of additional metastatic sites (P<0.03). CONCLUSIONS Repeated HPP treatments with mitomycin C plus cisplatin, followed by cetuximab targeted-therapy, may represent a safe and efficacious palliative therapy in patients with unresectable recurrent rectal cancer, in progression following standard systemic chemo- and radio-therapy, and thus warrants confirmation in a larger phase III study.
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Affiliation(s)
- Stefano Guadagni
- Section of General Surgery, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy -
| | - Giammaria Fiorentini
- Unit of Medical Oncology, Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paola Palumbo
- Laboratory of Immunopathology, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Section of Biostatistics and Epidemiology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Enrico Ricevuto
- Section of Oncology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Gemma Bruera
- Section of Oncology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marcello Deraco
- Unit of Peritoneal Surface Malignancies, Colon and Rectal Surgery, National Cancer Institute Foundation, Milan, Italy
| | - Shigeki Kusamura
- Unit of Peritoneal Surface Malignancies, Colon and Rectal Surgery, National Cancer Institute Foundation, Milan, Italy
| | - Donatella Sarti
- Unit of Medical Oncology, Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Caterina Fiorentini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sabine Gailhofer
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany
| | - Marco Clementi
- Section of General Surgery, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Guadagni S, Aigner K, Zoras O, Masedu F, Fiorentini G, Ricevuto E, Deraco M, Clementi M. Isolated thoracic perfusion in lung metastases from breast cancer: a retrospective observational study. Updates Surg 2018; 71:165-177. [PMID: 30542956 DOI: 10.1007/s13304-018-00613-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/05/2018] [Indexed: 01/19/2023]
Abstract
The median overall survival of metastatic breast cancer (MBC) patients is still approximately 2 years. This is even lower in triple-negative breast cancer (TNBC) patients with concomitant lung metastases. These patients are often not suitable for surgery and not responsive to systemic chemotherapy. Isolated thoracic perfusion (ITP) followed by chemofiltration has been used for palliation in selected specialised centres. A retrospective observational study evaluating 162 MBC patients who underwent 407 ITP procedures was performed. The primary objective was the evaluation of the feasibility, safety, tolerability and efficacy of ITP in the complete cohort of 162 patients with LM from breast cancer. The secondary objective of the study was the evaluation of responses and median survivals in 43 TNBC patients with LM. In the 162 patients, ITP appeared safe and well tolerated with MST from LM diagnosis to death or last contact of 19.5 months. In the subgroup of patients treated with systemic chemotherapy followed by ITP at progression, the MST from LM diagnosis to death or last contact was 29 months. In the subgroup of TNBC patients treated with systemic chemotherapy followed by ITP at progression, the MST from LM diagnosis to death or last contact was 19 months (ITP overall response rate was 65.52%). ITP followed by chemofiltration could be adopted in the sequential palliation treatments of BC patients with LM in progression after systemic chemotherapy, especially with TNBC. The present data allow interesting considerations about tolerability and responses, but do not allow robust conclusions about survival.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy.
| | - Karl Aigner
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany
| | - Odisseas Zoras
- Department of Surgical Oncology, University of Crete, Heraklion, Greece
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Giammaria Fiorentini
- Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Enrico Ricevuto
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancies Unit, Colon and Rectal Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Sista F, Abruzzese V, Guadagni S, Carandina S, Clementi M. High Resected Gastric Volume and poorly controlled DM2 in laparoscopic sleeve gastrectomy. Ann Med Surg (Lond) 2018; 36:142-147. [PMID: 30479760 PMCID: PMC6240704 DOI: 10.1016/j.amsu.2018.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/14/2018] [Indexed: 01/19/2023] Open
Abstract
Background Our aim is to evaluate the effects of High Resected Gastric Volume(HRGV) on poorly Type 2 Diabetes Mellitus(DM2) after Laparoscopic Sleeve Gastrectomy(LSG). Methods 256 patients were divided into two groups according to the RGV: < 1500 mL(Group A: 131 pts) and > 1500 mL(Group B: 147 pts). % excess body mass index loss (%EBMIL), Fasting Blood Glucose (FBG), HbA1c, C peptide were assessed before surgery and at the 3rd day, 6th,12th,24th,36th month after LSG. Results A significant difference in %EBMIL between the two groups at 24 and 36 months was found. RGV was not significantly associated with DM2 in the multivariate logistic regression. FBG levels showed no differences between the two groups. A significant decrease of Hb1Ac at 6 and 12 months was found in group B. The C-peptide level showed a significant reduction at 6 and 12 months in group B. Conclusion The HRGV may play a role in the regulation of the glucose metabolism in the first year after LSG without influence in poorly DM2 control. Further studies are needed to confirm these findings.
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Affiliation(s)
- Federico Sista
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Valentina Abruzzese
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Stefano Guadagni
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Sergio Carandina
- ELSAN, Surgical Obesity Center (CCO), Clinique Saint Michel, Toulon, France
| | - Marco Clementi
- Dipartimento MESVA, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
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Marco C, Luigi B, Federico S, Vincenzo V, Andrea S, Marino DF, Ilaria P, Stefano G. Laparoscopic treatment of obstructed internal supravesical hernia: A cases series and rewiev of the literature. Ann Med Surg (Lond) 2018; 36:58-62. [PMID: 30402220 DOI: 10.1016/j.amsu.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction internal supravesical hernia (ISH) is an exceptional subtype of internal hernia often presenting with small bowel obstruction (SBO). Its rarity makes preoperative suspicion and diagnosis very difficult in an emergency setting. Methods we retrospectively analyzed the database of patients admitted in a single center emergency unit for small bowel occlusion (SBO) in virgin abdomen and treated by surgery from August 2013 to October 2018. The patients with intraoperative diagnosis of ISH were included in this study. Results from 29 patients with virgin abdomen submitted to surgery for SBO, two cases of ISH were recorded. In both cases preoperative diagnosis was made by CT scan and urgent treatment was successfully performed by laparoscopy, reducing the entrapped small bowel and closing the hernia's ring by continuous suture. No intestinal resection was needed. Discussion urgent laparotomic repair of obstructive ISH is the standard treatment although laparoscopic approach has also been described in a small number of cases. We reported our experience on two cases in which totally laparoscopic treatment was successfully performed in patients with stable hemodynamic parameters thanks to early diagnosis and limited intestinal distension. By an extensive analysis of the international literature, clinical, diagnostic and therapeutic aspects of this form of internal hernia were discussed. Conclusion CT scan facilitates early ISH preoperative diagnosis, reducing the risk of small bowel resection and increasing the chances of minimally invasive laparoscopic treatment. Internal supravesical hernia is a rare condition presenting with acute small bowel obstruction. We present two cases in which laparoscopic treatment has been successfully performed. A complete review of the literature was also reported.
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Sista F, Abruzzese V, Carandina S, Salvatorelli A, Furia MD, Cipolloni G, Vicentini V, Guadagni S, Clementi M. Which is the correlation between carcinoid tumor and Laparoscopic Sleeve Gastrectomy? A case series and literature review. Ann Med Surg (Lond) 2018; 36:252-255. [PMID: 30568792 PMCID: PMC6287372 DOI: 10.1016/j.amsu.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction Gastric Carcinoid Tumors (GCT) are very rare in general population, but some studies evidenced a higher incidence among bariatric surgery patients. Laparoscopic Sleeve Gastrectomy (LSG) is a widely accepted procedure for the surgical treatment of morbid obesity. LSG acts both in reducing food intake and interfering with hormonal balance in the gut-brain axis. In these patients, incidental GCT diagnosis can occur both during pre-bariatric surgery investigation and during post-operative follow-up. Methods We retrospectively analyzed the database of obesity patients submitted to LSG in two different centers to find out incidence of GCT in patients treated by surgery from May 2013 to March 2018. Results From the 560 obese consecutive patients underwent LSG, we recorded two cases of patients with GCT (0.36%): the case 1 was a patient who had a pre-operative diagnosis of GTC receiving a curative LSG which totally included the carcinoid in the resected portion; the case 2 was a patient that received a curative endoscopic resection 42 months after LSG. Discussion the predisposing factors that can correlate GCT with obesity and LSG and in particular the hormonal changes have been discussed. We illustrated our experience about the management of these tumors in obese patients. Conclusion there are neither certain data which evidence a correlation between obesity and GCT, nor data to support the hypothesis of a higher incidence of GCT after bariatric surgery. Based on our experience in obese patients the finding of GCT in the pre-operatory phase is not an absolute contraindication for bariatric surgery. Recent observations showed a high incidence of Gastric Carcinoid Tumor (GCT) in candidate patients for bariatric surgery. From a multicenter experience with Laparoscopic Sleeve Gastrectomy. We retrospectively recorded two GCT cases in obese patients (the first found out during pre-operative investigations and the second one detected 52 months after surgery). The possible correlations between obesity, LSG and GTC have been discussed.
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Affiliation(s)
- Federico Sista
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Valentina Abruzzese
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Sergio Carandina
- ELSAN, Surgical Obesity Center(CCO), Clinique Saint Michel, Toulon, France
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Gianluca Cipolloni
- Pathology Unit, Biomedical Department, San Salvatore Hospital, Via L Natali 1, 67100, Coppito (AQ), Italy
| | - Vincenzo Vicentini
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Stefano Guadagni
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S, Tommasi, 67100, Coppito (AQ), Italy
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Guadagni S, Clementi M, Bencivenga M, Kusamura S, Fiorentini C, Masedu F. Palliation with a multimodality treatment including hypoxic pelvic perfusion for unresectable recurrent rectal cancer: outcomes based on a retrospective study. Updates Surg 2018; 70:441-447. [PMID: 30191532 DOI: 10.1007/s13304-018-0592-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/29/2018] [Indexed: 01/19/2023]
Abstract
Patients with unresectable recurrent rectal cancer that progresses after systemic chemotherapy and radiotherapy are candidates for palliation with hypoxic pelvic perfusion (HPP). The aim of this observational retrospective study was to evaluate if a multimodality treatment including HPP and targeted-therapy may be useful to prolong clinical responses and survival of these patients. From a cohort of 77 patients with unresectable recurrent rectal cancer in progression after standard treatments and submitted to HPP, 21 patients underwent repeat HPP using mitomycin C (MMC) at the dose of 25 mg/m2. After the last HPP, 7 patients received a targeted-therapy with cetuximab according to overexpression of epidermal growth factor receptor in recurrence cancer cells. The median overall survival of these 21 patients from the diagnosis of unresectable recurrent rectal cancer was 23 months (iqr 18-24). After the first HPP, the median survival of the 21 patients until death or end of follow-up was 10 months (iqr 9-13). The 1-year and 2-year survival rates were 71.4%, and 4.8%, respectively. From the first HPP, age > 60 years, a recurrence shrinkage of at least 30% (partial response), and the addition of a post-HPP targeted-therapy with cetuximab significantly affected survival (P < 0.04). In conclusion, repeated MMC-HPP followed by targeted-therapy seems to be an effective palliative treatment for patients with unresectable recurrent rectal cancer in progression after systemic chemotherapy and radiation but the results of this study have to be confirmed by a larger phase III trial.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, Section of General Surgery, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Shigeki Kusamura
- Fondazione IRCCS, Istituto Nazionale dei Tumori Milano, Via Venezian 1, 20133, Milan, Italy
| | - Caterina Fiorentini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
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Guadagni S, Fiorentini G, Clementi M, Palumbo G, Masedu F, Deraco M, De Manzoni G, Chiominto A, Valenti M, Pellegrini C. MGMT methylation correlates with melphalan pelvic perfusion survival in stage III melanoma patients: a pilot study. Melanoma Res 2017; 27:439-47. [PMID: 28486243 DOI: 10.1097/CMR.0000000000000367] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Approximately 25% of melanoma patients with locoregional metastases are nonresponsive to new molecular target therapy and immunotherapy. When metastases are located in the pelvis, melphalan hypoxic perfusion can be an optional treatment. Because methylation of MGMT promoter increases the efficacy of alkylating agents, studies on melanoma outcome of patients treated with melphalan regional chemotherapy should consider this epigenetic change. This study aims to evaluate whether the survival of stage III melanoma patients treated with melphalan regional chemotherapy may be correlated with MGMT methylation status. The metastatic tissues of 27 stage III melanoma patients with locoregional metastases located in the pelvis subjected to melphalan hypoxic pelvic perfusion were examined. The methylation status of the MGMT promoter was investigated by MS-MLPA probes analysis and the presence of the BRAF V600E mutation was analyzed by CAST-PCR. The median survival times were estimated using the Kaplan–Meier curves and were stratified according to the clinicopathological characteristics of patients and lesions. The overall median survival time was 17 months. The 1-year, 3-year, and 5-year survival rates were 66.7, 18.5, and 7.4%, respectively. Disease stage, burden, and percentage of MGMT methylation significantly affected survival. We estimated an MGMT promoter methylation cut-off of at least 14%, which was significantly associated with a longer survival after melphalan regional chemotherapy. Our data suggest that MGMT promoter methylation could be an important factor in determining which melanoma patients should receive melphalan regional chemotherapy, but its prognostic significance in the routine clinical setting needs to be clarified in a larger study.
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Di Furia M, Salvatorelli A, Della Penna A, Vicentini V, Sista F, Chiominto A, Guadagni S, Clementi M. Advantage of laparoscopic resection for pelvic Schwannoma: Case report and review of the literature. Int J Surg Case Rep 2018; 45:38-41. [PMID: 29571063 PMCID: PMC6000728 DOI: 10.1016/j.ijscr.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/11/2018] [Indexed: 01/19/2023] Open
Abstract
Retroperitoneal schwannomas are usually asymptomatic, rare neoplasms. Diagnosis can only be achieved with surgical removal of mass. Laparoscopy is the most useful therapeutic approach.
Introduction Single pelvic schwannomas are rare tumor arising from the retrorectal, lateral or obturatory space. Laparoscopic approach to schwannoma located in lateral pelvic space has been previously described only in one case report. We present a case of a successful laparoscopic resection of pelvic schwannoma emphasizing the advantages of such a minimal invasive approach. Presentation of case A 54-years-old, obese, male patient was admitted to our hospital referring dysuria and strangury. Abdominal CT scan showed a lateral pelvic well-circumscribed mass with smooth regular margins. A CT-guided fine needle biopsy resulted non-diagnostic. An elective laparoscopic resection was performed. The patient had a short, uneventful post-operative course. Pathological examination revealed a benign schwannoma. Discussion Using PubMed database, we reviewed the English language international literature using the MeSH terms “laparoscopic,” “minimally invasive” and “schwannoma”. We identified quite 20 previous cases of pelvic schwannomas removed by laparoscopy or robotic surgery. We found out that a preoperative diagnosis of these rare neoplasms is difficult to be obtained; in most cases, laparoscopic approach was successfully performed. Conclusion Despite it could not be proven yet, due to the rarity of this tumor, we agree with literature that laparoscopic removal of pelvic benign tumor may offer several advantages. The direct high-definition vision deeply into this narrow anatomical space, especially in obese patients, provides a detailed view that makes easier to isolate and spear the anatomical structures surrounding the tumor. Furthermore, the pneumoperitoneum may create the right plane of dissection, minimizing the risk of tumor rupture and bleeding.
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Affiliation(s)
- Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy.
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Andrea Della Penna
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Vincenzo Vicentini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Federico Sista
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Alessandro Chiominto
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Stefano Guadagni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
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Sista F, Abruzzese V, Clementi M, Guadagni S, Montana L, Carandina S. Resolution of type 2 diabetes after sleeve gastrectomy: a 2-step hypothesis. Surg Obes Relat Dis 2017; 14:284-290. [PMID: 29339031 DOI: 10.1016/j.soard.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Weight loss (WL) and altered gut hormonal levels are involved in glucose homeostasis after laparoscopic sleeve gastrectomy (LSG). OBJECTIVES The aim of this study was to evaluate the time-related effects of WL, ghrelin, and glucacon-like peptide-1 (GLP-1) plasma concentrations on type 2 diabetes resolution after LSG. SETTING University hospital, Italy. METHODS Ninety-one patients who underwent LSG were investigated. Insulin secretion (insulinogenic index [IGI]), insulin resistance, plasma glucose level and percentage glycated hemoglobin using the oral glucose tolerance test were assessed before surgery, on postoperative day 3, and then at 6, 12, 24, and 36 months after LSG. At the same time points, WL, ghrelin, and GLP-1 levels were determined. RESULTS During follow-up, the resolution rate of type 2 diabetes was 9.4%, 42.3%, 71.8%, 81.2%, and 91.8%, respectively. Ghrelin plasma concentrations decreased significantly after LSG (271.5 ± 24.5 pg/mL versus 122.4 ± 23.4 pg/mL, P = .04). GLP-1 plasma concentrations increased significantly after LSG (1.7 ± 2.6 pg/mL versus 2.5 ± 3.4 pg/mL, P = .04). The percentage of excess weight loss and IGI presented a positive linear correlation (r) at all follow-up time points with a strong positive correlation at 12 and 24 months. A strong negative correlation between ghrelin and IGI was recorded during the first 3 days after LSG (r = -.9). GLP-1 and IGI presented a strong positive correlation at day 3 and 6 months (i.e., .8 and .8, respectively). CONCLUSION LSG may affect glucose homeostasis by 2 different time-related modes: a first step in which the hormonal changes play a predominant role in glucose homeostasis and a second step in which the percentage excess weight loss determines the metabolic results.
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Affiliation(s)
- Federico Sista
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Valentina Abruzzese
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Marco Clementi
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Stefano Guadagni
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Laura Montana
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of digestive and metabolic surgery, Avicenne university hospital, Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France
| | - Sergio Carandina
- ELSAN, Surgical obesity Center (CCO), Clinique Saint Michel, Toulon, France.
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Guadagni S, Fiorentini G, Clementi M, Palumbo G, Palumbo P, Chiominto A, Baldoni S, Masedu F, Valenti M, Tommaso AD, Fabi B, Aliberti C, Sarti D, Guadagni V, Pellegrini C. Does Locoregional Chemotherapy Still Matter in the Treatment of Advanced Pelvic Melanoma? Int J Mol Sci 2017; 18:ijms18112382. [PMID: 29120401 PMCID: PMC5713351 DOI: 10.3390/ijms18112382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023] Open
Abstract
Pelvic Melanoma relapse occurs in 15% of patients with loco regional metastases, and 25% of cases do not respond to new target-therapy and/or immunotherapy. Melphalan hypoxic pelvic perfusion may, therefore, be an option for these non-responsive patients. Overall median survival time (MST), stratified for variables, including BRAF V600E mutation and eligibility for treatments with new immunotherapy drugs, was retrospectively assessed in 41 patients with pelvic melanoma loco regional metastases. They had received a total of 175 treatments with Melphalan hypoxic perfusion and cytoreductive excision. Among the 41 patients, 22 (53.7%) patients exhibited a wild-type BRAF genotype, 11 of which were not eligible for immunotherapy. The first treatment resulted in a 97.5% response-rate in the full cohort and a 100% response-rate in the 22 wild-type BRAF patients. MST was 18 months in the full sample, 20 months for the 22 wild-type BRAF patients and 21 months for the 11 wild-type BRAF patients not eligible for immunotherapy. Melphalan hypoxic perfusion is a potentially effective treatment for patients with pelvic melanoma loco regional metastases that requires confirmation in a larger multicenter study.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Giammaria Fiorentini
- Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy.
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Giancarlo Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Paola Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Alessandro Chiominto
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Stefano Baldoni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Ambra Di Tommaso
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Bianca Fabi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Camillo Aliberti
- Department of Radiology, Institute for the Research and Treatment of Cancer, 35128 Padova, Italy.
| | - Donatella Sarti
- Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy.
| | - Veronica Guadagni
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Cristina Pellegrini
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
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Clementi M, Colozzi S, Schietroma M, Sista F, Della Penna A, Chiominto A, Guadagni S. Intraluminal ileal tumour after right hemicolectomy for cancer: An implantation recurrence or a new cancer? A case report. Ann Med Surg (Lond) 2017; 23:17-20. [PMID: 29098076 PMCID: PMC5656755 DOI: 10.1016/j.amsu.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/13/2017] [Accepted: 09/17/2017] [Indexed: 01/19/2023] Open
Abstract
Introduction Extra-anastomotic intraluminal recurrence of the colon cancer after curative surgery was rarely reported but intraluminal ileal relapse has not been described to date.We report a case of intraluminal ileal tumor arising after curative right hemicolectomy that could be ascribed to an implantation of exfoliated cancer cells. Case report A 71-years old man was admitted with no metastatic stenotic adenocarcinoma of the hepatic flexure and submitted, without preoperative bowel preparation, to right hemicolectomy using a "no-touch" technique. Histology showed moderately differentiated adenocarcinoma without lymph nodes involvement (pT3N0). No adjuvant therapy was prescribed. First colonoscopy three months after surgery was negative but a second endoscopic examination nine months later revealed an ileal neoplasia, presenting like an ulcer 10 cm proximally to ileocolic anastomosis. A new ileo-colic resection including past anastomosis was performed with curative intent. Pathological examination showed moderately differentiated adenocarcinoma extended to peri-visceral fat tissue with 10 tumor-free lymph nodes. (pT3N0). Six courses of Capecitabine adjuvant chemotherapy was prescribed and 32 months after second surgery, the patient is alive without disease. Discussion In the present case, the relatively short time from the primary surgery and the fact that recurrence occurred outside the anastomosis suggest that implantation of exfoliated malignant cells seems to be the main pathogenetic mechanism. We suppose that the high grade of primary cancer and the occlusive condition could have promoted the cancer cells reflux through the ileocecal orifice and in the transverse colon. Conclusion This case seems to confirm the intraluminal implanting capacity of exfoliated carcinoma cells.
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Affiliation(s)
- Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Sara Colozzi
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Mario Schietroma
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Federico Sista
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Andrea Della Penna
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Alessandro Chiominto
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Stefano Guadagni
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
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Guadagni S, Palumbo G, Fiorentini G, Clementi M, Marsili L, Giordano AV, Masedu F, Valenti M. Surgical versus percutaneous isolated pelvic perfusion (IPP) for advanced melanoma: comparison in terms of melphalan pharmacokinetic pelvic bio-availability. BMC Res Notes 2017; 10:411. [PMID: 28810925 PMCID: PMC5558752 DOI: 10.1186/s13104-017-2738-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/07/2017] [Indexed: 01/19/2023] Open
Abstract
Background Isolated pelvic perfusion (IPP) can be used to treat unresectable melanoma metastases of the pelvis. IPP can be performed either by surgical or percutaneous approaches, using different balloon catheters. The aim of this study was to examine whether the surgical and percutaneous approaches were comparable with respect to tumor drug exposure in the pelvis. Methods A pharmacokinetic study was performed in 5 melanoma patients treated with surgical IPP and five with percutaneous IPP. Both groups received melphalan at the dose of 30 mg/m2. Melphalan pharmacokinetic analyses were performed and the main parameter used to evaluate pelvic tumor drug-exposure was the ratio of areas under the melphalan plasma concentration curves in the pelvis and the systemic compartment, during the perfusion time (AUC0 to 20). Non-parametric Mann–Whitney tests were employed for statistical comparisons. Results The median and interquartile range (IQR) values of the ratios between melphalan AUC0 to 20 in pelvic and systemic compartments were 7.9 (IQR 7.2 to 9.9) and 5 (IQR 4 to 7.9) for surgical and percutaneous IPPs, respectively (p = 0.209). Conclusions Tumor exposure to drug using these two methods did not statistically differ and both methods, therefore, can be adopted interchangeably, utilizing a perfusion blood flow rate of approximately 120 ml/min. The small sample size is a limitation of this study but our preliminary results can be used to calculate the effect size of a larger trial. Trial Registration Clinical Trials.gov Identifier NCT01920516; date of trial registration: August 6, 2013 Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2738-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy.
| | - Giancarlo Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Giammaria Fiorentini
- Medical Oncology Unit, Department of Oncology and Hematology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Luca Marsili
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Aldo Victor Giordano
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
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Guadagni S, Fiorentini G, Clementi M, Palumbo P, Mambrini A, Masedu F. Mitomycin C hypoxic pelvic perfusion for unresectable recurrent rectal cancer: pharmacokinetic comparison of surgical and percutaneous techniques. Updates Surg 2017; 69:403-10. [PMID: 28791628 DOI: 10.1007/s13304-017-0480-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/12/2017] [Indexed: 01/19/2023]
Abstract
Abstract Patients with unresectable recurrent rectal cancer that progresses after standard and multi-modular treatments are candidates for hypoxic pelvic perfusion. Hypoxic pelvic perfusion can be performed using a surgical or percutaneous approach. The aim of this study was to examine whether the surgical and percutaneous approaches are comparable with respect to tumor drug exposure in the pelvis. A pharmacokinetic study was performed in 18 patients. Both the surgical and percutaneous procedures were performed using mitomycin C (MMC) at a dose of 25 mg/m2. The main parameter that was used to evaluate pelvic tumor drug exposure was the ratio of the areas under the MMC plasma concentration curves in the pelvis and the systemic compartment during the perfusion time (AUC0–20). The mean values ± SD for the ratios between the MMC AUC0–20 in the pelvic and systemic compartments were 14.38 ± 4.31 and 13.15 ± 4.26 for the surgical and percutaneous techniques, respectively (p = 0.53). This pharmacokinetic study demonstrated that the percutaneous approach for hypoxic pelvic perfusion did not statistically differ from the surgical approach. When perfusion must be repeated several times in the same patient, the percutaneous and surgical methods may be adopted interchangeably. ClinicalTrials.gov Identifier NCT01891552.
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Schietroma M, Pessia B, Colozzi S, Carlei F, Clementi M, Amicucci G, Guadagni S. Septic Complications after Resection for Middle or Low Rectal Cancer: Role of Gut Barrier Function and Inflammatory Serum Markers. Dig Surg 2017; 34:507-517. [PMID: 28768258 DOI: 10.1159/000475847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 04/17/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The focus of this study was to understand the relationship between the failure of gut barrier function, inflammatory markers and septic complications after resection for extraperitoneal rectal cancer. METHODS One hundred seven patients were enrolled into this prospective observational study and underwent open colorectal resection for extraperitoneal cancer. All patients underwent an assessment of intestinal permeability (L/M ratio), endotoxemia, interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP) and elastase levels before surgery and on postoperative days 1, 3, and 7. RESULTS Septic complications developed in 23.3% of patients. There were no significant differences in preoperative L/M ratio, endotoxine, CRP, interleukin-1 (IL-1), IL-6, and elastase levels between septic and non-septic groups. All patients showed a significant increase in intestinal permeability, endotoxemia, IL-1, IL-6, CRP, and elastase on the first postoperative day. At postoperative day 7, the septic group continued to demonstrate an increase in intestinal permeability, endotoxemia and elastase and significant difference was observed between the 2 groups (p < 0.05), whereas there was no significant difference in IL-1, IL-6, and CRP levels. CONCLUSION The pattern of change in the postoperative period of intestinal permeability, systemic endotoxemia and elastase concentration is significantly higher in patients in whom sepsis develops, while the concentration of IL-1β, IL-6, and CRP does not permit to distinguish infection from inflammation.
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Schietroma M, Pessia B, Bianchi Z, De Vita F, Carlei F, Guadagni S, Amicucci G, Clementi M. Thyroid Surgery: To Drain or Not to Drain, That Is the Problem - A Randomized Clinical Trial. ORL J Otorhinolaryngol Relat Spec 2017; 79:202-211. [PMID: 28715809 DOI: 10.1159/000464137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/15/2017] [Indexed: 01/19/2023]
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Guadagni S, Fiorentini G, Clementi M, Palumbo G, Chiominto A, Cappelli S, Masedu F, Valenti M. Melphalan hypoxic perfusion with hemofiltration for melanoma locoregional metastases in the pelvis. J Surg Res 2017; 215:114-124. [PMID: 28688635 DOI: 10.1016/j.jss.2017.03.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/17/2017] [Accepted: 03/30/2017] [Indexed: 01/19/2023]
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Di Furia M, Della Penna A, Salvatorelli A, Clementi M, Guadagni S. A single thyroid nodule revealing early metastases from clear cell renal carcinoma: case report and review of literature. Int J Surg Case Rep 2017; 34:96-99. [PMID: 28376423 PMCID: PMC5379901 DOI: 10.1016/j.ijscr.2017.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION We report the case of an incidental solitary renal cancer cell (RCC) thyroid metastatic nodule treated by thyroidectomy. PRESENTATION OF CASE A 53 year male presented with a solitary, asymptomatic thyroid nodule. He was treated with left nephrectomy 1 year before for a RCC. Radiological standard follow-up was negative for secondary lesions but ultrasound (US) 12 months after surgery revealed a 1.5cm solid nodule in the right lobe of the gland. Fine needle aspiration biopsy (FNAB) was inadequate and the patient was submitted to total thyroidectomy. Histology showed the presence of solitary metastasis from RCC. At 2 years follow-up, no evidence of recurrence has been found. DISCUSSION Solitary RCC metastasis to the thyroid usually occurs late from nephrectomy and have no specific US pattern. When FNAB provides an uncertain cytological results, the patient received thyroidectomy for primary thyroid tumors and diagnosis of metastases from RCC was incidentally made. CONCLUSION Thyroid nodules in a patient with history of malignancy can pose a diagnostic challenge. The presence of a solitary thyroid nodule in a patient with history of RCC should be carefully suspected for metastasis. We suggest to extend at neck the thorax and abdomen CT scan routinely recommended during the follow-up in high-risk cases. Thyroidectomy may result in prolonged survival in selected cases of isolated thyroid metastasis from RCC.
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Affiliation(s)
- Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy.
| | - Andrea Della Penna
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Stefano Guadagni
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
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Clementi M, Colozzi S, Guadagni S, Pessia B, Sista F, Schietroma M, Della Penna A, Amicucci G. Spontaneous liver rupture associated with anticoagulant therapy A case report. Ann Ital Chir 2017. [PMID: 28630388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
UNLABELLED Spontaneous hepatic rupture without underlying liver diseases is uncommon entity. We report a rare case of spontaneous rupture of liver hematoma in patient treated with warfarin end enoxaparin sodium because of pulmonary embolism. Two day after admission the patient complained generalized abdominal pain and hemodynamic instability. The abdominal US and TC scan revealed free fluid and lesion at right liver lobe. The patient, despite intravenous fluid support and blood transfusion, was hemodinamically instable and urgent laparotomy was needed. At laparotomy, it was found that a subcapsular haematoma, involving the diaphragmatic face of the right liver, had ruptured into peritoneum. Hepatic bleeding was stopped using a conservative approach by Pringle manoeuvre, parenchymal suture and fibrin sealant. There was no complication related to hepatic surgery but the patient died because of new massive pulmonary embolism 10 days after surgery. The absence of underlying liver pathology was confirmed by autopsy examination. This case report suggests that the possibility of spontaneous liver rupture should be considered in patients being treated with oral anticoagulants. Early diagnosis are critically important given the high morbidity and mortality. Aggressive resuscitation and immediate exploratory laparotomy is needed when hemodynamic instability occurs. In our case a quick, safe and effective control of bleeding was provided by partial vascular occlusion, parenchymal suture and topical haemostatic agent. KEY WORD Anticoagulant therapy, Araumatic hemoperitoneum, Liver hematoma.
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Schietroma M, Piccione F, Clementi M, Cecilia EM, Sista F, Pessia B, Carlei F, Guadagni S, Amicucci G. Short- and Long-Term, 11-22 Years, Results after Laparoscopic Nissen Fundoplication in Obese versus Nonobese Patients. J Obes 2017; 2017:7589408. [PMID: 28584666 PMCID: PMC5444001 DOI: 10.1155/2017/7589408] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/10/2017] [Accepted: 04/23/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Some studies suggest that obesity is associated with a poor outcome after Laparoscopic Nissen Fundoplication (LNF), whereas others have not replicated these findings. The effect of body mass index (BMI) on the short- and long-term results of LNF is investigated. METHODS Inclusion criteria were only patients who undergone a LNF with at least 11-year follow-up data available, patients with preoperative weight and height data available for calculation of BMI (Kg/m2), and patients with a BMI up to a maximum of 34.9. RESULTS 201 patients met the inclusion criteria: 43 (21.4%) had a normal BMI, 89 (44.2%) were overweight, and 69 (34.4%) were obese. The operation was significantly longer in obese patients; the use of drains and graft was less in the normal BMI group (p < 0.0001). The hospital stay, conversion (6,4%), and intraoperative and early postoperative complications were not influenced by BMI. CONCLUSIONS BMI does not influence short-term outcomes following LNF, but long-term control of reflux in obese patients is worse than in normal weight subjects.
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Affiliation(s)
| | - Federica Piccione
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
- *Federica Piccione:
| | - Marco Clementi
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | | | - Federico Sista
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | - Beatrice Pessia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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Sista F, Abruzzese V, Clementi M, Carandina S, Amicucci G. Effect of Resected Gastric Volume on Ghrelin and GLP-1 Plasma Levels: a Prospective Study. J Gastrointest Surg 2016; 20:1931-41. [PMID: 27738878 DOI: 10.1007/s11605-016-3292-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The correlation between resected gastric volume (RGV) and neuro-humoral changes (ghrelin and GLP-1) after laparoscopic sleeve gastrectomy (LSG) and their effects on type 2 diabetes mellitus (T2DM) has been evaluated. MATERIALS Ninety-eight patients were divided in two groups: RGV <1200 mL (group A: 53 pts) and RGV >1200 mL (group B: 45 pts). Insulin secretion (insulin area under the curve (AUC)), insulinogenic index (IGI) and insulin-resistance (homeostasis model assessment, HOMAIR) were assessed before and after surgery (at the 3rd day and 6, 12 and 24 months after LSG) using the oral glucose tolerance test (OGTT). At the same time, ghrelin and GLP-1 levels were determined. RESULTS A significant difference in T2DM resolution rate was observed after 6, 12 and 24 months in favour of RGV >1200 mL. Group B performed better than group A at the 3rd day and at the 6th, 12th and 24th months with regard to AUC, IGI and HOMAIR. In both groups, OGTT resulted in decreased ghrelin values and a significant increase in GLP-1 values for group B at the 3rd day and at the 6th and 12th months with no difference at the 24th month. CONCLUSION Ghrelin and GLP-1 changes play a role in the regulation of glucose metabolism during the 1st year after LSG. RGV influences ghrelin and GLP-1 plasma levels after LSG, with a significant improvement in the T2DM control.
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Guadagni S, Müller H, Valenti M, Clementi M, Fiorentini G, Cantore M, Amicucci G. Thoracic Stop-Flow Perfusion in the Treatment of Refractory Non Small Cell Lung Cancer. J Chemother 2016; 16 Suppl 5:40-3. [PMID: 15675476 DOI: 10.1080/1120009x.2004.11782382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study was undertaken to determine the survival of patients with unresectable and refractory non small cell lung cancer (NSCLC) submitted to thoracic stop-flow perfusion (TSP). Forty-five patients with NSCLC confined to thoracic region entered the study. All 45 patients had been pretreated with some form of chemotherapy and had progression of disease. The cytostatic regimen was mitomycin 10 mg/m2, navelbine 25 mg/m2 and cisplatin 60 mg/m2. In 39/45 patients, immediately after TSP, hemofiltration was performed to reduce systemic side effects There were 16/45 responses to the first TSP (CR 0; PR 16): a response rate of 35.6%. Median time to progression was 4 months. Median survival was 7.5 months.1-year survival rate was 36.4%, 2-year survival rate was 14%, and 3-year survival rate was 5.7%.
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Affiliation(s)
- S Guadagni
- Dept of Surgical Sciences, University of L'Aquila, L'Aquila, Italy.
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Sista F, Abruzzese V, Clementi M, Carandina S, Cecilia M, Amicucci G. The effect of sleeve gastrectomy on GLP-1 secretion and gastric emptying: a prospective study. Surg Obes Relat Dis 2016; 13:7-14. [PMID: 27692912 DOI: 10.1016/j.soard.2016.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/23/2016] [Accepted: 08/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rapid gastric emptying has been proposed to justify the increase in glucagon-like polypeptide-1 (GLP-1) after laparoscopic sleeve gastrectomy (LSG). OBJECTIVES To assess gastric emptying changes after LSG and their relationship with GLP-1 secretion. SETTING San Salvatore Hospital general surgery unit, University of L'Aquila, Italy. METHODS 52 patients underwent gastric emptying scintigraphy for liquid and solid foods, before and 3 months after LSG. Twenty-six patients were in the liquid group (L group) and the remaining in the solid group (S group). We evaluated the half time of gastric emptying (T1/2) and percentage of gastric retention (%GR) at 15, 30, and 60 minutes for liquids and at 30, 60, 90, and 120 minutes for solids. GLP-1 plasma concentrations were measured in each group before and after LSG and related to %GR. Statistical analysis was performed by Χ2 test and Pearson correlation(r). RESULTS After surgery, T1/2 was significantly accelerated: 15.2±13 min and 33.5±18 min in the L group and S group, respectively (P<.05). In both groups, GLP-1 plasma concentrations were increased at each blood sampling time: 2.91±2.9 pg/mL, 3.06±3.1 pg/mL and 3.21±2.6 pg/mL at 15, 30, and 60 minutes, respectively, (P<.05) for L group and 2.72±1.5 pg/mL, 2.89±2.1 pg/mL, 2.93±1.8 pg/mL, and 2.95±1.9 pg/mL at 30, 60, 90, and 120 minutes, respectively, (P< .05) for the S group. After LSG, GLP-1 and %GR presented a negative linear correlation (r) at each blood sampling time in both groups. CONCLUSION The rapid gastric emptying 3 months after LSG upregulates the production of GLP-1 in the distal bowel. Further studies are needed to confirm these findings.
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Affiliation(s)
- Federico Sista
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie (DISCAB), Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy.
| | - Valentina Abruzzese
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie (DISCAB), Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Marco Clementi
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie (DISCAB), Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Sergio Carandina
- Service de Chirurgie Digestive, Hôpital Avicenne , Université Paris XIII, Bobigny, France
| | - Manuela Cecilia
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie (DISCAB), Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Gianfranco Amicucci
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie (DISCAB), Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
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Schietroma M, Piccione F, Carlei F, Clementi M, Bianchi Z, de Vita F, Amicucci G. Peritonitis from perforated appendicitis: stress response after laparoscopic or open treatment. Am Surg 2012; 78:582-90. [PMID: 22546132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Elevated intra-abdominal pressure during laparoscopy may promote systemic inflammatory response. In patients with generalized peritonitis from perforated appendicitis, we sought to compare acute phase response and immunologic status from laparoscopic and open approach. One hundred and forty-seven consecutive patients underwent appendectomy for perforated appendicitis (73 patients had laparoscopic appendectomy and 74 patients had open appendectomy. Bacteremia, endotoxemia, white blood cells, peripheral lymphocytes subpopulation, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase, interleukin-1 and 6 (IL-1 and 6), and C-reactive protein were investigated. One hour after intervention, bacteremia was significantly higher in the open group compared with the laparoscopic group (P < 0.05). A significantly higher concentration of systemic endotoxin was detected intraoperatively in the open group of patients in comparison with the laparoscopic group (P < 0.05). Laparotomy caused a significant increase in neutrophil concentration, neutrophil-elastase, IL-1 and 6, and C-reactive protein and a decrease of HLA-DR. We recorded 6 cases (8.1%) of intra-abdominal abscess in the open group and one (1.3%) in the laparoscopic group (P < 0.05). Open appendectomy, in case of peritonitis, increased the incidence of bacteremia, endotoxemia, and systemic inflammation compared with laparoscopic appendectomy. Early enhanced postoperative systemic inflammation may cause lower transient immunologic defense after laparotomy (decrease of HLA-DR), leading to enhanced sepsis in these patients.
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Guadagni S, Clementi M, Valenti M, Fiorentini G, Cantore M, Kanavos E, Caterino GP, Di Giuro G, Amicucci G. Hypoxic abdominal stop-flow perfusion in the treatment of advanced pancreatic cancer: a phase II evaluation/trial. Eur J Surg Oncol 2006; 33:72-8. [PMID: 17166688 DOI: 10.1016/j.ejso.2006.10.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 10/27/2006] [Indexed: 01/19/2023] Open
Abstract
In the past decade, some authors have reported objective responses and prolonged median survival times using hypoxic abdominal perfusion (HAP) for the treatment of advanced pancreatic cancer. However, these promising results have not been confirmed by others, making it difficult to define the effectiveness of this loco-regional chemotherapy. The aim of this study, therefore, was to evaluate the response rate, time to disease progression and overall survival following HAP treatment of 22 consecutive patients with advanced pancreatic tumors. Within the period from 1999 to 2003, 22 patients with histological diagnosis of unresectable stage III/IV pancreatic cancer, not responsive to systemic chemotherapy, were treated with mitomycin C 30mg/m(2) and cisplatin 60mg/m(2) by HAP (stop flow technique). Immediately after perfusion, hemofiltration was performed to reduce systemic side toxic effects. Responses were assessed by CT-scan 30days from the end of treatment. Minor or partial responses were confirmed by a second CT-scan 4weeks later. Following 26 treatment cycles no death or technical complications were recorded; four patients (18.2%) achieved a partial response, 2 (9.1%) a minimal response and 13 (59.1%) stable disease. The remaining 3 patients (13.6%) showed progression of the disease. The median time to disease progression was 3 months (range 1-10). The median survival time from the start of regional chemotherapy was 6 months (range 1.9-16), with a 1-year survival rate of 9%. Our data show that HAP is a relatively effective second-line treatment for advanced stage pancreatic cancer with a low complication rate. We do not concur with the opinion of others that HAP is an inactive treatment approach. However, taking into account the invasiveness of this procedure, and associated morbidity and cost, HAP would not appear to be preferable to less invasive loco-regional chemotherapeutic alternatives.
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Affiliation(s)
- S Guadagni
- Department of Surgical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
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Silecchia G, Fabiano P, Raparelli L, Perrotta N, Greco F, Clementi M, Elmore U, Pecchia A, Basso N. [Laparoscopic splenectomy: analysis of 60 consecutive cases]. Chir Ital 2002; 54:295-300. [PMID: 12192922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of the study was to analyze the results of 60 patients who were candidates for laparoscopic splenectomy. Over the period from May 1994 to May 2001, 60 patients were candidates for splenectomy. Laparoscopy was contraindicated in 3 cases because of ASA III and marked splenomegaly (2 cases) and previous gastric resection (1 case). The procedure was indicated for benign disease in 38 cases and for malignant disease in the remainder. Fifty-three procedures were completed laparoscopically (92.9%). Conversion proved necessary in 4 patients (6.7%) due to large incisional hernia, perisplenic abscess, bleeding of major splenic vessels at the hilum and marked splenomegaly (2 cases of lymphoma). The mean operative time was 200 min for the malignancies and 110 min for the benign conditions (P < 0.05). Major morbidity occurred in 5 cases (8.7%). No deaths were registered. The mean postoperative hospital stay was 7.5 days for patients with malignancies and 5.2 days for patients with benign disease (P < 0.05). Laparoscopic splenectomy was safe and effective in patients with benign disease, even in cases of marked splenomegaly. The morbidity rate was significantly higher in lymphoma patients than in patients with benign haematological disorders.
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Affiliation(s)
- Gianfranco Silecchia
- Dipartimento di Chirurgia Generale Specialità Chirurgiche e Trapianti d'Organo Paride Stefanini, Università degli Studi La Sapienza, Roma
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