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Perrone G, Giuffrida M, Abu-Zidan F, Kruger VF, Livrini M, Petracca GL, Rossi G, Tarasconi A, Tian BWCA, Bonati E, Mentz R, Mazzini FN, Campana JP, Gasser E, Kafka-Ritsch R, Felsenreich DM, Dawoud C, Riss S, Gomes CA, Gomes FC, Gonzaga RAT, Canton CAB, Pereira BM, Fraga GP, Zem LG, Cordeiro-Fonseca V, de Mesquita Tauil R, Atanasov B, Belev N, Kovachev N, Meléndez LJJ, Dimova A, Dimov S, Zelić Z, Augustin G, Bogdanić B, Morić T, Chouillard E, Bajul M, De Simone B, Panis Y, Esposito F, Notarnicola M, Lauka L, Fabbri A, Hentati H, Fnaiech I, Aurélien V, Bougard M, Roulet M, Demetrashvili Z, Pipia I, Merabishvili G, Bouliaris K, Koukoulis G, Doudakmanis C, Xenaki S, Chrysos E, Kokkinakis S, Vassiliu P, Michalopoulos N, Margaris I, Kechagias A, Avgerinos K, Katunin J, Lostoridis E, Nagorni EA, Pujante A, Mulita F, Maroulis I, Vailas M, Marinis A, Siannis I, Bourbouteli E, Manatakis DK, Tasis N, Acheimastos V, Maria S, Stylianos K, Kuzeridis H, Korkolis D, Fradelos E, Kavalieratos G, Petropoulou T, Polydorou A, Papacostantinou I, Triantafyllou T, Kimpizi D, Theodorou D, Toutouzas K, Chamzin A, Frountzas M, Schizas D, Karavokyros I, Syllaios A, Charalabopoulos A, Boura M, Baili E, Ioannidis O, Loutzidou L, Anestiadou E, Tsouknidas I, Petrakis G, Polenta E, Bains L, Gupta R, Singh SK, Khanduri A, Bala M, Kedar A, Pisano M, Podda M, Pisanu A, Martines G, Trigiante G, Lantone G, Agrusa A, Di Buono G, Buscemi S, Veroux M, Gioco R, Veroux G, Oragano L, Zonta S, Lovisetto F, Feo CV, Pesce A, Fabbri N, Lantone G, Marino F, Perrone F, Vincenti L, Papagni V, Picciariello A, Rossi S, Picardi B, Del Monte SR, Visconti D, Osella G, Petruzzelli L, Pignata G, Andreuccetti J, D'Alessio R, Buonfantino M, Guaitoli E, Spinelli S, Sampietro GM, Corbellini C, Lorusso L, Frontali A, Pezzoli I, Bonomi A, Chierici A, Cotsoglou C, Manca G, Delvecchio A, Musa N, Casati M, Letizia L, Abate E, Ercolani G, D'Acapito F, Solaini L, Guercioni G, Cicconi S, Sasia D, Borghi F, Giraudo G, Sena G, Castaldo P, Cardamone E, Portale G, Zuin M, Spolverato Y, Esposito M, Isernia RM, Di Salvo M, Manunza R, Esposito G, Agus M, Asti ELG, Bernardi DT, Tonucci TP, Luppi D, Casadei M, Bonilauri S, Pezzolla A, Panebianco A, Laforgia R, De Luca M, Zese M, Parini D, Jovine E, De Sario G, Lombardi R, Aprea G, Palomba G, Capuano M, Argenio G, Orio G, Armellino MF, Troian M, Guerra M, Nagliati C, Biloslavo A, Germani P, Aizza G, Monsellato I, Chahrour AC, Anania G, Bombardini C, Bagolini F, Sganga G, Fransvea P, Bianchi V, Boati P, Ferrara F, Palmieri F, Cianci P, Gattulli D, Restini E, Cillara N, Cannavera A, Nita GE, Sarnari J, Roscio F, Clerici F, Scandroglio I, Berti S, Cadeo A, Filippelli A, Conti L, Grassi C, Cattaneo GM, Pighin M, Papis D, Gambino G, Bertino V, Schifano D, Prando D, Fogato L, Cavallo F, Ansaloni L, Picheo R, Pontarolo N, Depalma N, Spampinato M, D'Ugo S, Lepre L, Capponi MG, Campa RD, Sarro G, Dinuzzi VP, Olmi S, Uccelli M, Ferrari D, Inama M, Moretto G, Fontana M, Favi F, Picariello E, Rampini A, Barberis A, Azzinnaro A, Oliva A, Totaro L, Benzoni I, Ranieri V, Capolupo GT, Carannante F, Caricato M, Ronconi M, Casiraghi S, Casole G, Pantalone D, Alemanno G, Scheiterle M, Ceresoli M, Cereda M, Fumagalli C, Zanzi F, Bolzon S, Guerra E, Lecchi F, Cellerino P, Ardito A, Scaramuzzo R, Balla A, Lepiane P, Tartaglia N, Ambrosi A, Pavone G, Palini GM, Veneroni S, Garulli G, Ricci C, Torre B, Russo IS, Rottoli M, Tanzanu M, Belvedere A, Milone M, Manigrasso M, De Palma GD, Piccoli M, Pattacini GC, Magnone S, Bertoli P, Pisano M, Massucco P, Palisi M, Luzzi AP, Fleres F, Clarizia G, Spolini A, Kobe Y, Toma T, Shimamura F, Parker R, Ranketi S, Mitei M, Svagzdys S, Pauzas H, Zilinskas J, Poskus T, Kryzauskas M, Jakubauskas M, Zakaria AD, Zakaria Z, Wong MPK, Jusoh AC, Zakaria MN, Cruz DR, Elizalde ABR, Reynaud AB, Hernandez EEL, Monroy JMVP, Hinojosa-Ugarte D, Quiodettis M, Du Bois ME, Latorraca J, Major P, Pędziwiatr M, Pisarska-Adamczyk M, Walędziak M, Kwiatkowski A, Czyżykowski Ł, da Costa SD, Pereira B, Ferreira ARO, Almeida F, Rocha R, Carneiro C, Perez DP, Carvas J, Rocha C, Ferreira C, Marques R, Fernandes U, Leao P, Goulart A, Pereira RG, Patrocínio SDD, de Mendonça NGG, Manso MIC, Morais HMC, Cardoso PS, Calu V, Miron A, Toma EA, Gachabayov M, Abdullaev A, Litvin A, Nechay T, Tyagunov A, Yuldashev A, Bradley A, Wilson M, Panyko A, Látečková Z, Lacko V, Lesko D, Soltes M, Radonak J, Turrado-Rodriguez V, Termes-Serra R, Morales-Sevillano X, Lapolla P, Mingoli A, Brachini G, Degiuli M, Sofia S, Reddavid R, de Manzoni Garberini A, Buffone A, Del Pozo EP, Aparicio-Sánchez D, Dos Barbeito S, Estaire-Gómez M, Vitón-Herrero R, de Los Ángeles Gil Olarte-Marquez M, Gil-Martínez J, Alconchel F, Nicolás-López T, Rahy-Martin AC, Pelloni M, Bañolas-Suarez R, Mendoza-Moreno F, Nisa FGM, Díez-Alonso M, Rodas MEV, Agundez MC, Andrés MIP, Moreira CCL, Perez AL, Ponce IA, González-Castillo AM, Membrilla-Fernández E, Salvans S, Serradilla-Martín M, Pardo PS, Rivera-Alonso D, Dziakova J, Huguet JM, Valle NP, Ruiz EC, Valcárcel CR, Moreno CR, Salazar YTM, García JJR, Micó SS, López JR, Farré SP, Gomez MS, Petit NM, Titos-García A, Aranda-Narváez JM, Romacho-López L, Sánchez-Guillén L, Aranaz-Ostariz V, Bosch-Ramírez M, Martínez-Pérez A, Martínez-López E, Sebastián-Tomás JC, Jimenez-Riera G, Jimenez-Vega J, Cuellar JAN, Campos-Serra A, Muñoz-Campaña A, Gràcia-Roman R, Alegre JM, Pinto FL, O'Sullivan SN, Antona FB, Jiménez BM, López-Sánchez J, Carmona ZG, Fernández RT, Sierra IB, de León LRG, Moreno VP, Iglesias E, Cumplido PL, Bravo AA, Simó IR, Domínguez CL, Caamaño AG, Lozano RC, Martínez MD, Torres ÁN, de Quiros JTMB, Pellino G, Cloquell MM, Moller EG, Jalal-Eldin S, Abdoun AK, Hamid HKS, Lohsiriwat V, Mongkhonsupphawan A, Baraket O, Ayed K, Abbassi I, Ali AB, Ammar H, Kchaou A, Tlili A, Zribi I, Colak E, Polat S, Koylu ZA, Guner A, Usta MA, Reis ME, Mantoglu B, Gonullu E, Akin E, Altintoprak F, Bayhan Z, Firat N, Isik A, Memis U, Bayrak M, Altıntaş Y, Kara Y, Bozkurt MA, Kocataş A, Das K, Seker A, Ozer N, Atici SD, Tuncer K, Kaya T, Ozkan Z, Ilhan O, Agackiran I, Uzunoglu MY, Demirbas E, Altinel Y, Meric S, Hacım NA, Uymaz DS, Omarov N, Balık E, Tebala GD, Khalil H, Rana M, Khan M, Florence C, Swaminathan C, Leo CA, Liasis L, Watfah J, Trostchansky I, Delgado E, Pontillo M, Latifi R, Coimbra R, Edwards S, Lopez A, Velmahos G, Dorken A, Gebran A, Palmer A, Oury J, Bardes JM, Seng SS, Coffua LS, Ratnasekera A, Egodage T, Echeverria-Rosario K, Armento I, Napolitano LM, Sangji NF, Hemmila M, Quick JA, Austin TR, Hyman TS, Curtiss W, McClure A, Cairl N, Biffl WL, Truong HP, Schaffer K, Reames S, Banchini F, Capelli P, Coccolini F, Sartelli M, Bravi F, Vallicelli C, Agnoletti V, Baiocchi GL, Catena F. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago. World J Emerg Surg 2024; 19:14. [PMID: 38627831 PMCID: PMC11020610 DOI: 10.1186/s13017-024-00543-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. METHODS This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. RESULTS 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. CONCLUSIONS After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.
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Affiliation(s)
- Gennaro Perrone
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Mario Giuffrida
- General Surgery Unit, Maggiore Hospital, Parma, Italy.
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy.
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vitor F Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Marco Livrini
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | | | - Giorgio Rossi
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Antonio Tarasconi
- General Surgery Department, UO Chirurgia Generale, ASST Cremona, Cremona, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Elena Bonati
- General Surgery Unit, Maggiore Hospital, Parma, Italy
| | - Ricardo Mentz
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Federico N Mazzini
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan P Campana
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Elisabeth Gasser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Kafka-Ritsch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Dawoud
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlos Augusto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Felipe Couto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Cassio Alfred Brattig Canton
- Medical Course, Department of Surgery - Emergency Surgery and Trauma Sector, Padre Albino University Center, Catanduva, Brazil
| | | | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Leticia Gonçalves Zem
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Boyko Atanasov
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikolay Belev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikola Kovachev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - L Juan José Meléndez
- Trauma and Acute Care Surgeon Hospital Rafael Angel Calderón Guardia, San José, Costa Rica
| | - Ana Dimova
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Stefan Dimov
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Zdravko Zelić
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branko Bogdanić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Trpimir Morić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Elie Chouillard
- Department of General and Bariatric Surgery, American Hospital in Paris, Paris, France
| | - Melinda Bajul
- Emergency and General Minimally Invasive Surgery, Poissy and St Germain Hospital, Poissy, France
| | - Belinda De Simone
- Department of Emergency and General Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve-Saint-Georges, France
| | - Yves Panis
- Colorectal Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Francesco Esposito
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | | | | | | | - Venara Aurélien
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Marie Bougard
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Maxime Roulet
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | | | - Irakli Pipia
- N.Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | | | | | | | - Sofia Xenaki
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Stamatios Kokkinakis
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | | | | | - Ioannis Margaris
- 4th Surgical Department "Attikon" University Hospital, Chaidari, Greece
| | | | | | - Jevgeni Katunin
- Department of Digestive Surgery, Athens Bioclinic Hospital, Athens, Greece
| | | | | | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Michail Vailas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Athanasios Marinis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Ioannis Siannis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Eirini Bourbouteli
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | | | - Nikolaos Tasis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | | | | | | | | | - Dimitrios Korkolis
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - Evangelos Fradelos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - George Kavalieratos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | | | | | | | - Tania Triantafyllou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Despina Kimpizi
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Dimitrios Theodorou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | | | - Alexandros Chamzin
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Maximos Frountzas
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Maria Boura
- National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratia Baili
- National and Kapodistrian University of Athens, Athens, Greece
| | - Orestis Ioannidis
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Lydia Loutzidou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Elissavet Anestiadou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Ioannis Tsouknidas
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Georgios Petrakis
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Eleni Polenta
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Sudhir K Singh
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Archana Khanduri
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Miklosh Bala
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Kedar
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Marcello Pisano
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Mauro Podda
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Gennaro Martines
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuseppe Trigiante
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuliano Lantone
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Antonino Agrusa
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Massimiliano Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Rossella Gioco
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Gastone Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Luigi Oragano
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | - Sandro Zonta
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | | | - Carlo V Feo
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Antonio Pesce
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Nicolò Fabbri
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Giulio Lantone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabio Marino
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabrizio Perrone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Leonardo Vincenti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Vincenzo Papagni
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Arcangelo Picciariello
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | | | - Diego Visconti
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giulia Osella
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Luca Petruzzelli
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giusto Pignata
- Chirurgia Generale 2 ASST Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | - Stefano Spinelli
- Chirurgia Generale PO Valle d'Itria ASL TA, Martina Franca, Italy
| | | | - Carlo Corbellini
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Leonardo Lorusso
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Alice Frontali
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Isabella Pezzoli
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Alessandro Bonomi
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Chierici
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Giuseppe Manca
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Antonella Delvecchio
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Nicola Musa
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | | | - Laface Letizia
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Emmanuele Abate
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Giorgio Ercolani
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Fabrizio D'Acapito
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Leonardo Solaini
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Gianluca Guercioni
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Simone Cicconi
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Diego Sasia
- Santa Croce and Carle Hospital, Cuneo, Italy
| | | | | | - Giuseppe Sena
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Pasquale Castaldo
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Eugenia Cardamone
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Matteo Zuin
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Ylenia Spolverato
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | | | | | | | - Romina Manunza
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | - Marcello Agus
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | | | | | - Davide Luppi
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Massimiliano Casadei
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Stefano Bonilauri
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Angela Pezzolla
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | | | - Rita Laforgia
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | - Maurizio De Luca
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Monica Zese
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Dario Parini
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Elio Jovine
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giuseppina De Sario
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Raffaele Lombardi
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giovanni Aprea
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giuseppe Palomba
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Marianna Capuano
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giulio Argenio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gianluca Orio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Marina Troian
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Martina Guerra
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Carlo Nagliati
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Alan Biloslavo
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Paola Germani
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Giada Aizza
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Igor Monsellato
- SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Fransvea
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Bianchi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Boati
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Ferrara
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Palmieri
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Pasquale Cianci
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Domenico Gattulli
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Enrico Restini
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Nicola Cillara
- Chirurgia Generale PO Santissima Trinità - ASL Cagliari, Cagliari, Italy
| | | | - Gabriela Elisa Nita
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Jlenia Sarnari
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Roscio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Federico Clerici
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Ildo Scandroglio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Stefano Berti
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alessandro Cadeo
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alice Filippelli
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Luigi Conti
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | - Carmine Grassi
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | | | - Marina Pighin
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | - Davide Papis
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | | | | | | | - Daniela Prando
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luisella Fogato
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Fabio Cavallo
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luca Ansaloni
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Roberto Picheo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Nicholas Pontarolo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Norma Depalma
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Marcello Spampinato
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Stefano D'Ugo
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Luca Lepre
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Michela Giulii Capponi
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Rossella Domenica Campa
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Giuliano Sarro
- G.Fornaroli" Hospital, Magenta ASST Ovest Milanese, Milan, Italy
- Istituto Clinico San Gaudenzio - Novara, Novara, Italy
| | | | | | | | | | - Marco Inama
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Gianluigi Moretto
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Michele Fontana
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Francesco Favi
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Alessia Rampini
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Andrea Barberis
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Antonio Azzinnaro
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Alba Oliva
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | | | | | - Gabriella Teresa Capolupo
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Filippo Carannante
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco Caricato
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Maurizio Ronconi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Silvia Casiraghi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Giovanni Casole
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Desire Pantalone
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Giovanni Alemanno
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Maximilian Scheiterle
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | | | | | | | - Federico Zanzi
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Stefano Bolzon
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Enrico Guerra
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Francesca Lecchi
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Paola Cellerino
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Ardito
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Rosa Scaramuzzo
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | - Andrea Balla
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | | | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Claudio Ricci
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Beatrice Torre
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Iris Shari Russo
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Rottoli
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marta Tanzanu
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Angela Belvedere
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Milone
- University of Naples "Federico II", Naples, Italy
| | | | | | - Micaela Piccoli
- General Surgery,Emergencies and New Technologies, Baggiovara Civil Hospital Modena, Baggiovara, Italy
| | | | - Stefano Magnone
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bertoli
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Pisano
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Massucco
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | - Marco Palisi
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | | | - Francesco Fleres
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Guglielmo Clarizia
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Alessandro Spolini
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | | | | | | | | | | | | | - Saulius Svagzdys
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Henrikas Pauzas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justas Zilinskas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Matas Jakubauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Zaidi Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Asri Che Jusoh
- Department of General Surgery, Hospital Sultan Ismail Petra, Kuala Krai, Kelantan, Malaysia
| | | | - Daniel Rios Cruz
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Aurea Barbara Rodriguez Elizalde
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Alejandro Bañon Reynaud
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | | | | | | | | | | | | | - Piotr Major
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Kwiatkowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Łukasz Czyżykowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | | | - Bela Pereira
- Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE, Vila Nova de Gaia, Portugal
| | | | - Filipe Almeida
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Ricardo Rocha
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Carla Carneiro
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Diego Pita Perez
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - João Carvas
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - Catarina Rocha
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | | | | | | | - Pedro Leao
- General Surgery Grupo Trofa Saúde, Porto, Portugal
| | | | - Rita Gonçalves Pereira
- General Surgery Department, Centro Hospitalar Barreiro Montijo, E.P.E., Barreiro, Portugal
| | | | | | | | | | | | - Valentin Calu
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Adrian Miron
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Elena Adelina Toma
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Abakar Abdullaev
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Taras Nechay
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Alexander Tyagunov
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Anvar Yuldashev
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | | | | | - Arpád Panyko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Zuzana Látečková
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Vladimír Lacko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Dusan Lesko
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Marek Soltes
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Jozef Radonak
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Victor Turrado-Rodriguez
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Roser Termes-Serra
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Xavier Morales-Sevillano
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Pierfrancesco Lapolla
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Andrea Mingoli
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Maurizio Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Silvia Sofia
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Rossella Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | | | | | | | | | | | - Mercedes Estaire-Gómez
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Rebeca Vitón-Herrero
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - José Gil-Martínez
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Felipe Alconchel
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Tatiana Nicolás-López
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Aida Cristina Rahy-Martin
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - María Pelloni
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Raquel Bañolas-Suarez
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Manuel Díez-Alonso
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Silvia Salvans
- Emergency Surgery Unit, Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Pablo Sancho Pardo
- Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain
| | | | - Jana Dziakova
- Hospital Clínico San Carlos in Madrid, Madrid, Spain
| | | | | | | | | | | | | | - Juan Jesús Rubio García
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Sevila Micó
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Joaquín Ruiz López
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | | | | | - Alberto Titos-García
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Jose Manuel Aranda-Narváez
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Laura Romacho-López
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Luis Sánchez-Guillén
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Veronica Aranaz-Ostariz
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Marina Bosch-Ramírez
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | - Elías Martínez-López
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | | | - Granada Jimenez-Riera
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Javier Jimenez-Vega
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Jose Aurelio Navas Cuellar
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | | | - Anna Muñoz-Campaña
- Emergency Surgery Unit at Hospital Universitari Parc Tauli, Sabadell, Spain
| | | | - Javier Martínez Alegre
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Francisca Lima Pinto
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Sara Nuñez O'Sullivan
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | | | | | - Jaime López-Sánchez
- General Surgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | | | | | | | | | | | - Eva Iglesias
- Hospital Universtario Puerta de Hierro, Madrid, Spain
| | | | | | - Ignacio Rey Simó
- HPB and Transplantation Unit, Head of Emergency Surgery Unit, Seville, Spain
| | | | | | - Rafael Calleja Lozano
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Manuel Durán Martínez
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Álvaro Naranjo Torres
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | | | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Ahmed K Abdoun
- Department of Sugery, Almoalem Medical City, Khartoum, Sudan
| | | | - Varut Lohsiriwat
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Aitsariya Mongkhonsupphawan
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Oussama Baraket
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Karim Ayed
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Imed Abbassi
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | | | | | | | - Elif Colak
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | - Suleyman Polat
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | | | - Ali Guner
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Mehmet Arif Usta
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Murat Emre Reis
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Baris Mantoglu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emre Gonullu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emrah Akin
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Necattin Firat
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Arda Isik
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ufuk Memis
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | | | | | - Yasin Kara
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocataş
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Koray Das
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Seker
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Nazmi Ozer
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Semra Demirli Atici
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Korhan Tuncer
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tayfun Kaya
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Zeynep Ozkan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Onur Ilhan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Ibrahim Agackiran
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | | | - Eren Demirbas
- Department of General Surgery, Bursa Kestel State Hospital, Kestel, Turkey
| | - Yuksel Altinel
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Serhat Meric
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Nadir Adnan Hacım
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Derya Salim Uymaz
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Nail Omarov
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Emre Balık
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Giovanni D Tebala
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hany Khalil
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mridul Rana
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mansoor Khan
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | | | - Cosimo Alex Leo
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Lampros Liasis
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Josef Watfah
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | | | - Edward Delgado
- Hospital de ClínicasClínica Quirúrgica ¨F¨, Montevideo, Uruguay
| | | | - Rifat Latifi
- Department of Surgery, School of Medicine, Westchester Medical Center, New York Medical College, Valhalla, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Sara Edwards
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Ana Lopez
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - George Velmahos
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ander Dorken
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony Gebran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Amanda Palmer
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - Jeffrey Oury
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - James M Bardes
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | | | | | | | | | | | | | | | | | | | - Jacob A Quick
- Department of Surgery, University of Missouri, Columbia, USA
| | - Tyler R Austin
- Department of Surgery, University of Missouri, Columbia, USA
| | | | | | | | | | | | | | | | | | - Filippo Banchini
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Patrizio Capelli
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | | | - Vanni Agnoletti
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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Fugazzola P, Cobianchi L, Di Martino M, Tomasoni M, Dal Mas F, Abu-Zidan FM, Agnoletti V, Ceresoli M, Coccolini F, Di Saverio S, Dominioni T, Farè CN, Frassini S, Gambini G, Leppäniemi A, Maestri M, Martín-Pérez E, Moore EE, Musella V, Peitzman AB, de la Hoz Rodríguez Á, Sargenti B, Sartelli M, Viganò J, Anderloni A, Biffl W, Catena F, Ansaloni L, Augustin G, Morić T, Awad S, Alzahrani AM, Elbahnasawy M, Massalou D, De Simone B, Demetrashvili Z, Kimpizi AD, Schizas D, Balalis D, Tasis N, Papadoliopoulou M, Georgios P, Lasithiotakis K, Ioannidis O, Bains L, Magnoli M, Cianci P, Conversano NI, Pasculli A, Andreuccetti J, Arici E, Pignata G, Tiberio GAM, Podda M, Murru C, Veroux M, Distefano C, Centonze D, Favi F, Bova R, Convertini G, Balla A, Sasia D, Giraudo G, Gabriele A, Tartaglia N, Pavone G, D’Acapito F, Fabbri N, Ferrara F, Cimbanassi S, Ferrario L, Cioffi S, Ceresoli M, Fumagalli C, Degrate L, Degiuli M, Sofia S, Licari L, Improta M, Patriti A, Coletta D, Conti L, Malerba M, Andrea M, Calabrò M, De Zolt B, Bellio G, Giordano A, Luppi D, Corbellini C, Sampietro GM, Marafante C, Rossi S, Mingoli A, Lapolla P, Cicerchia PM, Siragusa L, Grande M, Arcudi C, Antonelli A, Vinci D, De Martino C, Armellino MF, Bisogno E, Visconti D, Santarelli M, Montanari E, Biloslavo A, Germani P, Zaghi C, Oka N, Fathi MA, Ríos-Cruz D, Hernandez EEL, Garzali IU, Duarte L, Negoi I, Litvin A, Chowdhury S, Alshahrani SM, Carbonell-Morote S, Rubio-Garcia JJ, Moreira CCL, Ponce IA, Mendoza-Moreno F, Campaña AM, Bayo HL, Serra AC, Landaluce-Olavarria A, Serradilla-Martín M, Cano-Paredero A, Dobón-Rascón MÁ, Hamid H, Baraket O, Gonullu E, Leventoglu S, Turk Y, Büyükkasap Ç, Aday U, Kara Y, Kabuli HA, Atici SD, Colak E, Chooklin S, Chuklin S, Ruta F, Estraviz-Mateos B, Markinez-Gordobil I. Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study. World J Emerg Surg 2023; 18:20. [DOI: https:/doi.org/10.1186/s13017-023-00488-6] [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] [Received: 12/12/2022] [Accepted: 03/04/2023] [Indexed: 11/27/2023] Open
Abstract
Abstract
Background
Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.
Method
The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.
Results
A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a ‘Chole-POSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications.
Conclusions
The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.
Trial Registration: ClinicalTrial.gov NCT04995380.
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Sampietro GM, Sampietro GM, Corbellini C, Baldi C, Barberi S, Bollina R, De Angelis G, Giuliani G, Manes G, Omazzi B, Pessina C. Surgery Safety Protocol for Patients and Staff During the COVID-19 Global Pandemic – A Prospective Study of 78 Consecutive, Open and Laparoscopic Surgical Procedures. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.12.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To evaluate safety, for patients and staff, and efficacy of a protocol for the surgical treatment
of patients during COVID-19 pandemic (50 days period) in a hospital located in the northern Italy.
Methods: Two different pathways were adopted (non-COVID-19 and COVID-19), with dedicated OR and
ICU, and PPE for personnel. A monitoring of patients and staff for COVID-19 was carried out.
Results: 78 patients were included. Laparoscopy was used in 33.4% without gas filtration. COVID-19-
positive patients (11.5%) were older men (0.04%), with elevated ASA score (0.002), and two or more
comorbidities (0.02). They experienced longer hospitalization (0.003), more complications and more deaths
(0.0001). All COVID-19 related deaths were due to severe acute respiratory syndrome. None of the patients
included resulted infected, but one out of 47 staff personnel (<2%).
Conclusion: COVID-19 is largely unknown, but a safe and effective surgical pathway is feasible.
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Morandi E, Corbellini C, Castoldi M, de Vuono A, Pisoni L, Vignati G. Comparison between two different reconstruction techniques after pancreatic head resection. Technical feasibility and clinical benefits. Minerva Surg 2020; 76:90-96. [PMID: 32456401 DOI: 10.23736/s2724-5691.20.08338-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The study aim was to evaluate if diverting drainage of bile and pancreatic secretions with an isolated Roux loop technique helps to decrease the rate of postoperative morbidity and mortality, in particular postoperative pancreatic fistula (POPF). METHODS A prospectively maintained database between 2006 and 2018 was reviewed. Patients who underwent primary elective pancreaticoduodenectomy were included. Two types of reconstruction methods were compared: single loop (SJL) reconstruction (28 patients) and isolated Roux-en-Y (DJL) reconstruction (36 patients). Demographic characteristics and perioperative results were compared between the two groups. RESULTS This study includes 64 patients. The average duration of surgery was 308 mins; it was longer for DJL (P<0.0001). Major postoperative complications were seen in 24 patients (9 in SJL; 15 in DJL) without statistically significant difference. The most frequent complication that occurred was PJ anastomosis failure (4 in SJL; 6 in DJL). The choice of postoperative complication management was not related to surgical reconstruction technique (P=0.389). Length of hospital stay in DJL was significantly longer than in SJL (P=0.04). CONCLUSIONS No significant advantage of one technique over the other was found. In our opinion, surgeons should choose the approach with which they have the most experience and ease.
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Affiliation(s)
- Eugenio Morandi
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Carlo Corbellini
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy -
| | - Marco Castoldi
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Andrea de Vuono
- Department of Statistics, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Laura Pisoni
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Gianandrea Vignati
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
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Morandi E, Corbellini C, Castoldi M, de Vuono A, Pisoni L, Vignati G. Comparison between two different reconstruction techniques after pancreatic head resection. Technical feasibility and clinical benefits. Minerva Surg 2020. [PMID: 32456401 DOI: 10.23736/s0026-4733.20.08338-8] [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: 11/08/2022]
Abstract
BACKGROUND The study aim was to evaluate if diverting drainage of bile and pancreatic secretions with an isolated Roux loop technique helps to decrease the rate of postoperative morbidity and mortality, in particular postoperative pancreatic fistula (POPF). METHODS A prospectively maintained database between 2006 and 2018 was reviewed. Patients who underwent primary elective pancreaticoduodenectomy were included. Two types of reconstruction methods were compared: single loop (SJL) reconstruction (28 patients) and isolated Roux-en-Y (DJL) reconstruction (36 patients). Demographic characteristics and perioperative results were compared between the two groups. RESULTS This study includes 64 patients. The average duration of surgery was 308 mins; it was longer for DJL (P<0.0001). Major postoperative complications were seen in 24 patients (9 in SJL; 15 in DJL) without statistically significant difference. The most frequent complication that occurred was PJ anastomosis failure (4 in SJL; 6 in DJL). The choice of postoperative complication management was not related to surgical reconstruction technique (P=0.389). Length of hospital stay in DJL was significantly longer than in SJL (P=0.04). CONCLUSIONS No significant advantage of one technique over the other was found. In our opinion, surgeons should choose the approach with which they have the most experience and ease.
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Affiliation(s)
- Eugenio Morandi
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Carlo Corbellini
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy -
| | - Marco Castoldi
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Andrea de Vuono
- Department of Statistics, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Laura Pisoni
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
| | - Gianandrea Vignati
- Department of General Surgery, ASST - Rhodense, Rho Hospital, Rho, Milan, Italy
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Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, Costas-Chavarri A, Drake TM, Ntirenganya F, Fitzgerald JE, Fergusson SJ, Glasbey J, Ingabire JCA, Ismaïl L, Salem HK, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Morton D, Mutabazi AZ, Nepogodiev D, Adisa AO, Ots R, Pata F, Pinkney T, Poškus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Harrison EM, Khatri C, Mohan M, Jaffry Z, Altamini A, Kirby A, Søreide K, Recinos G, Cornick J, Modolo MM, Iyer D, King S, Arthur T, Nahar SN, Waterman A, Walsh M, Agarwal A, Zani A, Firdouse M, Rouse T, Liu Q, Correa JC, Talving P, Worku M, Arnaud A, Kalles V, Kumar B, Kumar S, Amandito R, Quek R, Ansaloni L, Altibi A, Venskutonis D, Zilinskas J, Poskus T, Whitaker J, Msosa V, Tew YY, Farrugia A, Borg E, Bentounsi Z, Gala T, Al-Slaibi I, Tahboub H, Alser OH, Romani D, Shu S, Major P, Mironescu A, Bratu M, Kourdouli A, Ndajiwo A, Altwijri A, Alsaggaf MU, Gudal A, Jubran AF, Seisay S, Lieske B, Ortega I, Jeyakumar J, Senanayake KJ, Abdulbagi O, Cengiz Y, Raptis D, Altinel Y, Kong C, Teasdale E, Irwin G, Stoddart M, Kabariti R, Suresh S, Gash K, Narayanan R, Maimbo M, Grizhja B, Ymeri S, Galiqi G, Klappenbach R, Antezana D, Mendoza Beleño AE, Costa C, Sanchez B, Aviles S, Fermani CG, Balmaceda R, Villalobos S, Carmona JM, Hamill D, Deutschmann P, Sandler S, Cox D, Nataraja R, Sharpin C, Ljuhar D, Gray D, Haines M, Iyer D, Niranjan N, D'Amours S, Ashtari M, Franco H, Rahman Mitul A, Karim S, Aman NF, Estee MM, Salma U, Razzaque J, Hamid Kanta T, Tori SA, Alamin S, Roy S, Al Amin S, Karim R, Haque M, Faruq A, Iftekhar F, O'Shea M, Padmore G, Jonnalagadda R, Litvin A, Filatau A, Paulouski D, Shubianok M, Shachykava T, Khokha D, Khokha V, Djivoh F, Dossou F, Seto DM, Gbessi DG, Noukpozounkou B, Imorou Souaibou Y, Keke KR, Hodonou F, Ahounou EYS, Alihonou T, Dénakpo M, Ahlonsou G, Ginbo Bedada A, Nsengiyumva C, Kwizera S, Barendegere V, Choi P, Stock S, Jamal L, Azzie G, Kushwaha S, Chen TL, Yip C, Montes I, Zapata F, Sierra S, Villegas Lanau MI, Mendoza Arango MC, Mendoza Restrepo I, Restrepo Giraldo RS, Domini E, Karlo R, Mihanovic J, Youssef M, Elfeki H, Thabet W, Sanad A, Tawfik G, Zaki A, Abdel-Hameed N, Mostafa M, Omar MFW, Ghanem A, Abdallah E, Denewer A, Emara E, Rashad E, Sakr A, Elashry R, Emile S, Khafagy T, Elhamouly S, Elfarargy A, Mamdouh Mohamed A, Saied Nagy G, Esam A, Elwy E, Hammad A, Khallaf S, Ibrahim E, Said Badr A, Moustafa A, Eldosouky Mohammed A, Elgheriany M, Abdelmageed E, Al Raouf EA, Samir Elbanby E, Elmasry M, Morsy Farahat M, Yahya Mansor E, Magdy Hegazy E, Gamal E, Gamal H, Kandil H, Maher Abdelrouf D, Moaty M, Gamal D, El-Sagheer N, Salah M, Magdy S, Salah A, Essam A, Ali A, Badawy M, Ahmed S, Mohamed M, Assal A, Sleem M, Ebidy M, Abd-Elrazek A, Zahran D, Adam N, Nazir M, Hassanein AB, Ismail A, Elsawy A, Mamdouh R, Mabrouk M, Ahmed LAM, Hassab Alnaby M, Magdy E, Abd-Elmawla M, Fahim M, Mowafy B, Ibrahim Mahmoud M, Allam M, Alkelani M, Halim El Gendy N, Saad Aboul-Naga M, Alaa El-Din R, Elgendy AH, Ismail M, Shalaby M, Adel Elsharkawy A, Elsayed Moghazy M, Hesham Elbisomy K, Abdel Gawad Shakshouk H, Hamed MF, Ebidy MM, Abdelkader M, Karkeet M, Ahmed H, Adel I, Omar ME, Ibrahim M, Ghoneim O, Hesham O, Gamal S, Hilal K, Arafa O, Adel Awad S, Salem M, Abdellatif Elsherif F, Elsabbagh N, Aboelsoud MR, Hossam Eldin Fouad Rida A, Hossameldin A, Hany E, Hosny Asar Y, Anwar N, Gadelkarim M, Abdelhady S, Mohamed Morshedy E, Saad R, Soliman N, Salama M, Ezzat E, Mohamed A, Ibrahim A, Fergany A, Mohammed S, Reda A, Allam Y, Saad HA, Abdelfatah A, Fathy AM, El-Sehily A, Abdalmageed Kasem E, Hassan ATA, Mohammed AR, Saad AG, Elfouly Y, Elfouly N, Ibrahim A, Hassaan A, Mohammed MM, Elhoseny G, Magdy M, Abd Elkhalek E, Zakaria Y, Ezzat T, Abo El Dahab A, Kelany M, Arafa S, Mokhtar Mohamed Hassan O, Mohamed Badwi N, Saber Sleem A, Ahmed H, Abdelbadeai K, Abozed Abdullah M, Lokman MAA, Bahar S, Rady Abdelazeam 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Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Corbellini C, Costa S, Canini T, Villa R, Contessini Avesani E. Diaphragmatic rupture: A single-institution experience and literature review. ULUS TRAVMA ACIL CER 2018; 23:421-426. [PMID: 29052830 DOI: 10.5505/tjtes.2017.78027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Diaphragmatic rupture (DR) is a rare and potentially life-threatening event caused by trauma or spontaneously. DR occasionally occurs several months after the injury. Chest X-ray and computed tomography are the most effective diagnostic methods. Delay in DR diagnosis occurs frequently. This study aimed to examine and improve our understanding of the etiology, clinical presentation, and management of DR. METHODS This study was performed at the Emergency and General Surgery Department of Fondazione I.R.R.C.S. Cà Granda, Ospedale Policlinico in Milan (Italy). Patients diagnosed with DR between 2001 and 2011 who underwent surgery were included, and their data were retrospectively collected. RESULTS Fourteen patients were diagnosed with DR, mainly left-sided DR. Road traffic collisions were the main causes (86%). DR diagnosis was preoperatively established in eight patients (57%). Chest X-ray was diagnostic in 50% of the patients and computed tomography in three patients (60%). Twelve patients had a diaphragmatic hernia. DR was repaired with a mesh in two patients. Mean hospital stay was 16.6 days. CONCLUSION Difficulty in achieving early diagnosis of DR is due to its nonspecific presentation. High index of suspicion is needed. Its treatment is using surgery involving reduction of the viscera and repair of the diaphragm defect.
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Affiliation(s)
- Carlo Corbellini
- Department of General Surgery and Emergency Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan-Italy.
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Anastasia A, Resovi A, Ghilardi C, Avigni R, Micotti E, Minoli L, Scanziani E, Corbellini C, Morandi E, Belotti D, Giavazzi R, Bani M. Abstract 3857: Patient-derived tumor xenografts as pharmacological model of human pancreatic ductal adenocarcinoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3857] [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: 11/16/2022]
Abstract
Abstract
INTRODUCTION and AIM
Pancreatic ductal adenocarcinoma is a lethal disease with an overall survival rate of 5% and a median survival time of less than 6 months. Current systemic treatments offer only a modest benefit in symptom control and survival, thus surgery remains the most effective treatment. The exploitation of new therapeutics is an urgent need, but the research is braked by the limited value of the current preclinical models as predictors of patients response. The aim of our study is to develop patient-derived primary pancreatic ductal adenocarcinoma xenografts (PDAC-PDX) growing into the pancreas of recipient mice that retain features of the patient’s tumors and mimic the biological heterogeneity of human pancreatic cancer.
METHODS
Cancer specimens from patients undergoing cephalic duodenopancreatectomy were transplanted in NSG mice and orthotopically propagated by their re-implantation into the pancreas of SCID mice. Tumor burden was measured by abdominal palpation and by non invasive magnetic resonance imaging (MRI). PDAC-PDXs were characterized histologically, for mutational status (KRAS, TP53 and SMAD4), and responsiveness to gemcitabine. Gemcitabine was administered alone or combined with nab-paclitaxel, to mice bearing tumor in their pancreas; drugs were given intravenously on days 1 and 8 of each 21-day cycle to copy as much as possible patient’s recommendations. To determine the antitumor effects of the treatments, changes in tumor growth over time were evaluated by MRI and plasma level of Ca19-9.
RESULTS
Surgically resectable pancreatic adenocarcinoma (histologically confirmed) engrafted successfully in 5 cases (out of 11) and retained the molecular, morphological and biological features of the original patient tumors.
Mutational landscape of the PDAC-PDXs reflect the clinical scenario: 80% are mutated in KRAS (G12D, G12R), 80% carry a TP53 mutation (I162F, R213*, Y220C, R248Q) and 20% show the deletion of SMAD4. Histological features recapitulate the human disease, the PDAC-PDXs exhibit a robust amount of host derived stroma with collagen deposition, constant through generations (up to five).
Orthotopic growing PDAC-PDXs were marginal responsive to gemcitabine treatment, while significant response (stable disease and regression) was observed with the gemcitabine and nab-paclitaxel combination regimen, which was more efficacious than paclitaxel (equimolar dose).
CONCLUSION
PDAC-PDXs growing orthotopically in the pancreas of mice provide a valuable tool for the preclinical exploitation of novel therapeutics for pancreatic cancer.
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Supported by Associazione Italiana per la Ricerca sul Cancro (AIRC 5 per mille n. 12182) and Fondazione “Eugenio Morandi” ONLUS per lo studio e la cura dei tumori del pancreas.
Citation Format: Alessia Anastasia, Andrea Resovi, Carmen Ghilardi, Roberta Avigni, Edoardo Micotti, Lucia Minoli, Eugenio Scanziani, Carlo Corbellini, Eugenio Morandi, Dorina Belotti, Raffaella Giavazzi, MariaRosa Bani. Patient-derived tumor xenografts as pharmacological model of human pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3857. doi:10.1158/1538-7445.AM2017-3857
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Affiliation(s)
- Alessia Anastasia
- 1Department of Oncology, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Andrea Resovi
- 1Department of Oncology, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Carmen Ghilardi
- 1Department of Oncology, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Roberta Avigni
- 1Department of Oncology, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Edoardo Micotti
- 2Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Lucia Minoli
- 3Department of Veterinary Medicine, University of Milan, Milano, Italy
| | - Eugenio Scanziani
- 3Department of Veterinary Medicine, University of Milan, Milano, Italy
| | | | | | - Dorina Belotti
- 1Department of Oncology, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Raffaella Giavazzi
- 1Department of Oncology, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - MariaRosa Bani
- 1Department of Oncology, Mario Negri Institute for Pharmacological Research, Milano, Italy
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Morandi E, Corbellini C, Castoldi M. Granulomatosis with polyangiitis: an unusual intestinal presentation. ANZ J Surg 2017; 88:E847-E848. [PMID: 28294494 DOI: 10.1111/ans.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/07/2016] [Accepted: 01/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Eugenio Morandi
- General Surgery Department, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Carlo Corbellini
- General Surgery Department, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Marco Castoldi
- General Surgery Department, Rho Hospital, ASST Rhodense, Rho, Italy
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Belli F, Gronchi A, Corbellini C, Milione M, Leo E. Abdominosacral resection for locally recurring rectal cancer. World J Gastrointest Surg 2016; 8:770-778. [PMID: 28070232 PMCID: PMC5183920 DOI: 10.4240/wjgs.v8.i12.770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/14/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate feasibility and outcome of abdominal-sacral resection for treatment of locally recurrent rectal adenocarcinoma.
METHODS A population of patients who underwent an abdominal-sacral resection for posterior recurrent adenocarcinoma of the rectum at the National Cancer Institute of Milano, between 2005 and 2013, is considered. Retrospectively collected data includes patient characteristics, treatment and pathology details regarding the primary and the recurrent rectal tumor surgical resection. A clinical and instrumental follow-up was performed. Surgical and oncological outcome were investigated. Furthermore an analytical review of literature was conducted in order to compare our case series with other reported experiences.
RESULTS At the time of abdomino-sacral resection, the mean age of patients was 55 (range, 38-64). The median operating time was 380 min (range, 270-480). Sacral resection was performed at S2/S3 level in 3 patients, S3/S4 in 3 patients and S4/S5 in 4 patients. The median operating time was 380 ± 58 min. Mean intraoperative blood loss was 1750 mL (range, 200-680). The median hospital stay was 22 d. Overall morbidity was 80%, mainly type II complication according to the Clavien-Dindo classification. Microscopically negative margins (R0) is obtained in all patients. Overall 5-year survival after first surgical procedure is 60%, with a median survival from the first surgery of 88 ± 56 mo. The most common site of re-recurrence was intrapelvic.
CONCLUSION Sacral resection represents a feasible approach to posterior rectal cancer recurrence without evidence of distant spreading. An accurate staging is essential for planning the best therapy.
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Deraco M, Kusamura S, Corbellini C, Guaglio M, Paviglianiti C, Baratti D. Treatment principles for peritoneal surface malignancies. MINERVA CHIR 2016; 71:124-145. [PMID: 26847729] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A paradigm shift has recently occurred in the clinical management of peritoneal surface malignancies (PSM). Once regarded as end-stage disseminated conditions only to be palliated, PSM are now increasingly recognized as local-regional disease entities amenable to potentially curative therapies. Better knowledge of the natural history and patterns of disease-progression has evolved into a novel treatment approach combining aggressive cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy, to treat the microscopic residual disease. Such a complex comprehensive treatment has reportedly resulted in a survival improvement over historical controls, and it is gaining an increasing acceptance as standard of care for selected patients with peritoneal metastases from gastrointestinal and gynecological tumor and rare primary peritoneal malignancies. This article addresses the rational bases supporting the comprehensive treatment of PSM. The biology and patho-physiology of peritoneal tumor dissemination, with their implication on surgical and local-regional management are reviewed. The cytoreductive surgical procedures and intraperitoneal chemotherapy administration techniques are described, together with the theoretical principles from which have originated. The main controversial issues in the operative management of PSM are discussed, focusing on the technical variants adopted in our institution. The most recent literature data on both patient selection and appropriate indications for combined treatment are presented. Additionally, a brief overview of treatment results and long-term outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in the different PSM is provided.
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Affiliation(s)
- Marcello Deraco
- Peritoneal Malignancy Program, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy -
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12
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Villa R, Costa S, Focchi S, Corbellini C, Vigorelli M, Avesani EC. Successful open abdomen treatment for multiple ischemic duodenal perforated ulcers in dermatomyositis. World J Emerg Surg 2014; 9:48. [PMID: 26085838 PMCID: PMC4470353 DOI: 10.1186/1749-7922-9-48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/12/2013] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Dermatomyositis is an autoimmune disease characterized by proximal myopathy, cutaneous Gottron papules and heliotrope rash; intestinal involvement associated to acute vasculitis is less common but could be a life-threatening condition. Methods A 21-year-old woman, affected by dermatomyositis, presented to our attention with a three-day story of severe abdominal pain, no bowel movement and biliary vomit. She was diagnosed with acute abdomen. A CT scan with bowel contrast demonstrated the presence of a leakage from the retroperitoneal aspect of duodenum. The surgical and clinical management in the light of literature review is presented. Results Our first approach consisted in primary repair of the duodenal perforation with omentopexy. Post-operative course was complicated by hemorrhage. A reintervention showed a new perforation associated with multiple ischemic intestinal areas. We performed a gastroenteric anastomosis with functional exclusion of the damaged duodenum and positioning of drainages to create a biliary fistula. A nutritional enteric tube and an open abdomen vacuum-assisted closure system to monitor the fistula creation and to prevent abdominal contamination and collections were positioned. To reduce the amount of biliary leakage, a percutaneous transhepatic biliary drainage was placed, with progressive fistula flow disappearance in four months. Conclusions In patients with dermatomyositis, when clinical findings and symptoms suggest abdominal vasculitis, it is very important to be aware of the risk of bowel and particularly duodenal perforations. Open abdomen treatment favors control of contamination by gastrointestinal contents, offers temporary abdominal closure, helps ICU care and delays definitive surgery.
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Affiliation(s)
- Roberta Villa
- Department of General and Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy ; Faculty of Medicine, Università degli Studi di Milano, Milano, Italy
| | - Stefano Costa
- Department of General and Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sibilla Focchi
- Department of General and Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy ; Faculty of Medicine, Università degli Studi di Milano, Milano, Italy
| | - Carlo Corbellini
- Department of General and Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy ; Faculty of Medicine, Università degli Studi di Milano, Milano, Italy
| | - Massimo Vigorelli
- Department of General and Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ettore Contessini Avesani
- Department of General and Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy ; Faculty of Medicine, Università degli Studi di Milano, Milano, Italy
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Bertani E, Chiappa A, Ubiali P, Fiore B, Corbellini C, Cossu ML, Minicozzi A, Andreoni B. Role of robotic surgery in colorectal resections for cancer. MINERVA GASTROENTERO 2012; 58:191-200. [PMID: 22971630] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In recent years, robotic surgery is becoming a valid alternative in colorectal diseases treatment to laparoscopic and traditional open surgery. The most relevant reported technical advantages of the robotic surgery are 3D-view, tremor-filtering, seven degree-free motion and a higher comfortable setting for the surgeon. Both case series and comparative studies available in Literature report only short and mid-term outcomes. These studies are able to demonstrate that robotic surgery is as safe and feasible as laparoscopic surgery regarding perioperative outcomes. Trials with long term follow up are needed to establish the real safety and effectiveness of the robotic surgery especially concerning resections for cancer. The robotic surgery could be considered a promising surgical field. The high costs represent one of the most relevant drawbacks.
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Affiliation(s)
- E Bertani
- General and Laparoscopic Surgery, European Institute of Oncology, Via G. Ripamonti 435, 20141 Milan, Italy.
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Corbellini C, Vingiani A, Maffini F, Chiappa A, Bertani E, Andreoni B. Retroperitoneal pararenal isolated neurofibroma: report of a case and review of literature. Ecancermedicalscience 2012; 6:253. [PMID: 22654960 PMCID: PMC3357181 DOI: 10.3332/ecancer.2012.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/28/2012] [Indexed: 11/17/2022] Open
Abstract
The neurofibroma is a tumour of neural origin. This kind of neoplasm, though, is generally skin located. Rare cases in deep organs or in the peritoneal cavity are also reported in the literature. There are two types of neurofibromas, localized and diffuse; the latter is associated with von Recklinghausen disease and always occurs together with skin neurofibromas. Here we report the case of a 47-year-old man affected by retroperitoneal neurofibroma, but not associated with von Recklinghausen disease. A computed tomography (CT) scan described a retroperitoneal pararenal lesion with no clear involvement of adjacent viscera. We describe the diagnostic modality, treatment planning and the timing of treatment of this neoplasm, reviewing also the literature.
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Affiliation(s)
- C Corbellini
- Division of General and Laparoscopic Surgery, European Institute of Oncology, University of Milan, 435 Ripamonti St., Milan 20141, Italy
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Chiappa A, Bertani E, Venturino M, Corbellini C, Spampatti S, Uccelli F, Zampino M, Magni E, Andreoni B. 12 Pattern of local recurrence and treatment following surgery with total mesorectal excision (TME) for rectal cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Andreoni B, Camellini L, Sonzogni A, Crosta C, Pirola ME, Corbellini C. Multicentric GISCoR Study "intensive clinical follow-up versus surgical radicalization after complete endoscopic polypectomy of a malignant adenoma" (SEC-GISCoR). Updates Surg 2011; 63:171-7. [PMID: 21647795 DOI: 10.1007/s13304-011-0081-8] [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] [Received: 11/01/2010] [Accepted: 05/14/2011] [Indexed: 10/18/2022]
Abstract
Colorectal cancer screening programs result in an early diagnosis of the disease. In 2007, 250 malignant polyps were identified in Lombardy, out of 1,329 screen-detected colorectal carcinomas. The Italian Group for Colorectal Cancer (GISCoR) promoted the multicentric study "Endoscopic Follow-up versus Surgical Radicalization of Malignant Polyps after Complete Endoscopic Polypectomy" (SEC-GISCoR). The protocol was a multicentric, prospective, observational, non-randomized study. It included patients diagnosed a colorectal malignant adenoma, after complete endoscopic removal. From November 2005 to September 2009, three participating centers enrolled 120 patients with malignant polyps after "complete" endoscopic polypectomy; malignant polyps were classified as "low risk" or "high risk". The study had two arms: "Intensive follow-up" (42 patients: 32 with low-risk and 10 with high-risk polyps) and "Surgical radicalization" (78 patients: 5 with low-risk and 73 with high-risk polyps). Data were collected using an online CRF. Overall, 37/120 polyps (30.8%) were low risk and 83/120 (69.2%) were high risk. 42 out of 120 patients (35%) were enrolled in the "clinical follow-up" arm, while 78/120 (65%) entered the surgery arm. In 15 cases, patients were not enrolled in the correct arm, according to the criteria agreed upon before starting the study. There still is a high incidence (11.5%) of pathological mismatches. No clinical event was reported in 2.9 years of follow-up. In conclusion, some differences emerged in the management of patients with malignant polyps among participating centers (p < 0.001), mismatches can be explained by high surgical risk or patient's choice. Only in 5 cases (4.2%), did data analysis not allow to exactly determine the reason for a choice different from protocol criteria. The availability of new risk factors and the evidence of pathological mismatches confirmed the need for future studies on this issue.
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Affiliation(s)
- Bruno Andreoni
- Division of General and Laparoscopic Surgery, European Institute of Oncology, 435 Ripamonti Street, 20141, Milan, Italy
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Chiappa A, Contino G, Bertani E, Bianchi P, Zampino M, Sandri M, Magni E, Branchi V, Corbellini C, Andreoni B. 1324 Detection of circulating tumour cells in locally advanced colorectal cancer: preliminary data. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chiappa A, Bertani E, Makuuchi M, Zbar AP, Contino G, Viale G, Pruneri G, Bellomi M, Della Vigna P, Zampino MG, Fazio N, Travaini ML, Trifirò G, Corbellini C, Andreoni B. Neoadjuvant chemotherapy followed by hepatectomy for primarily resectable colorectal cancer liver metastases. Hepatogastroenterology 2009; 56:829-834. [PMID: 19621711] [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: 05/28/2023]
Abstract
BACKGROUND/AIMS Hepatic resection in metastatic disease from colorectal cancer offers the best chance in selected cases for long-term survival. Neoadjuvant chemotherapy (NACT) has been advocated in some cases initially deemed irresectable with few reports of the efficacy of such a strategy and the influence of the response to chemotherapy on the outcome of radical hepatic resection. METHODOLOGY Between December 1995 and May 2005, 88 patients with colorectal liver metastases underwent hepatic resection with curative intent. Twenty-five of these patients, (7 males, 18 females, mean age: 58+/-9 years; range: 40-75 years) deemed as resectable cases at the time of diagnosis were treated with neoadjuvant chemotherapy. A 7-year survival analysis was performed. Chemotherapy included mainly oxaliplatin or irinotecan containing regimens for a median of 6 courses. RESULTS Fifteen patients (60%) had synchronous and 10 (40%) metachronous metastases. During preoperative chemotherapy tumor regression occurred in 8 cases (32%); stable disease (SD) in a further 10 patients (40%) and progressive disease (PD) developed in 7 cases (28%). The 5-year overall survival for NACT responders was 71% and only 15% for non-responders (p=0.026). CONCLUSIONS The response to chemotherapy is likely to be a significant prognostic factor affecting overall survival after radical hepatic resection for colorectal metastases.
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Affiliation(s)
- Antonio Chiappa
- Department of General Surgery, European Institute of Oncology, Milano, Italy.
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Andreoni B, Goldhirsch A, Orecchia R, Venturino M, Spirito R, Tadini L, Corbellini C, Bertani E, Veronesi U. Correlation between administered treatment and patient's living will. Ecancermedicalscience 2009; 3:158. [PMID: 22276019 PMCID: PMC3223999 DOI: 10.3332/ecancer.2009.158] [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: 09/29/2009] [Indexed: 11/08/2022] Open
Abstract
Respecting the wishes of an adequately informed patient should be a priority in any health structure. A patient with advanced or terminal cancer should be allowed to express their will during the most important phases of their illness. Unfortunately, this is seldom the case, and in general instructions regarding an individual’s medical care preferences, i.e., their ‘living will’, expressed when healthy, often change with the onset of a serious illness. At the European Institute of Oncology (IEO), a clinical study is ongoing to verify whether, during clinical practice, the patient is adequately informed to sign an ‘informed consent’, in a fully aware manner, that will allow the patient and doctor to share in the decisions regarding complex treatment strategies (living will). A further aim of the study is to verify if health workers, both in hospital and at home, respect the patient’s will. The observational study ‘Respecting the patient’s wishes: Correlation between administered treatment and that accepted by the patient in their Living Will’ was approved by the IEO Ethical Committee in April 2008.
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Affiliation(s)
- B Andreoni
- Division General Surgery, European Institute of Oncology, 20141 Milan, Italy
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20
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Paini A, Salvetti M, Aggiusti C, Belotti E, Galbassini G, Corbellini C, Agabiti-Rosei C, Micheletti L, Bertacchini F, Marino F, Muiesan M, Agabiti-Rosei E. 12.18 Correlation between Ambulatory Arterial Stiffness Index (AASI) and Pulse Wave Velocity in a General Population: the Vobarno Study. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Corbellini C, Guntzel A, Trevisan C, Vieira S. Predicting successful weaning in a cohort of elderly patients. Crit Care 2007. [PMCID: PMC4095227 DOI: 10.1186/cc5333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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22
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Paini A, L. Muiesan M, Salvetti M, Corbellini C, Belotti E, Galbassini G, Agabiti-Rosei C, Aggiusti C, Micheletti L, Paderno V, Agabiti-Rosei E. Arterial Stiffness in Patients with Sustained, Isolated Clinical and Ambulatory Hypertension: the Vobarno Study. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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23
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Paini A, Muiesan M, Salvetti M, Corbellini C, Belotti E, Galbassini G, Agabiti-Rosei C, Aggiusti C, Micheletti L, Paderno V, Agabiti-Rosei E. 06.08 RELATIONSHIP BETWEEN PULSE WAVE VELOCITY AND DIFFERENT BLOOD PRESSURE PATTERNS: THE VOBARNO STUDY. Artery Res 2007. [DOI: 10.1016/j.artres.2007.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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24
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Abstract
The efficacy of 2 teat dips, product 1 (Della Care with 5 to 8 ppm of free iodine, used as a positive control) and product 2 (New Della Care with 12 to 16 ppm of free iodine), was compared using a natural exposure trial on dairy cattle. The trial was based on National Mastitis Council guidelines and performed over 9 mo. Both teat dips contained 0.25% iodine. Product 2 reduced the infection rate 57.6% for major pathogens and 53.7% for minor pathogens, compared with the positive control. Product 2 gave highly significant reductions for Staphylococcus aureus, coagulase-negative staphylococci, and Corynebacterium bovis. Teat skin, teat ends, and teat hyperkeratosis were evaluated during trial. No significant difference in teat condition was observed between these 2 products.
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Affiliation(s)
- C J Foret
- DeLaval Inc., Kansas City, MO 64153, USA.
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25
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Turconi G, Vercesi P, Corbellini C, Roggi C. [Reference concentrations of dietary consumption of xenobiotics]. G Ital Med Lav Ergon 2003; 25:99-106. [PMID: 12696491] [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: 03/01/2023]
Abstract
Total diet studies are the best tool to evaluate food exposure to xenobiotics. These studies are based on xenobiotic concentrations measured in foods that are related to food consumption data in order to obtain reliable assessment of xenobiotic food intakes. This work is a review of the main international literature and points out international, European and Italian data of xenobiotic food ingestion. In particular, it focuses on metals, trace elements, polycyclic aromatic hydrocarbons (PAHs) and some mycotoxin intakes in the total diet. Recorded data show that xenobiotic ingestion differs from nation to nation in relation to environmental pollution and contamination, geographical and climatic conditions, food habits and consumption. Therefore, in order to define reference values for xenobiotic food exposure, it is necessary to set up a monitoring and risk surveillance program by collecting data in a permanent and systematic way. Nevertheless, we have hypothesized some xenobiotic reference values for the area of Pavia based on local studies.
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Affiliation(s)
- G Turconi
- Dipartimento Scienze Sanitarie Applicate e Psicocomportamentali, Sezione Alimentazione Università degli studi di Pavia
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26
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Salvetti M, Muiesan ML, Rizzoni D, Bettoni G, Monteduro C, Corbellini C, Viola S, Agabiti-Rosei E. Night time blood pressure and cardiovascular structure in a middle-aged general population in northern Italy: the Vobarno Study. J Hum Hypertens 2001; 15:879-85. [PMID: 11773992 DOI: 10.1038/sj.jhh.1001286] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 04/30/2001] [Revised: 07/17/2001] [Accepted: 07/17/2001] [Indexed: 11/08/2022]
Abstract
The aim was to determine, in a cross-sectional study, the relation between structural alterations in the heart and carotid arteries, and blood pressure (BP) changes from day to night time, measured by ambulatory BP (ABP). In 225 untreated subjects (107 F, 118 M, age range 48-64 years) and 59 treated subjects (24 M, 35 F, age range 50-64), living in a small town of northern Italy (Vobarno, Brescia) carotid intima media thickness as well as the occurrence of plaque, were evaluated by ultrasound. Echocardiographic left ventricular (LV) mass was measured according to the Penn Convention. BP was determined by clinic measurement and by 24-h non-invasive ABP monitoring. Subjects were divided in two groups, according to the decrease of night time systolic BP (SBP) "dippers" (SBP decreased by at least 10% during night time) and "non-dippers" (decrease of night time SBP <10%). The intima-media thickness in the common carotid, in the carotid bifurcation, in the internal carotid artery and average intima-media thickness were significantly greater in untreated non-dippers as compared with dipper subjects (ANOVA P < 0.05). A significantly higher prevalence of plaque was observed in untreated non-dippers as compared with dippers (P = 0.002). After adjusting for age, sex, 24-h SBP, and smoking, IMT in the carotid bifurcation and average intima-media thickness remained significantly greater in non-dipper subjects (P < 0.05 for all comparisons). No significant differences in LV mass were observed between dippers and non-dipper subjects. In conclusion, in a general population of unselected middle-aged subjects, night time BP values, among other risk factors, seem to represent an important determinant of carotid wall structure.
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Affiliation(s)
- M Salvetti
- Department of Medical and Surgical Sciences, University of Brescia, 2a Medecina, Brescia 25100, Italy
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Roggi C, Vercesi P, Minoia C, Fonte A, Corbellini C. [Food: a significant source of exposure to aromatic polycyclic hydrocarbons]. Ann Ig 2001; 13:405-13. [PMID: 11760416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- C Roggi
- Dip. di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione di Scienza dell'Alimentazione, Università degli Studi di Pavia
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Roggi C, Corbellini C, Maccarini L, Vercesi P, Minoia C, Ronchi A. [Trace elements in red and white wines from various Italian regions]. Ann Ig 2001; 13:415-26. [PMID: 11760417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- C Roggi
- Dip. di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione di Scienza dell'Alimentazione, Università degli Studi di Pavia
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Rizzoni D, Muiesan ML, Salvetti M, Castellano M, Bettoni G, Monteduro C, Corbellini C, Porteri E, Guelfi D, Rosei EA. The smoothness index, but not the trough-to-peak ratio predicts changes in carotid artery wall thickness during antihypertensive treatment. J Hypertens 2001; 19:703-11. [PMID: 11330873 DOI: 10.1097/00004872-200104000-00007] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [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: 11/26/2022]
Abstract
BACKGROUND It has recently been demonstrated that the smoothness index (SI) (the ratio between the average of the blood pressure changes computed for each hour of the recording and its standard deviation), a new and reproducible measure of the homogeneity of blood pressure reduction by antihypertensive treatment, has evident advantages over trough-to-peak ratio (T/P) in the prediction of the regression of left ventricular hypertrophy. Therefore we considered it to be worthwhile to compare the ability of SI and T/P to predict changes of the carotid artery intima-media thickness (IMT) during pharmacological treatment in patients with essential hypertension. METHODS In 100 patients with essential hypertension, 24 h ambulatory blood pressure and carotid artery IMT were measured after 3 weeks of therapeutic wash-out and after 12 months of antihypertensive treatment (calcium antagonists, diuretics, angiotensin converting enzyme (ACE) inhibitors or beta-blockers). The homogeneity of the effect of treatment over blood pressure was evaluated by computing T/P and SI. RESULTS Twenty-four hour blood pressure was significantly reduced by therapy, while, on average, a small but significant increase in indices of carotid artery wall thickness was observed. However, IMT was clearly reduced in patients with high SI. Statistically significant correlations were observed between changes in indices of carotid artery IMT during therapy and SI. No significant correlation was observed between indices of carotid artery morphology and T/P, basal 24 h blood pressure or changes in blood pressure during therapy. CONCLUSIONS SI, but not T/P is the predictor of changes in carotid artery wall thickness. The information provided by SI is independent from basal blood pressure values. For carotid artery morphology, the smoothness of blood pressure reduction is even more important than its absolute change.
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Affiliation(s)
- D Rizzoni
- Department of Medical and Surgical Sciences, University of Brescia, Italy.
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30
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Muiesan ML, Salvetti M, Monteduro C, Corbellini C, Guelfi D, Rizzoni D, Castellano M, Agabiti-Rosei E. Flow-mediated dilatation of the brachial artery and left ventricular geometry in hypertensive patients. J Hypertens 2001; 19:641-7. [PMID: 11327641 DOI: 10.1097/00004872-200103001-00018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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
OBJECTIVES In arterial hypertension, the spectrum of geometric patterns in the left ventricle may parallel the structural alterations detected in the carotid arteries and in subcutaneous small arteries. It has been also reported that hypertensive left ventricular hypertrophy (LVH) may be associated with endothelial dysfunction, as evaluated by the response of coronary or forearm vasculature to acetylcholine infusion. The aim of this study was to evaluate the flow-mediated vasodilatation (FMD) of the brachial artery, non-invasive estimate of endothelium-dependent vasodilatation according to left ventricular geometric adaptations in hypertensive patients. METHODS AND RESULTS In 16 normotensive (nine males, seven females, aged 40-68 years) and in 78 hypertensive subjects (50 males, 28 females, aged 42-67 years), we performed an echocardiographic study for the measurement of left ventricular mass index (LVMI) and relative wall thickness (RWT); we measured to a high resolution the brachial artery diameter at rest, during reactive hyperaemia (5 min of brachial artery occlusion) and after sublingual glyceril trinitrate (GTN); brachial artery flow velocity was measured by pulsed Doppler. Twenty-six hypertensive patients had a normal LVMI (LVMI < 51 g/ m2.7) and geometry (RWT < 0.44), five had concentric remodelling (RWT > or = 0.44), and concentric and eccentric LVH were observed in 19 and 28 patients, respectively. FMD was reduced in hypertensive patients as compared with normotensive subjects (P< 0.01). No correlation was found between FMD and LVMI (r= -0.078) or RWT (r = 0.049); in addition, no difference in FMD was found among the left ventricular geometric patterns in hypertensive patients. CONCLUSIONS In hypertensives, the presence of endothelial dysfunction is not associated with the LVH or with different left ventricular geometric patterns, suggesting that different and independent mechanisms may be responsible for the presence of LVH and of endothelial dysfunction.
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Affiliation(s)
- M L Muiesan
- Department of Medical and Surgical Sciences, Internal Medicine, University of Brescia, Italy.
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31
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Muiesan ML, Salvetti M, Monteduro C, Rizzoni D, Corbellini C, Castellano M, Porteri E, Agabiti-Rosei E. Changes in midwall systolic performance and cardiac hypertrophy reduction in hypertensive patients. J Hypertens 2000; 18:1651-6. [PMID: 11081779 DOI: 10.1097/00004872-200018110-00017] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
OBJECTIVE To investigate changes in left ventricular (LV) performance, as evaluated by measurement of midwall LV fractional shortening (FS), after reduction of cardiac hypertrophy. DESIGN AND METHODS Echocardiographic evaluation of LV anatomy and function was performed by M-mode echocardiography at baseline, after long-term antihypertensive therapy, and after treatment withdrawal in 68 asymptomatic hypertensive patients (50 males, 18 females, age range 22-62 years). Patients were divided according to the presence of LV hypertrophy (LVH) at baseline (LV mass index, LVMI, > or = 51 g/m(2.7)). RESULTS At baseline patients with concentric (relative wall thickness > 0.44) LV hypertrophy (n = 38) or remodelling (n = 7) had reduced midwall shortening with respect to patients with normal LV geometry (n = 4) or eccentric LVH (n = 19); no differences were observed for endocardial FS. After long-term treatment (average 15 months), in 11 patients LV mass remained within normal limits, in 45 patients LVH reduction was obtained, while in 12 patients LV mass remained persistently elevated. Midwall FS was significantly increased in patients with reduction of LVH both during treatment and after withdrawal of treatment, while it remained significantly lower in patients with persistently elevated LV mass. Changes in midwall fractional shortening were independently associated with modifications in relative wall thickness (P < 0.00001), with changes in end-diastolic dimensions (P < 0.0001) and those of LVMI (P< 0.02) as shown by multivariate analysis. CONCLUSION LV midwall systolic performance significantly improved after reduction of LVH, even in the presence of high blood pressure values. Modifications in relative wall thickness are more independently associated with changes, in LV diastolic dimensions and mass, to midwall improvement
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Affiliation(s)
- M L Muiesan
- Department of Medical and Surgical Sciences, Internal Medicine, University of Brescia, Italy.
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Agabiti-Rosei E, Castellano M, Corbellini C, Rossi F, Perani C. [Neurohormonal hypothesis and arterial hypertension: therapeutic implications]. CARDIOLOGIA (ROME, ITALY) 1999; 44 Suppl 1:197-9. [PMID: 12497907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- E Agabiti-Rosei
- Cattedra di Medicina Interna Università degli Studi Spedali Civili Piazzale Spedali Civili, 1, 25123 Brescia
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Muiesan ML, Salvetti M, Monteduro C, Rizzoni D, Zulli R, Corbellini C, Brun C, Agabiti-Rosei E. Effect of treatment on flow-dependent vasodilation of the brachial artery in essential hypertension. Hypertension 1999; 33:575-80. [PMID: 9931168 DOI: 10.1161/01.hyp.33.1.575] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [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: 11/16/2022]
Abstract
off aim of our study was to evaluate the effect of antihypertensive treatment on flow-mediated dilation (FMD)of a large artery, a noninvasive estimate of endothelial function, in hypertensive patients. In 78 consecutive hypertensive patients (40%men; age range, 42 to 67 years) we measured by a high-resolution ultrasound system the changes of brachial artery diameter during reactive hyperemia and after sublingual glyceryl trinitrate (400 microg); brachial artery flow velocity was measured by pulsed Doppler. The results of 2 studies are reported. In the first study, this procedure was repeated in 58 patients after 6 and 12 months of treatment with a combination of antihypertensive drugs; in a second study, the FMD was assessed in 20 patients after 2 months of monotherapy with either nifedipine or hydrochlorothiazide. In the first study, FMD was significantly increased after treatment compared with baseline (from 3.1+/-3% at baseline to 6.5+/-4.5% at 6 months and to 8.12+/-4. 6% at 12 months; P<0.001 by ANOVA), concomitant with blood pressure reduction (from 162+/-24/102+/-13 mm Hg to 141+/-12/89+/-6 mm Hg and to 141+/-9/89+/-6 mm Hg; P<0.001 by ANOVA); significant changes of endothelium-independent dilation were also observed, but only after 12 months of treatment (from 14.2+/-4.8 at baseline to 15.5+/-4.7 at 6 months and 16.8+/-5.9% at 12 months; P=0.03 by ANOVA). In the second study, FMD was significantly increased during nifedipine treatment as compared with baseline (from 5+/-6.18% at baseline to 9. 45+/-3.94%, P<0.001), while it did not change in patients receiving hydrochlorothiazide (from 5.15+/-5.28% at baseline to 4.69+/-4.34%, NS). No significant changes of endothelium-independent dilation were observed with both drugs (from 17.10+/-2.4% to 18.14+/-3.76% and from 18.73+/-4.07% to 17.46+/-4.27% during nifedipine and hydrochlorothiazide, respectively, NS). Thus, in essential hypertensive patients an improvement of the impaired FMD of the brachial artery, evaluated by noninvasive ultrasound, may be observed after long-term, effective blood pressure reduction, suggesting a beneficial effect of antihypertensive treatment on endothelial function. It seems that beyond blood pressure control, a calcium antagonist may be more effective than a diuretic in this respect.
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Affiliation(s)
- M L Muiesan
- Cattedra di Medicina Interna, University of Brescia, Italy.
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Agabiti-Rosei E, Zulli R, Muiesan ML, Salvetti M, Rizzoni D, Corbellini C, Monteduro C. Reduction of cardiovascular structural changes by nifedipine GITS in essential hypertensive patients. Blood Press 1998; 7:160-9. [PMID: 9758086 DOI: 10.1080/080370598437376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 10/17/2022]
Abstract
The aim of this study was to evaluate the effect of the calcium antagonist Nifedipine GITS in a double-blind, randomized comparison with the diuretic hydrochlorothiazide (HCTZ) on reduction of left ventricular (LV) mass and minimal vascular resistance in a group of essential hypertensives with left ventricular hypertrophy (LVH). The effects on blood pressure and on echocardiographic LV functional parameters were also analysed. After two months of randomized treatment with Nifedipine GITS or HCTZ, if diastolic blood pressure was > 90 mmHg, a combination of the two drugs was given and was continued for 24 weeks. M-mode, 2D-guided echocardiography was used to measure LV mass index (LVMI) according to the "Penn convention". Minimal vascular resistance was measured in the forearm, from arterial pressure and maximal blood flow, using a strain gauge plethysmography. All examinations were performed before and after 8 and 24 weeks of treatment. Changes in LVMI were analysed at 8 weeks and at 24 weeks in patients receiving monotherapy ("according to protocol" analysis), and also at the end of treatment in patients taking Nifedipine or HCTZ monotherapy or the combination of the two drugs ("intention to treat" analysis). Both Nifedipine and HCTZ significantly reduced systolic and diastolic blood pressure (p < 0.001), without any significant difference between the two drug treatments. Heart rate was not significantly modified by either treatment. A progressive decrease in LVMI was observed after 8 and 24 weeks of treatment with Nifedipine monotherapy (ANOVA, p = 0.03), while the decrease in LVMI during HCTZ treatment did not progress further at 24 weeks (ANOVA, p = 0.49). A significant reduction of minimal vascular resistance was observed in patients treated with Nifedipine GITS monotherapy (ANOVA, p = 0.001), but not in the HCTZ group (ANOVA, p = 0.06). Comparison of changes of forearm minimal vascular resistance, considering baseline values, could demonstrate a greater effect during Nifedipine monotherapy as compared to HCTZ monotherapy. In conclusion, in a group of hypertensive patients with LVH, treatment for 24 weeks with Nifedipine GITS alone or in combination with HCTZ induced a significant reduction in LVMI and of forearm vascular structural changes, as evaluated by minimal vascular resistance. The decrease of minimal vascular resistance was significantly greater in patients treated with Nifedipine monotherapy, as compared to those given HCTZ.
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Affiliation(s)
- E Agabiti-Rosei
- Semeiotica and Metodologia Medica, UOP Scienze Mediche, University of Brescia, Italy
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Abstract
EEG findings after sleep deprivation in 452 cases are reported. Effectiveness and specificity of this activating method in the field of epilepsy both in adult and in younger people are emphasized.
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