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Porcu A, Deiana G, Feo CF, Ninniri C, Turilli D, Tanda L, Fancellu A. Hepatopancreatoduodenectomy for the treatment of extrahepatic cholangiocarcinoma. Hepatobiliary Pancreat Dis Int 2023; 22:430-433. [PMID: 36041972 DOI: 10.1016/j.hbpd.2022.08.011] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Alberto Porcu
- Department of Clinical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Department of Clinical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Claudio F Feo
- Department of Clinical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Chiara Ninniri
- Department of Clinical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Davide Turilli
- Unit of Radiological Sciences, AOU Sassari, Sassari, Italy
| | - Lorena Tanda
- Faculty of Medicine and Surgery, University of Sassari, Sassari, Italy
| | - Alessandro Fancellu
- Department of Clinical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari, Italy.
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Fancellu A, Veneroni S, Santoru A, Meloni A, Sanna V, Ginesu GC, Deiana G, Paliogiannis P, Ninniri C, Perra T, Porcu A. How the COVID-19 pandemic has affected the colorectal cancer screening in Italy: A minireview. World J Gastrointest Oncol 2022; 14:1490-1498. [PMID: 36160740 PMCID: PMC9412930 DOI: 10.4251/wjgo.v14.i8.1490] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused detrimental effects on many aspects of healthcare practice. Screening programs for the commonest malignancies, namely colorectal cancer (CRC), breast cancer and cervical cancer have been discontinued or interrupted since the beginning of restriction measures aimed to limit transmission of the new coronavirus infection. Robust evidence exists in favour of the role of screening campaigns in reducing mortality from CRC. In fact, the majority of pre-malignant lesions of the colon and rectum can be diagnosed with colonoscopy and treated by endoscopic or surgical resection. Besides, colonoscopy screening allows the diagnosis of CRCs in their pre-clinical stage. Italy was one of the first European countries where a high level of COVID-19 infections and deaths was observed, and one of the first where lockdowns and strict measures were adopted to reduce the risk of COVID-19 diffusion among the population. A systematic review of the literature was performed, including the PubMed, Scopus, Web of Sciences, and Reference Citation Analysis databases, with the aim of critically evaluating the impact of the COVID-19 pandemic on CRC screening in Italy. We found that reduction of CRC screening activity surpassed 50% in most endoscopic units, with almost 600000 fewer CRC screening exams conducted in the first 5 mo of 2020 vs the same period of 2019. While the consequences of the discontinuation of endoscopy screening for the prognosis and mortality of CRC will be evident in the next few years, recent data confirm that CRC is currently treated at a more advanced stage than in the pre-COVID-19 era. Since delays in CRC prevention and early diagnosis may translate to increased CRC-specific mortality, world healthcare systems should adopt strategies to maintain the regularity of CRC screening during subsequent peaks of the COVID-19 pandemic, or future events that might hamper screening programs.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Simone Veneroni
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Antonio Santoru
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Arianna Meloni
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Giorgio C Ginesu
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Giulia Deiana
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Panagiotis Paliogiannis
- Department of Medical, Surgical, and Experimental Sciences. Unit of Pathology, University of Sassari, Sassari 07100, Italy
| | - Chiara Ninniri
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Teresa Perra
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Alberto Porcu
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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Sanna V, Fedele P, Deiana G, Alicicco MG, Ninniri C, Santoro AN, Pazzola A, Fancellu A. Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer. World J Clin Oncol 2022; 13:577-586. [PMID: 36157162 PMCID: PMC9346425 DOI: 10.5306/wjco.v13.i7.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale (ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.
AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.
METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy (ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS (no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications (grade 3-4) and the number of unplanned visits during the chemotherapy period.
RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group (age P = 0.880; breast cancer stage P = 0.56; cancer histology P = 0.415; tumour size P = 0.258; lymph node status P = 0.883; immunohistochemical classification P = 0.754; type of surgery P = 0.157), except for premenopausal status (P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.
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Affiliation(s)
- Valeria Sanna
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Palma Fedele
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Anna N Santoro
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Antonio Pazzola
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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Pusceddu C, Mascia L, Ninniri C, Ballicu N, Zedda S, Melis L, Deiana G, Porcu A, Fancellu A. The Increasing Role of CT-Guided Cryoablation for the Treatment of Liver Cancer: A Single-Center Report. Cancers (Basel) 2022; 14:cancers14123018. [PMID: 35740682 PMCID: PMC9221264 DOI: 10.3390/cancers14123018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: Cryoablation (CrA) is a minimally invasive treatment that can be used in primary and metastatic liver cancer. The purpose of this study was to assess the effectiveness of CrA in patients with hepatocellular carcinoma (HCC) and liver metastases. Methods: We retrospectively evaluated the patients who had CrA for HCC or liver metastases between 2015 and 2020. Technical success, complete ablation, CrA-related complications, local tumor progression, local recurrences, and distant metastases were evaluated in the study population. In patients with HCC, the median survival was also estimated. Results: Sixty-four liver tumors in 49 patients were treated with CrA (50 metastases and 14 HCC). The mean tumor diameter was 2.15 cm. The mean follow-up was 19.8 months. Technical success was achieved in the whole study population. Complete tumor ablation was observed after one month in 92% of lesions treated with CrA (79% and 96% in the HCC Group and metastases Group, respectively, p < 0.001). Local tumor progression occurred in 12.5 of lesions, with no difference between the study groups (p = 0.105). Sixteen patients (33%) developed local recurrence (45% and 29% in the HCC Group and metastases Group, respectively, p = 0.477). Seven patients (14%) developed distant metastases in the follow-up period. Ten patients (20.8%) underwent redo CrA for local recurrence or incomplete tumor ablation. Minor complications were observed in 14% of patients. In patients with HCC, the median survival was 22 months. Conclusions: CrA can be safely used for treatment of HCC and liver metastases not amenable of surgical resection. Further studies are necessary to better define the role of CrA in the multidisciplinary treatment of liver malignancies.
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Luigi Mascia
- Department of Medical Oncology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy;
| | - Chiara Ninniri
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Nicola Ballicu
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Stefano Zedda
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Luca Melis
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Giulia Deiana
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Alberto Porcu
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Alessandro Fancellu
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
- Correspondence: ; Tel.: +39-079-228432; Fax: +39-079-228394
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Feo CF, Ginesu GC, Fancellu A, Perra T, Ninniri C, Deiana G, Scanu AM, Porcu A. Current management of incidental gallbladder cancer: A review. Int J Surg 2022; 98:106234. [PMID: 35074510 DOI: 10.1016/j.ijsu.2022.106234] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/05/2023]
Abstract
Early-stage gallbladder cancer (GBC) is mostly discovered incidentally by the pathologist after cholecystectomy for a presumed benign disease. It is the most common malignancy of the biliary tract with a variable incidence rate all over the World. The majority of patients with GBC remain asymptomatic for a long time and diagnosis is usually late when the disease is at an advanced stage. Radical surgery consisting in resection of the gallbladder liver bed and regional lymph nodes seems to be the best treatment option for incidental GBC. However, recurrence rates after salvage surgery are still high and the addition of neoadjuvant/adjuvant chemotherapy may improve outcomes. The aim of the present review is to evaluate current literature for advances in management of incidental GBC, with particular focus on staging techniques and surgical options.
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Affiliation(s)
- Claudio F Feo
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
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Fancellu A, Ninniri C, Marinovich ML. Author response to: Outcomes after breast-conserving surgery or mastectomy in patients with triple-negative breast cancer: meta-analysis. Br J Surg 2021; 109:e46. [PMID: 34850829 DOI: 10.1093/bjs/znab419] [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: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences. University of Sassari, 07100 Sassari, Italy
| | - Chiara Ninniri
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences. University of Sassari, 07100 Sassari, Italy
| | - M Luke Marinovich
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney NSW 2006, Australia.,School of Public Health, Curtin University, Bentley, Western Australia WA 6102, Australia
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Feo CF, Ninniri C, Tanda C, Deiana G, Porcu A. Open Hemorrhoidectomy With Ligasure™ Under Local or Spinal Anesthesia: A Comparative Study. Am Surg 2021:31348211038590. [PMID: 34382441 DOI: 10.1177/00031348211038590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is increasing evidence that many anorectal surgical procedures may be performed under local anesthesia. The aim of the present study was to evaluate the safety and efficacy of local anesthesia in the outpatient clinic vs spinal anesthesia in the operating room for open hemorrhoidectomy. METHODS Sixty-two patients with grade III or IV hemorrhoids underwent open hemorrhoidectomy with LigaSure™ between 2018 and 2020. Of them, 32 procedures were performed in the operating room under spinal anesthesia with hyperbaric bupivacaine and other 30 procedures were undertaken in the outpatient clinic under local anesthesia with ropivacaine. RESULTS There were no significant differences regarding age, gender, American Society of Anesthesiologists class, and Goligher's grade in between groups. No significant differences were observed in postoperative pain score (P = .85), perioperative complications (P = .51), and reoperation rate (P = .96). No recurrences and no differences in patients' satisfaction degree (P = .76) were documented at long-term follow-up in both study groups. DISCUSSION Our results suggest that open hemorrhoidectomy with LigaSure™ performed in selected patients under local anesthesia in the outpatient clinic is a well-tolerated, safe, and effective procedure.
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Affiliation(s)
- Claudio F Feo
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, 9312University of Sassari, Sassari, Italy
| | - Chiara Ninniri
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, 9312University of Sassari, Sassari, Italy
| | - Cinzia Tanda
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, 9312University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, 9312University of Sassari, Sassari, Italy
| | - Alberto Porcu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, 9312University of Sassari, Sassari, Italy
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Fancellu A, Sanna V, Deiana G, Ninniri C, Turilli D, Perra T, Porcu A. Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review. World J Gastrointest Oncol 2021; 13:625-637. [PMID: 34163578 PMCID: PMC8204357 DOI: 10.4251/wjgo.v13.i6.625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/03/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatopancreatoduodenectomy (HPD) is the simultaneous combination of hepatic resection, pancreaticoduodenectomy, and resection of the entire extrahepatic biliary system. HPD is not a universally accepted due to high mortality and morbidity rates, as well as to controversial survival benefits.
AIM To evaluate the current role of HPD for curative treatment of gallbladder cancer (GC) or extrahepatic cholangiocarcinoma (ECC) invading both the hepatic hilum and the intrapancreatic common bile duct.
METHODS A systematic literature search using the PubMed, Web of Science, and Scopus databases was performed to identify studies reporting on HPD, using the following keywords: ‘Hepatopancreaticoduodenectomy’, ‘hepatopancreatoduodenectomy’, ‘hepatopancreatectomy’, ‘pancreaticoduodenectomy’, ‘hepatectomy’, ‘hepatic resection’, ‘liver resection’, ‘Whipple procedure’, ‘bile duct cancer’, ‘gallbladder cancer’, and ‘cholangiocarcinoma’.
RESULTS This updated systematic review, focusing on 13 papers published between 2015 and 2020, found that rates of morbidity for HPD have remained high, ranging between 37.0% and 97.4%, while liver failure and pancreatic fistula are the most serious complications. However, perioperative mortality for HPD has decreased compared to initial experiences, and varies between 0% and 26%, although in selected center it is well below 10%. Long term survival outcomes can be achieved in selected patients with R0 resection, although 5–year survival is better for ECC than GC.
CONCLUSION The present review supports the role of HPD in patients with GC and ECC with horizontal spread involving the hepatic hilum and the intrapancreatic bile duct, provided that it is performed in centers with high experience in hepatobiliary-pancreatic surgery. Extensive use of preoperative portal vein embolization, and preoperative biliary drainage in patients with obstructive jaundice, represent strategies for decreasing the occurrence and severity of postoperative complications. It is advisable to develop internationally-accepted protocols for patient selection, preoperative assessment, operative technique, and perioperative care, in order to better define which patients would benefit from HPD.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | | | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | | | - Teresa Perra
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
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Fancellu A, Houssami N, Sanna V, Porcu A, Ninniri C, Marinovich ML. Outcomes after breast-conserving surgery or mastectomy in patients with triple-negative breast cancer: meta-analysis. Br J Surg 2021; 108:760-768. [PMID: 34057990 DOI: 10.1093/bjs/znab145] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND In patients with triple-negative breast cancer (TNBC), oncological and survival outcomes based on locoregional treatment are poorly understood. In particular, the safety of breast-conserving surgery (BCS) for TNBC has been questioned. METHODS A meta-analysis was performed to evaluate locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) rates in patients with TNBC who had breast-conserving surgery versus mastectomy. Estimates were pooled in random-effects analysis. The effect of study-level co-variables was assessed by univariable metaregression. RESULTS Fourteen studies, including 19 819 patients operated for TNBC met the inclusion criteria; 9828 patients (49.6 per cent) underwent BCS and 9991 (50.4 per cent) had a mastectomy. Patients with smaller tumours were more likely to be selected for BCS (pooled odds ratio (OR) for T1 tumours 1.95, 95 per cent c.i. 1.64 to 2.32; P < 0.001). The pooled OR for LRR was 0.64 (0.48 to 0.85; P = 0.002), indicating a statistically significantly lower odds of LRR among women who had BCS relative to mastectomy. The pooled OR for DM was 0.70 (0.53 to 0.94; P = 0.02), indicating a lower odds of DM among women who had BCS; however, this difference diminished with increasing study-level age and follow-up time. A pooled hazard ratio of 0.78 (0.69 to 0.89; P < 0.001) showed a significantly lower hazard for all-cause mortality among women undergoing BCS versus mastectomy. CONCLUSION These results should be interpreted cautiously owing to likely differences in selection for BCS or mastectomy in the included studies. Patients with TNBC selected for BCS do not, however, have a worse prognosis than those treated with mastectomy, and breast conservation can be offered when feasible clinically.
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Affiliation(s)
- A Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - N Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - V Sanna
- Azienda Ospedaliero-Universitaria di Sassari, Unit of Medical Oncology, Sassari, Italy
| | - A Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - C Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - M L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
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Feo CF, Deiana G, Ninniri C, Cherchi G, Crivelli P, Fancellu A, Ginesu GC, Porcu A. Vascular resection for locally advanced pancreatic ductal adenocarcinoma: analysis of long-term outcomes from a single-centre series. World J Surg Oncol 2021; 19:126. [PMID: 33866970 PMCID: PMC8054428 DOI: 10.1186/s12957-021-02238-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis. Radical surgery is the best option for cure and, nowadays, it is performed by many surgeons also in cases of vascular infiltration. Whether this aggressive approach to a locally advanced PDAC produces a survival benefit is under debate. Most data in the literature come from retrospective comparative studies; therefore, it is still unclear if such an extensive surgery for an advanced cancer is justified. Methods A retrospective review of patients with PDAC treated at our institution over a 12-year period was performed. Data concerning patients’ characteristics, operative details, postoperative course, and long-term survival were retrieved from prospective databases and analysed. Factors associated with poor survival were assessed via Cox regression analysis. Results A total of 173 patients with PDAC were included in the analysis, 41 subjects underwent pancreatectomy with vascular resection for locally advanced disease, and in 132 patients, only a pancreatic resection was undertaken. Demographics, major comorbidities, and tumour characteristics were similar between the two groups. Length of surgery (P=0.0006), intraoperative blood transfusions (P<0.0001), and overall complications (P<0.0001) were significantly higher in the vascular resection group. Length of hospital stay (P=0.684) and 90-day mortality (P=0.575) were comparable between groups. Overall median survival (P= 0.717) and survival rates at 1, 3, and 5 years (P=0.964, P=0.500, and P=0.445, respectively) did not differ significantly between groups. Age ≥70 years and postoperative complications were independent predictors of lower survival. Conclusions Our study confirms that pancreatectomy with vascular resection for a locally advanced PDAC is a complex operation associated with a significant longer operating time that may increase morbidity; however, in selected patients, R0 margins can be obtained with an acceptable long-term survival rate. Older patients are less likely to benefit from surgery.
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Affiliation(s)
- Claudio F Feo
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
| | - Giulia Deiana
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Chiara Ninniri
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Giuseppe Cherchi
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Paola Crivelli
- Unit of Radiology, Department of Medical, Surgical and Experimental Sciences, University of Sassary, Viale San Pietro 10, Sassari, 07100, Italy
| | - Alessandro Fancellu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Giorgio C Ginesu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Alberto Porcu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
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Fancellu A, Petrucciani N, Porcu A, Deiana G, Sanna V, Ninniri C, Perra T, Celoria V, Nigri G. The Impact on Survival and Morbidity of Portal-Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies. Cancers (Basel) 2020; 12:cancers12071976. [PMID: 32698500 PMCID: PMC7409306 DOI: 10.3390/cancers12071976] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background: The literature is conflicting regarding oncological outcome and morbidity associated to portal–mesenteric resection during pancreaticoduodenectomy (PD) in patients with pancreatic head adenocarcinoma (PHAC). Methods: A meta-analysis of studies comparing PD plus venous resection (PD+VR) and standard PD exclusively in patients with adenocarcinoma of the pancreatic head was conducted. Results: Twenty-three cohort studies were identified, which included 6037 patients, of which 28.6% underwent PD+VR and 71.4% underwent standard PD. Patients who received PD+VR had lower 1-year overall survival (OS) (odds radio OR 0.79, 95% CI 0.67–0.92, p = 0.003), 3-year OS (OR 0.72, 95% CI 0.59–0.87, p = 0.0006), and 5-year OS (OR 0.57, 95% CI 0.39–0.83, p = 0.003). Patients in the PD+VR group were more likely to have a larger tumor size (MD 3.87, 95% CI 1.75 to 5.99, p = 0.0003), positive lymph nodes (OR 1.24, 95% CI 1.06–1.45, p = 0.007), and R1 resection (OR 1.74, 95% CI 1.37–2.20, p < 0.0001). Thirty-day mortality was higher in the PD+VR group (OR 1.93, 95% CI 1.28–2.91, p = 0.002), while no differences between groups were observed in rates of total complications (OR 1.07, 95% CI, 0.81–1.41, p = 0.65). Conclusions: Although PD+VR has significantly increased the resection rate in patients with PHAC, it has inferior survival outcomes and higher 30-day mortality when compared with standard PD, whereas postoperative morbidity rates are similar. Further research is needed to evaluate the role of PD+VR in the context of multimodality treatment of PHAC.
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Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, Italy; (A.P.); (G.D.); (C.N.); (T.P.); (V.C.)
- Correspondence: ; Tel.: +39-079-22-8432
| | - Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy; (N.P.); (G.N.)
| | - Alberto Porcu
- Unit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, Italy; (A.P.); (G.D.); (C.N.); (T.P.); (V.C.)
| | - Giulia Deiana
- Unit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, Italy; (A.P.); (G.D.); (C.N.); (T.P.); (V.C.)
| | - Valeria Sanna
- Unit of Medical Oncology, AOU Sassari, Via E. De Nicola, 07100 Sassari, Italy;
| | - Chiara Ninniri
- Unit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, Italy; (A.P.); (G.D.); (C.N.); (T.P.); (V.C.)
| | - Teresa Perra
- Unit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, Italy; (A.P.); (G.D.); (C.N.); (T.P.); (V.C.)
| | - Valentina Celoria
- Unit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, Italy; (A.P.); (G.D.); (C.N.); (T.P.); (V.C.)
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy; (N.P.); (G.N.)
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Fancellu A, Perra T, Ninniri C, Cottu P, Deiana G, Feo CF, Porcu A. The emerging role of pectoral nerve block (PECS block) in breast surgery: A case-matched analysis. Breast J 2020; 26:1784-1787. [PMID: 32564408 DOI: 10.1111/tbj.13939] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 02/05/2023]
Abstract
To evaluate the benefits of pectoral nerve block (PECS block) in breast cancer surgery, we compared outcomes of 100 patients receiving PECS vs 107 without PECS. Intraoperative use of fentanyl (P < .001) acetaminophen (P = .02), morphine (P < .01), and nonsteroidal anti-inflammatory drugs (NSAIDS) (P < .01) was lower in the PECS group. Occurrence of postoperative nausea and vomiting (PONV) was lower in the PECS group (P = .04). On postoperative day 1, the use of acetaminophen (P = .23), morphine (P = .83), and NSAIDS (P = .4) did not differ. Twenty-one patients received surgery with PECS block plus sedation alone. PECS block can reduce intraoperative use of opioids and analgesic drugs, and is associated with reduced occurrence of PONV. Selected patients can receive breast-conserving surgery with PECS plus sedation, avoiding general anesthesia.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Teresa Perra
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Pietrina Cottu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
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