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Puccetti F, Cinelli L, Molteni M, Gozzini L, Casiraghi U, Barbieri LA, Treppiedi E, Cossu A, Rosati R, Elmore U. Impact of imaging magnification on colorectal surgery: a matched analysis of a single tertiary center. Tech Coloproctol 2023; 27:1057-1063. [PMID: 36786847 DOI: 10.1007/s10151-023-02767-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Laparoscopy has been increasingly applied in colorectal surgery, and imaging systems have been improving concurrently. The present study aims to compare outcomes following colorectal surgery with the 4K and traditional high-definition (HD) video systems. METHODS All consecutive patients undergoing laparoscopic colorectal surgery between April 2016 and June 2020 were retrospectively retrieved from a prospective institutional database. The study population was matched according to the imaging system (4K versus HD groups) through a propensity score matching (PSM) based on perioperative characteristics of 15 patients. A stratified analysis according to surgical procedures (right, left colectomy, and low anterior resection) was also performed. Primary endpoints were intraoperative blood loss and perioperative transfusions. Also, intra- and postoperative morbidity, operative time, lymph node harvest, and length of hospital stay (LOS) were investigated as secondary outcomes. RESULTS After PSM, 225 patients were included in both 4K and HD groups. The intraoperative blood loss was significantly lower in the 4K group (p = 0.008), although no different volumes of blood transfusion were required. Postoperative complications presented in similar proportions, while significantly higher rates of abdominal collection (p = 0.045), reoperation (p = 0.005), and postoperative urinary disorders occurred in the HD group. After stratification, the right colectomy subgroup shared similar associations with the study population. LOS did not change between groups, although readmissions were significantly lower in the 4K group (p < 0.001). CONCLUSIONS The 4K imaging system represents a technological advance providing better surgical outcomes, such as the minimization of intraoperative blood loss and postoperative morbidity.
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Affiliation(s)
- F Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy.
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy.
| | - L Cinelli
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - M Molteni
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - L Gozzini
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - U Casiraghi
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - L A Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - E Treppiedi
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - A Cossu
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - U Elmore
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
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Mandarino FV, Barchi A, Leone L, Fanti L, Azzolini F, Viale E, Esposito D, Salmeri N, Puccetti F, Barbieri L, Cossu A, Treppiedi E, Elmore U, Rosati R, Danese S. Endoscopic vacuum therapy versus self-expandable metal stent for treatment of anastomotic leaks < 30 mm following oncologic Ivor-Lewis esophagectomy: a matched case-control study. Surg Endosc 2023; 37:7039-7050. [PMID: 37353654 DOI: 10.1007/s00464-023-10213-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/09/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Management of anastomotic leaks after Ivor-Lewis esophagectomy remains a challenge. Although intracavitary endoscopic vacuum therapy (EVT) has shown great efficacy for large dehiscences, the optimal management of smaller leaks has not been standardized. This study aims to compare EVT versus self-expandable metal stent (SEMS) in the treatment of leaks < 30 mm in size, due to the lack of current data on this topic. METHODS Patients undergoing EVT (cases) or SEMS (controls) between May 2017 and July 2022 for anastomotic leaks < 3 cm following oncologic Ivor-Lewis esophagectomy were enrolled. Controls were matched in a 1:1 ratio based on age (± 3 years), BMI (± 3 kg/m2) and leak size (± 4 mm). RESULTS Cases (n = 22) and controls (n = 22) showed no difference in baseline characteristics and leak size, as per matching at enrollment. No differences were detected between the two groups in terms of time from surgery to endoscopic treatment (p = 0.11) or total number of procedures per patient (p = 0.05). Remarkably, the two groups showed comparable results in terms of leaks resolution (90.9% vs. 72.7%, p = 0.11). The number of procedures per patient was not significant between the two cohorts (p = 0.05). The most frequent complication in the SEMS group was migration (15.3% of procedures). CONCLUSION EVT and SEMS seem to have similar efficacy outcomes in the treatment of anastomotic defects < 30 mm after Ivor-Lewis esophagectomy. However, larger studies are needed to corroborate these findings.
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Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy.
| | - Alberto Barchi
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Lorenzo Leone
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Lorella Fanti
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Francesco Azzolini
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Edi Viale
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Dario Esposito
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Noemi Salmeri
- Department of Gynecology/Obstetrics Unit, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Francesco Puccetti
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Lavinia Barbieri
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Elio Treppiedi
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Puccetti F, Cinelli L, Genova L, Battaglia S, Barbieri LA, Treppiedi E, Cossu A, Elmore U, Rosati R. ASO Visual Abstract: Applicative Limitations of Indocyanine Green Fluorescence Assistance to Laparoscopic Lymph Node Dissection in Total Gastrectomy for Cancer. Ann Surg Oncol 2023; 30:2962-2963. [PMID: 36509878 DOI: 10.1245/s10434-022-12882-6] [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] [Indexed: 12/14/2022]
Affiliation(s)
- Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Cinelli
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
| | - Luana Genova
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
| | - Silvia Battaglia
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
| | - Lavinia A Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
| | - Elio Treppiedi
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy.
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
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Mengardo V, Weindelmayer J, Veltri A, Giacopuzzi S, Torroni L, de Manzoni G, Agresta F, Alfieri R, Alfieri S, Antonacci N, Baiocchi GL, Bencini L, Bencivenga M, Benedetti M, Berselli M, Biondi A, Capolupo GT, Carboni F, Casadei R, Casella F, Catarci M, Cerri P, Chiari D, Cocozza E, Colombo G, Cozzaglio L, Dalmonte G, Degiuli M, De Luca M, De Luca R, De Manzini N, De Pasqual CA, De Pascale S, De Ruvo N, Di Cosmo M, Di Leo A, Di Paola M, Elio A, Ferrara F, Ferrari G, Fiscon V, Fumagalli U, Garulli G, Gennai A, Gentile I, Germani P, Gualtierotti M, Guerini F, Gurrado A, Inama M, La Torre F, Laterza E, Losurdo P, Macrì A, Marano A, Marano L, Marchesi F, Marino F, Massani M, Menghi R, Milone M, Molfino S, Montuori M, Moretto G, Morgagni P, Morpurgo E, Abdallah M, Nespoli L, Olmi S, Palaia R, Pallabazer G, Parise P, Pasculli A, Pericoli Ridolfini M, Pesce A, Pinotti E, Pisano M, Poiasina E, Postiglione V, Rausei S, Rella A, Rosa F, Rosati R, Rossi G, Rossit L, Rovatti M, Ruspi L, Sacco L, Saladino E, Sansonetti A, Sartori A, Scaglione D, Scaringi S, Schoenthaler C, Sena G, Simone M, Solaini L, Strignano P, Tartaglia N, Testa S, Testini M, Tiberio GAM, Treppiedi E, Vagliasindi A, Valmasoni M, Viganò J, Zanchettin G, Zanoni A, Zardini C, Zerbinati A. Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy (ADiGe) survey. Updates Surg 2022; 74:1839-1849. [PMID: 36279038 DOI: 10.1007/s13304-022-01397-0] [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: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
Abstract
AbstractEvidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.
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Puccetti F, Cinelli L, Genova L, Battaglia S, Barbieri LA, Treppiedi E, Cossu A, Elmore U, Rosati R. Applicative Limitations of Indocyanine Green Fluorescence Assistance to Laparoscopic Lymph Node Dissection in Total Gastrectomy for Cancer. Ann Surg Oncol 2022; 29:5875-5882. [PMID: 35729291 DOI: 10.1245/s10434-022-11940-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence has been recently introduced as a novel imaging technique improving the accuracy of lymph node (LN) dissection in gastric cancer (GC) surgery, although procedure standardization and achievements have not been clearly defined. This study analyzed the feasibility and effectiveness of ICG-guidance for laparoscopic D2-lymphadenectomy during total gastrectomy for cancer. METHODS This study retrospectively analyzed a single-center series of patients who underwent laparoscopic total gastrectomy for cancer between April 2015 and August 2021. All patients underwent surgery with standard D2 LN dissection. Intraoperative ICG-fluorescence was institutionally implemented in April 2018 and was performed routinely afterward. Primary outcomes were LN harvest and ratio. Secondary endpoints included operative time and subgroup analysis to assess variables potentially affecting LN retrieval. RESULTS The study population included 102 patients, and ICG-fluorescence was applied in 38 (37.3%). ICG and no-ICG groups presented similar median age, gender proportions, ASA score and comorbidities (age-adjusted Charlson Comorbidity Index), body mass index, and advanced pathological stage. The median of LNs retrieved was significantly higher after the intraoperative ICG-guidance (44 vs. 32; p = 0.004), although this association was not significant after neoadjuvant therapy or among patients with positive LNs. Lymph node ratio and operative time were not significantly impacted by ICG fluorescence. Multivariate analysis identified the ICG-assistance as the only independent determinant for LN harvest (p = 0.029). CONCLUSIONS ICG-guidance contributes to a significantly wider LN retrieval after laparoscopic D2-lymphadenectomy during total gastrectomy for cancer. However, neoadjuvant therapy and positive LN stage appeared to limit the procedural effectiveness to ICG-assisted LN identification.
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Affiliation(s)
- Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy.,Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Lorenzo Cinelli
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy
| | - Luana Genova
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy
| | - Silvia Battaglia
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy
| | - Lavinia A Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy
| | - Elio Treppiedi
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy. .,Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132, Milan, Italy.
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy.,Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132, Milan, Italy
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Trapani R, Rausei S, Reddavid R, Degiuli M, Bencivenga M, Dal Cero M, Rosa F, Alfieri S, Tiberio GA, Alfano MS, Gualtierotti M, Ferrari G, Persiani R, Biondi A, Donini A, Graziosi L, Sasia D, Geretto P, Vigano J, Cicuttin E, Galli F, Strignano P, Mazza E, Taddei A, Bartolini I, Taglietti L, Ruggiero S, Treppiedi E, Postiglione V, Casella F, Sansonetti A, Abatini C, Attalla EL Halabieh M, Millo P, Usai A, Mineccia M, Ferrero A. Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer. Eur J Surg Oncol 2020; 46:2243-2247. [DOI: 10.1016/j.ejso.2020.06.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022] Open
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Zimmitti G, La Mendola R, Manzoni A, Sega V, Malerba V, Treppiedi E, Codignola C, Monfardini L, Garatti M, Rosso E. Investigation of intraoperative factors associated with postoperative pancreatic fistula following laparoscopic left pancreatectomy with stapled closure: a video review-based analysis : Video-review for predictors of pancreatic leak. Surg Endosc 2020; 35:941-954. [PMID: 32914358 DOI: 10.1007/s00464-020-07912-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) following distal pancreatectomy (DP) remains the most frequent complication, potential precursor of more serious events, and mechanisms behind POPF development are not clear. Primary aim of the current study is to investigate correlations between patients' characteristics, including technical intraoperative data assessed by retrospective video review of laparoscopic DP (L-PD), and development of clinically relevant (CR-)POPF and major complication. METHODS Patients undergoing L-DP whose surgery video was available for review were included in this study. Retrospective video review, performed by two surgeons blinded for postoperative outcomes, was focused on pancreatic neck transection and identification of pancreatic capsule disruption (PCD)/staple line bleeding (SLB). Correlation between clinical, demographic, and intraoperative factors and CR-POPF/major complications and assessment of factors associated with PCD and SLB were investigated. RESULTS Of 41 L-DP performed at our institution (June 2015-June 2020) using a triple-row stapler (EndoGIA™ Reloads with Tri-Staple™), surgery video was available for 38 patients [men/women, 13/25; median age (range) 62 (25-84) years; median BMI (range) 24 (17-42)]. PCD and SLB occurred in 15(39%) and 19(50%) patients and were concomitant in 9(24%). CR-POPF and major complications occurred in 8(21%) and 12(31%) patients, respectively. PCD, SLB, and PCD + SLB rates were significantly higher among patients with CR-POPF, compared to patients without (all p < 0.05). Among patients with PCD, pancreatic thickness at pancreatic transection site was higher (19 mm), compared to non-PCD patients (13 mm, p < 0.001). A directly proportional relation between PCD, CR-POPF, and major complication rate and pancreatic thickness was confirmed by ROC analysis (AUC = 0.949, 0.798, and 0.740, respectively). CONCLUSION PCD and SLB close to the staple line detected by retrospective video-review are intraoperatively detectable indicators of severe pancreatic traumatism and a potential precursors of CR-POPF following L-PD. Given the strict correlation between PCD and pancreatic thickness, alternative techniques to stapled closure for pancreatic transection may be recommended for patients with a thick pancreas and modification in postoperative care may be considered in patients with PCD/SLB.
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Affiliation(s)
- Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy.
| | - Roberta La Mendola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Valentina Sega
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Valentina Malerba
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Elio Treppiedi
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Claudio Codignola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Lorenzo Monfardini
- Department of Radiology, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
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Rosso E, Manzoni A, Zimmitti G, Sega V, Treppiedi E, Giaccari S, Codignola C, Garatti M. Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Venous Tangential Resection: Focus on Periadventitial Dissection of the Superior Mesenteric Artery for Obtaining Negative Margin and a Safe Vascular Resection. Ann Surg Oncol 2020; 27:2902-2903. [PMID: 32323087 DOI: 10.1245/s10434-020-08271-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Due to its technical complexity, laparoscopic (L-) radical antegrade modular pancreatosplenectomy (RAMPS) for left-sided pancreatic ductal adenocarcinoma (PDAC) has been described in a few series.1-4 In addition, splenomesenteric junction tumor involvement is considered a formal contraindication to L-RAMPS. METHODS The video shows posterior L-RAMPS with a left approach to the superior mesenteric artery (SMA) for a left-sided PDAC with suspected involvement of the splenomesenteric junction. RESULTS The patient was a 61-year-old woman affected by a cT3N0M0 pancreatic body PDAC. Following dissection of the superior mesenteric vein (SMV), proper/common hepatic artery, and gastroduodenal artery, the pancreatic neck is encircled and the celiac trunk (CT) skeletonized. The treitz ligament is opened, and the SMA is identified and dissected on its left anterior margin. Pancreatic mobilization en bloc with the Gerota fascia and left adrenal gland is followed by splenic artery transection and suprapancreatic lymphadenectomy completion. The mesopancreas is dissected from the right margin of the SMA and CT and the pancreas is transected. The portal vein and SMV are cross-clamped and a venous tangential resection/closure is performed. Cryostate histological examination of the venous and pancreatic stumps showed absence of tumor cells. Final pathology revealed a pT2N0(0+/42)R0G2 PDAC of the pancreatic body. CONCLUSION During L-RAMPS, periadvential SMA dissection through the left-anterior approach, specular to the right posterior SMA approach described for laparoscopic pancreatoduodenectomy,5,6 has a primary role in maximizing the vascular surgical margin and, allowing for complete mobilization of the specimen before vein resection, may make a splenomesenteric junction tangential resection/closure easier and safer in case of tumor involvement of the splenomesenteric venous axis.
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Affiliation(s)
- Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Valentina Sega
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Elio Treppiedi
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Sara Giaccari
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Claudio Codignola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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Bencivenga M, Treppiedi E, Dal Cero M, Torroni L, Verlato G, Iglesias M, Renaud F, Tomezzoli A, Castelli C, Piessen G, Pera M, de Manzoni G. The amount of signet ring cells is significantly associated with tumour stage and survival in gastric poorly cohesive tumours. J Surg Oncol 2020; 121:1084-1089. [PMID: 32153051 DOI: 10.1002/jso.25885] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/19/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate whether the amount of signet ring cells (SRCs) affects clinicopathological characteristics and prognosis of poorly cohesive (PC) gastric tumours. STUDY DESIGN One hundred seventy-three patients with PC tumours treated at three European centres from 2004 to 2014 were reclassified in three categories: (a) pure SRC cancers (SRC1) (≥90% SRCs); (b) PC carcinoma with SRC component (SRC2) (>10%, <90% SRCs); (c) PC carcinoma not otherwise specified (SRC3) (≤10% SRCs). RESULTS The percentage of SRCs was inversely related to the pT stage (Spearman's ρ = -0.174, P < .001) and the number of positive nodes coded as a continuous variable (P = .009). Five year cancer-related survival was significantly higher (58%, 95% confidence interval [CI]: 36%-75%) in SRC1 compared with SRC2 (39%, 95% CI: 28%-50%) and SRC3 (38%, 95% CI: 22%-53%), (P = .048). In multivariable analysis, the impact of PC categories on cancer-related survival was significant when controlling for sex, age, pT, pN, and curativity (hazard ratio [HR] of sSRC2 vs SRC1 = 2.08, 95% CI: 1.01-4.29, P = .046; HR of SRC3 vs SRC1 = 2.38, 95% CI: 1.05-5.41, P = .039). CONCLUSION The percentage of SRCs was inversely related to tumour aggressiveness, with long-term survival significantly higher in SRC1 compared with SRC2 and SRC3 tumours.
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Affiliation(s)
- Maria Bencivenga
- Unit of General and Upper GI Surgery, Università degli studi di Verona, Verona, Italy
| | - Elio Treppiedi
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Department of Surgery, Hôpital Claude-Huriez, Lille, France
| | - Mariagiulia Dal Cero
- Unit of General and Upper GI Surgery, Università degli studi di Verona, Verona, Italy
- Section of Gastrointestinal Surgery, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Lorena Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, Università degli studi di Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, Università degli studi di Verona, Verona, Italy
| | - Mar Iglesias
- Department of Pathology, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Florence Renaud
- Department of Pathology, Hôpital Claude-Huriez, Lille, France
| | - Anna Tomezzoli
- Department of Pathology, Verona University Hospital, Verona, Italy
| | - Claudia Castelli
- Department of Pathology, Verona University Hospital, Verona, Italy
| | | | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Giovanni de Manzoni
- Unit of General and Upper GI Surgery, Università degli studi di Verona, Verona, Italy
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10
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Cocchi L, Di Domenico S, Bertoglio S, Treppiedi E, Ficarra G, De Cian F. Inferior vena cava resection without reconstruction for retroperitoneal malignancies. J Surg Case Rep 2019; 2019:rjz275. [PMID: 31636887 PMCID: PMC6796171 DOI: 10.1093/jscr/rjz275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/31/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
Inferior vena cava (IVC) involvement in retroperitoneal malignancies is a rare occurrence and radical surgery with major vascular resection represents the only potential curative treatment. IVC replacement after resection is still controversial and only small series and few prospective data are available. We report a series of three patients affected by retroperitoneal masses involving IVC treated with vena cava resection without replacement. All patients were treated by a radical R0 surgical procedure associated with infrarenal IVC resection and no reconstruction. Based on preoperative radiologic imaging and intraoperative findings, one patient also underwent right nephrectomy, while another patient underwent left renal vein ligation without nephrectomy. Neither early nor late severe post-operative complications related to the absence of IVC outflow were observed. Resection without replacement of the infrarenal IVC results in acceptable morbidity, thus specific risks related to the use of prosthetic grafts can be avoided.
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Affiliation(s)
- Lorenzo Cocchi
- Department of General Surgery, Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy
- Correspondence address. Department of General Surgery, Policlinico San Martino, University of Genoa, Largo Rosanna Benzi, 10-16132 Genova, Italy. Tel: +39 349 3381940; E-mail:
| | - Stefano Di Domenico
- Department of General Surgery, Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy
| | - Sergio Bertoglio
- Department of General Surgery, Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy
| | - Elio Treppiedi
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Gianluca Ficarra
- Department of Radiology, Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Franco De Cian
- Department of General Surgery, Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy
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11
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Treppiedi E, Cocchi L, Zimmitti G, Manzoni A, Seletti V, Bizzotto A, Spada C, Garatti M, Rosso E. Ileocolic invagination in adults: A totally minimally invasive endoscopic and laparoscopic staged approach. J Minim Access Surg 2019; 16:87-89. [PMID: 30777993 PMCID: PMC6945337 DOI: 10.4103/jmas.jmas_279_18] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Adult intussusception of the bowel is a rare clinical entity, and its management remains debated. The timing of treatment is not yet standardised, and no guidelines exist. We report a case of an 83-year-old woman presenting to the emergency department of our hospital with a history of increasing abdominal pain in the right iliac fossa. A contrast-enhanced computed tomography scan showed the presence of a large ileocolic intussusception with evidence of the terminal ileus invaginated within the right colon and the ileocolic vessels dragged and trapped into the intussusception. A colonoscopy confirmed the ileocolic invagination with a large right colonic lesion as leading point, and a partial pneumatic (carbon dioxide) and hydrostatic reduction was achieved. Subsequent laparoscopic right colectomy was performed according to oncological principles. A totally minimally invasive approach of this rare condition has been achieved but the literature lacks about the correct management of this entity.
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Affiliation(s)
- Elio Treppiedi
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Lorenzo Cocchi
- Department of General Surgery, University of Genoa, San Martino Hospital, Genova, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Valeria Seletti
- Department of Radiology, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alessandra Bizzotto
- Department of Digestive Endoscopy Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Cristiano Spada
- Department of Digestive Endoscopy Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
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12
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Treppiedi E, La Mendola R, Rosso E. Bowel preparation in elective colorectal surgery: back to the future? Updates Surg 2018; 71:595-596. [PMID: 29974353 DOI: 10.1007/s13304-018-0561-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Elio Treppiedi
- Department of General Surgery, Fondazione Poliambulanza, Istituto Ospedaliero, 25124, Brescia, Italy
| | | | - Edoardo Rosso
- Department of General Surgery, Fondazione Poliambulanza, Istituto Ospedaliero, 25124, Brescia, Italy
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13
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Bencivenga M, Treppiedi E, Verlato G, Mengardo V, Giacopuzzi S, de Manzoni G. The amount of cells with Signet Ring Cell morphology has a prognostic impact in poorly cohesive gastric carcinoma. Eur J Cancer 2018. [DOI: 10.1016/j.ejca.2018.01.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Zimmitti G, Manzoni A, Ramera M, Villanacci A, Sega V, Treppiedi E, Guerini F, Garatti M, Codignola C, Rosso E. Management of portal annular pancreas during laparoscopic pancreaticoduodenectomy. J Minim Access Surg 2018; 14:354-356. [PMID: 29582803 PMCID: PMC6130175 DOI: 10.4103/jmas.jmas_235_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Portal annular pancreas (PAP) is a pancreatic congenital anomaly consisting of pancreatic parenchyma encircling the portal vein and/or the superior mesenteric vein. It has been reported that the risk of developing a post-operative pancreatic fistula is higher following pancreaticoduodenectomy in patients with PAP, probably because of the possibility of leaving undrained a portion of pancreatic parenchyma during the reconstructive phase. Few manuscripts have reported a surgical technique of pancreaticoduodenectomy in case of PAP, herein we report the first case of a patient with PAP undergoing laparoscopic pancreaticoduodenectomy.
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Affiliation(s)
- Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Ramera
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Alberta Villanacci
- Department of Radiology and Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Valentina Sega
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Elio Treppiedi
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Francesca Guerini
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Claudio Codignola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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15
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Treppiedi E, Zimmitti G, Manzoni A, Sega V, Guerini F, Mutti S, Lombardi M, Bonaventure T, Rosso E. Extra peritoneal giant pelvic hibernoma: a case report. J Surg Case Rep 2017; 2017:rjx250. [PMID: 29255590 PMCID: PMC5730937 DOI: 10.1093/jscr/rjx250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/08/2017] [Accepted: 11/25/2017] [Indexed: 11/13/2022] Open
Abstract
Abdominal hibernoma is a rare slow-growing tumor originating from brown adipose tissue. Due to its rarity, only a few case reports have been published so far. Pelvic localization is anedoctal and preoperative differential diagnosis with other malignancies may be challenging. We present the case of a woman who, due to a lower abdominal pain, underwent an abdominal ultrasonography with diagnosis of a 15 cm hyperechogenous pelvic mass. A subsequent MRI showed a 16 × 5.8 × 7.8 cm3 lesion anterior to the left iliacus muscle, with an intra- and extrapelvic component longitudinally extending from the left anterior superior iliac spine until the lesser trochanter. Surgical resection was performed and final histopathology was consistent with hibernoma. This report emphasizes the necessity to include hibernoma among differential diagnosis when a retroperitoneal abdominal mass is diagnosed and the difficulty to perform preoperatively this diagnosis due to the extreme rarity of these neoplasms.
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Affiliation(s)
- Elio Treppiedi
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Alberto Manzoni
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Valentina Sega
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Francesca Guerini
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Stefano Mutti
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Mariano Lombardi
- Department of Pathological Anatomy, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Tamu Bonaventure
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Edoardo Rosso
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
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16
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Giacopuzzi S, Weindelmayer J, Treppiedi E, Bencivenga M, Ceola M, Priolo S, Carlini M, de Manzoni G. Enhanced recovery after surgery protocol in patients undergoing esophagectomy for cancer: a single center experience. Dis Esophagus 2017; 30:1-6. [PMID: 28375472 DOI: 10.1093/dote/dow024] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
Abstract
This article is about an emerging issue in esophageal surgery: enhanced recovery after surgery (ERAS) Few data are published in literature and its safety and feasibility is still debated. The focus of our paper is on the feasibility of an ERAS protocol for esophagectomy (including both the Ivor-Lewis and McKeown procedure) in a high volume center comparing to a standard perioperative protocol. We introduced a novelty item on this type of surgery: resume of oral feeding in the first postoperative day. We analyzed the dropout rate for each item and the postoperative morbidity. We studied 39 patients operated in the Upper GI division of Verona University Hospital between January 2013 and August 2014; 22 patients (ERAS group) were studied in a perspective way while 17 patients (standard group) were studied retrospectively. The enhanced recovery protocol included intraoperative fluid management, time of extubation after surgery, intensive care unit discharge, drains and nasogastric tube management, mobilization of the patient, oral food intake. We compared the results between the two groups in term of hospital stay, postoperative morbidity and mortality. We also calculated the percentage completion of the protocol, evaluating patient drop-out rates for each of the items. Patients showed an improvement in the ERAS group in terms of earlier extubation, earlier intensive care unit discharge (p < 0.01), earlier thoracic drain, urinary catheter (p < 0.01) and nasogastric tube removal (p = 0.02), earlier mobilization (p < 0.01), and resume of oral feeding (p < 0.01). Median length of hospital stays in the ERAS group was 9 days while in the standard group was 10 days (p = 0.23). Postoperative morbidity and mortality were comparable between the two groups. This study shows the feasibility and safety of an ERAS protocol for esophageal surgery in a high-volume center. These data strengthen the literature results on this argument calling for larger sample size studies.
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Bregni M, Bernardi M, Servida P, Pescarollo A, Crocchiolo R, Treppiedi E, Corradini P, Ciceri F, Peccatori J. Long-term follow-up of metastatic renal cancer patients undergoing reduced-intensity allografting. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7037] [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: 11/20/2022] Open
Abstract
7037 Background: Stem cell transplantation from a HLA-compatible sibling donor is an adoptive immunotherapy for cytokine-refractory, metastatic clear-cell renal cell cancer (RCC). However, the recent introduction of targeted therapy compounds has reduced the interest in this therapeutic strategy. We have reanalyzed our series with the aim to assess long-term benefit from allografting. Methods: Twenty-five RCC patients (Table) received a reduced-intensity allograft from an HLA-identical sibling donor after a thiotepa, fludarabine, and cyclophosphamide conditioning regimen, and a cyclosporine-based GVHD prophylaxis. Allogeneic peripheral blood hematopoietic cells were collected by apheresis after filgrastim treatment of the donor. Results: Best response to allograft was evaluable in 24 patients: 1 complete remission, 4 partial remissions, 12 minor response or stable disease, 7 progressive disease. Six patients died because of transplant related mortality (TRM) at day +12, +71, +86, +151, +259, +478. Cause of death was infection in four cases, GVHD in one case, and acute renal failure in one case. Fourteen patients died for progressive disease at median 415 (36–958) days from transplant. One-year survival was 48%, and 5-yr survival was 20%. At a median observation time of 65 months, 5 patients are alive, one in CR, one in PR, and three with stable disease. At multivariate analysis, CRP value before transplant, number of CD34+ infused cells and disease status at +90 significantly correlated with survival. Survival of patients at favourable/intermediate-risk according to the MSKCC score that underwent allografting was better in comparison to the survival predicted by historical controls. Conclusions: Transplantation is able to induce long-term disease control in a fraction (20%) of relapsed RCC patients. Identifying patients who could benefit from allografting, and incorporating molecularly targeted drugs in the transplant regimen, could further decrease progression and prolong overall survival. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Bregni
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - M. Bernardi
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - P. Servida
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - A. Pescarollo
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - R. Crocchiolo
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - E. Treppiedi
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - P. Corradini
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - F. Ciceri
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
| | - J. Peccatori
- Ospedale San Giuseppe, Milano, Italy; Istituto Scientifico San Raffaele, Milano, Italy; Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland; Ospedale Evangelico, Genova, Italy; Istituto Nazionale Tumori, Milano, Italy
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Bregni M, Bernardi M, Pescarollo A, Crocchiolo R, Treppiedi E, Ciceri F, Corradini P, Peccatori J. Long-Term Follow-Up of Metastatic Renal Cancer Patients Undergoing Reduced-Intensity Allografting. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.260] [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: 10/21/2022]
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