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Rocco N, Ghilli M, Curcio A, Bortul M, Burlizzi S, Cabula C, Cabula R, Ferrari A, Folli S, Fortunato L, Frittelli P, Gentilini O, Grendele S, Grassi MM, Grossi S, Magnoni F, Murgo R, Palli D, Rovera F, Sanguinetti A, Taffurelli M, Tazzioli G, Terribile DA, Caruso F, Galimberti V. Is routine axillary lymph node dissection needed to tailor systemic treatments for breast cancer patients in the era of molecular oncology? A position paper of the Italian National Association of Breast Surgeons (ANISC). Eur J Surg Oncol 2024; 50:107954. [PMID: 38217946 DOI: 10.1016/j.ejso.2024.107954] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/17/2023] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND De-escalation of axillary surgery in breast cancer (BC) management began when sentinel lymph node biopsy (SLNB) replaced axillary lymph node dissection (ALND) as standard of care in patients with node-negative BC. The second step consolidated ALND omission in selected subgroups of BC patients with up to two macrometastases and recognized BC molecular and genomic implication in predicting prognosis and planning adjuvant treatment. Outcomes from the recent RxPONDER and monarchE trials have come to challenge the previous cut-off of two SLN in order to inform decisions on systemic therapies for hormone receptor-positive (HR+), human epidermal growth factor receptor type-2 (HER2) negative BC, as the criteria included a cut-off of respectively three and four SLNs. In view of the controversy that this may lift in surgical practice, the Italian National Association of Breast Surgeons (Associazione Nazionale Italiana Senologi Chirurghi, ANISC) reviewed data regarding the latest trials on this topic and proposes an implementation in clinical practice. MATERIAL AND METHODS We reviewed the available literature offering data on the pathological nodal status of cN0 breast cancer patients. RESULTS The rates of pN2 status in cN0 patients ranges from 3.5 % to 16 %; pre-surgical diagnostic definition of axillary lymph node status in cN0 patients by ultrasound could be useful to inform about a possible involvement of ≥4 lymph nodes in this specific sub-groups of women. CONCLUSIONS The Italian National Association of Breast Surgeons (ANISC) considers that for HR + HER2-/cN0-pN1(sn) BC patients undergoing breast conserving treatment the preoperative workup should be optimized for a more detailed assessment of the axilla and the technique of SLNB should be optimized, if considered appropriate by the surgeon, not considering routine ALND always indicated to determine treatment recommendations according to criteria of eligibility to RxPONDER and monarch-E trials.
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Affiliation(s)
- Nicola Rocco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Matteo Ghilli
- Breast Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Marina Bortul
- SSD Chirurgia Senologica e Breast Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy Naples, Italy
| | - Stefano Burlizzi
- UOSD Chirurgia Senologica, Ospedale "A. Perrino", Brindisi, Italy
| | - Carlo Cabula
- Chirurgia Senologica Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Roberta Cabula
- Cagliari University Hospital, Surgery Unit, Cagliari, Italy
| | - Alberta Ferrari
- SSD Chirurgia Tumori eredo-famigliari, SC Chirurgia Generale 3, Senologia, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
| | - Secondo Folli
- SC di Chirurgia Oncologica-Senologia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Lucio Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Patrizia Frittelli
- UOC Chirurgia senologica, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy
| | - Oreste Gentilini
- Breast Unit, IRCCS Ospedale San Raffaele di Milano, Milan, Italy
| | - Sara Grendele
- Breast Surgery, Department of Functional Oncology, Alto Vicentino Hospital, Santorso, Vicenza, Italy
| | | | | | - Francesca Magnoni
- Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Murgo
- Chirurgia Senologica, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Dante Palli
- UOC di Chirurgia Generale ad Indirizzo Senologico-Breast Unit AUSL Piacenza, Italy
| | - Francesca Rovera
- S.S.D. Breast Unit - Ospedale Universitario, Varese, Italy; Dipartimento di Medicina e Innovazione Tecnologica, Università degli Studi dell'Insubria, Varese, Italy
| | - Alessandro Sanguinetti
- SSD Chirurgia della Mammella - Dipartimento di Chirurgia, Azienda Ospedaliera "S.Maria", Terni, Italy
| | - Mario Taffurelli
- Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | | | | | - Francesco Caruso
- Breast Unit, Humanitas Istituto Clinico Catanese, Misterbianco, (CT), Italy; National Association of Breast Surgeons (ANISC), Italy
| | - Viviana Galimberti
- Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy
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Rondelli F, Sanguinetti A, Polistena A, Avenia S, Marcacci C, Ceccarelli G, Bugiantella W, De Rosa M. Robotic Transanal Total Mesorectal Excision (RTaTME): State of the Art. J Pers Med 2021; 11:jpm11060584. [PMID: 34205596 PMCID: PMC8233761 DOI: 10.3390/jpm11060584] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/05/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Total mesorectal excision (TME) is the gold standard technique for the surgical management of rectal cancer. The transanal approach to the mesorectum was introduced to overcome the technical difficulties related to the distal rectal dissection. Since its inception, interest in transanal mesorectal excision has grown exponentially and it appears that the benefits are maximal in patients with mid-low rectal cancer where anatomical and pathological features represent the greatest challenges. Current evidence demonstrates that this approach is safe and feasible, with oncological and functional outcome comparable to conventional approaches, but with specific complications related to the technique. Robotics might potentially simplify the technical steps of distal rectal dissection, with a shorter learning curve compared to the laparoscopic transanal approach, but with higher costs. The objective of this review is to critically analyze the available literature concerning robotic transanal TME in order to define its role in the management of rectal cancer and to depict future perspectives in this field of research.
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Affiliation(s)
- Fabio Rondelli
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Alessandro Sanguinetti
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Andrea Polistena
- Department of General and Laparoscopic Surgery–University Hospital, University of Rome, “Umberto I”, 00161 Rome, Italy;
| | - Stefano Avenia
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Claudio Marcacci
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Graziano Ceccarelli
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
| | - Walter Bugiantella
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
| | - Michele De Rosa
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
- Correspondence:
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Polistena A, Galasse S, Sanguinetti A, Rozzi A, Avenia S, Pennella FP, Crocetti D, Avenia N. Ischemic colitis with non-gangrenous, stenotic evolution following hemorrhagic shock A case report and review of the literature. Ann Ital Chir 2021; 10:S2239253X21033922. [PMID: 33843722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Ischemic colitis (IC) accounts for more of the half of total diagnosis of gastrointestinal ischemia. It is a challenging condition due to non-specificity of the symptoms at onset, inconstant behaviour and a wide range of clinical gravity with a different therapeutic approach. A classification of IC into gangrenous, stricturing and transient forms can be considered. CASE REPORT In the presented case, due to hypovolemic hemorrhagic shock, the patient developed a progressive IC without gangrene but slowly evolving in multiple colonic strictures with general serious clinical condition. Endoscopy was used to confirm diagnosis and to tempt a pneumatic stricture dilation which resulted ineffective. A diverting stoma was required and an elective subtotal colectomy was carried out after resolution of the acute phase. CONCLUSIONS IC may present with a large spectrum of clinical conditions. In acute shocked patients it must be always considered when a complicated abdominal picture is present. Immediate surgery is not always required considering the spontaneous resolutions of the milder forms. Strictures are the most frequent evolution following the intermediate nongangrenous presentation and initially they can be treated conservatively with postponed tailored resection after the healing of the diffuse mucosal injuries. KEY WORDS Ischemic, colitis, Shock, Stricture.
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Sanguinetti A, Avenia S, Pennella FP, Chiummariello S, Lucchini R, Galasse S, Macciò T, Avenia N, Polistena A. Metastases to the breast. A clinical series from a single institution experience with review of the literature. Ann Ital Chir 2021; 92:141-148. [PMID: 34031289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Breast metastases although rare are challenging for diagnostic difficulties and management. Treatment differs according to morphological, immunophenotipycal and biologic features of the primary tumor and their general behaviour is extremely different compared to primary breast cancer. The most frequent primary tumors include melanoma, lymphomas, gynecological, pulmonary, head and neck, gastroenteric and urinary tract cancers. Patient's prognosis is poor being generally associated to disseminated systemic disease with limited survival despite the effects of systemic treatment. PATIENTS AND METHODS We report the analysis of the diagnostic and therapeutic approach on the institutional experience of four cases of breast metastases originating from melanoma, pulmonary adenocarcinoma and differentiated thyroid carcinomas. CONCLUSIONS The management of breast secondarisms requires focused diagnosis and evaluation in order to provide an adequate treatment with a multidisciplinary approach especially when the primary tumor is unknown. KEY WORDS Breast metastases, Melanoma, Pulmonary, Thyroid.
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Sanguinetti A, Puma F, Lucchini R, Santoprete S, Cirocchi R, Corsi A, Triola R, Avenia N. [Retraction] Breast metastasis from a pulmonary adenocarcinoma: Case report and review of the literature. Oncol Lett 2019; 18:6305. [PMID: 31788109 PMCID: PMC6865728 DOI: 10.3892/ol.2019.10965] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Francesco Puma
- Thoracic Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Lucchini
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Stefano Santoprete
- Thoracic Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberto Cirocchi
- General Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Alessia Corsi
- General Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Triola
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
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Sanguinetti A, Puma F, Lucchini R, Santoprete S, Cirocchi R, Corsi A, Triola R, Avenia N. [Retracted] Breast metastasis from a pulmonary adenocarcinoma: Case report and review of the literature. Oncol Lett 2019. [DOI: 10.3892/ol.2019.10714] [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: 11/05/2022] Open
Affiliation(s)
| | - Francesco Puma
- Thoracic Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Lucchini
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Stefano Santoprete
- Thoracic Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberto Cirocchi
- General Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Alessia Corsi
- General Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Triola
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
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Gambardella C, Clarizia G, Patrone R, Offi C, Mauriello C, Romano R, Filardo M, Conzo A, Sanguinetti A, Polistena A, Avenia N, Conzo G. Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation. BMC Surg 2019; 18:125. [PMID: 31074399 PMCID: PMC7402581 DOI: 10.1186/s12893-018-0454-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 09/18/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer is the most frequent neoplasm in women. Axillary lymph nodes dissection represents the treatment of choice in locally advanced breast cancer for prognostic and curative purposes. Seroma formation, an abnormal collection of fluid in the dead space of the axilla, is described in Literature with a wide range of incidence (3–85%). It is a source of significant morbidity and discomfort. The aim of the study is to compare the different haemostasis devices used in breast surgery, investigating the eventual superiority of an instrument among the others in terms of intraoperative and postoperative outcome, especially of seroma formation. Methods Clinical cases of female patients undergone axillary lymph nodes dissection for local advanced breast cancer between January 2013 and July 2017 at the Surgery Unit of University of Campania “Luigi Vanvitelli” were retrospectively reviewed. Patients were divided into four groups, according to device utilized during surgery: Electrocautery, Harmonic Scalpel, LigaSure and Thunderbeat. All patients underwent II level axillary lymph nodes dissection associated to radical mastectomy or quadrantectomy. Results One hundred consecutives patients were enrolled in the study. Intra-operative blood loss resulted statistically significant different (P < 0,01) between the Electrocautery group (94,7 ml) and the Thunderbeat group (57,2 ml), while the Harmonic Scalpel group and the Ligasure group, despite presented a lower amount of blood loss, did not differ significantly. Drainage volume resulted significantly lower (P = 0,002) in the comparison between the Electrocautery group and the Thunderbeat group; the Ligasure group and Harmonic Scapel group showed no difference between them and Electrocautery group. About the seroma formation, the Electrocautery group resulted affected by the highest seroma formation rate (64%). Seroma incidence in Harmonic Scalpel group was 24%, in Ligasure group was 44%, while Thunderbeat group showed the lowest presentation of seroma with 16%. Conclusions In patients affected by breast cancer requiring axillary lymphnodes dissection, the use of advanced hemostasis devices is highly desirable. Among the non-traditional tools, Thunderbeat resulted to be superior in terms of reduction of intra-operative blood loss and post-operative drainage output, moreover associated to a substantial reduction of postoperative seroma incidence.
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Affiliation(s)
- Claudio Gambardella
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Guglielmo Clarizia
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Renato Patrone
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Chiara Offi
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudio Mauriello
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Roberto Romano
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Marco Filardo
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Alessandra Conzo
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Alessandro Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Andrea Polistena
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
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Gambardella C, Patrone R, Di Capua F, Offi C, Mauriello C, Clarizia G, Andretta C, Polistena A, Sanguinetti A, Calò P, Docimo G, Avenia N, Conzo G. The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study. BMC Surg 2019; 18:110. [PMID: 31074400 PMCID: PMC7402571 DOI: 10.1186/s12893-018-0433-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population. METHODS A retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged ≥ 65 years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74 years old and over 75 years old. RESULTS Total thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75 years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B). CONCLUSIONS The role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75 years old, advocating a tailored surgical approach in elderly population.
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Affiliation(s)
- Claudio Gambardella
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Renato Patrone
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesco Di Capua
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Chiara Offi
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudio Mauriello
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Guglielmo Clarizia
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudia Andretta
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Andrea Polistena
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Alessandro Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Pietrogiorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giovanni Docimo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
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Polistena A, Sanguinetti A, Lucchini R, Avenia S, Galasse S, Farabi R, Monacelli M, Avenia N. Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy. BMC Surg 2019; 18:22. [PMID: 31074384 PMCID: PMC7402575 DOI: 10.1186/s12893-019-0485-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/08/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic mutations usually may influences the surgical approach. METHODS We retrospectively analyzed 52 cases of TIR3B underwent between 2015 and 2017 total thyroidectomy (TT) and lobectomy (L), focusing mainly on the observed rate of malignancy. Chi-squared test and Fisher's exact probability test were used for analysis, considering a P values less than 0.05 as significant. RESULTS Out of 52 patients 49 underwent TT and 3 L. In TT group a multinodular goiter was associated in 67.3% of patients. Malignancy rate was 81.6 and 33.3% respectively after TT and L (P 0.003). Multicentric and contralateral tumors were detected respectively in 36.7% and in 32.6% of patients underwent TT. No main post-operative complications were registered. CONCLUSIONS Ultrasound and elastography are useful to define within the TIR3B group those lesions at higher risk and therefore requiring a more radical approach. TT seems an appropriate approach to TIR3B lesions, especially in multinodular goiter, considering the incidence of malignancy with probably higher rate than previously reported.
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Affiliation(s)
- Andrea Polistena
- General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - Alessandro Sanguinetti
- General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - Roberta Lucchini
- General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - Stefano Avenia
- General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - Sergio Galasse
- General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - Raffaele Farabi
- Pathology Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - Massimo Monacelli
- General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - Nicola Avenia
- General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
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Di Vittorio M, Lo Valvo M, Di Trapani E, Sanguinetti A, Ciaccio A, Grenci S, Zafarana M, Giacalone G, Patti N, Cacopardi S, Rannisi P, Scuderi A, Luiselli L, La Grua G, Cortone G, Merlino S, Falci A, Spinella G, López-López P. Long-term changes in the breeding period diet of Bonelli. Wildl Res 2019. [DOI: 10.1071/wr18081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context
Dietary analyses are essential to achieve a better understanding of animal ecology. In the case of endangered species, assessing dietary requirements is crucial to improve their management and conservation. The Bonelli’s eagle (Aquila fasciata) has experienced a severe decline throughout its breeding range in Europe and, in Italy, fewer than 50 pairs remain, and only in Sicily. This species is subject to major threats, including changes in landscape composition and, consequently, prey availability, which is further aggravated by the occurrence of viral diseases in the case of rabbits.
Aims
To provide current data on the diet of the Bonelli’s eagle in Sicily during the breeding period and to examine dietary shifts with regard to previous studies conducted in the same study area. To discuss possible implications for conservation of the Italian population of this endangered species.
Methods
We used a combination of three methods, including pellet analysis, collection of prey remains, and imagery from camera-traps installed at nests, to examine the diet of 12 breeding pairs of Bonelli’s eagle from 2011 to 2017. We compared this information with data collected between 1993 and 1998 in the same study area.
Key results
In number, birds were the most frequently predated items (61.6%), followed by mammals (36.88%) and reptiles (1.52%). However, in terms of biomass, mammals were the main prey (65.71%), followed by birds (34.12%) and reptiles (0.17%). There was a decrease over the course of the current decade in the consumption of European wild rabbit (Oryctolagus cuniculus), which was compensated for with an increase in both dietary diversity and breadth in bird consumption, a trend not observed in the earlier study in the same region.
Conclusions
Here, we provide an updated assessment of diet composition of Bonelli’s eagle during the breeding period. Interestingly, we found significant differences within the study period (2011–2017) in terms of frequency of occurrence, percentage of biomass, dietary diversity and dietary breadth in a species at risk. Furthermore, we found significant differences between the two study periods in both frequency and percentage of biomass, with significant changes in the consumption of lagomorphs and birds.
Implications
Our results indicated that shifts in the diet are linked to changes in prey abundance, which may be contributing to population declines in the Bonelli’s eagle population in Sicily. Overall, measures aimed at increasing main dietary prey should be promoted to favour occupation of new territories and enhance vital demographic parameters (i.e. breeding success and survival rate) of Bonelli’s eagle across the species range. This would be particularly important for small isolated populations such as the Sicilian one.
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Ruscelli P, Renzi C, Polistena A, Sanguinetti A, Avenia N, Popivanov G, Cirocchi R, Lancia M, Gioia S, Tabola R. Clinical signs of retroperitoneal abscess from colonic perforation: Two case reports and literature review. Medicine (Baltimore) 2018; 97:e13176. [PMID: 30407351 PMCID: PMC6250550 DOI: 10.1097/md.0000000000013176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the retroperitoneal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess. We reported 2 cases of colonic retroperitoneal perforation from diverticulitis and locally advanced colon cancer, respectively. Aim of this report is to improve differential diagnosis based on clinical signs. PATIENTS' CONCERNS A 71-year-old man presented with pain in his left side, fatigue, fever, nausea, massive subcutaneous emphysema of the neck, and Blumberg sign in the left iliac fossa. A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign. DIAGNOSIS In the first patient the computerized tomography revealed pneumoperitoneum, gas in the mesosigma, pneumomediastinum, wall thickening of the descending colon, and retroperitoneal collection from diverticular perforation. In the second patient abdominal CT scan found thickening of the sigmoid colon adherent to the iliopsoas and fluid collection. INTERVENTIONS In the first patient, a left hemicolectomy extending to the transverse colon, followed by a toilette and debridement of the retroperitoneum were performed. In the second patient, tumor of descending colon perforated in the retroperitoneum with iliopsoas abscess was treated with left hemicolectomy and a drainage of the abscess. OUTCOMES The first patient underwent right colectomy with ileostomy in the 7 postoperative day for large bowel necrosis. He died of sepsis 2 days after. The second patient had regular postoperative and he is still alive. LESSONS The spread of retroperitoneal abscess in complicated colonic diverticulitis is different from that in advanced colonic cancer. The former can present with a subcutaneous emphysema, the latter with a groin mass. Hence a thorough clinical examination and radiological studies are needed to diagnose these conditions.
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Affiliation(s)
- Paolo Ruscelli
- Emergency Surgery Unit, Torrette Hospital, Faculty of Medicine and Surgery, Polytechnic University of Marche, Ancona
| | | | - Andrea Polistena
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | | | - Nicola Avenia
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | - Georgi Popivanov
- Military Medical Academy-Sofia, Department of Surgery, Sofia, Bulgaria
| | | | - Massimo Lancia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, Terni, Italy
| | - Sara Gioia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, Terni, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Medical University, Wroclaw. Poland
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Rondelli F, De Rosa M, Stella P, Boni M, Ceccarelli G, Balzarotti R, Polistena A, Sanguinetti A, Bugiantella W, Avenia N. Perforated vs. nonperforated acute appendicitis: evaluation of short-term surgical outcomes in an elderly population. MINERVA CHIR 2018; 74:374-378. [PMID: 30306768 DOI: 10.23736/s0026-4733.18.07715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute appendicitis is a common acute surgical abdominal condition and despite the majority of cases are observed in children and young adults, its occurrence in the elderly seems to be increasing, with a higher risk of perforation. The aim of this study was to evaluate the surgical outcomes following appendectomy for acute appendicitis in the elderly, making a comparison between perforated and nonperforated groups regarding operative time, hospital stay and postoperative complications. METHODS The medical records of 48 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis from January 2011 to December 2016 were retrospectively reviewed. Patients were grouped into those with perforated and those with non-perforated appendicitis (NPA) and a comparison was made between both groups regarding demography, operative time, length of hospital stay and postoperative complications. RESULTS From 48 patients over 60 years diagnosed with acute appendicitis, a PA was removed from 10 patients (20.8%). The PA group consisted of 3 males and 7 females, and their mean age was 71.6 years (range 65-84). The NPA group included 22 males and 16 females, and their mean age was 76.5 years (range 63-96). The mean operative time was 58±18.7 minutes and 43.3±9.9 minutes in the perforated and nonperforated groups respectively, with statistically significant difference (P=0.0013). The mean length of hospital stay was similar in the PA group and in the NPA group, being 6.5±1.8 days and 5.4±1.8 days respectively, but these differences were not statistically significant (P=0.093). The frequency of postoperative complications was similar in both groups as they were observed in 3 patients (30%) of the PA group and 10 patients (26%) of the NPA group (P=0.2488). No postoperative intraabdominal abscess was observed in both groups and there was no death after the surgery. CONCLUSIONS PA, despite requiring a longer mean operative time, in our series is not producing a longer hospital stay or more postoperative complications compared to NPA. The non-operative management of uncomplicated appendicitis is a reasonable option in frail patients in order to avoid the burden of morbidity related to operation, nevertheless surgery remains the standard of care in all age groups.
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Affiliation(s)
- Fabio Rondelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Michele De Rosa
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy -
| | - Paolo Stella
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Marcello Boni
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Graziano Ceccarelli
- Unit of Minimally Invasive and General Surgery, Department of Medicine and General Surgery, "San Donato" Hospital, ASL 8 Arezzo, Arezzo, Italy
| | - Ruben Balzarotti
- Department of General and Visceral Surgery, Civico Hospital, Lugano, Switzerland
| | - Andrea Polistena
- Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy
| | - Alessandro Sanguinetti
- Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy
| | - Walter Bugiantella
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Nicola Avenia
- Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy
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Ruscelli P, Popivanov G, Tabola R, Polistena A, Sanguinetti A, Avenia N, Renzi C, Cirocchi R, Ursi P, Fingerhut A. Modified Paul-Mikulicz jejunostomy in frail geriatric patients undergoing emergency small bowel resection. MINERVA CHIR 2018; 74:121-125. [PMID: 29795063 DOI: 10.23736/s0026-4733.18.07714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Proximal or extended bowel resections are sometimes necessary during emergency surgery of the small bowel and call for creating a high small bowel stomy as a part of damage control surgery. Secondary restoration of intestinal continuity in the frail geriatric patient, further weakened by subsequent severe malabsorption may be prohibitive. METHODS Six patients underwent emergency small bowel resection for proximal jejunal disease (83.3% high-grade adhesive SBO and 16.7% jejunal diverticulitis complicated with perforation). With the intention to avoid end jejunostomy and the need for repeat laparotomy for bowel continuity restoration we modified the classic Paul-Mikulicz jejunostomy. RESULTS The postoperative course was uneventful in four patients whose general condition improved considerably. At six-month follow-up, neither patients required parenteral nutrition. CONCLUSIONS This modified stoma can have the advantage of allowing a partial passage of the enteric contents, reducing the degree of malabsorption, and rendering jejunostomy reversal easy to perform later.
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Affiliation(s)
- Paolo Ruscelli
- Unit of Emergency Surgery, Torrette Hospital, Faculty of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Georgi Popivanov
- Military Medical Academy-Sofia, Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Sofia, Bulgaria
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Andrea Polistena
- Unit of General Surgery and Surgical Specialties, University of Perugia, Terni, Italy
| | | | - Nicola Avenia
- Unit of General Surgery and Surgical Specialties, University of Perugia, Terni, Italy
| | - Claudio Renzi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy -
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties, Sapienza University, Rome, Italy
| | - Abe Fingerhut
- Section for Surgical Research, Medical University of Graz, Graz, Austria
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Gambardella C, Allaria A, Siciliano G, Mauriello C, Patrone R, Avenia N, Polistena A, Sanguinetti A, Napolitano S, Conzo G. Recurrent esophageal stricture from previous caustic ingestion treated with 40-year self-dilation: case report and review of literature. BMC Gastroenterol 2018; 18:68. [PMID: 29788901 PMCID: PMC5964928 DOI: 10.1186/s12876-018-0801-3] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
Background Corrosive esophageal strictures are common. The severity of the strictures depends on type, quantity, duration of contact and concentration of the caustic substance ingested. Endoscopic balloon dilation and endoscopic bougienage are a cornerstone in the management of the benign esophageal strictures and are the most widely used treatments, but are expensive and invasive procedures. Case Presentation We report the case of an 82-year-old patient with a corrosive esophageal stricture treated for over 40 years by means of home self-bougienage. The procedure has been carried out for the longest lapse of time described in literature, with an excellent control of symptoms. In the case reported, after being carried out for more than 40 years, self-dilation allowed good quality of life and symptoms management, ensuring an excellent nutritional status. Conclusions Following an adequate patient training, self-dilatation can be a safe and effective option of treatment, avoiding frequent expensive hospital admissions for endoscopic esophageal dilatation.
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Affiliation(s)
- C Gambardella
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy.
| | - A Allaria
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - G Siciliano
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - C Mauriello
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - R Patrone
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - N Avenia
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Polistena
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - S Napolitano
- Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy
| | - G Conzo
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
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15
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Grassi V, Tabola R, Basile E, De Sol A, Polistena A, Sanguinetti A, Avenia N, Popivanov G, Burattini MF, Cirocchi R, Ursi P. Sigmoid diverticulitis in elderly patients: a rare cause of right iliac fossa pain. MINERVA CHIR 2018; 73:444-447. [PMID: 29600833 DOI: 10.23736/s0026-4733.18.07722-2] [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] [Indexed: 11/08/2022]
Affiliation(s)
- Veronica Grassi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Emanuela Basile
- Department and Clinic of Gastrointestinal and General Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Angelo De Sol
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | - Andrea Polistena
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | | | - Nicola Avenia
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | - Georgi Popivanov
- Military Medical Academy-Sofia, Clinic of Endoscopic, Endocrine, Surgery and Coloproctology, Sofia, Bulgaria
| | - Maria F Burattini
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy -
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
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Misso C, Calzolari F, Puxeddu E, Lucchini R, Monacelli M, Giammartino C, Sanguinetti A, d'Ajello M, Ragusa M, Avenia N. Persistent Hypercalcitoninemia in Patients with Medullary Thyroid Cancer. Tumori 2018; 95:484-7. [DOI: 10.1177/030089160909500413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Medullary thyroid carcinoma is a highly malignant and progressive disease. Surgery is the only effective treatment. Calcitonin is a significant marker for medullary thyroid carcinoma, and due to its sensitivity it represents a useful tool for the follow-up. The outcome of patients affected by medullary thyroid carcinoma depends on tumor size, lymph node involvement, and adequacy of primary surgical management. In the present study, the authors reviewed their own experience in the cure of medullary thyroid carcinoma. Forty-one patients operated for sporadic medullary thyroid carcinoma were included. Indications for surgery, inclusive of lymphectomy techniques, timing of redo surgery, and the meaning of calcitonin levels in highlighting disease are extensively discussed. Patients with elevated calcitonin levels and favorable outcome are considered, together with the various diagnostic tools to be employed during patient workup.
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Affiliation(s)
- Claudia Misso
- Endocrine Surgical Unit, University of Perugia, Perugia, Italy
| | | | - Efisio Puxeddu
- Internal Medicine Department, University of Perugia, Perugia, Italy
| | | | | | | | | | | | - Mark Ragusa
- Endocrine Surgical Unit, University of Perugia, Perugia, Italy
| | - Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Perugia, Italy
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17
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Avenia N, Ragusa M, Cirocchi R, Puxeddu E, Cavaliere A, De Feo P, Sidoni A, Roila F, Sanguinetti A, Puma F. Surgical Treatment of Primitive Thyroid Lymphoma. Tumori 2018; 95:712-9. [DOI: 10.1177/030089160909500613] [Citation(s) in RCA: 6] [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] [Indexed: 11/15/2022]
Abstract
Aims and Background Primitive thyroid lymphoma, although rare, is becoming more frequent. Its incidence is increasing, from 0.5% in the sixties to 1-5% of all thyroid neoplasms today. The diagnosis of such neoplasms is not always straightforward. In fact, it is often the result of pathologic findings on a gland resected for an apparently benign disease. Surgical dissection may prove more complicated than in standard cases of thyroidectomy for the possible tight adhesions existing between the gland's capsule and the surrounding structures. In cases of capsular infiltration, postoperative external local radiotherapy is indicated. Methods A retrospective observational analysis was performed to establish whether patients with incidental thyroid lymphomas who underwent total thyroidectomy for another pathology had major surgical complications and worse prognostic results than patients with an accurate preoperative diagnosis. Results Six cases of thyroid lymphoma were retrospectively reviewed: 4 diffuse large B-cell lymphomas and 2 MALT lymphomas. Of these, 2 were correctly preoperatively identified by fine-needle aspiration biopsy and 4 were an unexpected finding at histology: 3 cases of total thyroidectomy carried out for huge hypothyroid goiter in patients affected by Hashimoto's thyroiditis and in 1 case of total thyroidectomy carried out for anaplastic carcinoma in a patient affected by Hashimoto's thyroiditis. Conclusions In our experience, a correct preoperative diagnosis was extremely difficult (33%). In patients who underwent fine-needle aspiration, a correct diagnosis was made in 66% of cases. All patients with stage IE lymphoma who underwent total thyroidectomy had equivalent surgical complications and prognosis.
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Affiliation(s)
- Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Perugia
| | - Mark Ragusa
- Thoracic Surgical Unit, University of Perugia, Perugia
| | | | - Efisio Puxeddu
- Department of Internal Medicine, University of Perugia, Perugia
| | | | | | - Angelo Sidoni
- General Surgical Unit, University of Perugia, Perugia
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Conzo G, Gambardella C, Candela G, Sanguinetti A, Polistena A, Clarizia G, Patrone R, Di Capua F, Offi C, Musella M, Iorio S, Bellastella G, Pasquali D, De Bellis A, Sinisi A, Avenia N. Single center experience with laparoscopic adrenalectomy on a large clinical series. BMC Surg 2018; 18:2. [PMID: 29325527 PMCID: PMC5765650 DOI: 10.1186/s12893-017-0333-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/26/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy is considered the gold standard technique for the treatment of benign small and medium size adrenal masses (<6 cm), due to low morbidity rate, short hospitalization and patient rapid recovery. The aim of our study is to analyse the feasibility and efficiency of this surgical approach in a broad spectrum of adrenal gland pathologies. METHODS Pre-operative, intra-operative and post-operative data from 126 patients undergone laparoscopic adrenalectomy between January 2003 and December 2015 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in case of pheochromocytoma while spironolactone and potassium were employed to treat Conn's disease. Laparoscopic adrenalectomies were all performed by the same surgeon (CG). First 30 procedures were considered as learning curve adrenalectomies. RESULTS One hundred twenty-six patients were included in the study. Functioning tumors were diagnosed in 84 patients, 27 patients were affected by pheochromocytomas, 29 by Conn's disease, 28 by Cushing disease. Surgery mean operative time was 137.33 min (range 100-180) during the learning curve adrenalectomies and 96.5 min (range 75-110) in subsequent procedures. Mean blood loss was respectively 160.2 ml (range 60-280) and 90.5 ml (range 50-200) in the first 30 procedures and the subsequent ones. Only one conversion to open surgery occurred. No post-operative major complications were observed, while minor complications occurred in 8 patients (0,79%). In 83 out of 84 functioning neoplasms, laparoscopic adrenalectomy was effective in normalization of endocrine profile. CONCLUSIONS Laparoscopic adrenalectomy is a safe and feasible procedure, even for functioning masses and pheochromocytomas. A multidisciplinary team including endocrinologists, endocrine surgeons and anaesthesiologists, is recommended in the management of adrenal pathology, and adrenal surgery should be performed in referral high volume centers. A thirty-procedures learning curve is recommended to improve surgical outcomes.
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Affiliation(s)
- Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy.
| | - Claudio Gambardella
- Division of General and Oncologic Surgery, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy
| | - Giancarlo Candela
- Division of General and Oncologic Surgery, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy
| | - Alessandro Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Andrea Polistena
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Guglielmo Clarizia
- Division of General and Oncologic Surgery, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy
| | - Renato Patrone
- Division of General and Oncologic Surgery, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy
| | - Francesco Di Capua
- Division of General and Oncologic Surgery, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy
| | - Chiara Offi
- Division of General and Oncologic Surgery, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Federico II University, Napoli, Italy
| | - Sergio Iorio
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Giseppe Bellastella
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Daniela Pasquali
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Annamaria De Bellis
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonio Sinisi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
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Gambardella C, Polistena A, Sanguinetti A, Patrone R, Napolitano S, Esposito D, Testa D, Marotta V, Faggiano A, Calò PG, Avenia N, Conzo G. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: Is it the surgeon who pays the bill? Int J Surg 2018; 41 Suppl 1:S55-S59. [PMID: 28506414 DOI: 10.1016/j.ijsu.2017.01.112] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/19/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Thyroidectomy is one of the most common intervention in general surgery and, after the turn of the century, its rate has sharply increased, along with a worldwide increased incidence of differentiated thyroid cancers. Therefore, injuries of the recurrent laryngeal nerve have become one of the most frequent cause of surgical malpractice claims, mostly following surgery for benign pathology. MAIN BODY Even if the incidence of definitive paralysis is generally lower than 3%, during the last 20 years in Italy, the number of claims for damages has sharply raised. As a consequence, a lot of defensive medicine has been caused by this issue, and a witch-hunt has been accordingly triggered, so determining mostly a painful and lasting frustration for the surgeons, who sometimes are compelled to pay a lot of money for increasing insurance premiums and lawyers fees. Recurrent laryngeal nerve injury should be considered as a potentially catastrophic predictable but not preventable event, rather than the result of a surgical mistake. CONCLUSION Purposes of the Authors are analyzing incidence, conditions of risk, and mechanisms of recurrent laryngeal nerve injuries, underlining notes of surgical technique and defining medical practice recommendations useful to reduce the risk of malpractice lawsuits and judgments against surgeons.
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Affiliation(s)
- C Gambardella
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - A Polistena
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - R Patrone
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - S Napolitano
- Medical Officer, Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy
| | - D Esposito
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - D Testa
- Otolaryngology - Head and Neck Surgery Unit, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - V Marotta
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - A Faggiano
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042 Monserrato, CA, Italy
| | - N Avenia
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - G Conzo
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy.
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Agostino PV, Gatto EM, Cesarini M, Etcheverry JL, Sanguinetti A, Golombek DA. Deficits in temporal processing correlate with clinical progression in Huntington's disease. Acta Neurol Scand 2017; 136:322-329. [PMID: 28052315 DOI: 10.1111/ane.12728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Precise temporal performance is crucial for several complex tasks. Time estimation in the second-to-minutes range-known as interval timing-involves the interaction of the basal ganglia and the prefrontal cortex via dopaminergic-glutamatergic pathways. Patients with Huntington's disease (HD) present deficits in cognitive and motor functions that require fine control of temporal processing. The objective of the present work was to assess temporal cognition through a peak-interval time (PI) production task in patients with HD and its potential correlation with the Unified Huntington's Disease Rating Scale (UHDRS). MATERIALS AND METHODS Patients with molecular diagnosis of HD and controls matched by age, sex and educational level (n=18/group) were tested for interval timing in short- (3 seconds), medium- (6 seconds) and long (12 seconds)-duration stimuli. RESULTS Significant differences were observed in the PI task, with worse performance in HD compared to controls. Patients underestimated real time (left-shifted Peak location) for 6- and 12-second intervals (P<.05) and presented decreased temporal precision for all the intervals evaluated (P<.01). Importantly, a significant correlation was found between time performance and the UHDRS (P<.01). Patients' responses also deviated from the scalar property. CONCLUSIONS Our results contribute to support that timing functions are impaired in HD in correlation with clinical deterioration. Recordings of cognitive performance related to timing could be a potential useful tool to measure the neurodegenerative progression of movement disorder-related pathologies.
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Affiliation(s)
- P. V. Agostino
- Department of Science and Technology; National University of Quilmes/CONICET; Bernal Buenos Aires Argentina
| | - E. M. Gatto
- Instituto de Neurociencias de Buenos Aires; INEBA; Bernal Buenos Aires Argentina
| | - M. Cesarini
- Instituto de Neurociencias de Buenos Aires; INEBA; Bernal Buenos Aires Argentina
| | - J. L. Etcheverry
- Instituto de Neurociencias de Buenos Aires; INEBA; Bernal Buenos Aires Argentina
| | - A. Sanguinetti
- Instituto de Neurociencias de Buenos Aires; INEBA; Bernal Buenos Aires Argentina
| | - D. A. Golombek
- Department of Science and Technology; National University of Quilmes/CONICET; Bernal Buenos Aires Argentina
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Sanguinetti A, Polistena A, Luchini R, Monacelli M, Avenia S, Galasse S, Cirocchi R, Avenia N. Correct information to patients undergoing breast-conserving surgery: the medicolegal significance. G Chir 2017; 38:61-65. [PMID: 28691668 DOI: 10.11138/gchir/2017.38.2.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many of the women newly diagnosed with breast cancer not have access to all the information they need to make the surgical and treatment choices that are most appropriate for them. Research clearly shows that lumpectomy and other breast-conserving surgeries are just as safe as mastectomy for most women with early stage disease, and yet approximately half will undergo the more disfiguring procedures, but many healthy women who have strong family histories of breast cancer consider prophylactic mastectomies, and their decisions are also based on very limited information, because there are few studies showing the effectiveness of that procedure. This paper delineates how to avoid limited information and biased recommendations is important for a conscious and informed choice by the patients.
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Polistena A, Sanguinetti A, Lucchini R, Galasse S, Monacelli M, Avenia S, Boccolini A, Johnson LB, Avenia N. Timing and extension of lymphadenectomy in medullary thyroid carcinoma: A case series from a single institution. Int J Surg 2017; 41 Suppl 1:S70-S74. [DOI: 10.1016/j.ijsu.2017.04.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023]
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Polistena A, Lucchini R, Monacelli M, Triola R, Avenia S, Barillaro I, Johnson LB, Sanguinetti A, Avenia N. Current Indications for Surgical Treatment of Primary Hyperparathyroidism in the Elderly. Am Surg 2017; 83:296-302. [PMID: 28316315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study presents the results of surgery in the elderly for primary hyperparathyroidism (PHPT) from a single institution's experience. We retrospectively analyzed 898 cases of surgically treated PHPT, divided into two groups: 135 elderly patients (A) and 763 patients younger than 65 years (B). PHPT was symptomatic in 68.8 per cent patients in group A and in 81.6 per cent in group B. Unilateral temporary recurrent laryngeal nerve palsy was observed in 0.9 per cent in group A and 0.1 per cent in group B (P > 0.05). No cervical hematomas, mortality or major cardiovascular, neurological, respiratory or metabolic postoperative complications were registered. All the patients evaluated at one year had improvement in the quality of life, with increase of bone mineral density (BMD) in 85.6 per cent and 79.8 per cent of patients in groups A and B, with no significant differences between symptomatic and asymptomatic patients. Parathyroidectomy in elderly PHPT patients is safe, with rate of morbidity similar to what observed in younger individuals. Further investigations are recommended to confirm the role of surgery as an effective approach in elderly PHPT patients.
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Boselli C, Cirocchi R, Gemini A, Grassi V, Avenia S, Polistena A, Sanguinetti A, Burattini MF, Pironi D, Santoro A, Tabola R, Avenia N. Surgery for colorectal cancer in elderly: a comparative analysis of risk factor in elective and urgency surgery. Aging Clin Exp Res 2017; 29:65-71. [PMID: 27837462 DOI: 10.1007/s40520-016-0642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Colon cancer therapy is primarily surgical. Advanced age does not represent a contraindication to surgery. We analyse the results of surgery in ultra 75 patients undergoing surgery for colorectal cancer by examining the correlation between the comorbidity and any post-operative complications. MATERIALS AND METHODS We surgically treated 66 patients for colorectal cancer, aged over 75. The examined subjects were compromised for various reasons. We have evaluated the different influences of risk factors in elective and urgency operation. DISCUSSION Several studies have shown that age alone is not a significant prognostic factor in survival after colonic surgery. The assessment of general conditions in elderly patients, as demonstrated by the literature, is a fundamental moment in the management of colorectal cancer. CONCLUSIONS The surgical choice should be made case by case (custom-made), not based on age only.
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Affiliation(s)
- Carlo Boselli
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
| | - Alessandro Gemini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Veronica Grassi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Stefano Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Andrea Polistena
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Alessandro Sanguinetti
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Maria Federica Burattini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland
| | - Nicola Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
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Polistena A, Sanguinetti A, Lucchini R, Galasse S, Avenia S, Monacelli M, Johnson LB, Jeppsson B, Avenia N. Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience. Aging Clin Exp Res 2017; 29:23-28. [PMID: 27830521 DOI: 10.1007/s40520-016-0669-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/01/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. AIM The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. METHODS Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. RESULTS In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. DISCUSSION Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. CONCLUSIONS Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.
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Affiliation(s)
- Andrea Polistena
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Alessandro Sanguinetti
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Roberta Lucchini
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Segio Galasse
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Stefano Avenia
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Massimo Monacelli
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Louis Banka Johnson
- Surgical Department, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Bengt Jeppsson
- Surgical Department, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Nicola Avenia
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
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Bugiantella W, Rondelli F, Mariani L, Polistena A, Sanguinetti A, Avenia N, Mariani E. Cost-effectiveness analysis of the temporary percutaneous ileostomy for faecal diversion after colorectal resection in elderly. Aging Clin Exp Res 2017; 29:47-53. [PMID: 27832466 DOI: 10.1007/s40520-016-0658-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Conventional loop ileostomy (CLI) is a suitable procedure for transitory faecal diversion after colorectal anastomosis, but it causes relevant morbidities (dehydration, discomfort, peristomal infections) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI), which can be removed without surgery. AIMS We analyse the outcomes and the costs of the TPI in protecting low colorectal anastomosis in elderly, compared to the CLI. METHODS Data of patients underwent elective anterior rectal resection for rectal cancer with extra-peritoneal colorectal anastomosis protected by ileostomy from January 2011 to December 2015 were reviewed. Sixty-one out of 132 patients were older than 70; 35 underwent faecal diversion by TPI and 26 by CLI. RESULTS The two groups resulted homogenous about age, sex, operative time, short-term post-operative complications. None of the patients reported anastomotic leakage. The hospital stay and the cost for the first surgical procedure did not show statistically significant differences between TPI and CLI. When comparing the overall hospital stay and costs the differences are statistically significant: the TPI showed a shorter hospital stay (12.4 vs 19.3 days, -35.7%) and a lower cost of hospitalization (7954.0 vs 14,372.1€, -44.7%), compared to CLI. DISCUSSION The limited duration of the faecal diversion and the uselessness of a second surgical procedure to remove the TPI are the most important advantages of TPI, especially in elderly. CONCLUSION The TPI not only improved the post-operative outcome of the patients, but also allowed a remarkable saving for the National Health System.
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Tabola R, Mantese G, Cirocchi R, Gemini A, Grassi V, Boselli C, Avenia S, Sanguinetti A, Avenia N, Sroczynski M, Wierzbicki J. Postoperative mortality and morbidity in older patients undergoing emergency right hemicolectomy for colon cancer. Aging Clin Exp Res 2016; 29:121-126. [PMID: 27830519 DOI: 10.1007/s40520-016-0643-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Even with the advances in surgical technique and perioperative care, morbidity and mortality after colorectal cancer surgery remain considerable, and patients (pt) who present as an emergency have an even higher mortality and morbidity rate. METHODS A total of 35 pt with caecum or ascending colon cancer between January 2007 and June 2015, three departments in Italy and in Poland, were included in the study. The intention of surgery in all cases was curative resection with ileo-colic anastomosis. Comparative statistical analysis was performed. RESULTS Acute bowel obstruction was the major complication of CRC that led to an emergency hemicolectomy. Postoperative mortality and morbidity rates were in total 12.5 and 28.1%, respectively. All the deaths happened in Poland. Of the pt, 42.8% had morbidity in Poland and 16.6% in Italy. Out of the pt, 25% presenting with perforation: 25% died, 25% had wound dehiscence, 12.5% had pulmonary oedema, and 12.5% had an intra-abdominal abscess. The mean age of the pt with complications in Poland and in Italy was 79.3 and 72.0 years, respectively. CONCLUSION We observed that particularly lethal combination is older age, perforation with peritonitis and advanced stage of the cancer.
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Affiliation(s)
- Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, ul. Curie-Sklodowskiej 66, 50-369, Wrocław, Poland
| | - George Mantese
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, ul. Curie-Sklodowskiej 66, 50-369, Wrocław, Poland
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy.
| | - Alessandro Gemini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy
| | - Veronica Grassi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy
| | - Carlo Boselli
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte 1, 06134, Perugia, Italy
| | - Stefano Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Alessandro Sanguinetti
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Nicola Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Maciej Sroczynski
- Department of Minimally Invasive Surgery and Proctology, Medical University of Wroclaw, ul. Borowska 213, 50-556, Wrocław, Poland
| | - Jaroslaw Wierzbicki
- Department of Minimally Invasive Surgery and Proctology, Medical University of Wroclaw, ul. Borowska 213, 50-556, Wrocław, Poland
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Gambardella C, Tartaglia E, Nunziata A, Izzo G, Siciliano G, Cavallo F, Mauriello C, Napolitano S, Thomas G, Testa D, Rossetti G, Sanguinetti A, Avenia N, Conzo G. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients. World J Surg Oncol 2016; 14:247. [PMID: 27644091 PMCID: PMC5028971 DOI: 10.1186/s12957-016-1003-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 09/08/2016] [Indexed: 12/31/2022] Open
Abstract
Background Lymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of papillary thyroid cancer (PTC) has been an object of research, and it is now still controversial. Nevertheless, many scientific societies and referral authors have definitely stated that even if in expert hands, RCLD is not associated to higher morbidity; it should be indicated only in selected cases. Main body In order to better analyze the current role of prophylactic neck dissection in the surgical treatment of papillary thyroid cancers, an analysis of the most recent literature data was performed. Prophylactic or therapeutic lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, and papillary thyroid cancer were used by the authors as keywords performing a PubMed database research. Literature reviews, PTCs large clinical series and the most recent guidelines of different referral endocrine societies, inhering neck dissection for papillary thyroid cancers, were also specifically evaluated. A higher PTC incidence was nowadays reported in differentiated thyroid cancer (DTC) clinical series. In addition, ultrasound guided fine-needle aspiration citology allowed a more precocious diagnosis in the early phases of disease. The role of prophylactic neck dissection in papillary thyroid cancer management remains controversial especially regarding indications, approach, and surgical extension. Even if morbidity rates seem to be similar to those reported after total thyroidectomy alone, RCLD impact on local recurrence and long-term survival is still a matter of research. Nevertheless, only a selective use in high-risk cases is supported by more and more scientific data. Conclusions In the last years, higher papillary thyroid cancer incidence and more precocious diagnoses were worldwide reported. Among endocrine and neck surgeons, there is agreement about indications to prophylactic treatment of node-negative “high-risk” patients. A recent trend toward RCLD avoiding radioactive treatment is still debated, but nevertheless, prophylactic dissections in low-risk cases should be avoided. Prospective randomized trials are needed to evaluate the benefits of different approaches and allow to drawn definitive conclusions.
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Affiliation(s)
- Claudio Gambardella
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Ernesto Tartaglia
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Anna Nunziata
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Graziella Izzo
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giuseppe Siciliano
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Fabio Cavallo
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Claudio Mauriello
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Salvatore Napolitano
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Guglielmo Thomas
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Domenico Testa
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Gianluca Rossetti
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | | | - Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Perugia, Italy
| | - Giovanni Conzo
- Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
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Polistena A, Di Lorenzo P, Sanguinetti A, Buccelli C, Conzo G, Conti A, Niola M, Avenia N. Medicolegal implications of surgical errors and complications in neck surgery: A review based on the Italian current legislation. Open Med (Wars) 2016; 11:298-306. [PMID: 28352812 PMCID: PMC5329845 DOI: 10.1515/med-2016-0058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/07/2016] [Indexed: 11/15/2022] Open
Abstract
Aim of the present paper is the review of the principal complications associated to endocrine neck surgery considering how expertise, full adoption of guidelines, appropriate technology and proper informed consent may limit the medicolegal claims at the light of the incoming new regulation of the medical professional legal responsibility. A literature search, using the Medline/PubMed database for full-length papers, was used. Postoperative recurrent laryngeal nerve (RLN) palsy and hypoparathy-roidism remain the principal causes of surgical malpractice claims . In the procedure of neck lymphadenctomy intra-operative haemorrhage, thoracic duct injury, injuries to loco-regional nerves can be observed and can be source of claims. After many years of increased medicolegal litigations, the Italian government is proposing a drastic change in the regulations of supposed medical malpractice in order to guarantee the patient's right to a safe treatment and in the meantime to defend clinicians from often unmotivated and prejudicial legal cases. Surgical errors and complications in neck surgery are a relevant clinical issue. Only the combination of surgical and clinical expertise, application of guidelines, appropriate technology and a routinely use of specific informed consent can contain potential medicolegal implications.
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Affiliation(s)
- Andrea Polistena
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy
| | - Pierpaolo Di Lorenzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Sanguinetti
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Conzo
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - Adelaide Conti
- Department of Surgery, Radiology and Public Health, Public Health and Humanities Section, University of Brescia - Centre of Bioethics Research, Brescia, Italy
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola Avenia
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy
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Sanguinetti A, Polistena A, Lucchini R, Monacelli M, Galasse S, Avenia S, Bugiantella W, Triola R, Cirocchi R, Rondelli F, Avenia N. Myoblastoma of the breast: Our experience and review of literature. Int J Surg Case Rep 2016; 20S:5-7. [PMID: 26971123 PMCID: PMC4883056 DOI: 10.1016/j.ijscr.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Breast myoblastoma or granular cell tumor involving the breast parenchyma has been described in detail for the first time since Abrikossoff in 1931. The location of this injury to the breast is very rare, accounting for between 5% and 15% of all cases of cancer of the granular cells. We present our experience regarding the identification of two cases because of the relative rarity of this tumor. It is often confused with breast cancer on clinical and radiological, and its diagnosis can then be difficult for physicians, radiologists and pathologists. PRESENTATION OF CASES We report the cases of two young women who came to our attention because of the presence of mass shoveled breast, mobile and accompanied by pain cycle independent. In both cases, mammography and ultrasound revealed the presence of heterogeneous mass and irregular, but in one of two such mass located at the Union of external quadrants of the left breast and was in contact with his serratus anterior and suspicion for malignancy. In both cases the 'histology combined with immunohistochemical study proved to be a granular cell tumor. CONCLUSION Although a granular cell tumor of the breast is a rare tumor breast, should be considered in the differential diagnosis of benign and malignant lesions. Surgeons and pathologists should keep in mind when considering a granular cell tumor cells with abundant granular cytoplasm containing materials to avoid misdiagnosing breast cancer, which could lead to unnecessary surgery.
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Affiliation(s)
| | | | - R Lucchini
- S. Maria University Hospital, Terni, Italy.
| | | | | | - S Avenia
- Medical School University of Perugia, Italy.
| | | | - R Triola
- S. Maria University Hospital, Terni, Italy.
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Sanguinetti A, Polistena A, Bistoni G, Lucchini R, Monacelli M, Triola R, Avenia S, Barillaro I, Cirocchi R, Avenia N. Breast cancer and reconstruction: can surgical technique, reconstructive time and adjuvant treatment influence the result? Ann Ital Chir 2016; 87:S0003469X16024118. [PMID: 27319738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Some techniques for the total reconstruction of the breast, regardless of the complexity, have specific complications, with varying degrees of morbidity. Therefore, we wanted to identify the most frequent complications of the main techniques used for breast reconstruction, and compare the relation to the relevant independent variables. METHODS Our study was conducted by examining the medical records of patients who had received complete reconstruction of the breast after a mastectomy due to breast cancer from January 2008 to December 2010, with a minimum follow-up of 3 years postoperatively. The data collected, such as the time of intervention, reconstruction techniques, operating time, and adjuvant treatment, were statistically correlated to the presence of complications. RESULTS Of the 40 total breast reconstructions analyzed, the technique in which they were used expanders followed by replacement with implants showed the lowest prevalence of complications (16.7%, p <0.000). Some surgical techniques have shown particular complications. The operative time for transplant transverse rectus abdominis musculocutaneous flap (363.57 ± 59.91 min) was significantly higher than that required for the techniques that use alloplastic materials (155.71 ± 38.02 min, p = 0, 01), but similar to that for the latissimus dorsi flap (309.69 ± 77.66 min). The operative time, the timing of reconstructive surgery, and type of adjuvant treatment was not correlated with the incidence of complications. CONCLUSIONS Each technique has its indications, contraindications and complications. The application of each technique must be tailored to the individual characteristics of each patient. KEY WORDS Adjuvant treatment, Reconstructive surgery, Results, Surgical procedure.
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Polistena A, Sanguinetti A, Lucchini R, Galasse S, Monacelli M, Avenia S, Triola R, Bugiantella W, Rondelli F, Cirocchi R, Avenia N. Surgical approach to mediastinal goiter: An update based on a retrospective cohort study. Int J Surg 2015; 28 Suppl 1:S42-6. [PMID: 26708863 DOI: 10.1016/j.ijsu.2015.12.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/06/2015] [Accepted: 05/20/2015] [Indexed: 10/22/2022]
Abstract
AIM Surgery for mediastinal goiters (MG) is indicated for compression symptoms and risk of malignancy. Total thyroidectomy by cervicotomy is universally considered the standard surgical approach to MG. In selected cases sternotomy or a thoracotomy are used. Options of the operative technique and practical surgical problems are analysed. METHODS A retrospective analysis of twenty-eight-years on 1767 cases of MG in a referral centre for endocrine surgery was carried out. All patients underwent standard preoperative study and CT based surgical planning. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected case via sternotomy or thoracotomy. Clinical records were examined. RESULTS Total thyroidectomy was performed in all cases. A cervical approach was used in almost 99% of patients. Significant shorter surgical time was observed for surgery via the cervical approach vs sternotomy and thoracotomy. Benign struma was observed in 1503 patients and a carcinoma in 264. We observed postoperative bleeding in 0.5% of cases, permanent monolateral recurrent laryngeal nerve palsy occurred in 1.3%, bilateral palsy in 0.6%, transient and permanent hypoparathyroidism in 14% and 4.1% respectively. CONCLUSION MG may be approached by a cervicotomic access only with a clear knowledge of potential risk and complications of the surgical manoeuvres. Sternotomy or of a thoracotomy are indicated only in selected cases but their inapplicability may be really dangerous in those MG not otherwise resectable. MG should be referred only to specialized centre.
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Affiliation(s)
- Andrea Polistena
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | | | | | - Sergio Galasse
- Unit of Endocrine Surgery, S. Maria University Hospital, Italy.
| | - Massimo Monacelli
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | | | - Roberta Triola
- Unit of Endocrine Surgery, S. Maria University Hospital, Italy.
| | | | - Fabio Rondelli
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | - Roberto Cirocchi
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | - Nicola Avenia
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
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Bugiantella W, Rondelli F, Boni M, Stella P, Polistena A, Sanguinetti A, Avenia N. Necrotizing pancreatitis: A review of the interventions. Int J Surg 2015; 28 Suppl 1:S163-71. [PMID: 26708848 DOI: 10.1016/j.ijsu.2015.12.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 03/30/2015] [Revised: 04/11/2015] [Accepted: 05/10/2015] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis may have a wide range of severity, from a clinically self-limiting to a quickly fatal course. Necrotizing pancreatitis (NP) is the most dreadful evolution associated to a poor prognosis: mortality is approximately 15% and up to 30-39% in case of infected necrosis, which is the major cause of death. Intervention is generally required for infected pancreatic necrosis and less commonly in patients with sterile necrosis who are symptomatic (gastric or duodenal outlet or biliary obstruction). Traditionally the most widely used approach to infected necrosis has been open surgical necrosectomy, but it is burdened by high morbidity (34-95%) and mortality (11-39%) rates. In the last two decades the treatment of NP has significantly evolved from open surgery towards minimally invasive techniques (percutaneous catheter drainage, per-oral endoscopic, laparoscopy and rigid retroperitoneal videoscopy). The objective of this review is to summarize the current state of the art of the management of NP and to clarify some aspects about its diagnosis and treatment.
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Affiliation(s)
- Walter Bugiantella
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy.
| | - Fabio Rondelli
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy.
| | - Marcello Boni
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - Paolo Stella
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - Andrea Polistena
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
| | - Alessandro Sanguinetti
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
| | - Nicola Avenia
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
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Polistena A, Vannucci J, Monacelli M, Lucchini R, Sanguinetti A, Avenia S, Santoprete S, Triola R, Cirocchi R, Puma F, Avenia N. Thoracic duct lesions in thyroid surgery: An update on diagnosis, treatment and prevention based on a cohort study. Int J Surg 2015; 28 Suppl 1:S33-7. [PMID: 26708844 DOI: 10.1016/j.ijsu.2015.05.058] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/06/2015] [Accepted: 05/20/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Thoracic duct fistula at the cervical level is a severe but rare complication following thyroid surgery, particularly associated to lateral dissection of the neck and to mediastinal goiter. METHODS we retrospectively analyzed chylous fistulas observed in a cohort of 13.224 patients underwent surgery for thyroid disease since 1986 to 2014, in the Unit of Endocrine Surgery, S. Maria University Hospital, Terni, Italy. RESULTS We observed 20 cases of chylous fistula. Thirteen patients underwent primary surgery in our institution while the remaining 7 cases had been referred to our Department from other hospitals for an already diagnosed lymphatic leak. Surgical procedures carried out included total thyroidectomy for mediastinal goiter in 4 patients, total thyroidectomy for cancer in 2 patients, unilateral functional lymphadenectomy in 11 patients and bilateral in 3. Intraoperative repair was carried out in 4 cases. Of the remaining 16 cases, 4 of the 6 fistulas with low flow leakage healed in about 30 days of conservative treatment, 2 cases instead required surgical repair. All 10 patients with "high-flow" fistula underwent surgery. Despite surgery was performed later, postoperative course in patients with late surgical repair is similar to what observed in those patients with early surgical repair. Both groups underwent cervical drainage removal in post-operative day 4. CONCLUSION Healing of a cervical chylous fistula can be achieved by conservative medical therapy (nutritional and pharmacological) but in case of therapeutic failure with rapid decrease of general condition, the surgical approach is necessary. In our experience, duct ligation after unsuccessful conservative treatment, is the only resolutive treatment.
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Affiliation(s)
- Andrea Polistena
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | - Jacopo Vannucci
- Thoracic Surgery Unit, Medical School University of Perugia, Italy.
| | | | - Roberta Lucchini
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | | | - Stefano Avenia
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | | | - Roberta Triola
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | - Roberto Cirocchi
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | - Francesco Puma
- Thoracic Surgery Unit, Medical School University of Perugia, Italy.
| | - Nicola Avenia
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
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Polistena A, Monacelli M, Lucchini R, Triola R, Conti C, Avenia S, Barillaro I, Sanguinetti A, Avenia N. Surgical morbidity of cervical lymphadenectomy for thyroid cancer: A retrospective cohort study over 25 years. Int J Surg 2015; 21:128-34. [PMID: 26253851 DOI: 10.1016/j.ijsu.2015.07.698] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 07/18/2015] [Accepted: 07/27/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Prognosis of thyroid cancer is strictly related to loco-regional metastases. Cervical lymphadenectomy has a specific oncologic role but may lead to significant increase of morbidity. Aim of the study is the analysis of surgical morbidity in cervical lymphadenectomy for thyroid cancer. METHODS We retrospectively analyzed 1.765 thyroid cancers operated over a period of 25 years at S. Maria University Hospital, Terni, University of Perugia, Italy. Type of lymphadenectomy, histology and complications were analysed. RESULTS A prevalence of differentiated and medullary cancers was observed (respectively 88% and 7.2%). Central lymphadenectomy was carried out in 425 patients, lateral modified and radical lymphadenectomy respectively in 651 and 17 cases. Following central neck dissection we observed: bilateral and unilateral temporary recurrent nerves palsy respectively of 0.7% and 3.5%, unilateral permanent palsy in 1.6% of cases, temporary and permanent hypoparathyroidism respectively in 17.6% and 4.4%. After lateral neck dissection we observed: intra and post-operative haemorrhage respectively in 2% and 0.29%, respiratory distress in 0.29%, lesions of facial nerve in 0.44%, of vagus in 0.14%, of phrenic nerve in 0.14%, of hypoglossal nerve in 0.29%, of the accessory nerve, transient in 1.34% and permanent in 0.29%, permanent lesion of cervical plexus in 0.29%, salivary fistula in 0.14% and chylous fistula in 1.04% of patients. Student's t test was used to compare groups when appliable. CONCLUSION Central and lateral cervical lymph node dissection are associated to severe morbidity. Correct indication, surgical expertise, high volume of patients and early multidisciplinary management of complications is the key of an acceptable balance between oncologic benefits and surgical morbidity.
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Affiliation(s)
- Andrea Polistena
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Massimo Monacelli
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Roberta Lucchini
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Roberta Triola
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Claudia Conti
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Stefano Avenia
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Ivan Barillaro
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Alessandro Sanguinetti
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
| | - Nicola Avenia
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
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Cirocchi R, Graziosi L, Sanguinetti A, Boselli C, Polistena A, Renzi C, Desiderio J, Noya G, Parisi A, Hirota M, Donini A, Avenia N. Can the measurement of amylase in drain after distal pancreatectomy predict post-operative pancreatic fistula? Int J Surg 2015; 21 Suppl 1:S30-3. [PMID: 26117433 DOI: 10.1016/j.ijsu.2015.06.048] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The most frequent reason for performing a distal pancreatectomy is the presence of cystic or neuroendocrine tumors, in which the distal pancreatic stump is often soft and non fibrotic. This parenchymal consistence represents the main risk factor for post-operative pancreatic fistula. In order to identify the fistula and assessing its severity postoperative monitoring of amylase from intraperitoneal drains is important. METHODS From a retrospective multicentric database analysis were included 33 patients who underwent distal pancreatectomy for pancreatic neoplastic disease. RESULTS Postoperative pancreatic fistula occurred in four cases. One patient had a ductal adenocarcinoma, two presented with pancreatic endocrine neoplasms and the last one had an intraductal papillary mucinous neoplasia. Two patients underwent open, the other two laparoscopic distal pancreatectomy. DISCUSSION Postoperative pancreatic fistulas after distal pancreatectomy worsen the quality of life, prolong the post-operative stay and delay further adjuvant therapy. In patients who underwent distal pancreatectomy literature exposed some advantages deriving from the placement of abdominal drainages only in selected cases and from their early removal. Patients presenting a high risk of pancreatic fistula had higher amylase levels of drainage fluid in the first postoperative day. CONCLUSION POPF is the most frequently complication after pancreatectomy. In our analysis DFA1>5000 can be considered as a predictive factor for pancreatic fistula. For this reason, the systematic measurement of amylase in drain fluid in first-postoperative day can be considered a good clinical practice.
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Affiliation(s)
- Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, Terni, Italy.
| | - Luigina Graziosi
- General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
| | - Alessandro Sanguinetti
- Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy.
| | - Carlo Boselli
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
| | - Andrea Polistena
- Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy.
| | - Claudio Renzi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
| | - Jacopo Desiderio
- Department of General and Oncologic Surgery, University of Perugia, Terni, Italy.
| | - Giuseppe Noya
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
| | - Amilcare Parisi
- Department of Digestive Surgery, St. Maria Hospital, Terni, Italy.
| | | | - Annibale Donini
- General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
| | - Nicola Avenia
- Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy.
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Barillaro I, Di Patrizi MS, Boccolini A, Avenia S, Polistena A, Cerroni M, Sanguinetti A, Lucchini R, Avenia N. A rare case of Amyand's hernia in a 67-year-old male. A case report and review of the literature. Ann Ital Chir 2015; 86:S2239253X15023907. [PMID: 26098854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of the study is to indicate the Amyand's hernia as a possible complication during surgery for hernia repair performed in emergency CASE REPORT A case Amyand's hernia complicated by the presence of acute gangrenous appendicitis perforated at the base is reported. DISCUSSION Amyand's hernia is an hernia which is the vermiform appendix inside. This condition may remain asymptomatic and behave like a normal inguinal hernia or can simulate strangulated hernia when the hernia contains inflamed appendix. CONCLUSION Acute appendicitis in an incarcerated inguinal hernia is a rare event. The preoperative diagnosis is very difficult because it simulates the behavior of a strangulated inguinal hernia. The treatment depends on the severity of appendicitis. The appendicitis status influences the type of surgery and the type of access.
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Sanguinetti A, Santini D, Bonafè M, Taffurelli M, Avenia N. Interleukin-6 and pro inflammatory status in the breast tumor microenvironment. World J Surg Oncol 2015; 13:129. [PMID: 25881039 PMCID: PMC4397867 DOI: 10.1186/s12957-015-0529-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/28/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Greater than 50,000 new cases of breast cancer cases were diagnosed in Italy during 2013, with nearly 15,000 women succumbing to the disease. These epidemiological statistics highlight the overwhelming clinical dilemma of breast cancer and emphasize the need for novel therapeutic targets and prevention strategies. Countless studies in the fields of mammary gland development and breast cancer have led to an appreciation of a breast tumor microenvironment that actively contributes to the heterogeneous nature of breast cancer. METHODS The current review will focus on the impact of IL-6 and in the breast tumor microenvironment. Excessive IL-6 has been demonstrated in primary breast tumors and breast cancer patient sera and is associated with poor clinical outcomes in breast cancer. These clinical associations are corroborated by emerging preclinical data revealing that IL-6 is a potent growth factor and promotes an epithelial-mesenchyme (EMT) phenotype in breast cancer cells to indicate that IL-6 in the breast tumor microenvironment is clinically relevant. RESULTS High serum levels of interleukin-6 correlate with poor outcome in breast cancer patients. However, few data are yet available on the relationship between IL-6 and stem/progenitor cells, which may fuel the genesis of breast cancer in vivo. Mammospheres (MS) from node invasive breast carcinoma tissues express IL-6 mRNA at higher levels than MS from matched non-neoplastic mammary glands. IL-6 mRNA is detectable only in basal-like breast carcinoma tissues; our results reveal that IL-6 triggers a Notch-3-dependent upregulation of the Notch ligand Jagged-1, whose interaction with Notch-3 promotes the growth of MS and Michigan Cancer Foundation-7 (MCF-7)-derived spheroids. IL-6 induces a Notch-3-dependent upregulation of the carbonic anhydrase IX gene and promotes a hypoxia-resistant/invasive phenotype in MCF-7 cells and MS. CONCLUSIONS In conclusion, our data support the hypothesis that IL-6 induces malignant features in Notch-3-expressing, stem/progenitor cells from human ductal breast carcinoma and normal mammary gland.
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Affiliation(s)
- Alessandro Sanguinetti
- Struttura Complessa di Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera 'Santa Maria', University of Perugia Azienda Ospedaliera Terni, Viale Tristano di Joannuccio, 105100, Terni, Italy.
| | - Donatella Santini
- U.O. di Anatomia Patologica, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Bologna, Italy.
| | - Massimiliano Bonafè
- Department of Experimental, Diagnostic and Specialty Medicine, Università di Bologna, Via Zamboni, 40126, Bologna, Italy.
| | - Mario Taffurelli
- Dipartimento di Chirurgia generale e dei trapianti d'organo, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Via Pietro Albertoni, 40138, Bologna, Italy.
| | - Nicola Avenia
- Struttura Complessa di Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera 'Santa Maria', University of Perugia Azienda Ospedaliera Terni, Viale Tristano di Joannuccio, 105100, Terni, Italy.
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Polistena A, Monacelli M, Lucchini R, Triola R, Conti C, Avenia S, Barillaro I, Sanguinetti A, Avenia N. Approach to lymph node metastases in sporadic medullary thyroid carcinoma An istitutional experience. Ann Ital Chir 2015; 86:390-395. [PMID: 26567553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Analyse the impact of aggressive surgical treatment with accurate lymphadenectomy in medullary thyroid carcinoma. MATERIALS AND METHODS We retrospectively analysed 152 patients affected by medullary thyroid carcinoma, divided in two groups, considering outcome and surgical complications. RESULTS Primary surgical treatment with thyroidectomy plus central and lateral neck dissection, offers significant reduction in post-operative calcitonin levels, reduced recurrences and limited complications. DISCUSSION Accurate lymphadenectomy, according to the international guidelines and the main results of clinical studies, is the only treatment combined to total thyroidectomy which offers improved outcome in medullary thyroid carcinoma since inefficacy of chemotherapy and radiotherapy. CONCLUSIONS Surgery is the unique and fundamental therapy for patients affected by medullary thyroid carcinoma. Extended neck dissection combined to precocious diagnosis and strict follow-up might be considered the standard of treatment of medullary thyroid carcinoma. KEY WORDS Complications, Lymphadenectomy, Medullary carcinoma, Prognosis.
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Bugiantella W, Rondelli F, Longaroni M, Mariani E, Sanguinetti A, Avenia N. Left colon acute diverticulitis: an update on diagnosis, treatment and prevention. Int J Surg 2014; 13:157-164. [PMID: 25497007 DOI: 10.1016/j.ijsu.2014.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 02/06/2023]
Abstract
Diverticulosis of the colon is a common disease with an increasing incidence in Western Countries. It represents a significant burden for National Health Systems in terms of costs. Most people with diverticulosis remain asymptomatic, about one quarter of them will develop an episode of symptomatic diverticular disease and up to 5% an episode of acute diverticulitis (AD). AD shows an increasing prevalence. Recently, progresses have been reached about the etiology, pathogenesis, natural course of diverticular disease and its complications; improvements about the diagnosis and treatment of AD have been achieved. However, the treatment options are not well defined because of a lack of solid evidence: there are few systematic reviews and well conducted trials to guide decision-making in the treatment of AD and in the prevention of its recurrences. This review describes the recent evidence about diagnosis, treatment and prevention of AD.
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Affiliation(s)
- Walter Bugiantella
- General Surgery, "San Giovanni Battista" Hospital, AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy.
| | - Fabio Rondelli
- General Surgery, "San Giovanni Battista" Hospital, AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy.
| | - Maurizio Longaroni
- General Surgery, "San Giovanni Battista" Hospital, AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - Enrico Mariani
- General Surgery, "San Giovanni Battista" Hospital, AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - Alessandro Sanguinetti
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy.
| | - Nicola Avenia
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy.
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Sanguinetti A, Polistena A, Lucchini R, Monacelli M, Avenia S, Conti C, Barillaro I, Rondelli F, Bugiantella W, Avenia N. Breast cancer in older women: What factors affect the treatment? Int J Surg 2014; 12 Suppl 2:S177-S180. [DOI: 10.1016/j.ijsu.2014.08.346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/04/2023]
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Polistena A, Monacelli M, Lucchini R, Triola R, Conti C, Avenia S, Sole Di Patrizi M, Barillaro I, Boccolini A, Sanguinetti A, Avenia N. Thyroid anaplastic carcinoma: the impact of multimodality treatment on survival. The experience of a referral center for endocrine surgery. MINERVA CHIR 2014; 69:261-269. [PMID: 25052058] [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: 06/03/2023]
Abstract
AIM Anaplastic thyroid carcinoma (ATC) is characterized by local invasiveness, risk of recurrence and very poor prognosis. METHODS We retrospectively reviewed 79 consecutive patients treated between 1996 and 2012. We analysed the multimodality treatment of ATC considering the impact of surgery and radiotherapy on survival. RESULTS Patients were divided in groups A and B (tumor less and larger than 5 cm). Surgery was carried out in 44 patients, radiotherapy in 48 patients. Tracheostomy and endoprosthesis were used respectively in 48.1% and in 25.3% of patients. The mean survival was 5.35 (± 3.2) months with no significant difference in group A vs. group B. Considering patients undergone surgery, significant impact on survival was observed comparing A vs. B (P=0.013). Combination of surgery and radiotherapy significantly improves outcome comparing A vs. B (P=0.017). Improvement in survival compared to no treatment at all was observed in both groups respectively for surgery (P=0.001 and P=0.0001) and radiotherapy (P=0.047 and P=0.0001). CONCLUSION Although the severity of prognosis of ATC, multimodality treatment still significantly improves local control of the disease achieving acceptable survival in selected patients and adequate palliation of symptoms for the others. Surgery is still a fundamental treatment.
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Affiliation(s)
- A Polistena
- University of Perugia, Medical School Endocrine Surgery Unit S. Maria University Hospital Terni, Terni, Italy - apolis74yahoo.it
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Sanguinetti A, Parmeggiani D, Lucchini R, Monacelli M, Triola R, Avenia S, Conti C, Conzo G, Avenia N. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery Evaluation of its use in terms of "spending review". Ann Ital Chir 2014; 85:418-421. [PMID: 24614058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Intra Operative Nerve Monitoring (IONM) has been used in head and neck surgery since the 1970s. Its utilization for monitoring and protecting the recurrent laryngeal nerve, however, is a controversial subject. This paper details the use, value, and cost of this technology within a single institution. METHODS We conducted a retrospective chart review, analysis of surgery time with and without IONM, analysis of postoperative vocal cord function, and review of the literature RESULTS IONM did not reduce the operative time during total thyroidectomies in our experience. Use of IONM increased the cost of each surgery by € 450. IONM did not decrease the number of injured nerves (postoperative paresis). CONCLUSIONS IONM has proven to be highly useful in certain circumstances but has not been definitively proven to protect the nerve any more effectively than the gold standard of nerve visualization. In our study, the use of IONM did not reduce the time of thyroid surgery and did increase the cost. While IONM may, in special clinical circumstances such as revision and malignant thyroid surgery, increase the value of the operation, its use for every thyroid surgery does not appear to be cost effective or valuable to the patient.
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Rondelli F, Bugiantella W, Villa F, Sanguinetti A, Boni M, Mariani E, Avenia N. Robot-assisted or conventional laparoscoic rectopexy for rectal prolapse? Systematic review and meta-analysis. Int J Surg 2014; 12 Suppl 2:S153-S159. [PMID: 25157988 DOI: 10.1016/j.ijsu.2014.08.359] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 05/15/2014] [Revised: 08/05/2014] [Accepted: 06/15/2014] [Indexed: 02/08/2023]
Abstract
AIM The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However the role of robotic assistance in laparoscopic rectopexy is still not demonstrated. METHODS A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library, and Google Scholar up to 30th June 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the data currently available regarding the incidence of recurrence rate of rectal prolapse, conversion rate, operative time, intra-operative blood loss, post-operative complications, re-operation rate and hospital stay in robot-assisted rectopexy (RC) compared to conventional laparoscopic rectopexy (LR). RESULTS Six studies were included resulting in 340 patients. The meta-analysis showed that the RR does not influence the recurrence rate of rectal prolapse, the conversion rate and the re-operation rate, whereas it decreases the intra-operative blood loss, the post-operative complications and the hospital stay. Yet, the RR resulted to be longer than the LR. Post-operative ano-rectal and the sexual functionality and procedural costs could not meta-analyzed because the data from included studies about these issues were heterogeneous and incomplete. CONCLUSION The meta-analysis showed that the RR may ensure limited improvements in post-operative outcomes if compared to the LR. However, RCTs are needed to compare RR to LR in terms of short-term and long-term outcomes, specially investigating the functional outcomes that may confirm the cost-effectiveness of the robotic assisted rectopexy.
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Affiliation(s)
- F Rondelli
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy.
| | - W Bugiantella
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy.
| | - F Villa
- "Bellinzona e Valli" Regional Hospital, 6500, Bellinzona, Switzerland.
| | - A Sanguinetti
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
| | - M Boni
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - E Mariani
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - N Avenia
- University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy.
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Rondelli F, Desio M, Vedovati MC, Balzarotti Canger RC, Sanguinetti A, Avenia N, Bugiantella W. Intra-abdominal drainage after pancreatic resection: is it really necessary? A meta-analysis of short-term outcomes. Int J Surg 2014; 12 Suppl 1:S40-7. [PMID: 24824188 DOI: 10.1016/j.ijsu.2014.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pancreatic fistula (PF) is the most dreadful complication of patients after pancreatic resection. The use of operative site drains is considered routine all along in pancreatic surgery in order to remove any collections and to act as a warning of hemorrhage or anastomotic leakage. To date few studies investigated the potential benefit and safety of routine drainage compared with no drainage after pancreatic resection and the evidence by literature is not clear. METHODS A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE and Cochrane Library up to 28th February 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. The currently available data regarding the incidence of post-operative short-term outcomes after pancreatic resection were meta-analyzed according to the presence or absence of the intra-abdominal drainage. RESULTS Overall 7 studies were included in the meta-analysis, that is 2 randomized controlled trials (RCTs) and 5 non-RCTs resulting in 2704 patients totally. Intra-abdominal drainage showed to increase the PF (OR 2.31, 95% CI 1.52-3.51), the total post-operative complications (OR 1.52, 95% CI 1.30-1.78) and the re-admission (OR 1.30, 95% CI 1.06-1.61) rates. A non-significant correlation was found with the presence/absence of the drainage about biliary and enteric fistula, post-operative hemorrhage, intra-abdominal infected collection, wound infection and overall mortality rates. CONCLUSION The meta-analysis shows that the presence of an intra-abdominal drainage does not improve the post-operative outcome after pancreatic resection.
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Affiliation(s)
- Fabio Rondelli
- University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy; "San Giovanni" Bellinzona e Valli Regional Hospital, 6500 Bellinzona, Switzerland
| | - Matteo Desio
- University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy
| | - Maria Cristina Vedovati
- University of Perugia, Department of Medicine, Internal and Cardiovascular Medicine and Stroke Unit, "Santa Maria della Misericordia" Hospital, Via G. Dottori, 06100 Perugia, Italy
| | | | - Alessandro Sanguinetti
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy
| | - Nicola Avenia
- "San Giovanni" Bellinzona e Valli Regional Hospital, 6500 Bellinzona, Switzerland; General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy
| | - Walter Bugiantella
- University of Perugia, PhD School in Biotecnologies, "San Matteo degli Infermi" Hospital, AUSL Umbria 2, Via Loreto, 06049 Spoleto, Italy.
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Sanguinetti A, Lucchini R, Santoprete S, Farabi R, Fioriti L, Bistoni G, Triola R, Avenia N. Metaplastic carcinoma of the breast: Treatment, results and prognostic factors based on international literature. Ann Ital Chir 2014; 85:109-113. [PMID: 24195912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Metaplastic carcinoma of the breast (MCB) is a rare form of cancer containing mixture of epithelial and mesenchymal elements in variable combinations. Few and conflicting clinical data are available in the literature addressing optimal treatment modalities, prognosis and outcome. A retrospective study was conducted to review all patients with MCB diagnosed and treated at Breast Unit of Azienda Ospedaliera "Santa Maria" Terni - Italy between 2001/2010. The aim is to describe patient's clinic pathologic features and to analyze treatment results. Six female patients were studied. The median age was 48 years (range 14/58). The median tumor size was 9 cm. (range 3/18 cm.). Two cases (33%) were identified as purely epithelial and 4 (67%) as mixed epithelial and mesenchymal metaplasia. Hormone receptors were positive in only 2 patients. Modified radical mastectomy performed in 3 patients and 5 underwent axillary node dissection. Adjuvant chemotherapy was given to all patients and postoperative radiotherapy to 4. Four patients relapsed with median time of relapse of 12 months. MCB is an aggressive form of breast cancer associated with poor outcome, high incidence of local recurrence and pulmonary metastases. The disease tends to be estrogen/progesterone receptor negative. Tumor size has an important impact on outcome. The best treatment approach is yet to be defined.
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Sanguinetti A, Polistena A, D'Ermo G, Lucchini R, Triola R, Conti C, Avenia S, Cavallaro G, De Toma G, Avenia N. Axillary metastases from occult breast cancer. Our experience. Ann Ital Chir 2014; 85:S2239253X14022129. [PMID: 24576904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report the case of a 63-year-old woman with occult breast cancer who presented with a hard metastatic nodule in the left axilla. Although histology identified a metastatic carcinoma in the lymph nodes, numerous tests failed to detect the primary tumor. Resected lymph node was positive for both estrogen and progesterone receptors, suggesting the breast as the site of the primary tumor. Left modified radical mastectomy was performed. Pathology revealed an invasive lobular carcinoma (2.5 x 2 mm in size) with extensive lymphatic involvement, which strongly expressed both vascular endothelial growth factor-C (VEGF-C) and VEGF-D.
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Sanguinetti A, Polistena A, D'Ermo G, Lucchini R, Triola R, Conti C, Avenia S, Cavallaro G, De Toma G, Avenia N. Male breast cancer in the twenty-first century: What's new? Ann Ital Chir 2014; 85:544-550. [PMID: 24535709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Male breast cancer is an uncommon disease although the incidence has increased over the past 25 years. As with many other rare "orphan" diseases, male breast cancer is understudied. The rarity of the disease precludes prospective randomized clinical trials. In addition, few researchers and minimal funding have focused on breast cancer in men, but further work is clearly needed to better understand this disease. It shares many similarities with breast cancer in women; yet some clear differences have emerged. In this article, the latest information on the epidemiology, biology, and treatment of male breast cancer is reviewed. KEY WORDS Epidemiology, Male breast cancer, Prognosis, Treatment.
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Lucchini R, Monacelli M, Santoprete S, Triola R, Conti C, Pecoriello R, Favoriti P, Di Patrizi MS, Barillaro I, Boccolini A, Avenia S, D'Ajello M, Sanguinetti A, Avenia N. Differentiated thyroid tumors: surgical indications. G Chir 2013; 34:153-7. [PMID: 23837952 DOI: 10.11138/gchir/2013.34.5.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thyroid gland tumors represent 1% of malignant tumors. In Italy their incidence is in constant growth. The aggressiveness depends on the histological type. The relative non-aggressive grade of different forms of tumors is the basis for discussing the treatment of choice: total thyroidectomy vs lobectomy with or without lymphadenectomy of the sixth level in the absence of metastasis. Authors report about their experience, and they advocate, given the high percentage of multicentric forms, total thyroidectomy as treatment of choice.
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Sanguinetti A, Lucchini R, Santoprete S, Bistoni G, Avenia S, Triola R, Avenia N. Surgical margins in breast-conserving therapy: current trends and future prospects. Ann Ital Chir 2013; 84:595-606. [PMID: 24195861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse effects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher “a priori” risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radio-guided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.
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