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Valentini V, Alfieri S, Coco C, D'Ugo D, Crucitti A, Pacelli F, Persiani R, Sofo L, Picciocchi A, Doglietto GB, Barbaro B, Vecchio FM, Ricci R, Damiani A, Savino MC, Boldrini L, Cellini F, Meldolesi E, Romano A, Chiloiro G, Gambacorta MA. Four steps in the evolution of rectal cancer managements through 40 years of clinical practice: Pioneering, standardization, challenges and personalization. Radiother Oncol 2024; 194:110190. [PMID: 38438019 DOI: 10.1016/j.radonc.2024.110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Claudio Coco
- U.O.C. Chirurgia Generale 2, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Ugo
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Fabio Pacelli
- Unità chirurgica del peritoneo e del retroperitoneo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Persiani
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Sofo
- Divisione di Chirurgia Addominale, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Aurelio Picciocchi
- Dipartimento di Chirurgia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Battista Doglietto
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Brunella Barbaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Maria Vecchio
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Ricci
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Damiani
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Savino
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Grieco M, Galiffa G, Marcellinaro R, Santoro E, Persiani R, Mancini S, Di Paola M, Santoro R, Stipa F, Crucitti A, Carlini M. Impact of the COVID-19 Pandemic on Enhanced Recovery After Surgery (ERAS) Application and Outcomes: Analysis in the "Lazio Network" Database. World J Surg 2022; 46:2288-2296. [PMID: 35972532 PMCID: PMC9380676 DOI: 10.1007/s00268-022-06694-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/18/2023]
Abstract
Background The aim of this study was to investigate how the COVID-19 pandemic influenced ERAS program application in colorectal surgery across hospitals in the Lazio region (central district in Italy) participating in the “Lazio Network” project. Methods A multi-institutional database was constructed. All patients included in this study underwent elective colorectal surgery for both malignant and benign disease between January 2019 and December 2020. Emergency procedures were excluded. The population was divided into 2 groups: a pre-COVID-19 group (PG) of patients operated on between February and December 2019 and a COVID-19 group (CG) of patients operated on between February and December 2020, during the first 2 waves of the pandemic in Italy. Results The groups included 622 patients in the PG and 615 in the CG treated in 8 hospitals of the network. The mean number of items applied was higher in the PG (65.6% vs. 56.6%, p < 0.001) in terms of preoperative items (64.2% vs. 50.7%, p < 0.001), intraoperative items (65.0% vs. 53.3%, p < 0.001), and postoperative items (68.8% vs. 63.2%, p < 0.001). Postoperative recovery was faster in the PG, with a shorter time to first flatus, first stool, autonomous mobilization and discharge (6.82 days vs. 7.43 days, p = 0.021). Postoperative complications, mortality and reoperations were similar among the groups. Conclusions The COVID-19 pandemic had a negative impact on the application of ERAS in the centers of the “Lazio Network” study group, with a reduction in adherence to the ERAS protocol in terms of preoperative, intraoperative and postoperative items. In addition, in the CG, the patients had worse postoperative outcomes with respect to recovery and discharge.
Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06694-8.
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Affiliation(s)
- Michele Grieco
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy.
| | - Giampaolo Galiffa
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Rosa Marcellinaro
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | | | - Roberto Persiani
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | | | | | | | | | | | - Massimo Carlini
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
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Grieco M, Galiffa G, Lorenzon L, Marincola G, Persiani R, Santoro R, Pernazza G, Brescia A, Santoro E, Stipa F, Crucitti A, Mancini S, Palmieri RM, Di Paola M, Sacchi M, Carlini M. Enhanced recovery after surgery (ERAS) program in octogenarian patients: a propensity score matching analysis on the "Lazio Network" database. Langenbecks Arch Surg 2022; 407:3079-3088. [PMID: 35697818 DOI: 10.1007/s00423-022-02580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the safety and compliance with the enhanced recovery after surgery (ERAS) protocol in octogenarian patients undergoing colorectal surgery in 12 Italian high-volume centers. METHODS A retrospective analysis was conducted in a consecutive series of patients who underwent elective colorectal surgery between 2016 and 2018. Patients were grouped by age (≥ 80 years vs < 80 years), propensity score matching (PSM) analysis was performed, and the groups were compared regarding clinical outcomes and the mean number of ERAS items applied. RESULTS Out of 1646 patients identified, 310 were octogenarians. PSM identified 2 cohorts of 125 patients for the comparison of postoperative outcomes and ERAS compliance. The 2 groups were homogeneous regarding the clinical variables and mean number of ERAS items applied (11.3 vs 11.9, p-ns); however, the application of intraoperative items was greater in nonelderly patients (p 0.004). The functional recovery was similar between the two groups, as were the rates of postoperative severe complications and 30-day mortality rate. Elderly patients had more overall complications. Furthermore, the mean hospital stay was higher in the elderly group (p 0.027). Multivariable analyses documented that postoperative stay was inversely correlated with the number of ERAS items applied (p < 0.0001), whereas age ≥ 80 years significantly correlated with the overall complication rate (p 0.0419). CONCLUSION The ERAS protocol is safe in octogenarian patients, with similar levels of compliance and surgical outcomes. However, octogenarian patients have a higher rate of overall complications and a longer hospital stay than do younger patients.
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Affiliation(s)
| | | | - Laura Lorenzon
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | | | - Roberto Persiani
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | | | | | - Antonio Brescia
- Sant'Andrea University Hospital. "La Sapienza" University, Rome, Italy
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Sidoli C, Zambon A, Tassistro E, Rossi E, Mossello E, Inzitari M, Cherubini A, Marengoni A, Morandi A, Bellelli G, Tarasconi A, Sella M, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Porcella L, Nardiello I, Chimenti E, Zeni M, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, Pietrogrande L, Mosca M, Corazzin I, Rossi P, Nunziata V, D’Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell’Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Borghi C, Bianchetti A, Crucitti A, DiFrancesco V, Fontana G, Geriatria A, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cassadonte F, Vatrano M, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Seneci F, Fimognari F, Bambar V, Saitta A, Corica F, Braga M, Servi, Ettorre E, Camellini Bellelli CG, Annoni G, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Formilan M, Patrizia G, Santuar L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl’Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Alessandro M, Calogero P, Corvalli G, Di F, Pezzoni D, Platto C, D’Ambrosio V, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Bonetto M, Grasso M, Troisi E, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Faraci B, Bertoletti E, Vannucci M, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D’Amico F, Grippa A, Mazzone A, Cottino M, Vezzadini G, Avanzi S, Brambilla C, Orini S, Sgrilli F, Mello A, Lombardi Muti LE, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D’Amico F, D’Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Cortegiani A, Pistidda L, D’Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clin Exp Res 2022; 34:1827-1835. [PMID: 35396698 DOI: 10.1007/s40520-022-02099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
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Basso C, Gennaro N, Dotto M, Ferroni E, Noale M, Avossa F, Schievano E, Aceto P, Tommasino C, Crucitti A, Incalzi RA, Volpato S, Petrini F, Carron M, Pace MC, Bettelli G, Chiumiento F, Corcione A, Montorsi M, Trabucchi M, Maggi S, Corti MC. Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes. Updates Surg 2022; 74:609-617. [PMID: 34115323 PMCID: PMC8995267 DOI: 10.1007/s13304-021-01086-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022]
Abstract
There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection. Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate. Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.
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Affiliation(s)
- Cristina Basso
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy.
| | - Nicola Gennaro
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Matilde Dotto
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Eliana Ferroni
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Francesco Avossa
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Elena Schievano
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Paola Aceto
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Concezione Tommasino
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Anaesthesia and Intensive Care, Polo Universitario Ospedale San Paolo, Milan, Italy
| | - Antonio Crucitti
- SICG, Società Italiana di Chirurgia Geriatrica, Naples, Italy
- Cristo Re Hospital, Catholic University Rome, Rome, Italy
| | - Raffaele Antonelli Incalzi
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Cattedra di Medicina Interna e Geriatria, Università Campus Bio-Medico, Rome, Italy
| | - Stefano Volpato
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Flavia Petrini
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, Chieti-Pescara University, Pescara, Italy
| | - Michele Carron
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padua, Italy
| | - Maria Caterina Pace
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontostomatologiche, Università di Milano, Milan, Italy
| | - Gabriella Bettelli
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- University of San Marino, San Marino, San Marino
- Department of Anaestesia, Intensive Care, Day Surgery and Pain Therapy and Geriatric Surgery Area, IRCCS INRCA, Italian National Research Centres on Aging, Ancona, Italy
| | - Fernando Chiumiento
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Dipartimento Area Critica, ASL Salerno, Salerno, Italy
| | - Antonio Corcione
- Dipartimento di Area Critica UOC Anestesia e TIPO, AORN dei Colli-Monaldi, Naples, Italy
| | - Marco Montorsi
- SIC, Società Italiana di Chirurgia, Rome, Italy
- Humanitas University and Research Hospital IRCCS, Milan, Italy
| | | | - Stefania Maggi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Maria Chiara Corti
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
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Meldolesi E, Chiloiro G, Giannini R, Menghi R, Persiani R, Corvari B, Coco C, Manfrida S, Ratto C, De Luca V, Sofo L, Reina S, Crucitti A, Masiello V, Dinapoli N, Valentini V, Gambacorta MA. The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes. Cancers (Basel) 2022; 14:cancers14071643. [PMID: 35406415 PMCID: PMC8996944 DOI: 10.3390/cancers14071643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Aims: Between 11 to 14% of patients with locally advanced rectal cancer (LARC) have positive lateral pelvic lymph nodes (LPLN) at diagnosis, related to a worse prognosis with a 5-year survival rate between 30 to 40%. The best treatment choice for this group of patients is still a challenge. The optimal radiotherapy (RT) dose for LPLN patients has been investigated. Methods: We retrospectively collected data from LARC patients with LPLN at the primary staging MRI, treated in our center from March 2003 to December 2020. Patients underwent a neoadjuvant concomitant chemo-radiotherapy (CRT) treatment on the primary tumor (T), mesorectum, and pelvic nodes, associated with a fluoride-based chemotherapy. The total reached dose was 45 Gy at 1.8 Gy/fr on the elective sites and 55 Gy at 2.2 Gy/fr on the disease and mesorectum. Patients were divided in two groups based on whether they received a simultaneous integrated RT boost on the LPLN or not. Overall Survival (OS), Disease Free Survival (DFS), Metastasis Free Survival (MFS), and Local Control (LC) were evaluated in the whole group and then compared between the two groups. Results: A total of 176 patients were evaluated: 82 were included in the RT boost group and 94 in the non-RT boost group. The median follow-up period was 57.8 months. All the clinical endpoint (OS, DFS, MFS, LC), resulted were affected by the simultaneous integrated boost on LPLN with a survival rate of 84.7%, 79.5%, 84.1%, and 92%, respectively, in the entire population. From the comparison of the two groups, there was a statistical significance towards the RT boost group with a p < 0.006, 0.030, 0.042, 0.026, respectively. Conclusions: Concomitant radiotherapy boost on positive LPLN has shown to be beneficial on the survival outcomes (OS, DFS, MFR, and LC) in patients with LARC and LPLN. This analysis demonstrates that a higher dose of radiotherapy on positive pelvic lymph nodes led not only to a higher local control but also to a better survival rate. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years.
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Affiliation(s)
- Elisa Meldolesi
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Giuditta Chiloiro
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Roberta Giannini
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
- Correspondence:
| | - Roberta Menghi
- Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
| | - Roberto Persiani
- Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
| | - Barbara Corvari
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Claudio Coco
- Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
| | - Stefania Manfrida
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Carlo Ratto
- Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
| | - Viola De Luca
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Luigi Sofo
- Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
| | - Sara Reina
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Antonio Crucitti
- Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
| | - Valeria Masiello
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Nicola Dinapoli
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Vincenzo Valentini
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
| | - Maria Antonietta Gambacorta
- Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
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Chiloiro G, Meldolesi E, Corvari B, Romano A, Barbaro B, Coco C, Crucitti A, Genovesi D, Lupattelli M, Mantello G, Menghi R, Falchetto Osti M, Persiani R, Petruzziello L, Ricci R, Sofo L, Valentini C, De Paoli A, Valentini V, Antonietta Gambacorta M. BRIDGE -1 TRIAL: BReak Interval Delayed surgery for Gastrointestinal Extraperitoneal rectal cancer, a multicentric phase III randomized trial. Clin Transl Radiat Oncol 2022; 34:30-36. [PMID: 35340685 PMCID: PMC8943334 DOI: 10.1016/j.ctro.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/01/2022] Open
Abstract
The lengthening of the surgical interval has a positive impact on pathological complete response (pCR) rate. Lengthening the surgical interval from the end of preoperative chemoradiation is not detrimental to survival outcomes in locally advanced rectal cancer. Prospective validation of the impact of surgical interval lengthening on complete response and survival outcomes in a randomized trial.
Design Methods Conclusions
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Affiliation(s)
- Giuditta Chiloiro
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Barbara Corvari
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Angela Romano
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Corresponding author at: Department of Diagnostic Imaging, Radiation Oncology and Haematology Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy.
| | - Brunella Barbaro
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Claudio Coco
- Department of Surgical Sciences, Catholic University of Rome, Rome, Italy
| | - Antonio Crucitti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Genovesi
- Department of Radiotherapy, “SS Annunziata” Hospital “G. D’Annunzio” University, Chieti, Italy
| | | | - Giovanna Mantello
- Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Roberta Menghi
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center) Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital, Rome, Italy
| | - Roberto Persiani
- Department of General Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Riccardo Ricci
- Department of Pathology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Luigi Sofo
- Department of Gastroenterological, Endocrino-Metabolic and Nephro-Urological Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Valentini
- Klinik für Radioonkologie-OncoRay Universitätsklinikum C.G. Carus an der TU, Dresden, Germany
| | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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Zucchelli A, Manzoni F, Morandi A, Di Santo S, Rossi E, Valsecchi MG, Inzitari M, Cherubini A, Bo M, Mossello E, Marengoni A, Bellelli G, Tarasconi A, Sella M, Auriemma S, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Margola A, Porcella L, Nardiello I, Chimenti E, Zeni M, Giani A, Famularo S, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Ballestrero A, Minaglia C, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, De F, Pietrogrande L, De B, Mosca M, Corazzin I, Rossi P, Nunziata V, D‘Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell‘Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Bianchetti A, Crucitti A, Di Francesco V, Fontana G, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cannistrà U, Cassadonte F, Vatrano M, Cassandonte F, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Fimognari F, Bambara V, Saitta A, Corica F, Braga M, Ettorre E, Camellini C, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Patrizia G, Santuari L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl‘Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Calogero P, Corvalli G, Pezzoni D, Gentile S, Morandi A, Platto C, D‘Ambrosio V, Faraci B, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Confente S, Bonetto M, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Bertoletti E, Vannucci M, Tesi F, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D‘Amico F, Grippa A, Mazzone A, Riva E, Dell‘Acqua D, Cottino M, Vezzadini G, Avanzi S, Orini S, Sgrilli F, Mello A, Lombardi L, Muti E, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, De F, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D‘Amico F, D‘Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Scapigliati A, Cortegiani A, Vitale F, Pistidda L, D‘Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017. Aging Clin Exp Res 2022; 34:349-357. [PMID: 34417734 PMCID: PMC8847195 DOI: 10.1007/s40520-021-01950-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/31/2021] [Indexed: 01/22/2023]
Abstract
Introduction Delirium and sarcopenia are common, although underdiagnosed, geriatric
syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01950-8.
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Chiloiro G, Cusumano D, Boldrini L, Romano A, Placidi L, Nardini M, Meldolesi E, Barbaro B, Coco C, Crucitti A, Persiani R, Petruzziello L, Ricci R, Salvatore L, Sofo L, Alfieri S, Manfredi R, Valentini V, Gambacorta MA. THUNDER 2: THeragnostic Utilities for Neoplastic DisEases of the Rectum by MRI guided radiotherapy. BMC Cancer 2022; 22:67. [PMID: 35033008 PMCID: PMC8760695 DOI: 10.1186/s12885-021-09158-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background Neoadjuvant chemoradiation therapy (nCRT) is the standard treatment modality in locally advanced rectal cancer (LARC). Since response to radiotherapy (RT) is dose dependent in rectal cancer, dose escalation may lead to higher complete response rates. The possibility to predict patients who will achieve complete response (CR) is fundamental. Recently, an early tumour regression index (ERI) was introduced to predict pathological CR (pCR) after nCRT in LARC patients. The primary endpoints will be the increase of CR rate and the evaluation of feasibility of delta radiomics-based predictive MRI guided Radiotherapy (MRgRT) model. Methods Patients affected by LARC cT2-3, N0-2 or cT4 for anal sphincter involvement N0-2a, M0 without high risk features will be enrolled in the trial. Neoadjuvant CRT will be administered using MRgRT. The initial RT treatment will consist in delivering 55 Gy in 25 fractions on Gross Tumor Volume (GTV) plus the corresponding mesorectum and 45 Gy in 25 fractions on the drainage nodes. Chemotherapy with 5-fluoracil (5-FU) or oral capecitabine will be administered continuously. A 0.35 Tesla MRI will be acquired at simulation and every day during MRgRT. At fraction 10, ERI will be calculated: if ERI will be inferior than 13.1, the patient will continue the original treatment; if ERI will be higher than 13.1 the treatment plan will be reoptimized, intensifying the dose to the residual tumor at the 11th fraction to reach 60.1 Gy. At the end of nCRT instrumental examinations are to be performed in order to restage patients. In case of stable disease or progression, the patient will undergo surgery. In case of major or complete clinical response, conservative approaches may be chosen. Patients will be followed up to evaluate toxicity and quality of life. The number of cases to be enrolled will be 63: all the patients will be treated at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Discussion This clinical trial investigates the impact of RT dose escalation in poor responder LARC patients identified using ERI, with the aim of increasing the probability of CR and consequently an organ preservation benefit in this group of patients. Trial registration ClinicalTrials.gov Identifier: NCT04815694 (25/03/2021).
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Matteo Nardini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Claudio Coco
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Antonio Crucitti
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Roberto Persiani
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Lucio Petruzziello
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Ricci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Lisa Salvatore
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Sofo
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Sergio Alfieri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Lucchetti D, Zurlo IV, Colella F, Ricciardi-Tenore C, Di Salvatore M, Tortora G, De Maria R, Giuliante F, Cassano A, Basso M, Crucitti A, Laurenzana I, Artemi G, Sgambato A. Mutational status of plasma exosomal KRAS predicts outcome in patients with metastatic colorectal cancer. Sci Rep 2021; 11:22686. [PMID: 34811396 PMCID: PMC8608842 DOI: 10.1038/s41598-021-01668-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023] Open
Abstract
Liquid biopsy has become a useful alternative in metastatic colorectal cancer (mCRC) patients when tissue biopsy of metastatic sites is not feasible. In this study we aimed to investigate the clinical utility of circulating exosomes DNA in the management of mCRC patients. Exosomes level and KRAS mutational status in exosomal DNA was assesed in 70 mCRC patients and 29 CRC primary tumor and were analysed at different disease steps evaluating serial blood samples (240 blood samples). There was a significant correlation between the extension of disease and exosomes level and the resection of primary localized tumor was correlated with a decrease of KRAS G12V/ D copies and fractional abundance in metastatic disease. CEA expression and liver metastasis correlated with a higher number of KRAS G12V/D copies/ml and a higher fractional abundance; in the subgroup of mCRC patients eligible for surgery, the size of tumor and the radiological response were related to exosomes level but only the size was related to the number of KRAS WT copies; both KRAS wild-type and mutated levels were identified as a prognostic factor related to OS. Finally, we found that 91% of mutated mCRC patients became wild type after the first line chemotherapy but this status reverted in mutated one at progression in 80% of cases. In a prospective cohort of mCRC patients, we show how longitudinal monitoring using exosome-based liquid biopsy provides clinical information relevant to therapeutic stratification.
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Affiliation(s)
- Donatella Lucchetti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Ina Valeria Zurlo
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Filomena Colella
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Claudio Ricciardi-Tenore
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Mariantonietta Di Salvatore
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Giampaolo Tortora
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Ruggero De Maria
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Felice Giuliante
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Alessandra Cassano
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Michele Basso
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Antonio Crucitti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Division of General Surgery, Cristo Re Hospital, Rome, Italy
| | - Ilaria Laurenzana
- Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, PZ, Italy
| | - Giulia Artemi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Alessandro Sgambato
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, PZ, Italy.
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11
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Costa G, Bersigotti L, Massa G, Lepre L, Fransvea P, Lucarini A, Mercantini P, Balducci G, Sganga G, Crucitti A. The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery. Aging Clin Exp Res 2021; 33:2191-2201. [PMID: 33205380 PMCID: PMC8302529 DOI: 10.1007/s40520-020-01735-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. STUDY DESIGN 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called "EmSFI". Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. RESULTS 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654-0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682-0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. CONCLUSIONS The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.
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Affiliation(s)
- Gianluca Costa
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Laura Bersigotti
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
- Emergency Surgery Unit, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
| | - Giulia Massa
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, ASL Roma 1, Rome, Italy
| | - Pietro Fransvea
- Division of Emergency and Trauma Surgery - Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Alessio Lucarini
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Paolo Mercantini
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Genoveffa Balducci
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency and Trauma Surgery - Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Rome, Italy
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12
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Podda M, Sylla P, Baiocchi G, Adamina M, Agnoletti V, Agresta F, Ansaloni L, Arezzo A, Avenia N, Biffl W, Biondi A, Bui S, Campanile FC, Carcoforo P, Commisso C, Crucitti A, De'Angelis N, De'Angelis GL, De Filippo M, De Simone B, Di Saverio S, Ercolani G, Fraga GP, Gabrielli F, Gaiani F, Guerrieri M, Guttadauro A, Kluger Y, Leppaniemi AK, Loffredo A, Meschi T, Moore EE, Ortenzi M, Pata F, Parini D, Pisanu A, Poggioli G, Polistena A, Puzziello A, Rondelli F, Sartelli M, Smart N, Sugrue ME, Tejedor P, Vacante M, Coccolini F, Davies J, Catena F. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project. World J Emerg Surg 2021; 16:35. [PMID: 34215310 PMCID: PMC8254305 DOI: 10.1186/s13017-021-00378-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. METHODS The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. CONCLUSIONS The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.
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Affiliation(s)
- Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Gianluca Baiocchi
- ASST Cremona, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michel Adamina
- Department of Colorectal Surgery, Cantonal Hospital of Winterthur, Winterthur - University of Basel, Basel, Switzerland
| | | | - Ferdinando Agresta
- Department of General Surgery, Vittorio Veneto Hospital, AULSS2 Trevigiana del Veneto, Vittorio Veneto, Italy
| | - Luca Ansaloni
- 1st General Surgery Unit, University of Pavia, Pavia, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Nicola Avenia
- SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Antonio Biondi
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Simona Bui
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Fabio C Campanile
- Department of Surgery, ASL VT - Ospedale "San Giovanni Decollato - Andosilla", Civita Castellana, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Claudia Commisso
- Department of Radiology, University Hospital of Parma, Parma, Italy
| | - Antonio Crucitti
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital and Catholic University, Rome, Italy
| | - Nicola De'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Gian Luigi De'Angelis
- Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy
| | | | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | | | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Federica Gaiani
- Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy
| | | | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari K Leppaniemi
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andrea Loffredo
- UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, USA
| | | | | | - Dario Parini
- Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Adolfo Pisanu
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Polistena
- Dipartimento di Chirurgia Pietro Valdoni Policlinico Umberto I, Sapienza Università degli Studi di Roma, Rome, Italy
| | - Alessandro Puzziello
- UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Fabio Rondelli
- SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | | | | | - Michael E Sugrue
- Letterkenny University Hospital and CPM sEUBP Interreg Project, Letterkenny, Ireland
| | | | - Marco Vacante
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
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Crucitti A, La Greca A, Pepe G, Magalini S, Gui D, Sganga G, Bossola M. Percutaneous cholecystostomy in the treatment of acute cholecystitis: is there still a role? A 20-year literature review. Eur Rev Med Pharmacol Sci 2020; 24:10696-10702. [PMID: 33155228 DOI: 10.26355/eurrev_202010_23428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Percutaneous cholecystostomy (PC) is used for the treatment of acute cholecystitis in patients with high surgical risk due to the severity of cholecystitis and/or the underlying acute or chronic medical comorbidities. The evidence for this strategy is unclear. MATERIALS AND METHODS We searched PubMed and the Cochrane databases for English-language studies published from January 1979 through December 31, 2019, for randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies. RESULTS The two randomized studies that have compared PC with cholecystectomy (CCY) or conservative treatment have shown that the clinical outcomes did not differ significantly between the groups. Similar results have been found in the large majority of retrospective cohorts or single-center studies that have compared PC with CCY. CONCLUSIONS PC does not seem to offer any benefit compared with CCY in the treatment of acute cholecystitis in patients with high surgical risk due to the severity of cholecystitis and/or the underlying acute or chronic medical comorbidities. A large, prospective, randomized study that compares percutaneous PC and CCY in patients with high surgical risk and/or moderate to severe cholecystitis is warranted.
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Affiliation(s)
- A Crucitti
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy.
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14
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Aceto P, Antonelli Incalzi R, Bettelli G, Carron M, Chiumiento F, Corcione A, Crucitti A, Maggi S, Montorsi M, Pace MC, Petrini F, Tommasino C, Trabucchi M, Volpato S. Correction to: Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2020; 32:1907. [PMID: 32910423 PMCID: PMC7508731 DOI: 10.1007/s40520-020-01701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article Perioperative Management of Elderly patients (PriME).
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Affiliation(s)
- Paola Aceto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gabriella Bettelli
- Past Director Geriatric Surgery Area and Anaesthesia Dpt., INRCA, Italian National Research Centre on Aging, Ancona, Italy
| | | | | | | | - Antonio Crucitti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Maggi
- CNR, Institute of Neuroscience, Aging Branch, Padua, Italy
| | - Marco Montorsi
- Humanitas University and Research Hospital IRCCS, Milan, Italy
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15
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Grossi U, Petracca Ciavarella L, Fuso P, Crucitti A. Sister Mary Joseph's nodule and colorectal cancer: an aggressive treatment for an aggressive disease. ANZ J Surg 2020; 90:1504-1505. [DOI: 10.1111/ans.15590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ugo Grossi
- Tertiary Referral Pelvic Floor and Incontinence CentreRegional Hospital Treviso Treviso Italy
| | | | - Paola Fuso
- Medical Oncology UnitVito Fazzi Hospital Lecce Italy
| | - Antonio Crucitti
- A. Gemelli University Hospital Foundation IRCCS Rome Italy
- Catholic University of the Sacred Heart Rome Italy
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16
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Grieco M, Lorenzon L, Pernazza G, Carlini M, Brescia A, Santoro R, Crucitti A, Palmieri RM, Santoro E, Stipa F, Sacchi M, Persiani R. Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the "Lazio Network" collective database. Int J Colorectal Dis 2020; 35:445-453. [PMID: 31897650 DOI: 10.1007/s00384-019-03496-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND ERAS implementation improved outcomes in patients undergoing colorectal surgery. The process of incorporating this pathway in clinical practice may be challenging. This observational study investigated the impact of systematic ERAS implementation on surgical outcomes in patients undergoing colorectal resections in a regional network of 10 institutions. METHODS Implementation of ERAS pathway was designed using regular audits and a common protocol. All patients undergoing elective colorectal surgery between 2016 and 2017 were considered eligible. A collective database including 18 ERAS items, clinical and surgical data, and outcomes was designed. Univariate and multivariate analyses were performed for the following outcomes: morbidity, anastomotic leak, reinterventions, hospital stay, and readmissions. RESULTS A total of 827 patients were included, and a mean of 11.3 ERAS items applied/patient was reported. Logistic regression indicated that an increased number of ERAS items applied reduced overall and severe morbidity (OR 0.86 and 0.87, respectively 95%CI 0.8197-0.9202 and 95%CI 0.7821-0.9603), hospitalization (OR 0.53 95%CI 0.4917-0.5845) and reinterventions (OR 0.84 95%CI 0.7536-0.9518) in the entire series. The same results were obtained for a prolonged hospitalization differentiating right-sided (OR 0.48 95%CI 0.4036-0.5801), left-sided (OR 0.48 95%CI 0.3984-0.5815), and rectal resections (OR 0.46 95%CI 0.3753-0.5851). An inverse correlation was found between the application of ERAS items and morbidity in right-sided and rectal procedures (OR 0.89 and 0.84, respectively 95%CI 0.7976-0.9773 and 95%CI 0.7418-0.9634). CONCLUSIONS Systematic implementation of the ERAS pathway using multi-institutional audits can increase protocol adherence and improve surgical outcomes in patients undergoing colorectal surgery.
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Affiliation(s)
- Michele Grieco
- General Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Laura Lorenzon
- General Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | | | - Antonio Brescia
- Sant'Andrea University Hospital, "Sapienza" University, Rome, Italy
| | | | | | | | | | | | | | - Roberto Persiani
- General Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Crucitti A, Mazzari A, Tomaiuolo PM, Dionisi P, Diamanti P, Di Flumeri G, Donini LM, Bossola M. Enhanced Recovery After Surgery (ERAS) is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery: results of a prospective single center study. MINERVA CHIR 2020; 75:157-163. [PMID: 32083412 DOI: 10.23736/s0026-4733.20.08275-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It is still unknown whether ERAS program is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery. In addition, the definition of the "old patient" in terms of age varies across the studies and different age cut-off, such as 65, 70, and 75 years have been used worldwide. METHODS All adult patients undergoing primary, elective colorectal laparoscopic surgery between January 2017 and December 2018 were considered eligible to follow the ERAS protocol according to the Enhanced Recovery After Surgery (ERAS) Society guidelines. Elderly were defined according three different cut-off values: <65 and ≥65 years, <70 and ≥70 years, <75 and ≥75 years. RESULTS One hundred and eight patients were included in the study. Adherence to protocol did not differ significantly between younger and older patients, for most of the items. Thirty-day mortality was absent. The frequency of postoperative complications globally considered and the frequency of the various single complications did not differ significantly between younger and older patients, independently of the cutoff considered to define the older age. Similarly, the frequency of re-intervention and readmission was similar in younger and older patients. Time to flatus and time to stool were similar in young and older patients, independently of the age cut-off used. Time to oral liquid diet was similar in patients with age <65 and ≥65 years while it was moderately longer in patients ≥70 years (1.5±1.1 days;) than in those <70 years (1.1±0.4 days; P=0.030) as well as in patients ≥75 years with respect to the younger ones (1.2±0.5 vs. 1.6±1.2 days; P=0.045). The time to oral solid feeding was similar in young and old patients, independently of the age cut-off used. Time to bladder catheter removal was significantly longer in older patients, independently of the age cut-off used, although the differences do not seem to be clinically relevant. The length of stay was significantly higher in older patients, when the cutoff of 70 years or 75 years was used, but did not differ significantly when the cut-off of 65 years was used. CONCLUSIONS The present study shows that the ERAS protocol is safe, feasible, and effective in elderly patients as in the young ones, undergoing laparoscopic elective colorectal surgery. This suggests that the ERAS program can be applied usefully to elderly patients in the routine clinical practice.
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Affiliation(s)
- Antonio Crucitti
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy - .,Institute of General Surgery, Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Andrea Mazzari
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy
| | | | - Paolo Dionisi
- Department of Anesthesiology, Cristo Re Hospital, Rome, Italy
| | - Paolo Diamanti
- Department of Anesthesiology, Cristo Re Hospital, Rome, Italy
| | - Giada Di Flumeri
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy
| | - Lorenzo M Donini
- Food Science and Human Nutrition Research Unit, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Maurizio Bossola
- Hemodialysis Unit, Institute of Clinical Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Štimac D, Nardone G, Mazzari A, Crucitti A, Maconi G, Elisei W, Violi A, Tursi A, Di Mario F. What's New in Diagnosing Diverticular Disease. J Gastrointestin Liver Dis 2019; 28:17-22. [PMID: 31930228 DOI: 10.15403/jgld-553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/14/2019] [Indexed: 11/01/2022]
Abstract
In this session different issues for the diagnosis of diverticular disease (DD) were considered including "Biomarkers", "Computer tomography", "Ultrasonography in detecting acute diverticulitis", "Endoscopy" and "The DICA classification: a new predictive tool in managing diverticular disease". Most patients affected by DD suffer from recurrent attacks of abdominal pain without evidence of an active inflammatory process, causing a difficult differential diagnosis with other intestinal conditions. Several biomarkers, serological, fecal, urinary and genetic were considered, but recent studies confirmed that only CRP and fecal calprotectin are matching with the criteria for an ideal biomarker for DD. Colonoscopy still remains the gold standard for the diagnosis of DD, playing a key role in many clinical settings, such as colonic diverticular bleeding, or to differentiate inflammatory bowel disease (IBD) and segmental colitis associated with diverticulosis (SCAD); Moreover, in 2015 has been developed the DICA (Diverticular Inflammation and Complication Assessment) endoscopic classification that considers 10 different parameters, each one with a score, and the sum of items scores represents the severity of the disease; in this way the endoscopic exam would be able to predict the outcome of DD for each patient. On the other hand, computer tomography (CT) is the gold standard for acute diverticulitis (AD) with an excellent sensitivity and specificity; recently, metanalysis of prospective studies have shown that intestinal ultrasonography (IUS) and CT have the same sensitivity for the diagnosis of an AD and the advantage is that IUS is less expensive, non-invasive and easily accessible.
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Affiliation(s)
- Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia. .
| | | | - Andrea Mazzari
- General Mininvasive Surgery, Cristo Re Hospital, Catholic University Rome.
| | - Antonio Crucitti
- General Mininvasive Surgery, Cristo Re Hospital ,Catholic University Rome.
| | - Giovanni Maconi
- Gastrointestinal Unit, Department of Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy.
| | - Walter Elisei
- Unit of Gastroenterology and Endoscopy - San Camillo Forlanini Hospital, Rome, Italy.
| | - Alessandra Violi
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, "Maggiore" University Hospital, Parma, Italy.
| | - Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Italy.
| | - Francesco Di Mario
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, "Maggiore" University Hospital, Parma, Italy.
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Tursi A, Brandimarte G, Di Mario F, Lanas A, Scarpignato C, Bafutto M, Barbara G, Bassotti G, Binda GA, Biondi A, Biondo S, Cambiè G, Cassieri C, Crucitti A, Dumitrascu DL, Elisei W, Escalante R, Herszènyi L, Kruis W, Kupcinskas J, Lahat A, Lecca PG, Maconi G, Malfertheiner P, Mazzari A, Mearìn F, Milosavljeviċ T, Nardone G, Chavez De Oliveira E, Papa A, Papagrigoriadis S, Pera M, Persiani R, Picchio M, Regula J, Štimac D, Stollman N, Strate LL, Violi A, Walker MM. International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease. J Gastrointestin Liver Dis 2019; 28:57-66. [PMID: 31930220 DOI: 10.15403/jgld-562] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/18/2019] [Indexed: 11/01/2022]
Abstract
The statements produced by the Chairmen and Speakers of the 3rd International Symposium on Diverticular Disease, held in Madrid on April 11th-13th 2019, are reported. Topics such as current and evolving concepts on the pathogenesis, the course of the disease, the news in diagnosing, hot topics in medical and surgical treatments, and finally, critical issues on the disease were reviewed by the Chairmen who proposed 39 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 124 physicians from 18 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas.
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Affiliation(s)
- Antonio Tursi
- Gastroenterology Service, ASL BAT, Andria (BT), Italy.
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, Rome, Italy.
| | - Francesco Di Mario
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy.
| | - Angel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón, Zaragoza, Spain.
| | | | - Mauro Bafutto
- Instituto Goiano de Gastroenterologia e Endoscopia Digestiva Ltda, Rua 246, 25 Setor Coimbra, Goiânia, Goiás, Brazil.
| | - Giovanni Barbara
- Department of Clinical Medicine, Section of Gastroenterology "S. Orsola" Hospital, University of Bologna, Bologna, Italy.
| | - Gabrio Bassotti
- Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology Section "Santa Maria della Misericordia" Hospital, University of Perugia, San Sisto (PG), Italy.
| | | | - Alberto Biondi
- Department of Surgical Sciences, First General Surgery Unit, Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
| | - Ginevra Cambiè
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy.
| | - Claudio Cassieri
- Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, Rome, Italy.
| | | | - Dan L Dumitrascu
- 132nd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Walter Elisei
- Division of Gastroenterology, ASL Roma 6, Albano Laziale (Roma), Italy.
| | - Ricardo Escalante
- Universidad Central de Venezuela, Loira Medical Center, Caracas, Venezuela.
| | - László Herszènyi
- 2nd Department of Medicine, Semmelweis University, H-1088 Budapest, Hungary.
| | - Wolfgang Kruis
- Innere Medizin, Evangelische Krankenhaus Kalk, Cologne, Germany.
| | - Juozas Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas; Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Adi Lahat
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52651, Israel.
| | | | - Giovanni Maconi
- Gastrointestinal Unit, Department of Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy.
| | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany.
| | - Andrea Mazzari
- Division of General Surgery, "Cristo Re" Hospital, Rome, Italy.
| | - Fermìn Mearìn
- Servicio Aparato Digestivo, Centro Médico Teknon, Barcelona, Spain.
| | | | - Gerardo Nardone
- Department of Clinical and Experimental Medicine, University "Federico II", Naples, Italy.
| | | | - Alfredo Papa
- Division of Internal Medicine and Gastroenterology, CIC "Columbus", Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | | | - Miguel Pera
- Sección de Cirugía Gastrointestinal, Hospital Universitari del Mar, Barcelona, Spain.
| | - Roberto Persiani
- Department of Surgical Sciences, First General Surgery Unit, Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | - Marcello Picchio
- Division of General Surgery, "P. Colombo" Hospital, ASL Roma 6, Velletri (Roma), Italy.
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Postgraduate Education Centre; Department of Gastrointestinal Oncology, Maria Sklodowska-Curie Clinical Oncology Institute, Warsaw, Poland.
| | - Davor Štimac
- Division of Internal Medicine, University Hospital, Rijeka, Croatia.
| | - Neil Stollman
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, Oakland, CA, USA.
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, Seattle, Washington, USA.
| | - Alessandra Violi
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy.
| | - Marjorie Md Walker
- University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health Australian Gastrointestinal Research Alliance, Callaghan NSW 2308, Australia.
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Binda GA, Papa A, Persiani R, Escalante R, De Oliveira EC, Crucitti A, Mazzari A, Biondi A, Papagrigoriadis S. Hot Topics in Surgical Management of Acute Diverticulitiss. J Gastrointestin Liver Dis 2019; 28:29-34. [PMID: 31930226 DOI: 10.15403/jgld-555] [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] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/14/2019] [Indexed: 11/01/2022]
Abstract
In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.
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Affiliation(s)
| | - Alfredo Papa
- Division of Internal Medicine and Gastroenterology, CIC "Columbus", Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | - Roberto Persiani
- Department of Surgical Sciences, First General Surgery Unit, Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | - Ricardo Escalante
- Universidad Central de Venezuela, Loira Medical Center, Caracas, Venezuela.
| | | | | | - Andrea Mazzari
- Division of General Surgery, "Cristo Re" Hospital, Rome, Italy.
| | - Alberto Biondi
- Department of Surgical Sciences, First General Surgery Unit, Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
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Tursi A, Brandimarte G, Di Mario F, Lanas A, Scarpignato C, Bafutto M, Barbara G, Bassotti G, Binda GA, Biondi A, Biondo S, Cassieri C, Crucitti A, Dumitrascu DL, Elisei W, Escalante R, Herszènyi L, Kruis W, Kupcinskas J, Lahat A, Lecca PG, Maconi G, Malfertheiner P, Mazzari A, Mearìn F, Milosavljeviċ T, Nardone G, Chavez De Oliveira E, Papa A, Papagrigoriadis S, Pera M, Persiani R, Picchio M, Regula J, Štimac D, Stollman N, Strate LL, Walker MM. The DICA Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists: an International Study. J Gastrointestin Liver Dis 2019; 28:39-44. [PMID: 31930224 DOI: 10.15403/jgld-558] [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] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/14/2019] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. METHODS A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement. RESULTS Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. CONCLUSIONS The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.
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Affiliation(s)
- Antonio Tursi
- Gastroenterology Service, ASL BAT, Andria (BT), Italy.
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, Rome, Italy.
| | - Francesco Di Mario
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy.
| | - Angel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón, Zaragoza, Spain.
| | | | - Mauro Bafutto
- Consultório, R, 46 - 25 Clin de Gastroentero (St Coimbra) Goiânia, Goiás (GO), Brazil.
| | - Giovanni Barbara
- Department of Clinical Medicine, Section of Gastroenterology, "S. Orsola" Hospital, University of Bologna, Bologna, Italy.
| | - Gabrio Bassotti
- Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology Section, "Santa Maria della Misericordia" Hospital, University of Perugia, San Sisto (PG), Italy.
| | | | - Alberto Biondi
- Department of Surgical Sciences, First General Surgery Unit, Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
| | - Claudio Cassieri
- Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, Rome, Italy.
| | | | - Dan L Dumitrascu
- 2nd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Walter Elisei
- Division of Gastroenterology, ASL Roma 6, Albano Laziale (Roma), Italy.
| | - Ricardo Escalante
- Universidad Central de Venezuela, Loira Medical Center, Caracas, Venezuela.
| | - László Herszènyi
- 2nd Department of Medicine, Semmelweis University, H-1088 Budapest, Hungary.
| | - Wolfgang Kruis
- Innere Medizin, Evangelische Krankenhaus Kalk, Cologne, Germany.
| | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Adi Lahat
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52651, Israel.
| | | | - Giovanni Maconi
- Gastrointestinal Unit, Department of Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy.
| | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany.
| | - Andrea Mazzari
- Division of General Surgery, "Cristo Re" Hospital, Rome, Italy.
| | - Fermìn Mearìn
- Servicio Aparato Digestivo, Centro Médico Teknon, Barcelona, Spain.
| | | | - Gerardo Nardone
- Department of Clinical and Experimental Medicine, University "Federico II", Naples, Italy.
| | | | - Alfredo Papa
- Division of Internal Medicine and Gastroenterology, C.I. "Columbus", Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | | | - Miguel Pera
- Sección de Cirugía Gastrointestinal, Hospital Universitari del Mar, Barcelona, Spain.
| | - Roberto Persiani
- Department of Surgical Sciences, First General Surgery Unit, Catholic University - "A. Gemelli" University Hospital, Rome, Italy.
| | - Marcello Picchio
- Division of General Surgery, "P. Colombo" Hospital, ASL Roma 6, Velletri (Roma), Italy.
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Postgraduate Education Centre; Department of Gastrointestinal Oncology, Maria Sklodowska-Curie Clinical Oncology Institute, Warsaw, Poland.
| | - Davor Štimac
- Division of Internal Medicine, University Hospital, Rijeka, Croatia.
| | - Neil Stollman
- Division of Gastroenterology, Alta Bates Summit Medical Center, East Bay Center for Digestive Health, 300 Frank H Ogawa Plaza, Oakland, CA, USA.
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, Seattle, Washington, USA.
| | - Marjorie Md Walker
- University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, Australian Gastrointestinal Research Alliance, Callaghan NSW 2308, Australia.
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Grieco M, Lorenzon L, Marino P, Carlini M, Brescia A, Satntoro R, Crucitti A, Macarone Palmieri R, Santoro E, Stipa F, Sacchi M, Carlini M, Brescia A, Santoro R, Crucitti A, Macarone Palmieri R, Santoro E, Stipa F, Sacchi M, Persiani R. Eras program implementation in colorectal surgery: A multi-institution study based on the “lazio network” collective database including 1200 patients over two years. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G, Costa G, Allievi N, Amato B, Boerma D, Calcagno P, Campanati L, Campanile FC, Casati A, Chiara O, Crucitti A, di Saverio S, Filauro M, Gabrielli F, Guttadauro A, Kluger Y, Magnone S, Merli C, Poiasina E, Puzziello A, Sartelli M, Catena F, Ansaloni L. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg 2019; 14:10. [PMID: 30867674 PMCID: PMC6399945 DOI: 10.1186/s13017-019-0224-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 10/23/2018] [Accepted: 01/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. Material and methods The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. Results The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. Discussion and conclusions The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.
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Affiliation(s)
- Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Marco Ceresoli
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | | | - Kurinchi Gurusamy
- 4Division of Surgery and Interventional Science, University College London, London, UK
| | - Federico Coccolini
- 5General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Gianluca Costa
- 7Surgical and Medical Department of Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Bruno Amato
- 8Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Djamila Boerma
- 9Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Pietro Calcagno
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Luca Campanati
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | | | | | - Osvaldo Chiara
- 3Milano Trauma Network, ASST Niguarda Hospital, Milan, Italy
| | - Antonio Crucitti
- 12General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Sacro Cuore Catholic University, Rome, Italy
| | - Salomone di Saverio
- 13Cambridge Colorectal Unit, Box 201,Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Marco Filauro
- 14E.O.Ospedale Galliera di Genova, SC Chirurgia generale ed epatobiliopancreatica, Genova, Italy
| | - Francesco Gabrielli
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Angelo Guttadauro
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Stefano Magnone
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Cecilia Merli
- 16Unit of Emergency Medicine Bufalini Hospital, Cesena, Italy
| | - Elia Poiasina
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Alessandro Puzziello
- 17General and Day Surgery Unit, San Giovanni di Dio Hospital, University of Salerno, Fisciano, Italy
| | | | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- 6Department of Surgery, University Hospital of Verona, Verona, Italy
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Valentini V, Gambacorta MA, Cellini F, Aristei C, Coco C, Barbaro B, Alfieri S, D'Ugo D, Persiani R, Deodato F, Crucitti A, Lupattelli M, Mantello G, Navarria F, Belluco C, Buonadonna A, Boso C, Lonardi S, Caravatta L, Barba MC, Vecchio FM, Maranzano E, Genovesi D, Doglietto GB, Morganti AG, La Torre G, Pucciarelli S, De Paoli A. The INTERACT Trial: Long-term results of a randomised trial on preoperative capecitabine-based radiochemotherapy intensified by concomitant boost or oxaliplatin, for cT2 (distal)-cT3 rectal cancer. Radiother Oncol 2019; 134:110-118. [PMID: 31005204 DOI: 10.1016/j.radonc.2018.11.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Capecitabine-based radiochemotherapy (cbRCT) is standard for preoperative long-course radiochemotherapy of locally advanced rectal cancer. This prospective, parallel-group, randomised controlled trial investigated two intensification regimens. cT4 lesions were excluded. PRIMARY OBJECTIVE pathological outcome (TRG 1-2) among arms. MATERIALS AND METHODS Low-located cT2N0-2M0, cT3N0-2M0 (up to 12 cm from anal verge) presentations were treated with cbRCT randomly intensified by either radiotherapy boost (Xelac arm) or multidrug concomitant chemotherapy (Xelox arm). Xelac: concomitant boost to bulky site (45 Gy/1.8 Gy/die, 5 sessions/week to the pelvis, +10 Gy at 1 Gy twice/week to the bulky) plus concurrent capecitabine (1650 mg/mq/die). Xelox: 45 Gy to the pelvis + 5.4 Gy/1.8 Gy/die, 5 sessions/week to the bulky site + concurrent capecitabine (1300 mg/mq/die) and oxaliplatin (130 mg/mq on days 1,19,38). Surgery was planned 7-9 weeks after radiochemotherapy. RESULTS From June 2005 to September 2013, 534 patients were analysed: 280 in Xelac, 254 in Xelox arm. Xelox arm presented higher G ≥ 3 haematologic (p = 0.01) and neurologic toxicity (p < 0.001). Overall, 98.5% patients received curative surgery. The tumour regression grade distribution did not differ between arms (p = 0.102). TRG 1+2 rate significantly differed: Xelac arm 61.7% vs. Xelox 52.3% (p = 0.039). Pathological complete response (ypT0N0) rates were 24.4 and 23.8%, respectively (p non-significant). Median follow-up:5.62 years. Five-year disease-free survival rate were 74.7% (Xelac) and 73.8% (Xelox), respectively (p = 0.444). Five-year overall survival rate were 80.4% (Xelac) and 85.5% (Xelox), respectively (p = 0.155). CONCLUSION Xelac arm significantly obtained higher TRG1-2 rates. No differences were found about clinical outcome. Because of efficacy on TRG, inferior toxicity and good compliance, Xelac schedules or similar radiotherapy dose intensification schemes could be considered as reference treatments for cT3 lesions.
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Affiliation(s)
- Vincenzo Valentini
- Department Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Antonietta Gambacorta
- Department Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Cellini
- Department Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Claudio Coco
- Chirurgia Generale Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Alfieri
- Istituto di Clinica Chirurgica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Domenico D'Ugo
- Abdominal Surgery Area, General Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Persiani
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Deodato
- Radiotherapy Department, Fondazione Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Antonio Crucitti
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Lupattelli
- Radiation Oncology Centre - S. Maria Misericordia Hospital, Perugia, Italy
| | - Giovanna Mantello
- Radiotherapy Unit, Azienda Ospedaliero Universitaria, Ospedali Riuniti Ancona, Italy
| | - Federico Navarria
- Radiation Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Claudio Belluco
- Surgical Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Angela Buonadonna
- Medical Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Caterina Boso
- Radiotherapy and Nuclear Medicine Unit, IOV-IRCCS, Padova , Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, IOV-IRCCS, Padova, Italy
| | - Luciana Caravatta
- Radiotherapy Unit, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Fabio Maria Vecchio
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Domenico Genovesi
- Radiotherapy Unit, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Giovanni Battista Doglietto
- Istituto di Clinica Chirurgica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Speciality Medicine, DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy
| | - Antonino De Paoli
- Radiation Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
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Rossi S, Cinini C, Di Pietro C, Lombardi CP, Crucitti A, Bellantone R, Crucitti F. Diagnostic Delay in Breast Cancer: Correlation with Disease Stage and Prognosis. Tumori 2018; 76:559-62. [PMID: 2284692 DOI: 10.1177/030089169007600609] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diagnostic delay in a group of 189 women with breast cancer was studied and correlated with first symptom, stage of disease, histologic grade and prognosis. Diagnostic delay was divided into patient delay (time from the patient's discovery of a symptom to the first medical consultation) and system delay (time from medical diagnosis to treatment). Patients were divided into five groups by patient-delay time: 0 to 30 days; 31 to 90 days; 91 to 180 days; 181 to 365 days; and > 365 days. The median diagnostic delay was 60 days (range, 4-980) and was not influenced by patient age, marital status or nature of first symptom. A consistent and direct relationship was found between delay and tumor size, nodal involvement, presence of metastases, and histologic grade of disease at diagnosis. No correlation was found between diagnostic delay and histologic type distribution. The three-year survival rate after treatment was significantly lower for patients with a longer delay. Our data indicate that diagnostic delay appears to be an important determinant of stage at diagnosis in women with breast cancer and that it has an important influence on survival. In most cases, delay was mainly patient dependent (60 days); the median system-dependent delay was 15 days (range, 4-47). Since early treatment is generally accepted to be one of the most important determinants of prognosis in breast cancer patients, a reduction in diagnostic delay may lengthen survival time.
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Affiliation(s)
- S Rossi
- Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
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Bigotti G, Coli A, Magistrelli P, De Ninno M, Antonacci V, Crucitti A, Federico F, Antinori A, Massi G. Gastric Adenocarcinoma Associated with Granulomatous Gastritis. Case Report and Review of the Literature. Tumori 2018; 88:163-6. [PMID: 12088259 DOI: 10.1177/030089160208800216] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims We describe the fourth reported case of granulomatous gastritis associated with gastric adenocarcinoma, with a review of the literature and considerations about the prognostic implications of this association. Results A 48-year-old woman who had been suffering from gastritis for ten years was admitted to our institute for increasing left epigastric pain associated with vomiting. After an endoscopic biopsy had revealed an ulcerated signet ring cell carcinoma, the patient was submitted to subtotal gastrectomy with regional lymph node dissection. Pathological examination of the resected specimen revealed a superficial signet ring cell carcinoma (early cancer) associated with multiple granulomas. The granulomas, which were observed within the mucosa and the submucosa at the periphery of the carcinoma, were composed of CD68-positive, CD15-negative epithelioid and giant cells of the Langhans type, confirming their true histiocytic nature, and were also extensively found within the dissected lymph nodes. Since no ocular, skin, pulmonary or other gastrointestinal lesions were found and the granulomas were negative for acid-fast and fungal stain, a diagnosis of granulomatous gastritis was made. Conclusions To the best of our knowledge this is the fourth example of gastric adenocarcinoma and granulomatous gastritis. These cases suggest an association between granulomatous gastritis and early gastric cancer.
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Affiliation(s)
- Giulio Bigotti
- Department of Pathology, Columbus Clinic, Catholic University Sacro Cuore, Rome, Italy.
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Affiliation(s)
- Paolo Magistrelli
- Istituto di Patologia Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Armando Antinori
- Istituto di Patologia Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antonio Crucitti
- Istituto di Patologia Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antonio La Greca
- Istituto di Patologia Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Roberto Coppola
- Istituto di Patologia Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Gennaro Nuzzo
- Istituto di Patologia Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Aurelio Picciocchi
- Istituto di Patologia Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
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Crucitti A, Danza FM, Pirulli PGV, Antinori A, Antonacci V, La Greca A, Bock E, Magistrelli P. Radiofrequency Thermal Ablation (RFA) of Liver Tumors: Open Surgical or Percutaneous Approach? J Chemother 2016; 16 Suppl 5:82-5. [PMID: 15675487 DOI: 10.1080/1120009x.2004.11782393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
RFA was used to ablate 81 liver lesions: 61 liver metastases and 20 hepatomas. An open surgical approach was adopted in 19 instances (27.5%), 12 of which were simultaneously treated for associated diseases, and percutaneous treatment was adopted in 50 instances (72.5%). The CT liver control at 6 months showed a complete necrosis in 50 lesions (66.3%). The advantages of the percutaneous approach include less invasiveness, reduced postoperative pain, shorter hospitalization, reduced costs and less discomfort in repeating the procedure. In conclusion, radiofrequency liver nodule ablation could be considered, today, as one of the promising and versatile techniques for loco-regional liver cancer control.
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Affiliation(s)
- A Crucitti
- Department of General Surgery, Catholic University of the Sacred Heart - Rome, Italy.
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Tomaiuolo P, Mazzari A, Antinori A, Crucitti A, Berta R, Bellini R, Mancini R, Moretto C, Anselmino M, O'Hare L, Anwar S. Topic: Incisional Hernia - The "risky" zone: sovrapubic, subxifoid, sub costal. Hernia 2015; 19 Suppl 1:S356-7. [PMID: 26518847 DOI: 10.1007/bf03355392] [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: 11/26/2022]
Affiliation(s)
| | | | - A Antinori
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - R Berta
- Bariatric and Metabolic Surgery Unit, AOPU, University Hospital, Pisa, Italy
| | | | | | | | | | - L O'Hare
- Calderdale and Huddersfield NHS Trust, Huddersfield, UK
| | - S Anwar
- Calderdale and Huddersfield NHS Trust, Huddersfield, UK
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Crucitti A, Corbi M, Tomaiuolo PMC, Fanali C, Mazzari A, Lucchetti D, Migaldi M, Sgambato A. Laparoscopic surgery for colorectal cancer is not associated with an increase in the circulating levels of several inflammation-related factors. Cancer Biol Ther 2015; 16:671-7. [PMID: 25875151 PMCID: PMC4622611 DOI: 10.1080/15384047.2015.1026476] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/04/2015] [Accepted: 03/01/2015] [Indexed: 01/05/2023] Open
Abstract
It has been hypothesized that inflammatory response triggered by surgery might induce the release of molecules that could promote proliferation, invasion and metastasis of surviving cancer cells. To test this hypothesis, the levels of multiple inflammation-related circulating factors were analyzed in patients undergoing surgery for colorectal cancer. A Luminex xMAP system was used to simultaneously assess levels of IL-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, FGF, eotaxin, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1β, PDGF-BB, RANTES, TNF-α and VEGF in 20 colorectal cancer patients and 10 age-matched non-neoplastic patients. In cancer patients analyses were performed at baseline (before surgery) and at different time points (up to 30 days) following laparoscopic surgery. Significantly higher levels of IL-1β, IL-7, IL-8, G-CSF, IFN-γ and TNF-α were detected in colorectal cancer patients compared to controls at baseline. In colorectal cancer patients, circulating levels decreased progressively following surgery and after day 30 post-surgery were no longer different from controls. These findings suggest that expression levels of several cytokines are higher in colorectal cancer patients compared to control subjects and no significant increase in several inflammation-related circulating factors is observed following laparoscopic surgery for cancer. Confirmation and validation in a different and larger cohort of patients are warranted.
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Key Words
- CRC, Colorectal Cancer.
- CSC, Cancer Stem Cells
- EMT, Epithelial Mesenchymal Transition
- FGF-b, Fibroblast Growth Factor-basic
- G-CSF, Granulocyte Colony Stimulating Factor
- HuMCP-1, Human Monocyte Chemoattractant Protein 1
- IFN-γ, Interferon γ
- IL, Interleukin
- IP-10, IFN-γ
- Inducible Protein 10
- Luminex xMAP
- MIP-1α
- Normal T-cell Expressed Secreted
- PDGF-BB, Platelet Derived Growth Factor-BB
- RANTES, Regulated upon Activation
- Ra, Receptor antagonist
- TNF-α, Tumor Necrosis Factor-α
- VEGF, Vascular Endotelial Growth Factor
- and 1β
- and 1β, Macrophage Inflammatory Protein 1α
- cancer biology
- colon cancer
- cytokines
- inflammation
- serum markers
- surgery
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Affiliation(s)
- Antonio Crucitti
- Department of Surgery; Università Cattolica del Sacro Cuore; Rome, Italy
| | - Maddalena Corbi
- Institute of General Pathology; Università Cattolica del Sacro Cuore; Rome, Italy
| | | | - Caterina Fanali
- Institute of General Pathology; Università Cattolica del Sacro Cuore; Rome, Italy
| | - Andrea Mazzari
- Department of Surgery; Università Cattolica del Sacro Cuore; Rome, Italy
| | - Donatella Lucchetti
- Institute of General Pathology; Università Cattolica del Sacro Cuore; Rome, Italy
| | - Mario Migaldi
- Department of Pathology; Università di Modena e Reggio Emilia; Modena, Italy
| | - Alessandro Sgambato
- Institute of General Pathology; Università Cattolica del Sacro Cuore; Rome, Italy
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Basile G, Crucitti A, Cucinotta M, Lacquaniti A, Catalano A, Loddo S, Buemi M, Lasco A. Serum levels of Apelin-36 are decreased in older hospitalized patients with heart failure. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Villa M, Black S, Groth N, Rothman KJ, Apolone G, Weiss NS, Aquino I, Boldori L, Caramaschi F, Gattinoni A, Malchiodi G, Crucitti A, Della Cioppa G, Scarpini E, Mavilio D, Mannino S. Safety of MF59-adjuvanted influenza vaccination in the elderly: results of a comparative study of MF59-adjuvanted vaccine versus nonadjuvanted influenza vaccine in northern Italy. Am J Epidemiol 2013; 178:1139-45. [PMID: 23863759 PMCID: PMC3783089 DOI: 10.1093/aje/kwt078] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
MF59-adjuvanted trivalent influenza vaccine (Novartis Vaccines and Diagnostics, Siena, Italy) has been shown to be more effective than nonadjuvanted vaccine in the elderly population. Here we present results from a large-scale, observational, noninterventional, prospective postlicensure study that evaluated the safety of MF59-adjuvanted vaccine in elderly subjects aged 65 years or more. The study was performed in 5 northern Italian health districts during the 2006–2007, 2007–2008, and 2008–2009 influenza seasons. The choice of vaccine—either adjuvanted vaccine or a nonadjuvanted influenza vaccine—was determined by individual providers on the basis of local influenza vaccination policy. Hospitalizations for potential adverse events of special interest (AESIs) were identified from hospital databases and then reviewed against recognized case definitions to identify confirmed cases of AESI. Cumulative incidences were calculated for AESIs in predefined biologically plausible time windows, as well as in a 6-month window following vaccination. During the 3-year study period, 170,988 vaccine doses were administered to a total of 107,661 persons. Despite the large study size, cases of AESI resulting in hospitalization were rare, and risks of AESI were similar in both the MF59-adjuvanted and nonadjuvanted vaccination groups. In conclusion, similar safety profiles were observed for both nonadjuvanted and MF59-adjuvanted seasonal influenza vaccines in elderly recipients.
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Affiliation(s)
- Marco Villa
- Correspondence to Dr. Marco Villa, Unit of Statistical Analyses and Research Projects, Azienda Sanitaria Locale della Provincia di Cremona, Via San Sebastiano 14, 26100 Cremona, Italy (e-mail: )
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Mattiucci GC, Ippolito E, D'Agostino GR, Alfieri S, Antinori A, Crucitti A, Balducci M, Deodato F, Luzi S, Macchia G, Smaniotto D, Morganti AG, Valentini V. Long-term analysis of gemcitabine-based chemoradiation after surgical resection for pancreatic adenocarcinoma. Ann Surg Oncol 2012. [PMID: 23208130 DOI: 10.1245/s10434-012-2767-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the efficacy in terms of local control (LC) of 24 h infusion of gemcitabine plus radiotherapy after surgery for pancreatic cancer. METHODS Weekly gemcitabine (100 mg/m(2)) was provided as a 24-hour infusion during the course of radiotherapy (50.4 Gy to the tumor, 39.6 Gy to the nodes). Patients subsequently received five cycles of gemcitabine monochemotherapy (1,000 mg/m(2) 1, 8, q21). The primary end point of the study was to achieve a 2-year LC rate of ≥80 % with type I and II errors of 5 and 20 %. The study was designed to accrue a maximum sample size of 35 patients. Secondary end points were toxicity evaluation, metastasis-free survival (MFS), and overall survival (OS). RESULTS Data of 35 patients were available. Most of the patients (n = 27; 77.1 %) had duodeno-cephalo-pancreatectomy, 5 (14.3 %) distal pancreatectomy, and 3 (8.6 %) total pancreatectomy. The pathological stages were T1-T2 (n = 7; 20.0 %), T3-T4 (n = 28; 80.0 %), N0 (n = 17; 48.6 %), and N1 (n = 18; 51.4 %). Thirty patients (85.7 %) completed chemoradiation. Twenty-three patients (65.7 %) received further sequential chemotherapy. Acute toxicity was acceptable. No late toxicity occurred. The median follow-up period was 64 (range 24-118) months, and 2-year crude rate of LC was 83 (median not reached). Median MFS and OS were 26.5 and 22.5 months, respectively. CONCLUSIONS The rate of LC met the main goal of the study. The regimen resulted in a high LC rate but failed to show a benefit in terms of OS or MFS, thus suggesting the need for a more intensified multimodal approach.
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Affiliation(s)
- Gian Carlo Mattiucci
- Department of Radiotherapy, Policlinico Universitario "Agostino Gemelli", Catholic University, Rome, Italy
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Crucitti A, Fusco S, Cucinotta M, Figliomeni P, Maltese G, Basile G. Estimating glomerular filtration rate in centenarians: Comparison of the chronic kidney disease epidemiology collaboration (CKD-EPI) and modification of diet in renal disease (MDRD) study equations. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khromava A, Cohen CJ, Mazur M, Kanesa-thasan N, Crucitti A, Seifert H. Manufacturers' postmarketing safety surveillance of influenza vaccine exposure in pregnancy. Am J Obstet Gynecol 2012; 207:S52-6. [PMID: 22920060 DOI: 10.1016/j.ajog.2012.06.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 03/18/2012] [Revised: 05/08/2012] [Accepted: 06/28/2012] [Indexed: 11/15/2022]
Abstract
Pregnant women are at increased risk for hospitalization and death with influenza infection. The limited data on safety and effectiveness of influenza immunization in pregnancy emphasizes the importance of developing new and well-designed studies and of enhancing safety surveillance in pregnant women who are vaccinated with licensed influenza vaccines. Pregnancy exposure registries aim to collect and maintain data on the effects of marketed drugs and vaccines, when prescribed in pregnancy or during breastfeeding, on the women themselves and their children. Women who are prescribed a medication or vaccine as part of their routine clinical care can be enrolled directly or through reporting health care providers on a voluntary basis. Such registries generally are established for products that are intended for use by adolescents and adults and are a key component of the safety monitoring of licensed products. This article reviews some of the pregnancy registries that have been established for US-licensed vaccines, which includes influenza vaccines, and other postlicensure safety surveillance efforts for monitoring safety in vaccinated pregnant women.
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Affiliation(s)
- Alena Khromava
- Global Pharmacovigilance and Pharmacoepidemiology, Sanofi Pasteur, Toronto, Ontario, Canada
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Barba M, Rizzo G, Gambacorta M, Coco C, Doglietto G, Persiani R, Crucitti A, Manfrida S, Mantini G, Valentini V. EP-1072 PREOPERATIVE RADIOCHEMOTHERAPY IN RECTAL CANCER PATIENTS: THE IMPACT OF AGE ON COMPLIANCE AND OUTCOMES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barbaro B, Vitale R, Valentini V, Illuminati S, Vecchio FM, Rizzo G, Gambacorta MA, Coco C, Crucitti A, Persiani R, Sofo L, Bonomo L. Diffusion-weighted magnetic resonance imaging in monitoring rectal cancer response to neoadjuvant chemoradiotherapy. Int J Radiat Oncol Biol Phys 2011; 83:594-9. [PMID: 22099033 DOI: 10.1016/j.ijrobp.2011.07.017] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 06/15/2011] [Accepted: 07/14/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To prospectively monitor the response in patients with locally advanced nonmucinous rectal cancer after chemoradiotherapy (CRT) using diffusion-weighted magnetic resonance imaging. The histopathologic finding was the reference standard. METHODS AND MATERIALS The institutional review board approved the present study. A total of 62 patients (43 men and 19 women; mean age, 64 years; range, 28-83) provided informed consent. T(2)- and diffusion-weighted magnetic resonance imaging scans (b value, 0 and 1,000 mm(2)/s) were acquired before, during (mean 12 days), and 6-8 weeks after CRT. We compared the median apparent diffusion coefficients (ADCs) between responders and nonresponders and examined the associations with the Mandard tumor regression grade (TRG). The postoperative nodal status (ypN) was evaluated. The Mann-Whitney/Wilcoxon two-sample test was used to evaluate the relationships among the pretherapy ADCs, extramural vascular invasion, early percentage of increases in ADCs, and preoperative ADCs. RESULTS Low pretreatment ADCs (<1.0 × 10(-3)mm(2)/s) were correlated with TRG 4 scores (p = .0011) and associated to extramural vascular invasion with ypN+ (85.7% positive predictive value for ypN+). During treatment, the mean percentage of increase in tumor ADC was significantly greater in the responders than in the nonresponders (p < .0001) and a >23% ADC increase had a 96.3% negative predictive value for TRG 4. In 9 of 16 complete responders, CRT-related tumor downsizing prevented ADC evaluations. The preoperative ADCs were significantly different (p = .0012) between the patients with and without downstaging (preoperative ADC ≥1.4 × 10(-3)mm(2)/s showed a positive and negative predictive value of 78.9% and 61.8%, respectively, for response assessment). The TRG 1 and TRG 2-4 groups were not significantly different. CONCLUSION Diffusion-weighted magnetic resonance imaging seems to be a promising tool for monitoring the response to CRT.
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Affiliation(s)
- Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, Rome, Italy.
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Crucitti A, Tsai TF. Explorations of clinical trials and pharmacovigilance databases of MF59®-adjuvanted influenza vaccines for associated cases of narcolepsy: A six-month update. ACTA ACUST UNITED AC 2011; 43:993. [DOI: 10.3109/00365548.2011.608714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Crucitti A, Grossi U, Giustacchini P, Tomaiuolo PMC, Bellantone R. Solid pseudopapillary tumor of the pancreas in children: report of a case and review of the literature. Updates Surg 2011; 62:69-72. [PMID: 20845104 DOI: 10.1007/s13304-010-0006-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Solid pseudopapillary tumor (SPT) of the pancreas is an infrequent neoplasm of low malignant potential, first described by Frantz in 1933 and representing less than 3% of all exocrine tumors. SPT is rare in children, accounting for 6% of all cases and shows different clinical features compared with adults. Here, a pediatric case is reported and a review of the Literature is provided. A 15-year-old girl with a 12 × 14 × 10 cm solid mass growing from the tail and the body of the pancreas, involving spleen, left adrenal gland and kidney, stomach and some bowel loops, was referred for surgical treatment. A distal pancreasectomy with splenectomy was performed. Histopathological examination revealed that the tumor was a 14-cm well-circumscribed solid mass, with pseudopapillary cell architecture, showing strong cellular immunoreactivity for alpha-1 antitrypsin, vimentin, neurone-specific enolase, progesterone receptors and in part to CD10 and CAM 5.2, but not to sinaptofisin and chromogranin. A 24-month post-surgical follow-up after successful surgical resection showed no evidence of recurrent disease. SPT shows different clinical features in childhood. High survival rates can be achieved in most cases, warranting aggressive treatments even in metastatic disease.
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Affiliation(s)
- Antonio Crucitti
- Dipartimento di Scienze Chirurgiche, Policlinico "A. Gemelli", Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy.
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Brisinda G, Vanella S, Crocco A, Mazzari A, Tomaiuolo P, Santullo F, Grossi U, Crucitti A. Severe acute pancreatitis: advances and insights in assessment of severity and management. Eur J Gastroenterol Hepatol 2011; 23:541-51. [PMID: 21659951 DOI: 10.1097/meg.0b013e328346e21e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Often, there is no correlation between the degree of structural damage to pancreas and clinical manifestation of the disease. The effectiveness of any treatment is related to the ability to predict severity accurately, but there is no ideal predictive system or biochemical marker. Severity assessment is indispensable to the selection of proper initial treatment in the management of acute pancreatitis. The use of multiparametric criteria and the evaluation of severity index permit us to select high-risk patients. Furthermore, contrast-enhanced computed tomographic scanning and contrast-enhanced MRI play an important role in severity assessment. The adoption of multiparametric criteria proposed together with morphological evaluation consents the formulation of a discreetly reliable prognosis on the evolution of the disease a few days from onset.
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Affiliation(s)
- Giuseppe Brisinda
- Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Largo Agostino Gemelli 8, Rome, Italy.
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Tsai TF, Crucitti A, Nacci P, Nicolay U, Della Cioppa G, Ferguson J, Clemens R. Explorations of clinical trials and pharmacovigilance databases of MF59®-adjuvanted influenza vaccines for associated cases of narcolepsy. ACTA ACUST UNITED AC 2011; 43:702-6. [PMID: 21534891 DOI: 10.3109/00365548.2011.580777] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A potential association between the new onset of narcolepsy accompanied by cataplexy - a putative autoimmune disorder, and vaccination with an AS03-adjuvanted A(H1N1) pandemic influenza vaccine is under investigation. We sought cases of narcolepsy from the pharmacovigilance database of a pandemic vaccine adjuvanted with another emulsion adjuvant, MF59(®), and a pooled clinical trials database of MF59-adjuvanted and non-adjuvanted influenza vaccine recipients. METHODS Using 6 narrowly restrictive and 24 broad sleep disturbance-related MedDRA preferred search terms (PT), we analysed spontaneous adverse events (AEs) reports received through July 31, 2010 and adjudicated suspected cases with onset 1 week-3 months after vaccination, against standardized clinical criteria defining narcolepsy. A pooled clinical trials database of 115 trials comprising 79,004 subjects receiving various MF59-adjuvanted and non-adjuvanted influenza vaccines in controlled and uncontrolled trials was analysed for cases with a narrow PT that had onset 1 week after vaccination. RESULTS Five thousand three hundred and five spontaneous AE reports were received from an estimated 23.26 million MF59-adjuvanted pandemic vaccine doses that had been administered. No case meeting the clinical definition of narcolepsy was discovered. In the pooled database of controlled clinical trials, no cases were discovered using the narrow PT, and rates and adjusted odds ratio for broad search terms for all temporal windows showed no significant difference between subjects receiving MF59-adjuvanted or non-adjuvanted vaccine. CONCLUSIONS No case of narcolepsy and no evidence of an increased risk of sleep-related AEs were discovered in recipients of MF59-adjuvanted A(H1N1) pandemic and other MF59-adjuvanted influenza vaccine.
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Affiliation(s)
- Theodore F Tsai
- Novartis Vaccines and Diagnostics Inc., 350 Massachusetts Avenue, Cambridge, MA 02139, USA.
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Crucitti A, Zhang Q, Nilsson M, Brecht S, Yang CR, Wernicke J. Duloxetine treatment and glycemic controls in patients with diagnoses other than diabetic peripheral neuropathic pain: a meta-analysis. Curr Med Res Opin 2010; 26:2579-88. [PMID: 20874076 DOI: 10.1185/03007991003769241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Mood disorders are often associated with poor glycemic control, and antidepressant treatments for mood and pain disorders can alter plasma glucose levels in patients with diabetes. A previous meta-analysis from three studies showed that duloxetine modestly increased fasting plasma glucose (FPG) and HbA(1c) levels in patients with diabetic peripheral neuropathic pain (DPNP). This meta-analysis examined whether there were any short- and long-term effects of duloxetine (20-120 mg/day) on glycemic control in patients with diagnoses other than DPNP. RESEARCH DESIGN AND METHODS Short-term data (9-27 weeks): seven studies of duloxetine in general anxiety disorder, fibromyalgia, and chronic lower back pain (CLBP). Long-term data: 41-week, uncontrolled extension of the short-term CLBP study and 52-week study in patients with recurrence of major depressive disorder. MAIN OUTCOME MEASURES Baseline-to-endpoint changes in FPG and HbA(1c) levels. RESULTS In short-term studies, patients were randomly assigned to placebo (n = 1098) or duloxetine (n = 1563). Mean baseline-to-endpoint changes in FPG and HbA(1c) did not significantly differ in duloxetine-treated patients compared with placebo-treated patients. In the 41-week study (n = 181), duloxetine-treated patients experienced a small but significant within-group baseline-to-endpoint increase in HbA(1c) (mean change = 0.1%; p < 0.001). This result was in contrast to absence of effect on mean baseline-to-endpoint within-group changes in FPG (p = 0.326) in that study, and to absence of between-treatment changes in FPG (p = 0.744) and HbA(1c) (p = 0.180) in the 52-week placebo-controlled study. CONCLUSION Duloxetine treatment did not significantly alter FPG and HbA(1c) levels compared with placebo treatment in the short-term studies. A small but statistically significant within-group increase in HbA(1c) was found in the 41-week study, but not in between-treatment group differences in the 52-week study. Neither of the long-term studies showed significant changes in the FPG levels. The small, non-reproducible HbA(1c) increase in one study of patients without DPNP may have resulted from patients with unrecognized diabetes in these trials.
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Hall JA, Wang F, Oakes TMM, Utterback BG, Crucitti A, Acharya N. Safety and tolerability of duloxetine in the acute management of diabetic peripheral neuropathic pain: analysis of pooled data from three placebo-controlled clinical trials. Expert Opin Drug Saf 2010; 9:525-37. [PMID: 20465525 DOI: 10.1517/14740338.2010.484418] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Summarize safety and tolerability of duloxetine in treating diabetic peripheral neuropathic pain. RESEARCH DESIGN AND METHODS Pooled data from three double-blind, randomized studies with 12-week, placebo-controlled (acute) and 52-week, routine-care-controlled (extension) phases. MAIN OUTCOME MEASURES Frequency/discontinuations due to treatment-emergent adverse events (TEAEs). RESULTS There were 1139 (placebo, n = 339; duloxetine, n = 800) and 867 (routine-care, n = 287; duloxetine, n = 580) patients in the acute and extension phases, respectively. Patient details were as follow: 60 years (mean age); Caucasian, 84%; and male, 57%. In the acute phase, there were significantly more TEAEs, duloxetine versus placebo (p = 0.001), the most common being nausea and somnolence. Discontinuations due to adverse events were significantly greater (12.5 vs 5.6%, p < 0.001), with similar outcomes in the extension phase. Baseline-to-endpoint aspartate transaminase/alanine transaminase were significantly increased and fasting plasma glucose was increased for duloxetine (0.67 mmol/l) versus decreased in routine-care (-0.64 mmol/l, p < 0.001). HbA1c was significantly increased, duloxetine vs routine-care, in the extension phase (52 vs 19%, p < 0.001). Endpoint measures neuropathy, nephropathy and retinopathy indicated no disease progression. CONCLUSIONS Duloxetine was generally safe and well tolerated, with the three most commonly reported TEAEs being nausea, somnolence and constipation. Modest changes in glycemia were associated with duloxetine. Aspartate transaminase/alanine transaminase increases were transient and not considered predictive of more severe outcomes.
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Barbaro B, Vitale R, Leccisotti L, Vecchio FM, Santoro L, Valentini V, Coco C, Pacelli F, Crucitti A, Persiani R, Bonomo L. Restaging locally advanced rectal cancer with MR imaging after chemoradiation therapy. Radiographics 2010; 30:699-716. [PMID: 20462989 DOI: 10.1148/rg.303095085] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In recent years, preoperative therapy has become standard procedure for locally advanced rectal cancer. Tumor shrinkage due to preoperative chemotherapy-radiation therapy (CRT) is now a reality, and pathologically complete responses are not uncommon. Some researchers are now addressing organ preservation, thus increasing the demand for both functional and morphologic radiologic evaluation of response to CRT to distinguish responding from nonresponding tumors. On magnetic resonance (MR) images, post-CRT tumor morphologic features and volume changes have a high positive predictive value but a low negative predictive value for assessing response. Preliminary results indicate that diffusion-weighted MR imaging, especially at high b values, would be effective for prediction of treatment outcome and for early detection of tumor response. Some authors have reported that the use of apparent diffusion coefficient values in combination with other MR imaging criteria significantly improves discrimination between malignant and benign lymph nodes. Sequential determination of fluorodeoxyglucose uptake at positron emission tomography/computed tomography has proved useful in differentiating responding from nonresponding tumors during and at the end of CRT. However, radionuclide techniques have limitations, such as low spatial resolution and high cost. Large studies will be needed to verify the most effective morphologic and functional imaging modalities for post-CRT restaging of rectal cancer. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.303095085/-/DC1.
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Affiliation(s)
- Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli 1, 00168 Rome, Italy.
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Barbaro B, Vitale R, Leccisotti L, Vecchio FM, Santoro L, Valentini V, Coco C, Pacelli F, Crucitti A, Persiani R, Bonomo L. Authors’ Response. Radiographics 2010. [DOI: 10.1148/radiographics.30.3.30719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gambacorta M, Valentini V, Barba M, Mantini G, Barbaro B, Pacelli F, Persiani R, Crucitti A, Coco C, Doglietto G. What We Learn from a Large Database: Correlation between Progressive Intensified Preoperative Treatments and 5-years Survival in Rectal Cancer Patients. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Crucitti A, Feliciani C, Grossi U, La Greca A, Porziella V, Giustacchini P, Congedo MT, Fronterré P, Granone PM. Paraneoplastic acrokeratosis (bazex syndrome) in lung cancer. J Clin Oncol 2009; 27:e266-8. [PMID: 19826120 DOI: 10.1200/jco.2009.22.6852] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Barba M, van Stiphout R, Gambacorta M, Crucitti A, Barbaro B, Vecchio F, Corbosiero A, Mantini G, Lambin P, Valentinis V. 6039 Pathologic Complete Response (pCR) after preoperative radiochemotherapy in cT3M0 rectal cancer patients: an analysis from a large database. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71134-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ippolito E, Mattiucci G, Ciurlia E, Alfieri S, Antinori A, Balducci M, Crucitti A, Smaniotto D, Morganti A, Valentini V. 6601 Long term analysis of Gemcitabine based chemoradiation after surgical resection for pancreatic cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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