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Peltrini R, Carannante F, Giovine G, Petitti T, LA Vaccara V, Caricato M, Capolupo GT, Borzomati D. Long-term patient-reported outcomes after anti-reflux surgery for gastroesophageal reflux disease and hiatal hernia repair: a single-center experience. Minerva Surg 2023; 78:638-643. [PMID: 37486190 DOI: 10.23736/s2724-5691.23.09930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Patients with gastroesophageal reflux disease (GERD) and hiatal hernia who are candidates for surgery should be treated with minimally invasive partial or total fundoplication. As data on long-term clinical and functional outcomes after laparoscopic surgery for GERD are limited, the aim of this study was to evaluate the long-term effectiveness of fundoplication in terms of patient-reported symptoms and proton pump inhibitor (PPI) use. METHODS The data of 88 patients who underwent laparoscopic anti-reflux surgery for GERD between January 2007 and September 2020 were retrospectively reviewed. Preoperative and postoperative patient-reported outcomes were investigated after surgery using a 13-items Likert-Scale questionnaire based on the frequency (events/week) and severity of typical and atypical symptoms, dysphagia, and dyspepsia. Furthermore, variations in the use of PPIs were investigated as a secondary endpoint. RESULTS A total of 76 patients participated in the questionnaire survey. The median follow-up duration was 77 (2-165) months. The postoperative rate of mild and severe typical symptoms was significantly lower than the preoperative rate (P<0.01). Similarly, the atypical symptom rates decreased after surgery (P<0.05). Dysphagia was more frequent after fundoplication (P<0.01). Before the anti-reflux surgery, 94.7% of the patients were prescribed a PPI. At the time of follow-up, this proportion had decreased to 73.7% (P<0.01). However, the PPI intake rate was 90.9% in the group of patients interviewed >10 years after surgery. CONCLUSIONS In this cohort of patients, laparoscopic anti-reflux fundoplication reduced the rate typical and atypical symptoms of GERD. However, surgery appeared to have no impact on PPI intake over time.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, Federico II University Hospital, Naples, Italy
| | - Filippo Carannante
- Unit of Colorectal Surgery, Department of Surgery, Campus Bio-Medico University Hospital, Rome, Italy -
| | - Gennaro Giovine
- Department of Public Health, Federico II University Hospital, Naples, Italy
| | - Tommasangelo Petitti
- Department of Hygiene, Public Health and Statistics, Campus Bio-Medico University, Rome, Italy
| | | | - Marco Caricato
- Unit of Colorectal Surgery, Department of Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Gabriella T Capolupo
- Unit of Colorectal Surgery, Department of Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Domenico Borzomati
- Unit of Colorectal Surgery, Department of Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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Carannante F, Mazzotta E, Miacci V, Bianco G, Mascianà G, D'Agostino F, Caricato M, Capolupo GT. Identification and management of subvesical bile duct leakage after laparoscopic cholecystectomy: A systematic review. Asian J Surg 2023; 46:4161-4168. [PMID: 37127504 DOI: 10.1016/j.asjsur.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/10/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
Bile leak is a rare complication after Laparoscopic Cholecystectomy. Subvesical bile duct (SVBD) injury is the second cause of minor bile leak, following the unsuccessful clipping of the cystic duct stump. The aim of this study is to pool available data on this type of biliary tree anatomical variation to summarize incidence of injury, methods used to diagnose and treat SVBD leaks after LC. Articles published between 1985 and 2021 describing SVBD evidence in patients operated on LC for gallstone disease, were included. Data were divided into two groups based on the intra or post-operative evidence of bile leak from SVBD after surgery. This systematic report includes 68 articles for a total of 231 patients. A total of 195 patients with symptomatic postoperative bile leak are included in Group 1, while Group 2 includes 36 patients describing SVBD visualized and managed during LC. Outcomes of interest were diagnosis, clinical presentation, treatment, and outcomes. The management of minor bile leak is controversial. In most of cases diagnosed postoperatevely, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is the best way to treat this complication. Surgery should be considered when endoscopic or radiological approaches are not resolutive.
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Affiliation(s)
- F Carannante
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - E Mazzotta
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - V Miacci
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G Bianco
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G Mascianà
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - F D'Agostino
- Department of Anaesthesia, Intensive Care and Pain Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Caricato
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G T Capolupo
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Guida AM, Sensi B, Formica V, D'Angelillo RM, Roselli M, Del Vecchio Blanco G, Rossi P, Capolupo GT, Caricato M, Sica GS. Total neoadjuvant therapy for the treatment of locally advanced rectal cancer: a systematic minireview. Biol Direct 2022; 17:16. [PMID: 35698084 PMCID: PMC9195214 DOI: 10.1186/s13062-022-00329-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022] Open
Abstract
Colorectal carcinoma is the second leading cause of cancer-related deaths, and indeed, rectal cancer accounting for approximately one third of newly diagnosed patients. Gold standard in the treatment of rectal cancer is a multimodality approach, aiming at a good control of the local disease. Distant recurrences are the major cause of mortality. Currently, Locally Advanced Rectal Cancer (LARC) patients undergo a combined treatment of chemotherapy and radiotherapy, followed by surgery. Eventually, more chemotherapy, namely adjuvant chemotherapy (aCT), may be necessary. Total Neoadjuvant Therapy (TNT) is an emerging approach aimed to reduce distant metastases and improve local control. Several ongoing studies are analyzing whether this new approach could improve oncological outcomes. Published results were encouraging, but the heterogeneity of protocols in use, makes the comparison and interpretation of data rather complex. One of the major concerns regarding TNT administration is related to its effect on larger and more advanced cancers that might not undergo similar down-staging as smaller, early-stage tumors. This minireview, based on a systematic literature search of randomized clinical trials and meta-analysis, summarizes current knowledge on TNT. The aim was to confirm or refute whether or not current practice of TNT is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. A tentative grouping of general study characteristics, clinical features and treatments characteristics has been undertaken to evaluate if the reported studies are sufficiently homogeneous in terms of subjects involved, interventions, and outcomes to provide a meaningful idea of which patients are more likely to gain from this treatment.
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Affiliation(s)
- Andrea M Guida
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Vincenzo Formica
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | - Rolando M D'Angelillo
- Department of Biomedicine and Prevention, Radiation Oncology, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | | | - Piero Rossi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Gabriella T Capolupo
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Giuseppe S Sica
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy. .,Department of Surgery, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
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Grass JK, Chen CC, Melling N, Lingala B, Kemper M, Scognamiglio P, Persiani R, Tirelli F, Caricato M, Capolupo GT, Izbicki JR, Perez DR. Robotic rectal resection preserves anorectal function: Systematic review and meta-analysis. Int J Med Robot 2021; 17:e2329. [PMID: 34463416 DOI: 10.1002/rcs.2329] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/25/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Improving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well-established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta-analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME. METHODS All studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and were compared with a consecutive series of robotic TME (n = 48). RESULTS Thirty-two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI -9.709-17.309]) versus laparoscopic TME (26.4 [95%CI 19.524-33.286]), p = 0.006), open TME (26.0 [95%CI 24.338-29.702], p = 0.002) and transanal TME (27.9 [95%CI 22.127-33.669], p = 0.003). CONCLUSIONS Robotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high-quality studies are needed to confirm the benefits of robotic surgery.
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Affiliation(s)
- Julia K Grass
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chien-Chih Chen
- Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.,Department of Surgery, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
| | - Marius Kemper
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pasquale Scognamiglio
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roberto Persiani
- Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavio Tirelli
- Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Università Campus Bio-Medico, Rome, Italy
| | | | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel R Perez
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Carannante F, Bianco G, Lauricella S, Mascianà G, Caricato M, Capolupo GT. TaTME approach as a rescue during a laparoscopic TME for high rectal cancer. A case report. Int J Surg Case Rep 2021; 82:105870. [PMID: 33857768 PMCID: PMC8065283 DOI: 10.1016/j.ijscr.2021.105870] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 12/01/2022] Open
Abstract
There are several surgical approaches for patient with rectal cancer, depending on tumor stage and tumor distance from anal verge. Total mesorectal excision (TME) is the gold standard surgical technique for rectal tumors, reducing rectal cancer local recurrence. Transanal total mesorectal excision (TaTME) has been described in rectal cancer treatment, especially in challenging patients with narrow pelvis, improving not only dissection but also the preservation of autonomic pelvic nerves and the achievement of a restorative procedure. This case report aims to describe the possible use of TaTME procedure as a rescue also when this approach is not the first choice. In conclusion, we believe that, if performed by experienced surgeons, TaTME is safe and useful and could be used not in his conventional use.
Introduction and importance In the last years, transanal total mesorectal excision (TaTME) has been described in rectal cancer treatment, especially in challenging patients, difficulties in pelvic exposure and limitations of instrumentation improving not only dissection but also the preservation of autonomic pelvic nerves and the achievement of a restorative procedure. Here we report a case report of anterior laparoscopic rectal resection for adenocarcinoma of the high-mid rectum converted to transanal approach. Case presentation A 69-year-old male presented hepatic nodules during radiological follow-up for prostate cancer treated with radical prostatectomy and adjuvant radiotherapy (70 Gy). The biopsy of the lesion demonstrated the presence of a metastatic lesion of an adenocarcinoma, with suspected intestinal origin. Then, we perform an endoscopic examination, which showed the presence of a rectal lesion, which cause a bowel stenosis extended from the middle part to the upper part of the rectum. After chemoradiotherapy, an anterior rectal resection was performed. During surgery we could not perform the resection of the rectum due the thickness and fibrosis of the tissue, despite we used different branded mechanical stapler. So, we decided to complete the surgical treatment starting a TaTME procedure with resolution of the problem. Clinical discussion TaTME is a relatively new technique that had already become a valid option in the treatment of low rectal cancer, and, nowadays, also in the treatment of inflammatory bowel disease. As reported in literature, this technique has a number of advantages, especially in narrow pelvis and it is very useful in low rectal surgery. Conclusion This case report aims to describe the possible use of TaTME procedure as a rescue also when this approach is not the first choice.
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Affiliation(s)
- F Carannante
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - G Bianco
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - S Lauricella
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G Mascianà
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Caricato
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G T Capolupo
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Fiore M, Greco C, Coppola A, Caricato M, Caputo D, Trecca P, Floreno B, Rinaldi CG, Ippolito E, Capolupo GT, Grippo R, Beomonte Zobel B, D'Angelillo RM, Trodella L, Ramella S. Long-Term Results of a Prospective Phase 2 Study on Volume De-Escalation in Neoadjuvant Chemoradiotherapy of Rectal Cancer. Pract Radiat Oncol 2021; 11:e186-e194. [PMID: 33002647 DOI: 10.1016/j.prro.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE In the current study, we evaluated whether neoadjuvant chemoradiotherapy with reduced treatment volumes due to the exclusion of elective pelvic nodal irradiation is a feasible strategy for selected patients with locally advanced rectal cancer. METHODS AND MATERIALS Patients with T2 low-lying/T3, N0-N1 rectal lesions without evidence of disease in the lateral lymph nodes were prospectively recruited. All patients underwent pretreatment testing, including computed tomography imaging of the chest, abdomen, and pelvis with intravenous contrast, pelvic magnetic resonance imaging with intravenous contrast, and 18-fluorodeoxyglucose positron emission/computed tomography. The clinical target volume included the primary tumor and the mesorectum with vascular supply containing the perirectal and presacral nodes, with the upper border at the S2/S3 interspace. The total radiation dose was 50.4 Gy, and fluoropyrimidine-based chemotherapy was associated concomitantly. The primary endpoint of the study was the reduction of gastrointestinal (GI) toxicity, and the secondary endpoints were pathologic complete response, local control, overall survival, and disease-free survival. RESULTS Fifty-two patients (30 men, 22 women) with a median age of 67 years (range, 45-85 years) were enrolled in the study. Acute grade 3 GI toxicity was 7.6%, and there were no cases of grade 4 toxicity. Three patients (5.7%) developed a local recurrence. No relapse occurred in the lateral lymph nodes. The local control rate at 5 years was 96.1%. With a median follow-up time of 72.9 months (range, 2.5-127.6 months), the 3- and 5-year overall survival rates were 89.4% and 87%, respectively. The 3- and 5-year disease-free survival rates were 82.4% and 82.4%, respectively. CONCLUSIONS De-escalation of radiation therapy target volume reduces GI side effects without compromising efficacy in patients with rectal cancer. These results cannot be clearly extended to high-risk disease and need further evaluation in future randomized trials.
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Affiliation(s)
- Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy.
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | | | - Marco Caricato
- Geriatric Surgery, Campus Bio-Medico University, Rome, Italy
| | - Damiano Caputo
- General Surgery, Campus Bio-Medico University, Rome, Italy
| | - Pasquale Trecca
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Barnaba Floreno
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Carla G Rinaldi
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | | | - Raffaele Grippo
- Diagnostic Imaging, Campus Bio-Medico University, Rome, Italy
| | | | | | - Lucio Trodella
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
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Capolupo GT, Carannante F, Mascianà G, Lauricella S, Mazzotta E, Caricato M. Transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA) for ulcerative colitis: medium term functional outcomes in a single centre. BMC Surg 2021; 21:17. [PMID: 33407354 PMCID: PMC7789388 DOI: 10.1186/s12893-020-01007-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily. The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes. Methods Our Center has experienced the transanal approach for proctectomy and IPAA since August 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Fecal continence, genito-urinary activity and global quality of life at 1 and 6 months after ileostomy reversal have been assessed. Results Until March 2019, 8 patients underwent transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA). In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning loop ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding, not required a re-invertation. There were no cases of anastomotic leakage. Medium-term functional outcomes were determined prospectively using previously validated quality of life questionnaires (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, genitourinary and sexual functions were also investigated, showing comparable results with the literature data. Conclusions In our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.
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Affiliation(s)
- G T Capolupo
- Department of Colorectal Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - F Carannante
- Department of Colorectal Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - G Mascianà
- Department of Colorectal Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - S Lauricella
- Department of Colorectal Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - E Mazzotta
- Department of Colorectal Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Caricato
- Department of Colorectal Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Mazzotta E, Coppola A, Carannante F, Caricato M, Capolupo GT. How to do hernioscopy for incarcerated femoral hernia with laparoscopic O-ring retractor system. ANZ J Surg 2020; 90:2353-2354. [PMID: 32776631 DOI: 10.1111/ans.16217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/30/2022]
Abstract
Incarcerated groin hernia management often required emergency surgery. Hernioscopy is a safe alternative to repair hernia and explore intra-abdominal cavity. Alexis Laparoscope System is a useful device to perform hernioscopy.
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Affiliation(s)
- Erica Mazzotta
- Colorectal Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Alessandro Coppola
- Colorectal Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Filippo Carannante
- Colorectal Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco Caricato
- Colorectal Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Mazzotta E, Lauricella S, Carannante F, Mascianà G, Caricato M, Capolupo GT. Ileo-ileal intussusception caused by small bowel leiomyosarcoma: A rare case report. Int J Surg Case Rep 2020; 72:52-55. [PMID: 32506030 PMCID: PMC7283087 DOI: 10.1016/j.ijscr.2020.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Intussusception is the telescoping of one segment of the bowel into an adjacent bowel segment, causing venous congestion, edema, and blood supply reduction. We present a case of ileo-ileal intussusception in an adult patient with intestinal obstruction caused by a rare mesenchymal malignant lesion of the distal ileum: Leiomyosarcoma (LMS). PRESENTATION OF CASE A 90-year-old Caucasian man presented to the hospital with a two-day history of abdominal pain, nausea, and bowel occlusion. Preoperative Computer Tomography (CT) showed a solid mass with stratified walls in the lumen of the cecum with the classics "bulls-eye" appearance with concentric rings, suggestive of intussusception. The patient underwent emergency laparotomy with evidence of a small bowel wall tumor driving ileo-ileal intussusception with ischemic damage. Ileocecal resection was performed without postoperative complications. Histopathological examination showed a tumor on the muscular layer of the small bowel. The definitive diagnosis was LMS. DISCUSSION Adult intussusception is a rare condition, with an incidence of 2/1 000 000 cases per year worldwide. About 60% of patients suffering from this disease require surgery. Clinical presentation can be non-specific because of its no characteristic signs and symptoms. The most common presenting symptom is abdominal pain with bowel obstruction sings. Intussusception can occur anywhere along the small and large intestine and it is typically associated with a Lead Point (LP). The LP may be benign or malignant conditions. Infrequent malignant causes include LMS. CONCLUSION Diagnosis of intussusception is relatively challenging because of its non-specific symptoms. CT scan is the examimation of choice for the diagnosis because of its peculiar images. In adults, surgical treatment is recommended with laparoscopic or open approach according to surgeon expertise, sometimes in an emergency setting.
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Affiliation(s)
- Erica Mazzotta
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy.
| | - Sara Lauricella
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy
| | | | | | - Marco Caricato
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy
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Lauricella S, Caricato M, Mascianà G, Carannante F, Carnazza M, Bonaccorso A, Angeletti S, Ciccozzi M, Coppola R, Capolupo GT. Topographic lymph node staging system shows prognostic superiority compared to the 8th edition of AJCC TNM in gastric cancer. A western monocentric experience. Surg Oncol 2020; 34:223-233. [PMID: 32869748 DOI: 10.1016/j.suronc.2020.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/24/2019] [Revised: 03/23/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The current Tumor Node Metastasis staging system (TNM) for gastric cancer classifies the extent of lymph node metastasis based upon the number of lymph nodes involved. Choi et al. have recently proposed a new anatomical classification based upon the regionality of the involved nodes. This new classification seems to have a better predictive prognostic value than the traditional one. We investigated the prognostic role of the new anatomical based classification, reviewing our institutional gastric cancer database. METHODS We performed a retrospective chart review of 329 patients who underwent gastrectomy at our Institution from 2003 to 2017. We excluded from data analysis any patient with distant metastases at the time of first diagnosis and or surgery, pathology other than adenocarcinoma, lymphadenectomy less than D2, impossibility to identify location of lymph nodes (LNs) on pathological report and neoadjuvant chemotherapy. The extent of D2 lymphadenectomy was defined according to Japanese Gastric Cancer Association criteria. LN metastasis were reclassified into three topographic groups (lesser, greater curvature, and extraperigastric nodes) and staged according to Choi. The new N stage was combined with the current pT according to the 8th edition of TNM and a new hybrid TNM stage was established. All patients were followed up until June 2019. The prognostic performance of the new stage and of the current anatomical numeric based system (TNM) was analyzed and assessed by the C-index, AIC and likelihood ratio χ2 value. RESULTS In predicting both Overall Survival (OS) and Disease free Survival (DFS) the new N stage and the new TNM staging system had the highest C-index and likelihood ratio χ2 value and the lowest Akaike Information Criterion (AIC), showing a better accuracy and displaying a better prognostic performance. CONCLUSIONS Our study is the first from the Western world to compare the new hybrid classification, based on the anatomical location of metastatic nodes, to the 8th of American Joint Committee on Cancer (AJCC) TNM staging system. Our findings on a small, monocentric sample suggest that hybrid topographic lymph node staging system is more accurate than TNM.
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Affiliation(s)
- S Lauricella
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy.
| | - M Caricato
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - G Mascianà
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - F Carannante
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - M Carnazza
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - A Bonaccorso
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA
| | - S Angeletti
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico of Rome University, Italy
| | - M Ciccozzi
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico of Rome University, Italy
| | - R Coppola
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - G T Capolupo
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
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Capolupo GT, Lauricella S, Mascianà G, Mazzotta E, Carannante F, Caputo D, Pagnoni C, Ciccozzi M, Caricato M, Coppola R. Hybrid Topographic Lymph Node Staging System Shows Prognostic Superiority to Numeric Pathologic Lymph Node Classification in Gastric Cancer. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.773] [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: 10/25/2022]
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Mascianà G, Capolupo GT, Carannante F, Caricato M. An omental mass. Any idea? Int J Surg Case Rep 2019; 56:40-44. [PMID: 30831506 PMCID: PMC6403098 DOI: 10.1016/j.ijscr.2019.02.019] [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: 09/28/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022] Open
Abstract
Pseudomyxoma peritonei, omental mass, review, abdominal pain, mucinous mass.
Introduction Pseudomyxoma extraperitonei (PE) is a rare finding. The most common cause is the rupture of a mucocele of the appendix into the retroperitoneum. Presentation of case Here we report a case of a 52 years old female patient with a mass in the right abdomen and vague lower abdominal pain underwent resection of a extraperitoneal encapsulated mass. The histopathological examination revealed a mucinous pseudomyxoma with a low grade of differentiation. Discussion We report a case of pseudomyxoma extraperitonei with a review of literature. Conclusion The treatment of pseudomyxoma differs substantially depending on whether it is intraperitoneal or extraperitoneal. The risk of recurrence is such that follow-up, based on a physical examination, CT scan and serum markers, is essential.
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Affiliation(s)
- G Mascianà
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - G T Capolupo
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - F Carannante
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - M Caricato
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
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Capolupo GT, Mascianà G, Carannante F, Caricato M. Hepatic portal venous gas after colonoscopy: A case report and review. Int J Surg Case Rep 2018; 51:54-57. [PMID: 30144710 PMCID: PMC6107896 DOI: 10.1016/j.ijscr.2018.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/06/2018] [Indexed: 12/13/2022] Open
Abstract
Here we reported a rare case of hepatic portal venous gas with a relevant review of literature. Actually the mechanism of HPVG is still unknown. The case present in literature are few and the mortality, generally caused by complications like necrotizing enterocolitis, is still high.
Introduction Hepatic portal venous gas (HPVG) is a rare radiological finding in which gas enters the portal venous system and it is associated in case of necrotizing colitis with a mortality of 75%. We report a case of iatrogenic HPVG with a review of literature. Presentation of case A 41 years old patient underwent total colectomy and ileal pouch- anal anastomosis with derivative ileostomy for a familiar adenomatous polyposis coli in June 2008. A stenosis of the pouch-anal anastomosis developed. The patient underwent several endoscopic dilations. A recurrence of the stenosis was observed. The patient underwent to several endoscopic procedure. After the last colonoscopy the patient showed a fever with abdominal pain. A CT scan showed little peri-anastomotic collections and massive hepatic portal venous gas. Discussion The management of HPVG varied from surgical intervention to non-operative procedure. The surgical approach it's reserved to clinically unstable patients or those with evidence of peritonitis or bowel perforation. Stable patients, like those with an HPVG consequence of an endoscopic procedure, can be treated with non- operative management. Conclusion Our experience confirm that hepatic portal venous gas can be related to endoscopic procedure; thus, it can be managed on the basis of patient's general clinical conditions, and in selected cases it will disappear without therapeutic interventions with a good outcome.
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Affiliation(s)
- G T Capolupo
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
| | - G Mascianà
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy.
| | - F Carannante
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
| | - M Caricato
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
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Capolupo GT, Mascianà G, Carannante F, Caricato M. Spilled gallstones simulating peritoneal carcinomatosis: A case report and literature review. Int J Surg Case Rep 2018; 48:113-121. [PMID: 29885915 PMCID: PMC6041376 DOI: 10.1016/j.ijscr.2018.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) has become the "gold standard" for the treatment of symptomatic gallstones. However, this surgical technique increases the risk of bile duct injury and lost gallstones. Since over 90% of split gallstones never become symptomatic, they often present as incidental findings on CT-scans. Careful removal of as many stones as possible, intense irrigation and suction are recommended. It has been reported that 8.5% of lost gallstones will lead to a complication, most common are abscesses. PRESENTATION CASE We report a case of spilled gallstones simulating peritoneal metastases on radiological investigations. Diagnosis was very difficult, not even an US-guided biopsy of the lesion was decisive. Only a diagnostic laparoscopy confirms the diagnosis. DISCUSSION The reaction associated with lost gallstones can mimic other causes, such as soft tissue sarcoma, malignant lymphoma or, as in our case peritoneal carcinomatosis. CONCLUSION Spilled gallstones are associated with uncommon, but significant complications, and even the diagnosis of such a condition can cause serious difficulties. Serious effort must be made to prevent gallbladder perforation, and accidental stone spillage should be promptly recognized and properly managed.
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Affiliation(s)
- G T Capolupo
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
| | - G Mascianà
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy.
| | - F Carannante
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
| | - M Caricato
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
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Caricato M, Caputo D, Capolupo GT, Luffarelli P, Callea M. Cholesterol embolization of right colon, misdiagnosed as colon tumor. Updates Surg 2012; 66:77-9. [PMID: 23109036 DOI: 10.1007/s13304-012-0184-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 10/18/2012] [Indexed: 11/24/2022]
Affiliation(s)
- M Caricato
- Department of General Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200, 00128, Rome, Italy,
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