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Di Nuzzo MM, Castiglioni S, Pirozzi N, Di Santo Albini AG, De Luca M, Tedesco A, Bardascino F, de Werra C, Corcione F. Laparoscopic adrenalectomy for giant pheochromocytoma. What is the size limit ? Ann Ital Chir 2023; 94:52-55. [PMID: 36810354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
AIM This case report describes a giant pheochromocytoma in a young female, experienced cardiac symptoms, treated by a transperitoneal laparoscopic right adrenalectomy. MATERIAL AND METHODS A 29 years old female with Taki-tsubo syndrome, consequent to the chronic release of catecholamines, with a palpable abdominal mass and vague abdominal symptoms was referred to our department. Abdominal CT scan has demonstrated a solid mass of 13 cm in the right adrenal space so, after pre-operative management with alpha-adrenergic receptor and beta blockade and a 3D CT scan reconstruction a right adrenalectomy laparoscopic approach was performed. RESULTS Our result underlines that 13 cm in size for a giant pheochromocytoma is not an absolute contraindication to perform a minimally invasive approach in expert hands, with optimal surgical, oncological and cosmetic results. DISCUSSION The only curative option for non-metastatic pheochromocytomas disease is surgical resection. Laparoscopic adrenalectomy is the treatment of choice but the limit size for a safe and feasible minimally invasive approach is not yet defined. CONCLUSIONS This case report could help to better define more solid recommendations in the next future and also provide landmarks and key steps for laparoscopic surgeons. KEY WORDS Giant Pheochromocytoma, Laparoscopic Adrenalectomy, Pheochromocytoma Management.
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Pagano E, Romano B, Cicia D, Iannotti FA, Venneri T, Lucariello G, Nanì MF, Cattaneo F, De Cicco P, D'Armiento M, De Luca M, Lionetti R, Lama S, Stiuso P, Zoppoli P, Falco G, Marchianò S, Fiorucci S, Capasso R, Di Marzo V, Borrelli F, Izzo AA. TRPM8 indicates poor prognosis in colorectal cancer patients and its pharmacological targeting reduces tumour growth in mice by inhibiting Wnt/β-catenin signalling. Br J Pharmacol 2023; 180:235-251. [PMID: 36168728 PMCID: PMC10092658 DOI: 10.1111/bph.15960] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 03/03/2022] [Revised: 07/22/2022] [Accepted: 09/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Transient receptor potential melastatin type-8 (TRPM8) is a cold-sensitive cation channel protein belonging to the TRP superfamily of ion channels. Here, we reveal the molecular mechanism of TRPM8 and its clinical relevance in colorectal cancer (CRC). EXPERIMENTAL APPROACH TRPM8 expression and its correlation with the survival rate of CRC patients was analysed. To identify the key pathways and genes related to TRPM8 high expression, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were conducted in CRC patients. TRPM8 functional role was assessed by using Trpm8-/- mice in models of sporadic and colitis-associated colon cancer. TRPM8 pharmacological targeting by WS12 was evaluated in murine models of CRC. KEY RESULTS TRPM8 is overexpressed in colon primary tumours and in CD326+ tumour cell fraction. TRPM8 high expression was related to lower survival rate of CRC patients, Wnt-Frizzled signalling hyperactivation and adenomatous polyposis coli down-regulation. In sporadic and colitis-associated models of colon cancer, either absence or pharmacological desensitization of TRPM8 reduced tumour development via inhibition of the oncogenic Wnt/β-catenin signalling. TRPM8 pharmacological blockade reduced tumour growth in CRC xenograft mice by reducing the transcription of Wnt signalling regulators and the activation of β-catenin and its target oncogenes such as C-Myc and Cyclin D1. CONCLUSION AND IMPLICATIONS Human data provide valuable insights to propose TRPM8 as a prognostic marker with a negative predictive value for CRC patient survival. Animal experiments demonstrate TRPM8 involvement in colon cancer pathophysiology and its potential as a drug target for CRC.
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Affiliation(s)
- Ester Pagano
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Barbara Romano
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Donatella Cicia
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabio A Iannotti
- Institute of Biomolecular Chemistry ICB, CNR, Pozzuoli, Naples, Italy
| | - Tommaso Venneri
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Lucariello
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Francesca Nanì
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabio Cattaneo
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paola De Cicco
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria D'Armiento
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Marcello De Luca
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ruggiero Lionetti
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Stefania Lama
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Stiuso
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pietro Zoppoli
- Laboratory of Pre-Clinical and Translational Research, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Geppino Falco
- Istituto di Ricerche Genetiche Gaetano Salvatore Biogem Scarl, Ariano Irpino, Italy.,Department of Biology, University of Naples Federico II, Naples, Italy
| | - Silvia Marchianò
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Stefano Fiorucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Di Marzo
- Institute of Biomolecular Chemistry ICB, CNR, Pozzuoli, Naples, Italy.,Institut sur la Nutrition et les Aliments Fonctionnels, Centre NUTRISS, École de nutrition, Faculté des sciences de l'agriculture et de l'alimentation (FSAA), Université Laval, Québec, Canada.,Centre de Recherche de l'Institut de Pneumologie et Cardiologie de l'Université Laval, Faculté de Médecine, Université Laval, Québec, Canada.,Canada Research Excellence Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec, Canada
| | - Francesca Borrelli
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo A Izzo
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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3
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Abstract
Background The creation of the pneumoperitoneum is the first step for any minimally invasive surgical procedure. Although rare, iatrogenic vascular or visceral injuries are reported and they are mainly related to the insertion of the first trocar. The Open Veress Assisted (OVA) technique allows a safe maneuver of the first trocar in order to minimize the risk of intraoperative complications during positioning of the first trocar. The purpose of this study was to describe the OVA technique and discuss the use in our current surgical practice. Patients and Methods Each step of OVA technique is described in the text. A retrospective review of prospectively maintained institutional databases was performed to report clinical outcomes related to OVA technique use. Results Between December 2018 and July 2021 OVA technique was used in a total of 324 laparoscopic procedures categorized in 259 colorectal resection and 24 subtotal or total gastrectomies. No intraoperative and postoperative complications related to creation of the peritoneum occurred. Conclusion OVA technique can be considered a safe alternative procedure for laparoscopic entry. By avoiding potentially dangerous insertion-related forces, this technique can be used even in previously operated patients, when the first trocar needs to be positioned away from the umbilicus or abdominal scar.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Marcello De Luca
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Ruggero Lionetti
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Umberto Bracale
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
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4
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Bracale U, Peltrini R, De Luca M, Ilardi M, Di Nuzzo MM, Sartori A, Sodo M, Danzi M, Corcione F, De Werra C. Predictive Factors for Anastomotic Leakage after Laparoscopic and Open Total Gastrectomy: A Systematic Review. J Clin Med 2022; 11:jcm11175022. [PMID: 36078954 PMCID: PMC9457286 DOI: 10.3390/jcm11175022] [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: 07/29/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this systematic review is to identify patient-related, perioperative and technical risk factors for esophago-jejunal anastomotic leakage (EJAL) in patients undergoing total gastrectomy for gastric cancer (GC). A comprehensive literature search of PubMed/MEDLINE, Embase and Scopus databases was performed. Studies providing factors predictive of EJAL by uni- and multivariate analysis or an estimate of association between EJAL and related risk factors were included. All studies were assessed for methodological quality, and a narrative synthesis of the results was performed. A total of 16 studies were included in the systematic review, with a total of 42,489 patients who underwent gastrectomy with esophago-jejunal anastomosis. Age, BMI, impaired respiratory function, prognostic nutritional index (PNI), alcohol consumption, chronic renal failure, diabetes and mixed-type histology were identified as patient-related risk factors for EJAL at multivariate analysis. Likewise, among operative factors, laparoscopic approach, anastomosis type, additional organ resection, blood loss, intraoperative time and surgeon experience were found to be predictive factors for the development of EJAL. In clinical setting, we are able to identify several risk factors for EJAL. This can improve the recognition of higher-risk patients and their outcomes.
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Affiliation(s)
- Umberto Bracale
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
| | - Roberto Peltrini
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7462734
| | - Marcello De Luca
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Mariangela Ilardi
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | | | - Alberto Sartori
- Department of Surgery, San Valentino Montebelluna Hospital, 31044 Treviso, Italy
| | - Maurizio Sodo
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Michele Danzi
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Francesco Corcione
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Carlo De Werra
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
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5
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Romano B, Pagano E, Iannotti FA, Piscitelli F, Brancaleone V, Lucariello G, Nanì MF, Fiorino F, Sparaco R, Vanacore G, Di Tella F, Cicia D, Lionetti R, Makriyannis A, Malamas M, De Luca M, Aprea G, D'Armiento M, Capasso R, Sbarro B, Venneri T, Di Marzo V, Borrelli F, Izzo AA. NAAA is dysregulated in colorectal cancer patients and its inhibition reduces experimental cancer growth. Br J Pharmacol 2021; 179:1679-1694. [PMID: 34791641 PMCID: PMC9303321 DOI: 10.1111/bph.15737] [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: 12/30/2020] [Revised: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose N‐Acylethanolamine acid amidase (NAAA) is a lysosomal enzyme accountable for the breakdown of N‐acylethanolamines (NAEs) and its pharmacological inhibition has beneficial effects in inflammatory conditions. The knowledge of NAAA in cancer is fragmentary with an unclarified mechanism, whereas its contribution to colorectal cancer (CRC) is unknown to date. Experimental Approach CRC xenograft and azoxymethane models were used to assess the in vivo effect of NAAA inhibition. Further, the tumour secretome was evaluated by an oncogenic array, CRC cell lines were used for in vitro studies, cell cycle was analysed by cytofluorimetry, NAAA was knocked down with siRNA, human biopsies were obtained from surgically resected CRC patients, gene expression was measured by RT‐PCR and NAEs were measured by LC–MS. Key Results The NAAA inhibitor AM9053 reduced CRC xenograft tumour growth and counteracted tumour development in the azoxymethane model. NAAA inhibition affected the composition of the tumour secretome inhibiting the expression of EGF family members. In CRC cells, AM9053 reduced proliferation with a mechanism mediated by PPAR‐α and TRPV1. AM9053 induced cell cycle arrest in the S phase associated with cyclin A2/CDK2 down‐regulation. NAAA knock‐down mirrored the effects of NAAA inhibition with AM9053. NAAA expression was down‐regulated in human CRC tissues, with a consequential augmentation of NAE levels and dysregulation of some of their targets. Conclusion and Implications Our results show novel data on the functional importance of NAAA in CRC progression and the mechanism involved. We propose that this enzyme is a valid drug target for the treatment of CRC growth and development.
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Affiliation(s)
- Barbara Romano
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Endocannabinoid Research Group
| | - Ester Pagano
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Endocannabinoid Research Group
| | - Fabio A Iannotti
- Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Pozzuoli, Italy.,Endocannabinoid Research Group
| | - Fabiana Piscitelli
- Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Pozzuoli, Italy.,Endocannabinoid Research Group
| | | | - Giuseppe Lucariello
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Francesca Nanì
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Endocannabinoid Research Group
| | - Ferdinando Fiorino
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Rosa Sparaco
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giovanna Vanacore
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Federica Di Tella
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Donatella Cicia
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ruggero Lionetti
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alexandros Makriyannis
- Center for Drug Discovery and Departments of Chemistry and Chemical Biology and Pharmaceutical Sciences, Northeastern University, Boston, United States
| | - Michael Malamas
- Center for Drug Discovery and Departments of Chemistry and Chemical Biology and Pharmaceutical Sciences, Northeastern University, Boston, United States
| | - Marcello De Luca
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, Interuniversity Center for Technological Innovation Interdepartmental Center for Robotic Surgery, University of Naples Federico II, Naples, Italy
| | - Maria D'Armiento
- Department of Biomorphological and Functional Science, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy.,Endocannabinoid Research Group
| | - Bernardo Sbarro
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Tommaso Venneri
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Endocannabinoid Research Group
| | - Vincenzo Di Marzo
- Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Pozzuoli, Italy.,Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quèbec, Québec City, Canada.,Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec City, Canada.,Endocannabinoid Research Group
| | - Francesca Borrelli
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Endocannabinoid Research Group
| | - Angelo A Izzo
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Endocannabinoid Research Group
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Travaglino A, Raffone A, Catena U, De Luca M, Toscano P, Del Prete E, Vecchione ML, Lionetti R, Zullo F, Insabato L. Ki67 as a prognostic marker in uterine leiomyosarcoma: A quantitative systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 266:119-124. [PMID: 34624740 DOI: 10.1016/j.ejogrb.2021.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/26/2021] [Accepted: 09/26/2021] [Indexed: 12/29/2022]
Abstract
Ki67 labeling index (LI) has been proposed as a prognostic factor in uterine leiomyosarcoma (uLMS), although the evidence in this field is still unclear. We aimed to assess the prognostic value of ki67 LI in uLMS. A systematic review was performed by searching electronic databases from their inception to August 2020 for all studies assessing the prognostic value of ki67 LI in uLMS. Ki67 LI was assessed to the nearest 10% to define the most prognostically accurate threshold. Cox regression survival analysis with calculation of hazard ratio (HR) of death was performed; a p-value < 0.05 was considered significant. Ten studies were included in the qualitative review, out of which 6 were suitable for quantitative review. The absolute risk of death was 0.29 for a ki67 LI < 10%, remained stable at 0.49 in the 10%-39% LI range and increased to 0.65 for a LI ≥ 40%. On univariate analysis, both 10% and 40% thresholds were significantly associated with the hazard of death, with HRs of 3.349 (p = 0.007) and 3.172 (p = 0.001), respectively. On multivariate analysis, only the 10% threshold was significantly associated with the hazard of death (HR = 2.712; p = 0.028). In conclusion, a Ki67 LI ≥ 10% is a significant prognostic factor in uLMS.
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Affiliation(s)
- Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
| | - Ursula Catena
- Division of Gynecological Oncology, Department for the Protection of Women's and Children's Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS L.go A. Gemelli, Rome, Italy
| | - Marcello De Luca
- General Surgery Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Paolo Toscano
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Ester Del Prete
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria Luisa Vecchione
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Ruggero Lionetti
- Division of Gynecological Oncology, Department for the Protection of Women's and Children's Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS L.go A. Gemelli, Rome, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Insabato
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
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Peltrini R, Cantoni V, Green R, Lionetti R, D'Ambra M, Bartolini C, De Luca M, Bracale U, Cuocolo A, Corcione F. Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis. Surgeon 2021; 19:e549-e558. [PMID: 33640282 DOI: 10.1016/j.surge.2021.01.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/31/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-operative management is often the treatment of choice in cases of complicated appendicitis and routine interval appendectomy is not usually recommended. Actually, recent studies show an alarming number of appendiceal neoplasms following interval appendectomy. The aim of this study is to evaluate the prevalence of appendiceal neoplasms and their histological types after interval appendectomy for complicated appendicitis in adults. METHODS A comprehensive literature search of the PubMed, Scopus and Web of Science databases was conducted according to the PRISMA statement. Studies reporting appendiceal neoplasm rates after interval appendectomy and histopathological characteristics were included. The most recent World Health Organization (WHO) classification of malignant tumours was considered. A pooled prevalence analysis for both prevalence and pathology was performed. RESULTS A total of eight studies was included: seven retrospective series and one randomized controlled trial. The pooled prevalence of neoplasms after interval appendectomy was 11% (95% CI 7-15; I2 = 37.5%, p = 0.13). Appendiceal mucinous neoplasms occurred in 43% (95% CI 19-68), adenocarcinoma in 29% (95% CI 6-51), appendiceal neuroendocrine neoplasm in 21% (95% CI 6-36), globet cell carcinoma in 13% (95% CI -2-28), adenoma or serrated lesions in 20% (95% CI -0-41) of cases. CONCLUSION The risk of appendiceal neoplasm in patients treated with interval appendectomy for complicated appendicitis is 11%; mucinous neoplasm is the most common histopathological type. Further studies should investigate this association in order to clarify the biological pathway and clinical implications.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Carolina Bartolini
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Marcello De Luca
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Umberto Bracale
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Naples, Italy.
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8
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Lionetti R, De Luca M, Travaglino A, Raffone A, Saccone G, Di Cicco A, Insabato L, Mascolo M, D'Armiento M, Zullo F, Corcione F. Prognostic factors in Krukenberg tumor. Arch Gynecol Obstet 2019; 300:1155-1165. [PMID: 31542818 DOI: 10.1007/s00404-019-05301-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Krukenberg tumor (KT) is a rare secondary ovarian tumor. Little is known about clinicopathologic factors affecting prognosis in KT. OBJECTIVE To assess the prognostic value of clinicopathologic factors in KT through a systematic review and meta-analysis. METHODS Electronic databases were searched from their inception to February 2019 for studies assessing the association of clinicopathologic factors with overall survival in KT. Pooled hazard ratio (HR) was calculated for each factor; a p value < 0.05 was considered significant. RESULTS Twenty-three studies with 1743 patients were included. A decreased overall survival was significantly associated with peritoneal involvement (HR 1.944; p = 0.003), ascites (HR 2.055; p = 0.034), synchronous presentation (HR 1.679; p = 0.034) and increased serum CEA levels (HR 1.380; p = 0.010), but not with age > 50 (HR 0.946; p = 0.743), menopausal status (HR 1.565; p = 0.204), gastric origin (HR 1.600; p = 0.201), size > 5 cm (HR 1.292; p = 0.119), size > 10 cm (HR 0.925; p = 0.714), bilateral ovarian involvement (HR 1.113; p = 0.347), non-peritoneal extaovarian metastases (HR 1.648; p = 0.237), liver metastases (HR 1.118, p = 0.555), predominant signet ring cell morphology (HR 1.322; p = 0.208) and levels of CA125 (HR 0.933; p = 0.828) and CA19.9 (HR 0.996; p = 0.992). CONCLUSION Peritoneal involvement, synchronous presentation, ascites and increased serum CEA levels appear as unfavorable prognostic factors in KT and might affect the patient management.
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Affiliation(s)
- Ruggero Lionetti
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marcello De Luca
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Antonio Raffone
- Department of Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Antonietta Di Cicco
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria D'Armiento
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Department of Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Lionetti R, De Luca M, Travaglino A, Raffone A, Insabato L, Saccone G, Mascolo M, D'armiento M, Zullo F, Corcione F. Treatments and overall survival in patients with Krukenberg tumor. Arch Gynecol Obstet 2019; 300:15-23. [PMID: 31044302 DOI: 10.1007/s00404-019-05167-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/22/2019] [Accepted: 04/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Krukenberg tumor (KT) is a rare secondary ovarian tumor, primarily localized at the gastrointestinal tract in most cases. KT is related to severe prognosis due to its aggressiveness, diagnostic difficulties and poor treatment efficacy. Several treatments have been used, such as cytoreductive surgery (CRS), adjuvant chemotherapy (CT) and/or hyperthermic intraperitoneal chemotherapy (HIPEC). To date, it is still unclear which treatment or combination of treatments is related to better survival. OBJECTIVE To assess the most effective therapeutic protocol in terms of overall survival (OS). METHODS A systematic review of the literature was performed by searching MEDLINE, Scopus, EMBASE, ClinicalTrial.gov, OVID, Web of Sciences, Cochrane Library, and Google Scholar for all studies assessing the association of treatments with OS in KTs. The effectiveness of each treatment protocol was evaluated by comparing the OS between patients treated with different treatment protocols. RESULTS Twenty retrospective studies, with a total sample size of 1533 KTs, were included in the systematic review. Therapeutic protocols used were CRS in 18 studies, CT in 13 studies, HIPEC in 7 studies, neoadjuvant CT in 2 studies, and some combinations of these in 6 studies. Seven studies showed that CRS significantly improved OS compared to other treatments or association of treatments without it. 11 studies showed that CRS without residual (R0 CRS) had a significantly better OS than CRS with residual (R + CRS). Five studies showed that CT significantly improved OS, but other five showed it did not. Two studies showed that HIPEC in association with CRS improved OS, while another study showed that efficacy of HIPEC was comparable to CT. Two studies evaluated neoadjuvant CT, but results were conflicting. CONCLUSION CRS and in particular R0 CRS are the treatments showing the clearest results in improving OS in KT patients. Results about CT are conflicting. HIPEC appears effective both alone and in combination with CRS, and also related to fewer adverse effect than CT. The usefulness of neoadjuvant CT is still unclear. The association of R0 CRS with HIPEC seems to be the most effective and safe therapeutic protocol for KT patients.
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Affiliation(s)
- Ruggero Lionetti
- General Surgery Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marcello De Luca
- General Surgery Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Insabato
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Gabriele Saccone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Massimo Mascolo
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria D'armiento
- Pathology Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- General Surgery Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Alberici A, Bonato C, Borroni B, Cotelli M, Mattioli F, Binetti G, Gennarelli M, Luca MD, Simonati A, Perani D, Rossini P, Padovani A. Dementia, delusions and seizures: storage disease or genetic AD? Eur J Neurol 2007; 14:1057-9. [PMID: 17718701 DOI: 10.1111/j.1468-1331.2007.01664.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/30/2022]
Abstract
We describe a case of a young patient suffering from a rapidly progressive cognitive decline, associated with delusions, myoclonus and seizures and with no family history for dementia. Clinical features, along with skin biopsy findings were overlapping storage disease; the genetic analysis, however, demonstrated a de novo presenilin 1 mutation. The present report suggests the usefulness of genetic determinations in early-onset cases of dementia, even without an autosomal dominant trait of inheritance; for these cases and their relatives an extensive genetic counselling should be recommended.
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Affiliation(s)
- A Alberici
- Alzheimer Unit, IRCCS-S. Giovanni di Dio-FBF, Brescia, Italy.
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