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van der Wielen N, Daams F, Rosati R, Parise P, Weitz J, Reissfelder C, Del Val ID, Loureiro C, Parada-González P, Pintos-Martínez E, Vallejo FM, Achirica CM, Sánchez-Pernaute A, Campos AR, Bonavina L, Asti ELG, Poza AA, Gilsanz C, Nilsson M, Lindblad M, Gisbertz SS, van Berge Henegouwen MI, Romario UF, De Pascale S, Akhtar K, Cuesta MA, van der Peet DL, Straatman J. Correction: Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial. Surg Endosc 2023; 37:7393-7394. [PMID: 37516694 PMCID: PMC10462497 DOI: 10.1007/s00464-023-10336-y] [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: 07/31/2023]
Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Jürgen Weitz
- Department of of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Carlos Loureiro
- Department of Surgery, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Elena Pintos-Martínez
- Department of Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Luigi Bonavina
- Department of Surgery and Division of Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Emanuele L G Asti
- Department of Surgery and Division of Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | | | - Carlos Gilsanz
- Department of Surgery, Hospital del Sureste, Madrid, Spain
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Stefano De Pascale
- Digestive Surgery, European Institute of Oncology - IRCCS - Milan, Milan, Italy
| | - Khurshid Akhtar
- Department of Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
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2
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van der Wielen N, Daams F, Rosati R, Parise P, Weitz J, Reissfelder C, Del Val ID, Loureiro C, Parada-González P, Pintos-Martínez E, Vallejo FM, Achirica CM, Sánchez-Pernaute A, Campos AR, Bonavina L, Asti ELG, Poza AA, Gilsanz C, Nilsson M, Lindblad M, Gisbertz SS, van Berge Henegouwen MI, Romario UF, De Pascale S, Akhtar K, Cuesta MA, van der Peet DL, Straatman J. Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial. Surg Endosc 2023; 37:7317-7324. [PMID: 37468751 PMCID: PMC10462494 DOI: 10.1007/s00464-023-10278-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. METHODS This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. RESULTS A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7-12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024). CONCLUSION No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Jürgen Weitz
- Department of of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Carlos Loureiro
- Department of Surgery, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Elena Pintos-Martínez
- Department of Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Luigi Bonavina
- Department of Surgery and Division of Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Emanuele L G Asti
- Department of Surgery and Division of Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | | | - Carlos Gilsanz
- Department of Surgery, Hospital del Sureste, Madrid, Spain
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Stefano De Pascale
- Digestive Surgery, European Institute of Oncology - IRCCS - Milan, Milan, Italy
| | - Khurshid Akhtar
- Department of Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
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3
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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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4
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Elmore U, Milone M, Parise P, Velotti N, Cossu A, Puccetti F, Barbieri L, Vertaldi S, Milone F, De Palma GD, Rosati R. Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer. Updates Surg 2023; 75:429-434. [PMID: 35882769 PMCID: PMC9852154 DOI: 10.1007/s13304-022-01328-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/05/2022] [Indexed: 01/24/2023]
Abstract
Laparoscopy has already been validated for treatment of early gastric cancer. Despite that, no data have been published about the possibility of a minimally invasive approach to surgical complications after primary laparoscopic surgery. In this multicentre study, we describe our experience in the management of complications following laparoscopic gastrectomy for gastric cancer. A chart review has been performed over data from 781 patients who underwent elective gastrectomy for gastric cancer between January 1996 and July 2020 in two high referral department of gastric surgery. A fully descriptive analysis was performed, considering all the demographic characteristics of patients, the type of primary procedure and the type of complication which required reoperation. Moreover, a logistic regression was designed to investigate if either the patients or the primary surgery characteristics could affect conversion rate during relaparoscopy. Fifty-one patients underwent reintervention after elective laparoscopic gastric surgery. Among patients who received a laparoscopic reintervention, 11 patients (34.3%) required a conversion to open surgery. Recovery outcomes were significantly better in patients who completed the reoperation through laparoscopy. Relaparoscopy is safe and effective for management of complications following laparoscopic gastric surgery and represent a useful tool both for re-exploration and treatment, in expert and skilled hands.
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Affiliation(s)
- Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Lavinia Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Francesco Milone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
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5
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Milone M, D'Amore A, Alfieri S, Ambrosio MR, Andreuccetti J, Ansaloni L, Antonucci A, Arganini M, Baiocchi G, Barone M, Bencini L, Bencivenga M, Boccia L, Boni L, Braga M, Cianchi F, Cipollari C, Contine A, Cotsoglou C, D'Imporzano S, De Manzoni G, De Pascale S, De Ruvo N, Degiuli M, Donini A, Elmore U, Ercolani G, Ferrari G, Fumagalli RU, Garulli G, Gelmini R, Graziosi L, Gualtierotti M, Guglielmi A, Inama M, Maffeis F, Maione F, Manigrasso M, Marchesi F, Marrelli D, Massobrio A, Moretto G, Moukachar A, Navarra G, Nigri G, Olmi S, Palaia R, Papis D, Parise P, Pedrazzani C, Petri R, Pignata G, Pisano M, Rausei S, Reddavid R, Rocco G, Rosa F, Rosati R, Rossit L, Rottoli M, Roviello F, Santi S, Scabini S, Scaringi S, Solaini L, Staderini F, Taglietti L, Torre B, Ubiali P, Uccelli M, Uggeri F, Vertaldi S, Viganò J, De Palma GD, Giacopuzzi S. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG. Updates Surg 2022:10.1007/s13304-022-01438-8. [PMID: 36571661 DOI: 10.1007/s13304-022-01438-8] [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: 05/31/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022]
Abstract
Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Maria Raffaella Ambrosio
- Department of Surgical Pathology and General Surgery, Azienda Sanitaria Toscana Nord Ovest, Pisa, Italy
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Adelmo Antonucci
- UOC Chirurgia Generale Ospedale Sant'Anna Como Asst Lariana, San Fermo della Battaglia, Italy
| | - Marco Arganini
- Department of Surgical Pathology and General Surgery, Azienda Sanitaria Toscana Nord Ovest, Pisa, Italy
| | | | - Mirko Barone
- Department of General and Thoracic Surgery, SS. Annunziata University Hospital, Chieti, Italy
| | - Lapo Bencini
- Chirurgia Generale Azienda Ospedaliero-Universitaria Careggi Firenze, Florence, Italy
| | - Maria Bencivenga
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Luigi Boccia
- Dip Chirurgico Ortopedico UOC Chirurgia Generale Mininvasiva e d Urgenza ASST, Mantua, Italy
| | - Luigi Boni
- Department of Surgery Fondazione, IRCCS-Ca' Granda-Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Marco Braga
- Università degli Studi di Milano-Bicocca, Ospedale San Gerardo di Monza, Monza, Italy
| | - Fabio Cianchi
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Cipollari
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Alessandro Contine
- Department of General Surgery, Città di Castello Hospital, Città di Castello, Perugia, Italy
| | - Christian Cotsoglou
- General Surgery Unit, Vimercate Hospital-ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Simone D'Imporzano
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Medical University of Pisa, 56124, Pisa, Italy
| | - Giovanni De Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | | | - Nicola De Ruvo
- University of Modena and Reggio Emilia Policlinico of Modena Oncological and Emergency Surgery Unit ID, Modena, Italy
| | - Maurizio Degiuli
- Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
| | - Annibale Donini
- Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy
| | - Ugo Elmore
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Giovanni Ferrari
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | | | - Gianluca Garulli
- UOC Chirurgia Generale e d'Urgenza-Ospedale di Rimini (Novafeltria, Santarcangelo), Rimini, Italy
| | - Roberta Gelmini
- University of Modena and Reggio Emilia Policlinico of Modena Oncological and Emergency Surgery Unit ID, Modena, Italy
| | - Luigina Graziosi
- Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy
| | - Monica Gualtierotti
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University Hospital "G.B. Rossi", Verona, Italy
| | - Marco Inama
- Dipartimento di Chirurgia Generale Ospedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Federica Maffeis
- General Surgical Department St. Mary of Angels Hospital, Pordenone Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | | | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Andrea Massobrio
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluigi Moretto
- Dipartimento di Chirurgia Generale Ospedale Pederzoli, Peschiera del Garda, VR, Italy
| | | | - Giuseppe Navarra
- Department of Surgical Sciences, Faculty of Medicine, University of Messina, G. Martino University Hospital, Messina, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome St. Andrea University Hospital, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Stefano Olmi
- Head of General and Oncologic Surgery Center for Minimal Invasive and Laparoscopic Surgery Policlinico San Marco, Zingonia, Italy
| | - Raffaele Palaia
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale"-IRCCS-Via Mariano Semmola, 80131, Naples, Italy
| | - Davide Papis
- UOC Chirurgia Generale Ospedale Sant'Anna Como Asst Lariana, San Fermo della Battaglia, Italy
| | - Paolo Parise
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University Hospital "G.B. Rossi", Verona, Italy
| | - Roberto Petri
- Department of General Surgery, Azienda Ospedaliero-Universitaria of Udine Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Giusto Pignata
- General Surgery 2, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Pisano
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona Gallarate, Varese, Italy
| | - Rossella Reddavid
- Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
| | - Giuseppe Rocco
- Università di Bologna Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Fausto Rosa
- Chirurgia Digestiva, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Rossit
- Department of General Surgery, Azienda Ospedaliero-Universitaria of Udine Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Matteo Rottoli
- Policlinico Sant'Orsola Bologna U.O. Chirurgia Tratto Alimentare, Bologna, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Stefano Santi
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Medical University of Pisa, 56124, Pisa, Italy
| | - Stefano Scabini
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Scaringi
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Staderini
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lucio Taglietti
- Department of Surgery, Asst Valcamonica Brescia, Brescia, Italy
| | - Beatrice Torre
- Policlinico Sant'Orsola Bologna U.O. Chirurgia Tratto Alimentare, Bologna, Italy
| | - Paolo Ubiali
- General Surgical Department St. Mary of Angels Hospital, Pordenone Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Matteo Uccelli
- Head of General and Oncologic Surgery Center for Minimal Invasive and Laparoscopic Surgery Policlinico San Marco, Zingonia, Italy
| | - Fabio Uggeri
- Università degli Studi di Milano-Bicocca, Ospedale San Gerardo di Monza, Monza, Italy
| | - Sara Vertaldi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Jacopo Viganò
- General Surgery I, Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
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Mengardo V, Weindelmayer J, Veltri A, Giacopuzzi S, Torroni L, de Manzoni G, Agresta F, Alfieri R, Alfieri S, Antonacci N, Baiocchi GL, Bencini L, Bencivenga M, Benedetti M, Berselli M, Biondi A, Capolupo GT, Carboni F, Casadei R, Casella F, Catarci M, Cerri P, Chiari D, Cocozza E, Colombo G, Cozzaglio L, Dalmonte G, Degiuli M, De Luca M, De Luca R, De Manzini N, De Pasqual CA, De Pascale S, De Ruvo N, Di Cosmo M, Di Leo A, Di Paola M, Elio A, Ferrara F, Ferrari G, Fiscon V, Fumagalli U, Garulli G, Gennai A, Gentile I, Germani P, Gualtierotti M, Guerini F, Gurrado A, Inama M, La Torre F, Laterza E, Losurdo P, Macrì A, Marano A, Marano L, Marchesi F, Marino F, Massani M, Menghi R, Milone M, Molfino S, Montuori M, Moretto G, Morgagni P, Morpurgo E, Abdallah M, Nespoli L, Olmi S, Palaia R, Pallabazer G, Parise P, Pasculli A, Pericoli Ridolfini M, Pesce A, Pinotti E, Pisano M, Poiasina E, Postiglione V, Rausei S, Rella A, Rosa F, Rosati R, Rossi G, Rossit L, Rovatti M, Ruspi L, Sacco L, Saladino E, Sansonetti A, Sartori A, Scaglione D, Scaringi S, Schoenthaler C, Sena G, Simone M, Solaini L, Strignano P, Tartaglia N, Testa S, Testini M, Tiberio GAM, Treppiedi E, Vagliasindi A, Valmasoni M, Viganò J, Zanchettin G, Zanoni A, Zardini C, Zerbinati A. Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy (ADiGe) survey. Updates Surg 2022; 74:1839-1849. [PMID: 36279038 DOI: 10.1007/s13304-022-01397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
Abstract
AbstractEvidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.
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Milone M, Elmore U, Manigrasso M, Vertaldi S, Aprea G, Servillo G, Parise P, De Palma GD, Rosati R. Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis. Am J Surg 2021; 223:884-892. [PMID: 34627600 DOI: 10.1016/j.amjsurg.2021.09.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/24/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy. METHODS A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients' number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results. RESULTS 12 articles were included in the final analysis. A significant difference was observed in terms of "overall anastomotic complications" in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies. CONCLUSION Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sara Vertaldi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
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8
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Mandarino FV, Esposito D, Spelta GNE, Cavestro GM, Rosati R, Parise P, Gemma MF, Fanti L. Double layer stent for the treatment of leaks and fistula after upper gastrointestinal oncologic surgery: a retrospective study. Updates Surg 2021; 74:1055-1062. [PMID: 34510378 DOI: 10.1007/s13304-021-01155-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022]
Abstract
Anastomotic dehiscence is one of the most morbidity related and deadly complication after foregut oncologic surgery. The aim of the study is to evaluate the effectiveness of double layer stents (Niti-S™ Beta™ Esophageal Stent) in the management of dehiscences after upper gastrointestinal oncologic surgery. We retrospectively studied consecutive patients who underwent Niti-S™ Beta™ esophageal stent placement from June 2014 to September 2019 for the treatment of anastomotic leaks/fistula following esophagectomy or gastrectomy for cancer. Univariate two-sided logistic regression analysis was used to evaluate possible predictors of successful anastomotic leak/fistula closure. A total of 37 patients were studied and 75 stents were positioned in these patients during the endoscopic procedures. Effective leak/fistula closure was obtained in 23/37 (62.2%). No technical endoscopic failure or complications ensued during the placing of the devices. Regarding delayed complications, migration was observed in 17/75 (22.7%) procedures and stent leaking in 29/75 (38.6%). Three variables significantly favoured stent treatment failure, namely previous neoadjuvant therapy (OR 9.3, P = 0.01), fistula (instead of leak) (OR 6.5, P = 0.01), and stent leak (OR 17.0, P = 0.01). Placement of Beta Niti-S esophageal stent is a safe and effective method that could be considered for the management of leaks and fistula after upper gastrointestinal cancer. Crucial points in the management of post-surgical leaks with this technique are the prompt recognition of leaks and fistula, the prompt endoscopic/radiologic drain of collection and the choice of adequate size of the stent.
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Affiliation(s)
- Francesco Vito Mandarino
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Dario Esposito
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Greta Natalia Edmea Spelta
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Giulia Martina Cavestro
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Parise
- Division of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Fabio Gemma
- Department of Anaesthesia and Intensive Care, Fatebenefratelli Hospital, Milan, Italy
| | - Lorella Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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9
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van der Wielen N, Daams F, Rosati R, Parise P, Weitz J, Reissfelder C, Diez Del Val I, Loureiro C, Parada-González P, Pintos-Martínez E, Vallejo FM, Achirica CM, Sánchez-Pernaute A, Campos AR, Bonavina L, Asti ELG, Poza AA, Gilsanz C, Nilsson M, Lindblad M, Gisbertz SS, van Berge Henegouwen MI, Romario UF, De Pascale S, Akhtar K, Bonjer HJ, Cuesta MA, van der Peet DL, Straatman J. Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial. Eur J Surg Oncol 2021; 48:553-560. [PMID: 34503850 DOI: 10.1016/j.ejso.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Minimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life. MATERIALS AND METHODS A randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant. RESULTS Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60-90) in the open group and 68 (50-83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7-83,3) in the open group and 58,3 (35,4-66,7) in the minimally invasive group (P = 0.002). This was not statistically significant. CONCLUSION No differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands.
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | | | - Paolo Parise
- Department of Surgery, San Raffaele Hospital, Milan, Italy
| | - Jürgen Weitz
- Department of of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - Carlos Loureiro
- Department of Surgery, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Elena Pintos-Martínez
- Department of Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | - Emanuele L G Asti
- Department of Surgery, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | | | - Carlos Gilsanz
- Department of Surgery, Hospital Del Sureste, Madrid, Spain
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | | | - Khurshid Akhtar
- Department of Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H Jaap Bonjer
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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10
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de Pascale S, Parise P, Valmasoni M, Weindelmayer J, Terraneo F, Cella CA, Giacopuzzi S, Cossu A, Massaron S, Elmore U, Merigliano S, Fumagalli Romario U. Does Pathological Stage and Nodal Involvement Influence Long Term Oncological Outcomes after CROSS Regimen for Adenocarcinoma of the Esophagogastric Junction? A Multicenter Retrospective Analysis. Cancers (Basel) 2021; 13:cancers13040666. [PMID: 33562316 PMCID: PMC7915215 DOI: 10.3390/cancers13040666] [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: 12/27/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Chemoradiotherapy according to CROSS regimen is the standard of care for locally advanced esophageal cancer. The studies conducted on this topic have demonstrated the benefits of this type of treatment particularly for squamocellular cancers. Its application for adenocarcinoma has evidenced different results and few studies have investigated its role for adenocarcinomas of esophagogastric junction. Our intent is to evaluate the relation between pathological (yp) stage after CROSS regimen followed by surgery for adenocarcinoma of cardia and overall (OS) and disease-free survival (DFS) in a retrospectively analyzed group of patients. Sites of relapse after surgery were also analyzed. Our results evidenced no differences in term of OS and DFS according to different pathological response after chemoradiotherapy and surgery. Further analyses could be performed to identify the histological and molecular characteristics of these tumors and predict the efficacy of systemic therapy identifying patients who can most benefit from this type of treatment. Abstract Background:After the results reported by the “Chemoradiotherapy for esophageal Cancer Followed by Surgery Study” (CROSS) trial, neo-adjuvant chemoradiotherapy became the standard treatment for locally advanced cancers of esophagus and gastroesophageal junction (GEJ). Excellent results were reported for squamocellular carcinomas (SCCs). Since the advent of the CROSS regimen, the results of surgery for esophageal adenocarcinomas (EAC) have cast some doubts about its efficacy on overall survival (OS) even in the presence of local response. This study evaluated the relation between pathological (yp) stage after CROSS regimen followed by surgery for adenocarcinoma of cardia and overall (OS) and disease-free survival (DFS). Sites of relapse after surgery were also analyzed. Methods: Patients submitted to the CROSS regimen for locally advanced EAC of the cardia followed by transthoracic esophagectomy were analyzed. Actuarial OS and DFS were analyzed and stratified according to yp stage. The site of relapse, distal and local, was also analyzed. Results: The study included 132 patients. The 50-month OS and DFS were 45% and 6.7%, respectively. No differences emerged analyzing OS according to yp stage. Time to relapse was significantly longer for yp Stage I and II, and for yp N0, compared with yp N+. Recurrence occurred in 48 cases (36.3%) with a 9 months median time to relapse. Local and distal relapse were 10 (7.5%) and 38 (28.7%) cases, respectively (p ≦ 0.001). Conclusions: Pathological stage after CROSS regimen does not relate to OS and DFS. Time to recurrence is significantly longer for yp Stages I and II and ypN0. Chemoradiotherapy in a neoadjuvant setting may influence the site of relapse, significantly reducing local recurrences.
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Affiliation(s)
- Stefano de Pascale
- Department of Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy;
- Correspondence:
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132 Milan, Italy; (P.P.); (A.C.); (S.M.); (U.E.)
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastrointestinal Sciences, University of Padova, Clinica Chirurgica 3, 35128 Padova, Italy; (M.V.); (S.M.)
| | - Jacopo Weindelmayer
- General and Upper GI Surgery Division, University of Verona, 37129 Verona, Italy; (J.W.); (S.G.)
| | - Fabrizia Terraneo
- Department of Radiotherapy, Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Chiara Alessandra Cella
- Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), 20143 Milan, Italy;
- Departement of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, 37129 Verona, Italy; (J.W.); (S.G.)
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132 Milan, Italy; (P.P.); (A.C.); (S.M.); (U.E.)
| | - Simonetta Massaron
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132 Milan, Italy; (P.P.); (A.C.); (S.M.); (U.E.)
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132 Milan, Italy; (P.P.); (A.C.); (S.M.); (U.E.)
| | - Stefano Merigliano
- Department of Surgical, Oncological and Gastrointestinal Sciences, University of Padova, Clinica Chirurgica 3, 35128 Padova, Italy; (M.V.); (S.M.)
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11
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Parise P, Turi S, Talavera-Urquijo E, Carresi A, Barbieri L, Cossu A, Elmore U, Puccetti F, Rosati R. Application of ERAS protocol in esophagectomy: a national survey among Italian centers performing esophageal surgery. Updates Surg 2021; 73:297-303. [PMID: 33439468 DOI: 10.1007/s13304-020-00963-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions was mailed to Italian centers that performed at least 10 esophagectomies per year. It included questions about the type of hospital and unit and pre-, intra- and post-operative items. Difficulties encountered were investigated. Thirteen (65%) centers answered the survey, and all met the minimal safety requirements, e.g., the presence of intensive care units and 24-h on-call operative endoscopy and radiology facilities. Fifty percent of esophagectomies with a minimally invasive approach were performed in 84.6% of the centers. Regarding pre-operative items, the highest scores were for the application of nutritional support, dysphagia palliation and presence of a multidisciplinary tumor board, whereas the lowest score was for the use of immunonutrition. Regarding intra-operative items, hypothermia prevention and the use of goal-directed fluid therapy and volatile anesthesia were diffusely adopted, whereas the rate of using abdominal drains was high. Regarding post-operative items, nausea prevention, multimodal analgesia and early mobilization were applied frequently, whereas the use of nasogastric tubes and regular transfer to intensive care units was diffused. The primary barriers in enhanced recovery after surgery protocol application were resistance and a lack of paramedic personnel. This survey's results highlight the efforts undertaken by several centers to apply enhanced recovery after surgery philosophy and in this regard, demonstrate a good standing in Italy.
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Affiliation(s)
- Paolo Parise
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy.
| | - Stefano Turi
- Neurosurgery Intensive Care Unit, San Raffaele Hospital, Milan, Italy
| | - Eider Talavera-Urquijo
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy
| | - Agnese Carresi
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy
| | - Lavinia Barbieri
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy
| | - Andrea Cossu
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy
| | - Ugo Elmore
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy
| | - Francesco Puccetti
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy
| | - Riccardo Rosati
- Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy
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12
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van der Wielen N, Straatman J, Daams F, Rosati R, Parise P, Weitz J, Reissfelder C, Diez Del Val I, Loureiro C, Parada-González P, Pintos-Martínez E, Mateo Vallejo F, Medina Achirica C, Sánchez-Pernaute A, Ruano Campos A, Bonavina L, Asti ELG, Alonso Poza A, Gilsanz C, Nilsson M, Lindblad M, Gisbertz SS, van Berge Henegouwen MI, Fumagalli Romario U, De Pascale S, Akhtar K, Jaap Bonjer H, Cuesta MA, van der Peet DL. Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial. Gastric Cancer 2021; 24:258-271. [PMID: 32737637 PMCID: PMC7790799 DOI: 10.1007/s10120-020-01109-w] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical resection with adequate lymphadenectomy is regarded the only curative option for gastric cancer. Regarding minimally invasive techniques, mainly Asian studies showed comparable oncological and short-term postoperative outcomes. The incidence of gastric cancer is lower in the Western population and patients often present with more advanced stages of disease. Therefore, the reproducibility of these Asian results in the Western population remains to be investigated. METHODS A randomized trial was performed in thirteen hospitals in Europe. Patients with an indication for total gastrectomy who received neoadjuvant chemotherapy were eligible for inclusion and randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG). Primary outcome was oncological safety, measured as the number of resected lymph nodes and radicality. Secondary outcomes were postoperative complications, recovery and 1-year survival. RESULTS Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. The mean number of resected lymph nodes was 43.4 ± 17.3 in OTG and 41.7 ± 16.1 in MITG (p = 0.612). Forty-eight patients in the OTG group had a R0 resection and 44 patients in the MITG group (p = 0.617). One-year survival was 90.4% in OTG and 85.5% in MITG (p = 0.701). No significant differences were found regarding postoperative complications and recovery. CONCLUSION These findings provide evidence that MITG after neoadjuvant therapy is not inferior regarding oncological quality of resection in comparison to OTG in Western patients with resectable gastric cancer. In addition, no differences in postoperative complications and recovery were seen.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Location VU University, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
| | - Jennifer Straatman
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Location VU University, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Location VU University, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | | | - Paolo Parise
- Department of Surgery, San Raffaele Hospital, Milan, Italy
| | - Jürgen Weitz
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Carlos Loureiro
- Department of Surgery, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Elena Pintos-Martínez
- Department of Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Carlos Gilsanz
- Department of Surgery, Hospital del Sureste, Madrid, Spain
| | - Magnus Nilsson
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lindblad
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Suzanne S Gisbertz
- Department of Gastro-intestinal Surgery, Amsterdam University Medical Center Location AMC, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Gastro-intestinal Surgery, Amsterdam University Medical Center Location AMC, Amsterdam, The Netherlands
| | | | | | - Khurshid Akhtar
- Department of Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H Jaap Bonjer
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Location VU University, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Miguel A Cuesta
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Location VU University, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Location VU University, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
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13
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Puccetti F, Cossu A, Parise P, Barbieri L, Elmore U, Carresi A, De Pascale S, Fumagalli Romario U, Rosati R. Diaphragmatic hernia after Ivor Lewis esophagectomy for cancer: a retrospective analysis of risk factors and post-repair outcomes. J Thorac Dis 2021; 13:160-168. [PMID: 33569196 PMCID: PMC7867823 DOI: 10.21037/jtd-20-1974] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with incidence and risk factors not clearly demonstrated. This study evaluates presenting characteristics and repair outcomes in PEDH after Ivor Lewis esophagectomy for cancer. Methods All consecutive patients who underwent esophageal cancer surgery between March 1997 and April 2018 at two high-volume centers were included. The patients underwent Ivor Lewis esophagectomy and were managed according to a standardized follow-up care plan. The primary outcomes included PEDH incidence, risk factor identification, and surgical results after hernia repair. Patient characteristics and perioperative data were collected and a multivariate analysis was performed to identify risk factors for PEDH. Results A total of 414 patients were enrolled and 22 (5.3%) were diagnosed with PEDH during a median follow-up period of 16 (range, 6–177) months. All patients underwent surgical repair and 16 (73%) required treatment within 24 hours. PEDH repair was mainly performed through a laparoscopic approach (77.3%), with an overall postoperative morbidity of 22.7% and one mortality case. The median length of hospital stay was 6 (range, 2–95) days, and no early recurrences were observed, although three (13.6%) cases relapsed over a median follow-up of 10.1 months after hernia repair. Univariate analysis demonstrated a statistically significant association between PEDH and neoadjuvant chemoradiotherapy (P=0.016), pathological complete response (P=0.001), and lymph node harvest (P=0.024). On the other hand, multivariate analysis identified pathological complete response [3.616 (1.384–9.449), P=0.009] and lymph node harvest [3.029 (1.140–8.049), P=0.026] as the independent risk factors for developing PEDH. Conclusions PEDH represents a relevant surgical complication after Ivor Lewis esophagectomy for cancer, including a 5.3% incidence and requiring surgical repair. Pathological complete response and lymph node harvest were found to be independent risk factors for PEDH, independently of the esophagectomy technique.
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Affiliation(s)
- Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Lavinia Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Agnese Carresi
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Stefano De Pascale
- Digestive Surgery Unit, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
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14
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Rebecchi F, Arolfo S, Ugliono E, Morino M, Asti E, Bonavina L, Borghi F, Coratti A, Cossu A, De Manzoni G, De Pascale S, Ferrari GC, Fumagalli Romario U, Giacopuzzi S, Gualtierotti M, Guglielmetti M, Merigliano S, Pallabazzer G, Parise P, Peri A, Pietrabissa A, Rosati R, Santi S, Tribuzi A, Valmasoni M, Viganò J, Weindelmayer J. Impact of COVID-19 outbreak on esophageal cancer surgery in Northern Italy: lessons learned from a multicentric snapshot. Dis Esophagus 2020; 34:6007422. [PMID: 33245104 PMCID: PMC7717178 DOI: 10.1093/dote/doaa124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/10/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus Disease-19 (COVID-19) outbreak has significantly burdened healthcare systems worldwide, leading to reorganization of healthcare services and reallocation of resources. The Italian Society for Study of Esophageal Diseases (SISME) conducted a national survey to evaluate changes in esophageal cancer management in a region severely struck by COVID-19 pandemic. A web-based questionnaire (26 items) was sent to 12 SISME units. Short-term outcomes of esophageal resections performed during the lockdown were compared with those achieved in the same period of 2019. Six (50%) centers had significant restrictions in their activity. However, overall number of resections did not decrease compared to 2019, while a higher rate of open esophageal resections was observed (40 vs. 21.7%; P = 0.034). Surgery was delayed in 24 (36.9%) patients in 6 (50%) centers, mostly due to shortage of anesthesiologists, and occupation of intensive care unit beds from intubated COVID-19 patients. Indications for neoadjuvant chemo (radio) therapy were extended in 14% of patients. Separate COVID-19 hospital pathways were active in 11 (91.7%) units. COVID-19 screening protocols included nasopharyngeal swab in 91.7%, chest computed tomography scan in 8.3% and selective use of lung ultrasound in 75% of units. Postoperative interstitial pneumonia occurred in 1 (1.5%) patient. Recovery from COVID-19 pandemic was characterized by screening of patients in all units, and follow-up outpatient visits in only 33% of units. This survey shows that clinical strategies differed considerably among the 12 SISME centers. Evidence-based guidelines are needed to support the surgical esophageal community and to standardize clinical practice in case of further pandemics.
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Affiliation(s)
- Fabrizio Rebecchi
- Address correspondence to: Fabrizio Rebecchi, MD, Department of Surgical Sciences, University of Turin, Turin, Italy, 14 c/so AM Dogliotti, 10126 Turin, Italy.
| | - Simone Arolfo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Emanuele Asti
- Department of General and Foregut Surgery, University of Milan, IRCCS, Policlinico San Donato, Milan, Italy
| | - Luigi Bonavina
- Department of General and Foregut Surgery, University of Milan, IRCCS, Policlinico San Donato, Milan, Italy
| | - Felice Borghi
- General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic Surgery, Careggi University Hospital of Florence, Florence, Italy
| | - Andrea Cossu
- Gastrointestinal Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Giovanni De Manzoni
- General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, Verona, Italy
| | | | | | | | - Simone Giacopuzzi
- General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, Verona, Italy
| | - Monica Gualtierotti
- Mini-Invasive Oncological Surgical Department, Niguarda Hospital, Milan, Italy
| | | | - Stefano Merigliano
- Center for Esophageal Disease, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padua, Italy
| | | | - Paolo Parise
- Gastrointestinal Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Andrea Peri
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Riccardo Rosati
- Gastrointestinal Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Stefano Santi
- Esophageal Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Angela Tribuzi
- Division of Oncological and Robotic Surgery, Careggi University Hospital of Florence, Florence, Italy
| | - Michele Valmasoni
- Center for Esophageal Disease, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padua, Italy
| | - Jacopo Viganò
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Jacopo Weindelmayer
- General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, Verona, Italy
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15
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Parise P, Cinelli L, Ferrari C, Cossu A, Puccetti F, Garutti L, Elmore U, Rosati R. Early Red Flags Associated with Delayed Discharge in Patients Undergoing Gastrectomy: Analysis of Perioperative Variables and ERAS Protocol Items. World J Surg 2020; 44:223-231. [PMID: 31620813 DOI: 10.1007/s00268-019-05223-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) perioperative pathways are safe and effective for patients undergoing gastrectomy. However, adherence to these protocols varies and is generally underreported. This retrospective study aimed to assess whether perioperative variables or deviation from ERAS items is associated with delayed discharge after gastrectomy. METHODS All patients undergoing gastrectomy at our institution were managed with a standardised perioperative pathway according to ERAS principles. The target length of stay was set as the ninth post-operative day (POD). All significant variables were derived from a bivariate analysis and were entered into a logistic regression to confirm their statistical value. RESULTS The study included 180 patients. Multivariate regression analysis revealed that incomplete immunonutrition, failure to extubate the patient at the end of surgery, intraoperative crystalloids >2150 ml and blood transfusion >268 ml, surgery duration >195 min, and failure to mobilise patients within 24 h from surgery were associated with delayed discharge. The logistic regression model was statistically significant (p < 0.001) and correctly classified 73.6% of cases. Sensitivity and specificity were 74.1% and 73.2%, respectively. CONCLUSIONS These results seem clinically significant and consistent with those of previous studies. The reported perioperative variables showed a strong relationship with the length of hospital stay.
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Affiliation(s)
- Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Lorenzo Cinelli
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy.
| | - Carlo Ferrari
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Leonardo Garutti
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy
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16
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Vignali A, Elmore U, Aleotti F, Roberto D, Parise P, Rosati R. Re-laparoscopy in the treatment of anastomotic leak following laparoscopic right colectomy with intracorporeal anastomosis. Surg Endosc 2020; 35:6173-6178. [PMID: 33104916 DOI: 10.1007/s00464-020-08113-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Anastomotic leak still represents the most feared surgical complication following colorectal resection and is associated with high morbidity and mortality rates. The aim of this study is to assess the feasibility and safety of laparoscopic reoperation for symptomatic anastomotic leak (AL) after laparoscopic right colectomy with mechanical intracorporeal anastomosis (IA). METHODS From January 2012 to December 2019, 428 consecutive laparoscopic right colectomy with IA were performed. Overall symptomatic AL rate requiring reoperation was 5.8% (26/428). Data on patient demographics as well as operative findings, time elapsed from primary surgery and from the onset of symptoms of anastomotic leak, time and duration of re-laparoscopy, ICU stay, morbidity, mortality rate, length of hospital stay and readmission, were all retrospectively reviewed. RESULTS Laparoscopic approach was attempted in 23 (88.4%) hemodynamically stable patients. Conversion rate was 21.4%. Reasons for conversion were gross fecal peritonitis (n = 2), colonic ischemia (n = 1), severe bowel distension (n = 2). Eighteen (78.2%) patients underwent successfully laparoscopic (LPS) reoperation. A repair of the anastomotic defect was done in 11 (61.1%) patients, while in 7 patients the intracorporeal mechanical anastomosis was refashioned. A diverting ileostomy was done in 22.2% of cases (n = 4). A second reoperation for leak persistence was necessary in two cases (11.1%). Median (range) length of postoperative hospital stay from re-laparoscopy was 15.5 (9-53) days. Overall morbidity rate was 38.7%. Mortality rate was 5.5% (n = 1) CONCLUSION: laparoscopic re-intervention for the treatment of anastomotic leak following LPS right colectomy with intracorporeal anastomosis in hemodynamically stable and highly selected patients in the experienced hands of dedicated laparoscopic surgeons, is a safe option with acceptable morbidity and mortality rate.
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Affiliation(s)
- Andrea Vignali
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesca Aleotti
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Delpini Roberto
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
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17
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Vignali A, Elmore U, Guarneri G, De Ruvo V, Parise P, Rosati R. Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients. Updates Surg 2020; 73:111-121. [PMID: 32638264 DOI: 10.1007/s13304-020-00848-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Abstract
To identify factors associated with early deviation and delayed discharge within an Enhanced Recovery after Surgery (ERAS) pathway. This is a retrospective review of prospectively collected data of consecutive patients who underwent laparoscopic or open colorectal surgery and managed with a standardized ERAS pathway between April 2015 and October 2018. ERAS items were assessed within 48 h after surgery. Patients with early complications were excluded. The influence of factors on length of stay was calculated by univariate and multivariate analysis. A binary logistic regression was used to model a predicting score. Seven hundred and thirty-three patients met the inclusion criteria. Multivariate analysis showed that age ≥ 75 years (P = 0.02), ASA score ≥ 3 (P = 0.03), open surgery or conversion to open (P = 0.001), non-compliance with the intra-operative balanced fluid therapy (P = 0.049), failure to early removal of the urinary catheter (P = 0.001), to discontinue IV fluid (P = 0.02) and to early mobilization (P = 0.001) were independently associated with ERAS failure. The generated score had a specificity of 84% and a positive predictive value of 72%. Patients who would have a length of stay longer than the median for each surgical procedure were properly identified (Area under ROC Curve = 0.753, P < 0.001). The delayed discharge could be predicted at 48 h from the intervention. The ability of the model to weight the specific role of each statistically significant variable might be a useful tool to identify the most frail patients.
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Affiliation(s)
- Andrea Vignali
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Giovanni Guarneri
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Valentino De Ruvo
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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18
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Barbieri LA, Parise P, Cossu A, Puccetti F, Elmore U, Talavera Urquijo E, Rosati R. Treatment of Epiphrenic Diverticulum: How I Do It. J Laparoendosc Adv Surg Tech A 2020; 30:653-658. [DOI: 10.1089/lap.2020.0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Paolo Parise
- Department of Surgery, San Raffaele Hospital, Milan, Italy
| | - Andrea Cossu
- Department of Surgery, San Raffaele Hospital, Milan, Italy
| | | | - Ugo Elmore
- Department of Surgery, San Raffaele Hospital, Milan, Italy
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19
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Barbieri L, Talavera Urquijo E, Parise P, Nilsson M, Reynolds JV, Rosati R. Esophageal oncologic surgery in SARS-CoV-2 (COVID-19) emergency. Dis Esophagus 2020; 33:doaa028. [PMID: 32322892 PMCID: PMC7188144 DOI: 10.1093/dote/doaa028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Lavinia Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | | | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Magnus Nilsson
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland
| | - John V Reynolds
- Department of Digestive Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
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20
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Mandarino FV, Bonura GF, Esposito D, Rosati R, Parise P, Fanti L. A large anastomotic leakage after esophageal surgery treated with endoluminal vacuum-assisted closure: a case report. J Surg Case Rep 2020; 2020:rjaa071. [PMID: 32351683 PMCID: PMC7180323 DOI: 10.1093/jscr/rjaa071] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 01/23/2023] Open
Abstract
The treatment of anastomotic post-esophagectomy leaks and fistula is challenging. Endoluminal vacuum-assisted closure (EVAC) is an emerging technique that employs negative pressure wound therapy to treat anastomotic leaks endoscopically. Esosponge is specifically designed for esophageal EVAC therapy. We report on a 49-year-old woman who underwent a totally mini-invasive Ivor-Lewis esophagectomy and developed a giant postoperative leak with a complex pleural collection, but she was not fit for surgical re-intervention. The patient healed almost completely after 14 exchange sessions of Esosponge over 35 days.
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Affiliation(s)
- Francesco Vito Mandarino
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuliano Francesco Bonura
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Dario Esposito
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Parise
- Division of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorella Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Gianotti L, Fumagalli Romario U, De Pascale S, Weindelmayer J, Mengardo V, Sandini M, Cossu A, Parise P, Rosati R, Bencini L, Coratti A, Colombo G, Galli F, Rausei S, Casella F, Sansonetti A, Maggioni D, Costanzi A, Bernasconi DP, De Manzoni G. Association Between Compliance to an Enhanced Recovery Protocol and Outcome After Elective Surgery for Gastric Cancer. Results from a Western Population-Based Prospective Multicenter Study. World J Surg 2019; 43:2490-2498. [PMID: 31240434 DOI: 10.1007/s00268-019-05068-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/13/2022]
Abstract
BACKGROUND The association between compliance to an enhanced recovery protocol (ERAS) and outcome after surgery for gastric cancer has been poorly investigated, particularly in Western patients. The aim of the study was to evaluate whether the rate of adherence to the ERAS program was correlated with outcome and time of discharge. METHODS A prospective, observational, multicenter study was designed to be performed at Italian referral centers for gastric surgery. The protocol was discussed and approved by the Italian Research Group on Gastric Cancer. Twenty-three ERAS domains were applied. A multivariate logistic regression was used to assess the association between ERAS compliance and overall and major complication rates. The Poisson regression model (measured as mean ratios) was used to assess the association of ERAS compliance rate and length of stay (LOS). RESULTS Eight centers participated and 290 subjects with a median age of 73 years were enrolled. The overall rates of adherence to pre-, intra-, and postoperative ERAS items were 69.8%, 60.3%, and 82.5%, respectively. At the multivariate model, there was an association between overall rate of morbidity and an overall ERAS compliance rate greater than 70% (OR 0.413; 95% CI 0.235-0.7240; P 0.002). A similar association was found for major complications (OR 0.328; 95% CI 0.151-0.709; P 0.005). The Poisson regression showed that in patients with ERAS compliance rate >70%, LOS was reduced of approximately 20% (mean ratio 0.812; 95% CI 0.694-0.950; P 0.009). CONCLUSIONS These results suggest a moderate compliance to an ERAS program and a significant association between adherence and outcomes.
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Affiliation(s)
- Luca Gianotti
- Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy
| | | | | | | | - Valentina Mengardo
- General and Esophagogastric Surgery, University of Verona, Verona, Italy
| | - Marta Sandini
- Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy
| | - Andrea Cossu
- Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy
| | - Paolo Parise
- Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy
| | - Riccardo Rosati
- Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy
| | - Lapo Bencini
- Oncologic and Robotic Surgery, Department of Oncology, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Andrea Coratti
- Oncologic and Robotic Surgery, Department of Oncology, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Giovanni Colombo
- Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy
| | | | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
| | - Francesco Casella
- General Surgery, Vannini-Figlie di San Camillo Hospital, Rome, Italy
| | - Andrea Sansonetti
- General Surgery, Vannini-Figlie di San Camillo Hospital, Rome, Italy
| | - Dario Maggioni
- General Surgery 3, ASST-Monza, Desio Hospital, Desio, Italy
| | | | - Davide P Bernasconi
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
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22
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De Nardi P, Elmore U, Maggi G, Maggiore R, Boni L, Cassinotti E, Fumagalli U, Gardani M, De Pascale S, Parise P, Vignali A, Rosati R. Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc 2019; 34:53-60. [PMID: 30903276 DOI: 10.1007/s00464-019-06730-0] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient vascular supply is one of the main causes of anastomotic leak in colorectal surgery. Intraoperative indocyanine-green (ICG) angiography has been shown to provide information on tissue perfusion, identifying a well-perfused location for colonic and rectal transections, and thus possibly reducing the leak rate. Aim of this study was to evaluate the usefulness of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal resection with colorectal anastomosis. METHODS This randomized trial involved 252 patients undergoing laparoscopic left-sided colon and rectal resection randomized 1:1 to intraoperative ICG or to subjective visual evaluation of the bowel perfusion without ICG. The primary aim was to assess whether ICG angiography could lead to a reduction in anastomotic leak rate. Secondary outcomes were possible changes in the surgical strategy and postoperative morbidity. RESULTS After randomization, 12 patients were excluded. Accordingly, 240 patients were included in the analysis; 118 were in the study group, and 122 in the control group. ICG angiography showed insufficient perfusion of the colic stump, which led to extended bowel resection in 13 cases (11%). An anastomotic leak developed in 11 patients (9%) in the control group and in 6 patients (5%) in the study group (p = n.s.). CONCLUSIONS Intraoperative ICG fluorescent angiography can effectively assess vascularization of the colic stump and anastomosis in patients undergoing colorectal resection. This method led to further proximal bowel resection in 13 cases, however, there was no statistically significant reduction of anastomotic leak rate in the ICG arm. CLINICAL TRIAL ClinicalTrials.gov NCT02662946.
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Affiliation(s)
- Paola De Nardi
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giulia Maggi
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Maggiore
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Luigi Boni
- Department of Surgery, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Marco Gardani
- Chirurgia Generale 2, ASST Spedali Civili, Brescia, Italy
| | | | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Vignali
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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23
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Fumagalli U, Baiocchi GL, Celotti A, Parise P, Cossu A, Bonavina L, Bernardi D, de Manzoni G, Weindelmayer J, Verlato G, Santi S, Pallabazzer G, Portolani N, Degiuli M, Reddavid R, de Pascale S. Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks. World J Gastroenterol 2019; 25:356-366. [PMID: 30686903 PMCID: PMC6343094 DOI: 10.3748/wjg.v25.i3.356] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mediastinal leakage (ML) is one of the most feared complications of esophagectomy. A standard strategy for its diagnosis and treatment has been difficult to establish because of the great variability in their incidence and mortality rates reported in the existing series.
AIM To assess the incidence, predictive factors, treatment, and associated mortality rate of mediastinal leakage using the standardized definition of mediastinal leaks recently proposed by the Esophagectomy Complications Consensus Group (ECCG).
METHODS Seven Italian surgical centers (five high-volume, two low-volume) affiliated with the Italian Society for the Study of Esophageal Diseases designed and implemented a retrospective study including all esophagectomies (n = 501) with intrathoracic esophagogastric anastomosis performed from 2014 to 2017. Anastomotic MLs were defined according to the classification recently proposed by the ECCG.
RESULTS Fifty-nine cases of ML were recorded, yielding an overall incidence of 11.8% (95%CI: 9.1%-14.9%). The surgical approach significantly influenced the occurrence of ML: the proportion of leakage was 10.5% and 9% after open and hybrid esophagectomy (HE), respectively, and doubled (20%) after totally minimally invasive esophagectomy (TMIE) (P = 0.016). No other predictive factors were found. The 30- and 90-d overall mortality rates were 1.4% and 3.2%, respectively; the 30- and 90-d leak-related mortality rates were 5.1% and 10.2%, respectively; the 90-d mortality rates for TMIE and HE were 5.9% and 1.8%, respectively. Endoscopy was the first-line treatment in 49% of ML cases, with the need for retreatment in 17.2% of cases. Surgery was needed in 44.1% of ML cases. Endoscopic treatment had the lowest mortality rate (6.9%). Removal of the gastric tube with stoma formation was necessary in 8 (13.6%) cases.
CONCLUSION The incidence of ML after esophagectomy was high mainly in the TMIE group. However, the general and specific (leak-related) mortality rates were low. Early treatment (surgical or endoscopic) of severe leaks is mandatory to limit related mortality.
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Affiliation(s)
- Uberto Fumagalli
- Department of Digestive Surgery, IEO European Institute of Oncology IRCCS, Milano 20141, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Studies, Surgical Clinic, University of Brescia, Brescia 25123, Italy
| | - Andrea Celotti
- General Surgery 2, ASST Spedali Civili di Brescia, Brescia 25123, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milano 20132, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milano 20132, Italy
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milan, Milano 20122, Italy
| | - Daniele Bernardi
- Department of Surgery, IRCCS Policlinico San Donato, University of Milan, Milano 20122, Italy
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, University of Verona, Verona 37134, Italy
| | - Jacopo Weindelmayer
- General and Upper GI Surgery Division, University of Verona, Verona 37134, Italy
| | - Giuseppe Verlato
- Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Stefano Santi
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Cisanello Hospital, Pisa 56124, Italy
| | - Giovanni Pallabazzer
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Cisanello Hospital, Pisa 56124, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Studies, Surgical Clinic, University of Brescia, Brescia 25123, Italy
| | - Maurizio Degiuli
- University of Turin, Department of Oncology, Surgical Oncology and Digestive Surgery, San Luigi University Hospital, Orbassano 10043, Italy
| | - Rossella Reddavid
- University of Turin, Department of Oncology, Surgical Oncology and Digestive Surgery, San Luigi University Hospital, Orbassano 10043, Italy
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24
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Cossu A, Parise P, Puccetti F, Zotti M, Arru G, Elmore U, Rosati R. Enhanced recovery after surgery (ERAS) protocol in gastric surgery for cancer: Review of a single institution experience. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.041] [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: 11/17/2022] Open
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25
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Arru G, Cossu A, Parise P, Puccetti F, Zotti M, Elmore U, Rosati R. Application of an ERAS standardized pathway for perioperative management of Ivor-Lewis esophagectomies. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.013] [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: 10/28/2022] Open
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26
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Zotti M, Parise P, Cossu A, Puccetti F, Arru G, Elmore U, Rosati R. Totally minimally invasive vs hybrid Ivor Lewis esophagectomy for cancer: A comparative prospective study on safety and efficacy. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.030] [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: 10/28/2022] Open
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27
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Abstract
SummaryIn a randomized double-blind crossover study in 16 patients with enhanced in vitro spontaneous platelet aggregation, sulfinpyrazone proved to be effective in normalizing platelet aggregability within 4 days after initiation of therapy.
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Affiliation(s)
- G G Nenci
- The Medical Clinic, University of Perugia, Perugia, Italy
| | - G Agnelli
- The Medical Clinic, University of Perugia, Perugia, Italy
| | - M Berrettini
- The Medical Clinic, University of Perugia, Perugia, Italy
| | - P Parise
- The Medical Clinic, University of Perugia, Perugia, Italy
| | - E Ballatori
- The Medical Clinic, University of Perugia, Perugia, Italy
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28
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Berrettini M, Buoncristiani U, Parise P, Ballatori E, Nenci G. Polyacrilonytrile versus Cuprophan Membranes for Hemodialysis: Evaluation of Efficacy and Biocompatibility by Platelet Aggregation Studies. Int J Artif Organs 2018. [DOI: 10.1177/039139888100400505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The short- and long-term effect of hemodialysis with two different membranes — cuprophan and polyacrilonytrile — on platelet aggregation has been investigated in 12 uremic patients undergoing extracorporeal dialysis, passing from one treatment to the other. Cuprophan membranes failed to correct the defective platelet aggregation of uremia, and their thrombogenicity was documented by a fall in platelet count and further impairment of platelet aggregation during dialysis. On the contrary, polyacrilonitryle membranes showed the capacity to correct completely but transiently the platelet aggregation, without changes in platelet count. The results indicate that polyacrilonytrile membranes show a better biocompatibility toward platelets than cuprophan membranes.
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Affiliation(s)
| | | | - P. Parise
- Statistica University of Perugia, Perugia, Italy
| | | | - G.G. Nenci
- Institutes of Semeiotica Medica, Perugia, Italy
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29
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Slim N, Gumina C, Parise P, Mazza E, Cossu A, Albarello L, Puccetti F, Reni M, Rosati R, Passoni P, Di Muzio N. EP-1449: Neoadjuvant chemoradiotherapy IG-IMRT PET based in esophageal or esophageal gastric junction cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31758-4] [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: 10/14/2022]
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30
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Sarzo G, Finco C, Zustovich F, Parise P, Savastano S, Degregori S, Vecchiato M, Merigliano S. Early Rupture of Subclavian Vein Catheter: A Case Report and Literature Review. J Vasc Access 2018; 5:39-46. [PMID: 16596539 DOI: 10.1177/112972980400500109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prolonged venous access devices (PVADs) have become indispensable in antiblastic protocols for the treatment of cancer patients, in anti-infection protocols for acquired immunodeficiency syndrome (AIDS) patients and in the management of chronic malabsorption syndromes. Using these catheters carries the risk of several complications, and some are potentially lethal, for example, cardiac embolization of catheter fragments. Rupture is a complication almost exclusive to catheters positioned percutaneously: after using this technique, device malfunction can occur due to catheter kinking after its excessively medial introduction in the subclavian vein. The early recognition of any pinch-off sign (POS) is fundamental in preventing catheter rupture that frequently follows this complication. Other factors can be involved in early rupture, for example, excessive force on a syringe used to clear a catheter that shows early signs of malfunction, or a strength defect in the materials used in the catheter construction. This report describes an early rupture case of an initially correctly positioned catheter and reviews 20 such cases in the recent literature.
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Affiliation(s)
- G Sarzo
- Department of Medical and Surgical Sciences, 3rd General Surgery Clinic, S. Antonio Hospital, University of Padova, Padova, Italy.
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31
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Milone M, Elmore U, Musella M, Parise P, Zotti MC, Bracale U, Di Lauro K, Manigrasso M, Milone F, Rosati R. Safety and efficacy of laparoscopic wedge gastrectomy for large gastrointestinal stromal tumors. Eur J Surg Oncol 2017; 43:796-800. [PMID: 28132787 DOI: 10.1016/j.ejso.2017.01.005] [Citation(s) in RCA: 23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/29/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the feasibility of minimally invasive resection of small gastric GISTs is well established, less is known about safety and efficacy of laparoscopic surgery for large tumors. METHODS A retrospective analysis was performed, using a prospectively maintained comprehensive database. Patients were divided into two groups according to tumor size: Case group with tumors > 5 cm and control group with tumors <5 cm. Hospital charts were reviewed, and various outcome measures recorded, including operative time, estimated operative blood loss, post-operative leak, stasis, infection and recurrence. RESULTS No tumors were ruptured during surgical manipulation and no major morbidity or mortality occurred in either group. Operative time (75,8 ± 33,1 min in large cases vs 75,8 ± 33,1 min in small cases) was similar in both groups (p = 0,61). The incidence of post-operative complications did not differ between the two groups. In details there were 21 out of 25 (84%) uncomplicated cases among small GISTs versus 17 out of 24 (70,8%) uncomplicated cases among large GISTs (p = 0,32). CONCLUSION This matched-pair case control study demonstrates that laparoscopic wedge resection for large gastric GISTs is safe and effective, as demonstrated for small tumors.
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Affiliation(s)
- M Milone
- University of Naples "Federico II", Department of Surgical Specialities and Nephrology, Naples, Italy.
| | - U Elmore
- San Raffaele Hospital, Department of Gastrointestinal Surgery, Milan, Italy
| | - M Musella
- University of Naples "Federico II", Department of Surgical Specialities and Nephrology, Naples, Italy
| | - P Parise
- San Raffaele Hospital, Department of Gastrointestinal Surgery, Milan, Italy
| | - M C Zotti
- San Raffaele Hospital, Department of Gastrointestinal Surgery, Milan, Italy
| | - U Bracale
- University of Naples "Federico II", Department of Surgical Specialities and Nephrology, Naples, Italy
| | - K Di Lauro
- University of Naples "Federico II", Department of Surgical Specialities and Nephrology, Naples, Italy
| | - M Manigrasso
- University of Naples "Federico II", Department of Surgical Specialities and Nephrology, Naples, Italy
| | - F Milone
- University of Naples "Federico II", Department of Surgical Specialities and Nephrology, Naples, Italy
| | - R Rosati
- San Raffaele Hospital, Department of Gastrointestinal Surgery, Milan, Italy
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32
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Rosati R, Parise P, Giannone Codiglione F. Technical pro & cons of the laparoscopic lymphadenectomy. Transl Gastroenterol Hepatol 2016; 1:93. [PMID: 28138658 DOI: 10.21037/tgh.2016.12.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/24/2016] [Indexed: 01/10/2023] Open
Abstract
Laparoscopy has been introduced in treatment of gastric cancer to reduce surgical trauma and to improve post-operative functional recovery. Most of international guidelines allow the use of this minimally invasive approach in general surgical practice only in clinical stage I. One of the most important concerns in fact is the feasibility of D2 lymphadenectomy through laparoscopy. Reduced numbers of harvested lymph nodes have been reported, particularly in stations with a more difficult access. Nevertheless subsequent papers reported adequate numbers of total number of nodes retrieved, even with D2 dissection and even in complex stations but results from randomized controlled trials still lack. Laparoscopic approach has been proven safe and effective also in extremely complex maneuvers as spleen-preserving retropancreatic lymphadenectomy. The minimally invasive approach in D2 lymphadenectomy seems to be associated to comparable incidence of specific complications as compared to open surgery. The use of laparoscopy has extended the operating time but has reduced the blood loss. Because of high complexity of this kind surgery, laparoscopic gastric surgery for cancer should be done only in referral centers.
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Affiliation(s)
- Riccardo Rosati
- Gastroenterological Surgery Unit, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Paolo Parise
- Gastroenterological Surgery Unit, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Fabio Giannone Codiglione
- Gastroenterological Surgery Unit, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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33
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Parise P, Elmore U, Fumagalli U, De Manzoni G, Giacopuzzi S, Rosati R. Esophageal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it. Updates Surg 2016; 68:129-33. [DOI: 10.1007/s13304-016-0374-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/18/2016] [Indexed: 12/20/2022]
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34
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Salvador R, Caruso V, Costantini M, Parise P, Nicoletti L, Cavallin F, Zanatta L, Bardini R, Ancona E, Zaninotto G. Shorter myotomy on the gastric site (≤2.5 cm) provides adequate relief of dysphagia in achalasia patients. Dis Esophagus 2015; 28:412-7. [PMID: 24758747 DOI: 10.1111/dote.12226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The right length of the myotomy on the gastric side for esophageal achalasia is still a debated issue. We aimed to investigate the final outcome after classic myotomy (CM) as compared with a longer myotomy on the gastric side (LM) in two cohorts of achalasia patients. Forty-four achalasia patients who underwent laparoscopic Heller-Dor were considered; patients with a sigmoid-shaped esophagus were excluded. Symptoms were scored using a detailed questionnaire for dysphagia, regurgitation, and chest pain. Barium swallow, endoscopy, and esophageal manometry were performed before and 6 months after the surgical treatment; 24-hour pH-monitoring was also performed 6 months after the procedure. CM was defined as a gastric myotomy length in the range of 1.5-2.0 cm, while LM was 2.5-3 cm in length. The surgical treatment (CM or LM) was adopted in two consecutive cohorts. Treatment failure was defined as a postoperative symptom score >10th percentile of the preoperative score (i.e. >8). Of the 44 patients representing the study population, 20 had CM and 24 had LM. The patients' demographic and clinical parameters (age, sex, symptom score, duration of symptoms, esophageal diameter, and manometric pattern) were similar in the two groups. The median follow up was 24 months (interquartile range 12-39). One patient in each group was classified as a treatment failure. After the treatment, there was a significant decrease in both groups' symptom score, and resting and residual pressure (P < 0.01), with no statistically significant differences between the two groups in terms of postoperative symptom score, resting and residual pressure, or total and abdominal lower esophageal sphincter length and esophageal diameter. Extending the length of the myotomy on the gastric side does not seem to change the final outcome of the laparoscopic Heller-Dor procedure.
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Affiliation(s)
- R Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy
| | - V Caruso
- Department of Surgery, Sts Giovanni e Paolo Hospital, Venezia, Italy
| | - M Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy
| | - P Parise
- Department of Surgery, Sts Giovanni e Paolo Hospital, Venezia, Italy
| | - L Nicoletti
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy
| | - F Cavallin
- Surgical Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padua, Italy
| | - L Zanatta
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy
| | - R Bardini
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy
| | - E Ancona
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy
| | - G Zaninotto
- Department of Surgery and Cancer, St. Mary's Hospital, Imperial College, London, UK
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35
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Abstract
Epiphrenic diverticula (ED) are a rare clinical entity characterized by out-pouchings of the esophageal mucosa originating in the distal third of the esophagus, close to the diaphragm. The proportion of diverticula reported symptomatic enough to warrant surgery is extremely variable, ranging from 0% to 40%. The natural history of ED is still almost unknown and the most intriguing question concerns whether or not they all need surgical treatment. From 1993 to 2010 35 patients underwent surgery at our institution. Eleven patients were treated via a thoracotomic approach alone and were excluded from present study. The remaining 24 patients formed our study population. Seventeen patients (48.6%) underwent surgery via a purely laparoscopic approach, and received a diverticulectomy + myotomy + antireflux procedure. Seven patients (23%), with ED positioned well above inferior pulmonary vein, were treated via a combined laparoscopic-thoracotomic approach: they all underwent diverticulectomy + myotomy + an antireflux procedure. Mortality was nil. The overall morbidity rate was 25%. A suture leakage occurred in 4 patients (16.6%) and they were all conservatively treated. Patients' symptom scores decreased from a median of 15 to 0 (P = 0.0005). Laparoscopic surgery for ED is effective, but given the not negligible incidence of complications such suture-line leakage, should be considered only in symptomatic patients or in event of huge diverticula. A tailored combined laparoscopic-thoracotomic approach may be useful in case of ED located high in mediastinum or with large neck.
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Affiliation(s)
- Giovanni Zaninotto
- General Surgery Unit, SS Giovanni e Paolo Hospital, University of Padova, Venice, Italy.
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36
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Parise P, Rosati R, Savarino E, Locatelli A, Ceolin M, Dua KS, Tatum RP, Braghetto I, Gyawali CP, Hejazi RA, McCallum RW, Sarosiek I, Bonavina L, Wassenaar EB, Pellegrini CA, Jacobson BC, Canon CL, Badaloni A, del Genio G. Barrett's esophagus: surgical treatments. Ann N Y Acad Sci 2011; 1232:175-95. [PMID: 21950813 DOI: 10.1111/j.1749-6632.2011.06051.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The following on surgical treatments for Barrett's esophagus includes commentaries on the indications for antireflux surgery after medical treatment; the effects of the various procedures on the lower esophageal sphincter; the role of impaired esophageal motility and delayed gastric emptying in the choice of the surgical procedure; indications for associated highly selective vagotomy, duodenal switch, and gastric electrical stimulation; therapeutic strategies for detection and treatment of shortened esophagus; the role of antireflux surgery on the regression of metaplastic mucosa and the risk of malignant progression; the detection of asymptomatic reflux brfore bariatric surgery; the role of non-GERD symptoms on the results of surgery; and the indications of Collis gastroplasty and choice of the type of fundoplication.
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Affiliation(s)
- Paolo Parise
- Department of General Surgery IV, Regional Referal Center for Esophageal Pathology, Pisa, Italy
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37
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Appelman HD, Umar A, Orlando RC, Sontag SJ, Nandurkar S, El-Zimaity H, Lanas A, Parise P, Lambert R, Shields HM. Barrett's esophagus: natural history. Ann N Y Acad Sci 2011; 1232:292-308. [DOI: 10.1111/j.1749-6632.2011.06057.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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38
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Sarzo G, Finco C, Parise P, Savastano S, Portale G, Vecchiato M, Degregori S, Merigliano S. Immediate and long-term complications of prolonged-venous-access devices (PVAD): A comparison between surgical cutdown and percutaneous techniques. Int J Angiol 2011. [DOI: 10.1007/s00547-004-1072-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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39
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Sarzo G, Finco C, Parise P, Vecchiato M, Savastano S, Luongo B, Degregori S, Bocus P, Marino F, Poletti A, De Lazzari F, Merigliano S. Colitis cystica profunda of the rectum: report of a case and review of the literature. Chir Ital 2005; 57:789-98. [PMID: 16400778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Colitis cystica profunda is a rare intestinal lesion. Because of its clinical expression (rectorrhagia, mucorrhea and abdominal pain) and the way it appears to current imaging techniques this disease presents features which can be associated with colon neoplasm. Its diagnosis has to be confirmed histologically, and its etiology remains unclear. The following is a case report of colitis cystica profunda recurring 20 years after a first episode in a white woman, who had had an anterior resection of the sigmoid colon and upper rectum to deal with a colitis cystica profunda-induced stenosis of the sigmoid colon and at 41 underwent the transanal removal of a polypoid lesion. A review of 20 cases in the literature showed that colitis cystica profunda has a predilection for the male and generally affects the medial and lower rectum and the sigmoid colon. The literature also confirmed the association with ulcerative rectocolitis, Crohn's disease and rectal prolapse. The type of treatment varies from surgical, medical, and endoscopic to no treatment at all.
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Affiliation(s)
- Giacomo Sarzo
- Department of Medical and Surgical Sciences, III General Surgery Clinic, Coloproctology Units, S. Antonio Hospital, University of Padua
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40
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Parise P, Sarzo G, Finco C, Savastano S, Vecchiato M, Degregori S, Merigliano S. Laparoscopic-assisted resection is safe and effective for colorectal malignancies: a single-centre experience. Chir Ital 2004; 56:811-6. [PMID: 15771035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The aim of the study was to evaluate laparoscopic-assisted colorectal resection for malignancies in terms of effectiveness, safety and medium-term survival, comparing our results with those reported in literature. From November 2000 to March 2004, 78 patients with colorectal malignancies underwent laparoscopic-assisted resection. All anastomoses were performed extracorporeally. Where indicated, patients underwent pre- or post-operative chemo-radiotherapy. All patients were followed up at regular intervals for a mean period of 18 months (2-42). The conversion rate was 14.1% and mean intraoperative blood loss was 120 cc. The post-operative morbidity rate was 15.3%. The mean number of lymph nodes removed was 12 (3-38) and all resection margins were clear and adequate. The observed overall and "disease-free" survival rates were similar to those reported in literature. Although the body of evidence needs to be increased, our findings and the data in the literature suggest that laparoscopic-assisted resection for colorectal malignancies is safe and effective, also in the medium and long term.
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Affiliation(s)
- Paolo Parise
- Clinica Chirurgica Generale III, Unità di Chirurgia colo-proctologica, Università degli Studi di Padova
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41
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Agnelli G, Verso M, Bertoglio S, Ageno W, Bazzan M, Parise P, Salvagni S, Naglieri E, Santoro A, Lazzaro A. A double-blind placebo-controlled randomized study on the efficacy and safety of enoxaparin for the prevention of upper limb deep vein thrombosis in cancer patients with central vein catheter. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G. Agnelli
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - M. Verso
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - S. Bertoglio
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - W. Ageno
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - M. Bazzan
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - P. Parise
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - S. Salvagni
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - E. Naglieri
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - A. Santoro
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
| | - A. Lazzaro
- Sezione di Medicina Interna e Cardiovascolare, Perugia, Italy; Unità Organica di Oncologia Chirurgica, Genova, Italy; Divisione di Medicina interna, Ospedale di Circolo, Varese, Italy; Divisione di Ematologia, Osp. Evangelico Valdese, Torino, Italy; Divisione di Medicina, Ospedale civico, Gubbio, Italy; Divisione di Oncologia, Parma, Italy; Unità Organica di Oncologia Medica e Sperimentale, Bari, Italy; Unità Organica di Oncologia, ospedale Humanitas, Milano, Italy; Divisione di Oncoematologia, Piacenza,
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42
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Finco C, Sarzo G, Parise P, Savastano S, De Lazzari F, Polato F, Merigliano S. Laparoscopic treatment of post-hysterectomy colovaginal fistula in diverticular disease. Case report. MINERVA CHIR 2004; 59:301-5. [PMID: 15252398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Colonic diverticular disease is a benign condition typical of the Western world, but it is not rare for even the 1st episode of diverticulitis to carry potentially fatal complications. The evolution of a peridiverticular process generally poses problems for medical treatment and exposes patients to repeated episodes of diverticulitis, making surgical treatment necessary in approximately 30% of symptomatic patients. One of the most worrying complications of diverticulosis is internal fistula. The most common types of fistula are colovesical and colovaginal, against which the uterus can act as an important protective factor. The symptoms and the clinical and instrumental management of patients with diverticular fistulas are much the same as for patients with episodes of acute diverticulitis. Staging of the disease (according to Hinchey) should be done promptly so that the necessary action can be taken prior to surgery, implementing total parenteral nutrition (TPN), nasogastric aspiration and broad-spectrum antibiotic treatment. The best surgical approach to adopt in patients with diverticulitis complicated by fistula is still not entirely clear, though the 3-step strategy is currently tending to be abandoned due to its high morbidity and mortality rates. There is a widespread conviction, however, that the 2-step strategy (Hartmann, or resection with protective stomy) and the 1-step alternative should be reserved, respectively, for patients in Hinchey stages 3, 4 and 1, 2 with a situation of attenuated local inflammation. The 1-step approach seems to be safe and effective. This report describes a case of colovaginal fistula in a patient with colonic diverticulosis who had recently undergone hysterectomy, but who, unlike such cases in the past, was treated in a single step using a laparoscopic technique.
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Affiliation(s)
- C Finco
- Department of Medical and Surgical Sciences, IV General Surgical Clinic, University of Padua, Padua, Italy
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43
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Sarzo G, Finco C, Parise P, Savastano S, Vecchiato M, Degregori S, Merigliano S. Insertion of prolonged venous access device: a comparison between surgical cutdown and percutaneous techniques. Chir Ital 2004; 56:437-42. [PMID: 15287644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The use of totally implantable prolonged venous access devices (TIPVAD) in chemotherapy for oncological patients is now consolidated practice, whereas the choice between surgical cutdown and the percutaneous technique is still a controversial matter. The aim of this study was to retrospectively evaluate the validity and safety of the surgical approach by comparison with percutaneous techniques. Over a period of 17 months, 106 patients (mainly oncological cases) underwent surgical cutdown for TIPVAD placement in the cephalic vein. During a mean follow-up of 8 months (range 1-21), we evaluated the surgical and management complications and compared them with reported results obtained with the percutaneous technique. We observed a lower incidence of pneumothorax, 2 cases of malfunction due to kinking, and no catheter fractures, while management complications were similar to the findings in the literature. In expert hands, the surgical approach is a fast, safe technique with a lower rate of intraoperative complications than the percutaneous approach and less discomfort for the patient. Adequate training of medical and paramedical staff is the most important factor in making TIPVAD reliable and safe in the long term.
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Affiliation(s)
- Giacomo Sarzo
- Department of Medical and Surgical Sciences, 3rd General Surgery Clinic, Coloproctology Units, S. Antonio Hospital, University of Padua
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44
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Parise P, Sarzo G, Finco C, Marino F, Savastano S, Merigliano S. Giant condyloma acuminatum of the anorectum (Buschke-Lowenstein tumour): a case report of conservative surgery. Chir Ital 2004; 56:157-61. [PMID: 15038663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Giant condyloma acuminatum of the anorectum (Buschke-Lowenstein tumour) is a rare interesting infectious disease caused by the papillomavirus serotypes 16 and 18. In January 2002 a 47-year-old heterosexual male presented with Buschke-Lowenstein tumour and reported having had the disease for 12 years. The patient underwent thorough screening for sexually-transmitted diseases (which proved negative), abdominal CT, transanal US-endoscopy, inguinal ultrasound, chest X-ray and anorectal manometry, which revealed only localized disease. He was treated conservatively with radical local excision of the lesions. No postoperative complications were observed. Twelve months after surgery, there has been no local or remote recurrence and faecal continence is normal. The treatment of choice for Buschke-Lowenstein tumour is controversial; there is no evidence to support the need for demolitive surgery or chemo- and/or radiotherapy. The majority of authors prefer abdominoperineal amputation, but in our opinion conservative surgery is the best choice, especially in terms of the patient's quality of life.
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Affiliation(s)
- Paolo Parise
- Università di Padova, Dipartimento di Scienze Mediche e Chirurgiche, Clinica Chirurgica III, Unità di Chirurgia Colo-proctologica, Ospedale S. Antonio
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45
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Sarzo G, Finco C, Parise P, Savastano S, Degregori S, Marino F, Candiani F, Merigliano S. Role of transperineal Doppler and ultrasound in evaluating anal sphincter injury after stapled haemorrhoidopexy. Chir Ital 2004; 56:99-105. [PMID: 15038654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The stapler treatment first described by Longo is considered by some authors to be a good technical solution for mucohaemorrhoidectomy. The aim of the present prospective study was to assess the function and morphology of the internal and external anal sphincters preoperatively and one month after surgery by means of a clinical examination, anorectal manometry and transperineal ultrasound. Ten patients (6 M, 4 F) underwent rectal mucosal prolapsectomy according to Longo. Anoscopy, anorectal manometry and transperineal ultrasound were performed in all patients preoperatively and again one month after surgery. The thickness and integrity of the internal and external anal sphincters were ascertained and colour Doppler was performed to assess the presence, quantity and size of any haemorrhoid swellings. All anatomical specimens underwent histological examination in search of smooth muscle fibres. Anorectal manometry revealed no postoperative sphincter tone defects. Transperineal ultrasound detected no postoperative sphincter lesions and the presence of venous swellings (always present at preoperative colour Doppler) never persisted at postoperative follow-up. The mean follow-up was 52.7 days (range: 31-151). Transperineal ultrasound proved useful in demonstrating the lifting of the mucohaemorrhoid prolapse within the ampulla of the rectum one month after surgery. The Longo procedure, in our albeit limited experience, caused no sphincter lesions.
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Affiliation(s)
- Giacomo Sarzo
- University of Padua, Department of Medical and Surgical Sciences, 3rd General Surgery Clinic, Coloproctology Units, S. Antonio Hospital
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Finco C, Sarzo G, Parise P, Savastano S, Merigliano S. [Advantages of surgical treatment of hemorrhoids with mechanical sutures]. Chir Ital 2002; 54:835-9. [PMID: 12613332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The use of circular staplers for the treatment of haemorrhoids is a new technique that makes for better correction of the physiopathology of the condition, affords greater patient comfort and reduces health-care expenditure. This technique, which was invented by A. Longo in 1993, pulls up the haemorrhoidal cushions into their anatomical position, reduces or avoids postoperative pain, sparing the sensitive fibres of the anal canal, avoids anal canal stenosis and is not complicated by faecal incontinence. The authors present their experience in 41 patients affected by symptomatic haemorrhoidal prolapse and treated with a mucosal rectal prolapsectomy using a circular stapler. Each patient was followed up for 6 months to assess the incidence of complications and the degree of patient satisfaction. The results were compared with those reported in the literature, obtained using the Milligan-Morgan procedure. The Longo technique, which can be performed in the one-day surgery setting, allows very good relief of postoperative pain, rapid functional recovery and an early return to work, with a saving in health-care expenditure as compared with conventional treatment.
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Affiliation(s)
- Cristiano Finco
- Clinica Chirurgica Generale IV U.O. Funzionale di Chirurgia Colo-proctologica Dipartimento di Scienze Mediche e Chirurgiche Università degli Studi di Padova, ASL n. 16, Via Facciolati 71, 35127 Padova
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Baldan N, Rigotti P, Furian L, Valente ML, Calabrese F, Di Filippo L, Parise P, Sarzo G, Frison L, Ancona E. Pancreas preservation with Celsior solution in a pig autotransplantation model: comparative study with University of Wisconsin solution. Transplant Proc 2001; 33:873-5. [PMID: 11267111 DOI: 10.1016/s0041-1345(00)02358-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- N Baldan
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Padova, Padova, Italy
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Rigotti P, Cadrobbi R, Baldan N, Sarzo G, Parise P, Furian L, Marchini F, Ancona E. Mycophenolate mofetil (MMF) versus azathioprine (AZA) in pancreas transplantation: a single-center experience. Clin Nephrol 2000; 53:suppl 52-4. [PMID: 10809437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
AIM Advances in immunosuppression and careful monitoring for rejection are largely responsible for improved results in pancreas transplantation. We conducted a retrospective study to establish the effectiveness of immunosuppressive therapy with mycophenolate mofetil (MMF) instead of azatioprine (AZA) in pancreas transplantation and to assess adverse effects in the two different immunosuppressive regimes. SUBJECTS AND METHODS Since 1991, 27 pancreas transplantations were performed in 25 patients at our Institute. For induction therapy, immunosuppressant protocol consisted of quadruple immunosuppressive therapy with cyclosporine, steroids, antilymphocyte globulin and AZA in 13 patients or MMF in 12 patients respectively. RESULTS Acute rejection occurred in 76% of patients in the AZA group compared with 53% in the MMF group. Steroid-resistant rejection was observed in 7% in the MMF group compared to 38% of patients on AZA (p < 0.01). Two kidney grafts were lost due to acute rejection in the AZA group, one pancreas was lost due to acute rejection and one to chronic rejection in the MMF group. There were no significant differences in CMV infection. Severe fungal infections were noted in 2 patients treated with MMF. Malignancy occurred in 1 patient (pancreas graft lymphoma) in MMF. CONCLUSIONS In conclusion, patients treated with MMF required less frequent and less intensive treatment for acute rejection. However, its short- and long-term side effects should be further investigated.
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Affiliation(s)
- P Rigotti
- Department of Medical and Surgical Sciences, University of Padova, Italy
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Mussoni L, Mannucci L, Sirtori C, Pazzucconi F, Bonfardeci G, Cimminiello C, Notarbartolo A, Scafidi V, Bittolo Bon G, Alessandrini P, Nenci G, Parise P, Colombo L, Piliego T, Tremoli E. Effects of gemfibrozil on insulin sensitivity and on haemostatic variables in hypertriglyceridemic patients. Atherosclerosis 2000; 148:397-406. [PMID: 10657576 DOI: 10.1016/s0021-9150(99)00283-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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: 11/15/2022]
Abstract
In order to assess the efficacy of gemfibrozil on lipid and haemostatic parameters in patients with plurimetabolic syndrome, a multicenter double-blind placebo controlled, parallel study was carried out in 56 patients with primary hypertriglyceridemia and glucose intolerance. These patients had elevated PAI activity and antigen and t-PA antigen levels at rest and after venous occlusion. Gemfibrozil reduced plasma triglyceride levels (P<0.001), whereas it increased free fatty acids (P<0.05) and high density lipoprotein cholesterol levels (P<0.05). In those patients reaching normalization of plasma triglyceride levels (triglyceride reduction > or =50%) (n=15), insulin levels (P<0.05) as well as the insulin resistance index were reduced by gemfibrozil treatment, suggesting an improvement of the insulin resistance index in this patient subgroup. Gemfibrozil treatment did not affect plasma fibrinolysis or fibrinogen levels, despite marked reduction of plasma triglycerides and improvement of the insulin sensitivity associated with triglyceride normalization.
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Affiliation(s)
- L Mussoni
- Institute of Pharmacological Sciences and E. Grossi Paoletti Center, Via Balzaretti, 9, University of Milan, 20133, Milan, Italy
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50
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Baldan N, Parise P, Furian L, Savio ML, Valente ML, Calabrese F, Venturini R, Girotto A, Rigotti P. Swine pancreas preservation with Celsior solution. Transplant Proc 2000; 32:29-31. [PMID: 10700955 DOI: 10.1016/s0041-1345(99)00863-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- N Baldan
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Padova, Italy
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