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Chierici A, El Zibawi M, Liddo G, Anty R, Granieri S, Chevallier P, Iannelli A. Multimodal treatment confers best overall survival results in patients with huge hepatocellular carcinoma: a systematic review and network meta-analysis. HPB (Oxford) 2024:S1365-182X(24)01258-9. [PMID: 38702254 DOI: 10.1016/j.hpb.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/18/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Huge (>10 cm) hepatocellular carcinoma is burdened by elevated mortality due to its peculiar characteristics and delayed diagnosis. Liver resection is considered the gold standard although survival is poor. Recently, some different strategies have been evaluated to improve results in tumor recurrence and survival. The aim of this research is to identify which strategy offers the best results in terms of overall survival for resectable huge hepatocellular carcinoma. METHODS A systematic review and network meta-analysis of 13 studies was conducted from PubMed, Embase, Scopus, Cochrane Library, and Web of Science databases including research comparing two or more treatments to manage huge hepatocellular carcinoma. Results were synthesized through forest plots and risk of bias assessed with the CINeMA framework as recommended. RESULTS The association of liver resection and transcatheter arterial chemoembolization confers a significant improvement in survival compared to liver resection alone (HR: 0.55) while transcatheter arterial chemoembolization, radioembolization, and ethanol ablation alone were associated to decreased overall survival. Within-study bias, indirectness and incoherence were the domains mainly affected by concerns in risk of bias analysis. CONCLUSION Multimodal treatment including liver resection and transcatheter arterial chemoembolization increases survival in patients with resectable huge hepatocellular carcinoma.
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Affiliation(s)
- Andrea Chierici
- Centre Hospitalier Universitaire de Nice- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Mohamed El Zibawi
- Department of Radiology, University Hospital Centre Nice, Nice, France
| | - Guido Liddo
- Centre Hospitalier Universitaire de Nice- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Rodolphe Anty
- Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", France; Université Côte d'Azur, Digestive Center, Centre Hospitalier Universitaire, Archet 2 Hospital, Nice, France
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Patrick Chevallier
- Department of Radiology, University Hospital Centre Nice, Nice, France; Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", France.
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Spota A, Granieri S, Ferrario L, Zamburlini B, Frassini S, Reitano E, Cioffi SP, Altomare M, Bini R, Virdis F, Chiara O, Cimbanassi S. Injury Patterns of Electric-Scooter Related Trauma: A Systematic Review With Proportion Meta-Analysis. Am Surg 2024:31348241241682. [PMID: 38532248 DOI: 10.1177/00031348241241682] [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] [Indexed: 03/28/2024]
Abstract
Electric scooter (ES)-related injuries are increasing but poorly described. Clinicians need more information to be prepared for these patients. We supposed two prevalent patterns of patients: mildly injured (predominant upper-limb injuries) and severely injured (predominant head trauma). This study aims to understand the frequency of ES-related injuries and patients' characteristics despite the heterogeneity of data currently available. A systematic review with a proportion meta-analysis was conducted on studies with a multidisciplinary description of ES-related injuries in adult patients (PROSPERO-ID: CRD42022341241). Articles from inception to April 2023 were identified in MEDLINE, Embase, and Cochrane's databases. The risk of bias was evaluated using ROBINS-I. Twenty-five observational studies with 5387 patients were included in the meta-analysis, depending on reported data. Upper-limb (31.8%) and head (19.5%) injuries are the most frequent (25/25 studies included). When injured while riding, 19.5% of patients are intoxicated with drugs/alcohol, and only 3.9% use a helmet, increasing the possibility of severe injuries. About 80% of patients are victims of spontaneous falls. Half of the patients self-present to the ED, and 69.4% of cases are discharged directly from the ED. Studies' limitations include an overall moderate risk of bias and high heterogeneity. Electric scooter-related accidents are commonly associated with upper-limb injuries but often involve the head. Spontaneous falls are the most common mechanism of injury, probably related to frequent substance abuse and helmet misuse. This hot topic is not adequately investigated due to a lack of data. A prospective registry could fill this gap.
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Affiliation(s)
- Andrea Spota
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Luca Ferrario
- General Surgery Department, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milano, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Università Degli Studi di Milano, Milano, Italy
| | | | - Simone Frassini
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
- General Surgery Residency Program, University of Pavia, Pavia, Italy
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Stefano Pb Cioffi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Roma, Italy
| | - Michele Altomare
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Roma, Italy
| | - Roberto Bini
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
| | | | - Osvaldo Chiara
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, State University of Milan, Milano, Italy
| | - Stefania Cimbanassi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, State University of Milan, Milano, Italy
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Omoshoro-Jones J, Ielpo B, Abdelmageed A, Sandström P, Cristaudi A, Gloor B, Kuemmerli C, Tishreen AH, Chaaban MK, Wu CH, Jen PCYF, Baraket O, Taylor M, Jamieson N, Iype S, Giorgakis E, Qadan M, Ganai S, Al-Naggar H, Chihaka O, El Behi A, Kouicem AT, Chibane A, Bouzid C, Bentabak K, Bouali I, Samai N, Aya B, Drid B, Tidjane A, Tabeti B, Boudjenan-Serradj N, Larbi MH, Ouahab I, Touabti S, Ilhem O, Bouaoud S, Meriem A, Ouyahia A, Kouicem AT, Abdoun M, Mounira R, Rais M, Riffi O, Kacimi SE, McCormack L, Capitanich P, Goransky J, de Santibanes M, Mazza O, Salazar IP, Ramallo DR, Pablo F, Gondolesi GE, Schelotto PB, Rodriguez J, Apostolou C, Merrett N, Fox A, Hassen S, Joglekar S, Gananadha S, Wake R, Hagen K, Sritharan M, Hall K, Muralidharan V, Brown K, Nikfarjam M, Croagh D, Sritharan M, Berry R, Fayed A, Hodgson R, Kuany T, Loveday B, Banting S, Rowcroft A, Fox A, Knowles B, Taylor L, Chong L, Banting S, Perini M, Nikfarjam M, Lin YJ, Alsoudani A, Burnett D, Shah K, Fuge M, Bull N, Chen S, Navadgi S, Ng ZQ, Johansson M, Azaman NSBB, Pearson A, Apostolou C, Mischinger H, Schemmer P, Kornprat P, Hauer A, Hauer A, Kirbes K, Klug R, Schrittwieser R, Klaus A, Entschev A, Reichhold D, Ugrekhelidze K, Fink M, Stoyanova R, Sabateen M, Mahfoodh Z, Shenawi HA, Yaghan R, Chowdhury M, Shcherba A, Kirkovsky L, Korotkov S, Van den Bossche B, Boterbergh K, Poortmans M, Smet B, Strypstein S, Feryn T, Wahib EM, oubella S, Roeyen G, Hartman V, Bracke B, Hendrikx B, Gryspeerdt F, Berrevoet F, Poortmans N, Apers T, Appeltans B, Appeltans B, Wicherts D, Sergeant G, Garcia FOB, dos Santos IB, Garcia R, Pinto R, Leite TLS, Anghinoni M, Nobre CCG, Coelho G, Machado IFS, Carvalho N, Morais L, Barros AV, Gomes G, Buarque IL, Osvaldt AB, Militz M, Boff M, Marcelino L, Guerra E, Torelly L, Waechter FL, Rodrigues P, Teixeira UF, Osvaldt A, Marcelino L, Militz M, De Mello E, Goncalves R, Balzan S, Ramos EJB, Moraes-Junior JMA, Torres OJM, da Silva DV, Coimbra F, Coimbra FJF, Marques N, Marques N, Torres SM, Sampaio A, Canteras CA, Ferreira F, Machado MA, Kleinubing D, Lellis L, Brum SL, Gohar M, Atanasov B, Slavchev MT, Slavchev M, Belev N, Krastev P, Takorov I, Vladov N, Kostadinov R, Lukanova T, Mihaylov V, Chernopolsky PM, Madjov R, Bozhkov VM, Kostov VD, Kostov D, Nikolaev E, Muhezagiro F, Niyonkuru J, Irakoze P, Dixon E, Lo E, Ruo L, D'Souza D, Serrano PE, Skaro A, Tang E, Glinka J, Martin J, Zogopoulos G, Metrakos P, Chaudhury P, Torres-Quevedo R, Brañes A, Brañes A, Diaz C, Buckel E, Butte J, Devaud N, Paqui L, Wei K, Wang H, Cai L, Guo S, Chen Y, Hendi M, Cheung TT, Millan C, Argüello P, Pavlek G, Silovski H, Petrovic I, Romic I, Zedelj J, Amic F, Kolovrat M, Rakic M, Mikulic D, Štironja I, Bubalo T, Gouvas N, Papatheodorou P, Christophides T, Burda L, Straka M, Klos D, Tesarikova J, Loveček M, Gregorik M, Skalicky P, Stögerová C, Fichtl J, TomአS, Zaruba P, Nikov A, Tschuor C, Mohamed M, Sayed B, Shaheen A, Farid A, Attalla A, Ibrahim DF, Fathallah D, Elmzaien E, Magdy B, Salah S, Saleh A, Saker AAE, Swealem A, Sallam EI, Rozza H, Bassiony M, Elhassan M, Elmalah M, Belal M, El Gohary M, Hassanin MA, Elsayed N, Aboelfath S, El-Sayes I, Tayiawi M, Altatari A, Altatari AM, Saleh A, Qatora MS, Said M, Najjar A, Alahmed F, Zamri FMB, Ealreibi H, Alahmed H, Alyasin I, Abdelhalim K, Alfatah MA, Sharaan MA, El Moneam MA, Abdelalemm M, Mourad M, Sohaimee NB, Abosamak NE, Suhaimi NMFB, Shokralla S, Dean YE, Tanas Y, Waffa Z, Nafea A, Ramadan D, Abdelaal A, Mahmoud A, Nafea AM, Abuali ASAME, Korayem I, Fahmy M, Ibraheem M, Hamouda M, Helaly R, Khdour YF, Khdour Y, Farag M, Ibrahim A, Elareibi HE, Alboridy M, Mansour A, Ragab MG, Naguib M, Allam S, Elfarag HA, Elsakka A, Mannaa D, Elkeleny M, Suhaimi NAB, Uzir SSBM, Nasr S, El-Najjar A, Dohien M, Dohien M, Osman N, Gad N, Hassanin M, Fadel BA, Hamdan EHM, Monib F, Saad M, Abbas A, Abu-Elfatth AM, Elazeem HAA, Abdelhafez MHZ, Omar N, Hassan R, Mohamed A, Mahmoud SH, Abobakr AM, Mohamed EEE, Ahmed R, Hamza HM, Mohammed M, Marshod MA, Hussein AMM, Taha A, Ibrahim I, Nageh MA, Fouly MN, Hassan RA, Mohamed AKA, Elnabi MH, Salah M, Ali AYM, Sayed EGA, Sayad R, Saad MM, Abdelkarem M, Omar NG, Khalifa A, Faragalla H, Barakat A, Barakat ATM, Elshafey A, Eleisawy MF, Eleisawy M, Zahed MSM, Zahed M, Omer M, Allam M, Abuelnaga Y, Abdelzaher A, Alnimr A, Dabbous H, Sayed H, Elgarhy I, Elmeteini M, Bahaa M, Farag M, Eid M, Anas O, Ismail O, Nageeb O, Lasheen R, Tanyous S, Diab S, Badran Y, Fahim A, Alazab E, Elgarhy IM, Abdeljalil M, Hanna M, Gobran M, Gobran M, Abdelmawla MOMK, Nagy M, Nageeb OE, Ramadan S, Abdelmawgoud S, Zidan T, Abuelnaga Y, Tarkhan Y, Saad A, Awad AK, Elbadawy MA, Abdelmawla M, Mansy E, Moharam M, Elabd M, Eldabour A, Elwakil L, Hassanien MS, Elnashar A, Saleh HED, Michail M, Said A, El Garhy M, Ahmed MBE, Anas O, Ismail O, Abboud K, Nabil A, Elfiky M, Murad A, Azzam A, Azab MA, Awad S, Othman Z, Fahim AM, Abdelzaher AT, Zidan T, Abdelrhman R, Tolis EAN, Salem M, Ebrahim H, Abdelrazek HA, Abdelmoneim N, Salman D, Saa'd H, Ali D, Farouk A, Mandor AR, Monier A, Shehta A, Kassem A, Sanad A, Elsaadany R, Shaat MM, Elmorsi R, Awad S, Ghedan S, Menessy A, Elnabawy D, Abdou K, Abdelmaksoud M, Hassan M, Elweza O, Elboraei R, Abdallah A, Metwally IH, Elhamamsy M, Fareed AM, Zuhdy M, Elbalka SS, Alansary MN, Omar M, Elgharably AA, Hager E, El Gady A, Alsharif DS, Shaaban AM, Alsharif D, Samaan D, Samaan SSS, Oteem A, Shaaban AM, Alsharif DS, Samaan S, Zayed A, Allam A, El Gady A, Alsharif DS, Badr K, Elnoamany S, Samaan SS, Ellibady M, Ahmed EA, Elbassyiouny A, Boalot A, Badr H, Gamal M, Abuelazm M, Othman Z, Eldaly A, Eldaly AS, Essa M, Abdelrahman F, Sarhan A, Alsabbagh F, Allah MA, Bayomi A, Salama M, kivisild M, Tammik O, Podramagi T, Huhta H, Kauppila JH, Nortunen M, Jouffret L, Sommacale D, Brustia R, Cherif R, Lecolle K, El Amrani M, Beugniez C, Truant S, Piessen G, Degisors S, Dupré A, Perinel J, Adham M, Sgarbura O, Souche FR, Iannelli A, Gugenheim J, 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D, Avgerinos K, Ioannidis A, Konstantinidis KM, Konstantinidis MK, Papakonstantinou D, Papiri I, Michalopoulos N, Petropoulou Z, Christodoulou S, Margaris I, Chatzialis I, Selmani J, Papadoliopoulou M, Arkadopoulos N, Kokoropoulos P, Vassiliu P, Parasyris S, Sidiropoulos T, Stamopoulos P, Stergiou D, Sotiropoulou M, Vaslamatzis M, Roukounakis N, Kapiris SA, Kapiris SA, Vougas V, Roukounakis N, Dimitroulis D, Mantas D, Kotsifa E, Kotsifa E, Tomara N, Tomara NK, Machairas N, Dorovinis P, Kykalos S, Tsirlis T, Larentzakis A, Vrakopoulou GZ, Tzimas G, Pagkratis S, Triantafyllidis I, Papalampros A, Polydorou A, Syllaios A, Kontopoulou C, Politis D, Vouros D, Schizas D, Kyros E, Felekouras E, Karavokyros I, Griniatsos J, Bramis K, Toutouzas K, Karydakis L, Konstadoulakis M, Memos N, Kanavidis P, Massaras D, Fragulidis G, Frountzas M, Kordeni K, Vezakis A, Iliakopoulos K, Chardalias L, Kyriazanos I, Kyriazanos I, Marougkas M, Stamos N, Giannakopoulos T, Kalles V, Balalis D, Manatakis D, Korkolis D, Bourazani M, Delis S, Cyrochristos D, Baltagiannis E, Glantzounis G, Stylianidis S, Diamantis A, Valaroutsos A, Magouliotis D, Zacharoulis D, Christodoulidis G, Tepetes K, Perivoliotis K, Fergadi M, Tsiotos G, Mulita F, Maroulis I, Vailas M, Zygomalas A, Karavias D, Kontis E, Katsaros I, Kopanakis N, Tooulias A, Christou C, Raptis D, Katsanos G, Beradze N, Papaziogas V, Papadopoulos VN, Giakoustidis D, Katsourakis A, Efthymiou E, Chatzis I, Ntinas A, Hatzitheoklitos E, Tsalis K, Koustas P, Apostolos K, Petras P, Tsaramanidis S, Iakovidis C, Zacharakis E, Marjai T, Bursics A, Dede K, Tölgyes T, Vereczkei A, Kelemen D, Robert P, Vasavada B, Vaishnav D, Pawar P, Suryawanshi P, Shinde RM, Piplani C, Singh A, Sahu SK, Choudhary SR, Gupta R, Ramamurthy A, Babu E, Karuparthi S, Kumar S, Purushothaman G, Sathyanesan J, Venkatesh NR, John S, Singh AK, Gupta R, Singh SK, Sharma D, Yadav K, Leekha N, Pippari R, Pandey M, Francis NJ, Kumar T, Jain S, Poonia DR, Vishnoi JR, Sharma N, Pareek P, Byshetty R, Misra S, Varshney V, Ray R, Gulati S, Ghatak S, Das K, Khamrui S, Ray S, Sebastian GM, Chand JT, Appukuttan M, Chaturvedi A, Akhtar N, Prakash P, Gupta S, Rajan S, Kumar V, Sonkar AA, Ozair A, Suresh V, Virk S, Narasimhan M, Ardhanari R, Ramachandran S, Jain D, Velagala JR, Chattopadhyay S, Vodyala C, Velagala JR, Motwani K, Prajapati R, Tilak S, Bansal V, Kalayarasan R, Bhalerao S, S IP, Chisthi MM, A N, Latheef A, Yadev I, Sreekumar RC, Yadev I, KV V, Pandey D, Tripathi M, Fuadi AF, Prabowo E, Abbood AH, Hammoodi H, Al-juaifari MA, Al-Isawi A, Al-Tekreeti S, Al-Ogaili M, Hashim HT, Sadot E, Apel R, Sulimani O, Solomonov E, Itzhaki O, Lavy R, Shapira Z, Nicolini D, Vivarelli M, Rossi MDR, Mocchegiani F, Memeo R, Vincenti L, Fedele S, Andriola V, Gurrado A, Meo GD, Testini M, Neri V, Zironda A, Trizzino A, Pinelli D, Colledan M, Pizzini P, Cirelli R, Masetti M, Zanello M, Jovine E, Mastrangelo L, Lombardi R, Casadei R, Malpaga A, Frena A, Patauner S, Ciola M, Andreuccetti J, Manzoni A, Hilal MA, de Graaf N, Alfano MS, Molfino S, Baiocchi GL, Pisanu A, Mellano A, Papa MV, Carlo ID, Donati M, Zanatta M, Basile PF, Antonucci A, Papis D, Pighin M, Celotti A, Sasia D, Allisiardi F, Borghi F, Maione F, Giraudo G, Migliore M, Salomone S, Giaccardi S, Testa V, Giacometti M, Zonta S, Taddei A, Risaliti M, Muiesan P, Urciuoli I, Bencini L, Moraldi L, Anastasi A, Canonico G, Nelli T, Storto GL, D'Acapito F, Ercolani G, Solaini L, Cucchetti A, Gardini A, Pacilio CA, Barberis A, Filauro M, De Cian F, Valente R, Didomenico S, Papadia FS, Di Domenico S, De Rosa R, Massobrio A, Scabini S, Carganico G, Pessia B, Sista F, Schietroma M, Spampinato MG, Garritano S, D'Ugo S, Marchese T, Saladino E, Cuticone G, Gullá N, Recordare A, Palumbo R, Giani A, Ferrari G, Mazzola M, Dondossola D, Rossi G, Caccamo L, Zerbi A, Nappo G, Montorsi M, Coppa J, Busset MDD, Mazzaferro V, Troci A, Frontali A, Crespi M, Baldi C, Benuzzi L, Ferrara F, Stella M, Capurso G, Falconi M, Tamburrino D, Benedetto FD, Magistri P, Ballarin R, Zanus G, Brizzolari M, Uggeri F, Gianotti L, Cereda M, Ferraro D, Iacomino A, Ferraro D, Pisaniello D, Vennarecci G, Pisaniello D, Rompianesi G, Troisi RI, Patrone R, Belli A, Izzo F, Palaia R, Gianpaolo M, Maida P, Pasquale T, Bassi D, Cillo U, Moletta L, Sperti C, Serafini S, Milanetto AC, Pasquali C, Tolin F, Gruppo M, De Simoni O, Buscemi S, Marino MV, Giuffrida M, Dallavalle R, Calabretto F, Cobianchi L, Pugliese L, Giardino A, Butturini G, Regi P, Kauffmann EF, Di Franco G, Morelli L, Furbetta N, Napoli N, Boggi U, Pinotti E, Montuori M, Giuliani A, Izzo ML, Zanini N, Veneroni L, Giordano M, Palini GM, Garulli G, Vaccara VL, de Rose AM, Giuliante F, Ardito F, Mingoli A, Sapienza P, Lapolla P, Petrucciani N, Cossa A, Coppola A, Belloni E, Nigri G, Tisone G, Angelico R, Manzia TM, Caputo D, Saverio SD, Porcu A, Perra T, Feo C, Deiana G, Sartarelli L, Pisconti S, Tonini V, Patrono D, Moro F, Grasso L, Brolese A, Ciarleglio F, Marcucci S, Nistri C, Massani M, Tommaso S, Galasso E, Zanus G, Brizzolari M, Romano M, Rossi S, Novello S, Ferrero A, Langella S, Armentano S, Russolillo N, Dario L, Intini S, Giovanni T, Recordare AG, Pirozzolo G, Palumbo R, Calabrese F, Querini G, Zonta S, Caneparo A, Giacometti M, De Francesco M, Balduzzi A, Guglielmi A, Ruzzenente A, Iacono C, Poletto E, Marchegiani G, Isa G, Malleo G, Alaimo L, Salvia R, Conci S, Crinò SF, Campagnaro T, Frigerio I, De Marchi F, Bonomo M, Napetti S, Frontali A, Chierici A, Cotsoglou C, Gjoni E, Paleino S, Granieri S, Hashimoto D, Satoi S, Yamamoto T, Uemura K, Matsumoto I, Kamei K, Maehira H, Tani M, Hirano S, Nakamura T, Asano T, Akahoshi K, Tanabe M, Ishii T, H Al Saffaf M, Hamoud MA, Khattab R, Alissawi S, Hassouneh A, Al-Maadani B, Alali MB, Hmdan QA, Obed A, Nijadat D, Al-Shami K, Al-shami M, Mohsen M, Al-Mallah R, Albaba S, Theab M, Massadeh N, Theab RAK, Wardeh S, Salahwardeh, Alissawi SZ, Mardini A, Arabiyat HAA, Arabiyat H, Al-Hyari A, 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Dugalic V, Arbutina D, Milic L, Bezmarevic M, Antic A, Radenkovic D, Ignjatovic I, Zdujic P, Kmezic S, Karamarkovic A, Arbutina D, Juloski J, Radulovic R, Radulović R, Cuk V, Jeremic L, Radojkovic M, Stojanovic M, Golijanin D, Ignjatovic MK, Protic M, Chiow A, Seng LL, Thiruchelvam N, Poh BGK, Goh BKP, Quan DCW, Koh YX, TrotovŠek B, Petrič M, Djokić M, Tomazic A, Badovinac D, Loots E, Prodehl L, Khan MU, Marumo T, Devar JWS, Omoshoro-Jones J, Khan ZA, Jugmohan B, Valcarcel AQ, García BM, Mínguez J, Marcello M, Ramia J, Compañ A, Fernandes C, Morales M, Fernández JMV, Del Mar Rico-Morales M, Liñán MÁL, Figueras J, Soliva R, Butori E, Fondevila C, Ausania F, Martín B, Rodríguez M, Sánchez-Cabús S, Sánchez-Velázquez P, Arnau ABM, Domínguez RS, Ielpo B, Pinilla FB, Castro M, Valverde DP, Santos EPG, del Carmen Manzanares Campillo M, Ruiz P, Gutierrez EC, Falgueras L, Quer MTA, Shwely FA, Fragua RL, Gonzalez-Serna DB, Valmorisco MA, Beltran-Miranda P, Busquets J, Secanella L, Pelaez N, Plaza G, Duaigües MLG, álvarez PM, Escartín A, Loinaz C, Dziakova J, de la Serna S, Pérez-Aguirre E, Justo I, Saavedra J, Gomez JC, Boñar NL, Martín-Perez E, Di Martino M, de la Hoz Rogriguez Á, Marcacuzco A, Jiménez-Romero C, de la Rúa JFR, Hinojosa-Arco LC, Suárez-Muñoz MÁ, Martinez DF, Sanchez-Bueno F, Vazquez PG, de León AM, Saiz EC, García LS, Gonzalez-Pinto I, Rodríguez-Pino JC, Segura-Sampedro JJ, Morales R, Morales-Soriano R, Rotellar F, Zozaya G, Martí-Cruchaga P, López-Sánchez J, Muñoz-Bellvis L, Cuadrado A, ortega I, Fernández R, Gómez DD, Vera V, Padillo JP, Luque JB, Millan EI, Jorba R, García-Domingot MI, Redondo C, Cantos DM, Artigues E, Pozo CDD, Llorente CP, Martínez SN, Ibáñez CB, Ibáñez JM, Andujar RL, Dorcaratto D, Forner EM, Garces-Albir M, de Heredia JB, Montes-Manrique M, Rodriguez-Lopez M, Serrablo A, Milian D, Ruiz-Quijano P, Paterna-Lopez S, Dharmapala A, Dassanayake BK, Galketiya KB, Ibrahim AM, Hamid H, Alhaboob N, Abdelmageed A, Taha SSO, Vilhav C, Wennerblom JH, Bratlie SO, Bjornsson B, Lundgren L, Sandström P, Tingstedt B, Andersson R, Andersson B, Williamsson C, Sparrelid E, Holmberg M, Ghorbani P, Gkekas I, Kuemmerli C, Bolli M, Andreou A, Wenning AS, Gloor B, Peloso A, Toso C, Oldani G, Moeckli B, Wassmer CH, Cristaudi A, Pietro MH, Majno-Hurst PE, Roesel R, Abbassi F, Tarantino I, Steffen T, Ferrari C, Schmidt J, Meier O, Weber M, Gutknecht S, Jonas JP, Clavien PA, Al-Haj A, Aljaber A, Kayali AA, Kadoura L, Nashed E, Helaly H, Kayali H, Alhashemi M, Aloulou M, Alshaghel M, Mahli N, Al-Abed O, Azizeh O, Torab SS, Alkhaleel W, Aliwy MA, Alannaz O, Ghazal A, Masri R, Douba Z, Saad AS, Abdulmonem A, Shaban M, Alhouri AN, Alhouri A, Soliman A, Houri HNA, Houri HA, Omran S, Abbas A, Chaaban M, Kudmani MAA, Chaaban MK, Alhmaidi R, Yousef A, Youssef A, Nasri M, Alkhateb H, Almjersah A, Hassan N, Moussa A, Hamdan A, Hammed A, Alloush A, Hassan BH, Issa H, Dahhan HT, Souliman M, Hammed S, Tobba TM, Hamdan A, Ayoub S, Yu MC, Yang PC, Wu CH, Bouaziz H, Rahal K, Slim S, Karim A, Baraket O, Kchaou A, Houssem A, Said MA, Mabrouk MB, Hamida KB, Ghalleb M, Mahmoud AB, Maghrebi H, Kacem MJ, Tez M, Eminesariipek N, çetiindağ Ö, Tüzüner A, Karayalçin K, Emral AC, Dikmen K, Kerem M, Bayhan H, Türkoğlu MA, Iflazoğlu N, özet A, Aday U, öfkeli Ö, Gumusoglu A, Kabuli HA, Karabulut M, Peker K, Saglam S, Rahimi FSİ, Hanefa F, Isik A, Goksoy E, Dulundu E, Atici AE, Ozocak AB, Yegen C, Dural AC, Sahbaz NA, Ulgur HS, Aydin H, Ozkan OF, Duzgun O, çelik M, Pekmezci S, çoker A, Uguz A, Unalp OV, Sert I, Ertekin S, Ozbilgin M, Aydoğan S, Tekin E, Calik B, Yesilyurt D, Atici SD, Arıkan TB, Arıkan T, Gonullu E, Dikicier E, Capoglu R, Bayhan Z, Alfurais S, Colak E, Polat S, Çiftci AB, Milburn J, Jones C, Vass D, Taylor M, Dasari BVM, Kausar A, Sultana A, Subar D, Nunes Q, Skipworth J, Nwogwugwu O, van Laarhoven S, Kourdouli A, Awan AA, Bhatti I, Latif J, Hand F, Robertson F, Holroyd D, Holroyd D, Jamieson N, Lim W, Chang D, Frampton A, Lahiri R, Chakravartty S, Siddique H, Bashir M, Mcnally S, Young A, Smith A, Pine J, Garcea G, Haqq J, Malde D, Dunne D, Burridge I, Szatmary P, Hariharan D, Kocher H, Yip V, Khalil A, Nair AM, Liova I, O'Balogun A, Rothnie A, Chikkala B, Salinas CH, Frola C, Tsakiris C, Raptis D, Chasiotis D, Sharma D, Jessa F, Soggiu F, Fusai G, Kostakis I, Kathirvel M, Elnagar M, Dimitrokallis N, Iype S, Pericleous S, Mohamed A, Val ARD, Tinguely P, Likos-Corbett M, Afzal I, Bhogal R, Patel K, Siriwardena AK, de' Liguori Carino N, Sheen PA, Gareb F, Ammar K, Thakkar R, Pandanaboyana S, Leeds J, Gomez D, Gregory G, Ceresa C, Abbas H, Lazzereschi L, Reddy S, Gordon-Weeks A, Aroori S, Russell T, Roberts K, Chatzizacharias N, Sutcliffe R, Al-Sarireh B, Shingler G, Mortimer M, Skoryi D, Ilin I, Pisetska M, Cheverdiuk D, Kostyantyn K, Kopchak K, Kvasivka O, Valeriia S, Sumarokova V, Kryzhevskyi V, Sikachov S, Khomiak A, Malik A, Khomiak I, Bilyak A, Chooklin S, Chuklin S, Mikheiev I, Shylenko O, Klymenko A, Patel S, Cunningham S, Callery M, Kent T, Raut C, Wang J, Fairweather M, Sulciner M, Hirji S, Clancy T, Nebbia M, Qadan M, Musser A, Hogg M, Rodriquez J, Hamner J, Hennessy L, Dinerman A, Gupta A, Kimbrough C, Thompson R, Zeh HJ, Radi I, Polanco PM, Moris D, Lidsky ME, Lee D, Piper J, Gnerlich J, Tuvin D, Sticca R, Ganai S, Gusani N, Krinock D, Giorgakis E, Hardgrave H, Spencer-Cole RT, Klutts G, Hardgrave H, Nigh J, Nigh J, Andrade JCB, Mavros M, Osborn T, Ferrone C, O'Connor V, Boone B, Harris B, Schmidt C, Schrope B, Chabot J, Kluger M, Lasso ET, Nevler A, Yeo C, Ponzini F, Lavu H, Lamm R, Bowne W, Kyser N, Galanopoulos C, Abbasi A, Park J, Sham J, Dickerson L, Pillarisetty V, Sucandy I, Ross S, Winslow E, Hawksworth J, Radkani P, Fishbein T, Munoz AS, Lindberg J, Martins PN, Al-saban RAM, Al-Saban R, Al-Kubati W, Ghallab AAA, Alsanany GM, Almarashi H, Al-Samawi H, Al-Asadi MAMM, Alsayadi R, Hail S, Shream S, Bajjah HM, Al-Ameri S, Bajjah H, Al-Ameri SAAS, Al-Dowsh NA, AlDowsh NA, Al-Khawlani Q, Murshed YAA, Al-Shehari M, Jahaf AAD, Al-sharabi EAE, Aldumaini H, Alattas Z, Almassaudi A, Bajjah HMAH, Albakry R, Al-Naggar H, Shream SAA, Affary AA, Al-Markiz E, Al-Eryani F, Farhat H, Qadasi QA, Alwafy K, Abdualqader MYM, Ali RAAY, Albar A, Bleem HA, Galeb KSA, Ghushaim M, Sabbar M, Esmail M, Ali RAY, Salem RHM, Salem R, Saif W, Al-Faiq S, Alsharabi E, Hameed ATA, Almekhlafi T, Omairan A, Almarkiz E, Abduljawad H, Mansaleh O, Al-Melhani W, Abdualqader M, Al-Abdi R, Alwan HM, Mbanje C, Chihaka O. Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries. Br J Surg 2024; 111:znad330. [PMID: 38743040 DOI: 10.1093/bjs/znad330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 05/16/2024]
Abstract
BACKGROUND Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide. METHODS This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters. RESULTS A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries. CONCLUSION Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).
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Cotsoglou C, Granieri S, Bassetto S, Bagnardi V, Pugliese R, Grazi GL, Guglielmi A, Ruzzenente A, Aldrighetti L, Ratti F, De Carlis L, De Carlis R, Centonze L, De Angelis N, Memeo R, Delvecchio A, Felli E, Izzo F, Belli A, Patrone R, Ettorre GM, Berardi G, Di Benedetto F, Di Sandro S, Romano F, Garancini M, Scotti MA, Bianchi G, Germini A, Gjoni E, Bonomi A, Bruno F, Paleino S, Pugliese G. Dynamic surgical anatomy using 3D reconstruction technology in complex hepato-biliary surgery with vascular involvement. Results from an international multicentric survey. HPB (Oxford) 2024; 26:83-90. [PMID: 37838501 DOI: 10.1016/j.hpb.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Three-dimensional liver modeling can lead to substantial changes in choosing the type and extension of liver resection. This study aimed to explore whether 3D reconstruction helps to better understand the relationship between liver tumors and neighboring vascular structures compared to standard 2D CT scan images. METHODS Contrast-enhanced CT scan images of 11 patients suffering from primary and secondary hepatic tumors were selected. Twenty-three experienced HBP surgeons participated to the survey. A standardized questionnaire outlining 16 different vascular structures (items) having a potential relationship with the tumor was provided. Intraoperative and histopathological findings were used as the reference standard. The proper hypothesis was that 3D accuracy is greater than 2D. As a secondary endpoint, inter-raters' agreement was explored. RESULTS The mean difference between 3D and 2D, was 2.6 points (SE: 0.40; 95 % CI: 1.7-3.5; p < 0.0001). After sensitivity analysis, the results favored 3D visualization as well (mean difference 1.7 points; SE: 0.32; 95 % CI: 1.0-2.5; p = 0.0004). The inter-raters' agreement was moderate for both methods (2D: W = 0.45; 3D: W = 0.44). CONCLUSION 3D reconstruction may give a significant contribution to better understanding liver vascular anatomy and the precise relationship between the tumor and the neighboring structures.
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Affiliation(s)
- Christian Cotsoglou
- ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Stefano Granieri
- ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Serena Bassetto
- Politecnico di Milano, Scuola di Ingegneria Industriale e Dell'informazione, Via Raffaele Lambruschini, 15, 20156, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca Degli Arcimboldi 8, 20126, Milan, Italy
| | - Raffaele Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
| | - Gian Luca Grazi
- Hepato-bilio-pancreatic Surgery, Department of Experimental and Clinical Medicine, AOU Careggi, 50134, Florence, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Andrea Ruzzenente
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele and Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele and Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Luciano De Carlis
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Riccardo De Carlis
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Ph.D. Course in Clinical and Experimental Sciences, University of Padua, Padua, Italy
| | - Leonardo Centonze
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola De Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, 70021 Acquaviva Delle Fonti, Italy
| | - Antonella Delvecchio
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, 70021 Acquaviva Delle Fonti, Italy
| | - Emanuele Felli
- Service Chirurgie Digestive et Transplantation Hépatique, Hôpital Trousseau CHU, 37170 Tours, France
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131, Naples, Italy
| | - Andrea Belli
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131, Naples, Italy
| | - Renato Patrone
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131, Naples, Italy; DIETI Department, University of Naples Federico II, 80100, Naples, Italy
| | - Giuseppe Maria Ettorre
- Department of General and Hepatobiliary Surgery, Liver Transplantation Center, San Camillo-Forlanini Hospital, Rome, Italy
| | - Giammauro Berardi
- Department of General and Hepatobiliary Surgery, Liver Transplantation Center, San Camillo-Forlanini Hospital, Rome, Italy
| | - Fabrizio Di Benedetto
- HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Di Sandro
- HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Romano
- General Surgery 1, Hepatobiliary Unit, IRCCS San Gerardo Dei Tintori, University of Milano-Bicocca, 20900, Monza, Italy
| | - Mattia Garancini
- General Surgery 1, Hepatobiliary Unit, IRCCS San Gerardo Dei Tintori, University of Milano-Bicocca, 20900, Monza, Italy
| | - Mauro Alessandro Scotti
- General Surgery 1, Hepatobiliary Unit, IRCCS San Gerardo Dei Tintori, University of Milano-Bicocca, 20900, Monza, Italy
| | - Giorgio Bianchi
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP Centre, 75014 Paris, France
| | - Alessandro Germini
- ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Elson Gjoni
- ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | | | - Federica Bruno
- ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Sissi Paleino
- ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Giacomo Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
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Kersik A, Bracchetti G, Bonomi A, Bovo G, Serena Cuttin M, Germini A, Gjoni E, Granieri S, Cotsoglou C. Undifferentiated Embryonal Sarcoma of the Liver with Epithelioid Features: A Case Report of an Exceptional Histological Heterogeneity among Rare Diseases. Ann Ital Chir 2024; 95:119-125. [PMID: 38684493 DOI: 10.62713/aic.3374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive malignant tumor, with nonspecific clinical symptoms and radiological features. Less than 150 cases have been reported in adults across the world. PRESENTATION OF CASE We report a case of an extremely rare subtype of UESL with epithelioid features in a 29-year-old woman, presenting as a cystic lesion of 27 × 17 cm, completely subverting the right hepatic lobe. She underwent a right hepatectomy with anterior approach, complete hilum lymphadenectomy and partial diaphragmatic resection for local infiltration, followed by systemic chemotherapy. She remains with no evidence of disease and liver mass has been restored after 6 months. DISCUSSION The present case report represents the second case of UESL with epithelioid features described across the world. The immunohistochemical expression pattern, cytokeratin (CK)19 + and CK7 -, strongly suggests an origin of this epithelioid component from native biliary cells and not from a reshaped ductal plate. Due to the rarity of this form, to date it is impossible to define the prognostic impact of this subtype of UESL, and treatment remains challenging. CONCLUSION UESL is associated with a poor prognosis, especially in adults, but a comprehensive and multidisciplinary treatment based on radical resection and adjuvant therapy may provide a survival benefit. Surgical excision with negative margins remains mandatory to diagnose and treat UESL.
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Affiliation(s)
- Alessia Kersik
- General Surgery Unit, ASST Vimercate, 20871 Vimercate, Italy; Medicine and Surgery, University of Milan, 20122 Milan, Italy
| | - Greta Bracchetti
- General Surgery Unit, ASST Vimercate, 20871 Vimercate, Italy; Medicine and Surgery, University of Milan, 20122 Milan, Italy
| | - Alessandro Bonomi
- General Surgery Unit, ASST Vimercate, 20871 Vimercate, Italy; Medicine and Surgery, University of Milan, 20122 Milan, Italy
| | - Giorgio Bovo
- Medicine and Surgery, University of Milan, 20122 Milan, Italy
| | | | | | - Elson Gjoni
- Medicine and Surgery, University of Milan, 20122 Milan, Italy
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Granieri S, Sileo A, Altomare M, Frassini S, Gjoni E, Germini A, Bonomi A, Akimoto E, Wong CL, Cotsoglou C. Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies. Cancers (Basel) 2023; 16:199. [PMID: 38201626 PMCID: PMC10778561 DOI: 10.3390/cancers16010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25-4.86; 95%; p = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Annaclara Sileo
- General Surgery Residency Program, University of Milan, 20122 Milan, Italy; (A.S.); (A.B.)
| | - Michele Altomare
- Trauma Center and Emergency Surgery, ASST Great Metropolitan Hospital Niguarda, 20162 Milan, Italy;
| | - Simone Frassini
- General Surgery Residency Program, University of Pavia, 27100 Pavia, Italy;
| | - Elson Gjoni
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Alessandro Germini
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Alessandro Bonomi
- General Surgery Residency Program, University of Milan, 20122 Milan, Italy; (A.S.); (A.B.)
| | - Eigo Akimoto
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan;
| | - Chun Lam Wong
- Ruttonjee & Tang Siu Kin Hospital, Hong Kong, China;
| | - Christian Cotsoglou
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
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7
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Cioffi SPB, Altomare M, Podda M, Spota A, Granieri S, Reitano E, Zamburlini B, Virdis F, Bini R, Gupta S, Torzilli G, Mingoli A, Chiara O, Cimbanassi S. The burden of the knowledge-to-action gap in acute appendicitis. Surg Endosc 2023; 37:9617-9632. [PMID: 37884735 PMCID: PMC10709474 DOI: 10.1007/s00464-023-10449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The burden of emergency general surgery (EGS) is higher compared to elective surgery. Acute appendicitis (AA) is one of the most frequent diseases and its management is dictated by published international clinical practice guidelines (CPG). Adherence to CPG has been reported as heterogeneous. Barriers to clinical implementation were not studied. This study explored barriers to adherence to CPG and the clinico-economic impact of poor compliance. METHODS Data were extracted from the three-year data lock of the REsiDENT-1 registry, a prospective resident-led multicenter trial. We identified 7 items from CPG published from the European Association of Endoscopic Surgery (EAES) and the World Society of Emergency Surgery (WSES). We applied our classification proposal and used a five-point Likert scale (Ls) to assess laparoscopic appendectomy (LA) difficulty. Descriptive analyses were performed to explore compliance and group comparisons to assess the impact on outcomes and related costs. We ran logistic regressions to identify barriers and facilitators to implementation of CPG. RESULTS From 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%). Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units. CONCLUSIONS We confirmed low compliance with standardized items influenced by environmental factors and non-evidence-based practices in complex LA. Antibiotic stewardship is sub-optimal. Not following CPG may not influence clinical complications but has an impact in terms of logistics, costs and on the non-measurable magnitude of antibiotic resistance. Structured educational interventions and institutional bundles are required.
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Affiliation(s)
- Stefano Piero Bernardo Cioffi
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy.
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy.
| | - Michele Altomare
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | - Mauro Podda
- Department of Surgical Sciences, Cagliari State University, Cagliari, Italy
| | - Andrea Spota
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Beatrice Zamburlini
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Francesco Virdis
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | - Roberto Bini
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | | | | | - Andrea Mingoli
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
| | - Osvaldo Chiara
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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8
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Toro A, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:52. [PMID: 38012756 PMCID: PMC10683098 DOI: 10.1186/s13017-023-00522-7] [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] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Adriana Toro
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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Lombardi PM, Mazzola M, Veronesi V, Granieri S, Cioffi SPB, Baia M, Del Prete L, Bernasconi DP, Danelli P, Ferrari G. Learning curve of laparoscopic cholecystectomy: a risk-adjusted cumulative summation (RA-CUSUM) analysis of six general surgery residents. Surg Endosc 2023; 37:8133-8143. [PMID: 37684403 DOI: 10.1007/s00464-023-10345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LapC) is one of the most frequently performed surgical procedures worldwide. Reaching technical competency in performing LapC is considered one essential task for young surgeons. Investigating the learning curve for LapC (LC-LapC) may provide important information regarding the learning process and guide the training pathway of residents, improving educational outcomes. The present study aimed to investigate LC-LapC among general surgery residents (GSRs). METHODS Operative surgical reports of consecutive patients undergoing LapC performed by GSRs attending the General Surgery Residency Program at the University of Milan were analysed. Data on patient- and surgery-related variables were obtained from the ICD-9-CM diagnosis codes and gathered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis. RESULTS 340 patients operated by 6 GSRs were collected. The CUSUM and RA-CUSUM graphs based on surgical failures allowed to distinguish two defined phases for all GSRs: an initial phase ending at the peak, so-called learning phase, followed by a phase in which there was a significant decrease in failure incidence, so-called proficiency phase. The learning phase was completed for all GSRs at most within 25 procedures, but the trend of the curves and the number of procedures needed to achieve technical competency varied among operators ranging between 7 and 25. CONCLUSIONS The present study suggested that at most 25 procedures might be sufficient to acquire technical competency in LapC. The variability in the number of procedures needed to complete the LC, ranging between 7 and 25, could be due to the heterogeneous scenarios in which LapC was performed, and deserves to be investigated through a prospective study involving a larger number of GSRs and institutions.
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Affiliation(s)
- Pietro Maria Lombardi
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Valentina Veronesi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Marco Baia
- Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luca Del Prete
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico di Milan - General Surgery and Transplant Unit, Milan, Italy
- University of Milan - Translational Medicine PhD Program, Milan, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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10
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Adriana T, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:42. [PMID: 37496068 PMCID: PMC10373269 DOI: 10.1186/s13017-023-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
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Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Toro Adriana
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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Frassini S, Calabretto F, Granieri S, Fugazzola P, Massaro M, Sargenti B, Schiavone L, Zanghì S, Dal Mas F, Ansaloni L, Cobianchi L. Prophylactic mesh augmentation after laparotomy for elective and emergency surgery: meta-analysis. BJS Open 2023; 7:zrad060. [PMID: 37504969 PMCID: PMC10375944 DOI: 10.1093/bjsopen/zrad060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/30/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the laparotomy closure method in elective and emergency settings with the prophylactic mesh augmentation technique. METHODS The Scopus, PubMed, and Web of Science databases were screened without time restrictions up to 21 June 2022 using the keywords 'laparotomy closure', 'mesh', 'mesh positioning', and 'prophylactic mesh', and including medical subject headings terms. Only RCTs reporting the incidence of incisional hernia and other wound complications after elective or emergency midline laparotomy, where patients were treated with prophylactic mesh augmentation or without mesh positioning, were included. The primary endpoint was to explore the risk of incisional hernia at different follow-up time points. The secondary endpoint was the risk of wound complications. The risk of bias for individual studies was assessed according to the Revised Cochrane risk-of-bias tools for randomized trials. RESULTS Eighteen RCTs, including 2659 patients, were retrieved. A reduction in the risk of incisional hernia at every time point was highlighted in the prophylactic mesh augmentation group (1 year, risk ratio 0.31, P = 0.0011; 2 years, risk ratio 0.44, P < 0.0001; 3 years, risk ratio 0.38, P = 0.0026; 4 years, risk ratio 0.38, P = 0.0257). An increased risk of wound complications was highlighted for patients undergoing mesh augmentation, although this was not significant. CONCLUSIONS Midline laparotomy closure with prophylactic mesh augmentation can be considered safe and effective in reducing the incidence of incisional hernia. Further trials are needed to identify the ideal type of mesh and technique for mesh positioning, but surgeons should consider prophylactic mesh augmentation to decrease incisional hernia rate, especially in high-risk patients for fascial dehiscence and even in emergency settings. PROSPERO REGISTRATION ID CRD42022336242 (https://www.crd.york.ac.uk/prospero/record_email.php).
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Affiliation(s)
- Simone Frassini
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Francesca Calabretto
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Paola Fugazzola
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Matteo Massaro
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Benedetta Sargenti
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Luca Schiavone
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Simone Zanghì
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Luca Ansaloni
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Cobianchi
- General Surgery Residency, University of Pavia, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Chierici A, Granieri S, Frontali A. Diagnostic accuracy of water-soluble contrast enema, contrast-enema computed tomography and endoscopy in detecting anastomotic leakage after (Colo) proctectomy: A meta-analysis. Colorectal Dis 2023; 25:1371-1380. [PMID: 37264714 DOI: 10.1111/codi.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/19/2023] [Accepted: 04/02/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) as a result of creation of a colorectal/anal anastomosis still represents a frequent complication of colorectal surgery, with short- and long-term consequences on postoperative morbidity, quality of life and oncological outcomes. However, early diagnosis of AL may result in improved outcomes. The aims of this study were to evaluate the diagnostic accuracy of water-soluble contrast enema (WSCE), contrast enema computed tomography (CECT) and endoscopy in identifying AL and to identify the diagnostic procedure that is most accurate. METHODS A systematic review and meta-analysis of 19 studies accounting for a total of 25 tests reporting diagnostic accuracy estimates was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines up to June 2021. For the diagnostic tests we evaluated the pooled estimates and conducted pairwise comparisons. RESULTS For WSCE, the pooled sensitivity was 0.50, the pooled specificity was 0.99 and the area under the curve (AUC) was 0.91. For endoscopy, the pooled sensitivity was 0.69, specificity was 1.00 and AUC was 0.99. The pooled sensitivity and specificity for CECT were 0.89 and 1.00, respectively; the AUC was 0.99. The comparison between CECT and WSCE highlighted a significantly greater sensitivity (p = 0.04) for CECT, whereas no difference was found for specificity. Compared with CECT, endoscopy was not significantly more accurate in terms of either sensitivity or specificity. Endoscopy was found to be significantly more specific than WSCE (p = 0.031) but no difference was found for sensitivity. CONCLUSION Water-soluble contrast enema, endoscopy and CECT have an elevated diagnostic accuracy. However, WSCE is less accurate than either endoscopy or CECT. Although greater sensitivity was demonstrated for CECT compared with endoscopy, this was not significant.
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Affiliation(s)
- Andrea Chierici
- Service de Chirurgie Digestive et Transplantation Hépatique - Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, Vimercate, Italy
| | - Alice Frontali
- Coloproctology and IBD Surgery Unit, IRCCS San Raffaele, Milan, Italy
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Granieri S, Kersik A, Bonomi A, Frassini S, Bernasconi D, Paleino S, Germini A, Gjoni E, Cotsoglou C. The Role of Non-Peripancreatic Lymph Nodes in the Survival of Patients Suffering from Pancreatic Cancer of the Body and Tail: A Systematic Review and Meta-Analysis of High-Quality Studies. Cancers (Basel) 2023; 15:cancers15082322. [PMID: 37190250 DOI: 10.3390/cancers15082322] [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: 02/20/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Lymph nodes (LNs)' metastases have a well-known detrimental impact on the survival outcomes of patients suffering from pancreatic cancer of the body and tail. However, the extent of the lymphadenectomy for this tumor location is still debated. The aim of this study was to systematically review the current literature to explore the incidence and the prognostic impact of non-peripancreatic lymph nodes (PLNs) in patients suffering from pancreatic cancer of the body and tail. A systematic review was conducted according to PRISMA and MOOSE guidelines. The primary endpoint was to assess the impact of non-PLNs on overall survival (OS). As a secondary endpoint, the pooled frequencies of different non-PLN stations' metastatic patterns according to tumor location were explored. Eight studies were included in data synthesis. An increased risk of death for patients with positive non-PLNs was detected (HR: 2.97; 95% CI: 1.81-4.91; p < 0.0001). Meta-analysis of proportions pointed out a 7.1% pooled proportion of nodal infiltration in stations 8-9. The pooled frequency for station 12 metastasis was 4.8%. LN stations 14-15 were involved in 11.4% of cases, whereas station 16 represented a site of metastasis in 11.5% of cases. Despite its potential beneficial effect on survival outcome, a systematic extended lymphadenectomy could not be recommended yet for patients suffering from PDAC of the body/tail.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Alessia Kersik
- General Surgery Residency Program, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Alessandro Bonomi
- General Surgery Residency Program, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Simone Frassini
- General Surgery Residency Program, University of Pavia, Corso Str. Nuova, 65, 27100 Pavia, Italy
- General Surgery Unit, Department of Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - Davide Bernasconi
- Center of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Via Cadore, 48, 20854 Monza, Italy
| | - Sissi Paleino
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Alessandro Germini
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Elson Gjoni
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
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14
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Granieri S, Bonomi A, Frassini S, Gjoni E, Germini A, Kersik A, Bracchetti G, Bruno F, Paleino S, Lomaglio L, Frontali A, Cotsoglou C. Kimura's vs Warshaw's technique for spleen preserving distal pancreatectomy: a systematic review and meta-analysis of high-quality studies. HPB (Oxford) 2023:S1365-182X(23)00048-5. [PMID: 36941150 DOI: 10.1016/j.hpb.2023.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/31/2022] [Accepted: 02/10/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Spleen preserving distal pancreatectomy (SPDP) represents a widely adopted procedure in the presence of benign or low-grade malignant tumors. Splenic vessels preservation and resection (Kimura and Warshaw techniques respectively) represent the two main surgical modalities to avoid splenic resection. Each one is characterized by strengths and drawbacks. The aim of the present study is to systematically review the current high-quality evidence regarding these two techniques and analyze their short-term outcomes. METHODS A systematic review was conducted according to PRISMA, AMSTAR II and MOOSE guidelines. The primary endpoint was to assess the incidence of splenic infarction and splenic infarction leading to splenectomy. As secondary endpoints, specific intraoperative variables and postoperative complications were explored. Metaregression analysis was conducted to evaluate the effect of general variables on specific outcomes. RESULTS Seventeen high-quality studies were included in quantitative analysis. A significantly lower risk of splenic infarction for patients undergoing Kimura SPDP (OR = 0.14; p < 0.0001). Similarly, splenic vessel preservation was associated with a reduced risk of gastric varices (OR = 0.1; 95% p < 0.0001). Regarding all secondary outcome variables, no differences between the two techniques were noticed. Metaregression analysis failed to identify independent predictors of splenic infarction, blood loss, and operative time among general variables. CONCLUSIONS Although Kimura and Warshaw SPDP have been demonstrated comparable for most of postoperative outcomes, the former resulted superior compared to the latter in reducing the risk of splenic infarction and gastric varices. For benign pancreatic tumors and low-grade malignancies Kimura SPDP may be preferred.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Alessandro Bonomi
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy; University of Milan, Via Festa Del Perdono 7, 20122, Milan, Italy
| | - Simone Frassini
- University of Pavia, Corso Str. Nuova 65, 27100, Pavia, Italy; General Surgery Unit, Department of Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Elson Gjoni
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Alessandro Germini
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Alessia Kersik
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy; University of Milan, Via Festa Del Perdono 7, 20122, Milan, Italy
| | - Greta Bracchetti
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy; University of Milan, Via Festa Del Perdono 7, 20122, Milan, Italy
| | - Federica Bruno
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Sissi Paleino
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Laura Lomaglio
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Alice Frontali
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, ASS T Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
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15
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Bellini R, Salandini MC, Granieri S, Chierici A, Passaretta R, Cotsoglou C. Erector spine plane block as single loco-regional anesthesia in non-intubated video-assisted thoracic surgery for unfit patients: a case-match study. Updates Surg 2023:10.1007/s13304-023-01464-0. [PMID: 36820964 DOI: 10.1007/s13304-023-01464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
In the present study, we analyzed the safety and efficacy of non-intubated video-assisted thoracoscopy (NI-VATS) for the diagnosis and palliation of malignant pleural effusion in the elderly population using erector-spinae plane block (ESPB) as single loco-regional anesthesia. From January 2016 to December 2020 a consecutive series of 158 patients who underwent surgery for malignant pleural effusion was analyzed. Of these, 20 patients were operated using ESPB NI-VATS, while 138 were operated under general anesthesia (GA). After propensity score matching, the NI-VATS population was older (81 vs. 76 years p 0.006), and had more severe pre-existing comorbidities, evaluated using Charlson Comorbidity Index (p = 0.029) and ASA score (p < 0.001). GA and NI-VATS patients did not differ in terms of postoperative opioid consumption, complication rate and postoperative hospitalization. Both short- and long-term efficacy of talc poudrage was equal in the two populations. The overall length of stay in the operative room was significantly shorter for the NI-VATS than for the GA-VATS group (67.5 vs. 105 min, p < 0.001), and operative time significantly differed in the two groups (35 vs. 47.5 min, respectively, p < 0.001). ESPB NI-VATS can be a safe and effective option for the diagnosis and palliation of malignant pleural effusion for elderly and frail patients.
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Affiliation(s)
- Roberto Bellini
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Maria Chiara Salandini
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Andrea Chierici
- Service de Chirurgie Digestive, Centre Hospitalier d'Antibes Juan-Les-Pins, 107, av. de Nice, 06600, Antibes, France
| | - Rita Passaretta
- Anesthesia and Resuscitation Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
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Cioffi SPB, Granieri S, Scaravilli L, Molteni M, Altomare M, Spota A, Virdis F, Bini R, Renzi F, Reitano E, Ragozzino R, Gupta S, Chiara O, Cimbanassi S, Albanesi F, Altomare M, Andreatta E, Baldari L, Benuzzi L, Bevilaqua E, Bonomi AM, Brachetti G, Cannavale G, Chierici AP, Cioffi SPB, Cirelli R, Colletti G, D’abrosca V, Danelli P, Del Prete L, Di Capua F, Di Vittorio F, Ferrari D, Ferrario L, Fiore L, Frattaruol C, Froiio C, Gibelli L, Giusti I, Giustizieri U, Grandi S, Granieri S, Iacob G, Kersik A, Lombardi P, Longhi M, Lorusso L, Manara M, Manzo E, Marin JN, Maspero M, Messina V, Milito P, Molteni M, Monti E, Nicastro V, Novelli G, Paleino S, Pavesi S, Perali C, Pezzoli I, Ragozzino R, Santolamazza G, Scaravilli L, Spota A, Tornatore G, Toti F, Tripodi V, Vaterlini E, Vignati B. Surgeons' attitudes during laparoscopic appendectomy: do subjective intraoperative assessments affect the choice of peritoneal irrigation? A spin-off analysis from the REsiDENT-1 multicentre prospective observational trial. Surg Endosc 2023; 37:729-740. [PMID: 36307601 DOI: 10.1007/s00464-022-09674-0] [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: 05/12/2022] [Accepted: 09/24/2022] [Indexed: 01/18/2023]
Abstract
AIMS Laparoscopic appendectomy (LA) for acute appendicitis (AA) is one of the most performed procedures. The effects of peritoneal lavage (PL) and the reasons to perform it have not been cleared and all meta-analyses didn't show a statistical advantage to prevent infectious complications. This study aims to investigate surgeons' perceptions during LA, comparing intraoperative findings with histological results, and exploring how surgeons' subjectivity influences the decision-making process on PL. METHODS Data were extracted from the two-year data lock from REsiDENT-1 registry, a prospective resident-led multicentre observational trial. This study investigates the relationships between PL and postoperative intraabdominal abscesses (pIAA) introducing a classification for AA to standardize the intraoperative grading. We included pre, intra, and postoperative variables. We applied our classification proposal, used a five-point Likert scale (Ls) to assess subjective LA difficulty and ran a concordance analysis between the assessment of AA and histology. Subsequently, a multivariate logistic regression model was built to find factors influencing PL. RESULTS 561 patients were enrolled from twenty-one hospitals and 51 residents. 542 procedures were included in the logistic regression analysis and 441 in the concordance analysis, due to missing data. PL was used in 222 LA (39, 6%). We discovered a moderate positive monotonic relationship between surgical evaluation and histology, p < 0.001. Despite this, the reliability of the surgeon's assessment of appendicitis is progressively lower for gangrenous and perforated forms. The increasing grade of contamination, the increasing grade of subjective difficulty and the intraoperative finding of a gangrenous or perforated appendicitis were independent predictors of PL. CONCLUSION This study shows how surgeons' evaluation of AA severity overestimated more than half of gangrenous or perforated appendices with the perception of a challenging procedure. These perceptions influenced the choice of PL. We proved that the evaluation during LA could be affected by subjectivity with a non-negligible impact on the decision-making process.
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Affiliation(s)
- Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. .,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Luca Scaravilli
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,General Surgery Residency Program, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Mattia Molteni
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,General Surgery Residency Program, San Raffaele Hospital University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Altomare
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Andrea Spota
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Francesco Virdis
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Roberto Bini
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Federica Renzi
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Elisa Reitano
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
| | - Roberta Ragozzino
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Shailvi Gupta
- University of Maryland, Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Pathophysiology and Transplants, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Pathophysiology and Transplants, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
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Granieri S, Bracchetti G, Kersik A, Frassini S, Germini A, Bonomi A, Lomaglio L, Gjoni E, Frontali A, Bruno F, Paleino S, Cotsoglou C. Preoperative indocyanine green (ICG) clearance test: Can we really trust it to predict post hepatectomy liver failure? A systematic review of the literature and meta-analysis of diagnostic test accuracy. Photodiagnosis Photodyn Ther 2022; 40:103170. [PMID: 36302467 DOI: 10.1016/j.pdpdt.2022.103170] [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: 09/10/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Post hepatectomy liver failure (PHFL) still represents a potentially fatal complication after major liver resection. Indocyanine green (ICG) clearance test represents one of the most widely adopted examinations in the preoperative workup. Despite a copious body of evidence which has been published on this topic, the role of ICG in predicting PHLF is still a matter of debate. METHODS A systematic review of the literature was conducted according to PRISMA-DTA guidelines. The primary outcome was the assessment of diagnostic performance of ICG in predicting PHLF. The secondary outcome was the mean ICGR15 and ICGPDR in patients experiencing PHLF. RESULTS Seventeen studies, for a total of 4852 patients, were deemed eligible. Sensitivity ranged from 25% to 83%; Specificity ranged from 66.1% to 93.8%. ICG clearance test pooled AUC was 0.673 (95% CI: 0.632-0.713). The weighted mean ICGR15 was 11 (95%CI: 8.3-13.7). The weighted mean ICGPDR was 16.5 (95%CI: 13.3-19.8). High risk of bias was detected in all examined domains. CONCLUSIONS Preoperative ICG clearance test alone may not represent a reliable method to predict post hepatectomy liver failure. Its diagnostic significance should be framed within multiparametric models involving clinical and imaging features.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy.
| | - Greta Bracchetti
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy; University of Milan, Via Festa del Perdono, 7, Milan 20122, Italy
| | - Alessia Kersik
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy; University of Milan, Via Festa del Perdono, 7, Milan 20122, Italy
| | - Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, Pavia 27100, Italy; General Surgery Unit, Department of surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, Pavia 27100, Italy
| | - Alessandro Germini
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy
| | - Alessandro Bonomi
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy; University of Milan, Via Festa del Perdono, 7, Milan 20122, Italy
| | - Laura Lomaglio
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy
| | - Elson Gjoni
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy
| | - Alice Frontali
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy
| | - Federica Bruno
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy
| | - Sissi Paleino
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy
| | - Christian Cotsoglou
- General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy
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Frassini S, Calabretto F, Granieri S, Fugazzola P, Viganò J, Fazzini N, Ansaloni L, Cobianchi L. Intraperitoneal chemotherapy in the management of pancreatic adenocarcinoma: A systematic review and meta-analysis. Eur J Surg Oncol 2022; 48:1911-1921. [PMID: 35688711 DOI: 10.1016/j.ejso.2022.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/24/2022] [Revised: 05/09/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pancreatic cancer represents one of the leading causes of cancer-related death worldwide. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal chemotherapy (NIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proven with curative intent mainly for other tumors and there is a lack of consensus regarding possible benefits also in pancreatic cancer. The present systematic review and meta-analysis aim to provide an up-to-date overview of the effectiveness and safety of intraperitoneal treatments in the management of pancreatic cancer. METHODS A systematic review of articles was conducted according to PRISMA and AMSTAR-2 guidelines. 11 studies were included in the analysis. RESULTS We included in our analysis 212 patients subdivided in three groups: 64 in the HIPEC group (57 with prophylactic intent and 7 with curative intent), 55 in the PIPAC group and 93 in the NIPEC group. Primary outcomes were represented by survival rates; we evidenced at an observation time of three years a survival of 24% in the HIPEC group (25.5% in the prophylactic arm and 6.2% in the curative arm), 5.3% in the PIPAC group and 7.9% in the NIPEC group. CONCLUSIONS HIPEC could be considered as a promising technique for prophylaxis and treatment of peritoneal metastasis (PM) in case of borderline resectable and locally advanced disease. Increased survival rates emerged without additional morbidity when surgical resection and CRS are possible. In addition, our data about PIPAC and NIPEC as palliative treatment in unresectable disease seems to identify more favorable survival rates compared to literature.
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Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Francesca Calabretto
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Jacopo Viganò
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Nicola Fazzini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
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Chierici A, Frontali A, Granieri S, Facciorusso A, De' Angelis N, Cotsoglou C. Postoperative morbidity and mortality after pancreatoduodenectomy with pancreatic duct occlusion compared to pancreatic anastomosis: a systematic review and meta-analysis. HPB (Oxford) 2022; 24:1395-1404. [PMID: 35450800 DOI: 10.1016/j.hpb.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/15/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreatoduodenectomy is burdened by elevated postoperative morbidity. Pancreatic duct ligation or occlusion have been experimented as an alternative to reduce the insurgence of postoperative pancreatic fistula. The aim of this systematic review and meta-analysis was to compare postoperative mortality and morbidity (pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, pancreatic exocrine insufficiency and diabetes mellitus) between patients undergoing pancreatic anastomosis or pancreatic duct ligation/occlusion after pancreatoduodenectomy. METHODS A systematic review and meta-analysis of 13 studies was conducted following the PRISMA guidelines and the Cochrane protocol (PROSPERO ID: CRD42021249232). RESULTS No difference in postoperative mortality was highlighted. Pancreatic anastomosis was found to be protective considering all-grades pancreatic fistula (RR: 2.38, p = 0.0005), but pancreatic duct occlusion presented a 3-folded reduced risk to develop "grade C" pancreatic fistula (RR: 0.36, p = 0.1186), although not significant. Diabetes mellitus was more often diagnosed after duct occlusion (RR: 1.61, p < 0.0001); no difference was found in terms of pancreatic exocrine insufficiency (RR: 1.19, p = 0.151). CONCLUSION Postoperative mortality is not influenced by the pancreatic reconstruction technique. Pancreatic anastomosis is associated with a reduction in all-grades pancreatic fistula. More high-quality studies are needed to clarify if duct sealing could reduce the prevalence of "grade C" fistula.
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Affiliation(s)
- Andrea Chierici
- General Surgery Unit, Vimercate Hospital - ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Alice Frontali
- General Surgery Unit, Vimercate Hospital - ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Stefano Granieri
- General Surgery Unit, Vimercate Hospital - ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy
| | - Nicola De' Angelis
- Unit of Digestive Surgery, University of Paris Est, UPEC, Créteil, France
| | - Christian Cotsoglou
- General Surgery Unit, Vimercate Hospital - ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
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20
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Granieri S, Frassini S, Cimbanassi S, Bonomi A, Paleino S, Lomaglio L, Chierici A, Bruno F, Biondi R, Di Saverio S, Khan M, Cotsoglou C. Impact of resuscitative endovascular balloon occlusion of the aorta (REBOA) in traumatic abdominal and pelvic exsanguination: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:3561-3574. [DOI: 10.1007/s00068-022-01955-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/13/2022] [Indexed: 12/29/2022]
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21
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Chierici A, Intotero M, Granieri S, Paleino S, Flocchini G, Germini A, Cotsoglou C. Timely synergic surgical and radiological aggressiveness improves perioperative mortality after hemorrhagic complication in Whipple procedure. Hepatobiliary Pancreat Dis Int 2021; 20:387-390. [PMID: 33358611 DOI: 10.1016/j.hbpd.2020.12.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Andrea Chierici
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871 Vimercate, Italy
| | - Marcello Intotero
- Radiodiagnostic Unit, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871 Vimercate, Italy
| | - Stefano Granieri
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871 Vimercate, Italy
| | - Sissi Paleino
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871 Vimercate, Italy
| | - Giovanni Flocchini
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871 Vimercate, Italy
| | - Alessandro Germini
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871 Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871 Vimercate, Italy.
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22
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Sessa F, Campi R, Granieri S, Tuccio A, Polverino P, Spatafora P, Sebastianelli A, Cocci A, Rivetti A, Gacci M, Carini M, Serni S, Oriti R, Minervini A. Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience. Front Surg 2021; 8:705105. [PMID: 34395511 PMCID: PMC8358301 DOI: 10.3389/fsurg.2021.705105] [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: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate. Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate. Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times. Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.
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Affiliation(s)
- Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Granieri
- Azienda Socio-Sanitaria Territoriale (ASST)-Brianza, General Surgery Unit, Vimercate, Italy
| | - Agostino Tuccio
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Oriti
- Unit of Urology, S.Stefano Hospital, University of Florence, Prato, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
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23
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Spota A, Cereatti F, Granieri S, Antonelli G, Dumont JL, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Tranchart H, Lainas P, Danan D, Tuszynski T, Pacini F, Arienzo R, Trelles N, Soprani A, Lazzati A, Torcivia A, Genser L, Derhy S, Fazi M, Bouillot JL, Marmuse JP, Chevallier JM, Donatelli G. Endoscopic Management of Bariatric Surgery Complications According to a Standardized Algorithm. Obes Surg 2021; 31:4327-4337. [PMID: 34297256 DOI: 10.1007/s11695-021-05577-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Endoscopy is effective in management of bariatric surgery (BS) adverse events (AEs) but a comprehensive evaluation of long-term results is lacking. Our aim is to assess the effectiveness of a standardized algorithm for the treatment of BS-AE. PATIENTS AND METHODS We retrospectively analyzed 1020 consecutive patients treated in our center from 2012 to 2020, collecting data on demographics, type of BS, complications, and endoscopic treatment. Clinical success (CS) was evaluated considering referral delay, healing time, surgery, and complications type. Logistic regression was performed to identify variables of CS. RESULTS In the study period, we treated 339 fistulae (33.2%), 324 leaks (31.8%), 198 post-sleeve gastrectomy twist/stenosis (19.4%), 95 post-RYGB stenosis (9.3 %), 37 collections (3.6%), 15 LAGB migrations (1.5%), 7 weight regains (0.7%), and 2 hemorrhages (0.2%). Main endoscopic treatments were as follows: pigtail-stent positioning under endoscopic view for both leaks (CS 86.1%) and fistulas (CS 77.2%), or under EUS-guidance for collections (CS 88.2%); dilations and/or stent positioning for sleeve twist/stenosis (CS 80.6%) and bypass stenosis (CS 81.5%). After a median (IQR) follow-up of 18.5 months (4.29-38.68), complications rate was 1.9%. We found a 1% increased risk of redo-surgery every 10 days of delay to the first endoscopic treatment. Endoscopically treated patients had a more frequent regular diet compared to re-operated patients. CONCLUSIONS Endoscopic treatment of BS-AEs following a standardized algorithm is safe and effective. Early endoscopic treatment is associated with an increased CS rate.
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Affiliation(s)
- Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milan, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Ospedale dei Castelli, ASL Roma 6, Via Nettunense km 115, 00040 Ariccia, Roma, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Giulio Antonelli
- Ospedale dei Castelli, ASL Roma 6, Via Nettunense km 115, 00040 Ariccia, Roma, Italy
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint - Denis, Saint - Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - David Danan
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Maurizio Fazi
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Jean-Luc Bouillot
- Service de Chirurgie Digestive et Obésité, Hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
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24
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Granieri S, Sessa F, Bonomi A, Paleino S, Bruno F, Chierici A, Sciannamea IM, Germini A, Campi R, Talso M, Facciorusso A, Deiana G, Serni S, Cotsoglou C. Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence. BMC Surg 2021; 21:265. [PMID: 34044862 PMCID: PMC8157688 DOI: 10.1186/s12893-021-01272-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/21/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. METHODS A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran's Q test were computed to assess inter-studies' heterogeneity. RESULTS Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. CONCLUSIONS Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Largo Piero Palagi, 1, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Piazza di San Marco, 4, 50121 Florence, Italy
| | - Alessandro Bonomi
- University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
- General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157 Milan, Italy
| | - Sissi Paleino
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
- University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Federica Bruno
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Andrea Chierici
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
- University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | | | - Alessandro Germini
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Largo Piero Palagi, 1, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Piazza di San Marco, 4, 50121 Florence, Italy
| | - Michele Talso
- Urology Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122 Foggia, Italy
| | - Gianfranco Deiana
- Urology Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Largo Piero Palagi, 1, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Piazza di San Marco, 4, 50121 Florence, Italy
| | - Christian Cotsoglou
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
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25
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Granieri S, Altomare M, Bruno F, Paleino S, Bonomi A, Germini A, Facciorusso A, Fagnani D, Bovo G, Cotsoglou C. Surgical treatment of gastric cancer liver metastases: Systematic review and meta-analysis of long-term outcomes and prognostic factors. Crit Rev Oncol Hematol 2021; 163:103313. [PMID: 34044098 DOI: 10.1016/j.critrevonc.2021.103313] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022] Open
Abstract
The prognosis of patients with metastatic gastric cancer remains dismal, with palliative treatment as standard of care. However, encouraging results have been reported for surgical resection of liver only metastatic gastric cancer in carefully selected patients. A systematic review of articles published from 2000 onwards was conducted according to PRISMA guidelines. Twenty-nine studies were included in qualitative and quantitative analysis. Meta-analysis of proportions pointed out 29.1 % 5ySR (I 2 = 39 %). The pooled weighted median of MSTs was 31.1 months. T stage > 2, metastasis greatest dimension ≥ 5 cm, the presence of multiple metastases and bilobar disease resulted among the strongest predictors of mortality. Funnel plots, Egger's tests, and P-curve analyses failed to show significant publication bias. Based on strict selection criteria and robust statistical analyses, our results show that, in very carefully selected patients without extrahepatic disease, surgical resection with curative intent may significantly improve overall survival.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Michele Altomare
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; Gastrointestinal, Hepato-Pancreatic Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Federica Bruno
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Sissi Paleino
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy; University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Alessandro Bonomi
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Alessandro Germini
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy.
| | - Daniele Fagnani
- Medical Oncology Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Giorgio Bovo
- Pathology Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Christian Cotsoglou
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
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26
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Granieri S, Bonomi A, Frassini S, Chierici AP, Bruno F, Paleino S, Kusamura S, Germini A, Facciorusso A, Deraco M, Cotsoglou C. Prognostic impact of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients: A meta-analysis of randomized controlled trials. Eur J Surg Oncol 2021; 47:2757-2767. [PMID: 34001385 DOI: 10.1016/j.ejso.2021.05.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 03/03/2021] [Revised: 04/25/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND gastric cancer patients frequently develop peritoneal metastases (PM) with a poor long-term prognosis. A solid body of evidence underlines the beneficial role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on survival, but to date, there is a lack of consensus regarding the optimal strategy in the treatment of locally advanced primary tumors with or without peritoneal metastasis. The present meta-analysis aims to assess the impact of CRS + HIPEC on survival analyzing the results of randomized studies only. METHODS A systematic review of articles was conducted according to PRISMA guidelines. Twelve studies were included in qualitative and quantitative analysis. RESULTS A survival benefit for patients treated with CRS + HIPEC at all time points was highlighted. However, difference in survival was significant at all time points for patients treated for prophylaxis of PM, but no difference was found when considering resection with a curative intent. The 1, 2, 3 and 5-year survival rates (SR) for patients undergoing CRS + HIPEC were 86.9%, 70.5%, 63.7% and 55.7% respectively. CRS + HIPEC for the treatment rather than prophylaxis of PM was the only predictor of a reduced 3y SR. CONCLUSIONS CRS + HIPEC may lead to improved prognosis for patients suffering from locally advanced gastric cancer in both prophylactic and curative settings. However, due to far from negligible postoperative morbidity and mortality rates, a strict patient selection is crucial to achieve the best results. The presence of extraperitoneal disease strongly limits the indication of this kind of surgery.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Alessandro Bonomi
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; General Surgery Unit, Department of Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Andrea Piero Chierici
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Federica Bruno
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Sissi Paleino
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Shigeki Kusamura
- Peritoneal Surface Malignancies Unit, Fondazione I.R.C.C.S., Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Alessandro Germini
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy.
| | - Marcello Deraco
- Peritoneal Surface Malignancies Unit, Fondazione I.R.C.C.S., Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Christian Cotsoglou
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy.
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Donatelli G, Spota A, Cereatti F, Granieri S, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Dammaro C, Tranchart H, Lainas P, Tuszynski T, Pacini F, Arienzo R, Chevallier JM, Trelles N, Lazzati A, Paolino L, Papini F, Torcivia A, Genser L, Arapis K, Soprani A, Randone B, Chosidow D, Bouillot JL, Marmuse JP, Dumont JL. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis 2021; 17:1432-1439. [PMID: 33931322 DOI: 10.1016/j.soard.2021.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. OBJECTIVES To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. SETTING Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. METHODS EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. RESULTS A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). CONCLUSION Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Viale Concordia 1, Cremona, Italy
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luca Paolino
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Federica Papini
- Service de Chirurgie Digestive, Group Hospitalier Nord-Essonne Site d'Orsay, Orsay, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Kostas Arapis
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Bruto Randone
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Denis Chosidow
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Jean-Luc Bouillot
- Service de chirurgie digestive et obésité, hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
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Facciorusso A, Abd El Aziz MA, Cincione I, Cea UV, Germini A, Granieri S, Cotsoglou C, Sacco R. Angiotensin Receptor 1 Blockers Prolong Time to Recurrence after Radiofrequency Ablation in Hepatocellular Carcinoma patients: A Retrospective Study. Biomedicines 2020; 8:E399. [PMID: 33050084 PMCID: PMC7599746 DOI: 10.3390/biomedicines8100399] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023] Open
Abstract
Inhibition of angiotensin II synthesis seems to decrease hepatocellular carcinoma recurrence after radical therapies; however, data on the adjuvant role of angiotensin II receptor 1 blockers (sartans) are still lacking. Aim of the study was to evaluate whether sartans delay time to recurrence and prolong overall survival in hepatocellular carcinoma patients after radiofrequency ablation. Data on 215 patients were reviewed. The study population was classified into three groups: 113 (52.5%) patients who received neither angiotensin-converting enzyme inhibitors nor sartans (group 1), 59 (27.4%) patients treated with angiotensin-converting enzyme inhibitors (group 2) and 43 (20.1%) patients treated with sartans (group 3). Survival outcomes were analyzed using Kaplan-Meier analysis and compared with log-rank test. In the whole study population, 85.6% of patients were in Child-Pugh A-class and 89.6% in Barcelona Clinic Liver Cancer A stage. Median maximum tumor diameter was 30 mm (10-40 mm) and alpha-fetoprotein was 25 (1.1-2100) IU/mL. No differences in baseline characteristics among the three groups were reported. Median overall survival was 48 months (42-51) in group 1, 51 months (42-88) in group 2, and 63 months (51-84) in group 3 (p = 0.15). Child-Pugh stage and Model for End-staging Liver Disease (MELD) score resulted as significant predictors of overall survival in multivariate analysis. Median time to recurrence was 33 months (24-35) in group 1, 41 (23-72) in group 2 and 51 months (42-88) in group 3 (p = 0.001). Number of nodules and anti-angiotensin treatment were confirmed as significant predictors of time to recurrence in multivariate analysis. Sartans significantly improved time to recurrence after radiofrequency ablation in hepatocellular carcinoma patients but did not improve overall survival.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, 71122 Foggia, Italy; (U.V.C.); (R.S.)
| | | | - Ivan Cincione
- Department of Clinical and Experimental Medicine, Faculty of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Ugo Vittorio Cea
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, 71122 Foggia, Italy; (U.V.C.); (R.S.)
| | - Alessandro Germini
- General Surgery Department, ASST-Vimercate, 20871 Vimercate, Italy; (A.G.); (S.G.); (C.C.)
| | - Stefano Granieri
- General Surgery Department, ASST-Vimercate, 20871 Vimercate, Italy; (A.G.); (S.G.); (C.C.)
| | - Christian Cotsoglou
- General Surgery Department, ASST-Vimercate, 20871 Vimercate, Italy; (A.G.); (S.G.); (C.C.)
| | - Rodolfo Sacco
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, 71122 Foggia, Italy; (U.V.C.); (R.S.)
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Casati A, Granieri S, Cimbanassi S, Reitano E, Chiara O. Falls from Height. Analysis of Predictors of Death in a Single-Center Retrospective Study. J Clin Med 2020; 9:jcm9103175. [PMID: 33007955 PMCID: PMC7601239 DOI: 10.3390/jcm9103175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
Falls from height (FFH) represent a distinct form of blunt trauma in urban areas. This study aimed to identify independent predictors of in-hospital mortality after accidental or intentional falls in different age groups. We conducted a retrospective study of all patients consecutively admitted after a fall in eight years, recording mechanism, intentionality, height of fall, age, site, classification of injuries, and outcome. We built multivariate regression models to identify independent predictors of mortality. A total of 948 patients with 82 deaths were observed. Among the accidental falls, mortality was 5.2%, whereas intentional jumpers showed a mortality of 20.4%. The death rate was higher for increasing heights, age >65, suicidal attempts, and injuries with AIS ≥3 (Abbreviated Injury Scale). Older patients reported a higher in-hospital mortality rate. Multivariate analysis identified height of fall, dynamic and severe head and chest injuries as independent predictors of mortality in the young adults’ group (18–65 years). For patients aged more than 65 years, the only risk factor independently related to death was severe head injuries. Our data demonstrate that in people older than 65, the height of fall may not represent a predictor of death.
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Affiliation(s)
- Alberto Casati
- General Surgery Unit, Policlinico Sant’Orsola-Malpighi, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy;
| | - Stefano Granieri
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
| | - Elisa Reitano
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
- Correspondence: ; Tel.: +39-02-6444-2541; Fax: +39-02-6444-2392
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Frassini S, Gupta S, Granieri S, Cimbanassi S, Sammartano F, Scalea TM, Chiara O. Extraperitoneal packing in unstable blunt pelvic trauma: A single-center study. J Trauma Acute Care Surg 2020; 88:597-606. [PMID: 32317576 DOI: 10.1097/ta.0000000000002618] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemodynamically unstable pelvic fractures often require a multi-modal approach including both operative and endovascular management. While an important adjunct in hemorrhage control, time to angioembolization even at the most advanced trauma centers may take hours. Extraperitoneal packing (EPP) is a fast and effective procedure that can immediately address pelvic hemorrhage from the retroperitoneal space in severe pelvic injuries. The aim of this study was to evaluate the efficacy of early EPP, looking at 24 hours and overall mortality, and the hemodynamic impact of EPP in unstable blunt pelvic trauma. METHODS All trauma patients admitted to an urban Level I trauma center were evaluated from 2002 to 2018 in a retrospective single-center comparative study. Inclusion criteria were patients 14 years or older who sustained blunt trauma with pelvic fractures and hemodynamic instability. Exclusion criteria were a concomitant head injury (Abbreviated Injury Scale >3) and patients who underwent resuscitative thoracotomy. The patient population was divided into two groups: an EPP group and a no-EPP group. Propensity score matching was used to adjust for differences in baseline characteristics in the two groups: a one-to-one matched analysis using nearest-neighbor matching was performed based on the estimated propensity score of each patient. RESULTS Two hundred forty-four patients presented hemodynamically unstable, with a pelvic fracture (180 no-EPP, 64 EPP). With propensity score matching, 37 patients in each group were analyzed. Survival within the first 24 hours was significantly improved in the EPP group (81.1% vs. 59.5%, p = 0.042) and we registered similar results in overall survival rate (78.4% EPP group vs. 56.8% no-EPP group, p = 0.047). Those patients who underwent early EPP (n = 64) were associated with a significant improvement in hemodynamic stability, with a pre-EPP mean arterial pressure of 49.9 mm Hg and post-EPP mean arterial pressure of 70.1 mm Hg (p < 0.01). CONCLUSION Extraperitoneal pelvic packing is an effective procedure that can be performed immediately, even within the trauma bay, to improve hemodynamic stability and overall survival in patients who sustain severe blunt pelvic trauma. The early use of EPP can be lifesaving. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- Simone Frassini
- From the General Surgery and Trauma Team (S.F., S.G., O.C., S.C., F.S.), University of Milan, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; R Adams Cowley Shock Trauma Center (S.G., T.M.S.), University of Maryland, Baltimore, Maryland
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Cioffi SPB, Altomare M, Spota A, Granieri S, Cimbanassi S, Chiara O. REsiDENT 1 (Re-assessment of Appendicitis Evaluation during laparoscopic appendectomy: Do we End a Non-standardized Treatment approach and habit?): peritoneal irrigation during laparoscopic appendectomy-does the grade of contamination matter? A prospective multicenter resident-based evaluation of a new classification system. World J Emerg Surg 2019; 14:25. [PMID: 31164914 PMCID: PMC6543631 DOI: 10.1186/s13017-019-0243-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022] Open
Abstract
Background Laparoscopic appendectomy has progressively gained acceptance as the standard of care for acute appendicitis. Focusing on the incidence of postoperative intra-abdominal abscess after a laparoscopic appendectomy, discordant data have been reported ranging from 1.5 to 20%. Besides, evidence advocating advantages from peritoneal irrigation over suction only are lacking. Most studies are burdened by a high level of heterogeneity regarding the severity of the appendicitis and modalities of peritoneal irrigation. One of the main drawbacks is the lack of an accepted classification for different degrees of appendicitis and peritoneal contamination. The aim of the study is to introduce a classification to clarify the relationship between grade of appendicitis, contamination, and postoperative incidence of IAA considering the surgeon’s attitude toward irrigation or suction alone. Preoperative, intra-operative, and postoperative predictive factors for infectious complication will also be assessed. This study is meant to be the first Italian multicenter resident-based observational study. Methods Patients suffering from acute appendicitis will be enrolled during a 1-year period, according to inclusion and exclusion criteria. Participants will fill an online form reporting all clinical and intra-operative data of each patient undergoing a laparoscopic appendectomy. General surgery residents will be responsible for data collection. Our proposal of classification is based on the histological grade of appendicitis and intra-operative degree of peritoneal contamination. For each grade, a progressively increasing score is assigned. Discussion The observational nature of this study is mandatory to examine surgeons’ attitude toward peritoneal contamination during laparoscopic appendectomy for appendicitis. Identification of different severity grades of acute appendicitis and their relationship with the development of postoperative abscesses is necessary. The resulting classification and score, even considering peritoneal lavage or suction alone, will define risk classes of peri-appendiceal contamination each one related to a specific incidence rate of postoperative IAA. Nowadays, maximum effort should be made to reach the best procedural standardization and surgical decision-making should be supported by solid evidence, especially in an emergency surgery setting.
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Affiliation(s)
| | - Michele Altomare
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy
| | - Andrea Spota
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy
| | - Stefano Granieri
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy.,2Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | | | - Osvaldo Chiara
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy.,2Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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Granieri S, Tebaldi M, Furlan WD. Parallel fractional correlation: an optical implementation. Appl Opt 2001; 40:6439-6444. [PMID: 18364952 DOI: 10.1364/ao.40.006439] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An optical setup to obtain all the fractional correlations of a one-dimensional input in a single display is implemented. The system works as a multichannel parallel correlator for a continuous set of fractional orders and presents a variable shift variance. Some experimental results together with computer simulations are performed to illustrate the performance of our proposal.
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Granieri S, Furlan WD, Saavedra G, Andrés P. Radon-Wigner display: a compact optical implementation with a single varifocal lens. Appl Opt 1997; 36:8363-8369. [PMID: 18264378 DOI: 10.1364/ao.36.008363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A new optical implementation of the Radon-Wigner display for one-dimensional objects is presented, making use of the fractional Fourier transform approach. The proposed setup makes use of only two conventional refractive elements: a cylindrical lens and a varifocal lens. Although the exact magnifications cannot be achieved simultaneously for all the fractional transforms, an optimum design can be obtained through balancing the conflicting magnification requirements. Experimental results are obtained with a commercially available progressive addition lens. For comparison, computer simulations are also provided.
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Abstract
Some properties of optical correlation based on the fractional Fourier transform are analyzed. For a particular set of fractional orders, a filter is obtained that becomes insensitive to scale variations of the object. An optical configuration is also proposed to carry out the fractional correlation in a flexible way, and some experimental results are shown.
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Granieri S, Del Carmen Lasprilla M, Bolognini N, Sicre EE. Space-variant optical correlator based on the fractional Fourier transform: implementation by the use of a photorefractive Bi(12)GeO(2(a)) (BGO) holographic filter. Appl Opt 1996; 35:6951-6954. [PMID: 21151293 DOI: 10.1364/ao.35.006951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A space-variant optical correlator is proposed on the basis of the fractional Fourier transform. The optical device uses as a recording medium for the holographic filter a photorefractive Bi(12)GeO(2) (BGO) crystal. The experimental results confirm the shift-variance properties. Some limitations that arise from the volume diffraction are also considered.
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