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Russo G, Di Bartolo P, Candido R, Lucisano G, Manicardi V, Giandalia A, Nicolucci A, Rocca A, Rossi MC, Di Cianni G. Corrigendum to "The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care" [Diabetes Res. and Clin. Pract. 199 (2023) 110672]. Diabetes Res Clin Pract 2024; 210:111619. [PMID: 38580525 DOI: 10.1016/j.diabres.2024.111619] [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] [Indexed: 04/07/2024]
Affiliation(s)
- G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - P Di Bartolo
- Ravenna Diabetes Center - Romagna Local Health Authority, Ravenna, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | - M C Rossi
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
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Rocca A, Komici K, Brunese MC, Pacella G, Avella P, Di Benedetto C, Caiazzo C, Zappia M, Brunese L, Vallone G. Quantitative ultrasound (QUS) in the evaluation of liver steatosis: data reliability in different respiratory phases and body positions. Radiol Med 2024; 129:549-557. [PMID: 38512608 PMCID: PMC11021279 DOI: 10.1007/s11547-024-01786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
Liver steatosis is the most common chronic liver disease and affects 10-24% of the general population. As the grade of disease can range from fat infiltration to steatohepatitis and cirrhosis, an early diagnosis is needed to set the most appropriate therapy. Innovative noninvasive radiological techniques have been developed through MRI and US. MRI-PDFF is the reference standard, but it is not so widely diffused due to its cost. For this reason, ultrasound tools have been validated to study liver parenchyma. The qualitative assessment of the brightness of liver parenchyma has now been supported by quantitative values of attenuation and scattering to make the analysis objective and reproducible. We aim to demonstrate the reliability of quantitative ultrasound in assessing liver fat and to confirm the inter-operator reliability in different respiratory phases. We enrolled 45 patients examined during normal breathing at rest, peak inspiration, peak expiration, and semi-sitting position. The highest inter-operator agreement in both attenuation and scattering parameters was achieved at peak inspiration and peak expiration, followed by semi-sitting position. In conclusion, this technology also allows to monitor uncompliant patients, as it grants high reliability and reproducibility in different body position and respiratory phases.
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Affiliation(s)
- Aldo Rocca
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy.
| | - Giulia Pacella
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Pasquale Avella
- Department of General Surgery, Center for Hepatobiliary and Pancreatic Surgery, Pineta Grande Hospital, Castel Volturno, CE, Italy
| | - Chiara Di Benedetto
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
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Da Porto A, Candido R, Rocca A, Manicardi V, Nicolucci A, Miranda C, Cimino E, Di Bartolo P, Di Cianni G, Russo G. Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals. J Endocrinol Invest 2024:10.1007/s40618-024-02327-0. [PMID: 38436903 DOI: 10.1007/s40618-024-02327-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia. METHODS This was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score. RESULTS Using the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM. CONCLUSIONS In conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.
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Affiliation(s)
- A Da Porto
- Diabetes and Metabolism Unit, Clinica Medica, University of Udine, Udine, Italy.
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | | | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy
| | - C Miranda
- Endocrinology and Diabetes Unit, ASFO, Pordenone, Italy
| | - E Cimino
- UOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - P Di Bartolo
- Ravenna Diabetes Center-Romagna Local Health Authority, Ravenna, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
| | - G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Rocca A, Avella P, Scacchi A, Brunese MC, Cappuccio M, De Rosa M, Bartoli A, Guerra G, Calise F, Ceccarelli G. Robotic versus open resection for colorectal liver metastases in a "referral centre Hub&Spoke learning program". A multicenter propensity score matching analysis of perioperative outcomes. Heliyon 2024; 10:e24800. [PMID: 38322841 PMCID: PMC10844024 DOI: 10.1016/j.heliyon.2024.e24800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
Background Surgical resection is still considered the optimal treatment for colorectal liver metastasis (CRLM). Although laparoscopic and robotic surgery demonstrated their reliability especially in referral centers, the comparison between perioperative outcomes of robotic liver resection (RLR) and open (OLR) liver resection are still debated when performed in referral centers for robotic surgery, not dedicated to HPB. Our study aimed to verify the efficacy and safety of perioperative outcomes after RLR and OLR for CRLM in an HUB&Spoke learning program (H&S) between a high volume center for liver surgery and high volume center for robotic surgery. Methods We analyzed prospective databases of Pineta Grande Hospital (Castel Volturno) and Robotic Surgical Units (Foligno-Spoleto and Arezzo) from 2011 to 2021. A 1:1 propensity score matching (PSM) was performed according to baseline characteristics of patients, solitary/multiple CRLM, anterolateral/posterosuperior location. Results 383 patients accepted to be part of the study (268 ORL and 115 RLR). After PSM, 45 patients from each group were included. Conversion rate was 8.89 %. RLR group had a significantly lower blood loss (226 vs. 321 ml; p=0.0001), and fewer major complications (13.33 % vs. 17.78 %; p=0.7722). R0 resection was obtained in 100% of OLR (vs.95.55%, p =0.4944. Hospital stay was 8.8 days in RLR (vs. 15; p=0.0001).Conclusion: H&S represents a safe and effective program to train general surgeons also in Hepatobiliary surgery providing R0 resection rate, blood loss volume and morbidity rate superimposable to referral centers. Furthermore, H&S allow a reduction of health mobility with consequent money saving for patients and institutions.
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Affiliation(s)
- Aldo Rocca
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Pasquale Avella
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Andrea Scacchi
- General Surgery Department, University of Milano-Bicocca, Milan, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Michele De Rosa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, Foligno, Italy
| | - Alberto Bartoli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, Foligno, Italy
| | - Germano Guerra
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Fulvio Calise
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, Foligno, Italy
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Cafarchio A, Iasiello M, Brunese MC, Francica G, Rocca A, Andreozzi A. Emprint Microwave Thermoablation System: Bridging Thermal Ablation Efficacy between Human Patients and Porcine Models through Mathematical Correlation. Bioengineering (Basel) 2023; 10:1057. [PMID: 37760159 PMCID: PMC10525213 DOI: 10.3390/bioengineering10091057] [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: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
To investigate the in vivo ablation characteristics of a microwave ablation antenna in the livers of humans with tumors, a retrospective analysis of the ablation zones was conducted after applying Emprint microwave ablation systems for treatment. Percutaneous microwave ablations performed between January 2022 and September 2022 were included in this study. Subsequently, immediate post-ablation echography images were subjected to retrospective evaluation to state the long ablated diameter, short ablated diameter, and volume. The calculated ablation lengths and volume indices were then compared between in vivo and ex vivo results obtained from laboratory experiments conducted on porcine liver. The ex vivo data showed a good correlation between energy delivered and both increasing ablated dimensions (both p < 0.001) and volume (p < 0.001). The in vivo data showed a good correlation for dimensions (p = 0.037 and p = 0.019) and a worse correlation for volume (p = 0.142). When comparing ex vivo and in vivo data for higher energies, the ablated volumes grew much more rapidly in ex vivo cases compared to in vivo ones. Finally, a set of correlations to scale ex vivo results with in vivo ones is presented. This phenomenon was likely due to the absence of perfusion, which acts as a cooling system.
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Affiliation(s)
- Andrea Cafarchio
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Marcello Iasiello
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
| | - Maria Chiara Brunese
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy;
| | - Aldo Rocca
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Assunta Andreozzi
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
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Rocca A, Gkaniatsa E, Brunese MC, Hessman E, Muth A, Nwaru BI, Ragnarsson O, Bobbio E, Esposito D. Therapeutic outcomes with surgical and medical management for primary aldosteronism: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e072585. [PMID: 37518075 PMCID: PMC10387625 DOI: 10.1136/bmjopen-2023-072585] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Treatment strategies for primary aldosteronism (PA) include unilateral adrenalectomy and medical treatment with mineralocorticoid receptor (MR) antagonists. Whether these two different treatment strategies are comparable in mitigating the detrimental effect of PA on outcomes is still debated. OBJECTIVES The primary aim of this systematic review is to identify, appraise and synthesise existing literature comparing clinical outcomes after treatment in patients with PA. METHODS AND ANALYSIS A systematic and comprehensive search will be performed using PubMed, Web of Science and EMBASE, for studies published until December 2022. Observational and interventional studies will be eligible for inclusion. The quality of observational studies will be assessed using the Newcastle-Ottawa Scale, while interventional studies will be assessed using the Cochrane Effective Practice Organization of Care tool. The collected evidence will be narratively synthesised. We will perform meta-analysis to pool estimates from studies considered to be homogeneous. Reporting of the systematic review and meta-analysis will be in accordance with the Meta-analysis of Observational Studies in Epidemiology Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. ETHICS AND DISSEMINATION As this study is based solely on the published literature, no ethics approval is required. This review will aim to provide some estimates on outcomes, including survival, rates of clinical and biochemical control, cardiovascular and cerebrovascular events, as well as data on quality of life and renal function, in patients with PA treated surgically or with MR antagonists. The study findings will be presented at scientific meetings and will be published in an international peer-reviewed scientific journal. PROSPERO REGISTRATION NUMBER CRD42022362506.
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Affiliation(s)
- Aldo Rocca
- Department of Medicine and Health Science 'V Tiberio', University of Molise, Campobasso, Italy
| | - Eleftheria Gkaniatsa
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Chiara Brunese
- Department of Medicine and Health Science 'V Tiberio', University of Molise, Campobasso, Italy
| | - Eva Hessman
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Muth
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniela Esposito
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Russo G, Di Bartolo P, Candido R, Lucisano G, Manicardi V, Giandalia A, Nicolucci A, Rocca A, Rossi MC, Di Cianni G. The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care. Diabetes Res Clin Pract 2023; 199:110672. [PMID: 37084893 DOI: 10.1016/j.diabres.2023.110672] [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] [Indexed: 04/23/2023]
Abstract
AIMS Since 2006, the Italian AMD (Associations of Medical Diabetologists) Annals Initiative promoted a continuous monitoring of the quality of diabetes care, that was effective in improving process, treatment and outcome indicators through a periodic assessment of standardized measures. Here, we show the 2022 AMD Annals data on type 2 diabetes (T2D). METHODS A network involving ∼1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic clinical records, by a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated. RESULTS 295 centers provided the annual sample of 502,747 T2D patients. Overall, HbA1c value ≤7.0% was documented in 54.6% of patients, blood pressure <130/80 mmHg in 23.0%, and LDL-cholesterol levels <70 mg/dl in 34.3%, but only 5.2% were at- target for all the risk factors. As for innovative drugs, 29.0% of patients were on SGLT2-i, and 27.5% on GLP1-RAs. In particular, 59.7% were treated with either GLP1-RAs or SGLT2-i among those with established cardiovascular disease (CVD), 26.6% and 49.3% with SGLT2-i among those with impaired renal function and heart failure, respectively. Notably, only 3.2% of T2D patients showed a Q score <15, which correlates with a 80% higher risk of incident CVD events compared to scores >25. CONCLUSIONS The 2022 AMD Annals data show an improvement in the use of innovative drugs and in the overall quality of T2D care in everyday clinical practice. However, additional efforts are needed to reach the recommended targets for HbA1c and major CVD risk factors.
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Affiliation(s)
- G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - P Di Bartolo
- Ravenna Diabetes Center - Romagna Local Health Authority, Ravenna, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | - M C Rossi
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
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Rocca A, Porfidia C, Russo R, Tamburrino A, Avella P, Vaschetti R, Bianco P, Calise F. Neuraxial anesthesia in hepato-pancreatic-bilio surgery: a first western pilot study of 46 patients. Updates Surg 2023; 75:481-491. [PMID: 36607598 PMCID: PMC9817460 DOI: 10.1007/s13304-022-01437-9] [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] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 01/07/2023]
Abstract
The most common anesthetic approach in hepato-pancreatic-biliary (HPB) surgery is general anesthesia (GA), but it may result in increased morbidity and mortality and peri-operative risks especially in frail patients. The aim of this study was to assess the safety and effectiveness of neuraxial anesthesia (NA) in HPB in a pilot clinical series. This analysis was conducted on 46 consecutive patients undergoing HPB surgery in an Italian Tertial referral center. Data were prospectively collected and retrospectively analyzed. continuous spinal anesthesia (CSA), combined spino-epidural anesthesia (CSEA) and peridural anesthesia (PA) were used in major and minor hepatectomies and bilio-pancreatic surgery instead of GA. NA was evaluated by analyzing the surgical and anesthesiological short-term outcomes. 46 patients were considered eligible for the study between February 2018 and May 2020. The average age was 69.07 (± 9.95) years. 22 were males and 24 were females. According to the ASA score, 19 (41.30%) patients had ASA II, 22 (47.83%) had ASA III and 5 (10.87%) had ASA IV. 22 (47.83%) patients underwent CSA, 20 (43.48%) CSEA and 4 (8.69%) PA. We performed 8 major and 19 minor hepatectomies, 7 bilio-digestive derivations, 5 Whipple procedures, 4 iatrogenic biliary duct injuries, 2 splenopancreatectomies and 1 hepatic cyst fenestration. Clavien-Dindo ≥ 3 was observed in 3 patients. The conversion rate to endotracheal intubation occurring in 3 of 46 (6.52%) patients. After surgery, no local or pulmonary complications and delirium were reported in our series. The present study demonstrates that NA is a safe and feasible option in selected patients, if performed in referral centers by well-trained anaesthesiologists and surgeons.
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Affiliation(s)
- Aldo Rocca
- HPB Surgery Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy.
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy.
| | - Carmela Porfidia
- Intensive Care Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
| | - Raffaele Russo
- Intensive Care Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
| | | | - Pasquale Avella
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy
| | - Roberto Vaschetti
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy
| | - Paolo Bianco
- HPB Surgery Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
| | - Fulvio Calise
- HPB Surgery Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy
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Angeletti G, Mazzolini M, Rocca A. Two years follow-up of relapsing eosinophilic pneumonia with concomitant severe asthma successfully treated with benralizumab: A case report and brief review of the literature. Respir Med Case Rep 2022; 41:101795. [PMID: 36579077 PMCID: PMC9791164 DOI: 10.1016/j.rmcr.2022.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Relapsing eosinophilic pneumonia and severe eosinophilic asthma are rare and disabling diseases, which share common inflammatory backgrounds and often require long-term systemic steroid therapy. Benralizumab is a humanized antibody targeting IL-5 receptor that reduces corticosteroid dependence and flares up in severe eosinophilic asthma on long term. In this case report, successful treatment of eosinophilic pneumonia and severe eosinophilic asthma with benralizumab is described after a 2-year follow up, showing the promising results of this therapy for eosinophilic pneumonia management.
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Luciani C, Scacchi A, Vaschetti R, Di Marzo G, Fatica I, Cappuccio M, Guerra G, Ceccarelli G, Avella P, Rocca A. The uniportal VATS in the treatment of stage II pleural empyema: a safe and effective approach for adults and elderly patients-a single-center experience and literature review. World J Emerg Surg 2022; 17:46. [PMID: 36038946 PMCID: PMC9423701 DOI: 10.1186/s13017-022-00438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pleural empyema (PE) is a frequent disease, associated with a high morbidity and mortality. Surgical approach is the standard of care for most patients with II-III stage PE. In the last years, the minimally invasive surgical revolution involved also thoracic surgery allowing the same outcomes in terms of safety and effectiveness combined to better pain management and early discharge. The aim of this study is to demonstrate through our experience on uniportal-video-assisted thoracoscopy (u-VATS) the effectiveness and safety of its approach in treatment of stage II PE. As secondary endpoint, we will evaluate the different pattern of indication of u-VATS in adult and elderly patients with literature review. Methods We retrospectively reviewed our prospectively collected database of u-VATS procedures from November 2018 to February 2022, in our regional referral center for Thoracic Surgery of Regione Molise General Surgery Unit of “A. Cardarelli” Hospital, in Campobasso, Molise, Italy. Results A total of 29 patients underwent u-VATS for II stage PE. Fifteen (51.72%) patients were younger than 70 years old, identified as “adults,” 14 (48.28%) patients were older than 70 years old, identified as “elderly.” No mortality was found. Mean operative time was 104.68 ± 39.01 min in the total population. The elderly group showed a longer operative time (115 ± 53.15 min) (p = 0.369). Chest tube was removed earlier in adults than in elderly group (5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038). The Length of Stay (LOS) was shorter in the adults group (6.44 ± 2.35 vs. 12.29 ± 6.96 p = 0.033). Patients evaluated through Instrumental Activities of Daily Living (IADL) scale returned to normal activities of daily living after surgery. Conclusion In addition, the u-VATS approach seems to be safe and effective ensuring a risk reduction of progression to stage III PE with a lower recurrence risk and septic complications also in elderly patients. Further comparative multicenter analysis are advocated to set the role of u-VATS approach in the treatment of PE in adults and elderly patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00438-8.
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Affiliation(s)
- Claudio Luciani
- General Surgery Unit, A. Cardarelli Hospital, Campobasso, CB, Italy
| | - Andrea Scacchi
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Roberto Vaschetti
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | | | - Ilaria Fatica
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Graziano Ceccarelli
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Pasquale Avella
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - Aldo Rocca
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
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Buondonno A, Avella P, Cappuccio M, Scacchi A, Vaschetti R, Di Marzo G, Maida P, Luciani C, Amato B, Brunese MC, Esposito D, Selvaggi L, Guerra G, Rocca A. A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy. Front Surg 2022; 9:855527. [PMID: 35402486 PMCID: PMC8987280 DOI: 10.3389/fsurg.2022.855527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/25/2022] [Indexed: 01/25/2023] Open
Abstract
BackgroundMetabolic and bariatric surgery (BS) are considered life-changing and life-saving treatments for obese patients. The Italian Society of Obesity Surgery (SICOB) requires at least 25 operations per year to achieve the standard of care in the field. Despite the increasing need to treat obese patients, some small southern regions of Italy, such as Molise, do not have enough experience in bariatric procedures to be allowed to perform them. Therefore, our aim was to run a Hub and Spoke Program with a referral center in BS to treat obese patients and provide a proper learning curve in BS in Molise.MethodsIn 2020, the “A. Cardarelli Hospital” in Campobasso, Molise, started a formal “Learning Model of Hub and Spoke Collaboration” with the Hub center “Ospedale Del Mare”, Naples. A multidisciplinary approach was achieved. Patients were supervised and operated under the supervision and tutoring of the referral center. We retrospectively reviewed our prospectively collected database from February 2020 to August 2021 in order to analyze the safety and effectiveness of our learning program.ResultsIn total, 13 (3 men and 10 women) patients underwent BS with the mean age of 47.08 years and a presurgery BMI of 41.79. Seven (53.84%) patients were the American Society of Anesthesiologist (ASA) II, and 6 (46.16%) patients were ASA III. Twelve (92.31%) procedures were laparoscopic sleeve gastrectomies, 1 (7.69%) patient underwent endoscopic BioEnterics Intragastric Balloon (BIB) placement. One (8.33%) sleeve gastrectomy was associated to gastric band removal. Mean surgical time was 110.14 ± 23.54 min. The mean length of stay was 4.07 ± 2.40 days. No Clavien-Dindo ≥ III and mortality were reported. The follow-up program showed a mean decrease of 11.82 in terms of body mass index (BMI) value. The last 5 procedures were performed by the whole equips from “A. Cardarelli” under external tutoring without any impact on complication rate.ConclusionThe setup of a proper Hub and Spoke Program may allow to perform BS to provide the standard of care. This approach may reduce health costs and related patient migration.
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Affiliation(s)
| | - Pasquale Avella
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Andrea Scacchi
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- *Correspondence: Andrea Scacchi
| | - Roberto Vaschetti
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- Roberto Vaschetti
| | | | - Pietro Maida
- General Surgery Unit, Ospedale del Mare, Centro Sanitario Locale Napoli 1 Centro, Naples, Italy
| | - Claudio Luciani
- General Surgery Unit, A. Cardarelli Hospital, Campobasso, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Daniela Esposito
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lucio Selvaggi
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Germano Guerra
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Aldo Rocca
- General Surgery Unit, A. Cardarelli Hospital, Campobasso, Italy
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
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12
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Ceccarelli G, Codacci-Pisanelli M, De Rosa M, Mariani L, Rocca A, Mazzucca D, Polistena A. Robot-Assisted Liver Resection and Cholecystectomy Using Indocyanine-Green for Intrahepatic Cholangiocarcinoma, in a Very Rare Anatomical Anomaly of ‘Bipartite Liver’. Surg Innov 2022; 29:488-493. [DOI: 10.1177/15533506221081116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Robotic hepatobiliary surgery has significantly developed worldwide with substantial clinical results. Hepatobiliary anatomical anomalies increase the complexity of hepatobiliary resection with a relevant risk of iatrogenic lesions. Among congenital liver anomalies, the ‘bipartite liver’ is an extremely rare condition which might be associated with complex surgical dissection of the hepatic hilum. We herein report a rare case of congenital ‘bipartite liver’ associated with a cholangiocarcinoma of segment VI and calculous cholecystitis. The patient underwent robot-assisted segmentectomy and cholecystectomy with the use of indocyanine-green cholangiography and intraoperative ultrasound. A challenging hilar dissection was performed using this approach. To the best of our knowledge, this is the first case reported that describes a robot-assisted liver resection and cholecystectomy in a patient having a cholangiocarcinoma associated with this rare liver anomaly. The robotic approach was safe and effective and the 3D preoperative imaging, as well as the intraoperative green-indocyanine cholangiography was extremely useful, especially during hilar dissection and cholecystectomy.
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Affiliation(s)
| | - Massimo Codacci-Pisanelli
- General and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Italy
| | | | | | - Aldo Rocca
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Italy
| | | | - Andrea Polistena
- General and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Italy
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13
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Amato B, Compagna R, De Vivo S, Rocca A, Carbone F, Gentile M, Cirocchi R, Squizzato F, Spertino A, Battocchio P. Groin Surgical Site Infection in Vascular Surgery: Systemic Review on Peri-Operative Antibiotic Prophylaxis. Antibiotics (Basel) 2022; 11:antibiotics11020134. [PMID: 35203737 PMCID: PMC8868080 DOI: 10.3390/antibiotics11020134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and post-operative care, SSI rates in the vascular surgery field remain significant. However, compliant antibiotic therapy can successfully reduce the SSI incidence pre- and post-surgery. Methods: In October 2021, we conducted a systematic literature review using OVID, PubMed, and EMBASE databases, centered on studies published between January 1980 and December 2020. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist. Inclusion/exclusion criteria have been carefully selected and reported in the text. For analyses, we calculated 95% confidence intervals (CI) and weighted odds ratios to amalgamate control and study groups in publications. We applied The Cochrane Collaboration tool to assess bias risk in selected studies. Results: In total, 592 articles were identified. After the removal of duplicates and excluded studies, 36 full-texts were included for review. Conclusions: The review confirmed that antibiotic therapy, administered according to all peri-operative protocols described, is useful in reducing groin SSI rate in vascular surgery.
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Affiliation(s)
- Bruno Amato
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-3403604022
| | - Rita Compagna
- Division of Vascular Surgery, Ospedale Pellegrini, 80100 Naples, Italy; (R.C.); (S.D.V.)
| | - Salvatore De Vivo
- Division of Vascular Surgery, Ospedale Pellegrini, 80100 Naples, Italy; (R.C.); (S.D.V.)
| | - Aldo Rocca
- Deparment of Medicine and Health Sciences “V. Tiberio”, University of Campobasso, 86100 Campobasso, Italy;
| | - Francesca Carbone
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
| | - Maurizio Gentile
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Naples, Italy;
| | - Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, 05100 Terni, Italy;
| | - Francesco Squizzato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
| | - Andrea Spertino
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
| | - Piero Battocchio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
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14
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Giuliani A, Avella P, Segreto AL, Izzo ML, Buondonno A, Coluzzi M, Cappuccio M, Brunese MC, Vaschetti R, Scacchi A, Guerra G, Amato B, Calise F, Rocca A. Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers. Front Surg 2022; 8:804675. [PMID: 34993230 PMCID: PMC8725883 DOI: 10.3389/fsurg.2021.804675] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 12/07/2022] Open
Abstract
Background: Surgical resection is the only possible choice of treatment in several pancreatic disorders that included periampullar neoplasms. The development of a postoperative pancreatic fistula (POPF) is the main complication. Despite three different surgical strategies that have been proposed–pancreatojejunostomy (PJ), pancreatogastrostomy (PG), and pancreatic duct occlusion (DO)–none of them has been clearly validated to be superior. The aim of this study was to analyse the postoperative outcomes after DO. Methods: We retrospectively reviewed 56 consecutive patients who underwent Whipple's procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit. After pancreatic resection in open surgery, we performed DO of the Wirsung duct with Cyanoacrylate glue independently from the stump characteristics. The mean follow-up was 24.5 months. Results: In total, 29 (60.4%) were men and 19 were (39.6%) women with a mean age of 62.79 (SD ± 10.02) years. Surgical indications were in 95% of cases malignant diseases. The incidence of POPF after DO was 31 (64.5%): 10 (20.8%) patients had a Grade A fistula, 18 (37.5%) Grade B fistula, and 3 (6.2%) Grade C fistula. No statistical differences were demonstrated in the development of POPF according to pancreatic duct diameter groups (p = 0.2145). Nevertheless, the POPF rate was significantly higher in the soft pancreatic group (p = 0.0164). The mean operative time was 358.12 min (SD ± 77.03, range: 221–480 min). Hospital stay was significantly longer in patients who developed POPF (p < 0.001). According to the Clavien-Dindo (CD) classification, seven of 48 (14.58%) patients were classified as CD III–IV. At the last follow-up, 27 of the 31 (87%) patients were alive. Conclusions: Duct occlusion could be proposed as a safe alternative to pancreatic anastomosis especially in low-/medium-volume centers in selected cases at higher risk of clinically relevant POPF.
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Affiliation(s)
- Antonio Giuliani
- Unit of General and Emergency Surgery, AOR "San Carlo", Potenza, Italy.,Unit of Hepatobiliary Surgery and Liver Transplant Centre, "Cardarelli" Hospital, Naples, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Anna Lucia Segreto
- Department of General Surgery "SS. Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Maria Lucia Izzo
- Unit of General and Emergency Surgery, AOR "San Carlo", Potenza, Italy
| | - Antonio Buondonno
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | | | - Micaela Cappuccio
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Roberto Vaschetti
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Scacchi
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fulvio Calise
- Unit of Hepatobiliary Surgery and Liver Transplant Centre, "Cardarelli" Hospital, Naples, Italy.,HPB Surgery Unit, Pineta Grande Hospital, Campania, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.,HPB Surgery Unit, Pineta Grande Hospital, Campania, Italy
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15
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Sena G, Picciariello A, Marino F, Goglia M, Rocca A, Meniconi RL, Gallo G. One-Stage Total Laparoscopic Treatment for Colorectal Cancer With Synchronous Metastasis. Is It Safe and Feasible? Front Surg 2021; 8:752135. [PMID: 34869559 PMCID: PMC8637405 DOI: 10.3389/fsurg.2021.752135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022] Open
Abstract
Liver is the main target organ for colorectal cancer (CRC) metastases. It is estimated that ~25% of CRC patients have synchronous metastases at diagnosis, and about 60% of CRC patients will develop metastases during the follow up. Although several teams have performed simultaneous laparoscopic resections (SLR) of liver and colorectal lesions, the feasibility and safety of this approach is still widely debated and few studies on this topic are present in the literature. The purpose of this literature review is to understand the state of the art of SLR and to clarify the potential benefits and limitations of this approach. Several studies have shown that SLR can be performed safely and with short-term outcomes similarly to the separated procedures. Simultaneous laparoscopic colorectal and hepatic resections combine the advantages of one stage surgery with those of laparoscopic surgery. Several reports compared the short-term outcomes of one stage laparoscopic resection with open resections and showed a similar or inferior amount of blood loss, a similar or lower complication rate, and a significant reduction of hospital stay for laparoscopic surgery respect to open surgery but much longer operating times for the laparoscopic technique. Few retrospective studies compared long term outcomes of laparoscopic one stage surgery with the outcomes of open one stage surgery and did not identify any differences about disease free survival and the overall survival. In conclusion, hepatic and colorectal SLR are a safe and effective approach characterized by less intraoperative blood loss, faster recovery of intestinal function, and shorter length of postoperative hospital stay. Moreover, laparoscopic approach is associated to lower rates of surgical complications without significant differences in the long-term outcomes compared to the open surgery.
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Affiliation(s)
- Giuseppe Sena
- Department of Vascular Surgery, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | | | - Fabio Marino
- Unit of Surgery, National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Marta Goglia
- Department of General Surgery, "La Sapienza" University of Rome-Sant'Andrea University Hospital, Rome, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Roberto L Meniconi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
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16
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Rocca A, Scacchi A, Cappuccio M, Avella P, Bugiantella W, De Rosa M, Costa G, Polistena A, Codacci-Pisanelli M, Amato B, Carbone F, Ceccarelli G. Robotic surgery for colorectal liver metastases resection: A systematic review. Int J Med Robot 2021; 17:e2330. [PMID: 34498805 DOI: 10.1002/rcs.2330] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/10/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The role of robotic surgery for colorectal cancer liver metastases (CRCLMs) has never been investigated in large series. METHODS A systematic literature review was carried out on PubMed and Cochrane libraries. RESULTS We selected nine studies between 2008 and 2021. Two hundred sixty-two patients were included. One hundred thirty-one patients underwent simultaneous resections. The mean blood loss was 309.4 ml (range, 200-450 ml), the mean operative time was 250.5 min (range, 198.5-449.0 min). The mean length of hospital stay was 7.98 days (range, 4.5 to 12 days). The overall postoperative mortality was 0.4%. The overall morbidity rate was 37.0%, Clavien-Dindo grade III-IV complications were 8.4%. The mean 3-year overall survival was 55.25% (range, 44.4-66.1%), the mean 3-year disease free survival was 37% (range, 33.3-41.9%) CONCLUSION: We can conclude that robotic-assisted surgery might be considered as a technical upgrade option for minimally invasive approach to CRCLM resections even for simultaneous operations and challenging cases.
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Affiliation(s)
- Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Scacchi
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Walter Bugiantella
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
| | - Michele De Rosa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
| | - Gianluca Costa
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Polistena
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery "P. Valdoni", Sapienza, University of Study of Rome, University Policlinic Umberto I, Rome, Italy
| | - Massimo Codacci-Pisanelli
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery "P. Valdoni", Sapienza, University of Study of Rome, University Policlinic Umberto I, Rome, Italy
| | - Bruno Amato
- Division of General Surgery, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Fabio Carbone
- Department of Advanced Biomedical Sciences, Università di Napoli - "Federico II", Naples, Italy
| | - Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
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17
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Ceccarelli G, Costa G, De Rosa M, Codacci Pisanelli M, Frezza B, De Prizio M, Bravi I, Scacchi A, Gallo G, Amato B, Bugiantella W, Tacchi P, Bartoli A, Patriti A, Cappuccio M, Komici K, Mariani L, Avella P, Rocca A. Minimally Invasive Approach to Gastric GISTs: Analysis of a Multicenter Robotic and Laparoscopic Experience with Literature Review. Cancers (Basel) 2021; 13:cancers13174351. [PMID: 34503161 PMCID: PMC8431126 DOI: 10.3390/cancers13174351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary Gastrointestinal stromal tumors (GISTs) represent about 1–3% of all gastrointestinal malignancies, of which 50–60% are gastric GISTs (GGs). To the date, surgery represents the best therapeutic option, and the robotic gastric surgery could gain an important role, overcoming many laparoscopic drawbacks. The aim of this study is to evaluate safety and effectiveness of minimally invasive surgery (MIS) for GGs, reporting 10-year experience of three different centers. We included a population of 81 patients who underwent MIS approaches (36 laparoscopy vs. 45 robotic surgery). Seventy-two (72) patients were enrolled in a follow-up program to evaluate the long-term oncological outcomes. Furthermore, we discussed some technical notes and also we analyzed the operative and peri-operative outcomes. In conclusion, our results suggest that the robotic approach might be a suitable treatment, especially for GISTs >5 cm, even located in unfavorable places, despite longer operative time and costs than laparoscopic approach. Abstract Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, 105 patients with a primary gastrointestinal stromal tumor (GISTs) located in the stomach, underwent surgery at three surgical units. (2) Results: A multi-institutional analysis of minimally invasive series including 81 cases (36 laparoscopic and 45 robotic) from 3 referral centers was performed. Males were 35 (43.2%), the average age was 66.64 years old. ASA score ≥3 was 6 (13.3%) in the RS and 4 (11.1%) in the LS and the average tumor size was 4.4 cm. Most of the procedures were wedge resections (N = 76; 93.8%) and the main operative time was 151 min in the RS and 97 min in the LS. Conversion was necessary in five cases (6.2%). (3) Conclusions: Minimal invasive approaches for gastric GISTs performed in selected patients and experienced centers are safe. A robotic approach represents a useful option, especially for GISTs that are more than 5 cm, even located in unfavorable places.
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Gianluca Costa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Surgery Center, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Michele De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, 06034 Perugia, Italy;
| | - Massimo Codacci Pisanelli
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery P. Valdoni, Policlinic Umberto I, Sapienza University of Study of Rome, 00161 Rome, Italy;
| | - Barbara Frezza
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Marco De Prizio
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Ilaria Bravi
- Histopathology Department, Usl Umbria 2, San Giovanni Battista Hospital, 06034 Foligno, Italy;
| | - Andrea Scacchi
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy;
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80126 Naples, Italy;
| | - Walter Bugiantella
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Piergiorgio Tacchi
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Bartoli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Patriti
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Division of General Surgery, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Klara Komici
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Lorenzo Mariani
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Aldo Rocca
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
- Correspondence:
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Komici K, Bianco A, Perrotta F, Dello Iacono A, Bencivenga L, D’Agnano V, Rocca A, Bianco A, Rengo G, Guerra G. Clinical Characteristics, Exercise Capacity and Pulmonary Function in Post-COVID-19 Competitive Athletes. J Clin Med 2021; 10:jcm10143053. [PMID: 34300219 PMCID: PMC8304629 DOI: 10.3390/jcm10143053] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Limited evidence exists regarding adverse modifications affecting cardiovascular and pulmonary function in physical active adults affected by COVID-19, especially in athletic populations. We aimed to describe the clinical presentation of COVID-19 in a cohort of competitive athletes, as well as spirometry and echocardiography findings and cardio-respiratory performance during exercise. Methods: Twenty-four competitive athletes with COVID-19 were recruited for this study after ending self-isolation and confirmation of negative laboratory results. All athletes underwent clinical evaluation, spirometry, echocardiography and cardiopulmonary exercise testing (CPET). These data were compared to a group of healthy control athletes. Results: Anosmia was the most frequent symptom present in 70.83% patients, followed by myalgia, fatigue and ageusia. The most frequent persisting symptoms were anosmia 11 (45.83%) and ageusia 8 (33.33%). Compared to controls, COVID-19 patients presented lower FEV1%: 97.5 (91.5–108) vs. 109 (106–116) p = 0.007. Peak Oxygen Uptake (VO2) in COVID-19 patients was 50.1 (47.7–51.65) vs. 49 (44.2–52.6) in controls (p = 0.618). Conclusions: Reduced exercise capacity was not identified and pulmonary and cardiovascular function are not impaired during early recovery phase in a population of physical active adults except FEV1 reduction.
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Affiliation(s)
- Klara Komici
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (V.D.); (A.R.); (G.G.)
- Exercise and Sports Medicine Unit, “Antonio Cardarelli Hospital”, 86100 Campobasso, Italy
- Correspondence: ; Tel./Fax: +39-087-440-4710
| | - Antonio Bianco
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (V.D.); (A.R.); (G.G.)
- Exercise and Sports Medicine Unit, “Antonio Cardarelli Hospital”, 86100 Campobasso, Italy
| | - Fabio Perrotta
- UOC Pneumologia AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | - Antonio Dello Iacono
- School of Health and Life Sciences, University of the West of Scotland, Hamilton G72 0LH, UK;
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (L.B.); (G.R.)
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Vito D’Agnano
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (V.D.); (A.R.); (G.G.)
| | - Aldo Rocca
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (V.D.); (A.R.); (G.G.)
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (L.B.); (G.R.)
- Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), 82037 Telese Terme, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (A.B.); (V.D.); (A.R.); (G.G.)
- Exercise and Sports Medicine Unit, “Antonio Cardarelli Hospital”, 86100 Campobasso, Italy
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Ceccarelli G, Rocca A, De Rosa M, Fontani A, Ermili F, Andolfi E, Bugiantella W, Levi Sandri GB. Correction to: Minimally invasive robotic-assisted combined colorectal and liver excision surgery: feasibility, safety and surgical technique in a pilot series. Updates Surg 2021; 73:1023-1027. [PMID: 33970451 DOI: 10.1007/s13304-021-01057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Graziano Ceccarelli
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy. .,San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy.
| | - Aldo Rocca
- San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco de Sanctis, 1, 86100, Campobasso, Italy
| | - Michele De Rosa
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Andrea Fontani
- San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy
| | - Fabio Ermili
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Enrico Andolfi
- San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy
| | - Walter Bugiantella
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, Polo Ospedaliero Interaziendale Trapianti (POIT), San Camillo-Forlanini Hospital, Rome, Italy
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Ceccarelli G, Rocca A, De Rosa M, Fontani A, Ermili F, Andolfi E, Bugiantella W, Levi Sandri GB. Minimally invasive robotic-assisted combined colorectal and liver excision surgery: feasibility, safety and surgical technique in a pilot series. Updates Surg 2021; 73:1015-1022. [PMID: 33830484 DOI: 10.1007/s13304-021-01009-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Different strategies may be adopted in patients with synchronous colorectal liver metastases (LM). The role of laparoscopy has been investigated to define the benefits of minimally invasive surgery in a single-stage operation. In our study, we report our experience of 28 Minimally Invasive Robotic-Assisted combined Colorectal and Liver Excision Surgery (MIRACLES). From October 2012 to December 2019, 135 Robotic liver resections and 218 Robotic Colorectal resections were performed in our center. Twenty-eight patients underwent MIRACLES resection with 37 nodules removed. Fifty-two lesions in 28 patients were resected in minimally invasive robot-assisted surgery. Eighteen lesions were located in postero-superior liver segments (eight in segment VII, two in segment VIII, eight in segment IVa). Nine right colectomies, seven left colectomies, ten anterior rectal resections, one Hartmann and one MILES procedures were performed. The median surgical time of MIRACLES procedures was 332 min. Two conversions to open approach were necessary. Four major complications (> III) were observed. No postoperative mortality was recorded. The median hospital stay was 8 days. The median overall survival was 27.5 months. The MIRACLES approach is feasible and safe for colorectal resection and hepatic nodules located in all segments, with a low rate of postoperative complications. Surgical technique is demanding and should be reserved, presently, to tertiary centers.
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Affiliation(s)
- Graziano Ceccarelli
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy. .,San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy.
| | - Aldo Rocca
- San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco de Sanctis, 1, 86100, Campobasso, Italy
| | - Michele De Rosa
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Andrea Fontani
- San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy
| | - Fabio Ermili
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Enrico Andolfi
- San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy
| | - Walter Bugiantella
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, Polo Ospedaliero Interaziendale Trapianti (POIT), San Camillo-Forlanini Hospital, Rome, Italy
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21
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Komici K, Dello Iacono A, De Luca A, Perrotta F, Bencivenga L, Rengo G, Rocca A, Guerra G. Adiponectin and Sarcopenia: A Systematic Review With Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:576619. [PMID: 33935962 PMCID: PMC8082154 DOI: 10.3389/fendo.2021.576619] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sarcopenia is a progressive loss of skeletal muscle mass whose pathophysiology has been proposed to possibly involve mechanisms of altered inflammatory status and endocrine function. Adiponectin has been shown to modulate inflammatory status and muscle metabolism. However, the possible association between adiponectin levels and sarcopenia is poorly understood. In order to fill this gap, in the present manuscript we aimed to summarize the current evidence with a systematic review and a meta-analysis of studies reporting serum adiponectin levels in patients with sarcopenia compared to non-sarcopenic controls. METHODS An electronic search through Medline/PubMed, Cochrane Library, and Science Direct was performed till March 1, 2020. From the included papers, meta-analysis of cross-sectional studies comparing serum levels of adiponectin between patients with sarcopenia and controls was performed. RESULTS Out of 1,370 initial studies, seven studies were meta-analyzed. Sarcopenic participants had significantly higher levels of adiponectin Hedges' g with 95% confidence interval (CI): 1.20 (0.19-2.22), p = 0.02 than controls. Subgroup analysis, performed in Asian population and focused on identification of the condition based on AWGS criteria, reported higher adiponectin levels in sarcopenic population (2.1 (0.17-4.03), p = 0.03 and I2 = 98.98%. Meta-regression analysis revealed female gender to significantly influence the results as demonstrated by beta = 0.14 (95% CI (0.010-0.280), p = 0.040). CONCLUSIONS Our meta-analysis found evidence that sarcopenia is associated with higher adiponectin levels. However, caution is warranted on the interpretation of these findings, and future longitudinal research is required to disentangle and better understand the topic.
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Affiliation(s)
- Klara Komici
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
- *Correspondence: Klara Komici,
| | - Antonio Dello Iacono
- School of Health and Life Sciences, University of the West of Scotland, Hamilton, United Kingdom
| | - Antonio De Luca
- Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), Telese Terme, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
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Pellegrino B, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Schirone A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Todeschini R, Tognetto M, Naldi N, Bortesi B, Montemurro F, Ardizzoni A, Boni L, Musolino A. Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). ESMO Open 2020; 6:100019. [PMID: 33399082 PMCID: PMC7808100 DOI: 10.1016/j.esmoop.2020.100019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background The combination of a microtubule inhibitor (eribulin) with a nucleoside analog (gemcitabine) may synergistically induce tumor cell death, particularly in triple negative breast cancer (TNBC) characterized by high cell proliferation, aggressive behavior, and chemo-resistance. Patients and methods This is an open-label, multicenter phase II study evaluating the combination of eribulin (0.88 mg/m2) plus gemcitabine (1000 mg/m2) on days 1 and 8 of a 21-day cycle as either first- or second-line treatment of locally advanced or metastatic TNBC. The primary endpoint was the objective response for evaluable patients. A prospective, molecular correlative study was carried out to assess the role of germinal BRCA pathogenic variants and single nucleotide polymorphisms (SNPs) in predicting efficacy and toxicity of the combination regimen. Results From July 2013 to September 2016, 83 evaluable patients were enrolled. They received a median number of six cycles of treatment. An overall response rate (ORR) of 37.3% (31 patients) was observed, with a complete response rate of 2.4% and a partial response rate of 34.9%; the clinical benefit rate was 48.8%. With a median follow-up of 28.8 months, the median response duration was 6.6 months, the median progression-free survival (PFS) was 5.1 months, and the median overall survival (OS) was 14.5 months. The most common grade 3-4 adverse events were aminotransferase elevation (in 25% of the patients) and neutropenia (in 23.8%). Women with BRCA1/2 pathogenic variants were associated with worse ORR, PFS, and OS than BRCA1/2 wild-type carriers. CYP3A4 and FGD4 SNPs were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS. Conclusions The combination of eribulin and gemcitabine showed promising activity and a moderate toxicity profile in metastatic TNBC. BRCA status and pharmacogenetics tests may help identify patients with high probability of response with negligible toxicity. EudraCT number 2012-003505-10. Eribulin plus gemcitabine showed a remarkable best ORR of 37.3% and a clinical benefit rate of 48.8%. The most common grade 3/4 toxicities were liver toxicity and neutropenia without febrile neutropenia. The study regimen partially lost its efficacy in patients harboring BRCA1/2 pathogenic variants. SNPs in CYP3A4 and FGD4 genes were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS.
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Affiliation(s)
- B Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Cavanna
- Hospital of Piacenza, Piacenza, Italy
| | - D Boggiani
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Frassoldati
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Schirone
- Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Caldara
- Medical Oncology Unit, Ospedale Santa Chiara, Trento, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - S Gori
- Sacro Cuore-Don Calabria Hospital, Negrar (VR), Italy
| | - F Piacentini
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | - R Berardi
- Ancona University Hospital, Ancona, Italy
| | - A A Brandes
- Department of Medical Oncology, Azienda USL, Bologna, Italy
| | | | - F Villa
- Hospital of Lecco, Lecco, Italy
| | - R Todeschini
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - M Tognetto
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - N Naldi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - B Bortesi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - F Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - A Ardizzoni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - L Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Palleschi M, Barzotti E, Melegari E, Manunta S, Mannozzi F, Vagheggini A, Maltoni R, Fedeli A, Sarti S, Cecconetto L, Possanzini P, Ravaioli S, Tumedei M, Amadori D, Bravaccini S, Rocca A. Impact of Ki67 and progesterone receptor on PFS with cyclin-dependent kinase 4/6 inhibitors in HER2-negative advanced breast cancer: A real world mono-institutional experience. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ceccarelli G, Pasculli A, Bugiantella W, De Rosa M, Catena F, Rondelli F, Costa G, Rocca A, Longaroni M, Testini M. Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review. World J Emerg Surg 2020; 15:37. [PMID: 32487136 PMCID: PMC7268602 DOI: 10.1186/s13017-020-00316-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background Giant hiatal hernia (GHH) is a condition where one-third of the stomach migrates into the thorax. Nowadays, laparoscopic treatment gives excellent postoperative outcomes. Strangulated GHH is rare, and its emergent repair is associated with significant morbidity and mortality rates. We report a series of five cases of strangulated GHH treated by a minimally invasive laparoscopic and robot-assisted approach, together with a systematic review of the literature. Methods During 10 years (December 2009–December 2019), 31 patients affected by GHH were treated by robot-assisted or conventional laparoscopic surgical approach. Among them, five cases were treated in an emergency setting. We performed a PubMed MEDLINE search about the minimally invasive emergent treatment of GHH, selecting 18 articles for review. Results The five cases were male patients with a mean age of 70 ± 18 years. All patients referred to the emergency service complaining of severe abdominal and thoracic pain, nausea and vomiting. CT scan and endoscopy were the main diagnostic tools. All patients showed stable hemodynamic conditions so that they could undergo a minimally invasive attempt. The surgical approach was robotic-assisted in three patients (60%) and laparoscopic in two (40%). Patients reported no complications or recurrences. Conclusion Reviewing current literature, no general recommendations are available about the emergent treatment of strangulated hiatal hernia. Acute mechanical outlet obstruction, ischemia of gastric wall or perforation and severe bleeding are the reasons for an emergent surgical indication. In stable conditions, a minimally invasive approach is often feasible. Moreover, the robot-assisted approach, allowing a stable 3D view and using articulated instruments, represents a reasonable option in challenging situations.
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Alessandro Pasculli
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Walter Bugiantella
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Michele De Rosa
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Viale Antonio Gramsci 11, 43126, Parma, Italy
| | - Fabio Rondelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Gianluca Costa
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco de Sanctis 1, 86100, Campobasso, Italy
| | - Mattia Longaroni
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Mario Testini
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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25
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Amato B, Farina MA, Campisi S, Ciliberti M, Donna VD, Florio A, Grasso A, Miranda R, Pompeo F, Farina E, Serra R, Cirocchi R, Calemma F, Rocca A, Compagna R. CGF Treatment of Leg Ulcers: a Randomized Controlled Trial. Open Med (Wars) 2020; 14:959-967. [PMID: 31934641 PMCID: PMC6947757 DOI: 10.1515/med-2019-0113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/04/2019] [Indexed: 01/14/2023] Open
Abstract
Background Concentrated Growth Factors (CGF) is a concentration of second generation autologous growth factors compared to platelet rich plasma (PRP) and represents a multifactorial stimulation system that can be used for the management and treatment of chronic skin ulcers. Aim The aim of this work is to evaluate the additional benefits of the CGF compared to the standard of dressing and its effects on the dynamics of the healing process. Methods Autologous CGFs were obtained from 100 patients with chronic mixed ulcers (venous ulcers in patients with II stage claudication) of the lower limbs in a multicentric controlled randomized study. Results The results showed a significant advantage in the use of CGF in association with cleansing and selective compression in the healing time and stabilization of mixed ulcers of the lower extremities. Conclusions These results support the CGF’s clinical use for improving clinical outcomes in mixed ulcers of the legs.
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Affiliation(s)
- Bruno Amato
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
| | | | - Silvana Campisi
- Transfusion Immunohematology Service, S.Andrea Hospital, 00192 Rome, Italy
| | | | | | - Anna Florio
- Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonino Grasso
- Vascular Surgery Unit, University of Catania, "Policlinico, Vittorio Emanuele" P.O. G. Rodolico , Catania, Italy
| | - Rosario Miranda
- Angiology Service ASL NA 3 Sud, Nola District, 80035 Nola, Napoli, Italy
| | - Francesco Pompeo
- Vascular Surgery Unit, Neurologic Mediterranean Institute Neuromed, 86077 Pozzilli, Isernia, Italy
| | - Eleonora Farina
- Vascular Surgery Unit, Villa Del Sole Hospital 81100 Caserta, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy.,Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Division of Week surgery, S. Maria Hospital, Terni, Italy
| | - Francesca Calemma
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy, via S. Pansini, 5, 80131 Naples, Italy
| | - Rita Compagna
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy.,Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Amato B, Compagna R, Florio A, Calemma F, Rocca A, Salzano F, Brongo S, Gasbarro V, Aprea G. Surgical Versus Sequential Hybrid Treatment of Carotid Body Tumors. Open Med (Wars) 2019; 14:968-976. [PMID: 31934642 PMCID: PMC6947761 DOI: 10.1515/med-2019-0115] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022] Open
Abstract
Carotid body tumor (CBT) are slow-growing tumors that develop in the cervical region at the carotid bifurcation. . In a randomized study, 33 patients were treated for CBT excision: 10 patients performed preoperative embolization (PE) and 23 were treated only by isolated traditional surgery (N-PE). The first group includes patients undergoing preoperative embolization. The second group of patients (N-PE) included 11 males and 12 females. Intraoperative complications were lower in patients treated with a hybrid procedure (PE): sections of the cranial nerves were recorded in 7% of cases compared to 12% of the surgical procedure (P-value = 0.72); while the reversible nerve lesions (P value = 0.21) and the permanent ones (P value = 0.46), were instead similar in both procedures. The comparative blood loss during the operative procedure shows a P-value of 0.02. Operating times, reversible damage of the cranial nerves , incidence of stroke (0% vs1%, P value> 0.99) and post-operative hospital stay (4.1 vs. 4.2 days, P value = 0.91) did not show differences in the two groups of patients. The analysis of the results detects pre-operative embolization of CBT in reducing intraoperative blood loss and resection of the cranial nerves..
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Affiliation(s)
- Bruno Amato
- Department of Clinical Medicine and Surgery – University Federico II of Naples, Italy – via S. Pansini, 5 - 80131Naples, Italy
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
| | - Rita Compagna
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
- Department of Cardio-thoracic and Respiratory Sciences - University of Campania "Luigi Vanvitelli", Naples - via S. Pansini, 5 - 80131Naples, Italy
| | - Anna Florio
- Department of Cardio-thoracic and Respiratory Sciences - University of Campania "Luigi Vanvitelli", Naples - via S. Pansini, 5 - 80131Naples, Italy
| | - Francesca Calemma
- Department of Clinical Medicine and Surgery – University Federico II of Naples, Italy – via S. Pansini, 5 - 80131Naples, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery – University Federico II of Naples, Italy – via S. Pansini, 5 - 80131Naples, Italy
| | - Francesco Salzano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Sergio Brongo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular Surgery, S. Anna Hospital, Via Aldo Moro 8, Ferrara, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery – University Federico II of Naples, Italy – via S. Pansini, 5 - 80131Naples, Italy
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Costa G, Frezza B, Fransvea P, Massa G, Ferri M, Mercantini P, Balducci G, Buondonno A, Rocca A, Ceccarelli G. Clinico-pathological Features of Colon Cancer Patients Undergoing Emergency Surgery: A Comparison Between Elderly and Non-elderly Patients. Open Med (Wars) 2019; 14:726-734. [PMID: 31637303 PMCID: PMC6778396 DOI: 10.1515/med-2019-0082] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background Colorectal cancer (CRC) is one of the most common cancers in patients older than 65 years. Emergency presentation represents about 30% of cases, with increased morbidity and mortality rates. The aim of this study is to compare the perioperative outcome between elderly and non-elderly patients undergoing emergency surgery. Method We retrospectively analysed CRC patients that underwent emergency surgery at the Departments of Surgery of the Sapienza University Sant'Andrea Hospital in Rome, and at San Donato Hospital in Arezzo, between June 2012 and June 2017. Patients were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Variables analysed were sex, onset symptoms, associated disease, ASA score, tumor site and TNM stage, surgical procedures and approach, and morbidity and mortality. Results Of a total of 123 patients, 29 patients were non-elderly and 94 patients were elderly. No significant differences were observed in sex, onset symptoms and tumor site between the two groups. Comorbidities were significantly higher in elderly patients (73.4% vs 41.4%, p<0.001). No significant differences were observed between the two groups in surgical approach and the rate of one-stage procedures. Elderly patients were more frequently treated by Hartmann's procedure compared to non-elderly patients (20.2% vs 6.9%). Left colorectal resection with protective ileostomy was most frequent in the non-elderly group (27.6% vs 11.7%). No significant differences were found in the pT and pN categories of the TNM system between the two groups. However, a higher number of T3 in non-elderly patients was observed. A consistent number of non-oncologically adequate resections were observed in the elderly (21.3% vs 3.5%; p<0.03). The morbidity rate was significantly higher in the elderly group (31.9 % vs 3.4%, p<0.001). No significant difference was found in the mortality rate between the two groups, being 13.8% in the elderly and 6.9% in the non-elderly. Conclusions Emergency colorectal surgery for cancer still presents significant morbidity and mortality rates, especially in elderly patients. More aggressive tumors and advanced stages were more frequent in the non-elderly group and as a matter it should be taken into account when treating such patients in the emergency setting in order to perform a radical procedure as much as possible.
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Affiliation(s)
- Gianluca Costa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Barbara Frezza
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy.,Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100 Arezzo, Italy
| | - Pietro Fransvea
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Giulia Massa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Mario Ferri
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Genoveffa Balducci
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Antonio Buondonno
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Aldo Rocca
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Graziano Ceccarelli
- Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100 Arezzo, Italy
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Rocca A, Andolfi E, Zamboli AGI, Surfaro G, Tafuri D, Costa G, Frezza B, Scricciolo M, Amato M, Bianco P, Brongo S, Ceccarelli G, Giuliani A, Amato B. Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy. Open Med (Wars) 2019; 14:376-383. [PMID: 31157303 PMCID: PMC6534101 DOI: 10.1515/med-2019-0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/05/2018] [Accepted: 03/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND According to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma. METHODS From June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first - line strategy for damage control surgery (DCS) in liver trauma. RESULTS 26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure.In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%). CONCLUSIONS The improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding.
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Affiliation(s)
- Aldo Rocca
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Via Sergio Pansini, 80131 Naples, Italy General Surgery Unit, Clinica Padre Pio, Mondragone (CE), Italy Department of Abdominal Oncology, Fondazione Giovanni Pascale, IRCCS, Naples, Italy
- Centre of Hepatobiliarypancreatic surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
| | - Enrico Andolfi
- Department of Surgery, Division of general Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
| | | | | | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
| | - Gianluca Costa
- Surgical and Medical Department of Traslational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Barbara Frezza
- Department of Surgery, Division of general Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
| | - Marta Scricciolo
- Department of Surgery, Division of general Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
| | - Maurizio Amato
- Department of Clinical Medicine and Surgery, University Federico II of Naples. Naples, Italy
| | - Paolo Bianco
- Centre of Hepatobiliarypancreatic surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
| | - Sergio Brongo
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", San Giovanni di Dio e Ruggi D'Aragona University Hospital, University of Salerno, Salerno, Italy
| | - Graziano Ceccarelli
- Department of Surgery, Division of general Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
| | - Antonio Giuliani
- Department of Transplantation, Unit of Hepatobiliary Surgery and Liver Transplant Center, ‘A. Cardarelli’ Hospital, Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University Federico II of Naples. Naples, Italy
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Bravaccini S, Ravaioli S, Rocca A, Tumedei MM, Bucchi E, Malmesi M, Medri L, Bonafè M, Puccetti M. Abstract P4-02-10: Are fine-needle aspiration (FNA)-derived cell blocks a useful tissue sample surrogate for testing conventional biomarkers and PD-L1 in breast cancer? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background The diagnosis of breast cancer (BC) is based on clinical examination in combination with imaging and confirmed by pathological assessment of core needle biopsy (CNB) or fine needle aspiration (FNA). The biological profile of the lesion is needed to define prognosis and guide therapy. Given the importance of an early and minimally invasive diagnosis, we aimed to verify whether the biological features detected in FNA-derived cytological material reflect the biological characteristics of surgical specimens.
Methods We used immunohistochemistry and fluorescence in situ hybridization (FISH) to study a panel of biomarkers (ER, PgR, Ki67 and HER2 in 93 patients, programmed death-ligand 1 (PD-L1) in 20 patients) in FNA-derived cell blocks of BC, comparing the results with those obtained on the histological specimens.Immunostaining was performed with the Ventana Benchmark XT system and the Ultraview DAB Detection Kit (Ventana Medical Systems). Confirm anti-ER (clone SP1, Ventana), Confirm Anti-PgR (clone 1E2, Ventana) and Ki67 (clone Mib-1, Dako, Carpinteria, CA, US) antibodies were used. Ventana PD-L1 (SP263) assay (Ventana Medical Systems) was used for PD-L1 immunostaining. HER2 status was analyzed by FISH using PathVysion kit (Abbott Molecular, Abbott Park, Illinois, IL, USA).
Results Median immunopositive values of ER, PgR Ki67, and PD-L1 were similar in cell blocks and surgical samples. Concordance for ER and PgR between FNA and histological samples was 98% and 84%, respectively. With regard to Ki67 and HER2 status, concordance between the two specimen types was 90% and 96%, respectively. PD-L1 expression analyzed in FNA-derived samples was 100% concordant with that of surgical specimens. Tumor subtype classification for triple-negative and HER2-positive tumors in FNA samples was always concordant with the subtype determined in surgical material.
Table 1.Concordance of tumor subtype classification between FNAB-derived and histological samples.Overall series (n=93)87%Luminal A (n=26)81%Luminal B (n=47)86%HER2-positive (n=6)100%Triple-negative (n=14)100%
Conclusions We showed that biological marker determination in FNA-derived cell blocks is feasible and provides useful information and comparable results with those obtained by histological evaluation. Given the low cost of the procedure and its minimal impact on patients, that cytological samples could be used as an alternative to tissue samples for early BC biomarker evaluation to facilitate the planning of tailored neoadjuvant therapy.
Citation Format: Bravaccini S, Ravaioli S, Rocca A, Tumedei MM, Bucchi E, Malmesi M, Medri L, Bonafè M, Puccetti M. Are fine-needle aspiration (FNA)-derived cell blocks a useful tissue sample surrogate for testing conventional biomarkers and PD-L1 in breast cancer? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-10.
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Affiliation(s)
- S Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - S Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - MM Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - E Bucchi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - M Malmesi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - L Medri
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - M Bonafè
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - M Puccetti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
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Bravaccini S, Ravaioli S, Rocca A, Maltoni R, Cristalli C, Marasco E, De Carolis S, Cricca M, Bonafè M. Abstract P2-04-01: Human papillomavirus (HPV) DNA detection in breast cancer by liquid biopsy: Something new on the horizon? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-04-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background The presence of human papillomavirus (HPV) DNA in breast cancer (BC) tissues has been widely investigated in recent years. HPV DNA has been detected in ductal lavage fluids and in serum-derived extracellular vesicles of patients with benign or in situ breast lesions. However, there are no data attesting to its presence in liquid biopsies of different BC subtypes or to its impact on prognosis.
Methods We analyzed a total of 72 serum samples for the presence of circulating HPV DNA, of which 20 were from luminal A BC (5 relapsed, 15 non relapsed), 17 from luminal B BC (5 relapsed, 12 non relapsed), 15 from triple-negative BC (6 relapsed and 9 non relapsed), 12 from HER2-positive BC (3 relapsed, 9 non relapsed) and 8 from healthy subjects. Circulating DNA was extracted and purified from 500 μl of serum by Qiamp DNA minikit (Qiagen, Milan, Italy) according to the manufacturer's instructions. HPV DNA was assessed by a high-throughput MALDI-TOF mass spectrometry-based method (Mass Array Platform, Agena Bioscience, Hamburg, Germany). The DNA target sequence was amplified by a multiplex PCR with HPV E6 or E7 gene-specific primers. A primer for primer extension annealing to the amplified product was extended at its 3′ terminal base for each HPV type.
Results HPV DNA was detected in 5 BC patients but in none of the healthy controls. None of the serum samples analyzed showed HPV DNA types 16 or 18. Four of the 5 BC cases had high-risk HPV DNA (type 39,45,52,59) and one had low-risk HPV DNA (type 73). The 4 patients with high risk HPV DNA had low-grade cervical intraepithelial neoplasia (CIN 1) detected by Pap smear prior to the diagnosis of BC. No relation was found between HPV infection and tumor subtype or prognosis. Our in vitro studies also revealed the active release of HPV DNA into the extracellular vesicle compartment of cervical cancer cells.
Table 1.Features of BC patients positive for circulating HPV DNA.Sample IDAge (years)GradingSubtypeDeathRelapseHPV type, riskCervical lesion17471Luminal A-No59, highCIN 139783Luminal B20/03/2015No45, highCIN 145462Luminal B-No39, highCIN 160583TN03/01/2011Yes73, lowHyperplasia63523HER2-positive-Yes52, highCIN 1TN, triple negative; CIN 1:low-grade cervical intraepithelial neoplasia
Conclusions Our findings support the feasibility of HPV DNA evaluation by liquid biopsy in BC. They also suggest that circulating HPV DNA in BC patients might be of cervical tissue origin and that the presence of HPV DNA in BC may be a consequence of its spreading from virus-infected tissue such as that of the uterine cervix.
Citation Format: Bravaccini S, Ravaioli S, Rocca A, Maltoni R, Cristalli C, Marasco E, De Carolis S, Cricca M, Bonafè M. Human papillomavirus (HPV) DNA detection in breast cancer by liquid biopsy: Something new on the horizon? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-04-01.
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Affiliation(s)
- S Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - R Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - C Cristalli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - E Marasco
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S De Carolis
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Cricca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Bonafè
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Musolino A, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Pellegrino B, Todeschini R, Tognetto M, Naldi N, Bortesi B, Boni L, Montemurro F, Ardizzoni A. Abstract P1-14-05: Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE Trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-14-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There are no well-established chemotherapy regimens for metastatic triple negative breast cancer. The combination of a microtubule inhibitor (eribulin) with a nucleoside analog (gemcitabine) may synergistically induce tumor cell death, especially in tumors like triple negative breast cancers (TNBC) characterized by high cell proliferation, aggressive tumor behavior, and chemo-resistance.
Materials and Methods:This is an open-label, national multicenter phase II study evaluating the combination of eribulin (0.88 mg/m2) plus gemcitabine (1000 mg/m2) on day 1 and 8, q21 as either first- or second-line treatment of locally advanced or metastatic TNBC.The primary endpoint was the objective response rate (ORR) for evaluable patients (pts). The study was designed according to the Simon's two stage optimal design. We chose the lower activity (p0) of 0.20 and target activity level (p1) of 0.35. A prospective, molecular correlative study has been being carried out on germinal DNA of study population to assess the role of BRCA mutations and single nucleotide polymorphisms (SNPs) in predicting efficacy and toxicity of the combination regimen.
Results: From July 2013 to September 2016, 83 evaluable pts (37 in the first stage, 46 in the second one) were enrolled. They received a median number of 6 cycles of treatment (range 1-24). The ORR (CR+PR) was 37.35% (90% CI: 28.47-46.93) and the clinical benefit rate (CR+PR+SD ≥ 24wks) was 48.78% (90% CI: 39.24%-58.39%). The most common grade 3-4 adverse events (> 10% of patients) were neutropenia and liver toxicity. With a median follow-up of 28.8 months, the median progression-free survival (PFS) and overall survival (OS) were 5.1 months (95% CI: 4.2-7.0) and 14.7 months (95% CI: 10.2-20.0), respectively. BRCA1/2 deleterious mutations were observed in 15 (22%) out of 68 genotyped pts. Women with BRCA1/2 mutations were associated with worse ORR, PFS and OS than those with BRCA1/2 wild-type. A panel of SNPs in genes of study drug metabolism pathways was evaluated. Among these, CYP3A4 392A >G and FGD4 2044236G>A SNPs were associated with greater liver toxicity by logistic regression analysis. Furthermore, CDA*2 79A>C, RRM1 2455 A>G, and CYP2C8 416G>A SNPs were associated with poorer overall survival by Cox proportional hazards model.
Conclusions:The combination of eribulin and gemcitabine shows promising activity and a moderate toxicity profile in metastatic TNBC. BRCA status and pharmacogenetics tests may help identify pts with high probability of response with negligible toxicity.
Citation Format: Musolino A, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Pellegrino B, Todeschini R, Tognetto M, Naldi N, Bortesi B, Boni L, Montemurro F, Ardizzoni A. Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE Trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-14-05.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - L Cavanna
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - D Boggiani
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Zamagni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Frassoldati
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Caldara
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Rocca
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - S Gori
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Piacentini
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Berardi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - AA Brandes
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - J Foglietta
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Villa
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - B Pellegrino
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Todeschini
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - M Tognetto
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - N Naldi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - B Bortesi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - L Boni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Montemurro
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Ardizzoni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
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Rega D, Scala D, Pace U, Bucci AF, Patrone R, Rocca A, Delrio P. Closure of the defect after TAMIS for rectal tumor: which methods. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Salzano E, Raible SE, Kaur M, Wilkens A, Sperti G, Tilton RK, Bettini LR, Rocca A, Cocchi G, Selicorni A, Conlin LK, McEldrew D, Gupta R, Thakur S, Izumi K, Krantz ID. Prenatal profile of Pallister-Killian syndrome: Retrospective analysis of 114 pregnancies, literature review and approach to prenatal diagnosis. Am J Med Genet A 2018; 176:2575-2586. [PMID: 30289601 DOI: 10.1002/ajmg.a.40499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/15/2018] [Revised: 06/23/2018] [Accepted: 07/14/2018] [Indexed: 01/10/2023]
Abstract
Pallister-Killian syndrome (PKS) is a tissue limited mosaic disorder, characterized by variable degrees of neurodevelopmental delay and intellectual disability, typical craniofacial findings, skin pigmentation anomalies and multiple congenital malformations. The wide phenotypic spectrum of PKS in conjunction with the mosaic distribution of the i(12p) makes PKS an underdiagnosed disorder. Recognition of prenatal findings that should raise a suspicion of PKS is complicated by the fragmentation of data currently available in the literature and challenges in diagnosing a mosaic diagnosis on prenatal testing. Ultrasound anomalies, especially congenital diaphragmatic hernia, congenital heart defects, and rhizomelic limb shortening, have been related to PKS, but they are singularly not specific and are not present in all affected fetuses. We have combined prenatal data from 86 previously published reports and from our cohort of 114 PKS probands (retrospectively reviewed). Summarizing this data we have defined a prenatal growth profile and identified markers of perinatal outcome which collectively provide guidelines for early recognition of the distinctive prenatal profile and consideration of a diagnosis of PKS as well as for management and genetic counseling.
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Affiliation(s)
- E Salzano
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S E Raible
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - M Kaur
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Wilkens
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - G Sperti
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - R K Tilton
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L R Bettini
- Dipartimento di Scienze Della Salute, San Paolo Hospital Medical School, Università degli Studi di Milano, Milan, Italy
| | - A Rocca
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - G Cocchi
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - L K Conlin
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D McEldrew
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - R Gupta
- Department of Fetal Medicine, Maharaja Agrasen Hospital, Delhi & Sonepat Genetic and Fetal Medicine Centre, Sonepat, Haryana
| | - S Thakur
- Department of Genetic & Fetal Medicine, Fortis Hospital, Delhi-NCR & Apollo Hospital, Delhi, India
| | - K Izumi
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - I D Krantz
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Stefanovska B, Vicier C, Scott V, Bouakka I, Rocca A, André F, Fromigué O. TRIB3: A new transcriptional target gene of rapalogs, modulating their effects on splicing. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Serra R, Barbetta A, Fugetto F, Licastro N, Aprea G, Petrella G, Danzi M, Rocca A, Compagna R, De Franciscis S, Amato B. Emergent treatment of carotid stenosis: an evidence-based systematic review. MINERVA CHIR 2018; 73:505-511. [PMID: 29806753 DOI: 10.23736/s0026-4733.18.07767-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Stroke is one of the major causes of death in the world, but above all is the condition most associated with severe long-term disabilities. It is clear that this condition therefore requires the best therapeutic approach possible to minimize the consequences that this can lead to. The major issues concern the type of treatment to be used for revascularization (carotid endarterectomy [CEA] or stenting of the carotid artery [CAS]) and the timing of the treatment itself. Many studies have been conducted on this issue, but a definitive and unanimous verdict has not yet been reached on account of the great variety of results obtained from the various study group. The aim of this review is to analyze the latest scientific findings focused on revascularization following a symptomatic carotid stenosis (SCS). EVIDENCE ACQUISITION We searched all publications addressing treatments and timing of approach to SCS. Randomized trials, cohort studies and reviews were contemplated in order to give a breadth of clinical data. Medline and Science Direct were searched from January 2013 to April 2017. EVIDENCE SYNTHESIS Of the 819 records found, 76 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 54 manuscripts because of the following reasons: 1) no innovative or important content; 2) insufficient data; 3) no clear potential biases or strategies to solve them; 4) no clear endpoints; and 5) inconsistent or arbitrary conclusions. The final set included 22 articles. CONCLUSIONS CEA is considered a less problematic method than CAS, especially for patients over the age of 75; CAS remains recommended in patients with a favorable anatomy or high surgical risks. Studies that showed more solid results seem to lead to the conclusion that optimal timing may be between 2 days and the end of the first week from the onset of symptoms in patients who are appropriate candidates for surgery.
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Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), Magna Græcia University, Catanzaro, Italy - .,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy -
| | - Andrea Barbetta
- Interuniversity Center of Phlebolymphology (CIFL), Magna Græcia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Francesco Fugetto
- Interuniversity Center of Phlebolymphology (CIFL), Magna Græcia University, Catanzaro, Italy
| | - Noemi Licastro
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Michele Danzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rita Compagna
- Interuniversity Center of Phlebolymphology (CIFL), Magna Græcia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stefano De Franciscis
- Interuniversity Center of Phlebolymphology (CIFL), Magna Græcia University, Catanzaro, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Bruno Amato
- Interuniversity Center of Phlebolymphology (CIFL), Magna Græcia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Amato B, Fugetto F, Compagna R, Zurlo V, Barbetta A, Petrella G, Aprea G, Danzi M, Rocca A, de Franciscis S, Serra R. Endovascular repair versus open repair in the treatment of ruptured aortic aneurysms: a systematic review. MINERVA CHIR 2018; 74:472-480. [PMID: 29806754 DOI: 10.23736/s0026-4733.18.07768-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Rupture of abdominal aortic aneurysm remains a fatal event in up to 65% of cases and emergency open surgery (ruptured open aneurysm repair or rOAR) has a great intraoperative mortality of about 30-50%. The introduction of endovascular repair of abdominal aortic aneurysm (ruptured endovascular aneurysm repair or rEVAR) has rapidly challenged the conventional approach to this catastrophic event. The purpose of this systematic review is to compare the outcomes of open surgical repair and endovascular interventions. EVIDENCE ACQUISITION A literature search was performed using Medline, Scopus, and Science Direct from August 2010 to March 2017 using keywords identified and agreed by the authors. Randomized trials, cohort studies, and case-report series were contemplated to give a breadth of clinical data. EVIDENCE SYNTHESIS Ninety-three studies were included in the final analysis. Thirty-five (50.7%) of the listed studies evaluating the within 30 days mortality rates deposed in favor of rEVAR, while the others (comprising all four included RCTs) failed detecting any difference. Late mortality rates were found to be lower in rEVAR group in seven on twenty-seven studies (25.9%), while one (3.7%) reported higher mortality rates following rEVAR performed before 2005, one found lower incidence of mortality at 6 months in the endovascular group but higher rates in the same population at 8 years of follow-up, and the remaining (66.7%) (including all three RCTs) failed finding any benefit of rEVAR on rOAR. A lower incidence of complications was reported by thirteen groups (46.4%), while other thirteen studies did not find any difference between rEVAR and rOAR. Each of these two conclusions was corroborated by one RCTs. Other two studies (7.2%) found higher rates of tracheostomies, myocardial infarction, and acute tubular necrosis or respiratory, urinary complications, and acute renal failure respectively in rOAR group. The majority of studies (59.0%, 72.7%, and 89.3%, respectively) and all RCTs found significantly lower rates of length of hospitalization, intensive care unit transfer, and blood loss with or without transfusion need in rEVAR group. The large majority of the studies did not specified neither the type nor the brands of employed stent grafts. CONCLUSIONS The bulk of evidence regarding the comparison between endovascular and open surgery approach to RAAA points to: 1) non-inferiority of rEVAR in terms of early (within 30 days) and late mortality as well as rate of complications and length of hospitalization, with trends of better outcomes associated to the endovascular approach; 2) significantly better outcomes in terms of intensive care unit transfer and blood loss with or without transfusion need in the rEVAR group. These conclusions reflect the results of the available RCTs included in the present review. Thus rEVAR can be considered a safe method in treating RAAA and we suggest that it should be preferred when technically feasible. However, more RCTs are needed in order to give strength of these evidences, bring to definite clinical recommendations regarding this subject, and assess the superiority (if present) of one or more brands of stent grafts over the others.
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Affiliation(s)
- Bruno Amato
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Francesco Fugetto
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy
| | - Rita Compagna
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Valeria Zurlo
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy
| | - Andrea Barbetta
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | | | - Giovanni Aprea
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Michele Danzi
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Aldo Rocca
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stefano de Franciscis
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Graecia University, Catanzaro, Italy - .,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
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Ceccarelli G, Andolfi E, Fontani A, Calise F, Rocca A, Giuliani A. Robot-assisted liver surgery in a general surgery unit with a "Referral Centre Hub&Spoke Learning Program". Early outcomes after our first 70 consecutive patients. MINERVA CHIR 2018; 73:460-468. [PMID: 29795060 DOI: 10.23736/s0026-4733.18.07651-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to evaluate safety, feasibility and short-term outcomes of our first 70 consecutive patients treated by robotic-assisted liver resection after a reversal proctoring between a high HPB volume centre and our well-trained center in minimally invasive General Surgery. Six surgeons were involved in this Hub&Spoke learning program. METHODS From September 2012 to December 2016, 70 patients underwent robotic-assisted liver resections (RALR). We treated 18 patients affected by colorectal and gastric cancer with synchronous liver lesions suspected for metastases in a one-stage robotic-assisted procedure. For the first 20 procedures we had a tutor in the operatory room, who was present also in the next most difficult procedures. RESULTS The 30- and 90-day mortality rate was zero with an overall morbidity rate of 10.1%. Associated surgical procedures were performed in about 65,7% of patients. The observed conversion rate was 10%. The results of the first 20 cases were similar to the next 50 showing a shortned learning curve. CONCLUSIONS Minimally invasive robot-assisted liver resection is a safe technique; it allows overcoming many limits of conventional laparoscopy. This innovative, time-enduring Hub&Spoke may allow patients to undergo a proper standard of care also for complex surgical procedures, without the need of reaching referral centres.
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Affiliation(s)
- Graziano Ceccarelli
- Unit of General and Robotic Surgery, San Donato Hospital, Arezzo, Italy.,Unit of Hepato-Biliary Surgery, P.O. Pineta Grande Hospital, Castel Volturno, Caserta, Italy.,Department of Medicine and Health's Sciences "V. Tiberio", University of Molise, Campobasso, Italy.,Department of General and Robotic Surgery, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Enrico Andolfi
- Unit of General and Robotic Surgery, San Donato Hospital, Arezzo, Italy
| | - Andrea Fontani
- Unit of General and Robotic Surgery, San Donato Hospital, Arezzo, Italy
| | - Fulvio Calise
- Department of Medicine and Health's Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Aldo Rocca
- Unit of General and Robotic Surgery, San Donato Hospital, Arezzo, Italy - .,Unit of Hepato-Biliary Surgery, P.O. Pineta Grande Hospital, Castel Volturno, Caserta, Italy.,Department of Medicine and Health's Sciences "V. Tiberio", University of Molise, Campobasso, Italy.,Department of Colorectal Cancer Surgery, G. Pascale Foundation and Institute for Research and Care, Naples, Italy
| | - Antonio Giuliani
- Department of Medicine and Health's Sciences "V. Tiberio", University of Molise, Campobasso, Italy
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Lepore G, Bonfanti R, Bozzetto L, Di Blasi V, Girelli A, Grassi G, Iafusco D, Laviola L, Rabbone I, Schiaffini R, Bruttomesso D, Mammì F, Bruzzese M, Schettino M, Nuzzo M, Di Blasi V, Fresa R, Lambiase C, Iafusco D, Zanfardino A, Confetto S, Bozzetto L, Annuzzi G, Alderisio A, Riccardi G, Gentile S, Marino G, Guarino G, Zucchini S, Maltoni G, Suprani T, Graziani V, Nizzoli M, Acquati S, Cavani R, Romano S, Michelini M, Manicardi E, Bonadonna R, Dei Cas A, Dall'aglio E, Papi M, Riboni S, Manicardi V, Manicardi E, Manicardi E, Pugni V, Lasagni A, Street M, Pagliani U, Rossi C, Assaloni R, Brunato B, Tortul C, Zanette G, Li Volsi P, Zanatta M, Tonutti L, Agus S, Pellegrini M, Ceccano P, Pozzilli G, Anguissola B, Buzzetti R, Moretti C C, Leto G, Pozzilli P, Manfrini S, Maurizi A, Leotta S, Altomare M, Abbruzzese S, Carletti S, Suraci C, Filetti S, Manca Bitti M, Arcano S, Cavallo M, De Bernardinis M, Pitocco D, Caputo S, Rizzi A, Manto A, Schiaffini R, Cappa M, Benevento D, Frontoni S, Malandrucco I, Morano S, Filardi T, Lauro D, Marini M, Castaldo E, Sabato D, Tuccinardi F, Forte E, Viterbori P, Arnaldi C, Minuto N, d'Annunzio G, Corsi A, Rota R, Scaranna C, Trevisan R, Valentini U, Girelli A, Bonfadini S, Zarra E, Plebani A, Prandi E, Felappi B, Rocca A, Meneghini E, Galli P, Ruggeri P, Carrai E, Fugazza L, Baggi V, Conti D, Bosi E, Laurenzi A, Caretto A, Molinari C, Orsi E, Grancini V, Resi V, Bonfanti R, Favalli V, Bonura C, Rigamonti A, Bonomo M, Bertuzzi F, Pintaudi B, Disoteo O, Perseghin G, Perra S, Chiovato L, De Cata P, Zerbini F, Lovati E, Laneri M, Guerraggio L, Bossi A, De Mori V, Galetta M, Meloncelli I, Aiello A A, Di Vincenzo S, Nuzzi A, Fraticelli E, Ansaldi E, Battezzati M, Lombardi M, Balbo M, Lera R, Secco A, De Donno V, Cadario F, Savastio S, Ponzani C, Aimaretti G, Rabbone I, Ignaccolo G, Tinti D, Cerutti F, Bari F, Giorgino F, Piccinno E, Zecchino O, Cignarelli M, Lamacchia O, Picca G, De Cosmo S, Rauseo A, Tomaselli L, Tumminia A, Egiziano C, Scarpitta A, Maggio F, Cardella F, Roppolo R, Provenzano V, Fleres M, Scorsone A, Scatena A, Gregori G, Lucchesi S, Gadducci F, Di Cianni S, Pancani S, Del Prato S, Aragona M, Crisci I, Calianno A, Fattor B, Crazzolara D, Reinstadler P, Longhi S, Incelli G, Rauch S, Romanelli T, Orrasch M, Cauvin V, Franceschi R, Lalli C, Pianta A, Marangoni A, Aricò C, Marin N, Nogara N, Simioni N, Filippi A, Gidoni Guarneri G, Contin M.L M, Decata A, Bondesan L, Confortin L, Coracina A, Lombardi S, Costa Padova S, Cipponeri E, Scotton R, Galasso S, Boscari F, Zanon M, Vinci C, Lisato G, Gottardo L, Bonora E, Trombetta M, Negri C, Brangani C, Maffeis C, Sabbion A, Marigliano M. Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion. Nutr Metab Cardiovasc Dis 2018; 28:335-342. [PMID: 29428572 DOI: 10.1016/j.numecd.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/31/2017] [Accepted: 12/02/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII). METHODS AND RESULTS Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA1c) level was 60 mmol/mol (7.6%). The HbA1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis. CONCLUSIONS Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia. CLINICAL TRIAL REGISTRATION NUMBER NCT 02620917 (ClinicalTrials.gov).
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Rinaldi A, Dell'Amore A, Pastore S, Rocca A, Giunta D, Palazzini M, Manes A, Dardi F, Gotti E, Galiè N. Double Lungtransplantation In Patients with End-Stage Pulmonary Arterial Hypertension or End-Stage Inoperable Chronic Thromboembolic Pulmonary Hypertension. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Musolino A, Gori S, Cavanna L, Graiff C, Frassoldati A, Bria E, Bisagni G, Zambelli A, Partesotti G, Brandes A, Bonetti A, Moscetti L, Zamagni C, Rocca A, Generali D, Montemurro F, Gianni L, Tognetto M, Maglietta G, Todeschini R. Abstract OT1-03-03: Phase II, open label, randomized, biomarker study of immune-mediated mechanism of action of neoadjuvant subcutaneous trastuzumab in patients with operable or locally advanced/Inflammatory HER2-positive breast cancer. ImmunHER trial on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumor-infiltrating lymphocytes (TILs) have been reported to be associated with increased therapeutic efficacy of trastuzumab in the (neo)adjuvant setting for HER2-positive breast cancer (BC). Subcutaneous (SC) trastuzumab has been observed to act at different immunologic levels than IV trastuzumab. Therefore, by modifying the modality of administration of trastuzumab, it could be possible to interfere with different pathways of the immune system and exert a favorable immunomodulation in HER2-positive BC.
Trial design: In this non-comparative, phase II, neoadjuvant, randomized study, patients will be treated with FEC chemotherapy (fluorouracil 500 mg/m2; epirubicin 75 mg/m2; cyclophosphamide 500 mg/m2) q21 for 3 cycles. Then, they will be randomly assigned in a 1:1 ratio to receive: docetaxel (75 mg/m2) plus pertuzumab (840 mg loading dose, then 420 mg) plus IV trastuzumab (8 mg/kg loading dose, then 6 mg/kg) q21 for 4 cycles (Group A) or, docetaxel plus pertuzumab plus SC trastuzumab (fixed dose of 600 mg) q21 for 4 cycles (Group B). After surgery, study patients will receive trastuzumab q21 x 14 cycles using the same formulation (SC or IV) of the preoperative phase.
Eligibility criteria: Patients must have previously untreated, T2-4d primary HER2-positive BC with no metastatic disease. Other inclusion criteria are: age 18 or older; ECOG performance status 0-1; availability of tumor tissue from diagnostic biopsy; normal left ventricular ejection fraction; normal organ and marrow function.
Specific aims: The main objective of this trial is to evaluate variations of host immune response parameters to either trastuzumab SC or trastuzumab IV given in combination with pertuzumab and chemotherapy as neoadjuvant treatment of patients with HER2-positive BC. Tumor samples obtained at diagnosis and at definitive surgery will be centrally analyzed for TILs. Blood samples will be also collected during study treatment for tumor-specific lymphocyte cell activity (TLA) analysis. Feasibility, efficacy, safety and health-related quality of life will be also evaluated.
Statistical methods: The primary endpoint is post-surgery pathologic TIL rate on residual disease. The threshold for classifying subjects with high TILs, or not, is defined as equal to 15%, according to the median TIL rate observed in primary HER2-positive tumors. Because this is a phase II study with 2 non-comparative arms, Simon's optimal 2-stage design will be used for each of the 2 study groups. For each arm we assume: p1 = 0.4, expected rate of subjects with high TILs on residual disease, p0 = 0.1, lowest limit of the subject rate (alpha= 0.05; beta= 0.20).
Present accrual and target accrual: A total of 60 patients (first stage: 16 patients) will be enrolled from multiple institutions. From November 29, 2016 to June 11, 2017, 34 patients have been recruited.
Contact information:Dr. Antonino Musolino, MD, MSc, PhD; Medical Oncology Unit, University Hospital of Parma; Tel: +390521702316; Fax: +390521995448; e-mail: amusolino@ao.pr.it. Clinical Trials.gov: NCT03144947.
Citation Format: Musolino A, Gori S, Cavanna L, Graiff C, Frassoldati A, Bria E, Bisagni G, Zambelli A, Partesotti G, Brandes A, Bonetti A, Moscetti L, Zamagni C, Rocca A, Generali D, Montemurro F, Gianni L, Tognetto M, Maglietta G, Todeschini R. Phase II, open label, randomized, biomarker study of immune-mediated mechanism of action of neoadjuvant subcutaneous trastuzumab in patients with operable or locally advanced/Inflammatory HER2-positive breast cancer. ImmunHER trial on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-03-03.
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Affiliation(s)
- A Musolino
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - S Gori
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - L Cavanna
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - C Graiff
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Frassoldati
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - E Bria
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - G Bisagni
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Zambelli
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - G Partesotti
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Brandes
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Bonetti
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - L Moscetti
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - C Zamagni
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Rocca
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - D Generali
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - F Montemurro
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - L Gianni
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - M Tognetto
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - G Maglietta
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - R Todeschini
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
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Abstract
INTRODUCTION Minimally invasive surgery has gained wide acceptance in many institutions. Complex surgery such as pancreatic resections delayed its diffusion due to high rate postoperative complications and technical aspects, while for pancreaticoduodenctomy the role of a minimally invasive approach is still on debate. Laparoscopic distal pancreatectomy may be considered a safe procedure and a valid alternative in selected cases. The operating time, learning curve and the costs represent major drawbacks for the laparoscopic approach. Elderly patients (>70 years of age) are generally considered to be at higher risk for developing complications after pancreatic surgery due to compromised physiological reserve and presence of multiple comorbidities. Our aim was to make a review about the role of laparoscopic distal pancreatectomy (LDP) in the elderly population. EVIDENCE ACQUISITION A systematic search of the scientific literature was performed using PubMed, EMBASE, online journals, and the Internet for all publications on LDP and open distal pancreatectomy (ODP) in old age patients. All selected articles were reviewed and analyzed. We found 393 abstract that were reviewed. We considered all type of publications. EVIDENCE SYNTHESIS Laparoscopic pancreatic resections are considered more difficult due to the retroperitoneal organ location and by the presence of surrounding large vessels and other crucial structures. Therefore, an adequate learning curve is needed. Beyond these remarks, in many institutions, LDP is a standard approach in patients with lesions in the body and tail of the pancreas. The most evident advantage of LDP is the shorter length of stay. Age alone should not be considered as an absolute contraindication for LDP. Obviously, it is still too early to assess oncological outcomes, but the R0 resection rate, the number of harvested lymph nodes, and the overall survival rate are superimposable to ODP. CONCLUSIONS LDP is safe and feasible if compared to ODP in selected elderly patients with body and tail pancreatic tumors. Less blood loss and shorter hospital stay are the most evident advantages of minimally invasive approach. Randomized controlled trials and high-volume centers prospective studies with long-term outcomes are necessary to consider laparoscopy a standard of care. Minimally invasive robotic surgery may represent an interesting alternative to laparoscopy especially for spleen-preserving procedures.
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Affiliation(s)
- Antonio Giuliani
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Graziano Ceccarelli
- General and Robotic Surgery Unit, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Aldo Rocca
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy - .,General and Robotic Surgery Unit, San Giovanni Battista Hospital, Foligno, Perugia, Italy.,Colorectal Cancer Surgery Unit, G. Pascale Foundation and Institute for Research and Care in Oncologic Surgery, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Rocca A, Tafuri D, Paccone M, Giuliani A, Zamboli AGI, Surfaro G, Paccone A, Compagna R, Amato M, Serra R, Amato B. Cell Based Therapeutic Approach in Vascular Surgery: Application and Review. Open Med (Wars) 2017; 12:308-322. [PMID: 29071303 PMCID: PMC5651406 DOI: 10.1515/med-2017-0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 08/16/2017] [Indexed: 01/14/2023] Open
Abstract
Multipotent stem cells - such as mesenchymal stem/stromal cells and stem cells derived from different sources like vascular wall are intensely studied to try to rapidly translate their discovered features from bench to bedside. Vascular wall resident stem cells recruitment, differentiation, survival, proliferation, growth factor production, and signaling pathways transduced were analyzed. We studied biological properties of vascular resident stem cells and explored the relationship from several factors as Matrix Metalloproteinases (MMPs) and regulations of biological, translational and clinical features of these cells. In this review we described a translational and clinical approach to Adult Vascular Wall Resident Multipotent Vascular Stem Cells (VW-SCs) and reported their involvement in alternative clinical approach as cells based therapy in vascular disease like arterial aneurysms or peripheral arterial obstructive disease.
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Affiliation(s)
- Aldo Rocca
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyVia Sergio Pansini, 80131Naples, Italy
| | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Marianna Paccone
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Antonio Giuliani
- A.O.R.N. A. Cardarelli Hepatobiliary and Liver Transplatation Center, Naples, Italy
| | | | - Giuseppe Surfaro
- Antonio Cardarelli Hospital, General Surgery Unit, Campobasso, Italy
| | - Andrea Paccone
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Rita Compagna
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Maurizo Amato
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Bruno Amato
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
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Recine F, Bongiovanni A, Fausti V, Mercatali L, Riva N, Calpona S, Faedi M, De Vita A, Liverani C, Spadazzi C, Miserocchi G, Foca F, Vespignani R, Rocca A, Amadori D, Ibrahim T. Bone health management in early breast cancer patients: an Italian Osteoncology Center experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ravaioli S, Rocca A, Bronte G, Puccetti M, Tumedei M, Scarpi E, Maltoni R, Sarti S, Cecconetto L, Andreis D, Pietri E, Calistri D, Amadori D, Bravaccini S. Is Androgen Receptor a predicitive biomarker of response to antiestrogen therapy in advanced breast cancer? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gennari A, Brain E, Nanni O, Muñoz Couselo E, Harbeck N, Geiss R, Rocca A, Cortés J, Degenhardt T, Piccardo A, Albérini JL, Matteucci F, Decensi A, Corradengo D, Andreis D, Marra D, Gebhart G, Brambati C, Amadori D, Bruzzi P. Molecular imaging with 18F-fluoroestradiol (18F-FES) to assess intra-patient heterogeneity in metastatic breast cancer (MBC): A European TRANSCAN program. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aprea G, Aloia S, Quarto G, Furino E, Amato M, Bianco T, Di Domenico L, Rocca A, Maurea S, Sivero L. Uncommon primary hydatid cyst occupying the adrenal gland space, treated with laparoscopic surgical approach in an old patient. Open Med (Wars) 2017; 11:413-417. [PMID: 28352829 PMCID: PMC5329862 DOI: 10.1515/med-2016-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/02/2016] [Indexed: 12/15/2022] Open
Abstract
Hydatid disease (HD) is caused by Echinococcus Granulosus (EG), which is a larva endemic in many undeveloped areas. The most common target is the liver (59%–75%). The retroperitoneal space is considered as a rare localization. We report an uncommon case of HD located in the adrenal gland space. Presentation of case. This is a 78-year-old Moroccan woman, with right flank pain for eight months previously. She denied contact with dogs or sheep. Her physical examination was normal. There was no pathological alteration of laboratory exams. CT scan measuring 5 cm without clear signs for a sure diagnosis found a round lesion in the right adrenal gland. An abdominal MRI showed a round mass of 34 x 27 mm with fluid component without a clear plane of dissection from kidney and liver. A laparoscopic procedure was performed to obtain a histological diagnosis. We reached a conclusive diagnosis of Hydatid cyst of right adrenal gland space. Hydatid cysts often develop in the liver. The location in the adrenal bed is rare without clinical signs related to alteration of the gland’s secretion. Hydatid cyst identification in the adrenal gland space is based on ultrasonography, CT or MRI scans. The differential diagnosis includes various benign and malignant lesions. Laparoscopic procedure is the best approach available to obtain a histological diagnosis and a curative treatment. The best treatment for HD is the pericystectomy. Laparoscopic surgery can guarantee a radical resection of these lesions when it performed by an expert surgeon.
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Affiliation(s)
- Giovanni Aprea
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Sergio Aloia
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Gennaro Quarto
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Ermenegildo Furino
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Maurizio Amato
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Tommaso Bianco
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Lorenza Di Domenico
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. Via Sergio Pansini, 80131 Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 80100, Napoli, Italy
| | - Luigi Sivero
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
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Ceccarelli G, Andolfi E, Biancafarina A, Rocca A, Amato M, Milone M, Scricciolo M, Frezza B, Miranda E, De Prizio M, Fontani A. Robot-assisted surgery in elderly and very elderly population: our experience in oncologic and general surgery with literature review. Aging Clin Exp Res 2017; 29:55-63. [PMID: 27905087 DOI: 10.1007/s40520-016-0676-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/03/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥65 or 75 years is used. Nowadays most of malignancies requiring surgical treatment are diagnosed in old population. Comorbidities and frailty represent well-known problems during and after surgery in elderly patients. Minimally invasive surgery offers earlier postoperative mobilization, less blood loss, lower morbidity as well as reduction in hospital stay and as such represents an interesting and validated option for elderly population. Robot-assisted surgery is a recent improvement of conventional minimally invasive surgery. AIMS We provided a complete review of old and very old patients undergoing robot-assisted surgery for oncologic and general surgery interventions. PATIENTS AND METHODS A retrospective review of all patients undergoing robot-assisted surgery in our General Surgery Unit from September 2012 to June 2016 was conducted. Analysis was performed for the entire cohort and in particular for three of the most performed surgeries (gastric resections, right colectomy, and liver resections) classifying patients into three age groups: ≤64, 65-79, and ≥80. Data from these three different age groups were compared and examined in respect of different outcomes: ASA score, comorbidities, oncologic outcomes, conversion rate, estimated blood loss, hospital stay, geriatric events, mortality, etc. RESULTS Using our in-patient robotic surgery database, we retrospectively examined 363 patients, who underwent robot-assisted surgery for different diseases (402 different robotic procedures): colorectal surgery, upper GI, HPB, etc.; the oncologic procedures were 81%. Male were 56%. The mean age was 65.63 years (18-89). Patients aged ≥65 years represented 61% and ≥80 years 13%. Overall conversion rate was of 6%, most in the group 65-79 years (59% of all conversions). The more frequent diseases treated were colorectal surgery 43%, followed by hepatobilopancreatic surgery 23.4%, upper gastro-intestinal 23.2%, and others 10.4%. DISCUSSION Robot-assisted surgery is a safe and effective technique in aging patient population too. There was no increased risk of death or morbidity compared to younger patients in the three groups examined. A higher conversion rate was observed in our experience for patients aged 65-79. Prolonged operative time and in any cases steep positions (Trendelenburg) have not represented a problem for the majority of patients. CONCLUSIONS In any case, considering the high direct costs, minimally invasive robot-assisted surgery should be performed on a case-by-case basis, tailored to each patient with their specific histories and comorbidities.
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Affiliation(s)
- Graziano Ceccarelli
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
| | - Enrico Andolfi
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
| | - Alessia Biancafarina
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
| | - Aldo Rocca
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy.
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via Sergio Pansini, 80131, Naples, Italy.
| | - Maurizio Amato
- Department of Surgical Specialities and Nephrology, University of Naples "Federico II", Naples, Italy
| | - Marco Milone
- Department of Surgical Specialities and Nephrology, University of Naples "Federico II", Naples, Italy
| | - Marta Scricciolo
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
| | - Barbara Frezza
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
| | - Egidio Miranda
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
| | - Marco De Prizio
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
| | - Andrea Fontani
- Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy
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Giuliani A, Bianco P, Guerra G, Rocca A, Calise F. Totally laparoscopic liver resection for colorectal metastasis located in Segment 7 in a patient with situs inversus totalis. J Surg Case Rep 2017; 2017:rjw243. [PMID: 28096324 PMCID: PMC5241714 DOI: 10.1093/jscr/rjw243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Situs inversus totalis (SIT) is a congenital condition consisting of a mirror image of transposition of the abdominal and thoracic organs occurring in about 1:5000 to 1:10 000 adults. We report on a 60-year-old male with a single colorectal liver metastasis in the Segment 7. The patients underwent a totally laparoscopic sub-segmentectomy. Intraoperative approach on a reverse posterior segment was difficult because of left-sided position of the liver. Postoperative course was uneventful and the patient was discharged after 5 days. To our knowledge, only a few cases of open liver resections in patients with SIT have been published. This is, therefore, the first case of laparoscopic liver resection for colorectal liver metastasis in a patient with SIT. We provide the readers with useful tips to perform minimally invasive liver surgery in such patients.
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Affiliation(s)
- Antonio Giuliani
- Department of Transplantation, Unit of Hepatobiliary Surgery and Liver Transplant Center, 'A. Cardarelli' Hospital, Naples, Italy
| | - Paolo Bianco
- Department of Transplantation, Unit of Hepatobiliary Surgery and Liver Transplant Center, 'A. Cardarelli' Hospital, Naples, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Aldo Rocca
- Department of Transplantation, Unit of Hepatobiliary Surgery and Liver Transplant Center, 'A. Cardarelli' Hospital, Naples, Italy
| | - Fulvio Calise
- Centre of Hepatobiliarypancreatic surgery, Pineta Grande Hospital, Castelvolturo (CE), Italy
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Vacchiano G, Rocca A, Compagna R, Zamboli AGI, Cirillo V, Di Domenico L, Di Nardo V, Servillo G, Amato B. Transurethral Resection of the Prostate, Bladder Explosion and Hyponatremic Encephalopathy: A Rare Case Report of Malpractice. Open Med (Wars) 2017; 12:50-57. [PMID: 28435905 PMCID: PMC5394766 DOI: 10.1515/med-2017-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/01/2017] [Indexed: 12/25/2022] Open
Abstract
We present an original case report of a bladder explosion during a TURP intervention for benign prostatic hypertrophy, that was brought on by the absorption of about 5 liters of glycine 1.5% and then onset of a severe hyponatremia. The quick and inappropriate correction of this electrolyte imbalance led the onset of encephalopathy and the death of the patient. The authors discuss the pathogenesis of these uncommon diseases and, considering the most recent Italian Legislation, they highlight the importance to respect good clinical practice standards and guidelines to ensure the most appropriate treatments for the patient and remove any assumptions of medical liability.
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Affiliation(s)
- Giuseppe Vacchiano
- Department of Law, Economics, Management and Quantitative Methods University of Sannio, Benevento, Italy
| | - Aldo Rocca
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Rita Compagna
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Vera Cirillo
- Department of Neuroscience, University of Naples Federico II, Naples, Italy
| | | | - Veronica Di Nardo
- Department of Nuclear Physics and Radiation, Guglielmo Marconi University, Rome, Italy
| | - Giuseppe Servillo
- Department of Neuroscience, University of Naples Federico II, Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
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50
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Andreis D, Bonardi S, Allevi G, Aguggini S, Gussago F, Milani M, Strina C, Spada D, Ferrero G, Ungari M, Rocca A, Nanni O, Roviello G, Berruti A, Harris AL, Fox SB, Roviello F, Polom K, Bottini A, Generali D. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with T2 to T4, N0 and N1 breast cancer. Breast 2016; 29:55-61. [PMID: 27428471 DOI: 10.1016/j.breast.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/25/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Histological status of axillary lymph nodes is an important prognostic factor in patients receiving surgery for breast cancer (BC). Sentinel lymph node (SLN) biopsy (B) has rapidly replaced axillary lymph node dissection (ALND), and is now the standard of care for axillary staging in patients with clinically node-negative (N0) operable BC. The aim of this study is to compare pretreatment lymphoscintigraphy with a post primary systemic treatment (PST) scan in order to reduce the false-negative rates for SLNB. METHODS In this single-institution study we considered 170 consecutive T2-4 N0-1 M0 BC patients treated with anthracycline-based PST. At the time of incisional biopsy, we performed sentinel lymphatic mapping. After PST, all patients repeated lymphoscintigraphy with the same methodology. During definitive surgery we performed further sentinel lymphatic mapping, SLNB and ALND. RESULTS The SLN was removed in 158/170 patients giving an identification rate of 92.9% (95% confidence interval (CI) = 88.0-96.3%) and a false-negative rate of 14.0% (95% CI = 6.3-25.8%). SLNB revealed a sensitivity of 86.0% (95% CI = 74.2-93.7%), an accuracy of 94.9% (95% CI = 90.3-97.8%) and a negative predictive value of 92.7% (95% CI = 86.1-96.8%). CONCLUSION Identification rate, sensitivity and accuracy are in accordance with other studies on SLNB after PST, even after clinically negative node conversion following PST. This study confirms that diagnostic biopsy and neoadjuvant chemotherapy maintain breast lymphatic drainage unaltered.
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Affiliation(s)
- D Andreis
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - S Bonardi
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - G Allevi
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - S Aguggini
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - F Gussago
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - M Milani
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - C Strina
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - D Spada
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - G Ferrero
- U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - M Ungari
- U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - A Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - O Nanni
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - G Roviello
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Section of Pharmacology and University Center DIFF - Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124 Brescia, Italy
| | - A Berruti
- Oncologia Medica, Spedali Civili di Brescia, Università di Brescia, Italy
| | - A L Harris
- Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DS Oxford, UK
| | - S B Fox
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia
| | - F Roviello
- Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy
| | - K Polom
- Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy
| | - A Bottini
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - D Generali
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129 Trieste, Italy.
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