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Luceri C, Dragoni G, Zambonin D, Pesi B, Russo E, Scaringi S, Ficari F, Cianchi F, Giudici F. Is the age at surgery in Crohn's disease clinically relevant? Differences and peculiarities: a wide single centre experience after long-term follow-up. Langenbecks Arch Surg 2022; 407:2987-2996. [PMID: 35879620 DOI: 10.1007/s00423-022-02613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE The Montreal classification for Crohn's disease includes "age at diagnosis" as a parameter but few is reported about the age at surgery. The aim of this study is to evaluate the short- and long-term differences in the postoperative surgical outcome and disease behaviour, according to the age at the first surgery. METHODS Patients consecutively operated for abdominal Crohn's disease during the period 1986-2012 at our centre were systematically analysed according to their age at first surgery. In our retrospective cohort, the age at first surgery ranged from 13 to 83 years, and patients were arbitrarily divided into four groups: ≤ 19 (G1), 20-39 (G2), 40-59 (G3) and ≥ 60 (G4) years old. RESULTS In total, 1051 patients were included with a median follow-up time of 232 months. The four groups exhibited statistically significant differences in age at diagnosis, smoke habit, time between diagnosis and surgery, disease location and behaviour, history of perianal fistula or abscess, severe malnutrition requiring total parental nutrition before surgery, type of surgery, total length of resected bowel, median duration of hospitalization, incidence of abdominal recurrences and number of surgical recurrences. G1 displays an inverse linear trend with time in the severity of clinical characteristics when compared to G4 groups. On the contrary, the incidence of short-term complications, types of abdominal recurrence and presence of concomitant perianal disease did not vary among groups. In addition, at multivariate analysis, the age at surgery and the disease location were the only independent risk factors for abdominal surgical recurrence. CONCLUSION Despite first surgery is extremely more frequent between 20 and 59 years, patients from G1 and G4 groups showed clinical differences and peculiarities when compared to the other age groups. The most indolent CD behaviour and occurrence of surgical recurrence was observed in patients having their first abdominal surgery in the elderly, while patients operated before the age of 19 experienced a more aggressive disease course.
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Affiliation(s)
- Cristina Luceri
- NEUROFARBA Department, Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Daniela Zambonin
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Benedetta Pesi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Ferdinando Ficari
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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2
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Bartolini I, Nelli T, Russolillo N, Cucchetti A, Pesi B, Moraldi L, Ferrero A, Ercolani G, Grazi G, Batignani G. Multiple hepatocellular carcinoma: Long-term outcomes following resection beyond actual guidelines. An Italian multicentric retrospective study. Am J Surg 2021; 222:599-605. [PMID: 33546852 DOI: 10.1016/j.amjsurg.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is frequently diagnosed as multinodular. This study aims to assess prognostic factors for survival and identify patients with multiple HCC who may benefit from surgery beyond the Barcelona Clinic Liver Cancer classification indications. METHODS This retrospective study included all the consecutive patients from 4 Italian tertiary centers receiving liver resection for naive multiple HCC between 1990 and 2012 to have a potential follow-up of 5 years. RESULTS Included patients were 144. Ninety-day morbidity and mortality rates were 38.3% and 8.3%, respectively. The 5-year overall and disease-free survival rates were 33.3% and 19.1%, respectively. Tumor size <3 cm, bilirubin, Child-Pugh A, BCLC-A stage, being within "up-to-7" criteria, and minor resections resulted in prognostic factors. The Child-Pugh score resulted in an independent prognostic factor. CONCLUSIONS Surgery may be related to good outcomes in selected patients with multiple HCC.
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Affiliation(s)
- Ilenia Bartolini
- Department of Experimental and Clinical Medicine, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Tommaso Nelli
- Department of Experimental and Clinical Medicine, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Nadia Russolillo
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Largo Filippo Turati 62, 10128, Turin, Italy
| | - Alessandro Cucchetti
- Department of Emergency, Surgery, and Transplants, S. Orsola-Malpighi University Hospital, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Benedetta Pesi
- Department of Experimental and Clinical Medicine, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Luca Moraldi
- Surgical Oncology and Robotics, Department of Oncology, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandro Ferrero
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Largo Filippo Turati 62, 10128, Turin, Italy
| | - Giorgio Ercolani
- Department of Emergency, Surgery, and Transplants, S. Orsola-Malpighi University Hospital, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Gianluca Grazi
- General and Hepatopancreatobiliary Surgery Unit, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00128, Rome, Italy
| | - Giacomo Batignani
- Department of Experimental and Clinical Medicine, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy
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Pesi B, Bencini L, Moraldi L, Tofani F, Batignani G, Bechi P, Farsi M, Annecchiarico M, Coratti A. Robotic Versus Open Liver Resection in Hepatocarcinoma: Surgical and Oncological Outcomes. Surg Laparosc Endosc Percutan Tech 2021; 31:468-474. [PMID: 33480668 DOI: 10.1097/sle.0000000000000904] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive approaches are spreading in every field of surgery, including liver surgery. However, studies comparing robotic hepatectomy with the conventional open approach regarding oncologic outcomes for hepatocellular carcinoma are limited. MATERIALS AND METHODS We retrospectively reviewed demographics characteristics, pathologic features, surgical, and oncological outcomes of patients who underwent robotic and conventional open liver resection for hepatocellular carcinoma. RESULTS No significant differences in demographics features, tumor size, tumor location, and type of liver resection were found. The morbidity rate was similar, 23% for the open group versus 17% of the robotic group (P=0.605). Perioperative data analysis showed a greater estimated blood loss in patients who underwent open resection, if compared with robotic group (P=0.003). R0 resection and disease-free resection margins showed no statistically significant differences. The 3-year disease-free survival of the robotic group was comparable with that of the open group (54% vs. 37%; P=0.592), as was the 3-year overall survival (87% vs. 78%; P=0.203). CONCLUSIONS The surgical and the oncological outcomes seem to be comparable between minimally invasive and open hepatectomy. Robotic liver resections are effective, and do not compromise the oncological outcome, representing a reasonable alternative to the open approach.
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Affiliation(s)
- Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Lapo Bencini
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Luca Moraldi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Federica Tofani
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Giacomo Batignani
- Department of Surgery and Translational Medicine, Hepatobiliary Surgery Unit, University of Florence, Florence, Italy
| | - Paolo Bechi
- Department of Surgery and Translational Medicine, Hepatobiliary Surgery Unit, University of Florence, Florence, Italy
| | - Marco Farsi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Mario Annecchiarico
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
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Magistri P, Boggi U, Esposito A, Carrano FM, Pesi B, Ballarin R, De Pastena M, Menonna F, Moraldi L, Melis M, Coratti A, Newman E, Napoli N, Ramera M, Di Benedetto F. Robotic vs open distal pancreatectomy: A multi-institutional matched comparison analysis. J Hepatobiliary Pancreat Sci 2020; 28:1098-1106. [PMID: 33314791 DOI: 10.1002/jhbp.881] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pancreatic surgery is still a challenge even in high-volume centers. Clinically relevant postoperative pancreatic fistula (CR-POPF) represents the greatest contributor to major morbidity and mortality, especially following pancreatic distal resection. In this study, we compared robotic distal pancreatectomy (RDP) to open distal pancreatectomy (ODP) in terms of CR-POPF development and analyzed oncologic efficacy of RDP in the subgroup of patients with pancreatic ductal adenocarcinoma (PDAC). METHODS We collected data from five high-volume centers for pancreatic surgery and performed a matched comparison analysis to compare short and long-term outcomes after ODP or RDP. Patients were matched with a 2:1 ratio according to age, ASA (American Society of Anesthesiologists) score, body mass index (BMI), final pathology, and TNM (Tumour, Node, Metastasis) staging system VIII ed. RESULTS Two hundred and forty-six patients who underwent 82 RDPs and 164 ODPs were included. No differences were found in the incidence of CR-POPF. In the PDAC group, median DFS and OS were 10.8 months and 14.8 months in the ODP group and 10.4 months and 15 months in the RDP group, respectively. CONCLUSIONS Robotic distal pancreatectomy is a safe surgical strategy for PDAC and incidence of CR-POPF is equivalent between RDP and ODP. RDP should be considered equivalent to ODP in terms of oncological efficacy when performed in high-volume and proficient centers.
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Affiliation(s)
- Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Francesco Maria Carrano
- Department of Surgery, NYU School of Medicine, New York, NY, USA.,Department of General, Emergency and Transplant Surgery, Ospedale di Circolo e "Fondazione Macchi,", ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Francesca Menonna
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luca Moraldi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | | | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Elliot Newman
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Niccolò Napoli
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Marco Ramera
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
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Magistri P, Pecchi A, Franceschini E, Pesi B, Guadagni S, Catellani B, Assirati G, Guidetti C, Guerrini GP, Tarantino G, Ballarin R, Codeluppi M, Morelli L, Coratti A, Di Benedetto F. Not just minor resections: robotic approach for cystic echinococcosis of the liver. Infection 2019; 47:973-979. [PMID: 31236898 DOI: 10.1007/s15010-019-01333-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/06/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Human echinococcosis is among the 17 neglected tropical diseases recognized by the World Health Organization. It is responsible for over $3 billion of health costs every year being endemic in large areas worldwide, and liver is affected in 70% of the cases. Surgery associated to medical treatment is the gold standard and robotic approach may be a valuable tool to achieve safe, parenchyma sparing resections. METHODS We retrospectively analyzed the outcomes of patients that underwent robotic radical surgical treatment for hydatid liver disease, from prospectively maintained databases of three Italian centers. RESULTS 15 patients were included in this study, median age 51 years (24-76). 1 right hepatectomy, 2 left lateral sectionectomies, 5 segmentectomies (including 1 caudatectomy), 3 wedge resections and 5 cyst-pericystectomies were performed. Median estimated blood loss was of 100 ml (50-550 ml), and median operative time including docking was 210 min (95-590 min), with no need for conversion to open. Median hospital stay was 4 days, with only one readmission for fever. Only one patient experienced recurrence in a different liver segment. CONCLUSIONS In our experience, robotic approach for cystic echinococcosis of the liver proved to be a safe and effective strategy also in the so-called "difficult segments", with short post-operative stay and quick return to daily activities, along with the absence of surgical site recurrences. To the best of our knowledge, this is the largest report of robotic approach to hydatid liver disease.
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Affiliation(s)
- Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Annarita Pecchi
- Department of Radiology, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Benedetta Pesi
- Division of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Di Careggi, 50139, Florence, FI, Italy
| | - Simone Guadagni
- Department of Translational and New Technologies in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Barbara Catellani
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Cristiano Guidetti
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Giuseppe Tarantino
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Mauro Codeluppi
- Department of Infectious Diseases, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Luca Morelli
- Department of Translational and New Technologies in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Andrea Coratti
- Division of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Di Careggi, 50139, Florence, FI, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy.
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Pesi B, Zambonin D, Giudici F, Ficari F, Scaringi S, Muiesan P. Mucinous adenocarcinoma of the rectum with uninjured mucosa. ANZ J Surg 2019; 90:E65-E66. [PMID: 31081269 DOI: 10.1111/ans.15239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Benedetta Pesi
- Hepatobiliary Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Daniela Zambonin
- Hepatobiliary Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesco Giudici
- Hepatobiliary Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Ferdinando Ficari
- Hepatobiliary Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Stefano Scaringi
- Hepatobiliary Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Paolo Muiesan
- Hepatobiliary Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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7
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Zambonin D, Giudici F, Ficari F, Pesi B, Malentacchi C, Scaringi S. Preliminary study of short- and long-term outcome and quality of life after minimally invasive surgery for Crohn's disease: Comparison between single incision, robotic-assisted and conventional laparoscopy. J Minim Access Surg 2019; 16:364-371. [PMID: 31031322 PMCID: PMC7597873 DOI: 10.4103/jmas.jmas_61_19] [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] [Indexed: 11/04/2022] Open
Abstract
Background The feasibility of minimally invasive approach for Crohn's disease (CD) is still controversial. However, several meta-analysis and retrospective studies demonstrated the safety and benefits of laparoscopy for CD patients. Laparoscopic surgery can also be considered for complex disease and recurrent disease. The aim of this study was to investigate retrospectively the effect of three minimally invasive techniques on short- and long-term post-operative outcome. Patients and Methods We analysed CD patients underwent minimally invasive surgery in the Digestive Surgery Unit at Careggi University Hospital (from January 2012 to March 2017). Short-term outcome was evaluated with Clavien-Dindo classification and visual analogue scale for post-operative pain. Long-term outcome was evaluated through four questionnaires: Short Form Health Survey (SF-36), Gastrointestinal Quality Of Life Index (GIQLI), Body Image Questionnaire (BIQ) and Hospital Experience Questionnaire (HEQ). Results There were 89 patients: 63 conventional laparoscopy, 16 single-incision laparoscopic surgery and 10 robotic-assisted laparoscopy (RALS). Serum albumin <30 g/L (P = 0.031) resulted to be a risk factor for post-operative complications. HEQ had a better result for RALS (P = 0.019), while no differences resulted for SF-36, BIQ and GIQLI. Conclusions Minimally invasive technique for CD is feasible, even for complicated and recurrent disease. Our study demonstrated low rates of post-operative complications. However, it is a preliminary study with a small sample size. Further studies should be performed to assess the best surgical technique.
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Affiliation(s)
- Daniela Zambonin
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Francesco Giudici
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Ferdinando Ficari
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Benedetta Pesi
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Cecilia Malentacchi
- Department of Experimental and Clinical Biomedical Sciences (SBSC) 'Mario Serio', University of Florence, Florence, Italy
| | - Stefano Scaringi
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
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8
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Pesi B, Moraldi L, Guerra F, Tofani F, Nerini A, Annecchiarico M, Coratti A. Surgical and oncological outcomes after ultrasound-guided robotic liver resections for malignant tumor. Analysis of a prospective database. Int J Med Robot 2019; 15:e2002. [PMID: 31022774 DOI: 10.1002/rcs.2002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/16/2018] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 12/23/2022]
Abstract
AIM Robotic surgery is thought to have a role in widening the application of minimally invasive liver surgery. Nonetheless, data concerning surgical results for liver malignancies are presently still lacking. We aimed to evaluate the surgical and oncological outcomes of ultrasound guided robotic liver resections for hepatic malignancies. METHODS All consecutive patients who received robotic resection of primary and secondary liver malignancies from September 2008 to January 2017 were analyzed. The same surgical team performed all procedures following the principle of parenchymal-sparing surgery. RESULTS From a total of 51 patients, 13 patients (25%) underwent major and 38 (75%) minor hepatectomy. No mortality occurred. Two procedures were converted to open surgery. Five patients experienced major complications, with a reintervention rate of 6%. Median hospital stay was 5 days. CONCLUSIONS Robotic surgery is a safe and feasible procedure for liver resection even when dealing with malignancies. Our data show that robotic surgery can be considered a valid option to treat patients with liver malignancies in a minimally invasive manner, without compromise the oncological results.
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Affiliation(s)
- Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Luca Moraldi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Federica Tofani
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Alessandro Nerini
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
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9
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Moraldi L, Pesi B, Bencini L, Farsi M, Annecchiarico M, Coratti A. Robotic distal pancreatectomy with selective closure of pancreatic duct: surgical outcomes. Updates Surg 2018; 71:145-150. [DOI: 10.1007/s13304-018-0605-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 11/09/2018] [Indexed: 01/08/2023]
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Abstract
BACKGROUND Liver resection may be complicated by unpredictable intraoperative bleeding. Pringle's maneuver was the first attempt to control bleeding, but the main problem is the duration of ischemia. Robotic surgery thanks to the magnified view, three-dimensional visualization associated and fine movement allow to perform good parenchymal dissection and identification of vascular structure. Aim of study is to evaluate blood loss and the need to perform Pringle maneuver in patients underwent robotic liver resection. METHODS Thirty-three patients underwent robotic liver resections were analyzed, 16 (48%) male and 17 (52%) female, with median age of 64 years. Seven (21%) patients had benign lesions and twenty-six (79%) malignant tumor. RESULTS Seventeen (52%) patients had anatomical resections, while sixteen (48%) patients had non anatomical resection. Operative time was 270 minutes. Estimated blood loss was 100 mL and Pringle maneuver was carried out on seven patients. Median hospital stay was 4 days. CONCLUSIONS Our results show that liver resections with robotic technique can be performed safely even without systematic Pringle maneuver.
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Affiliation(s)
- Benedetta Pesi
- Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy -
| | - Luca Moraldi
- Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Ilenia Bartolini
- Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Federica Tofani
- Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Francesco Guerra
- Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
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11
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Donadon M, Cescon M, Cucchetti A, Cimino M, Costa G, Pesi B, Ercolani G, Pinna AD, Torzilli G. Parenchymal-Sparing Surgery for the Surgical Treatment of Multiple Colorectal Liver Metastases Is a Safer Approach than Major Hepatectomy Not Impairing Patients' Prognosis: A Bi-Institutional Propensity Score-Matched Analysis. Dig Surg 2017; 35:342-349. [PMID: 29032372 DOI: 10.1159/000479336] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The performance of parenchymal-sparing hepatectomy (PSH) versus major hepatectomy (MH) in patients with multiple colorectal liver metastases (CLM) is a matter that is yet debated. We investigated the outcome of patients with multiple CLM undergoing PSH instead of MH. METHODS Databases at 2 institutions were reviewed. A propensity score-matched analysis was applied. Among 554 patients, 110 undergoing PSH and 110 undergoing MH were matched. They were similar in baseline characteristics, comorbidity, and tumor features. Primary outcomes were short- and long-term outcomes. RESULTS Morbidity was significantly higher in the MH group, while mortality was not significantly different. There were no differences in free-margins width, but a trend of increased survival was seen in the PSH group with a median advantage of 6 months over the MH group. Among the prognostic factors, the T status (hazard ratio [HR] 2.6; p = 0.001), the N status (HR 2.9; p = 0.001), the timing of CLM diagnosis (HR 2.1; p = 0.002), the tumor number (HR 2.0; p = 0.001), the tumor size (HR 2.2; p = 0.015), and the neo-adjuvant chemotherapy (HR 1.7; p = 0.023) were found to be statistically and independently significant for survival. CONCLUSIONS PSH conveys advantage over MH in terms of decreased postoperative morbidity, and a trend of survival benefit. PSH should be considered a suitable alternative to MH whenever it is technically feasible.
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Affiliation(s)
- Matteo Donadon
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Pesi B, Scaringi S, Di Martino C, Batignani G, Giudici F, Bisogni D, Tonelli F, Bechi P. Results of Surgical Salvage Treatment for Anal Canal Cancer: A Retrospective Analysis with Overview of the Literature. Dig Surg 2017; 34:380-386. [PMID: 28099957 DOI: 10.1159/000453589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/17/2016] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Chemoradiotherapy (CRT) is the gold standard treatment for anal cancer, which permits the maintenance of the anal function. However, about 30-40% of patients develop local disease progression, for which surgery represents a good salvage therapy. The aim of this study is to evaluate survival and morbidity rate in patients who undergo salvage surgery in our single institution, with an overview of the literature. METHODS A retrospective study was carried out on patients who underwent surgical treatment of anal canal cancer after failure of CRT. We evaluated overall survival at 1, 3, and 5 years and postoperative morbidity rate. RESULTS Twenty patients who underwent radical surgery with abdominoperineal resection were included in the study. The survival rates at 1, 3, and 5 years were 75, 60, and 37.4%; with a disease-free survival of 67, 53, and 35%, respectively. There was no postoperative mortality. The morbidity rate was 35%. CONCLUSION Surgery represents the recommended therapy for persistent or recurrent anal canal cancer after CRT, with a good survival rate and an acceptable morbidity.
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Affiliation(s)
- Benedetta Pesi
- Digestive Surgery Unit, Careggi University Hospital, Florence, Italy
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Giudici F, Pesi B, Zambonin D, Scaringi S, Bechi P, Batignani G. Safer intestinal invagination for a solid pancreatico-jejunal anastomosis in presence of a soft texture pancreatic remnant and non-dilated duct. Hepatobiliary Pancreat Dis Int 2016; 15:324-8. [PMID: 27298111 DOI: 10.1016/s1499-3872(15)60027-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pancreatico-jejunal anastomosis after pancreatoduodenectomy still represents the Achilles' heel of the procedure: the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic fistula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico-jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The variation could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.
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Affiliation(s)
- Francesco Giudici
- Unit of Surgery, Department of Surgery and Translational Medicine, University of Florence Medical School, Careggi University Hospital, Florence, Italy.
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Guerra F, Pesi B, Amore Bonapasta S, Perna F, Di Marino M, Annecchiarico M, Coratti A. Does robotics improve minimally invasive rectal surgery? Functional and oncological implications. J Dig Dis 2016; 17:88-94. [PMID: 26749061 DOI: 10.1111/1751-2980.12312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/22/2015] [Accepted: 12/27/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Robot-assisted surgery has been reported to be a safe and effective alternative to conventional laparoscopy for the treatment of rectal cancer in a minimally invasive manner. Nevertheless, substantial data concerning functional outcomes and long-term oncological adequacy is still lacking. We aimed to assess the current role of robotics in rectal surgery focusing on patients' functional and oncological outcomes. METHODS A comprehensive review was conducted to search articles published in English up to 11 September 2015 concerning functional and/or oncological outcomes of patients who received robot-assisted rectal surgery. All relevant papers were evaluated on functional implications such as postoperative sexual and urinary dysfunction and oncological outcomes. RESULTS Robotics showed a general trend towards lower rates of sexual and urinary postoperative dysfunction and earlier recovery compared with laparoscopy. The rates of 3-year local recurrence, disease-free survival and overall survival of robotic-assisted rectal surgery compared favourably with those of laparoscopy. CONCLUSIONS This study fails to provide solid evidence to draw definitive conclusions on whether robotic systems could be useful in ameliorating the outcomes of minimally invasive surgery for rectal cancer. However, the available data suggest potential advantages over conventional laparoscopy with reference to functional outcomes.
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Affiliation(s)
- Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Stefano Amore Bonapasta
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Federico Perna
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Michele Di Marino
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
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Guerra F, Pesi B, Fatucchi LM, Amore Bonapasta S, Coratti A. Splenic preservation during open and minimally-invasive distal pancreatectomy. Surgery 2015; 158:1743-4. [PMID: 26032823 DOI: 10.1016/j.surg.2015.04.022] [Citation(s) in RCA: 3] [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] [Received: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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Guerra F, Pesi B, Amore Bonapasta S, Di Marino M, Perna F, Annecchiarico M, Coratti A. Challenges in robotic distal pancreatectomy: systematic review of current practice. MINERVA CHIR 2015; 70:241-7. [PMID: 25916194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Over the last decade, robotics has gained popularity and is increasingly employed to accomplish several abdominal surgical procedures. Nevertheless, pancreatectomies are regarded as demanding procedures for which the application of minimally-invasive surgery is still limited and its effectiveness has not been conclusively established. We aimed to investigate the current role of robot-assisted surgery to perform distal pancreatectomy. A systematic review of the English-language literature was conducted for articles dealing with robotic-assisted distal pancreatectomies. All relevant papers were evaluated on surgical and oncological outcomes. A total of 10 articles reporting on robotic distal pancreatectomies were finally considered in the analysis, including 259 patients. Mean operative time was 271 minutes (range 181-398); mean blood loss was 210 mL (range 104-361), in 11.6% of cases conversion to laparotomy occurred, spleen preservation was accomplished in 51.4% of procedures, mean time of postoperative hospital stay was 7 days. Overall, postoperative mortality and morbidity were 0% and 23.4% respectively, the mean number of lymph nodes harvested was 12.7. In all included series, no case of R1 resection was reported. Despite its relatively recent introduction in clinical practice, robotic-assisted surgery has been widely employed to perform distal pancreatectomy worldwide and it should be considered a safe and effective procedure. Both surgical and pathologic data support its application in the management of pancreatic lesions of the body and tail.
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Affiliation(s)
- F Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy -
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17
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Pesi B, Ferrero A, Grazi GL, Cescon M, Russolillo N, Leo F, Boni L, Pinna AD, Capussotti L, Batignani G. Liver resection with thrombectomy as a treatment of hepatocellular carcinoma with major vascular invasion: results from a retrospective multicentric study. Am J Surg 2015; 210:35-44. [PMID: 25935229 DOI: 10.1016/j.amjsurg.2014.09.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of liver resection (LR) of hepatocellular carcinoma with macroscopic vascular thrombosis (MVT) remains controversial. The aim of this study is to evaluate whether the presence of MVT should still be considered a contraindication for LR. METHODS Retrospective study was carried out on 62 patients who underwent LR and thrombectomy for hepatocellular carcinoma complicated by MVT. Of the 62 patients, 15 (36.5%) had tumor thrombus (TT) in the peripheral portal vein (Vp1), 5 (12.2%) in second branch (Vp2), and 21 (51.3%) in the first branch/portal vein trunk (Vp3), while on the hepatic/cava vein side, 8 (12.9%) had TT in the main trunk of the hepatic veins (Vv2) and 3 (4.8%) had TT reaching the vena cava/right atrium (Vv3). RESULTS Perioperative major morbidity was 14.5%, while in-hospital mortality was 4.8%. Overall, 1, 3, and 5-year survival rates were 53.3%, 30.1%, and 20%, and disease-free survival rates were 31.7%, 20.8%, and 15.6%, respectively. There were no differences in survival about the MVT localized in Vp1, Vp2, or Vp3 (P = .77), while we found a statistical trend between patients with Vv2 and Vv3 (P = .06). CONCLUSION Surgical resection seems to be justified in these patients, and the presence of MVT should no longer be considered an absolute contraindication for LR.
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Affiliation(s)
- Benedetta Pesi
- Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Alessandro Ferrero
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - Gianluca L Grazi
- Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Cescon
- Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Nadia Russolillo
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - Francesca Leo
- Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Luca Boni
- Department of Oncology/Core Research Laboratory, Careggi University Hospital, Florence, Italy
| | - Antonio D Pinna
- Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lorenzo Capussotti
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - Giacomo Batignani
- Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy.
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Pesi B, Moraldi L, Zambonin D, Giudici F, Cavalli T, Addasi R, Leo F, Scaringi S, Batignani G. Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jct.2014.514134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Alemanno G, Zambonin D, Sturiale A, Cavalli T, Bellucci F, Pesi B, Di Martino C, Giudici F, Tonelli F. A multidisciplinary approach to desmoid tumors. When intra-abdominal fibromatosis degenerates into an abscess, which is the right treatment? Int J Surg Case Rep 2013; 4:757-60. [PMID: 23856253 DOI: 10.1016/j.ijscr.2013.05.015] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/20/2013] [Accepted: 05/09/2013] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Desmoid tumors are rare benign tumors that originates in the fibrous sheath or musculo-aponeurotic structure. Histologically benign, they tends to invade locally and to be recurrent. PRESENTATION OF CASE We report a rare case of an intra-abdominal desmoid tumor in a patient affected by familial adenomatous polyposis, which degenerated into abscess. Male, 38 years, was hospitalized for abdominal pain, bowel obstruction and fever. The computed tomography showed a big dishomogeneous mass occupying the whole mesentery with internal massive liquefaction. The mass extended from the epigastrium for 13cm up to L3. On the right mesogastric side a solid, thick mass of about 2cm, with a length of 4.5cm, was identified; it was not cleavable from the wall and from some of the loops. We decided to perform a computed tomography-guided percutaneous drainage. Two hundred ml of purulent necrotic material was aspirated, and washing with antibiotic solution was carried out. Cytological examination of fluid drainage showed histiocytes and neutrophils. At follow-up, the patient's clinical condition had improved. An abdominal ultrasound showed a substantial reduction in the diameter of the mass. DISCUSSION Diagnosis and treatment of desmoids tumor in patients with familial adenomatous polyposis may be difficult, especially when desmoids are located intra-abdominally and in the mesentery. Seldom will desmoid tumors be complicated by abscess formation. CONCLUSION The management of desmoids tumors is not easy and the choice of the best treatment may be difficult due to the different possible anatomical presentations.
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Affiliation(s)
- Giovanni Alemanno
- Digestive Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, Careggi University Hospital, Florence, Italy.
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Pesi B, Leo F, Liscia G, Alemanno G, Zambonin D, Falchini M, Batignani G. Radiofrequency on the liver remnant after liver resection to reach the haemostasis not otherwise achievable with conventional techniques. Int J Surg Case Rep 2013; 4:558-60. [PMID: 23632073 DOI: 10.1016/j.ijscr.2013.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION During liver resection, in same case of inflamed, steatotic or neo-vascularized liver parenchyma, reaching of haemostasis on the liver resection surface could be very difficult for the surgeon because of the presence of fragile tissue that does not allows the proper placement of stitches, and the conventional method fail. PRESENTATION OF CASE The authors describe a novel technique in which, after a formal liver resection, liver haemostasis is achieved using radiofrequency energy on the resected surface. A patient affected by a hystiocytic sarcoma localized on the VI-V and IVa segments was scheduled for liver resection. During the resection a diffuse bleeding from the resected surface started with little success obtained with conventional method. So we decided to use the coagulative necrosis generated by the radiofrequency, using a cool type cluster needle, hand-piece with 3 needle, bending 2 needles in a way resembling a "fork", to reach a complete and definitive haemostasis. DISCUSSION Haemostasis remains a critical issue in liver surgery not only for the catastrophic effect of haemorrhage but also because it is correlated to complications rate and to survival. The coagulative necrosis generated by the radiofrequency could be used to facilitate the creation of a necrotic plane to be transacted. CONCLUSION The use of the radiofrequency energy, delivered through needles, is suggested when the conventional techniques fail to reach a proper haemostasis after a liver resection or, to consider its use, prior to resect the liver in presence of fragile parenchyma.
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Affiliation(s)
- Benedetta Pesi
- Digestive Surgery Unit, Department of Surgery and Traslational Medicine, University of Florence Medical School, Careggi University Hospital, Florence, Italy.
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Pesi B, Scaringi S, Zambonin D, Di Martino C, Batignani G. Vascular control in liver resection for hepatocellular carcinoma. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.058] [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: 10/27/2022] Open
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Pesi B, Batignani G, Tonelli F. Right colon adenocarcinoma with gastroduodenal-pancreatic invasion and multiple liver metastases: What to do? Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.039] [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: 11/16/2022] Open
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Pesi B, Scaringi S, Zambonin D, Di Martino C, Batignani G. Results of liver resection for hepatocellular carcinoma: Prognostic factors. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.055] [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: 11/15/2022] Open
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Zambonin D, Di Martino C, Scaringi S, Pesi B, Tonelli F. Morbidity, mortality and long-term survival in patients undergoing extended cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.069] [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: 10/27/2022] Open
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Pesi B, Zambonin D, Scaringi S, Batignani G. Results of Liver Resection for Hepatocellular Carcinoma Inside and Outside the Milan's Criteria. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.09.020] [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: 10/15/2022] Open
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Di Martino C, Scaringi S, Zambonin D, Giudici F, Pesi B, Tonelli F. Colorectal Cancer in Crohn's and Ulcerative Colitis: A Comparative Study in 63 Patients. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.09.014] [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: 10/15/2022] Open
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