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Fossati V, Cattaneo GM, Zerbi A, Galli L, Bordogna G, Reni M, Parolini D, Carlucci M, Bissi A, Staudacher C. The Role of Intraoperative Therapy by Electron Beam and Combination of Adjuvant Chemotherapy and External Radiotherapy in Carcinoma of the Pancreas. Tumori 2018; 81:23-31. [PMID: 7754537 DOI: 10.1177/030089169508100106] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background In the treatment of pancreatic carcinomas, one modality is intraoperative radiotherapy (IORT). A study was carried out to assess the feasibility of IORT alone or in a multimodality approach with postoperative adjuvant chemotherapy and external radiotherapy and to compare local control and survival of patients. Another objective of this retrospective study was to verify prognostic factors in resected patients treated with IORT. Methods From January 1985 through September 1992, 54 adenocarcinomas of the pancreas (unresectable and resected patients) were treated with IORT by electron beam at the San Raffaele Hospital and then analyzed. Comparison was also carried out between IORT-treated resected patients and a non-randomized control group of resected patients treated without IORT in the same period. Results In unresectable patients treated by laparotomy bypass and IORT, overall median survival was 6 months and 8 months in non-metastatic patients. Relief of severe pain present in 14 patients was observed in 85% within 12 days of IORT. As regards resected patients, the most important finding was that significantly better local control resulted from IORT. In fact, overall, local relapses were 25% in the IORT group and 55.8% in the non-IORT group (control group); instead, survival of the IORT group was not significantly longer than that of the control group. From a statistical analysis of resected patients treated with IORT and performed on prognostic factors on the basis of available data, survival was significantly influenced by tumor pathologic grading and diameter; postoperative adjuvant therapy was not a significant prognosis factor. Conclusions IORT has a role in local control of unresectable pancreatic carcinomas and in control of resultant severe pain. In resected patients, IORT is effective in decreasing local recurrences but has little impact on survival. To obtain more satisfactory results, new and more effective adjuvant therapies and better abdominal prophylaxis should be tested.
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Affiliation(s)
- V Fossati
- Radiation-Oncology Department, Istituto Nazionale Tumori, Milan, Italy
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Abstract
AIMS AND BACKGROUND The clinical value of the UICC TNM classification and the Izumi TNM modification regarding prognosis after hepatic resection was evaluated. METHODS Between January 1993 and December 1998, survival and disease-free survival were analyzed in 53 cirrhotic patients (40 males, 13 females; mean age, 65 years; range, 43-81) who underwent hepatic resection for HCC. RESULTS The 1-, 3-, and 5-year overall survivals were: 89%, 54%, and 50%, with disease-free survivals of 70%, 38%, and 28%, respectively. The difference between stages 1 and 2 or stages 3 and 4A using the UICC TNM classification was not significant with respect to survival or disease-free survival. Conversely, the Izumi TNM modification showed a significant difference between each stage with respect to survival and disease-free survival. In a multivariate analysis the lack of micro/macro vascular invasion was predictive of long-term outcome. CONCLUSIONS Our results show that the UICC TNM classification for hepatocellular carcinoma is inadequate. The Izumi modified TNM staging system is superior in assessing prognosis for surgical HCC patients.
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Affiliation(s)
- C Staudacher
- Department of Emergency Surgery, Surgical Oncology, University of Milan, School of Medicine, San Raffaele Scientific Institute, Italy
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3
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Chiari D, Orsenigo E, Guarneri G, Baiocchi GL, Mazza E, Albarello L, Bissolati M, Molfino S, Staudacher C. Effect of neoadjuvant chemotherapy on HER-2 expression in surgically treated gastric and oesophagogastric junction carcinoma: a multicentre Italian study. Updates Surg 2017; 69:35-43. [PMID: 28276033 DOI: 10.1007/s13304-017-0423-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/21/2017] [Indexed: 12/22/2022]
Abstract
Predictors of response to neoadjuvant chemotherapy are not available for gastric and oesophago-gastric junction carcinoma. HER-2 over-expression in breast cancer correlates with poor prognosis and high incidence of recurrence. First aim of this study was to evaluate if the HER-2 expression/amplification is predictive of response to neoadjuvant chemotherapy in terms of pathologic regression. Secondary aim was to evaluate if HER-2 expression varies after neoadjuvant treatment. Thirty-five patients with locally advanced gastric or oesophago-gastric junction carcinoma underwent preoperative chemotherapy and surgical resection at San Raffaele Scientific Institute and Spedali Civili of Brescia. HER-2 expression/amplification was evaluated on every biopsy at diagnosis time and on every surgical sample after neoadjuvant chemotherapy. Pathologic response to chemotherapy was evaluated according to TNM classification (ypT status and ypN status) and Mandard's tumour regression grade classification. In our series 10 patients (28.6%) showed a reduction in HER-2 overexpression and in 6 of them (17.1%) HER-2 expression completely disappeared. Only three of the six patients with HER-2 disappearance had a complete pathological response to neoadjuvant chemotherapy. There was a strong correlation between HER-2 negativity on biopsy and absence of lymph node metastasis in surgical samples after neoadjuvant chemotherapy, irrespective of nodal status before chemotherapy. A direct correlation between HER-2 reduction after neoadjuvant chemotherapy and pathologic regression (primary tumour and lymph nodes) in surgical samples was found. HER-2 negativity may represent a predictor of pathologic response to neoadjuvant chemotherapy for gastric and oesophago-gastric junction adenocarcinoma. Neoadjuvant treatment can reduce HER-2 overexpression.
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Affiliation(s)
- Damiano Chiari
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Guarneri
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Gian Luca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Elena Mazza
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Albarello
- Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Sarah Molfino
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
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Giganti F, Marra P, Ambrosi A, Salerno A, Antunes S, Chiari D, Orsenigo E, Esposito A, Mazza E, Albarello L, Nicoletti R, Staudacher C, Del Maschio A, De Cobelli F. Pre-treatment MDCT-based texture analysis for therapy response prediction in gastric cancer: Comparison with tumour regression grade at final histology. Eur J Radiol 2017; 90:129-137. [PMID: 28583623 DOI: 10.1016/j.ejrad.2017.02.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/25/2017] [Accepted: 02/27/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE An accurate prediction of tumour response to therapy is fundamental in oncology, so as to prompt personalised treatment options if needed. The aim of this study was to investigate the ability of preoperative texture analysis from multi-detector computed tomography (MDCT) in the prediction of the response rate to neo-adjuvant therapy in patients with gastric cancer. MATERIAL AND METHODS Thirty-four patients with biopsy-proven gastric cancer were examined by MDCT before neo-adjuvant therapy, and treated with radical surgery after treatment completion. Tumour regression grade (TRG) at final histology was also assessed. Image features from texture analysis were quantified, with and without filters for fine to coarse textures. Patients with TRG 1-3 were considered responders while TRG 4-5 as non- responders. The response rate to neo-adjuvant therapy was assessed both at univariate and multivariate analysis. RESULTS Fourteen parameters were significantly different between the two subgroups at univariate analysis; in particular, entropy and compactness (higher in responders) and uniformity (lower in responders). According to our model, the following parameters could identify non-responders at multivariate analysis: entropy (≤6.86 with a logarithm of Odds Ratio - Log OR -: 4.11; p=0.003); range (>158.72; Log OR: 3.67; p=0.010) and root mean square (≤3.71; Log OR: 4.57; p=0.005). Entropy and three-dimensional volume were not significantly correlated (r=0.06; p=0.735). CONCLUSION Pre-treatment texture analysis can potentially provide important information regarding the response rate to neo-adjuvant therapy for gastric cancer, improving risk stratification.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology and Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Marra
- Department of Radiology and Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Annalaura Salerno
- Department of Radiology and Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Sofia Antunes
- Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Chiari
- Vita-Salute San Raffaele University, Milan, Italy; Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Department of Radiology and Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Mazza
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Albarello
- Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Nicoletti
- Department of Radiology and Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Staudacher
- Vita-Salute San Raffaele University, Milan, Italy; Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology and Experimental Imaging Centre, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Giganti F, Ambrosi A, Chiari D, Orsenigo E, Esposito A, Mazza E, Albarello L, Staudacher C, Del Maschio A, De Cobelli F. Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer. Chin J Cancer Res 2017; 29:118-126. [PMID: 28536490 PMCID: PMC5422413 DOI: 10.21147/j.issn.1000-9604.2017.02.04] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To investigate the role of apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) when applied to the 7th TNM classification in the staging and prognosis of gastric cancer (GC). Methods Between October 2009 and May 2014, a total of 89 patients with non-metastatic, biopsy proven GC underwent 1.5T DW-MRI, and then treated with radical surgery. Tumor ADC was measured retrospectively and compared with final histology following the 7th TNM staging (local invasion, nodal involvement and according to the different groups — stage I, II and III). Kaplan-Meier curves were also generated. The follow-up period is updated to May 2016. Results Median follow-up period was 33 months and 45/89 (51%) deaths from GC were observed. ADC was significantly different both for local invasion and nodal involvement (P<0.001). Considering final histology as the reference standard, a preoperative ADC cut-off of 1.80×10–3 mm2/s could distinguish between stages I and II and an ADC value of ≤1.36×10–3 mm2/s was associated with stage III (P<0.001). Kaplan-Meier curves demonstrated that the survival rates for the three prognostic groups were significantly different according to final histology and ADC cut-offs (P<0.001).
Conclusions ADC is different according to local invasion, nodal involvement and the 7th TNM stage groups for GC, representing a potential, additional prognostic biomarker. The addition of DW-MRI could aid in the staging and risk stratification of GC.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Ambrosi
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Chiari
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Orsenigo
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Mazza
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Albarello
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Staudacher
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Giganti F, Ambrosi A, Petrone MC, Canevari C, Chiari D, Salerno A, Arcidiacono PG, Nicoletti R, Albarello L, Mazza E, Gallivanone F, Gianolli L, Orsenigo E, Esposito A, Staudacher C, Del Maschio A, De Cobelli F. Prospective comparison of MR with diffusion-weighted imaging, endoscopic ultrasound, MDCT and positron emission tomography-CT in the pre-operative staging of oesophageal cancer: results from a pilot study. Br J Radiol 2016; 89:20160087. [PMID: 27767330 DOI: 10.1259/bjr.20160087] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance of MR and diffusion-weighted imaging (DWI), multidetector CT, endoscopic ultrasonography (EUS) and 18F-FDG (fluorine-18 fludeoxyglucose) positron emission tomography CT (PET-CT) in the pre-operative locoregional staging of oesophageal cancer. METHODS 18 patients with oesophageal or Siewert I tumour (9 directly treated with surgery and 9 addressed to chemo-/radiotherapy before) underwent 1.5-T MR and DWI, 64-channel multidetector CT, EUS and PET-CT before (n = 18) and also after neoadjuvant treatment (n = 9). All images were analysed and staged blindly by dedicated operators (seventh TNM edition). Two radiologists calculated independently the apparent diffusion coefficient from the first scan. Results were compared with histopathological findings. After the population had been divided according to local invasion (T1-T2 vs T3-T4) and nodal involvement (N0 vs N+), sensitivity, specificity, accuracy, positive- and negative-predictive values were calculated and compared. Quantitative measurements from DWI and PET-CT were also analysed. RESULTS For T staging, EUS showed the best sensitivity (100%), whereas MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%), but none of the techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage, although this was not significantly different to the other modalities. The apparent diffusion coefficient was different between surgery-only and chemo-/radiotherapy groups (1.90 vs 1.30 × 10-3 mm2 s-1, respectively; p = 0.005)-optimal cut off for local invasion: 1.33 × 10-3 mm2 s-1 (p = 0.05). Difference in standardized uptake value was also very close to conventional levels of statistical significance (8.81 vs 13.97 g cm-3, respectively; p = 0.05)-optimal cut off: 7.97 g cm-3 (p = 0.44). CONCLUSION In this pilot study, we have shown that MR with DWI could enrich the current pre-operative work-up for oesophageal cancer and could be used for T and N staging. However, larger studies will need to be carried out before introducing this technique in the standard diagnostic pathway, in order to understand if MR with DWI could change its management and replace more costly or invasive tests such as PET-CT or EUS. Advances in knowledge: This pilot study represents the first effort where the four techniques have been prospectively compared together for oesophageal cancer staging. The combination of MR and DWI could provide important, additional information for staging and initial treatment decision-making.
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Affiliation(s)
- Francesco Giganti
- 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.,2 Vita-Salute San Raffaele University, Milan, Italy
| | | | - Maria C Petrone
- 3 Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Carla Canevari
- 4 Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Chiari
- 2 Vita-Salute San Raffaele University, Milan, Italy.,5 Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Annalaura Salerno
- 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.,2 Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo G Arcidiacono
- 3 Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Roberto Nicoletti
- 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Albarello
- 6 Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Mazza
- 7 Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Gallivanone
- 8 Institute of Molecular Bioimaging and Physiology, National Research Council, IBFM-CNR, Milan, Italy
| | - Luigi Gianolli
- 4 Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Orsenigo
- 5 Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonio Esposito
- 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.,2 Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Staudacher
- 2 Vita-Salute San Raffaele University, Milan, Italy.,5 Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alessandro Del Maschio
- 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.,2 Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.,2 Vita-Salute San Raffaele University, Milan, Italy
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7
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Giganti F, Antunes S, Salerno A, Ambrosi A, Marra P, Nicoletti R, Orsenigo E, Chiari D, Albarello L, Staudacher C, Esposito A, Del Maschio A, De Cobelli F. Gastric cancer: texture analysis from multidetector computed tomography as a potential preoperative prognostic biomarker. Eur Radiol 2016; 27:1831-1839. [PMID: 27553932 DOI: 10.1007/s00330-016-4540-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/17/2016] [Accepted: 08/01/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the association between preoperative texture analysis from multidetector computed tomography (MDCT) and overall survival in patients with gastric cancer. METHODS Institutional review board approval and informed consent were obtained. Fifty-six patients with biopsy-proved gastric cancer were examined by MDCT and treated with surgery. Image features from texture analysis were quantified, with and without filters for fine to coarse textures. The association with survival time was assessed using Kaplan-Meier and Cox analysis. RESULTS The following parameters were significantly associated with a negative prognosis, according to different thresholds: energy [no filter] - Logarithm of relative risk (Log RR): 3.25; p = 0.046; entropy [no filter] (Log RR: 5.96; p = 0.002); entropy [filter 1.5] (Log RR: 3.54; p = 0.027); maximum Hounsfield unit value [filter 1.5] (Log RR: 3.44; p = 0.027); skewness [filter 2] (Log RR: 5.83; p = 0.004); root mean square [filter 1] (Log RR: - 2.66; p = 0.024) and mean absolute deviation [filter 2] (Log RR: - 4.22; p = 0.007). CONCLUSIONS Texture analysis could increase the performance of a multivariate prognostic model for risk stratification in gastric cancer. Further evaluations are warranted to clarify the clinical role of texture analysis from MDCT. KEY POINTS • Textural analysis from computed tomography can be applied in gastric cancer. • Preoperative non-invasive texture features are related to prognosis in gastric cancer. • Texture analysis could help to evaluate the aggressiveness of this tumour.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology and Centre for Experimental Imaging San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
- San Raffaele Vita-Salute University, Milan, Italy.
| | - Sofia Antunes
- Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy
| | - Annalaura Salerno
- Department of Radiology and Centre for Experimental Imaging San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- San Raffaele Vita-Salute University, Milan, Italy
| | | | - Paolo Marra
- Department of Radiology and Centre for Experimental Imaging San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- San Raffaele Vita-Salute University, Milan, Italy
| | - Roberto Nicoletti
- Department of Radiology and Centre for Experimental Imaging San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Chiari
- San Raffaele Vita-Salute University, Milan, Italy
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Albarello
- Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Staudacher
- San Raffaele Vita-Salute University, Milan, Italy
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Department of Radiology and Centre for Experimental Imaging San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- San Raffaele Vita-Salute University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Centre for Experimental Imaging San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- San Raffaele Vita-Salute University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology and Centre for Experimental Imaging San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- San Raffaele Vita-Salute University, Milan, Italy
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Vignali A, Bissolati M, De Nardi P, Di Palo S, Staudacher C. Extracorporealvs.Intracorporeal Ileocolic Stapled Anastomoses in Laparoscopic Right Colectomy: An Interim Analysis of a Randomized Clinical Trial. J Laparoendosc Adv Surg Tech A 2016; 26:343-8. [DOI: 10.1089/lap.2015.0547] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Andrea Vignali
- Department of Surgery, IRCCS San Raffaele, University Vita e Salute, Milan, Italy
| | | | - Paola De Nardi
- Department of Surgery, IRCCS San Raffaele, University Vita e Salute, Milan, Italy
| | - Saverio Di Palo
- Department of Surgery, IRCCS San Raffaele, University Vita e Salute, Milan, Italy
| | - Carlo Staudacher
- Department of Surgery, IRCCS San Raffaele, University Vita e Salute, Milan, Italy
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9
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Orsenigo E, Gazzetta P, Di Palo S, Tamburini A, Staudacher C. Experience on surgical treatment of gastrointestinal stromal tumor of the stomach. Updates Surg 2016; 62:101-4. [PMID: 20845009 DOI: 10.1007/s13304-010-0018-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In spite of their rarity, gastrointestinal stromal tumors (GISTs) represent a complex clinical problem, mainly diagnostic and therapeutic, for their unpredictable biological course and their long-term prognosis, the most involved site being the stomach. Although a great number of tyrosine-kinase inhibitors has been developed for blocking their proliferative pathways (constitutive CD117 and PDGFRa activation), surgical treatment still remains the only curative one. Nevertheless, their particular non-lymphatic spread and their tendency to peritoneal seeding have emphasized technical issues that are still greatly debated. The definition of the best surgical procedure aiming at the complete R0 resection of the tumor has changed in the recent years and, with the improvement of laparoscopic techniques, the minimally invasive approach of gastric GIST has become feasible in most cases. In this paper we present our experience on surgical treatment of 43 gastric GISTs observed from 2001 to 2008 taken from our case study (75 patients from 1994). The risk class, treatment and long-term follow-up (mean 36 months) has been analyzed. All patients underwent a surgical procedure; 10 of them were also treated with molecular tyrosine-kinase inhibitors as adjuvant treatment. Overall survival at 60 months was 89.3%, with a disease-free survival of 87.68%.
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Affiliation(s)
- Elena Orsenigo
- Chirurgia Gastroenterologica, Department of Surgery, San Raffaele Scientific Hospital, University Vita-Salute-San Raffaele, Via Olgettina, 60, 20132, Milan, Italy,
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Bissolati M, Orsenigo E, Staudacher C. Minimally invasive approach to colorectal cancer: an evidence-based analysis. Updates Surg 2016; 68:37-46. [DOI: 10.1007/s13304-016-0350-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/20/2016] [Indexed: 12/13/2022]
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11
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Ratti F, Catena M, Di Palo S, Staudacher C, Aldrighetti L. Impact of totally laparoscopic combined management of colorectal cancer with synchronous hepatic metastases on severity of complications: a propensity-score-based analysis. Surg Endosc 2016; 30:4934-4945. [PMID: 26944725 DOI: 10.1007/s00464-016-4835-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 12/18/2015] [Accepted: 02/15/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Thanks to widespread diffusion of minimally invasive approach in the setting of both colorectal and hepatic surgeries, the interest in combined resections for colorectal cancer and synchronous liver metastases (SCLM) by totally laparoscopic approach (TLA) has increased. Aim of this study was to compare outcome of combined resections for SCLM performed by TLA or by open approach, in a propensity-score-based study. STUDY DESIGN All 25 patients undergoing combined TLA for SCLM at San Raffaele Hospital in Milano were compared in a case-matched analysis with 25 out of 91 patients undergoing totally open approach (TOA group). Groups were matched with 1:2 ratio using propensity scores based on covariates representing disease severity. Main endpoints were postoperative morbidity and long-term outcome. The Modified Accordion Severity Grading System was used to quantify complications. RESULTS The groups resulted comparable in terms of patients and disease characteristics. The TLA group, as compared to the TOA group, had lower blood loss (350 vs 600 mL), shorter postoperative stay (9 vs 12 days), lower postoperative morbidity index (0.14 vs 0.20) and severity score for complicated patients (0.60 vs 0.85). Colonic anastomosis leakage had the highest fractional complication burden in both groups. In spite of comparable long-term overall survival, the TLA group had better recurrence-free survival. CONCLUSION TLA for combined resections is feasible, and its indications can be widened to encompass a larger population of patients, provided its benefits in terms of reduced overall risk and severity of complications, rapid functional recovery and favorable long-term outcomes.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Saverio Di Palo
- Gastrointestinal Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Carlo Staudacher
- Gastrointestinal Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
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12
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Giganti F, Orsenigo E, Arcidiacono PG, Nicoletti R, Albarello L, Ambrosi A, Salerno A, Esposito A, Petrone MC, Chiari D, Staudacher C, Del Maschio A, De Cobelli F. Preoperative locoregional staging of gastric cancer: is there a place for magnetic resonance imaging? Prospective comparison with EUS and multidetector computed tomography. Gastric Cancer 2016; 19:216-25. [PMID: 25614468 DOI: 10.1007/s10120-015-0468-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 10/08/2014] [Accepted: 01/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to prospectively compare the diagnostic performance of magnetic resonance imaging (MRI), multidetector computed tomography (MDCT) and endoscopic ultrasonography (EUS) in the preoperative locoregional staging of gastric cancer. METHODS This study had Institutional Review Board approval, and informed consent was obtained from all patients. Fifty-two patients with biopsy-proven gastric cancer underwent preoperative 1.5-T MRI, 64-channel MDCT and EUS. All images were analysed blind, and the results were compared with histopathological findings according to the seventh edition of the TNM classification. After the population had been divided on the basis of the local invasion (T1-3 vs T4a-b) and nodal involvement (N0 vs N+), sensitivity, specificity, positive and negative predictive value, and accuracy were calculated and diagnostic performance measures were assessed using the McNemar test. RESULTS For T staging, EUS showed higher sensitivity (94%) than MDCT and MRI (65 and 76%; p = 0.02 and p = 0.08). MDCT and MRI had significantly higher specificity (91 and 89%) than EUS (60%) (p = 0.0009 and p = 0.003). Adding MRI to MDCT or EUS did not result in significant differences for sensitivity. For N staging, EUS showed higher sensitivity (92%) than MRI and MDCT (69 and 73%; p = 0.01 and p = 0.02). MDCT showed better specificity (81%) than EUS and MRI (58 and 73%; p = 0.03 and p = 0.15). CONCLUSIONS Our prospective study confirmed the leading role of EUS and MDCT in the staging of gastric cancer and did not prove, at present, the value of the clinical use of MRI.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Nicoletti
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Albarello
- Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Annalaura Salerno
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Esposito
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Chiara Petrone
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Damiano Chiari
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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13
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D'Addio F, La Rosa S, Maestroni A, Jung P, Orsenigo E, Nasr MB, Tezza S, Bassi R, Finzi G, Marando A, Vergani A, Frego R, Albarello L, Andolfo A, Manuguerra R, Viale E, Staudacher C, Corradi D, Batlle E, Breault D, Secchi A, Folli F, Fiorina P. Circulating IGF-I and IGFBP3 Levels Control Human Colonic Stem Cell Function and Are Disrupted in Diabetic Enteropathy. Cell Stem Cell 2015; 17:486-498. [PMID: 26431183 PMCID: PMC4826279 DOI: 10.1016/j.stem.2015.07.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 06/02/2015] [Accepted: 07/19/2015] [Indexed: 01/10/2023]
Abstract
The role of circulating factors in regulating colonic stem cells (CoSCs) and colonic epithelial homeostasis is unclear. Individuals with long-standing type 1 diabetes (T1D) frequently have intestinal symptoms, termed diabetic enteropathy (DE), though its etiology is unknown. Here, we report that T1D patients with DE exhibit abnormalities in their intestinal mucosa and CoSCs, which fail to generate in vitro mini-guts. Proteomic profiling of T1D+DE patient serum revealed altered levels of insulin-like growth factor 1 (IGF-I) and its binding protein 3 (IGFBP3). IGFBP3 prevented in vitro growth of patient-derived organoids via binding its receptor TMEM219, in an IGF-I-independent manner, and disrupted in vivo CoSC function in a preclinical DE model. Restoration of normoglycemia in patients with long-standing T1D via kidney-pancreas transplantation or in diabetic mice by treatment with an ecto-TMEM219 recombinant protein normalized circulating IGF-I/IGFBP3 levels and reestablished CoSC homeostasis. These findings demonstrate that peripheral IGF-I/IGFBP3 controls CoSCs and their dysfunction in DE.
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Affiliation(s)
- Francesca D'Addio
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston 02115, MA, USA
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Stefano La Rosa
- Department of Pathology, Ospedale di Circolo, Varese 21100, Italy
| | - Anna Maestroni
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Peter Jung
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona 08028, Spain
| | - Elena Orsenigo
- Surgery, Protein Microsequencing Facility, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Moufida Ben Nasr
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston 02115, MA, USA
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Sara Tezza
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston 02115, MA, USA
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Roberto Bassi
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston 02115, MA, USA
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Giovanna Finzi
- Department of Pathology, Ospedale di Circolo, Varese 21100, Italy
| | | | - Andrea Vergani
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston 02115, MA, USA
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Roberto Frego
- Gastroenterology, Protein Microsequencing Facility, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Luca Albarello
- Pathology Unit, Protein Microsequencing Facility, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Annapaola Andolfo
- ProMiFa, Protein Microsequencing Facility, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Roberta Manuguerra
- Department of Biomedical, Biotechnological and Translational Sciences, Unit of Pathology, University of Parma, Parma 43121, Italy
| | - Edi Viale
- Gastroenterology, Protein Microsequencing Facility, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Carlo Staudacher
- Surgery, Protein Microsequencing Facility, IRCCS Ospedale San Raffaele, Milan 20132, Italy
| | - Domenico Corradi
- Department of Biomedical, Biotechnological and Translational Sciences, Unit of Pathology, University of Parma, Parma 43121, Italy
| | - Eduard Batlle
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona 08028, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona 08028, Spain
| | - David Breault
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston 02115, MA, USA
| | - Antonio Secchi
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
- Vita Salute San Raffaele University, Milano 20132, Italy
| | - Franco Folli
- Department of Medicine, Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio 78229, Texas, USA
- Department of Internal Medicine, Obesity and Comorbidities Research Center (O.C.R.C.), State University of Campinas, São Paulo 13100, Brazil
| | - Paolo Fiorina
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston 02115, MA, USA
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan 20132, Italy
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14
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Giganti F, Salerno A, Ambrosi A, Chiari D, Orsenigo E, Esposito A, Albarello L, Mazza E, Staudacher C, Del Maschio A, De Cobelli F. Prognostic utility of diffusion-weighted MRI in oesophageal cancer: is apparent diffusion coefficient a potential marker of tumour aggressiveness? Radiol Med 2015; 121:173-80. [PMID: 26392393 DOI: 10.1007/s11547-015-0585-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 09/09/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate the role of the apparent diffusion coefficient (ADC) as a potential prognostic biomarker in the evaluation of the aggressiveness of oesophageal cancer. MATERIALS AND METHODS Between November 2009 and December 2013, 43 patients with evidence of oesophageal or oesophago-gastric junction cancer were referred to our institution and prospectively entered in our database. The final study population consisted of 23 patients (18 men; 5 women; mean age, 64.62 ± 10.91 years) who underwent diffusion-weighted Magnetic Resonance before surgical intervention. Specifically, 14 were directly treated with surgery and 9 were addressed to chemo/radiotherapy beforehand. Two radiologists independently measured mean tumour ADC and inter-observer agreement (Spearman's and intraclass correlation coefficient [ICC]) was assessed. In the univariate analysis, overall survival curves related to pathological ADC, pT, pN, tumour location and histotype were fitted using the Kaplan-Meier method. Survival curves were then compared using the log-rank test. RESULTS Inter-observer reproducibility was very good (Spearman's rho = 0.95; ICC = 0.94). At a total median follow-up of 19 months (2-49 months), 4 patients had died. The median follow-up was 18.50 months (5-49 months) for the surgery-only group (1/4 events, 25 %) and 24 months (2-34 months) for the chemo/radiotherapy group (3/4 events, 75 %). Survival time at 48 months for the overall population was 59 % (±0.11), while for the surgery-only group and the chemo/radiotherapy group was 90 % (±0.09) and 61 % (±0.34), respectively. In the univariate analysis, ADC values below or equal to 1.4 × 10(-3) mm(2)/s were associated with a negative prognosis both in the total population (P = 0.016) and in the surgery-only group (P < 0.001). CONCLUSION Despite the biggest limitation of our study (i.e. the small study population), we were able to show that pathological ADC could be considered a prognostic factor for oesophageal cancer. DWI might be introduced into clinical practice as a promising and reliable technique in the diagnostic pathway of this tumour.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Annalaura Salerno
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | | | - Damiano Chiari
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonio Esposito
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Albarello
- Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Mazza
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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15
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Giganti F, Orsenigo E, Esposito A, Chiari D, Salerno A, Ambrosi A, Albarello L, Mazza E, Staudacher C, Del Maschio A, De Cobelli F. Prognostic Role of Diffusion-weighted MR Imaging for Resectable Gastric Cancer. Radiology 2015; 276:444-52. [PMID: 25816106 DOI: 10.1148/radiol.15141900] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To prospectively investigate the role of apparent diffusion coefficient (ADC) calculated from diffusion-weighted magnetic resonance (MR) imaging as a potential prognostic biomarker in the evaluation of the aggressiveness of gastric cancer. MATERIALS AND METHODS This prospective study had institutional review board approval. Informed consent was obtained from all patients. Between October 2009 and December 2013, a total of 99 patients (65 men, 34 women; mean age, 62.02 years; age range, 32.33-85.15 years) with biopsy-proved cancer (28 esophagogastric junction and 71 gastric cancers) were examined with a 1.5-T MR imaging system, including T1-, T2-, and diffusion-weighted sequences. ADC measurements were obtained. Seventy-one patients were directly treated with surgery, while 28 underwent neoadjuvant chemotherapy beforehand. Pathologic ADC, pathologic T and N stages, tumor location, surgical approach, and histologic subtype were investigated with univariate and multivariate analyses by using the Cox regression model. RESULTS At a total median follow-up period of 21 months, 31 patients had died. The median follow-up was 25 months for the surgery-only group (19 of 31 events [61%]) and 28 months for the chemotherapy group (12 of 31 events [39%]). In the multivariate analysis, ADC values of 1.5 × 10(-3) mm(2)/sec or lower were associated with a negative prognosis, both in the total population (log-relative risk, 1.73; standard error, 0.56; P = .002) and in the surgery-only (log-relative risk, 1.97; standard error, 0.66; P = .003) and chemotherapy (log-relative risk, 2.93; standard error, 1.41; P = .03) groups, along with other significant prognostic factors (in particular, pathologic T and N stages). CONCLUSION Pathologic ADC represents a strong independent prognostic factor in the evaluation of the aggressiveness of gastric cancer, in addition to clinical and surgical variables.
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Affiliation(s)
- Francesco Giganti
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Elena Orsenigo
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Antonio Esposito
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Damiano Chiari
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Annalaura Salerno
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Ambrosi
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Luca Albarello
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Elena Mazza
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Carlo Staudacher
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Del Maschio
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco De Cobelli
- From the Department of Radiology and Center for Experimental Imaging (F.G., A.E., A.S., A.D.M., F.D.C.), Department of Surgery (E.O., D.C., C.S.), Neurobiology of Learning Unit (A.A.), Pathology Unit (L.A.), and Department of Oncology (E.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
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16
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Chiari D, Orsenigo E, Guarneri G, Bissolati M, Elena M, Staudacher C. Effect of neoadjuvant chemotherapy on HER-2 expression in surgically treated gastric and oesophago-gastric junction carcinoma. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.019] [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: 10/24/2022] Open
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17
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Orsenigo E, Bissolati M, Socci C, Chiari D, Muffatti F, Nifosi J, Staudacher C. Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience. Gastric Cancer 2014; 17:733-44. [PMID: 24399492 DOI: 10.1007/s10120-013-0327-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/16/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. METHODS All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. RESULTS Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p < 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p < 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p < 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p < 0.001), liver cirrhosis (OR 13.2; p < 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses >300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p < 0.001) were found to be independent risk factors for DSF development. CONCLUSIONS Duodenal stump fistula still remains a life-threatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.
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Affiliation(s)
- Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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18
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Balzano G, Dugnani E, Pasquale V, Capretti G, Radaelli MG, Garito T, Stratta G, Nini A, Di Fenza R, Castoldi R, Staudacher C, Reni M, Scavini M, Doglioni C, Piemonti L. Clinical signature and pathogenetic factors of diabetes associated with pancreas disease (T3cDM): a prospective observational study in surgical patients. Acta Diabetol 2014; 51:801-11. [PMID: 24974302 DOI: 10.1007/s00592-014-0614-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/12/2014] [Indexed: 01/27/2023]
Abstract
To characterize the clinical signature and etiopathogenetic factors of diabetes associated with pancreas disease [type 3 diabetes mellitus (T3cDM)]. To estimate incidence and identify predictors of both diabetes onset and remission after pancreatic surgery. A prospective observational study was conducted. From January 2008 to December 2012, patients (n = 651) with new diagnosis of pancreatic disease admitted to the Pancreatic Surgery Unit of the San Raffaele Scientific Institute were evaluated. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up. At baseline, the prevalence of diabetes was 38 % (age of onset 64 ± 11 years). In most cases, diabetes occurred within 48 months from pancreatic disease diagnosis. Among different pancreatic diseases, minor differences were observed in diabetes characteristics, with the exception of the prevalence. Diabetes appeared associated with classical risk factors for type 2 diabetes (i.e., age, sex, family history of diabetes and body mass index), and both beta-cell dysfunction and insulin resistance appeared relevant determinants. The prevalence of adult-onset autoimmune diabetes was as previously reported within type 2 diabetes. Within a few days after surgery, either diabetes remission or new-onset diabetes was observed. In patients with pancreatic cancer, no difference in diabetes remission was observed after palliative or resective surgery. Classical risk factors for type 2 diabetes were associated with the onset of diabetes after surgery. T3cDM appeared as a heterogeneous entity strongly overlapped with type 2 diabetes.
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Affiliation(s)
- Gianpaolo Balzano
- Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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De Manzoni G, Baiocchi GL, Framarini M, De Giuli M, D'Ugo D, Marchet A, Nitti D, Marrelli D, Morgagni P, Rinnovati A, Rosati R, Roviello F, Allieta R, Berti S, Bracale U, Capelli P, Cavicchi A, Di Martino N, Donini A, Filippini A, Francioni G, Frascio M, Garofalo A, Giulini SM, Grassi GB, Innocenti P, Martino A, Mazzocconi G, Mazzola L, Montemurro S, Palasciano N, Pantuso G, Pernthaler H, Petri R, Piazza D, Sacco R, Sgroi G, Staudacher C, Testa M, Vallicelli C, Vettoretto N, Zingaretti C, Capussotti L, Morino M, Verdecchia GM. The SIC-GIRCG 2013 Consensus Conference on Gastric Cancer. Updates Surg 2014; 66:1-6. [PMID: 24523031 DOI: 10.1007/s13304-014-0248-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The topic chosen by the Board of the Italian Society of Surgery for the 2013 annual Consensus Conference was gastric cancer. With this purpose, under the direction of 2 chairmen, 36 experts nominated by the Regional Societies of Surgery and by the Italian Research Group for Gastric Cancer (GIRCG) participated in an experts consensus exercise, preceded by a questionnaire and mainly held by telematic vote, in accordance with the rules of the Delphi method. The results of this Consensus Conference, presented to the 115th National Congress of the Italian Society of Surgery, and approved in plenary session, are reported in the present paper.
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Affiliation(s)
- Giovanni De Manzoni
- 1st Department of General Surgery, Borgo Trento Hospital, University of Verona, P.le Stefani, 1, 37121, Verona, Italy,
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Balzano G, Carvello M, Piemonti L, Nano R, Ariotti R, Mercalli A, Melzi R, Maffi P, Braga M, Staudacher C. Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm. World J Gastroenterol 2014; 20:4030-4036. [PMID: 24744593 PMCID: PMC3983459 DOI: 10.3748/wjg.v20.i14.4030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/05/2013] [Accepted: 03/07/2013] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck.
METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery.
RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo.
CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.
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Balzano G, Pecorelli N, Piemonti L, Ariotti R, Carvello M, Nano R, Braga M, Staudacher C. Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy: a comparison of different surgical strategies. HPB (Oxford) 2014; 16:40-5. [PMID: 23458209 PMCID: PMC3892313 DOI: 10.1111/hpb.12062] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/28/2012] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A relaparotomy for a pancreatic fistula (PF) after a pancreaticoduodenectomy (PD) is a formidable operation, and the appropriate treatment of anastomotic leakage is under debate. The objective of this study was to compare the outcomes of different strategies in managing the pancreatic remnant during a relaparotomy for PF after a PD. METHODS In this retrospective study on prospectively collected data, 669 PD were performed between 2004 and 2011. The study group comprised 31 patients requiring a relaparotomy, because of delayed haemorrhage (n = 19) or sepsis (n = 12). The pancreatic stump was treated either using pancreas-preserving techniques (simple drainage or duct occlusion) or completion of a pancreatectomy (CP). In 2008, autologous islet transplantation (AIT) was introduced for endocrine tissue rescue of CP. RESULTS The mortality rate, blood loss and transfusion requirement were similar for all techniques. Patients undergoing a CP required a further relaparotomy less frequently than patients with pancreas preservation (7% versus 59%, P < 0.01), and the intensive care unit (ICU) stay was reduced after CP (P = 0.058). PF persisted at discharge in 66% of patients after pancreas-preserving techniques. AIT was associated with CP in 7 patients, of whom one died post-operatively. Long-term graft function was maintained in four out of six surviving patients, with one insulin-independent patient at 36 months after transplantation. CONCLUSIONS When a PF requires a relaparotomy, CP has become our favoured technique. AIT can reduce the metabolic impact of the procedure.
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Affiliation(s)
- Gianpaolo Balzano
- Pancreatic Surgery Unit, Department of Surgery, San Raffaele Scientific InstituteMilan, Italy
| | - Nicolò Pecorelli
- Pancreatic Surgery Unit, Department of Surgery, San Raffaele Scientific InstituteMilan, Italy
| | - Lorenzo Piemonti
- Islet Producing Facility, San Raffaele Scientific InstituteMilan, Italy
| | - Riccardo Ariotti
- Pancreatic Surgery Unit, Department of Surgery, San Raffaele Scientific InstituteMilan, Italy
| | - Michele Carvello
- Pancreatic Surgery Unit, Department of Surgery, San Raffaele Scientific InstituteMilan, Italy
| | - Rita Nano
- Islet Producing Facility, San Raffaele Scientific InstituteMilan, Italy
| | - Marco Braga
- Pancreatic Surgery Unit, Department of Surgery, San Raffaele Scientific InstituteMilan, Italy
| | - Carlo Staudacher
- Pancreatic Surgery Unit, Department of Surgery, San Raffaele Scientific InstituteMilan, Italy
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Volonté A, Di Tomaso T, Spinelli M, Todaro M, Sanvito F, Albarello L, Bissolati M, Ghirardelli L, Orsenigo E, Ferrone S, Doglioni C, Stassi G, Dellabona P, Staudacher C, Parmiani G, Maccalli C. Cancer-initiating cells from colorectal cancer patients escape from T cell-mediated immunosurveillance in vitro through membrane-bound IL-4. J Immunol 2013; 192:523-32. [PMID: 24277698 DOI: 10.4049/jimmunol.1301342] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cancer-initiating cells (CICs) that are responsible for tumor initiation, propagation, and resistance to standard therapies have been isolated from human solid tumors, including colorectal cancer (CRC). The aim of this study was to obtain an immunological profile of CRC-derived CICs and to identify CIC-associated target molecules for T cell immunotherapy. We have isolated cells with CIC properties along with their putative non-CIC autologous counterparts from human primary CRC tissues. These CICs have been shown to display "tumor-initiating/stemness" properties, including the expression of CIC-associated markers (e.g., CD44, CD24, ALDH-1, EpCAM, Lgr5), multipotency, and tumorigenicity following injection in immunodeficient mice. The immune profile of these cells was assessed by phenotype analysis and by in vitro stimulation of PBMCs with CICs as a source of Ags. CICs, compared with non-CIC counterparts, showed weak immunogenicity. This feature correlated with the expression of high levels of immunomodulatory molecules, such as IL-4, and with CIC-mediated inhibitory activity for anti-tumor T cell responses. CIC-associated IL-4 was found to be responsible for this negative function, which requires cell-to-cell contact with T lymphocytes and which is impaired by blocking IL-4 signaling. In addition, the CRC-associated Ag COA-1 was found to be expressed by CICs and to represent, in an autologous setting, a target molecule for anti-tumor T cells. Our study provides relevant information that may contribute to designing new immunotherapy protocols to target CICs in CRC patients.
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Affiliation(s)
- Andrea Volonté
- Unit of Immuno-Biotherapy of Melanoma and Solid Tumors, San Raffaele Foundation Centre, 20132 Milan, Italy
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Vignali A, Nardi PD, Ghirardelli L, Palo SD, Staudacher C. Short and long-term outcomes of laparoscopic colectomy in obese patients. World J Gastroenterol 2013; 19:7405-7411. [PMID: 24259971 PMCID: PMC3831222 DOI: 10.3748/wjg.v19.i42.7405] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/03/2013] [Accepted: 10/14/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.
METHODS: A total of 98 obese (body mass index > 30 kg/m2) patients who underwent laparoscopic (LPS) right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open colectomy. Controls were selected to match for body mass index, site of primary disease, American Society of Anesthesiologists score, and year of surgery (± 3 year). The parameters analyzed included age, gender, comorbid conditions, American Society of Anaesthesiologists class, diagnosis, procedure, and duration of operation, operative blood loss, and amount of homologous blood transfused. Conversion rate, intra and postoperative complications as were as reoperation rate, 30 d and long-term morbidity rate were also analyzed. For continuous variables, the Student’s t test was used for normally distributed data the Mann-Whitney U test for non-normally distributed data. The Pearson’s χ2 tests, or the Fisher exact test as appropriate, were used for proportions.
RESULTS: Conversion to open surgery was necessary in 13 of 98 patients (13.3%). In the LPS group, operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy (P = 0.03, P = 0.0001, respectively). Overall morbidity, anastomotic leak and readmission rate did not significantly differ between the two groups. A trend toward a reduction of wound complications was observed in the LPS when compared to open group (P = 0.09). In the LPS group, an earlier recovery of bowel function (P = 0.001) and a shorter length of stay (P = 0.03) were observed. After a median follow-up of 62 (range 12-132) mo 23 patients in the LPS group and 38 in the open group experienced long-term complications (LPS vs open, P = 0.03). Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the laparoscopic one (P = 0.03).
CONCLUSION: Laparoscopic colectomy in obese patients is safe, does not jeopardize postoperative complications and resulted in lower incidence of long-term complications when compared with open cases.
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Giganti F, De Cobelli F, Canevari C, Orsenigo E, Gallivanone F, Esposito A, Castiglioni I, Ambrosi A, Albarello L, Mazza E, Gianolli L, Staudacher C, Del Maschio A. Response to chemotherapy in gastric adenocarcinoma with diffusion-weighted MRI and (18) F-FDG-PET/CT: correlation of apparent diffusion coefficient and partial volume corrected standardized uptake value with histological tumor regression grade. J Magn Reson Imaging 2013; 40:1147-57. [PMID: 24214734 DOI: 10.1002/jmri.24464] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/21/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To assess whether changes in diffusion-weighted MRI (DW-MRI) and (18) F-fluoro-2-deoxyglucose positron emission tomography/computed tomography ((18) F-FDG PET/CT), correlate with treatment response to neoadjuvant therapy (NT), as expressed by tumor regression grade (TRG), from locally advanced gastric adenocarcinoma (GA). MATERIALS AND METHODS Seventeen patients underwent both DW-MRI and (18) F-FDG-PET/CT scans before and after the end of NT. Apparent diffusion coefficient (ADC) and mean standardized uptake value (SUV) corrected for partial volume effect (PVC-SUVBW-mean ) were evaluated and compared with histopathological TRG. RESULTS Pre- and post-NT and percentage changes for ADC and PVC-SUVBW-mean were assessed. Post-NT ADC and ΔADC showed a significant inverse correlation with TRG (r = -0.71; P = 0.0011 and r = -0.78; P = 0.00020, respectively) and significant differences in their mean values were found between responders (TRG 1-2-3) and nonresponders (TRG 4-5) (P = 0.0009; P = 0.000082, respectively). No correlations with TRG were found for pre-NT ADC and for all PVC-SUVBW-mean values as well as between ΔADC and Δ PVC-SUVBW-mean . CONCLUSION DW-MRI seems more accurate than (18) F-FDG-PET/CT and ADC modifications may represent a reproducible tool to assess tumor response for GA.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Maffi P, Balzano G, Ponzoni M, Nano R, Sordi V, Melzi R, Mercalli A, Scavini M, Esposito A, Peccatori J, Cantarelli E, Messina C, Bernardi M, Del Maschio A, Staudacher C, Doglioni C, Ciceri F, Secchi A, Piemonti L. Autologous pancreatic islet transplantation in human bone marrow. Diabetes 2013; 62:3523-31. [PMID: 23733196 PMCID: PMC3781459 DOI: 10.2337/db13-0465] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The liver is the current site of choice for pancreatic islet transplantation, even though it is far from being ideal. We recently have shown in mice that the bone marrow (BM) may be a valid alternative to the liver, and here we report a pilot study to test feasibility and safety of BM as a site for islet transplantation in humans. Four patients who developed diabetes after total pancreatectomy were candidates for the autologous transplantation of pancreatic islet. Because the patients had contraindications for intraportal infusion, islets were infused in the BM. In all recipients, islets engrafted successfully as shown by measurable posttransplantation C-peptide levels and histopathological evidence of insulin-producing cells or molecular markers of endocrine tissue in BM biopsy samples analyzed during follow-up. Thus far, we have recorded no adverse events related to the infusion procedure or the presence of islets in the BM. Islet function was sustained for the maximum follow-up of 944 days. The encouraging results of this pilot study provide new perspectives in identifying alternative sites for islet infusion in patients with type 1 diabetes. Moreover, this is the first unequivocal example of successful engraftment of endocrine tissue in the BM in humans.
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Affiliation(s)
- Paola Maffi
- Islet Transplantation Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
- Division of Immunology, Transplantation, and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Gianpaolo Balzano
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Maurilio Ponzoni
- Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | - Rita Nano
- Division of Immunology, Transplantation, and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- Beta Cell Biology Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Valeria Sordi
- Division of Immunology, Transplantation, and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- Beta Cell Biology Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Raffaella Melzi
- Division of Immunology, Transplantation, and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- Beta Cell Biology Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Alessia Mercalli
- Division of Immunology, Transplantation, and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- Beta Cell Biology Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Marina Scavini
- Epidemiology and Data Management Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Antonio Esposito
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Jacopo Peccatori
- Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Cantarelli
- Division of Immunology, Transplantation, and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- Beta Cell Biology Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Carlo Messina
- Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Bernardi
- Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Doglioni
- Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Ciceri
- Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Secchi
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical Transplant Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- Corresponding author: Lorenzo Piemonti, , or Antonio Secchi,
| | - Lorenzo Piemonti
- Division of Immunology, Transplantation, and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- Beta Cell Biology Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
- Corresponding author: Lorenzo Piemonti, , or Antonio Secchi,
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Muffatti F, Orsenigo E, Socci C, Chiari D, Totaro L, Staudacher C. Intraoperative and postoperative effects of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis: Results from a monocentric retrospective study. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.009] [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: 10/26/2022] Open
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Di Palo S, Orsenigo E, Gazzetta P, Staudacher C. Surgical treatment for local recurrence of rectal and anal cancer. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.056] [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: 10/26/2022] Open
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Passoni P, Fiorino C, Slim N, Ronzoni M, Ricci V, Di Palo S, De Nardi P, Orsenigo E, Tamburini A, De Cobelli F, Losio C, Iacovelli NA, Broggi S, Staudacher C, Calandrino R, Di Muzio N. Feasibility of an Adaptive Strategy in Preoperative Radiochemotherapy for Rectal Cancer With Image-Guided Tomotherapy: Boosting the Dose to the Shrinking Tumor. Int J Radiat Oncol Biol Phys 2013; 87:67-72. [DOI: 10.1016/j.ijrobp.2013.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 01/03/2023]
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Gazzetta P, Orsenigo E, Di Palo S, Staudacher C. The role of lymph-node ratio in predicting recurrence after total mesorectal excision for rectal cancer. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.019] [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: 11/29/2022] Open
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Vignali A, Ghirardelli L, Di Palo S, Orsenigo E, Staudacher C. Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery. Colorectal Dis 2013; 15:944-8. [PMID: 23398664 DOI: 10.1111/codi.12170] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 09/24/2012] [Accepted: 12/08/2012] [Indexed: 12/15/2022]
Abstract
AIM The safety, feasibility and oncological results of laparoscopic resection for advanced colon cancer were evaluated. METHOD Seventy consecutive patients with a histologically proven T4 colon cancer who underwent laparoscopic (LPS) right or left colectomy were matched for comorbidity on admission (American Society of Anesthesiologists score), tumour stage and grading with 70 patients who underwent open colectomy over a 10-year period. Short- and long-term outcome measures were evaluated. RESULTS The overall conversion rate was 7.1%. Less intra-operative blood loss (P = 0.01), a trend toward a longer operation time (P = 0.09) and a lower peri-operative blood transfusion rate (P = 0.06) were observed in the LPS group. A similar number of lymph nodes were retrieved (P = 0.37) and the R1 resection rate (P = 0.51) was no different in the two groups. The overall mortality rate was 1.4%. The overall morbidity rate was 21.4% (15/70 patients) in the LPS group and 27.5% (19/70 patients) in the open group (P = 0.42), with anastomotic leakage rates of 7.1% and 4.2% (P = 0.32). Length of stay was shorter after LPS (P = 0.009). Five-year overall survival rate (P = 0.18) and disease-free survival rate (P = 0.20) did not differ significantly between the two groups. CONCLUSION Laparoscopic treatment of T4 colon cancer is safe and feasible and provides a similar surgical and oncological outcome compared with the open technique.
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Affiliation(s)
- A Vignali
- Department of Surgery, San Raffaele Scientific Institute, University Vita Salute, Milan, Italy.
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Abstract
Oncological treatment is currently directed toward a tailored therapy concept. Squamous cell carcinoma of the anal canal could be considered a suitable platform to test new therapeutic strategies to minimize treatment morbidity. Standard of care for patients with anal canal cancer consists of a combination of radiotherapy and chemotherapy. This treatment has led to a high rate of local control and a 60% cure rate with preservation of the anal sphincter, thus replacing surgical abdominoperineal resection. Lymph node metastases represent a critical independent prognostic factor for local recurrence and survival. Mesorectal and iliac lymph nodes are usually included in the radiation field, whereas the inclusion of inguinal regions still remains controversial because of the subsequent adverse side effects. Sentinel lymph node biopsies could clearly identify inguinal node-positive patients eligible for therapeutic groin irradiation. A sentinel lymph node navigation procedure is reported here to be a feasible and effective method for establishing the true inguinal node status in patients suffering from anal canal cancer. Based on the results of sentinel node biopsies, a selective approach could be proposed where node-positive patients could be selected for inguinal node irradiation while node-negative patients could take advantage of inguinal sparing irradiation, thus avoiding toxic side effects.
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Bissolati M, Orsenigo E, Socci C, Capretti G, Staudacher C. Multivisceral resection for gastric adenocarcinoma: When surgery can go no further. A retrospective analysis of a single-center experience. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.043] [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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Orsenigo E, Chiari D, Albarello L, Mazza E, Doglioni C, Staudacher C. Clinical and morphological evaluation of response to neoadjuvant chemotherapy in surgically treated adenocarcinoma of the stomach and cardia. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.048] [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: 12/01/2022] Open
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Chiari D, Orsenigo E, Albarello L, Mazza E, Socci C, Staudacher C. HER2 overexpression/amplification and neoadjuvant chemotherapy in gastric and esophagogastric junction adenocarcinoma. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.047] [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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Tamburini A, Orsenigo E, Di Palo S, Albarello L, Ronzoni M, Staudacher C. Long-term outcome of pathological complete response patients after neoadjuvant therapy for locally advanced rectal cancer. A single-center prospective trial. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tamburini A, Castiglioni A, Orsenigo E, Manfredi A, Staudacher C. Open colon cancer surgery increases levels of vascular endothelial growth factor more than laparoscopic approach. Results of a randomized controlled trial. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.035] [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: 11/27/2022] Open
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Bissolati M, Socci C, Orsenigo E, Staudacher C. Duodenal stump fistula after gastric surgery for malignancy. A retrospective analysis of risk factors in a single-center experience. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.042] [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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Tamburini A, Castiglioni A, Orsenigo E, Manfredi A, Staudacher C. 309. Colon Cancer Surgery Increases Levels of Vascular Endothelial Growth Factor Open more than Laparoscopic Approach. Results of a Randomised Controlled Trial. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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39
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Tamburini A, Di Palo S, Orsenigo E, Ricci V, Albarello L, Staudacher C. 70. Long term outcome of pathological complete response patients after neoadjuvant therapy for locally advanced rectal cancer. Monoistitutional prospetictive trial. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.069] [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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Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-64. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
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Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
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Carvello M, Petrelli A, Vergani A, Lee KM, Tezza S, Chin M, Orsenigo E, Staudacher C, Secchi A, Dunussi-Joannopoulos K, Sayegh MH, Markmann JF, Fiorina P. Inotuzumab ozogamicin murine analog-mediated B-cell depletion reduces anti-islet allo- and autoimmune responses. Diabetes 2012; 61:155-65. [PMID: 22076927 PMCID: PMC3237644 DOI: 10.2337/db11-0684] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
B cells participate in the priming of the allo- and autoimmune responses, and their depletion can thus be advantageous for islet transplantation. Herein, we provide an extensive study of the effect of B-cell depletion in murine models of islet transplantation. Islet transplantation was performed in hyperglycemic B-cell-deficient(μMT) mice, in a purely alloimmune setting (BALB/c into hyperglycemic C57BL/6), in a purely autoimmune setting (NOD.SCID into hyperglycemic NOD), and in a mixed allo-/autoimmune setting (BALB/c into hyperglycemic NOD). Inotuzumab ozogamicin murine analog (anti-CD22 monoclonal antibody conjugated with calicheamicin [anti-CD22/cal]) efficiently depleted B cells in all three models of islet transplantation examined. Islet graft survival was significantly prolonged in B-cell-depleted mice compared with control groups in transplants of islets from BALB/c into C57BL/6 (mean survival time [MST]: 16.5 vs. 12.0 days; P = 0.004), from NOD.SCID into NOD (MST: 23.5 vs. 14.0 days; P = 0.03), and from BALB/c into NOD (MST: 12.0 vs. 5.5 days; P = 0.003). In the BALB/c into B-cell-deficient mice model, islet survival was prolonged as well (MST: μMT = 32.5 vs. WT = 14 days; P = 0.002). Pathology revealed reduced CD3(+) cell islet infiltration and confirmed the absence of B cells in treated mice. Mechanistically, effector T cells were reduced in number, concomitant with a peripheral Th2 profile skewing and ex vivo recipient hyporesponsiveness toward donor-derived antigen as well as islet autoantigens. Finally, an anti-CD22/cal and CTLA4-Ig-based combination therapy displayed remarkable prolongation of graft survival in the stringent model of islet transplantation (BALB/c into NOD). Anti-CD22/cal-mediated B-cell depletion promotes the reduction of the anti-islet immune response in various models of islet transplantation.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Humanized/chemistry
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibody-Dependent Cell Cytotoxicity/drug effects
- Antibody-Dependent Cell Cytotoxicity/physiology
- Autoimmunity/drug effects
- B-Lymphocytes/cytology
- B-Lymphocytes/drug effects
- B-Lymphocytes/immunology
- Cell Death/drug effects
- Cell Death/immunology
- Cells, Cultured
- Female
- Graft Survival/immunology
- Inotuzumab Ozogamicin
- Islets of Langerhans/drug effects
- Islets of Langerhans/immunology
- Islets of Langerhans Transplantation/immunology
- Islets of Langerhans Transplantation/pathology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, SCID
- Mice, Transgenic
- Transplantation Tolerance/drug effects
- Transplantation Tolerance/immunology
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Affiliation(s)
- Michele Carvello
- Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Petrelli
- Nephrology Division, Transplantation Research Center, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Vergani
- Nephrology Division, Transplantation Research Center, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kang Mi Lee
- Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara Tezza
- Nephrology Division, Transplantation Research Center, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Melissa Chin
- Nephrology Division, Transplantation Research Center, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Secchi
- Department of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | | | - Mohamed H. Sayegh
- Nephrology Division, Transplantation Research Center, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - James F. Markmann
- Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paolo Fiorina
- Nephrology Division, Transplantation Research Center, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, San Raffaele Scientific Institute, Milan, Italy
- Corresponding author: Paolo Fiorina,
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42
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Tamburini A, Pozzi S, Mazza E, Albarello L, Rognone A, Orsenigo E, Staudacher C. Clinical Relevance of Cox-2 Expression in Gastric Cancer Relapse Patients. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.09.021] [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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43
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Tamburini A, Pozzi S, Albarello L, Orsenigo E, Mazza E, Rognone A, Staudacher C. Prognostic Role of Vascular Endothelial Growth Factor and Cyclooxygenase-2 Protein Expressions in Intestinal Type Gastric Adenocarcinoma. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.09.033] [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: 11/27/2022] Open
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Ferraro A, Socci C, Stabilini A, Valle A, Monti P, Piemonti L, Nano R, Olek S, Maffi P, Scavini M, Secchi A, Staudacher C, Bonifacio E, Battaglia M. Expansion of Th17 cells and functional defects in T regulatory cells are key features of the pancreatic lymph nodes in patients with type 1 diabetes. Diabetes 2011; 60:2903-13. [PMID: 21896932 PMCID: PMC3198077 DOI: 10.2337/db11-0090] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Autoimmune diseases, including type 1 diabetes, are thought to have a Th17-cell bias and/or a T-regulatory cell (Treg) defect. Understanding whether this is a hallmark of patients with type 1 diabetes is a crucial question that is still unsolved, largely due to the difficulties of accessing tissues targeted by the disease. RESEARCH DESIGN AND METHODS We phenotypically and functionally characterized Th17 cells and Tregs residing in the pancreatic-draining lymph nodes (PLNs) of 19 patients with type 1 diabetes and 63 nondiabetic donors and those circulating in the peripheral blood of 14 type 1 diabetic patients and 11 healthy subjects. RESULTS We found upregulation of Th17 immunity and functional defects in CD4(+)CD25(bright) Tregs in the PLNs of type 1 diabetic subjects but not in their peripheral blood. In addition, the proinsulin-specific Treg-mediated control was altered in the PLNs of diabetic patients. The dysfunctional Tregs isolated from diabetic subjects did not contain contaminant effector T cells and were all epigenetically imprinted to be suppressive, as defined by analysis of the Treg-specific demethylated region within the forkhead box P3 (FOXP3) locus. CONCLUSIONS These data provide evidence for an unbalanced immune status in the PLNs of type 1 diabetic subjects, and treatments restoring the immune homeostasis in the target organ of these patients represent a potential therapeutic strategy.
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Affiliation(s)
- Alessandra Ferraro
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
- Telethon Institute for Gene Therapy, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Socci
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Angela Stabilini
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
- Telethon Institute for Gene Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Valle
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
- Telethon Institute for Gene Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Monti
- Center for Regenerative Therapies Dresden, Dresden, Germany
| | - Lorenzo Piemonti
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Rita Nano
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | | | - Paola Maffi
- Department of Transplantation Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Marina Scavini
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Secchi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Transplantation Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Staudacher
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Dresden, Germany
| | - Manuela Battaglia
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
- Corresponding author: Manuela Battaglia,
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Affiliation(s)
- P De Nardi
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
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46
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Reni M, Cereda S, Bonetto E, Viganò MG, Passoni P, Zerbi A, Balzano G, Nicoletti R, Staudacher C, Di Carlo V. Dose-intense PEFG (cisplatin, epirubicin, 5-fluorouracil, gemcitabine) in advanced pancreatic adenocarcinoma: a dose-finding study. Cancer Invest 2011; 25:594-8. [PMID: 17852117 DOI: 10.1080/07357900701359932] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to assess the maximum tolerated dose (MTD) of an intensified PEFG regimen administered every 14 days to patients with Stage III or metastatic pancreatic adenocarcinoma. Twenty-nine patients received fixed doses of both epirubicin (30 mg/m2) and 5-fluorouracil (200 mg/m2/day on Days 1-14) and of escalating doses of cisplatin and gemcitabine. The MTD was cisplatin 30 mg/m2 and gemcitabine 800 mg/m2. With respect to classical PEFG, intensified regimen potentially improved the dose-intensity of both cisplatin and epirubicin by 50 percent and of gemcitabine by 33 percent, reduced Grade 3-4 haematological toxicity and the number of outpatient accesses.
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Affiliation(s)
- M Reni
- Department of Oncology, S. Raffaele H. Scientific Institute, Milan, Italy.
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47
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Orsenigo E, Kusamura S, Staudacher C. Sentinel lymph node and prognostic factors in gastric cancer. Surg Endosc 2011; 25:3715-6. [PMID: 21557000 DOI: 10.1007/s00464-011-1609-1] [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: 10/18/2022]
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48
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Maffi P, Scavini M, Socci C, Piemonti L, Caldara R, Gremizzi C, Melzi R, Nano R, Orsenigo E, Venturini M, Staudacher C, Del Maschio A, Secchi A. Risks and benefits of transplantation in the cure of type 1 diabetes: whole pancreas versus islet transplantation. A single center study. Rev Diabet Stud 2011; 8:44-50. [PMID: 21720672 DOI: 10.1900/rds.2011.8.44] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pancreas and islet transplantation are the only available options to replace beta-cell function in patients with type 1 diabetes. Great variability in terms of rate of success for both approaches is reported in the literature and it is difficult to compare the respective risks and benefits. OBJECTIVES The aim of this study was to analyze risks and benefits of pancreas transplantation alone (PTA) and islet transplantation alone (ITA) by making use of the long-term experience of a single center where both transplantations are performed. We focused on the risks and benefits of both procedures, with the objective of better defining indications and providing evidence to support the decision-making process. The outcomes of 33 PTA and 33 ITA were analyzed, and pancreas and islet function (i.e., insulin independence), perioperative events, and long-term adverse events were recorded. RESULTS We observed a higher rate of insulin independence in PTA (75%) versus ITA (59%), with the longer insulin independence among PTA patients receiving tacrolimus. The occurrence of adverse events was higher for PTA patients in terms of hospitalization length and frequency, re-intervention for surgical and immunological acute complications, CMV reactivation, and other infections. CONCLUSIONS In conclusion, these results support the practice of listing patients for PTA when the metabolic control and the progression of chronic complications require a rapid normalization of glucose levels, with the exception of patients with cardiovascular disease, because of the high surgical risks. ITA is indicated when replacement of beta-cell mass is needed in patients with a high surgical risk.
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Affiliation(s)
- Paola Maffi
- Diabetes Research Institute, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.
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49
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De Nardi P, Bissolati M, Cristallo M, Staudacher C. Recurrent giant liposarcoma of the spermatic cord. Urology 2011; 79:113-4. [PMID: 21492916 DOI: 10.1016/j.urology.2011.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/03/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
A giant recurrent retroperitoneal liposarcoma of the spermatic cord was removed in a 40-year-old man. The tumor measured 50 cm and weighed 42 Kilograms. Radiotherapy and chemotherapy have little role in this neoplasm. Despite the huge dimension of the mass surgery was successfully undertaken without relapse at 12 months follow-up.
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Affiliation(s)
- Paola De Nardi
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
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50
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Fiorina P, Pietramaggiori G, Scherer SS, Jurewicz M, Mathews JC, Vergani A, Thomas G, Orsenigo E, Staudacher C, La Rosa S, Capella C, Carothers A, Zerwes HG, Luzi L, Abdi R, Orgill DP. The Mobilization and Effect of Endogenous Bone Marrow Progenitor Cells in Diabetic Wound Healing. Cell Transplant 2010; 19:1369-81. [DOI: 10.3727/096368910x514288] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Diabetic patients suffer from impaired wound healing, characterized by only modest angiogenesis and cell proliferation. Stem cells may stimulate healing, but little is known about the kinetics of mobilization and function of bone marrow progenitor cells (BM-PCs) during diabetic wound repair. The objective of this study was to investigate the kinetics of BM-PC mobilization and their role during early diabetic wound repair in diabetic db/db mice. After wounding, circulating hematopoietic stem cells (Lin-c-Kit+Sca-1+) stably increased in the periphery and lymphoid tissue of db/db mice compared to unwounded controls. Peripheral endothelial progenitor cells (CD34+VEGFR+) were 2.5- and 3.5-fold increased on days 6 and 10 after wounding, respectively. Targeting the CXCR4—CXCL12 axis induced an increased release and engraftment of endogenous BM-PCs that was paralleled by an increased expression of CXCL12/SDF-1α in the wounds. Increased levels of peripheral and engrafted BM-PCs corresponded to stimulated angiogenesis and cell proliferation, while the addition of an agonist (GM-CSF) or an antagonist (ACK2) did not further modulate wound healing. Macroscopic histological correlations showed that increased levels of stem cells corresponded to higher levels of wound reepithelialization. After wounding, a natural release of endogenous BM-PCs was shown in diabetic mice, but only low levels of these cells homed in the healing tissue. Higher levels of CXCL12/SDF-1α and circulating stem cells were required to enhance their engraftment and biological effects. Despite controversial data about the functional impairment of diabetic BM-PCs, in this model our data showed a residual capacity of these cells to trigger angiogenesis and cell proliferation.
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Affiliation(s)
- Paolo Fiorina
- Transplantation Research Center, Division of Nephrology, Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine & Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Pietramaggiori
- Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Surgery, University of Geneva, Geneva, Switzerland
| | - Saja S. Scherer
- Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Surgery, University of Geneva, Geneva, Switzerland
| | - Mollie Jurewicz
- Transplantation Research Center, Division of Nephrology, Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasmine C. Mathews
- Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Vergani
- Transplantation Research Center, Division of Nephrology, Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine & Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Gebhard Thomas
- Autoimmunity, Transplantation and Inflammation and Global Discovery Chemistry, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Elena Orsenigo
- Department of Medicine & Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Staudacher
- Department of Medicine & Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano La Rosa
- Department of Pathology, Ospedale di Circolo and Department of Human Morphology, University of Insubria, Varese, Italy
| | - Carlo Capella
- Department of Pathology, Ospedale di Circolo and Department of Human Morphology, University of Insubria, Varese, Italy
| | - Adelaide Carothers
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hans-Gunter Zerwes
- Autoimmunity, Transplantation and Inflammation and Global Discovery Chemistry, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Livio Luzi
- Facolta di Scienze Motorie, Università di Milano, Milan, Italy
| | - Reza Abdi
- Transplantation Research Center, Division of Nephrology, Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dennis P. Orgill
- Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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