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Degiuli M, Aguilar AHR, Solej M, Azzolina D, Marchiori G, Corcione F, Bracale U, Peltrini R, Di Nuzzo MM, Baldazzi G, Cassini D, Sica GS, Pirozzi B, Muratore A, Calabrò M, Jovine E, Lombardi R, Anania G, Chiozza M, Petz W, Pizzini P, Persiani R, Biondi A, Reddavid R. A Randomized Phase III Trial of Complete Mesocolic Excision Compared with Conventional Surgery for Right Colon Cancer: Interim Analysis of a Nationwide Multicenter Study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-in trial). Ann Surg Oncol 2024; 31:1671-1680. [PMID: 38087139 PMCID: PMC10838239 DOI: 10.1245/s10434-023-14664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/12/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Although complete mesocolic excision (CME) is supposed to be associated with a higher lymph node (LN) yield, decreased local recurrence, and survival improvement, its implementation currently is debated because the evidence level of these data is rather low and still not supported by randomized controlled trials. METHOD This is a multicenter, randomized, superiority trial (NCT04871399). The 3-year disease-free survival (DFS) was the primary end point of the study. The secondary end points were safety (duration of operation, perioperative complications, hospital length of stay), oncologic outcomes (number of LNs retrieved, 3- and 5-year overall survival, 5-year DFS), and surgery quality (specimen length, area and integrity rate of mesentery, length of ileocolic and middle-colic vessels). The trial design required the LN yield to be higher in the CME group at interim analysis. RESULTS Interim data analysis is presented in this report. The study enrolled 258 patients in nine referral centers. The number of LNs retrieved was significantly higher after CME (25 vs. 20; p = 0.012). No differences were observed with respect to intra- or post-operative complications, postoperative mortality, or duration of surgery. The hospital stay was even shorter after CME (p = 0.039). Quality of surgery indicators were higher in the CME arm of the study. Survival data still were not available. CONCLUSIONS Interim data show that CME for right colon cancer in referral centers is safe and feasible and does not increase perioperative complications. The study documented with evidence that quality of surgery and LN yield are higher after CME, and this is essential for continuation of patient recruitment and implementation of an optimal comparison. Trial registration The trial was registered at ClinicalTrials.gov with the code NCT04871399 and with the acronym CoME-In trial.
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Affiliation(s)
- Maurizio Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy
| | - Aridai H Resendiz Aguilar
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy
| | - Mario Solej
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy
| | - Danila Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Via Fossato di Mortara, Ferrara, Italy
| | - Giulia Marchiori
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesco Corcione
- Chirurgia Oncologica e Miniinvasiva Clinica Mediterranea Napoli, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Roberto Peltrini
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Maria M Di Nuzzo
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | | | - Diletta Cassini
- ASST Ovest Milanese, P.O. Nuovo Ospedale di Legnano, Legnano, Italy
| | - Giuseppe S Sica
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - Brunella Pirozzi
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | | | - Elio Jovine
- IRCCS AOU of Bologna, University of Bologna, Bologna, Italy
| | | | - Gabriele Anania
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Matteo Chiozza
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Wanda Petz
- Digestive Surgery, European Institute of Oncology-IRCCS, Milan, Italy
| | - Paolo Pizzini
- Digestive Surgery, European Institute of Oncology-IRCCS, Milan, Italy
| | - Roberto Persiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Biondi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossella Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy.
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Degiuli M, Aguilar HAR, Solej M, Azzolina D, Marchiori G, Corcione F, Bracale U, Peltrini R, Di Nuzzo MM, Baldazzi G, Cassini D, Sica GS, Pirozzi B, Muratore A, Calabrò M, Jovine E, Lombardi R, Anania G, Chiozza M, Petz W, Pizzini P, Persiani R, Biondi A, Reddavid R. ASO Visual Abstract: A Randomized Phase III Trial of Complete Mesocolic Excision in Comparison with Conventional Surgery for Right Colon Cancer: Interim Analysis of a Nationwide Multicenter Study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-In Trial). Ann Surg Oncol 2024; 31:1700-1701. [PMID: 38198001 DOI: 10.1245/s10434-023-14794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- M Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy
| | - H A Resendiz Aguilar
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy
| | - M Solej
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy
| | - D Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - G Marchiori
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - F Corcione
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - U Bracale
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - R Peltrini
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - M M Di Nuzzo
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - G Baldazzi
- ASST Ovest Milanese, P.O. Nuovo Ospedale di Legnano, Legnano, Italy
| | - D Cassini
- ASST Ovest Milanese, P.O. Nuovo Ospedale di Legnano, Legnano, Italy
| | - G S Sica
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - B Pirozzi
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - A Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - M Calabrò
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - E Jovine
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - R Lombardi
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - G Anania
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - M Chiozza
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - W Petz
- Digestive Surgery European Institute of Oncology IRCCS, Milan, Italy
| | - P Pizzini
- Digestive Surgery European Institute of Oncology IRCCS, Milan, Italy
| | - R Persiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Biondi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy.
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Lauricella S, Brucchi F, Palmisano D, Baldazzi G, Bottero L, Cassini D, Faillace G. Right-sided colonic diverticulitis. Short and long-term surgical outcomes and 2-year quality of life. World J Surg 2024; 48:484-492. [PMID: 38529850 DOI: 10.1002/wjs.12065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 03/27/2024]
Abstract
AIM We aimed to investigate the short and the long-term outcomes and 2-year Quality of Life (QoL) of patients with right-sided colonic diverticulitis (RCD) surgically managed. METHOD We conducted an ambidirectional cohort study of patients with RCD undergoing surgery between 2012/2022. A colonoscopy was performed at 1-year post surgery. The enrolled patients completed the EuroQoL (EQ-5D-3L) during a regular follow-up visit at 12 and 24 months after surgery. RESULTS Three hundred nineteen patients with RCD were selected: 223 (70%) patients were treated by non-operative management (NOM) while 33 underwent surgery. Acute diverticulitis occurred in 30 patients: 9 (27.2%) were classified by CT as uncomplicated and 21 (63.6%) as complicated diverticulitis. Additionally, chronic diverticulitis occurred in 3 cases (9.2%). Specifically, 27 patients were classified by CT as 1a (81.8%) and 6 patients as 3 (18.2%). Right hemicolectomy was performed in 30 patients (90.8%), and ileo-caecectomy in 3 (9.2%). Nine (27.27%) experienced postoperative complications: 7 (77.7%) were classified according to the Clavien-Dindo as grade I-II, and 2 (22.2%) as grade III. No disease recurrence or colorectal cancer (CRC) was detected on colonoscopy. Thirty (90.8%) patients completed the 24-month follow-up. A statistically significant difference between preoperative and 24-month QoL index values (median 0.72; IQR = 0.57-0.8 vs. median 0.9; IQR = 0.82-1; p = 0.0003) was observed. CONCLUSIONS The study results demonstrate satisfactory surgical outcomes and a better QoL after surgery. No disease recurrence or CRC was observed at colonoscopy 1 year after surgery.
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Affiliation(s)
- Sara Lauricella
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Francesco Brucchi
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
- University of Milan, Milan, Italy
| | - Dario Palmisano
- University of Milano-Bicocca, Cinisello Balsamo, Milan, Italy
- General and Laparoscopic Surgery, ASST Nord Milano, Cinisello Balsamo, Milan, Italy
| | | | - Luca Bottero
- General and Laparoscopic Surgery, ASST Nord Milano, Cinisello Balsamo, Milan, Italy
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Giuseppe Faillace
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D'Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Correction: Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023:10.1007/s00464-023-10102-0. [PMID: 37160809 DOI: 10.1007/s00464-023-10102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy.
- Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- Clinica Chirurgica Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
- Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy
| | - Ugo Elmore
- Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132, Milan, Italy
| | - Francesca Pecchini
- Unita' Operativa di chirurgia generale, d'urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples "Federico II", Naples, Italy
| | - Roberta La Mendola
- General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- S.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- SCDU Clinica Chirurgica, General Surgery Department, AOU "Maggiore Della Carità" Hospital, Novara, Italy
| | - Francesco Marchegiani
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, "Valli del Noce" Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- Gastrointestinal Surgery, San Raffaele Hospital, 20132, Milan, Italy
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D'Ugo
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
- Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, "Valli del Noce" Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- SCDU Clinica Chirurgica, General Surgery Department, AOU "Maggiore Della Carità" Hospital, Novara, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell'umanesimo, 10, 00144, Rome, Italy
| | - Angelo Restivo
- Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- S.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples "Federico II", Naples, Italy
| | - Micaela Piccoli
- Unita' Operativa di chirurgia generale, d'urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132, Milan, Italy
| | - Antonino Spinelli
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
- Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060, Torino, Italy
| | - Marco Guerrieri
- Clinica Chirurgica Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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5
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D’Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023; 37:977-988. [PMID: 36085382 PMCID: PMC9944710 DOI: 10.1007/s00464-022-09547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.
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Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy. .,Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- grid.7605.40000 0001 2336 6580BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.432329.d0000 0004 1789 4477Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- grid.417728.f0000 0004 1756 8807Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Francesca Pecchini
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Roberta La Mendola
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’Umanesimo, 10, 00144 Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Francesco Marchegiani
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- grid.18887.3e0000000417581884Gastrointestinal Surgery, San Raffaele Hospital, 20132 Milan, Italy
| | - Luca Ferraro
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- grid.9024.f0000 0004 1757 4641UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D’Ugo
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy ,grid.415928.3Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Alessandro Ferrero
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’umanesimo, 10, 00144 Rome, Italy
| | - Angelo Restivo
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Micaela Piccoli
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Antonino Spinelli
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56 Rozzano, 20089 Milan, Italy ,grid.452490.eDepartment of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.419555.90000 0004 1759 7675Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060 Torino, Italy
| | - Marco Guerrieri
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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6
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Medellin Abueta A, Senejoa NJ, Pedraza Ciro M, Fory L, Rivera CP, Jaramillo CEM, Barbosa LMM, Varela HOI, Carrera JA, Garcia Duperly R, Sanchez LA, Lozada‐Martinez ID, Cabrera‐Vargas LF, Mendoza A, Cabrera P, Sanchez Ussa S, Paez C, Wexner SD, Strassmann V, DaSilva G, Di Saverio S, Birindelli A, Florez RJR, Kestenberg A, Obando Rodallega A, Robles JCS, Carrasco CAN, Impagnatiello A, Cassini D, Baldazzi G, Roscio F, Liotta G, Marini P, Gomez D, Figueroa Avendaño CE, Villamizar DM, Cabrera L, Reyes JC, Narvaez‐Rojas A. Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients. Health Sci Rep 2022; 5:e788. [PMID: 36090626 PMCID: PMC9434380 DOI: 10.1002/hsr2.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/27/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. “Temporary” colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30‐day mortality, length of stay, complications, and postoperative outcomes. Results Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II‐III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.
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Affiliation(s)
| | | | | | - Lina Fory
- Department of General Surgery Hospital Militar Central Bogotá Colombia
| | | | | | | | | | - Javier A. Carrera
- Department of Colorectal Surgery Fundación Santa Fe de Bogotá Bogotá Colombia
| | | | - Luis A Sanchez
- Department of Colorectal Surgery Hospital Militar Central Bogotá Colombia
| | - Ivan David Lozada‐Martinez
- Medical and Surgical Research Center Future Surgeons Chapter, Colombian Surgery Association Bogotá Colombia
- International Coalition on Surgical Research Universidad Nacional Autónoma de Nicaragua Managua Nicaragua
| | - Luis Felipe Cabrera‐Vargas
- Medical and Surgical Research Center Future Surgeons Chapter, Colombian Surgery Association Bogotá Colombia
- Department of Surgery Fundación Santa Fe de Bogotá Bogotá Colombia
| | - Andres Mendoza
- Department of Surgery Universidad El Bosque Bogotá Colombia
| | - Paulo Cabrera
- Department of General Surgery Hospital Militar Central Bogotá Colombia
| | | | - Cristian Paez
- Department of Surgery Fundación Universitaria Sanitas Bogotá Colombia
| | - Steven D. Wexner
- Department of Colorectal Surgery Cleveland Clinic Florida Weston FL USA
| | - Victor Strassmann
- Department of Colorectal Surgery Cleveland Clinic Florida Weston FL USA
| | - Giovanna DaSilva
- Department of Colorectal Surgery Cleveland Clinic Florida Weston FL USA
| | - Salomone Di Saverio
- Emergency and General Surgery Department CA Pizzardi Maggiore Hospital Bologna Italy
| | | | | | - Abraham Kestenberg
- Department of Colorectal Surgery Fundación Clínica Valle del Lili Cali Colombia
| | | | | | | | | | - Diletta Cassini
- Complex Unit of General and Emergency Surgery Città di Sesto San Giovanni Hospital Milan Italy
| | - Gianandrea Baldazzi
- Complex Unit of General and Emergency Surgery Città di Sesto San Giovanni Hospital Milan Italy
| | - Francesco Roscio
- Department of General Surgery ASST Valle Olona Busto Arsizio Italy
| | - Gianluca Liotta
- Department of Surgery San Caillo – Forlanini Hospital Rome Italy
| | - Pierluigi Marini
- Department of Surgery San Caillo – Forlanini Hospital Rome Italy
| | - Daniel Gomez
- Department of Surgery Universidad El Bosque Bogotá Colombia
| | | | | | - Laura Cabrera
- Department of Surgery Universidad El Bosque Bogotá Colombia
| | - Juan Carlos Reyes
- Department of Colorectal Surgery Hospital Militar Central Bogotá Colombia
| | - Alexis Narvaez‐Rojas
- International Coalition on Surgical Research Universidad Nacional Autónoma de Nicaragua Managua Nicaragua
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7
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Epifani AG, Cassini D, Cirocchi R, Accardo C, Di Candido F, Ardu M, Baldazzi G. Right sided diverticulitis in western countries: A review. World J Gastrointest Surg 2021; 13:1721-1735. [PMID: 35070076 PMCID: PMC8727183 DOI: 10.4240/wjgs.v13.i12.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/28/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia.
AIM To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries.
METHODS MEDLINE and PubMed searches were performed using the key words “right-sided diverticulitis’’, ‘‘right colon diverticulitis’’, ‘‘caecal diverticulitis’’, ‘‘ascending colon diverticulitis’’ and ‘‘caecum diverticula’’ in order to find relevant articles published until 2021.
RESULTS A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases.
CONCLUSION The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.
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Affiliation(s)
- Angelo Gabriele Epifani
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy
| | - Diletta Cassini
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Perugia 06123, Italy
| | - Caterina Accardo
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy
| | - Francesca Di Candido
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Massimiliano Ardu
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Gianandrea Baldazzi
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
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8
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Cirocchi R, Nascimbeni R, Burini G, Boselli C, Barberini F, Davies J, Di Saverio S, Cassini D, Amato B, Binda GA, Bassotti G. The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review. Medicina (Kaunas) 2021; 57:medicina57101127. [PMID: 34684164 PMCID: PMC8538273 DOI: 10.3390/medicina57101127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Gloria Burini
- General & Emergency Surgical Clinic, University of Ancona, Hospital “Ospedali Riuniti di Ancona”, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-34-6570-0300
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Francesco Barberini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Justin Davies
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, 20099 Milano, Italy;
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | | | - Gabrio Bassotti
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
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9
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Spalluto M, Bevilacqua E, Baldazzi G, Cassini D. Operative versus non-operative management in acute surgical diseases during COVID-19 pandemic: a 30-day experience from an Italian hospital in Lombardy. MINERVA CHIR 2020; 75:457-461. [PMID: 32975386 DOI: 10.23736/s0026-4733.20.08391-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The spread of COVID-19 pandemic has determined a huge imbalance between real clinical needs of the population and effective resources availability. The aim of this study was to report how this situation forces surgeons to consider a non-operative management as an alternative. This is a retrospective monocentric study and we collected data from 60 patients, split in two groups: info from Group A, 28 patients (11 March to 11 April 2020) were compared with info from group B, 32 patients (11 March to 11 April 2019). The most relevant difference between the groups is related to patient's clinical management. The two groups had a considerably different number of cases that were treated with an operative management: 18 cases (64,7%) in group A vs. 28 cases (87,5%) in group B. Otherwise, non-operative approach occurred in 10 cases (35,7%) in group A and only in 4 patients (12,5%) in group B. These data suggest that the drastic reduction of means narrows the range of therapeutic choices. Indeed, in this emergency scenario, the rationing of healthcare resources was the propelling for surgeons to consider alternative therapeutic pathways.
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Affiliation(s)
- Marta Spalluto
- Hospital of Sesto San Giovanni, Sesto San Giovanni, Milan, Italy -
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10
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Sollazzo BM, Cassini D, Biacchi D, Sammartino P, Baldazzi G. ICG-assisted D3 lymphadenectomy in right colectomy for cancer. Ann Laparosc Endosc Surg 2020. [DOI: 10.21037/ales-20-62] [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: 02/05/2023]
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11
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Tamini N, Cassini D, Giani A, Angrisani M, Famularo S, Oldani M, Montuori M, Baldazzi G, Gianotti L. Computed tomography in suspected anastomotic leakage after colorectal surgery: evaluating mortality rates after false-negative imaging. Eur J Trauma Emerg Surg 2020; 46:1049-1053. [PMID: 30737521 DOI: 10.1007/s00068-019-01083-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSES We sought to investigate the accuracy of abdominal CT scanning for anastomotic leakage and the effect of false-negative scans on the delay in therapeutic intervention and clinical outcome. METHOD Data from a prospectively bi-institutionally maintained database of all patients who underwent elective colorectal surgery with primary anastomosis for malignant or benign disease between 2010 and 2017 were reviewed. Patients with confirmed anastomotic dehiscence at reintervention who underwent a postoperative CT scan for suspected leakage were identified and radiological reports were retrieved. RESULTS Seventy-six patients with anastomotic dehiscence were included in the study. American Society of Anesthesiologists score, sex, type of surgical procedure, malignancy, and type of anastomosis do not correlate with postoperative false-negative CT imaging. Postoperative false-negative CT scan, however, led to delayed reintervention (3 vs. 6 h, p = 0.023) and increased mortality (five deaths vs. no deaths, p = 0.043). Free abdominal air (p = 0.001) and extraluminal contrast extravasation (p = 0.001) were found to be predictive of accuracy in anastomotic leakage diagnosis. CONCLUSION The suboptimal specificity of a postoperative CT scan in suspected anastomotic leakage after colorectal surgery can delay reintervention and increase mortality.
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Affiliation(s)
- Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, Monza, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | | | - Alessandro Giani
- Department of Surgery, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marco Angrisani
- Department of Surgery, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simone Famularo
- Department of Surgery, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Massimo Oldani
- Department of Surgery, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mauro Montuori
- Department of Surgery, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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12
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Depalma N, Cassini D, Grieco M, Barbieri V, Altamura A, Manoochehri F, Viola M, Baldazzi G. Feasibility of a tailored ERAS programme in octogenarian patients undergoing minimally invasive surgery for colorectal cancer. Aging Clin Exp Res 2020; 32:265-273. [PMID: 30982218 DOI: 10.1007/s40520-019-01195-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The enhanced recovery after surgery (ERAS) is nowadays a widely accepted multimodal programme of care in colorectal surgery, but still there is some reluctance in its application to very elderly patients. AIM The aim of this study is to investigate short-term outcomes of laparoscopic resection for colorectal cancer in octogenarian patients within the ERAS programme. METHODS Data on 162 consecutive patients aged ≥ 80 years receiving elective minimally invasive colorectal resections within ERAS programme were collected in a multicentre, retrospective database in the period 2008-2017 in Italy. Univariate and multivariate analyses were performed to assess possible risk factors for poor clinical outcomes. RESULTS The postoperative minor morbidity rate (Clavien-Dindo 1 and 2) was 25.9%. The incidence of postoperative major morbidity rate (severe medical and surgical complications defined as Clavien-Dindo 3 and 4) accounted 6.1% and only 1.8% had an anastomotic leakage. Reoperation rate was 5.5%, perioperative 30-day mortality was 1.8%, and 30-day readmission rate was 6.8%. On average, patients were released after 6 days. A univariate analysis showed that possible risk factors for severe medical complications were: low preoperative albumin level, high Charlson Age Comorbidity Index Score and number of days in the intensive care unit (ICU); risk factors for severe surgical complications were: low preoperative albumin level; risk factors for late hospital discharge were: multivisceral resections, number of days in ICU and body mass index (BMI) > 25 kg/m2. The multivariate analysis confirmed a low level of preoperative albumin and a longer ICU stay as independent risk factors for both postoperative severe surgical complications and late hospital discharge. DISCUSSION The minimal invasive nature of the laparoscopic approach together with a multimodal analgesia therapy, the early resumption to oral diet and mobilisation could minimize the surgical stress and play an essential role in order to reduce medical morbidity in high-risk patients. CONCLUSION Colorectal surgery within ERAS programme in octogenarians is a safe and flexible treatment in high-volume centres.
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Affiliation(s)
- N Depalma
- Emergency Surgery Department, "Sapienza" Medical School, Viale Policlinico 155, 00161, Rome, Italy.
| | - D Cassini
- Department of General Surgery, Sesto San Giovanni Hospital, Milan, Italy
| | - M Grieco
- General Surgery Department, Fondazione Policlinico Universitario Agostino Gemelli-Catholic University, Rome, Italy
| | - V Barbieri
- Department of General Surgery, Cardinale Panico di Tricase Hospital, Lecce, Italy
| | - A Altamura
- Department of General Surgery, Cardinale Panico di Tricase Hospital, Lecce, Italy
| | - F Manoochehri
- Department of General and Mini-invasive Surgery, Abano Terme, Padova, Italy
| | - M Viola
- Department of General Surgery, Cardinale Panico di Tricase Hospital, Lecce, Italy
| | - G Baldazzi
- Department of General Surgery, Sesto San Giovanni Hospital, Milan, Italy
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Cirocchi R, Fearnhead N, Vettoretto N, Cassini D, Popivanov G, Henry BM, Tomaszewski K, D'Andrea V, Davies J, Di Saverio S. The role of emergency laparoscopic colectomy for complicated sigmoid diverticulits: A systematic review and meta-analysis. Surgeon 2019; 17:360-369. [PMID: 30314956 DOI: 10.1016/j.surge.2018.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nowadays sigmoidectomy is recommended as "gold standard" treatment for generalized purulent or faecal peritonitis from sigmoid perforated diverticulitis. This systematic review and meta-analysis aimed to assess effectiveness and safety of laparoscopic access versus open sigmoidectomy in acute setting. METHODS A systematic literature search was performed for randomized controlled trials (RCTs) and non-RCTs published in PubMed, SCOPUS and Web of Science. RESULTS The search yielded four non-RCTs encompassing 436 patients undergoing either laparoscopic (181 patients, 41.51%) versus open sigmoid resection (255 patients, 58.49%). All studies reported ASA scores, but only four studies reported other severity scoring systems (Mannheim Peritonitis Index, P-POSSUM). Level of surgical expertise was reported in only one study. Laparoscopy improves slightly the rates of overall post-operative complications and post-operative hospital stay, respectively (RR 0.62, 95% CI 0.49 to 0.80 and MD -6.53, 95% CI -16.05 to 2.99). Laparoscopy did not seem to improve the other clinical outcomes: rate of Hartmann's vs anastomosis, operating time, reoperation rate and postoperative 30-day mortality. CONCLUSION In this review four prospective studies were included, over 20 + year period, including overall 400 + patients. This meta-analysis revealed significant advantages associated with a laparoscopic over open approach to emergency sigmoidectomy in acute diverticulitis in terms of postoperative complication rates, although no differences were found in other outcomes. The lack of hemodynamic data and reasons for operative approach hamper interpretation of the data suggesting that patients undergoing open surgery were sicker and these results must be considered with extreme caution and this hypothesis requires confirmation by future prospective randomised controlled trials.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy.
| | - Nicola Fearnhead
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | | | | | - Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Sofia, Bulgaria.
| | | | | | - Vito D'Andrea
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
| | - Justin Davies
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G, Testa S, Carlini M. Intracorporeal Versus Extracorporeal Anastomosis for Laparoscopic Resection of the Splenic Flexure Colon Cancer: A Multicenter Propensity Score Analysis. Surg Laparosc Endosc Percutan Tech 2019; 29:483-488. [PMID: 30817694 DOI: 10.1097/sle.0000000000000653] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study is to compare the short and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) during laparoscopic resection of splenic flexure for cancer, in 3 high-volume Italian centers. MATERIALS AND METHODS A retrospective analysis was conducted on a multicenter database of a consecutive series of patients who underwent an elective laparoscopic resection of the splenic flexure for colon cancer in 3 high-volume centers between January 2008 and August 2017. Propensity score matching analysis was performed to overcome patients' selection bias between the 2 surgical techniques. Data on patients' demographics, operative details, short-term and long-term outcomes were prospectively recorded. RESULTS In total, 102 patients were selected. After propensity score match, 72 patients were compared: 36 for the IA group, 36 for the EA group. The IA group showed a significantly shorter median time to first flatus, time to first stool, time to oral feeding, and time to discharge, as well as significantly lower incidence of postoperative severe surgical complications, especially in terms of wound infections, and of incisional hernia (IH).Risk factors for IH on logistic regression were longer operative time, EA, longer incision, postoperative blood transfusions, and longer specimen. CONCLUSIONS The IA in laparoscopic resection of the splenic flexure is feasible and safe in terms of short-term and long-term outcomes. Major advantages are shorter time to first flatus and first stool, complete oral feeding and time to discharge, with minor incidence of severe surgical complications, such as wound infection, and lower incidence of IH.
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Affiliation(s)
- Michele Grieco
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo
| | - Diletta Cassini
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo, Abano Terme (PD)
| | - Domenico Spoletini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo
| | - Enrica Soligo
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate, Vercelli, Italy
| | - Emanuela Grattarola
- Statistical and Big Data Department, Elis Consulting & Labs, Via S. Sandri, Rome
| | - Gianandrea Baldazzi
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo, Abano Terme (PD)
| | - Silvio Testa
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate, Vercelli, Italy
| | - Massimo Carlini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo
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Cassini D, Miccini M, Manoochehri F, Gregori M, Baldazzi G. Emergency Hartmann's Procedure and its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis. Surg Innov 2019; 26:770-771. [PMID: 31530222 DOI: 10.1177/1553350619874272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Diletta Cassini
- Sesto San Giovanni Hospital, Sesto San Giovanni, Milan, Italy
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16
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Cassini D, Depalma N, Grieco M, Cirocchi R, Manoochehri F, Baldazzi G. Robotic pelvic dissection as surgical treatment of complicated diverticulitis in elective settings: a comparative study with fully laparoscopic procedure. Surg Endosc 2019; 33:2583-2590. [PMID: 30406387 DOI: 10.1007/s00464-018-6553-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 08/21/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, minimally invasive treatment of complicated sigmoid diverticulitis is becoming a valid alternative to standard procedures. Robotic approach may be useful to allow more precise dissection in arduous pelvic dissection as in complicated diverticulitis. The aim of this study is to investigate effectiveness, potential benefits and short-term outcomes of robotic-assisted laparoscopic surgical resection, compared with fully laparoscopic resection in complicated diverticulitis. METHODS Between January 2009 and December 2017, 156 consecutive patients with history of complicated diverticular disease were referred to our Department of General, Mininvasive and Robotic Surgery. All patients underwent elective colonic resections performed by the same colorectal surgeon and followed a perioperative ERAS program. Demographic and clinical features, surgical data, postoperative data, 30-day morbidity and mortality, VAS for surgeon's compliance were evaluated. RESULTS One hundred and fifty-six consecutive patients underwent elective colonic resection: 92 fully laparoscopic (FL) colorectal resections and 64 procedures with robotic hybrid approach (RHA). Conversion rate was none in the RHA group versus 6.5% in the FL group, because of poor vision due to bowel distension, inflammatory pseudotumor and peritoneal adhesions. No 30-day mortality was observed. Mean operative time was 167.5 ± 54.4 min (80-420) in the FL group and 172.5 ± 55.64 min (110-325) in the RHA group (p 0.079), mean intraoperative blood loss was 144.6 ± 40.6 ml (40-200) with the FL technique and 138.4 ± 28.3 ml (20-185) with the RHA (p 0.295). Mean hospital stay for FL was 5 ± 4.1 days (range 3-45) and 5 ± 2.7 days (range 3-20) for RHA (p 0.974). Overall postoperative morbidity rate was 21.6% in the FL group and 12.3% in the RHA (p 0.067). Major postoperative morbidity (Clavien-Dindo 3 and 4) represented 13% and 4.6%, respectively (p 0.091). VAS for surgeon's compliance revealed a better performance in the robotic arm (p 0.059). CONCLUSIONS This preliminary study highlights the potential benefits of robotic-assisted laparoscopy in colorectal resections for complicated diverticular disease in terms of surgical efficacy, postoperative morbidity and better surgeon's compliance.
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Affiliation(s)
- Diletta Cassini
- Department of General and Mini-Invasive Surgery, Policlinico Abano Terme, Padova, Italy.
| | - Norma Depalma
- Department of Emergency Surgery, "Sapienza" Medical School, Rome, Italy
| | - Michele Grieco
- General Surgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biochemical Sciences, University of Perugia, AOSP Terni, Perugia, Italy
| | - Farshad Manoochehri
- Department of General and Mini-Invasive Surgery, Policlinico Abano Terme, Padova, Italy
| | - Gianandrea Baldazzi
- Department of General e Surgery, Ospedale Citta Sesto San Giovanni, ASST Milano Nord, Sesto San Giovanni, Italy
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Ficari F, Borghi F, Catarci M, Scatizzi M, Alagna V, Bachini I, Baldazzi G, Bardi U, Benedetti M, Beretta L, Bertocchi E, Caliendo D, Campagnacci R, Cardinali A, Carlini M, Cascella M, Cassini D, Ciotti S, Cirio A, Coata P, Conti D, DelRio P, Di Marco C, Ferla L, Fiorindi C, Garulli G, Genzano C, Guercioni G, Marra B, Maurizi A, Monzani R, Pace U, Pandolfini L, Parisi A, Pavanello M, Pecorelli N, Pellegrino L, Persiani R, Pirozzi F, Pirrera B, Rizzo A, Rolfo M, Romagnoli S, Ruffo G, Sciuto A, Marini P. Enhanced recovery pathways in colorectal surgery: a consensus paper by the Associazione Chirurghi Ospedalieri Italiani (ACOI) and the PeriOperative Italian Society (POIS). G Chir 2019; 40:1-40. [PMID: 32003714 DOI: pmid/32003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) pathway is a multi-disciplinary, patient-centered protocol relying on the implementation of the best evidence-based perioperative practice. In the field of colorectal surgery, the application of ERAS programs is associated with up to 50% reduction of morbidity rates and up to 2.5 days reduction of postoperative hospital stay. However, widespread adoption of ERAS pathways is still yet to come, mainly because of the lack of proper information and communication. Purpose of this paper is to support the diffusion of ERAS pathways through a critical review of the existing evidence by members of the two national societies dealing with ERAS pathways in Italy, the PeriOperative Italian Society (POIS) and the Associazione Italiana Chirurghi Ospedalieri (ACOI), showing the results of a consensus development conference held at Matera, Italy, during the national ACOI Congress on June 10, 2019.
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Cassini D, Clementi S, Colletti G, Cortellazzi P, Baldazzi G. ERAS prehabilitation in “low budget” era…“where there’s a will, there’s a way”. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.124] [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: 11/30/2022]
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Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G, Testa S, Carlini M. Laparoscopic resection of splenic flexure colon cancers: a retrospective multi-center study with 117 cases. Updates Surg 2019; 71:349-357. [PMID: 30406933 DOI: 10.1007/s13304-018-0601-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
The objective is to investigate the short- and long-term outcomes of laparoscopic resections of splenic flexure colon cancers in three Italian high-volume centers. The laparoscopic resection of splenic flexure colon cancers is a challenging procedure and has not been completely standardized, mainly due to the technical difficulty, the arduous identification of major blood vessels, and the problems associated with anastomosis construction. In this retrospective cohort observational study, a consecutive series of patients treated in three Italian high-volume centers with elective laparoscopic resection of the splenic flexure for cancer is analyzed. The observational period was from January 2008 to August 2017. Patient demographics and clinical features, operative data, and short- and long-term outcomes were prospectively recorded in a specific database and were retrospectively analyzed. During the observation period, 117 patients were selected. Conversion to open surgery was necessary in 15 patients (12.8%). Of 102 complete laparoscopic procedures, multi-visceral resection was performed in 13 cases (12.7%). Postoperative surgical complications occurred in 13 patients (12.7%), with 3 cases of anastomotic leak (2.9%) and 3 cases of re-operation (2.9%). The postoperative mortality in this population was null. The 5-year overall survival rate was 84.3%, and the 5-year disease-free survival rate was 87.8%. Laparoscopic resection of the splenic flexure is feasible and safe in high-volume centers. Compared to the results of other laparoscopic colonic resections, the short- and long-term outcomes are similar, but the conversion rate is higher.
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Affiliation(s)
- Michele Grieco
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | - Diletta Cassini
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo 1, 35031, Abano Terme, PD, Italy
| | - Domenico Spoletini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Enrica Soligo
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate 21, 13100, Vercelli, Italy
| | - Emanuela Grattarola
- Statistical and Big Data Department, Elis Consulting & Labs, Via S. Sandri 81, 00159, Rome, Italy
| | - Gianandrea Baldazzi
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo 1, 35031, Abano Terme, PD, Italy
| | - Silvio Testa
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate 21, 13100, Vercelli, Italy
| | - Massimo Carlini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
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Gregori M, Cassini D, Depalma N, Miccini M, Manoochehri F, Baldazzi GA. Laparoscopic lavage and drainage for Hinchey III diverticulitis: review of technical aspects. Updates Surg 2019; 71:237-246. [PMID: 30097970 DOI: 10.1007/s13304-018-0576-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023]
Abstract
The surgical treatment for patients with generalized peritonitis complicating sigmoid diverticulitis is currently debated; particularly in case of diffuse purulent contamination (Hinchey 3). Laparoscopic lavage and drainage (LLD) has been proposed by some authors as a safe and effective alternative to single- or multi-stage resective surgery. However, among all the different studies on LLD, there is no uniformity in terms of surgical technique adopted and data show significant differences in postoperative outcomes. Aim of this review was to analyze the differences and similarities among the authors in terms of application, surgical technique and outcomes of LLD in Hinchey 3 patients. A bibliographical research was performed by referring to PubMed and Cochrane. "Purulent peritonitis", "Hinchey 3 diverticulitis", "acute diverticulitis", "colonic perforation" and "complicated diverticulitis" were used as key words. Twenty-eight papers were selected, excluding meta-analysis, reviews and case reports with a very small number of patients. The aim of this review was to establish how LLD should be done, suggesting important technical tricks. We found agreement in terms of indications, preoperative management, ports' positioning, antibiotics, enteral feeding and drain management. On the contrast, different statements regarding indications, adhesiolysis and management of colonic hole and failure of laparoscopic lavage are reported. A widespread diffusion of LLD and standardization of its technique are impossible because of data heterogeneity and selection bias in the limited RCTs. It is necessary to wait for long terms results from randomized clinical trials (RCTs) in progress to establish the efficacy and safety of this technique. More importantly, an increased number of highly skilled and dedicated colorectal laparoscopic surgeons are required to standardized the procedure.
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Affiliation(s)
- Matteo Gregori
- University Hospitals Birmingham, "Queen Elizabeth Hospital" Birmingham, Birmingham, UK.
- , 3 New Street Chambers, 67A New Street, Birmingham, B2 4DU, UK.
| | - Diletta Cassini
- Department of Mini-invasive and Robotic Surgery, Abano Terme, Padua, Italy
| | - Norma Depalma
- First Department of Surgery "Pietro Valdoni", "Sapienza" Medical School, Rome, Italy
| | - Michelangelo Miccini
- First Department of Surgery "Pietro Valdoni", "Sapienza" Medical School, Rome, Italy
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Cavaliere D, Popivanov G, Cassini D, Cirocchi R, Henry BM, Vettoretto N, Ercolani G, Solaini L, Gerardi C, Tabakov M, Tomaszewski KA. Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:973-981. [PMID: 31025093 DOI: 10.1007/s00384-019-03276-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The anastomotic leak rate in colorectal surgery is highest in patients receiving anterior rectal resections. The placement of prophylactic pelvic drains remains a routine option for preventing postoperative leaks, despite increasing evidence suggesting no clinical benefit. The present study seeks to identify a consensus on the use of prophylactic drains in anterior rectal resections. METHODS A systematic search was conducted of MEDLINE, Scopus, EMBASE, and Cochrane Library databases to identify clinical trials comparing the use of drainage to non-drainage in cases of colorectal anastomosis. RESULTS Three randomized clinical trials (RCTs) and two controlled clinical trials (CCTs) were identified that met the inclusion criteria, with a total of 1702 patients with rectal cancer who underwent anterior resection: 1206 with a pelvic drain and 496 without a pelvic drain. Meta-analysis showed that the use of a drain did not significantly improve the outcomes of anastomotic leaks; the overall reoperation rate during the 30-day postoperative period and the postoperative mortality were statistically lower in the drained group (OR 2.82, 95% CI 1.33 to 5.97; I2 = 0%). CONCLUSIONS The use of prophylactic pelvic drainage after anterior rectal resections does not provide significant benefits with respect to anastomotic leaks and overall complication rates. However, an approximately threefold reduction of the postoperative mortality of the drained patients was observed. Given the limitations of the present study, these findings warrant the use of a drain after anterior rectal resection. Nevertheless, due to the low quality of the available data, further multicenter trials with uniform inclusion criteria are needed to evaluate drain usage in the anterior rectal resection.
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Affiliation(s)
- Davide Cavaliere
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Georgi Popivanov
- Military Medical Academy, ul. "Sveti Georgi Sofiyski" 3, Sofia Center, 1606, Sofia, Bulgaria
| | - Diletta Cassini
- Department of Minimally-Invasive and General Surgery, Policlinico Abano Terme, Piazza Cristoforo Colombo, 1, 35031, Abano Terme, Padova, Italy
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy.
| | - Brandon M Henry
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
| | - Nereo Vettoretto
- Laparoscopic Surgery Unit, Department of Surgery, M Mellini Hospital, Viale Mazzini, 4, 25032, Chiari, Brescia, Italy
| | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Leonardo Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Chiara Gerardi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy
| | - Mihail Tabakov
- Clinic of Surgery, University Hospital for Active Treatment, "St. Ivan Rilski", Sofia, Bulgaria
| | - Krzysztof Andrzej Tomaszewski
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
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Grieco M, Polti G, Lambiase L, Cassini D. Jejunal multiple perforations for combined abdominal typhoid fever and miliary peritoneal tuberculosis. Pan Afr Med J 2019; 33:51. [PMID: 31448014 PMCID: PMC6689839 DOI: 10.11604/pamj.2019.33.51.14664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/05/2019] [Indexed: 02/05/2023] Open
Abstract
Typhoid fever and tuberculosis, considered rare diseases in western countries, is still considered a notable problem of health issue in developing countries. The gastrointestinal manifestations of typhoid fever are the most common and the typhoid intestinal perforation (TIP) is considered the most dangerous complication. Abdominal localization of tuberculosis is the 6th most frequent site for extra pulmonary involvement, it can involve any part of the digestive system, including peritoneum, causing miliary peritoneal tuberculosis (MPT). This is the case report of a 4 years old girl with multiple jejunal perforations in a setting of contemporary miliary peritoneal tuberculosis and typhoid fever occurred in "Hopital Saint Jean de Dieu" in Tanguietà, north of Benin. The patient was admitted in the emergency department with an acute abdomen and suspect of intestinal perforation, in very bad clinical conditions, underwent emergency laparotomy. The finding was a multiple perforations of the jejunum in a setting of combined abdominal typhoid fever and miliary peritoneal tuberculosis. Typhoid intestinal perforations and peritoneal tuberculosis are a very rare cause of non-traumatic peritonitis in western country, but still common in developing country. Considering the modern migratory flux and the diffusion of volunteer missions all around the world, the western surgeon should know this pathological entities, and the best treatments available, well known by surgeons with experience of working in developing countries. The combination of both TIP and MPT in the same patient, is a very rare finding which can worsen the outcome of the patient itself.
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Affiliation(s)
- Michele Grieco
- General Surgery Department, S Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144 Rome, Rome, Italy
| | - Giorgia Polti
- Immunoinfectivology Department, Bambino Gesù Pediatric Hospital, Piazza di Sant'Onofrio 4, 00165 Rome, Rome, Italy
| | - Lara Lambiase
- Infectious Disease Department, Aurelia Hospital, Via Aurelia 860, 00165 Rome, Rome, Italy
| | - Diletta Cassini
- General Surgery, Policlinico Abano Terme, Piazza C Colombo 1, 35031 Abano Terme (PD), Padua, Italy
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Tocchi A, Mazzoni G, Puma F, Miccini M, Daddi G, Bettelli E, Cassini D, Brozzetti S. Clinical Significance of Serum Gastrin Levels in Patients with Colorectal Cancer. Int J Biol Markers 2018; 19:46-51. [PMID: 15077926 DOI: 10.1177/172460080401900106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims An association between elevated serum gastrin levels and the presence of human colorectal cancer has been reported, and gastrin has been shown to stimulate the growth of experimentally induced colon neoplasia. The aim of this study was to determine the preoperative and postoperative concentrations of serum gastrin in 53 patients with colorectal cancer and to assess the correlation between gastrin levels and tumor characteristics and prognosis. Materials and Methods A prospective study was performed over a six-year period during which 53 patients received potentially curative surgery for colorectal cancer. The prognostic variables used for the analysis included age, sex, tumor site, stage and degree of differentiation, preoperative and postoperative serum values of carcinoembryonic antigen (CEA) and gastrin, cancer-related mortality, and survival. CEA and gastrin serum values were determined using radioimmunological methods. Follow-up was carried out with clinical and radiological tests. Results The mean preoperative gastrin concentration was 51.2 ± 27.4 pg/mL (range 12–146). Significantly increased serum gastrin concentrations, which returned to normal after surgery, were detected only in patients with well-differentiated cancer (74.2 ± 28.3 pg/mL; moderately differentiated, 52.1 ± 23.8; poorly differentiated, 29.9 ± 12.3, p=0.02). The prognosis was unrelated to serum gastrin level; instead, tumor stage, preoperative CEA value, and degree of differentiation affected patient survival. Conclusions This study showed that the serum gastrin concentration is not an appropriate clinical oncogenic factor. Although occurring only in well-differentiated tumors, serum gastrin is unrelated to the prognosis of patients with colorectal cancer.
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Affiliation(s)
- A Tocchi
- First Surgical Department, University of Rome La Sapienza Medical School, Rome, Italy.
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Cassini D, Miccini M, Gregori M, Manoochehri F, Baldazzi G. Impact of radiofrequency energy on intraoperative outcomes of laparoscopic colectomy for cancer in obese patients. Updates Surg 2017; 69:471-477. [PMID: 28474219 DOI: 10.1007/s13304-017-0454-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
Abstract
Nowadays laparoscopic approach is accepted as a valid alternative to open surgery for the treatment of colorectal cancer. Several studies consider this approach to be safe and feasible also in obese patients, even if dissection in these patients may require a longer operative time and involve higher blood loss. To facilitate laparoscopic approach, more difficult in these patients, several energy sources for laparoscopic dissection and sealing, has been adopted recently. The aim of this study is to investigate the possible intraoperative advantages of radiofrequency energy in terms of blood loss and operative time in obese patients undergoing laparoscopic resection for cancer. All patients who underwent laparoscopic surgery for colorectal cancer from January 2010 to December 2015 were registered in a prospective database. Patients with a body mass index BMI (kg/m2) ≥30 were defined as obese, and patients with a BMI (kg/m2) <30 were defined as non-obese. All 136 obese patients observed were divided retrospectively into 2 groups according to the devices used for dissection: 83 patients (Historical group: B) on whom dissection and coagulation were performed using other energy sources (monopolar electrocautery scissors, bipolar electrical energy, ultrasonic coagulating shears) and 53 patients who were treated with electrothermal bipolar vessel sealing (Caiman group: A). In group A, the Laparoscopic Caiman 5 (Aesculap AG, Tuttlingen, Germany) was the only instrument employed in the whole procedure. The study examined only three types of operation: right colectomy (RC), left colectomy (LC), and anterior resection (AR). Preoperative data were similar for RC, LC, and AR in both groups (A and B). The mean operative time was statistically shorter in the Caiman group than in the Historical group [104 vs 124 min (p 0.004), 116 vs 140 min (p 0.004), and 125 vs 151 min (p 0.003) for RC, LC, and AR between group A and B, respectively]. Also intraoperative blood loss results significantly lower in the Caiman group than in the historical one [52 ml vs 93 for RC (p 0.003); 65 vs 120 ml for LC (p 0.001); 93 vs 145 ml for AR (p 0.002) between group A and B, respectively]. No intraoperative complications were recorded in either group. The mean conversion rate was 4.4% (6 patients). There were no statistical differences in intensive care unit (ICU) stay, functional outcomes, mean hospital stay and overall morbidity rate between the two groups. There was no mortality in either group. The use of the Caiman EBVS instrument shows significant advantages with respect to a small number of intraoperative parameters. We can conclude that use of this radiofrequency device, in the laparoscopic approach, offers advantages in terms of lower intraoperative blood loss and shorter operative time in obese patients with colorectal cancer.
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Affiliation(s)
- Diletta Cassini
- Department of General and Mini-invasive Surgery, Policlinic of Abano Terme Piazza Cristoforo Colombo, Abano Terme (Padua), Italy.
| | - Michelangelo Miccini
- First Department of Surgery of the University of Rome "Sapienza" Medical School, Rome, Italy
| | - Matteo Gregori
- First Department of Surgery of the University of Rome "Sapienza" Medical School, Rome, Italy
| | - Farshad Manoochehri
- Department of General and Mini-invasive Surgery, Policlinic of Abano Terme Piazza Cristoforo Colombo, Abano Terme (Padua), Italy
| | - Gianandrea Baldazzi
- Department of General and Mini-invasive Surgery, Policlinic of Abano Terme Piazza Cristoforo Colombo, Abano Terme (Padua), Italy
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Cassini D, Miccini M, Manoochehri F, Gregori M, Baldazzi G. Emergency Hartmann's Procedure and Its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis. Surg Innov 2017; 24:557-565. [PMID: 28748737 DOI: 10.1177/1553350617722226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hartmann's procedure (HP) followed by reversal restoration is the first choice for treatment of diffuse diverticular peritonitis. There is no unanimous consensus regarding the use of laparoscopy to treat the same condition. METHODS Data from 60 patients with diverticular diffuse peritonitis who underwent urgent HP followed by laparoscopic reversal were retrospectively analyzed. Patients were divided into 2 groups according to the open or laparoscopic HP (OHP, 24 patients; LHP, 36 patients). Outcomes were measured in terms of functional recovery, morbidity, mortality, and length of hospital stay. RESULTS HPs showed no differences among the groups in terms of operative time, blood loss, and length of intensive care unit stay. Overall morbidity was significantly lower in LHP than in OHP, corresponding to 33.3% and 66.7% respectively ( P = .018). The incidence of both surgical and medical complications was higher in OHP than in LHP (41.7% vs 22.2% [ P = .044] and 45.8% vs 24.3% [ P = .023], respectively). Mortality was 16.6% for each group. LHP showed a faster return to bowel movements and a shorter hospital stay than OHP. The secondary intestinal reversal was possible in 92% of cases, successfully completed laparoscopically in 91.3%. No patients of LHP group required a conversion to open intestinal reversal. CONCLUSION LHP for treatment of diverticular diffuse peritonitis showed significantly lower morbidity, faster recovery, shorter hospital stay, and higher rates of successful laparoscopic reversal when compared with OHP.
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Crafa F, Smolarek S, Missori G, Shalaby M, Quaresima S, Noviello A, Cassini D, Ascenzi P, Franceschilli L, Delrio P, Baldazzi G, Giampiero U, Megevand J, Maria Romano G, Sileri P. Transanal Inspection and Management of Low Colorectal Anastomosis Performed With a New Technique: the TICRANT Study. Surg Innov 2017; 24:483-491. [PMID: 28514887 DOI: 10.1177/1553350617709182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anastomotic leakage is one of the most serious complications after rectal cancer surgery. METHOD A prospective multicenter interventional study to assess a newly described technique of creating the colorectal and coloanal anastomosis. The primary outcome was to access the safety and efficacy of this technique in the reduction of anastomotic leak. RESULT Fifty-three patients with rectal cancer who underwent low or ultra-low anterior resection were included in the study. There were 35 males and 18 females, with a median age of 68 years (range = 49-89 years). The median tumor distance from the anal verge was 8 cm (range = 4-12 cm), and the median body mass index was 24 kg/m2 (range = 20-35 kg/m2). Thirty patients underwent open, 16 laparoscopic, and 7 robotic surgeries. Multiple firing (2-charges) was required in 30 patients to obtain a complete rectal division. Forty-five patients had colorectal anastomosis, and 8 patients had coloanal anastomosis. The protective ileostomy was created in 40 patients at the time of initial surgery. There was no mortality in the first 30 days postoperatively, and only 10 (19%) patients developed complications. There were 3 anastomotic leakages (6%); 2 of them were subclinical with ileostomy created at initial operation and both were treated conservatively with transanal drainage and intravenous antibiotics. One patient required reoperation and ileostomy. The median length of hospital stay was 10 days (range = 4-20 days). CONCLUSION Our technique is a safe and efficient method of creation of colorectal anastomosis. It is also a universal method that can be used in open, laparoscopic, and robotic surgeries.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paolo Delrio
- 5 Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
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Miccini M, Cassini D, Gregori M, Gazzanelli S, Cassibba S, Biacchi D. Ultrasound-Guided Placement of Central Venous Port Systems via the Right Internal Jugular Vein: Are Chest X-Ray and/or Fluoroscopy Needed to Confirm the Correct Placement of the Device? World J Surg 2016; 40:2353-8. [PMID: 27216807 DOI: 10.1007/s00268-016-3574-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/07/2023]
Abstract
BACKGROUND Percutaneous central venous port (CVP) placement using ultrasound-guidance (USG) via right internal jugular vein is described as a safe and effective procedure. The aim of this study is to determine whether intraoperative fluoroscopy (IF) and/or postoperative chest X-ray (CXR) are required to confirm the correct position of the catheter. METHODS Between January 2012 and December 2014, 302 adult patients underwent elective CVP system placement under USG. The standard venous access site was the right internal jugular vein. The length of catheter was calculated based on the height of the patient. IF was always performed to confirm US findings. RESULTS 176 patients were men and 126 were women and average height was 176.2 cm (range 154-193 cm). The average length of the catheter was 16.4 cm (range 14-18). Catheter malposition and pneumothorax were observed in 4 (1.3 %) and 3 (1 %) patients, respectively. IF confirmed the correct position of the catheter in all cases. Catheter misplacement (4 cases) was previously identified and corrected on USG. Our rates of pneumothorax are in accordance with those of the literature (0.5-3 %). CONCLUSION Ultrasonography has resulted in improved safety and effectiveness of port system implantation. The routine use of CXR and IF should be considered unnecessary.
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Affiliation(s)
| | - Diletta Cassini
- Department of Surgery, "Abano Terme" Hospital, Abano Terme, Padua, Italy
| | - Matteo Gregori
- First Department of Surgery, Sapienza University Medical School, Rome, Italy
| | - Sergio Gazzanelli
- Department of Anaesthesiology, Sapienza University Medical School, Rome, Italy
| | - Simone Cassibba
- First Department of Surgery, Sapienza University Medical School, Rome, Italy
| | - Daniele Biacchi
- First Department of Surgery, Sapienza University Medical School, Rome, Italy
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Cerullo G, Cassini D, Martellucci J, Baldazzi G. Laparoscopic approach in a case of retroperitoneal and mesorectal haematoma following STARR procedure. Int J Surg Case Rep 2015; 6C:237-40. [PMID: 25553530 PMCID: PMC4337917 DOI: 10.1016/j.ijscr.2014.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/29/2014] [Accepted: 10/08/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Stapled transanal rectal resection (STARR) is a widely accepted procedure for treatment of obstructed defecation syndrome. PRESENTATION OF CASE We analyzed major bleeding following STARR and exposed our experience regarding its conservative management with particular attention about diagnostic and therapeutic aspects. DISCUSSION A case by case discussion should be carried out and treatments should be driven by the features and the progression of the haematoma with regards to size, inflammatory signs or severe rectal obstruction. CONCLUSION If a second surgical time and exploration is considered, laparoscopy should be an effective choice while laparotomy, stoma or rectal resection should be considered in those cases with strong suspicious of peritonitis and pelvic abscess.
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Affiliation(s)
- Guido Cerullo
- General and Mininvasive Surgery - Policlinic of Abano Terme, Italy; Second Unit of General Surgery - "Santa Maria degli Angeli" Hospital of Pordenone, Italy.
| | - Diletta Cassini
- General and Mininvasive Surgery - Policlinic of Abano Terme, Italy
| | - Jacopo Martellucci
- General, Emergency and Minimally Invasive Surgery - Careggi University Hospital of Florence, Italy
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Abstract
BACKGROUND Deep pelvic endometriosis is a complex disorder that affects 6% to 12% of all women in childbearing age. The incidence of bowel endometriosis ranges between 5.3% and 12%, with rectum and sigma being the most frequently involved tracts, accounting for about 80% of cases. It has been reported that segmental colorectal resection is the best surgical option in terms of recurrence rate and improvement of symptoms. The aim of this study is to analyze indications, feasibility, limits, and short-term results of robotic (Da Vinci Surgical System)-assisted laparoscopic rectal sigmoidectomy for the treatment of deep pelvic endometriosis. PATIENTS AND METHODS Between January 2006 and December 2010, 19 women with bowel endometriosis underwent colorectal resection through the robotic-assisted laparoscopic approach. Intraoperative and postoperative data were collected. All procedures were performed in a single center and short-term complications were evaluated. RESULTS Nineteen robotic-assisted laparoscopic colorectal resections for infiltrating endometriosis were achieved. Additional procedures were performed in 7 patients (37%). No laparotomic conversion was performed. No intraoperative complications were observed. The mean operative time was 370 minutes (range = 250-720 minutes), and the estimated blood loss was 250 mL (range = 50-350 mL). The overall complication rate was 10% (2 rectovaginal fistulae). CONCLUSIONS Deep pelvic endometriosis is a benign condition but may have substantial impact on quality of life due to severe pelvic symptoms. We believe that robotic-assisted laparoscopic colorectal resection is a feasible and relatively safe procedure in the context of close collaboration between gynecologists and surgeons for treatment of deep pelvic endometriosis with intestinal involvement, with low rates of complications and significant improvement of intestinal symptoms.
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Cerullo G, Cassini D, Baldazzi G. Application of Petersen Index score for Dukes'B colorectal cancer in a population of 103 consecutive resected patients. Updates Surg 2012; 64:95-9. [PMID: 22460519 DOI: 10.1007/s13304-012-0146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 03/14/2012] [Indexed: 02/07/2023]
Abstract
Dukes' B colorectal cancer (CRC) represents a wide spectrum of disease from early penetration through the bowel wall to aggressive and extensive tumours with extramural venous spread and involvement of the serosa, surgical margins or adjacent organs. Among Dukes' B cancers, Petersen Index allows stratification to identify those patients whom chemotherapy may benefit. One hundred and three resected patients with CRC Dukes' B were included prospectively in a database and considered in the present study. According to Petersen Index, a score (from 0 to 4) for each patient was calculated on the basis of peritoneal and margin involvement, venous invasion and tumour perforation. Twenty-four out of 103 tumours were located in the rectum and 79 in the colon. According to PI score 59 patients had a score of 0, 30 of 1 and 14 of ≥2. The overall R0 resection was achieved in 95.1 % of cases and the majority of patients with PI score of ≥2 were R1-2. The mean of harvested lymph nodes was 23.6 (±10.7) with no difference according to the PI score. Patients in the high-risk group had a worse 5-year survival rate (66.3 %) compared with the other group (P < 0.009). Multivariate analysis validated the PI score as a significant independent factor (P = 0.017). Both high-quality pathology and adequate harvested lymph nodes are needed for a proper staging. Even though the influence of PI score on survival is confirmed as it leads to an additional rate of colorectal cancer being considered for adjuvant therapy, we underline that a comparison with additional clinical and histological prognostic factors should be needed.
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Affiliation(s)
- Guido Cerullo
- Department of General and Mini-invasive Surgery, Policlinic of Abano Terme, Abano Terme, Italy.
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Miccini M, Borghese O, Cassini D, Gregori M, Tocchi A. Desmoplastic fibroblastoma of the thigh. A case report. Ann Ital Chir 2011; 82:225-8. [PMID: 21780566 DOI: pmid/21780566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Desmoplastic fibroblastoma (DF) is an extremely rare benign soft tissue tumor, prevalent in adult men, mostly arising in deep regions of extremities. The tumor presents with a slowly growing and no recurrence or metastases after surgical excision. Histologically, DF is characterized by a collagenous stroma that contains spindle- and stellated-shaped fibroblastic cells positive for vimentin. Differential diagnosis with locally aggressive soft tissue tumors could be difficult. This case report deals with the clinical pathological and immunoistochemical features of a DF of the left thigh in a 63-years old man.
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Miccini M, Borghese O, Scarpini M, Cassini D, Gregori M, Amore Bonapasta S, Tocchi A. Anastomotic leakage and septic complications: impact on local recurrence in surgery of low rectal cancer. Ann Ital Chir 2011; 82:117-23. [PMID: 21682101 DOI: pmid/21682101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We thought to determine the influence of anastomotic leakages (AL) and septic complications (SC) on the incidence of local recurrence (LR) in patients undergoing curative surgery for rectal cancer. METHODS The records of 479 patients (286 male, 193 female; median age 67 years) who received, between 1966 and 1975 (Group A) and 1976 and 1985 (Group B), curative surgery for middle to low rectal cancer were retrospectively reviewed. All patients received mesorectal excision in the course of abdominoperineal excision (Group A) and of anterior resection with colorectal anastomosis (Group B). The outcome of SC in both groups and that of AL in Group B were investigated. AL were divided into clinical leaks (CL) and radiological leaks (RL). All patients surviving surgery were followed up for a mean period of 71 months. The development of pelvic recurrence was registered. The effect of SC and AL on LR was statistically analyzed. RESULTS LR was diagnosed in 24 (9.3%) patients of Group A. No difference was detected between patients with SC (9.3%) and those without (9.3%). In Group B, LR occurred in 28 (12.7%) patients: 12.5% without SC and 12.7% with SC. A significant difference in the prevalence of LR was found between patients with CL (14.2%) and those with RL (30.0%). When CL were excluded, RL resulted as an independent predictor of LR. DISCUSSION Many factors have been shown to affect the rate of LR, including operative technique and surgeon expertise as well as margins of clearance and tumor stage. In our study, overall LR rate of Group B was 13.2%. The incidence of this event in patients with AL (24%) was significantly higher than that in the nonleakage group (11.1%). Correspondent results have been reported by some authors who evidenced RL as a negative prognostic factor for higher rates of LR. The mechanism by which AL affects LR remains to be elucidated. CONCLUSIONS All were found to be associated with higher rates of LR, especially if associated with prolonged inflammatory local reaction.
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Miccini M, Borghese O, Scarpini M, Cassini D, Gregori M, Amore Bonapasta S, Tocchi A. Urgent surgery for sigmoid diverticulitis. Retrospective study of 118 patients. Ann Ital Chir 2011; 82:41-8. [PMID: 21657154 DOI: pmid/21657154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Aim of our study was to identij5 the risk factors for operative morbility and mortality after urgent surgery for complicated sigmoid diverticulitis. A further end point was define the adequate surgical approach in these patients. METHODS Data fJom 118 patients who were admitted for emergency surgery between 2000 and 2009 for non-haemorrhagic complicated diverticulitis of the sigmoid colon were retrospectively evaluated and analysed. Operative options included resection with primary anastomoses (PA), Hartmann's procedure (HP) and colostomy. All operative complications were noted and potential risk factors listed. RESULTS One hundred eighteen patients were enrolled in this study. Surgery for peritonitis was indicated for 102 patients and for intestinal obstruction in the remainder. Overall morbidity and mortality rates were 37.3% and 9.3%, respectively. Primary resection was performed on 113 patients (95.8%). Age greater than 70 years, diffuse peritonitis, Mannheim Peritonitis Index (MPI) above 18, and symptoms lasting longer than 24 hours are considered as independent risk factors for operative morbidity and mortality. DISCUSSION Our results confirmed that while age older than 70 years and delaying treatment (>24h) are independent risk factors for operative morbidity and mortality, comorbidity is not. According to general guidelines, first target of surgery was to attempt a primary resection of the diseased colon (95.8% of our patients). In our series an high rate of Hartmann procedure (HP) in Hinchey's class 2 patients was observed. This unusually high number is explained by the rate (68.4%) of pelviperitonitis diagnosed in these patients. Extended pelvic peritonitis is generally defined as a local peritonitis (class 2 Hinchey), which is not accurate. Colonic resection in these cases would not completely remove peritoneal contamination and renders the indication for PA questionable. CONCLUSIONS Emergency surgery for complicated diverticulitis is characterised by high rates of morbidity and mortality. Age greater than 70 years, symptoms lasting longer than 24 hours, MPI above 18, and diffuse peritonitis were significant predictors. Early eradication of septic focus is the main goal of surgery. Primary anastomosis is recommended only if sepsis is completely removed.
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Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy of intra-operative ultrasound (IOUS) imaging in detecting liver secondaries at the time of primary colorectal surgery and to evaluate the impact of IOUS on patient management. METHODS Data from 167 patients with primary colorectal cancer who were admitted for elective surgery between January 1995 and December 2003 were prospectively evaluated and analysed. All patients underwent pre-operative abdominal ultrasonography (US) and computed tomography (CT), as well as IOUS. The final diagnosis of liver metastases was made by means of histological examination of either biopsy or surgical specimens. The sensitivities of pre-operative US and CT were compared with the sensitivity of IOUS, referred to histology. Changes in surgical management owing to IOUS findings were noted. RESULTS IOUS supplied additional information in the case of 31 patients. In 28 of these patients, this information had a major impact on the intra-operative strategy, in that the procedure was altered. CONCLUSIONS IOUS is safe, simple to perform and more accurate than pre-operative imaging. It reduces the number of patients subjected to superfluous surgery. The use of IOUS is therefore encouraged during colorectal cancer surgery.
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Affiliation(s)
- Gianluca Mazzoni
- Department of Surgery, 'La Sapienza' University Medical School, Rome, Italy
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Abstract
BACKGROUND Bronchobiliary fistula (BBF) is an uncommon but severe complication of hydatid disease of the liver. Operation is considered the treatment of choice but the most appropriate operation is uncertain. The aim of this study was to evaluate the early and long-term outcomes following different surgical procedures. METHODS A retrospective evaluation of 31 patients with BBF was performed. Surgical access consisted of laparotomy, thoracotomy or a thoracoabdominal (TA) incision. Surgical procedures for the treatment of the cyst were classified as conservative or radical. RESULTS Radical treatment including lung resection and pericystectomy was performed in all patients in whom the surgical exposure was obtained by either thoracotomy or TA. Of the patients treated by laparotomy, two had a pericystectomy, and four had drainage of the cyst. There were two deaths among the seven thoracotomy patients and one among the 18 TA patients. Pleural effusion was observed in six of the TA, two of the thoracotomy, and three of the laparotomy patients. Biliary fistula occurred in two of the five thoracotomy patients surviving operation and in two laparotomy patients (2/6). Progression of the lung disease was observed in four laparotomy patients and in one thoracotomy patient. CONCLUSIONS The better outcome achieved in TA patients is the result of the simultaneous radical treatment of all the pathological aspects of BBF.
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Affiliation(s)
- Adriano Tocchi
- First Department of Surgery, University of Rome La Sapienza Medical School, Rome, Italy.
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Mazzoni G, Tocchi A, Miccini M, Bettelli E, Cassini D, De Santis M, Colace L, Brozzetti S. Surgical treatment of liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis 2007; 22:77-83. [PMID: 16538491 DOI: 10.1007/s00384-006-0096-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [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] [Accepted: 12/23/2005] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The liver is the most frequent site of liver metastases (LM) from colorectal cancer. Because of short life expectancies and improved nonoperative modalities, the role of liver resection in elderly patients with LM is unclear. METHODS During a 15-year period, 197 patients underwent liver resection for colorectal metastases. This study was designed to compare morbidity, mortality, and long-term outcome after hepatic resection in patients aged 70 years and older and in patients younger than 70. According to the age at the time of operation, patients were divided into two groups. Group A included patients aged 70 years or older and group B included younger patients. RESULTS The clinical and pathologic parameters of the two groups were compared and tested as factors affecting early and long-term outcomes after resection. A modified oncologic clinical risk score (CRS) was tested on this series of patients. Overall morbidity was 16.3% (group A 20.7% vs group B 14.6%; P=0.18). Hospital mortality was 3% (5.7% in group A and 2.1% in group B; P=0.19). Actuarial 5 years survival were 30% in group A and 38% in group B (P=ns). DISCUSSION The presence of more than three Fong's CRS parameters and microscopic involvement of resectional margin directly affected survival. Under meticulous preoperative assessment and postoperative care, liver resection for LM is justified in patients over 70 years of age; age by itself may not be a controindication to surgery.
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Affiliation(s)
- Gianluca Mazzoni
- Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Medical School, Viale del Policlinico, Rome, 00100, Italy.
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Brozzetti S, Mazzoni G, Miccini M, Puma F, De Angelis M, Cassini D, Bettelli E, Tocchi A, Cavallaro A. Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 2006; 141:137-42. [PMID: 16490889 DOI: 10.1001/archsurg.141.2.137] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
HYPOTHESIS The treatment of cancer in elderly patients has become a global clinical issue, considering the increasingly longer life expectancy. Three quarters of patients with pancreatic adenocarcinoma are older than 60 years. Surgical resection is the only chance of cure, and early outcome of pancreaticoduodenectomy in elderly patients is comparable with that obtained in a younger population. DESIGN During an 11-year period, 166 patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. Clinical and demographic factors were evaluated by univariate and multivariate analyses to test their effect on early outcome. SETTING State university medical school tertiary care center. PATIENTS One hundred sixty-six patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. They were divided into 2 groups according to age (group A for patients older than 70 years, group B for patients younger than 70 years). INTERVENTION Pancreaticoduodenectomy was performed using a Whipple procedure. An end-to-end pancreaticojejunostomy was constructed. Lymphadenectomy was carried out along the hepatoduodenal ligament, common hepatic artery, vena cava, superior mesenteric vein, and along the right side of the superior mesenteric artery. Four abdominal drainage sites were routinely used. MAIN OUTCOME MEASURES The postoperative hospital stay was calculated and morbidity and mortality were assessed. RESULTS Significantly higher operative morbidity and mortality were observed in group A (group A, 49.1% vs group B, 45.8% and 10.5% vs 3.7%, respectively). Underlying comorbid conditions in group B patients influenced postoperative morbidity but not mortality. Rate and nature of surgical complications were indicated as causes of significant higher mortality in group B patients. CONCLUSIONS An aggressive surgical approach is justified for elderly patients with pancreatic adenocarcinoma. However, surgical complications that lead to reoperation are responsible for a high mortality in elderly patients. In addition to general causes, such as concomitant disorders, reduced functional reserve, poor tolerance to stress, and the texture of the pancreatic remnant, there are specific prognostic factors affecting pancreaticojejunostomy leakage and related mortality.
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Affiliation(s)
- Stefania Brozzetti
- Department of Surgery, University of Rome La Sapienza Medical School, Rome, Italy
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Miccini M, Mazzoni G, Cassini D, Bettelli E, Colace L, De Angelis M, Brozzetti S, Tocchi A. [Colorectal carcinoma in the young. Prognostic factors]. G Chir 2005; 26:365-70. [PMID: 16371187 DOI: pmid/16371187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal carcinoma is the third most frequently diagnosed malignant neoplasm. Usually patients affected by this neoplasia belong to VI decade of life. However approximately 2-8% of tumors arise in patients with age under 40 years. Aim of the study was to analyse the results of surgical treatment of colorectal cancer in patients aged under forty. From January 1987 to December 2002, 46 patients under forty years with colorectal cancer underwent surgical procedure. No perioperative mortality was registered, and complications were evidenced in nine patients (20%). Actuarial five years survival was 33%, and overall mean survival was 53 months. Univariate and multivariate analyses identified as prognostic factors the tumor grade, Dukes' stage, nodal status, and length of symptoms.
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Affiliation(s)
- M Miccini
- Dipartimento de Chirurgia Pietro Valdoni, Università degli Studi La Sapienza di Roma
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Tocchi A, Mazzoni G, Brozzetti S, Miccini M, Cassini D, Bettelli E. Hepatic resection in stage IV colorectal cancer: prognostic predictors of outcome. Int J Colorectal Dis 2004; 19:580-5. [PMID: 15103491 DOI: 10.1007/s00384-004-0594-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [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] [Accepted: 02/05/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Hepatic resection has been proposed as an effective way to treat metastatic colorectal carcinoma. The aim of the study was to determine if contemporary resection of intestinal primary tumor and hepatic metastases is effective in the treatment of patients with metastases that are recognized at the initial clinical presentation of the primary tumor. METHODS In a retrospective study, univariate and multivariate models were used to analyze the effect of patient demographics, tumor characteristics, and treatment factors on early and long-term outcome of patients submitted to synchronous intestinal and hepatic resection for colorectal liver metastases. From 1988 to 1999, 78 patients underwent surgical resection of primary colorectal tumor and hepatic metastases with curative intent. Criteria for study recruitment included primary tumor controllable, no extrahepatic disease detectable, and negative surgical margins of hepatic resection. RESULTS The univariate analysis disclosed as adverse predictors of the long-term outcome the numbers of metastases (</=3; >3), pre-operative CEA value >100 ng/ml, resection margin <10 mm, and portal nodal status. Multivariate analysis confirmed number of metastases, resection margin and portal nodal status as independent predictors. CONCLUSIONS Our findings confirm hepatic resection as an effective procedure when undertaking combined bowel and hepatic resection. The applicability and the outcome of this surgical strategy is definitively influenced by the chance of a radical resection of the primary tumor, the number of hepatic metastases, resection margin wider than 1 cm, positive portal nodes, and the absence of any extrahepatic metastatic disease.
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Affiliation(s)
- Adriano Tocchi
- First Department of Surgery, University of Rome La Sapienza Medical School, Viale del Policlinico 155, 00161 Rome, Italy.
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Tocchi A, Mazzoni G, Miccini M, Bettelli E, Cassini D, Brozzetti S. [Primary adenocarcinoma of the ureter. Case report]. G Chir 2004; 25:291-3. [PMID: 15560304 DOI: pmid/15560304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary ureteral adenocarcinoma is an infrequent histological type of urinary neoplasm. Many authors consider intestinal metaplasia the pivotal event of the pathogenetic process, whether it occurs on a pre-existing urothelial carcinoma or on a normal urothelium. Diagnosis is essentially based on case history and clinical findings (hematuria and pain) and on diagnostic imaging. Treatment is surgical and the ideal procedure is nephroureterectomy with excision of a bladder margin adjacent to the ureteral opening and ispilateral para-aortoiliac lymphadenectomy. A 76-year-old man with primary adenocarcinoma of the ureter case is reported.
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Affiliation(s)
- A Tocchi
- Università degli Studi La Sapienza--Roma, Dipartimento di Chirurgia Pietro Valdoni
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Abstract
BACKGROUND AND AIMS Initial experience with the posterior sphincterotomy for treating anal fissures was unsatisfactory, with a significant rate of recurrences and anal incontinence. This report describes the lateral approach to complete section of the internal sphincter. PATIENTS AND METHODS Between 1997 and 2001 we surgically treated 164 patients for anal fissure. Preoperative and postoperative anal manometries were recorded. Postoperative course and early and long-term results were recorded. RESULTS No fissure failed to heal. Early complications included bleeding, hematoma, and pain. A transient, variable degree of incontinence occurred in 15 patients and persistent incontinence to flatus and soiling in 5. After total sphincterotomy no long-term complication was observed. Patient satisfaction was 96%. CONCLUSION Total subcutaneous, internal sphincterotomy is a safe, effective procedure for the treatment of chronic anal fissure.
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Affiliation(s)
- Adriano Tocchi
- First Department of Surgery, Medical School, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy.
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Tocchi A, Mazzoni G, Puma F, Miccini M, Daddi G, Bettelli E, Cassini D, Brozzetti S. Clinical significance of serum gastrin levels in patients with colorectal cancer. Int J Biol Markers 2004. [PMID: 15077926 DOI: 10.5301/jbm.2008.2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS An association between elevated serum gastrin levels and the presence of human colorectal cancer has been reported, and gastrin has been shown to stimulate the growth of experimentally induced colon neoplasia. The aim of this study was to determine the preoperative and postoperative concentrations of serum gastrin in 53 patients with colorectal cancer and to assess the correlation between gastrin levels and tumor characteristics and prognosis. MATERIALS AND METHODS A prospective study was performed over a six-year period during which 53 patients received potentially curative surgery for colorectal cancer. The prognostic variables used for the analysis included age, sex, tumor site, stage and degree of differentiation, preoperative and postoperative serum values of carcinoembryonic antigen (CEA) and gastrin, cancer-related mortality, and survival. CEA and gastrin serum values were determined using radioimmunological methods. Follow-up was carried out with clinical and radiological tests. RESULTS The mean preoperative gastrin concentration was 51.2+/-27.4 pg/mL (range 12-146). Significantly increased serum gastrin concentrations, which returned to normal after surgery, were detected only in patients with well-differentiated cancer (74.2+/-28.3 pg/mL; moderately differentiated, 52.1+/-23.8; poorly differentiated, 29.9+/-12.3, p=0.02). The prognosis was unrelated to serum gastrin level; instead, tumor stage, preoperative CEA value, and degree of differentiation affected patient survival. CONCLUSIONS This study showed that the serum gastrin concentration is not an appropriate clinical oncogenic factor. Although occurring only in well-differentiated tumors, serum gastrin is unrelated to the prognosis of patients with colorectal cancer.
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Affiliation(s)
- A Tocchi
- First Surgical Department, University of Rome La Sapienza Medical School, Rome, Italy.
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Tocchi A, Mazzoni G, Miccini M, Bettelli E, Cassini D, Brozzetti S. [Rectal cancer in women]. G Chir 2003; 24:73-7. [PMID: 12822211 DOI: pmid/12822211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective chart review was performed utilizing the First Department of Surgery of the University of Rome "La Sapienza" Medical School database. Ninety-two women who underwent abdominal surgery between 1980 and 1993 for rectal cancer were identified. Data collected included demographics, history, intraoperative findings and complications, cancer histology and stage and follow up. Special attention was focused on intraoperative incidental gynecological findings and follow up. Twenty-two patients being previously submitted to hysterectomy and three with oral intake of hormones were dismitted from the study. Of the remaining 67 patients gynecological procedure was associated to rectal surgery because of a previously undiagnosed gynecological condition. No prophylactic oophorectomies were performed. At follow up 7 patients experienced further surgery for gynecologic disease. The necessity to offer these patients the benefit of a preoperative informed decision about adjunctive gynecologic surgery and indications for bilateral oophorectomy is discussed.
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Affiliation(s)
- A Tocchi
- Dipartimento di Chirurgia P. Valdoni, Università degli Studi La Sapienza, Roma
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Tocchi A, Mazzoni G, Puma F, Miccini M, Cassini D, Bettelli E, Tagliacozzo S. Adenocarcinoma of the third and fourth portions of the duodenum: results of surgical treatment. Arch Surg 2003; 138:80-5. [PMID: 12511157 DOI: 10.1001/archsurg.138.1.80] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
HYPOTHESIS To verify the adequacy of duodenal segmentectomy after intestinal derotation in the treatment of primary adenocarcinoma of the third and fourth portions of the duodenum. DESIGN A retrospective review of the surgical management of patients who underwent derotation of the third and fourth portions of the duodenum was undertaken to determine long-term outcome. SETTING Departments of surgery in 3 university hospitals. PATIENTS Between January 1, 1980, and December 31, 2000, 47 patients with primary adenocarcinoma of the third and fourth portions of the duodenum were surgically treated at 3 different institutions. MAIN OUTCOME MEASURES Details of primary surgery were abstracted from clinical records of the original hospital referral. Postoperative clinical course and long-term outcome were evaluated by a review of the hospital records and follow-up. RESULTS The results of a barium swallow test series was positive in 38 cases (80.8%) and esophagogastroduodenoscopy was primarily diagnostic in 30 patients (63.8%). In all cases duodenal segmentectomy was attempted. Twenty-two patients underwent palliative gastrojejunal bypass and in 9 patients pancreaticoduodenectomy was performed. In 16 cases duodenal segmentectomy was performed after intestinal derotation. Anastomoses were performed manually in all cases. Fifteen of the resected patients died of recurrent disease. A median (SD) disease-free survival of 36 (23.6) months (range, 6-85 months) was observed. The median (SD) overall survival was 37.5 (23.9) months (range, 11-85 months), the overall 5-year survival rate was 23% (11 patients), and the actuarial 5-year survival rate was 51% (24 patients). CONCLUSIONS Duodenal segmentectomy associated with intestinal derotation was shown to be a straightforward, safe procedure for the treatment of the primary adenocarcinoma of the third and fourth portions of the duodenum. This surgical procedure should be preferred to pancreaticoduodenectomy because it is associated with negligible rates of morbidity and mortality, while allowing for satisfactory margin clearance and adequate lymphadenectomy.
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Affiliation(s)
- Adriano Tocchi
- First Department of Surgery of the University of Rome La Sapienza Medical School, Rome, Italy.
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Tocchi A, Mazzoni G, Miccini M, Bettelli E, Cassini D, Assenza M, Puma F, Giuliani A. [Cecal volvulus]. G Chir 2002; 23:423-6. [PMID: 12652917 DOI: pmid/12652917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective study on 18 patients with cecal volvulus surgically treated was made. Demographics and clinical data, as well as treatment were determined from clinical reports. The operative procedures employed were cecostomy (56%), cecopexy (22%) and right colectomy (22%). The length of follow up averaged 63 months and there was one recurrence. The Authors suggest that cecostomy should be employed in patients with viable bowel, and resection should be limited to cases with gangrene.
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Affiliation(s)
- A Tocchi
- Dipartimento di Chirurgia P. Valdoni, Università degli Studi La Sapienza, Roma
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Tocchi A, Mazzoni G, Lepre L, Liotta G, Miccini M, Bettelli E, Cassini D, Agostini N, Costa G. [Carcinoma of the male breast. Prognostic factors and outcome of surgical treatment]. G Chir 2002; 23:325-9. [PMID: 12564307 DOI: pmid/12564307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective study was made on 18 male patients with breast carcinoma treated at the Department of Surgery "Pietro Valdoni" of the University "La Sapienza" of Rome, Medical School. Demographics, pathology, stages, and treatment were determined from clinical reports. All patients but one underwent modified radical mastectomy. The length of follow up averaged 57.5 months. Five years actuarial survival rate was 62%. In the current study the Authors suggest that the clinical, prognostic and treatment features of breast carcinoma in men are similar to those reported in literature for post-menopausal women.
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Affiliation(s)
- A Tocchi
- Università degli Studi La Sapienza, Roma Dipartimento di Chirurgia Pietro Valdoni
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Tocchi A, Lepre L, Mazzoni G, Costa G, Liotta G, Miccini M, Bettelli E, Cassini D. [Pancreatic anastomotic fistula after pancreaticoduodenectomy: incidence, significance and treatment]. G Chir 2002; 23:185-9. [PMID: 12228969 DOI: pmid/12228969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Authors reviewed the complications, and outcomes in a consecutives series of 97 patients undergoing pancreaticoduodenectomy. The clinical leak rate in this series was 21.8%. There was a difference in the pancreatic leak rate in those patients who underwent pancreatic ductal closure or end to end pancreaticojejunal invagination compared with end to side pancreaticojejunal anastomosis. The postoperative complication rate was 41.8% and the most common complications were pancreatic fistula. 9 deaths occurred in hospital or within 30 days from operation. Univariate and multivariate analysis revealed that operative technique, the pathological status of the pancreatic remnant, and mayor complications were the significant risk factors for the development of pancreatic anastomotic leak. In the 2000s pancreatic leak remains a potentially lethal problem. After pancreaticoduodenectomy, pancreatic remnant management by end to side pancreaticojejunostomy appeared safe in low-risk patients. Morbidity was greatest after pancreatic duct closure without anastomosis.
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Affiliation(s)
- A Tocchi
- Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi di Roma La Sapienza
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Tocchi A, Mazzoni G, Costa G, Cassini D, Bettelli E, Agostini N, Miccini M. Symptomatic nonparasitic hepatic cysts: options for and results of surgical management. Arch Surg 2002; 137:154-8. [PMID: 11822951 DOI: 10.1001/archsurg.137.2.154] [Citation(s) in RCA: 45] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Management options for symptomatic nonparasitic hepatic cysts (SNHC) lack verification through comparative studies with respect to safety and long-term effectiveness. HYPOTHESIS Open cystectomy is the treatment of choice for patients with SNHC. SETTING University hospital department of surgery. PATIENTS Data were retrospectively analyzed from the clinical charts of 34 patients (26 women and 8 men) undergoing surgery for SNHC from January 1, 1975, through January 1, 1999. Charts were obtained from the original hospital referral. MAIN OUTCOME MEASURES Morbidity rates and long-term recurrence. We considered the following variables for analysis: age, sex, hepatic cyst location, diameter of the cyst at primary surgery, symptoms, surgical procedure, postoperative morbidity and mortality, length of postoperative hospital stay, and long-term outcome. RESULTS The 34 patients underwent 47 operations for SNHC (mean diameter, 15.0 cm), with a mean follow-up of 50.0 months. Ten patients underwent open and 8, laparoscopic deroofing of the cyst. Enucleation of the cyst and hepatic resections were performed as primary procedures in 4 and 2 patients, respectively, and as secondary procedures in 6 and 7 patients, respectively. Two recurrences (25%) were found after laparoscopic deroofing and 3 (30%) after open deroofing. Two (50%) and 6 (100%) recurrences were found after cystojejunostomy and needle aspiration, respectively. No symptomatic recurrences occurred after 10 cystectomies and 9 hepatectomies. One operative death (3%) occurred; however, morbidity rates were 18% (6/34) and 15% (2/13) after primary and secondary surgery, respectively. CONCLUSIONS These results support our policy of performing open radical procedures in the treatment of SNHC; cystectomy is performed for primary surgery and hepatic resections for recurrences and complications. Conservative procedures have shown higher rates of recurrence and the need for further surgery. Only further technological improvements will allow a systematic and safe use of laparoscopy for radical surgery for SNHC.
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Affiliation(s)
- Adriano Tocchi
- First Department of Surgery, University of Rome La Sapienza, Italy.
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Tocchi A, Mazzoni G, Miccini M, Bettelli E, Cassini D. [Use of ileostomy and colostomy as temporal derivation in colorectal surgery]. G Chir 2002; 23:48-52. [PMID: 12043472 DOI: pmid/12043472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective study on 41 patients with primary stoma creation after low anterior resection of the rectum was made. Among the 41 patients 24 had a loop colostomy (Group A) and 17 had a loop ileostomy (Group B). The two groups were well matched for each of the data analysed and there was no significant difference in the rate of complications related to stomas creation and closure. In this study the Authors suggest that loop ileostomy is the best procedure to electively defunctionate colorectal anastomoses.
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Affiliation(s)
- A Tocchi
- I Facoltà di Medicina e Chirurgia, I Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Roma
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Tocchi A, Mazzoni G, Liotta G, Lepre L, Cassini D, Miccini M. Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients. Ann Surg 2001; 234:210-4. [PMID: 11505067 PMCID: PMC1422008 DOI: 10.1097/00000658-200108000-00011] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [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: 02/07/2023]
Abstract
OBJECTIVE To evaluate the correlation between biliary-enteric surgical drainage and the late development of cholangiocarcinoma of the biliary tract. SUMMARY BACKGROUND DATA In patients with biliary-enteric drainage, reflux of intestinal contents into the bile duct may occur and cause cholangitis, which is regarded as the most serious complication of these procedures. Lithiasis of the biliary tract and a previous biliary-enteric anastomosis have both been suggested to favor the late onset of cholangiocarcinoma. METHODS Consecutive patients (n = 1,003) undergoing three different procedures of biliary-enteric anastomosis (transduodenal sphincteroplasty, choledochoduodenostomy, and hepaticojejunostomy) between 1967 and 1997 were included in this study. The postoperative clinical course and long-term outcome were evaluated by a retrospective review of the hospital records and follow-up. Mean follow-up was 129.6 months. RESULTS Fifty-five (5.5%) cases of primary bile duct cancer were found among the 1,003 patients at intervals of 132 to 218 months from biliary-enteric anastomosis. The incidence of cholangiocarcinoma in the three groups was 5.8% in transduodenal sphincteroplasty patients, 7.6% in choledochoduodenostomy patients, and 1.9% in hepaticojejunostomy patients. The incidence of malignancy related to the different underlying diagnosis was 5.9%, 7.2%, and 1.9% in patients with choledocholithiasis, sphincter of Oddi stenosis, and postoperative benign stricture, respectively. Although only one patient who developed cholangiocarcinoma had previous concurrent lithiasis of the biliary tract, 40 patients had experienced mostly severe, recurrent cholangitis. No case of malignancy occurred in patients scored as having no cholangitis in the early and long-term postoperative outcome. Univariate and multivariate analyses have shown the presence of cholangitis as the only factor affecting the incidence of cholangiocarcinoma. CONCLUSIONS Chronic inflammatory changes consequent to biliary-enteric drainage should be closely monitored for the late development of biliary tract malignancies.
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Affiliation(s)
- A Tocchi
- First Department of Surgery of the University of Rome La Sapienza Medical School, Rome, Italy.
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