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Spolverato G, Bao QR, Delrio P, Guerrieri M, Ortenzi M, Cillara N, Restivo A, Deidda S, Spinelli A, Romano C, Bianco F, Sarzo G, Morpurgo E, Belluco C, Palazzari E, Chiloiro G, Meldolesi E, Coco C, Pafundi DP, Feleppa C, Aschele C, Bonomo M, Muratore A, Mellano A, Chiaulon G, Crimì F, Maretto I, Perin A, Urso EDL, Scarpa M, Bigon M, Scognamiglio F, Bergamo F, Del Bianco P, Gambacorta MA, Rega D, Pucciarelli S. Rectal sparing approach after preoperative radio - and/or Chemo-therapy (ReSARCh): a prospective, multicentre, observational study. Int J Surg 2024:01279778-990000000-01238. [PMID: 38518084 DOI: 10.1097/js9.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/03/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Rectal-sparing approaches for patients with rectal cancer who achieved a complete or major response following neoadjuvant therapy constitute a paradigm of a potential shift in the management of patients with rectal cancer, however their role remains controversial. The aim of this study was to investigate the feasibility of rectal-sparing approaches to preserve the rectum without impairing the outcomes. METHODS This prospective, multicentre, observational study investigated the outcomes of patients with clinical stage II-III mid-low rectal adenocarcinoma treated with any neoadjuvant therapy, and either transanal local excision or watch-and-wait approach, based on tumor response (major or complete) and patient/surgeon choice. The primary endpoint of the study was rectum preservation at a minimum follow-up of two years. Secondary endpoints were overall, disease-free, local and distant recurrence-free, and stoma-free survival at three years. RESULTS Of 178 patients enrolled in 16 centres, 112 (62.9%) were managed with local excision and 66 (37.1%) with watch-and-wait. At a median (interquartile range) follow-up of 36.1 (30.6-45.6) months, the rectum was preserved in 144 (80.9%) patients. The 3-year rectum-sparing, overall, disease-free, local recurrence-free, distant recurrence-free survival was 80.6% (95%CI 73.9-85.8), 97.6% (95%CI 93.6-99.1), 90.0% (95%CI 84.3-93.7), 94.7% (95%CI 90.1-97.2), and 94.6% (95%CI 89.9-97.2), respectively. The 3-year stoma-free survival was 95.0% (95%CI 89.5-97.6). The 3-year regrowth-free survival in the watch-and-wait group was 71.8% (95%CI 59.9-81.2). CONCLUSIONS In rectal cancer patients with major or complete clinical response after neoadjuvant therapy, the rectum can be preserved in about 80% of cases, without compromise the outcomes.
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Affiliation(s)
- Gaya Spolverato
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Quoc Riccardo Bao
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Paolo Delrio
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | | | | | - Nicola Cillara
- Department of Surgery, Santissima Trinità Hospital, Cagliari, Italy
| | - Angelo Restivo
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Simona Deidda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Antonino Spinelli
- Humanitas Clinical and Research Centre, Division of Colon and Rectal Surgery, Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Carmela Romano
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesco Bianco
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Giacomo Sarzo
- Department of Surgery, Hospital Sant' Antonio, Padova, Italy
| | - Emilio Morpurgo
- Department of Surgery, Hospital of Camposampiero, Camposampiero, Padova, Italy
| | - Claudio Belluco
- Department of Surgical Oncology, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - Elisa Palazzari
- Department of Radiation Oncology, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - Giuditta Chiloiro
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Elisa Meldolesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Claudio Coco
- Division of General Surgery 2, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Roma, Italy
| | - Donato Paolo Pafundi
- Division of General Surgery 2, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Roma, Italy
| | - Cosimo Feleppa
- Department of Surgery, Ospedale Sant'Andrea, La Spezia, Italy
| | - Carlo Aschele
- Medical Oncology Unit, Department of Oncology, Ospedale Sant'Andrea, La Spezia, Italy
| | | | - Andrea Muratore
- Department of General Surgery, E. Agnelli Hospital, Pinerolo, Italy
| | - Alfredo Mellano
- Surgical Oncology Unit, Candiolo Cancer Institute-IRCCS, Turin, Italy
| | - Germana Chiaulon
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Filippo Crimì
- Department of Radiology, Department of Medicine (DiMED), University of Padova, Padova, Italy
| | - Isacco Maretto
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Alessandro Perin
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Emanuele Damiano Luca Urso
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Marco Scarpa
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Mariasole Bigon
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Federico Scognamiglio
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - Francesca Bergamo
- Medical Oncology Unit 1, Istitituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Daniela Rega
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
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Mengardo V, Weindelmayer J, Veltri A, Giacopuzzi S, Torroni L, de Manzoni G, Agresta F, Alfieri R, Alfieri S, Antonacci N, Baiocchi GL, Bencini L, Bencivenga M, Benedetti M, Berselli M, Biondi A, Capolupo GT, Carboni F, Casadei R, Casella F, Catarci M, Cerri P, Chiari D, Cocozza E, Colombo G, Cozzaglio L, Dalmonte G, Degiuli M, De Luca M, De Luca R, De Manzini N, De Pasqual CA, De Pascale S, De Ruvo N, Di Cosmo M, Di Leo A, Di Paola M, Elio A, Ferrara F, Ferrari G, Fiscon V, Fumagalli U, Garulli G, Gennai A, Gentile I, Germani P, Gualtierotti M, Guerini F, Gurrado A, Inama M, La Torre F, Laterza E, Losurdo P, Macrì A, Marano A, Marano L, Marchesi F, Marino F, Massani M, Menghi R, Milone M, Molfino S, Montuori M, Moretto G, Morgagni P, Morpurgo E, Abdallah M, Nespoli L, Olmi S, Palaia R, Pallabazer G, Parise P, Pasculli A, Pericoli Ridolfini M, Pesce A, Pinotti E, Pisano M, Poiasina E, Postiglione V, Rausei S, Rella A, Rosa F, Rosati R, Rossi G, Rossit L, Rovatti M, Ruspi L, Sacco L, Saladino E, Sansonetti A, Sartori A, Scaglione D, Scaringi S, Schoenthaler C, Sena G, Simone M, Solaini L, Strignano P, Tartaglia N, Testa S, Testini M, Tiberio GAM, Treppiedi E, Vagliasindi A, Valmasoni M, Viganò J, Zanchettin G, Zanoni A, Zardini C, Zerbinati A. Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy (ADiGe) survey. Updates Surg 2022; 74:1839-1849. [PMID: 36279038 DOI: 10.1007/s13304-022-01397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
Abstract
AbstractEvidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.
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Marchegiani F, Palatucci V, Capelli G, Guerrieri M, Belluco C, Rega D, Morpurgo E, Coco C, Restivo A, De Franciscis S, Aschele C, Perin A, Bonomo M, Muratore A, Spinelli A, Ramuscello S, Bergamo F, Montesi G, Spolverato G, Del Bianco P, Gambacorta MA, Delrio P, Pucciarelli S. ASO Visual Abstract: Rectal Sparing Approach After Neoadjuvant Therapy in Patients with Rectal Cancer: The Preliminary Results of the ReSARCh Trial. Ann Surg Oncol 2022. [PMID: 35041095 DOI: 10.1245/s10434-021-11171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Francesco Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | - Valeria Palatucci
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | - Giulia Capelli
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | - Mario Guerrieri
- Surgery Clinic, Marche Polytechnic University, Ancona, Italy
| | - Claudio Belluco
- Oncological Surgery Department, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - Daniela Rega
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - Emilio Morpurgo
- Department of Surgery, Regional Center for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padova, Italy
| | - Claudio Coco
- Department of Surgical Sciences, Catholic University of Rome, Roma, Italy
| | - Angelo Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | | | | | - Alessandro Perin
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | | | - Andrea Muratore
- Division of General Surgery, E. Agnelli Hospital, Pinerolo, Turin, Italy
| | - Antonino Spinelli
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | | | | | - Giampaolo Montesi
- Radiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy.
| | | | | | - Paolo Delrio
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
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Marchegiani F, Palatucci V, Capelli G, Guerrieri M, Belluco C, Rega D, Morpurgo E, Coco C, Restivo A, De Franciscis S, Aschele C, Perin A, Bonomo M, Muratore A, Spinelli A, Ramuscello S, Bergamo F, Montesi G, Spolverato G, Del Bianco P, Gambacorta MA, Delrio P, Pucciarelli S. Rectal Sparing Approach After Neoadjuvant Therapy in Patients with Rectal Cancer: The Preliminary Results of the ReSARCh Trial. Ann Surg Oncol 2021; 29:1880-1889. [PMID: 34855063 DOI: 10.1245/s10434-021-11121-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/12/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rectum-preservation for locally advanced rectal cancer has been proposed as an alternative to total mesorectal excision (TME) in patients with major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The purpose of this study was to report on the short-term outcomes of ReSARCh (Rectal Sparing Approach after preoperative Radio- and/or Chemotherapy) trial, which is a prospective, multicenter, observational trial that investigated the role of transanal local excision (LE) and watch-and-wait (WW) as integrated approaches after neoadjuvant therapy for rectal cancer. METHODS Patients with mid-low rectal cancer who achieved mCR or cCR after neoadjuvant therapy and were fit for major surgery were enrolled. Clinical response was evaluated at 8 and 12 weeks after completion of chemoradiotherapy. Treatment approach, incidence, and reasons for subsequent TME were recorded. RESULTS From 2016 to 2019, 160 patients were enrolled; mCR or cCR at 12 weeks was achieved in 64 and 96 of patients, respectively. Overall, 98 patients were managed with LE and 62 with WW. In the LE group, Clavien-Dindo 3+ complications occurred in three patients. The rate of cCR increased from 8- to 12-week restaging. Thirty-three (94.3%) of 35 patients with cCR had ypT0-1 tumor. At a median 24 months follow-up, a tumor regrowth was found in 15 (24.2%) patients undergoing WW. CONCLUSIONS LE for patients achieving cCR or mCR is safe. A 12-week interval from chemoradiotherapy completion to LE is correlated with an increased cCR rate. The risk of ypT > is reduced when LE is performed after cCR.
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Affiliation(s)
- Francesco Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | - Valeria Palatucci
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | - Giulia Capelli
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | - Mario Guerrieri
- Surgery Clinic, Marche Polytechnic University, Ancona, Italy
| | - Claudio Belluco
- Oncological Surgery Department, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - Daniela Rega
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - Emilio Morpurgo
- Department of Surgery, Regional Center for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - Claudio Coco
- Department of Surgical Sciences, Catholic University of Rome, Rome, Italy
| | - Angelo Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | | | | | - Alessandro Perin
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
| | | | - Andrea Muratore
- Division of General Surgery, E. Agnelli Hospital, Pinerolo, Turin, Italy
| | - Antonino Spinelli
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | | | - Giampaolo Montesi
- Radiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy.
| | | | | | - Paolo Delrio
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padova, Padua, Italy
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Spolverato G, Capelli G, Battagello J, Barina A, Nordio S, Finotti E, Mondi I, Da Lio C, Morpurgo E, Navarro JA, Ceccato F, Perin A, Pedrazzani C, Turri G, Zanus G, Campi M, Massani M, Di Giacomo A, Prando D, Agresta F, Pucciarelli S, Zorzi M, Rugge M. More Favorable Short and Long-Term Outcomes for Screen-Detected Colorectal Cancer Patients. Front Oncol 2021; 11:620644. [PMID: 33791207 PMCID: PMC8005726 DOI: 10.3389/fonc.2021.620644] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/01/2021] [Indexed: 01/06/2023] Open
Abstract
Background Screening significantly reduces mortality from colorectal cancer (CRC). Screen detected (SD) tumors associate with better prognosis, even at later stage, compared to non-screen detected (NSD) tumors. We aimed to evaluate the association between diagnostic modality (SD vs. NSD) and short- and long-term outcomes of patients undergoing surgery for CRC. Materials and Methods This retrospective cohort study involved patients aged 50–69 years, residing in Veneto, Italy, who underwent curative-intent surgery for CRC between 2006 and 2018. The clinical multi-institutional dataset was linked with the screening dataset in order to define diagnostic modality (SD vs. NSD). Short- and long-term outcomes were compared between the two groups. Results Of 1,360 patients included, 464 were SD (34.1%) and 896 NSD (65.9%). Patients with a SD CRC were more likely to have less comorbidities (p = 0.013), lower ASA score (p = 0.001), tumors located in the proximal colon (p = 0.0018) and earlier stage at diagnosis (p < 0.0001). NSD patients were found to have more aggressive disease at diagnosis, higher complication rate and higher readmission rate due to surgical complications (all p < 0.05). NSD patients had a significantly lower Disease Free Survival and Overall Survival (all p < 0.0001), even after adjusting by demographic, clinic-pathological, tumor, and treatment characteristics. Conclusions SD tumors were associated with better long-term outcomes, even after multiple adjustments. Our results confirm the advantages for the target population to participate in the screening programs and comply with their therapeutic pathways.
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Affiliation(s)
- Gaya Spolverato
- Department Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Giulia Capelli
- Department Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | | | - Andrea Barina
- Department Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Susi Nordio
- General Surgery Unit, "SS. Giovanni e Paolo" Hospital, Venezia, Italy
| | - Elena Finotti
- General Surgery Unit, "SS. Giovanni e Paolo" Hospital, Venezia, Italy
| | | | | | - Emilio Morpurgo
- General Surgery Unit, Camposampiero Hospital, Camposampiero, Italy
| | | | - Fabio Ceccato
- General Surgery Unit, "Sant'Antonio" Hospital, Padova, Italy
| | - Alessandro Perin
- Department Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giulia Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giacomo Zanus
- IV Surgical Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Michela Campi
- IV Surgical Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Marco Massani
- III Surgical Unit, Ca' Foncello Hospital, Treviso, Italy
| | | | - Daniela Prando
- Department of General Surgery, Adria Civil Hospital, Adria, Italy
| | | | - Salvatore Pucciarelli
- Department Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Massimo Rugge
- Department of Medicine DIMED, Pathology and Cytopathology Unit, University of Padova, Padova, Italy
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Gavaruzzi T, Pace U, Giandomenico F, Pucciarelli S, Bianco F, Selvaggi F, Restivo A, Asteria CR, Morpurgo E, Cuicchi D, Jovine E, Coletta D, La Torre G, Amato A, Chiappa A, Marchegiani F, Rega D, De Franciscis S, Pellino G, Zorcolo L, Lotto L, Boccia L, Spolverato G, De Salvo GL, Delrio P, Del Bianco P. Colonic J-Pouch or Straight Colorectal Reconstruction After Low Anterior Resection For Rectal Cancer: Impact on Quality of Life and Bowel Function: A Multicenter Prospective Randomized Study. Dis Colon Rectum 2020; 63:1511-1523. [PMID: 33044292 DOI: 10.1097/dcr.0000000000001745] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patient-reported outcomes associated with different bowel reconstruction techniques following anterior resection for rectal cancer are still a matter of debate. OBJECTIVE This study aimed to assess quality of life and bowel function in patients who underwent colonic J-pouch or straight colorectal anastomosis reconstruction after low anterior resection. DESIGN Bowel function and quality of life were assessed within a multicenter randomized trial. Questionnaires were administered before the surgery (baseline) and at 6, 12, and 24 months after surgery. SETTINGS Patients were enrolled by 19 centers. The enrollment started in October 2009 and was stopped in February 2016. The study was registered at www.clinicaltrials.gov (Identifier: NCT01110798). PATIENTS Patients who underwent low anterior resection for primary mid-low rectal cancer and who were randomly assigned in a 1:1 ratio to receive either stapled colonic J-pouch or straight colorectal anastomosis were selected. MAIN OUTCOME MEASURES The primary outcomes measured were quality of life and bowel function. RESULTS Of the 379 patients who were evaluable, 312 (82.3%) completed the baseline, 259 (68.3%) the 6-month, 242 (63.9%) the 12-month, and 199 (52.5%) the 24-month assessment. Bowel functioning and quality of life did not significantly differ between arms for almost all domains. The total bowel function score, the urgency, and the stool fractionation scores significantly worsened after surgery and remained impaired over time in both arms (p < 0.0032), whereas constipation improved after surgery but recovered to baseline levels from 1 year onward (p < 0.0036). All patients showed a significant and continuous improvement in emotional functioning (p < 0.0013) and future perspective (p < 0.0001) from baseline to the end of the study. LIMITATIONS Limitations of the study include missing data, which increased over time; the possibility that some treatments have slightly changed since the study was conducted; and investigators not blind to treatment allocation. CONCLUSION The findings of this study do not support the routine use of colonic J-pouch reconstruction in patients with rectal cancer who undergo a low anterior resection. See Video Abstract at http://links.lww.com/DCR/B328. BOLSA J COLÓNICA O RECONSTRUCCIÓN COLORRECTAL RECTA DESPUÉS DE RESECCIÓN ANTERIOR BAJA PARA CÁNCER RECTAL: IMPACTO EN LA CALIDAD DE VIDA Y LA FUNCIÓN INTESTINAL: UN ESTUDIO ALEATORIZADO PROSPECTIVO MULTICÉNTRICO: Los resultados informados por el paciente asociados con diferentes técnicas de reconstrucción intestinal después de la resección anterior para el cáncer de recto aún son tema de debate.Evaluar la calidad de vida y la función intestinal en pacientes que se sometieron a una bolsa en J colónica o reconstrucción de anastomosis colorrectal recta después de una resección anterior baja.La función intestinal y la calidad de vida se evaluaron en un ensayo aleatorizado multicéntrico. Los cuestionarios se administraron antes de la cirugía (basal) y a los 6, 12 y 24 meses después de la cirugía.Los pacientes fueron incluidos en 19 centros. La inscripción comenzó en Octubre de 2009 y se detuvo en Febrero de 2016. El estudio se registró en www.clinicaltrials.gov (Identificador: NCT01110798).Pacientes que se sometieron a resección anterior baja por cáncer rectal primario medio-bajo y que fueron aleatorizados en una proporción de 1: 1 para recibir bolsa J colónica con grapas o anastomosis colorrectal recta.calidad de vida y función intestinal.De los 379 pacientes que fueron evaluables, 312 (82.3%) completaron la evaluación inicial, 259 (68.3%) a los 6 meses, 242 (63.9%) a los 12 meses y 199 (52.5%) a los 24 meses. . El funcionamiento intestinal y la calidad de vida no difirieron significativamente entre los dos grupos en casi todos los dominios. La puntuación total de la función intestinal, la urgencia y las puntuaciones de fraccionamiento de las heces empeoraron significativamente después de la cirugía y continuaron con el tiempo extra en ambos grupos (p <0.0032), mientras que el estreñimiento mejoró después de la cirugía pero se recuperó a los niveles basales a partir de 1 año en adelante (p <0.0036). Todos los pacientes mostraron una mejora significativa y continua en el funcionamiento emocional (p <0.0013) y la perspectiva futura (<0.0001) desde el inicio hasta el final del estudio.Datos faltantes, que aumentaron con el tiempo; la posibilidad de que algunos tratamientos hayan cambiado ligeramente desde que se realizó el estudio; investigadores no cegados a la asignación del tratamiento.Los hallazgos de este estudio no respaldan el uso rutinario de la reconstrucción de la bolsa J colónica en pacientes con cáncer rectal que se someten a una resección anterior baja. Consulte Video Resumen en http://links.lww.com/DCR/B328. (Traducción-Dr. Yesenia Rojas-Khalil).
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Affiliation(s)
- Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy.,First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Ugo Pace
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesca Giandomenico
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Salvatore Pucciarelli
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Francesco Bianco
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesco Selvaggi
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Angelo Restivo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Corrado Rosario Asteria
- Colo-rectal Surgery Unit, Department of Surgery and Orthopaedics, ASST "Carlo Poma", Mantua, Italy
| | - Emilio Morpurgo
- Department of Surgery, Regional Centre for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - Dajana Cuicchi
- General Surgery Unit, Department of Alimentary Tract, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elio Jovine
- General Surgery and Emergency, Maggiore Hospital, Azienda Sanitaria Locale di Bologna, Bologna, Italy
| | - Diego Coletta
- Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Giuseppe La Torre
- Abdominal Surgical Oncology, Department of Surgery, IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Antonio Amato
- Department of Coloproctology, Sanremo Hospital, Sanremo, Italy
| | - Antonio Chiappa
- Innovative Techniques in Surgery Unit, European Institute of Oncology, University of Milan, Milan, Italy
| | - Francesco Marchegiani
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Daniela Rega
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Silvia De Franciscis
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Gianluca Pellino
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Luigi Zorcolo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Lorella Lotto
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Luigi Boccia
- Colo-rectal Surgery Unit, Department of Surgery and Orthopaedics, ASST "Carlo Poma", Mantua, Italy
| | - Gaya Spolverato
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Paolo Delrio
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Paola Del Bianco
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
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7
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Monsellato I, Garibaldi E, Cassinotti E, Baldari L, Boni L, Elmore U, Delpini R, Rosati R, Perinotti R, Alongi F, Bertocchi E, Gori S, Ruffo G, Pernazza G, Pulighe F, De Nisco C, Morpurgo E, Contardo T, Mammano E, Perna F, Menegatti B, Coratti A, Buccianti P, Balestri R, Ceccarelli C, Cavaliere D, Solaini L, Ercolani G, Traverso E, Fusco V, Torri V, Orecchia S. Expression levels of circulating miRNAs as biomarkers during multimodal treatment of rectal cancer - TiMiSNAR-mirna: a substudy of the TiMiSNAR Trial (NCT03962088). Trials 2020; 21:678. [PMID: 32711544 PMCID: PMC7382047 DOI: 10.1186/s13063-020-04568-9] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 07/02/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy followed by surgery is the mainstay treatment for locally advanced rectal cancer, leading to significant decrease in tumor size (downsizing) and a shift towards earlier disease stage (downstaging). Extensive histopathological work-up of the tumor specimen after surgery including tumor regression grading and lymph node status helped to visualize individual tumor sensitivity to chemoradiotherapy, retrospectively. As the response to neoadjuvant chemoradiotherapy is heterogeneous, however, valid biomarkers are needed to monitor tumor response. A relevant number of studies aimed to identify molecular markers retrieved from tumor tissue while the relevance of blood-based biomarkers is less stringent assessed. MicroRNAs are currently under investigation to serve as blood-based biomarkers. To date, no screening approach to identify relevant miRNAs as biomarkers in blood of patients with rectal cancer was undertaken. The aim of the study is to investigate the role of circulating miRNAs as biomarkers in those patients included in the TiMiSNAR Trial (NCT03465982). This is a biomolecular substudy of TiMiSNAR Trial (NCT03962088). METHODS All included patients in the TiMiSNAR Trial are supposed to undergo blood collection at the time of diagnosis, after neoadjuvant treatment, after 1 month from surgery, and after adjuvant chemotherapy whenever indicated. DISCUSSION TiMiSNAR-MIRNA will evaluate the association of variation between preneoadjuvant and postneoadjuvant expression levels of miRNA with pathological complete response. Moreover, the study will evaluate the role of liquid biopsies in the monitoring of treatment, correlate changes in expression levels of miRNA following complete surgical resection with disease-free survival, and evaluate the relation between changes in miRNA during surveillance and tumor relapse. TRIAL REGISTRATION Clinicaltrials.gov NCT03962088 . Registered on 23 May 2019.
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Affiliation(s)
- Igor Monsellato
- Department of Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy
| | - Elisabetta Garibaldi
- Department of Radiation Oncology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ludovica Baldari
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ugo Elmore
- Ospedale San raffaele IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | - Emilio Morpurgo
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Tania Contardo
- Ospedale Civile Pietro Cosma, Camposampiero, Padova, Italy
| | - Enzo Mammano
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Federico Perna
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Andrea Coratti
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | | | | | | | | | - Elena Traverso
- Department of Oncology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Vittorio Fusco
- Department of Oncology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Valter Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sara Orecchia
- Department of Pathology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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8
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Monsellato I, Alongi F, Bertocchi E, Gori S, Ruffo G, Cassinotti E, Baldari L, Boni L, Pernazza G, Pulighe F, De Nisco C, Perinotti R, Morpurgo E, Contardo T, Mammano E, Elmore U, Delpini R, Rosati R, Perna F, Coratti A, Menegatti B, Gentilli S, Baroffio P, Buccianti P, Balestri R, Ceccarelli C, Torri V, Cavaliere D, Solaini L, Ercolani G, Traverso E, Fusco V, Rossi M, Priora F, Numico G, Franzone P, Orecchia S. Correction to: Standard (8 weeks) vs long (12 weeks) timing to minimally-invasive surgery after NeoAdjuvant Chemoradiotherapy for rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR). BMC Cancer 2020; 20:128. [PMID: 32066408 PMCID: PMC7026949 DOI: 10.1186/s12885-020-6632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Igor Monsellato
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | | | | | | | | | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ludovica Baldari
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | | | - Emilio Morpurgo
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant'Antonio, Padova, Italy
| | - Tania Contardo
- Ospedale Civile Pietro Cosma, Padova, Camposampiero, Italy
| | - Enzo Mammano
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant'Antonio, Padova, Italy
| | - Ugo Elmore
- Ospedale San raffaele IRCCS, Milan, Italy
| | | | | | - Federico Perna
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Coratti
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Sergio Gentilli
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | - Paolo Baroffio
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | | | | | | | - Valter Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | | | - Elena Traverso
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Vittorio Fusco
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Maura Rossi
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Priora
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - G Numico
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paola Franzone
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sara Orecchia
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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9
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Palatucci V, Spolverato G, Pucciarelli S, De Paoli A, Maretto I, Perin A, Bigon M, Guerrieri M, Muratore A, Bianco F, Vespa D, Morpurgo E, Restivo A, Coco C, Pace U, Bellucco C, Mantello G, Gambacorta MA, Bergamo F, Delrio P. Rectal sparing approach after preoperative radio- and/or chemo-therapy (resarch) in patients with rectal cancer: preliminary analysis of an observational multicentre prospective study. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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10
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Monsellato I, Alongi F, Bertocchi E, Gori S, Ruffo G, Cassinotti E, Baldarti L, Boni L, Pernazza G, Pulighe F, De Nisco C, Perinotti R, Morpurgo E, Contardo T, Mammano E, Elmore U, Delpini R, Rosati R, Perna F, Coratti A, Menegatti B, Gentilli S, Baroffio P, Buccianti P, Balestri R, Ceccarelli C, Torri V, Cavaliere D, Solaini L, Ercolani G, Traverso E, Fusco V, Rossi M, Priora F, Numico G, Franzone P, Orecchia S. Standard (8 weeks) vs long (12 weeks) timing to minimally-invasive surgery after NeoAdjuvant Chemoradiotherapy for rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR). BMC Cancer 2019; 19:1215. [PMID: 31842784 PMCID: PMC6912945 DOI: 10.1186/s12885-019-6271-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/08/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal timing of surgery in relation to chemoradiation is still controversial. Retrospective analysis has demonstrated in the recent decades that the regression of adenocarcinoma can be slow and not complete until after several months. More recently, increasing pathologic Complete Response rates have been demonstrated to be correlated with longer time interval. The purpose of the trial is to demonstrate if delayed timing of surgery after neoadjuvant chemoradiotherapy actually affects pathologic Complete Response and reflects on disease-free survival and overall survival rather than standard timing. METHODS The trial is a multicenter, prospective, randomized controlled, unblinded, parallel-group trial comparing standard and delayed surgery after neoadjuvant chemoradiotherapy for the curative treatment of rectal cancer. Three-hundred and forty patients will be randomized on an equal basis to either robotic-assisted/standard laparoscopic rectal cancer surgery after 8 weeks or robotic-assisted/standard laparoscopic rectal cancer surgery after 12 weeks. DISCUSSION To date, it is well-know that pathologic Complete Response is associated with excellent prognosis and an overall survival of 90%. In the Lyon trial the rate of pCR or near pathologic Complete Response increased from 10.3 to 26% and in retrospective studies the increase rate was about 23-30%. These results may be explained on the relationship between radiation therapy and tumor regression: DNA damage occurs during irradiation, but cellular lysis occurs within the next weeks. Study results, whether confirmed that performing surgery after 12 weeks from neoadjuvant treatment is advantageous from a technical and oncological point of view, may change the current pathway of the treatment in those patient suffering from rectal cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT3465982.
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Affiliation(s)
- Igor Monsellato
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | | | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ludovica Baldarti
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | | | - Emilio Morpurgo
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Tania Contardo
- Ospedale Civile Pietro Cosma, Padova, Camposampiero Italy
| | - Enzo Mammano
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Ugo Elmore
- Ospedale San raffaele IRCCS, Milan, Italy
| | | | | | - Federico Perna
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Coratti
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Sergio Gentilli
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | - Paolo Baroffio
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | | | | | | | - Valter Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | | | - Elena Traverso
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Vittorio Fusco
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Maura Rossi
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Priora
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - G. Numico
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paola Franzone
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sara Orecchia
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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11
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Pucciarelli S, Del Bianco P, Pace U, Bianco F, Restivo A, Maretto I, Selvaggi F, Zorcolo L, De Franciscis S, Asteria C, Urso EDL, Cuicchi D, Pellino G, Morpurgo E, La Torre G, Jovine E, Belluco C, La Torre F, Amato A, Chiappa A, Infantino A, Barina A, Spolverato G, Rega D, Kilmartin D, De Salvo GL, Delrio P. Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer. Br J Surg 2019; 106:1147-1155. [PMID: 31233220 DOI: 10.1002/bjs.11222] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. METHODS This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. RESULTS Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. CONCLUSION Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov).
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Affiliation(s)
- S Pucciarelli
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - P Del Bianco
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - U Pace
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - F Bianco
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - A Restivo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - I Maretto
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - F Selvaggi
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - L Zorcolo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - S De Franciscis
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - C Asteria
- Department of General Surgery, Ospedale Carlo Poma, Mantua, Italy
| | - E D L Urso
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - D Cuicchi
- General Surgery Unit, Department of Alimentary Tract, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Pellino
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - E Morpurgo
- Department of Surgery, Regional Centre for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - G La Torre
- Abdominal Surgical Oncology, Department of Surgery, IRCCS, Centro di Riferimento oncologico della Basilicata, Rionero in Vulture, Italy
| | - E Jovine
- General Surgery and Emergency, Maggiore Hospital, Azienda Sanitaria Locale di Bologna, Bologna, Italy
| | - C Belluco
- Department of Surgical Oncology, Centro di Riferimento Oncologico -IRCCS, National Cancer Institute, Aviano, Italy
| | - F La Torre
- Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - A Amato
- Department of Coloproctology, Sanremo Hospital, Sanremo, Italy
| | - A Chiappa
- Innovative Techniques in Surgery Unit, European Institute of Oncology, University of Milan, Milan, Italy
| | - A Infantino
- Surgical Unit, Department of General Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Italy
| | - A Barina
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - G Spolverato
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - D Rega
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - D Kilmartin
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - P Delrio
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
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12
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Baldan N, Munegato G, Di Leo A, Lauro E, Morpurgo E, Pianigiani S, Briscolini D, Ferrara R, Fiscon V, Brolese A, De Manzoni G, Baldazzi G, Snidero D, Merigliano S, Ricci F, Laterza E, Merenda R, Gianesini R. Lessons learned from 227 biological meshes used for the surgical treatment of ventral abdominal defects. Hernia 2019; 24:57-65. [PMID: 30661179 DOI: 10.1007/s10029-019-01883-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/25/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The advantages of biological meshes for ventral hernia repair are still under debate. Given the high financial cost, the proper indications for biological meshes should be clarified to restrict their use to properly selected patients. METHODS A retrospective database was instituted to register all cases of abdominal wall defect treated with biological meshes from 1/2010 to 3/2016. RESULTS A total of 227 patients (mean age: 64 years) whose ventral abdominal defects were reconstructed with a biological mesh were included in the study. Patients were divided according to the 2010 four-level surgical-site complication risk grading system proposed by the Ventral Hernia Working Group (VHWG): Grade 1 (G1, 12 cases), Grade 2 (G2, 68 cases), Grade 3 (G3, 112 cases), and Grade 4 (G4, 35 cases). The surgical site complication rate was higher in patients with one or more risk factors (33.6% vs 19% in patients with no risk factors) (P = 0.68). Statistically significant risk factors associated with the onset of one or more postoperative surgical site complications included: diabetes, coronary artery disease, immunosuppression, and obesity. Recurrence was more common in patients with surgical site complications and mainly associated with infection (38.9%) and wound necrosis (44.4%), and in cases of inlay positioning of the mesh (36%). CONCLUSIONS Due to their high costs, biological mesh should not be used in G1 patients. In infected fields (G4), they should only be used if no other surgical solution is feasible. There is a clear need to prospectively evaluate the performance of biological meshes.
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Affiliation(s)
- N Baldan
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy.
| | - G Munegato
- Ospedale "S. Maria dei Battuti", Conegliano, TV, Italy
| | - A Di Leo
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - E Lauro
- Ospedale "S. Maria del Carmine" di Rovereto, Rovereto, TV, Italy
| | - E Morpurgo
- Ospedale di Camposampiero, Camposampiero, PD, Italy
| | - S Pianigiani
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, Università di Padova, Padua, Italy
| | - D Briscolini
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy
| | | | - V Fiscon
- Ospedale di Cittadella, Cittadella, PD, Italy
| | - A Brolese
- Ospedale "Santa Chiara", Trento, Italy
| | - G De Manzoni
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - G Baldazzi
- ASST NORD MILANO Presidio Ospedaliero di Sesto San Giovanni, Sesto San Giovanni, MI, Italy
| | - D Snidero
- Ospedale di San Daniele del Friuli, San Daniele del Friuli, UD, Italy
| | - S Merigliano
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy
| | - F Ricci
- Ospedale "S. Maria del Carmine" di Rovereto, Rovereto, TV, Italy
| | - E Laterza
- Ospedale di Legnago, Legnago, VR, Italy
| | - R Merenda
- Ospedale "SS. Giovanni e Paolo", Venice, Italy
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Scotton G, Contardo T, Zerbinati A, Tosato SM, Orsini C, Morpurgo E. From Laparoscopic Right Colectomy with Extracorporeal Anastomosis to Robot-Assisted Intracorporeal Anastomosis to Totally Robotic Right Colectomy for Cancer: The Evolution of Robotic Multiquadrant Abdominal Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:1216-1222. [PMID: 30117748 DOI: 10.1089/lap.2017.0693] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Intracorporeal anastomosis (IA) in right colectomies shows many advantages over extracorporeal anastomosis (EA). Many difficulties encountered in laparoscopic IA can be overcome with hybrid robot-assisted IA or recently with totally robotic procedures. In the literature, few works have been published comparing laparoscopic, hybrid, and totally robotic right colectomies. The aim of this study is to retrospectively analyze the improvements brought on by the evolution of robotic surgery at our specialized center. MATERIALS AND METHODS Two hundred six (hybrid and totally) robotic right colectomies (RRCs) with IA were compared with 160 laparoscopic right colectomies (LRCs) with EA. A separate analysis carried out by the robotic group compared 30 totally robotic right colectomies (TRRCs) with 176 hybrid robot-assisted right colectomies (HRRCs). Demographics, pathological features, operative details, and postoperative outcomes were retrospectively analyzed from a prospectively maintained database. RESULTS The groups were comparable with respect to demographics and tumor staging. When compared with LRC, RRC showed shorter time to first flatus (P < .001), stools (P < .001), solid diet (P < .001), and discharge (P < .001). The number of lymph nodes harvested was 23.13 ± 11.2 in RRC versus 20.5 ± 11.2 in LRC (P = .031). Operative time was longer in RRC (253.0 ± 47 minutes versus 209.9 ± 64 minutes; P < .001), but conversion to open (2.4% versus 18.1%; P < .001), anastomotic leaks (0.5% versus 5%; P = .012), and bleeding (0.3% versus 4.4%; P = .024) were significantly less frequent. Subsequent analysis shows no significant increase in operative time in TRRC versus HRRC (261.0 ± 41 minutes versus 251.6 ± 47.6 minutes; P = .310). Even if not statistically significant, TRRC showed faster bowel function recovery and tolerance to solid diet. CONCLUSIONS We confirmed the clinical advantages of RRC with IA over LRC with EA in postoperative recovery outcomes and complication rate. Furthermore, our preliminary analysis in a cohort of 30 TRRC shows promising results.
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Affiliation(s)
- Giovanni Scotton
- 1 Department of Surgery, Regional Specialized Center of Videolaparoscopic Robotic Surgery , Hospital of Camposampiero, Padua, Italy .,2 Department of General Surgery, ASUITS, Cattinara Hospital , Trieste, Italy
| | - Tania Contardo
- 1 Department of Surgery, Regional Specialized Center of Videolaparoscopic Robotic Surgery , Hospital of Camposampiero, Padua, Italy
| | - Antonio Zerbinati
- 1 Department of Surgery, Regional Specialized Center of Videolaparoscopic Robotic Surgery , Hospital of Camposampiero, Padua, Italy
| | - Sara Maria Tosato
- 1 Department of Surgery, Regional Specialized Center of Videolaparoscopic Robotic Surgery , Hospital of Camposampiero, Padua, Italy
| | - Camillo Orsini
- 1 Department of Surgery, Regional Specialized Center of Videolaparoscopic Robotic Surgery , Hospital of Camposampiero, Padua, Italy
| | - Emilio Morpurgo
- 1 Department of Surgery, Regional Specialized Center of Videolaparoscopic Robotic Surgery , Hospital of Camposampiero, Padua, Italy
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Barina A, De Paoli A, Delrio P, Guerrieri M, Muratore A, Bianco F, Vespa D, Asteria C, Morpurgo E, Restivo A, Coco C, Pace U, Belluco C, Aschele C, Lonardi S, Valentini V, Mantello G, Maretto I, Del Bianco P, Perin A, Pucciarelli S. Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: a multicentre observational study. Tech Coloproctol 2017; 21:633-640. [PMID: 28755256 DOI: 10.1007/s10151-017-1665-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/19/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rectum-sparing approaches appear to be appropriate in rectal cancer patients with a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The aim of the present study is to evaluate the effectiveness of rectum-sparing approaches at 2 years after the completion of neoadjuvant treatment. STUDY DESIGN Patients with rectal adenocarcinoma eligible to receive neoadjuvant therapy will be prospectively enrolled. Patients will be restaged 7-8 weeks after the completion of neoadjuvant therapy and those with mCR (defined as absence of mass, small mucosal irregularity no more than 2 cm in diameter at endoscopy and no metastatic nodes at MRI) or cCR will be enrolled in the trial. Patients with mCR will undergo local excision, while patients with cCR will either undergo local excision or watch and wait policy. The main end point of the study is to determine the percentage of rectum preservation at 2 years in the enrolled patients. CONCLUSION This protocol is the first prospective trial that investigates the role of both local excision and watch and wait approaches in patients treated with neoadjuvant therapy for rectal cancer. The trial is registered at clinicaltrials.gov (NCT02710812).
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Affiliation(s)
- A Barina
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy.
| | - A De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - P Delrio
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - M Guerrieri
- Surgery Clinic, Marche Polytechnic University, Ancona, Italy
| | - A Muratore
- E. Agnelli Hospital, Pinerolo, TO, Italy
| | - F Bianco
- Abdominal Surgical Oncology Unit, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - D Vespa
- General Surgery Unit, San Bortolo Hospital, Vicenza, Italy
| | - C Asteria
- Department of Surgery and Orthopaedics, General Surgery Units of Asola, Mantua, Italy
| | - E Morpurgo
- Department of Surgery, Regional Center for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - A Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - C Coco
- Department of Surgical Sciences, Catholic University of Rome, Rome, Italy
| | - U Pace
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - C Belluco
- Department of Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - C Aschele
- Medical Oncology Unit, S. Andrea Hospital, La Spezia, Italy
| | - S Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - V Valentini
- Institute of Radiotherapy, Catholic University of Rome, Rome, Italy
| | - G Mantello
- Department of Radiotherapy, Ospedali Riuniti, Ancona, Italy
| | - I Maretto
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
| | | | - A Perin
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
| | - S Pucciarelli
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
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Morpurgo E, Contardo T, Molaro R, Zerbinati A, Orsini C, D'Annibale A. Robotic-assisted intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy for cancer: a case control study. J Laparoendosc Adv Surg Tech A 2013; 23:414-7. [PMID: 23627922 DOI: 10.1089/lap.2012.0404] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for cancer has a significant risk of complications. The aim of this study is to evaluate the operative and postoperative results of hybrid right hemicolectomy with intracorporeal robotic-assisted anastomosis for adenocarcinoma of the ascending colon compared with the standard extracorporeal anastomosis in a case control study. PATIENTS AND METHODS Forty-eight right hemicolectomies for cancer (2009-2012) with laparoscopic medial to lateral dissection, vascular ligation, bowel transection, and robotic-assisted intracorporeal anastomosis with specimen extraction through a Pfannestiel incision (robotic group [RG]) were compared with 48 laparoscopic hemicolectomies (2009-2011) with extracorporeal anastomosis (laparoscopic group [LG]). RESULTS The two groups were comparable with respect to age, gender, stage of cancer, and body mass index. Surgery time was significantly longer in RG patients (RG, 266±41 minutes; LG, 223±51 minutes; P<.05). Operative results were similar in the two groups. Recovery of bowel function (day of first bowel movement: RG, 3.0±1.0 days; LG, 4.0±1.2 days; P<.05) and hospital stay (RG, 7.5±2.0 days; LG, 9.0±3.2 days; P<.05) were quicker and shorter, respectively, in RG. There were four anastomotic complications and four incisional hernias in LG and none in RG (P<.05). CONCLUSIONS There are fewer anastomotic and wound complications in RG patients. Intracorporeal robotic-assisted ileocolic anastomosis allows a faster recovery compared with extracorporeal anastomosis.
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Affiliation(s)
- Emilio Morpurgo
- Department of Surgery, Regional Specialized Center for Robotic and Laparoscopic Surgery, P. Cosma Hospital, Camposampiero (Padova), Italy
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Molaro R, Morpurgo E. Image of the month. Necrosis of the bile duct system. ACTA ACUST UNITED AC 2011; 146:1449-50. [PMID: 22184312 DOI: 10.1001/archsurg.146.12.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Roberta Molaro
- Department of General Surgery, P. Cosma Hospital, Via P. Cosma 1, Camposampiero, Italy.
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D'Annibale A, Pende V, Pernazza G, Monsellato I, Mazzocchi P, Lucandri G, Morpurgo E, Contardo T, Sovernigo G. Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results. J Surg Res 2010; 166:e113-20. [PMID: 21227455 DOI: 10.1016/j.jss.2010.11.881] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 02/09/2023]
Abstract
BACKGROUND Widespread diffusion of minimally-invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended D2-lymphadenectomy. This surgical step can be facilitated by using robot-assisted surgery. The aim of this study is to describe our technique and short-term results of a consecutive series of full robotic gastrectomies with D2-lymphadenectomy for gastric cancer, using the da Vinci Surgical System. MATERIALS AND METHODS Between May 2004 and December 2009, we performed 24 consecutive full robot-assisted total and subtotal gastrectomies with extended D2-lymphadenectomy for histologically-proven gastric adenocarcinoma. Data referring to 11 robot-assisted total gastrectomies and 13 subtotal gastrectomies were collected in a database and analyzed. RESULTS Median operative time was 267.50 min (255-305). Median intraoperative blood loss was 30 mL. Median number of harvested lymph nodes was 28 (23-34). Resection margins were negative in all cases. No conversions occurred. Surgery-related morbidity was 8%. Thirty-day mortality was 0%. Liquid diet started on postoperative d 5 (2-5). Median length of stay was 6 d (5-8). CONCLUSIONS Robot-assisted gastrectomy with D2-lymphadenectomy is a safe technique and allows achieving an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity and the learning curve appears to be shorter than in laparoscopic surgery. Longer follow-up and randomized clinical trials are needed to define the role of robot-assistance in gastric cancer surgery.
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D'Annibale A, Pernazza G, Morpurgo E, Monsellato I, Pende V, Lucandri G, Termini B, Orsini C, Sovernigo G. Robotic right colon resection: evaluation of first 50 consecutive cases for malignant disease. Ann Surg Oncol 2010; 17:2856-62. [PMID: 20567918 DOI: 10.1245/s10434-010-1175-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colorectal cancer is the fourth leading cause of death in the world. Minimally invasive surgery has been demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. This study aims to evaluate surgical and oncological short-term outcomes of robotic-assisted right colon resection in malignant disease. METHODS Fifty consecutive patients affected by right-sided colon cancer were operated from May 2001 to May 2009 using the da Vinci(®) surgical system. Data regarding surgical and early oncological outcomes were systematically collected in a specific database for statistical analysis. RESULTS Twenty-four male and 26 female patients underwent robotic right colectomy. Median age was 73.34 ± 11 years. Median operative time was 223.50 (180-270) min. No conversion occurred. Specimen length was 26.7 ± 8 cm (range 21-50 cm), number of harvested lymph nodes was 18.76 ± 7.2 (range 12-44), and mean number of positive lymph nodes was 1.65 ± 3 (range 0-17). Surgery-related morbidity was 1/50 (2%): one twisting of the mesentery in one case with extracorporeal anastomosis. All patients were included in a follow-up regimen. Disease-free survival was 90% (45/50), and overall survival was 92% (46/50). Cancer-related mortality was 8% (4/50). CONCLUSIONS Robotic assistance allows performance of oncologically adequate dissection of the right colon with radical lymphadenectomy and to fashion a handsewn intracorporeal anastomosis as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.
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Affiliation(s)
- Annibale D'Annibale
- Minimally Invasive and Robotic Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
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Baig M, Larach J, Chang S, Long C, Weiss E, Nogueras J, Wexner S, Bouchoucha M, Devroede G, Dorval E, Faye A, Arhan P, Arsac M, Zbar A, Oyetunji R, Gill R, D’Annibale A, Morpurgo E, Fiscon V, Termini B, Serventi A, Sovernigo G, Orsini C, Fa-Si-Oen P, van de Gender P, Putter H, Ectors N, D’Hoore A, Topal B, Penninckx F, Marques C, Nahas S, Nahas C, Sobrado C, Habr-Gama A, Kiss D, Verdaasdonk E, Bueno de Mesquita J, Stassen L, Nano M, Prunotto M, Ferronato M, Solej M, Galloni M, Pigot F, Dao-Quang M, Castinel A, Juguet F, Bouchard D, Bockle J, Allaert F, de la Portilla F, Zbar A, Rada R, Vega J, Cisneros N, Maldonado V, Utrera A, Espinosa E, Trecca A, Gaj F, Di Lorenzo G, Ricciardi M, Silano M, Bella A, Sperone M, Vorobiev G, Tsarkov P, Sorokin E. Erratum. Tech Coloproctol 2009. [DOI: 10.1007/s10151-006-0317-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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D'Annibale A, Morpurgo E, Fiscon V, Termini B, Serventi A, Sovernigo G, Orsini C. Minimally invasive resection for colorectal cancer: perioperative and medium-term results in an unselected patient group at a single institution. Tech Coloproctol 2006; 10:303-7. [PMID: 17115319 DOI: 10.1007/s10151-006-0297-7] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 05/27/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of laparoscopy for colorectal cancer resection is still controversial. METHODS We prospectively analyzed the outcome of minimally invasive resection for colorectal cancer, performed at our institution from 1998, when laparoscopic surgery became the treatment of choice for colorectal cancer, until 2004. All patients undergoing elective resection were assessed in terms of perioperative results (duration of surgery, number of lymph nodes removed, length of specimen, rate of conversion, complications) and survival. Patients were assessed yearly with follow-up visits and telephone interviews. RESULTS In the study period, 302 patients (mean age 66.1 years; range, 32-93 years) underwent 114 left hemicolectomies, 108 low anterior resections, 61 right hemicolectomies, 12 Miles procedures, 4 subtotal colectomies, and 3 transverse colon resections. Surgery took an average of 226 minutes (SD=71 min). The number of lymph nodes removed was 14+/-8. The conversion rate was 10%; most of the conversions were due to locally advanced cancer (15 cases) and bowel distension (7 cases). Fifteen anastomotic leaks were observed (5%). Twenty patients needed reoperation and two died: one of septic shock due to an anastomotic leak; the other of electrolyte imbalance and dehydration after peritonitis due to a bowel loop injury. Follow-up was available for 91% of patients. Cancer-related survival curves showed a 90% survival for stage II, 85% for stage III, and 10% for stage IV disease, 30 months after surgery. CONCLUSIONS Minimally invasive laparoscopic resection for colorectal cancer enables an oncologically adequate resection with complication and survival rates that are no worse than are to be expected after traditional open surgery. Locally advanced tumor and bowel distension are the most frequent reasons for conversion to open surgery.
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Affiliation(s)
- A D'Annibale
- Department of Surgery, Camposampiero Hospital, Camposampiero (PD), Italy
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21
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D'Annibale A, Orsini C, Morpurgo E, Sovernigo G. [Robotic surgery: considerations after 250 procedures]. Chir Ital 2006; 58:5-14. [PMID: 16729603] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The aim of this study was to investigate the results of the first 250 procedures performed on 216 patients with the da Vinci Robotic Surgical System (34/216 patients were submitted to double procedure). The purpose of the da Vinci surgical system is to exactly translate the surgeon's hand movements to the robotic arms that manipulate the laparoscopic instruments, thus facilitating minimally invasive surgery. The da Vinci system has been available in our department since 2001. The first 50 procedures were simple cases (cholecystectomies and transperitoneal hernia repairs) and were performed during the learning curve of the surgical team. The last 200 procedures were more complex cases. Time of preparation of the robot gradually decreased with growing experience. The total conversion rate (to standard laparoscopy and to open surgery) was 4.8% (12/250); conversion to laparotomy was 2.8% (7/250). Morbidity was 8.8% (19/216), and reoperation was needed in 6 patients. Mortality was 1.8% (4/216). We conclude that robotic surgery has now moved beyond the learning phase with the device and may be routinely used in selected, more complex cases, such as colorectal surgery and surgery of the gastro-oesophageal junction. The device can also be used in pancreatic and gastric surgery.
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D'Annibale A, Serventi A, Orsini C, Morpurgo E. Locating polyps by endoscopy with or without videolaparoscopy, radioguided occult colonic lesion identification or magnetic endoscopic imaging: the way forward to complete polyp removal. Tech Coloproctol 2005; 8 Suppl 2:s295-9. [PMID: 15666110 DOI: 10.1007/s10151-004-0180-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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] [Indexed: 11/30/2022]
Abstract
Endoscopic polypectomy is the gold standard for the treatment of colorectal polyps. In the case of non-palpable lesions or to complete polyp removal, the lesions are located intra-operatively. With the advent of laparoscopy, identifying their position is even more important because there is no opportunity for intestinal palpation. Several methods of preoperative endoscopic marking have been proposed using different types of tattooing and recently using clips followed by ultrasonography detection. Innovative methods are analysed; magnetic endoscopic imaging is a reliable and accurate method for determining the anatomical position of the tip of the endoscope during colonoscopy. Radioguided colonic lesion identification needs a gamma detection probe. Endoscopic removal can be converted to endo-laparoscopic rendezvous, failing which, laparoscopic resection is a reliable and safe choice, offering all the advantages of minimally invasive surgical techniques.
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Affiliation(s)
- A D'Annibale
- Department of Surgery and Center for Minimally Invasive and Robotic Surgery, Hospital of Camposampiero, Via Cosma 1, I-35102 Camposampiero, Padua, Italy.
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Abstract
PURPOSE In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare the traditional laparoscopic approach and robotic techniques in the treatment of colorectal diseases. METHODS The study compares a consecutive series of patients treated surgically for colorectal disease from June 2001 to May 2003 with the da Vinci robotic system (Intuitive Surgical) and a matched number of patients who underwent conventional laparoscopy during the same time interval. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and postoperative results. RESULTS The study included 106 patients (53 in each group). No differences were observed in total time of surgery (laparoscopic group, 222 +/- 77 minutes vs. robotic group, 240 +/- 61 minutes), specimen length (laparoscopic group, 29 +/- 11 cm vs. robotic group, 27 +/- 13 cm), or number of lymph nodes retrieved (laparoscopic group, 16 +/- 9 vs. robotic group, 17 +/- 10). It took significantly longer to prepare the operating room and patient in the robotic group (24 +/- 12 minutes) than in the laparoscopic group (18 +/- 7 minutes). There were three conversions to laparotomy in the laparoscopic group; in the robotic group, two cases were converted to laparoscopy and three to hand-assisted laparoscopy. No significant differences were observed between the two groups in terms of recovery of bowel function and postoperative hospital stay. CONCLUSIONS Robot-assisted surgery proved to be as safe and effective as laparoscopic techniques in the treatment of colorectal diseases. Because of its dexterity and three-dimensional view, the da Vinci system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.
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Abstract
HYPOTHESIS Rectal resection is associated with a risk of sexual dysfunction even when performed for benign disease, with the most frequent type resulting in retrograde ejaculation due to injury to the hypogastric nerves. DESIGN A simple technique to identify and protect these nerves during rectal mobilization. SETTING Exposure of the hypogastric plexus during rectal resection. CONCLUSION Careful identification of the hypogastric nerves during rectal mobilization using the described technique may reduce injury to these nerves and related sexual dysfunction.
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Affiliation(s)
- Emilio Morpurgo
- Department of Surgery, Hospital of Camposampiero (Padova), Italy
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Morpurgo E, Vitale GC, Galandiuk S, Kimberling J, Ziegler C, Polk HC. Clinical characteristics of familial adenomatous polyposis and management of duodenal adenomas. J Gastrointest Surg 2004; 8:559-64. [PMID: 15239991 DOI: 10.1016/j.gassur.2004.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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] [Indexed: 01/31/2023]
Abstract
The aim of this study was to evaluate the clinical characteristics of patients with familial adenomatous polyposis (FAP) undergoing surgical treatment over a 10-year period and specifically to evaluate the incidence and clinical outcome of patients treated for duodenal adenomas. Patients with FAP who underwent surgical treatment for colonic polyposis at the University of Louisville from January 1992 to July 2002 were investigated. Surgical treatment included colectomy and ileal J-pouch-anal anastomosis (IPAA) or completion proctectomy with or without IPAA in those who had previously undergone subtotal colectomy elsewhere. All patients underwent screening gastroduodenoscopy at 3-year intervals beginning at the time of diagnosis or referral. Postoperative morbidity, mortality, and functional outcome were evaluated, as well as the occurrence of extracolonic manifestations and results of treatment for duodenal adenomas when required. Fifty-four patients were included in the study (mean age 28 +/- 2 years). Twenty-seven of them (50%) underwent colectomy and IPAA as the initial operation. Twenty-seven patients had previously undergone subtotal colectomy. Eight of these 27 patients had cancer in the rectum, of which three were T4 and one was T2N1 cancer. Twenty-two patients underwent a completion proctectomy and three required abdominoperineal resection. Twenty of the 54 patients developed duodenal adenomas. The mean age of diagnosis of duodenal disease was not significantly different from that of patients who were still free of duodenal polyps (40 +/- 11 vs. 34 +/- 12 years). Seven of these 20 patients underwent local excision of duodenal polyps (either endocopically or transduodenally); four of these patients developed recurrent disease. Six patients underwent pancreaticoduodenectomy for duodenal adenomas with severe dyplasia. These patients experienced an increased number of bowel movements, from five per day (range 4 to 8) to 10 per day (range 6 to 15). One patient required pouch excision and end ileostomy to control diarrhea. Our data demonstrate the following: (1) patients with FAP who have undergone prior subtotal colectomy and ileorectal anastomosis have a high risk of developing advanced cancer in the rectal stump; (2) duodenal adenomas are common in patients with FAP and may occur at an early age; (3) screening duodenoscopy should be initiated at the time of diagnosis of FAP; (4) local excision of duodenal adenomas is associated with a high risk of local recurrence; and (5) even though pancreaticoduodenectomy is the treatment of choice for advanced duodenal adenomas, this procedure may adversely affect pouch function in some patients.
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Affiliation(s)
- Emilio Morpurgo
- Department of Surgery, University of Louisville School of Medicine and the Digestive Health Center, Louisville, Kentucky 40292, USA
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D'Annibale A, Fiscon V, Trevisan P, Pozzobon M, Gianfreda V, Sovernigo G, Morpurgo E, Orsini C, Del Monte D. The da Vinci Robot in Right Adrenalectomy. Surg Laparosc Endosc Percutan Tech 2004; 14:38-41. [PMID: 15259586 DOI: 10.1097/00129689-200402000-00011] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The da Vinci Robotic System (Intuitive Surgical, Mountain View, CA) became available at the General Surgery Department of Camposampiero Hospital in May 2001. From May 2001 to October 2002, 139 robotic operations were performed, one of which was a right adrenalectomy for a right adrenal mass. The progressive growth of the mass was the indication for surgical excision. Surgical adrenalectomy was successfully completed with da Vinci Robotic System using 5 ports (3 for the robotic system, 2 as service trocars). The wrist-like movements of the instrument's tip easily enabled the detachment of the right hepatic lobe from the gland and vessel isolation, while the 3-dimensional vision facilitated dissection of the veins from the vena cava.
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Morpurgo E, Petras R, Kimberling J, Ziegler C, Galandiuk S. Characterization and clinical behavior of Crohn's disease initially presenting predominantly as colitis. Dis Colon Rectum 2003; 46:918-24. [PMID: 12847366 DOI: 10.1007/s10350-004-6685-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [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] [Indexed: 02/08/2023]
Abstract
PURPOSE We studied patients with Crohn's disease affecting the colon to characterize disease behavior and to determine whether such patients might be candidates for sphincter-sparing surgery. METHODS Ninety-two consecutive patients with Crohn's colitis were studied prospectively. Mean follow-up after diagnosis was 82 (range, 6-291) months. Parameters that were evaluated included previous surgery for Crohn's disease, granulomatous vs. nongranulomatous disease, extent of colonic involvement, and presence or absence of extracolonic disease. The clinical course of the disease and postoperative outcome were evaluated. The outcome of Crohn's colitis patients who underwent ileal pouch-anal anastomosis for presumed ulcerative colitis was also evaluated. RESULTS There were 39 patients with granulomatous colitis and 53 patients without granulomas. There was no statistical difference in the age of diagnosis or presence of small-bowel (23 vs. 27 percent), ileocolic (34 vs. 30 percent), or perineal (36 vs. 22 percent) disease in these patients. At initial presentation, 88 percent of patients with pancolitis had colitis alone without other sites of intestinal disease compared with only 37 percent of patients with segmental colitis (P < 0.001). Kaplan-Meier analysis showed that patients with granulomas and patients with segmental colitis at presentation have a significantly higher recurrence when compared with patients without granulomas and patients with pancolitis (P < 0.03). Thirteen patients without granulomatous disease and eight with granuloma underwent ileal pouch-anal anastomosis. Seven patients (3 with granuloma, 4 without granuloma) had a recurrence of Crohn's disease in the ileal pouch; 2 required pouch removal and permanent diversion for fistulizing disease in the ileal pouch and 5 were successfully treated conservatively without surgery. CONCLUSION The presence of granulomas and segmental involvement of the colon in patients with Crohn's colitis may reflect a more virulent clinical course. Ileal pouch-anal anastomosis may be considered as an option in select patients with Crohn's colitis without small-bowel or perianal disease. Based on our data, patients with nongranulomatous pancolitis may be better candidates for sphincter-sparing surgery.
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Affiliation(s)
- Emilio Morpurgo
- Department of Surgery, Section of Colorectal Surgery, University of Louisville, Louisville, Kentucky 40292, USA
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Abstract
Fournier's gangrene can still be a life-threatening condition with a high mortality rate. Diagnosis and treatment should be prompt and adequate. Radiological studies may help to define the extent of the disease preoperatively in cases in which this is unclear. Surgery with extensive debridement of all necrotic tissue is the mainstay of treatment.
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Affiliation(s)
- Emilio Morpurgo
- Section of Colon and Rectal Surgery, University of Louisville, 550 South Jackson Street, Louisville, KY40292, USA
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D'Annibale A, Orsini C, Fiscon V, Trevisan P, Sovernigo G, Morpurgo E, Galeotafiore G. [Videolaparoscopic surgery in the treatment of colorectal disease: our experience with 200 patients]. Chir Ital 2002; 54:777-83. [PMID: 12613325] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
In this article we examine our experience over the last 4 years, from 1998 to 2001, in the surgical treatment of colorectal disease using the laparoscopic approach. We treated 200 patients, 54 of whom presented benign disease and 146 malignancies. The operations were performed by a team of surgeons and nurses experienced in advanced laparoscopy. Over this period, the duration of the surgical intervention was gradually reduced by 17%. The conversion rate from laparoscopy to open procedures was also reduced (mean rate 11%). Canalization and the resumption of walking and nutrition were reasonably fast. Postoperative complications occurred in 22% of cases The number of fistulas and anastomotic dehiscences was high (10/200 = 5%), due both to evaluation errors and the choice of surgical material. At present, on applying the criteria of traditional open surgery, this figure is also coming down. Bleeding complications (12/200 = 6%) can also be ascribed to the learning curve (2 bleeds in the trocar site and 2 haematomas in the Pfannenstiel laparotomy site) and are therefore likely to be reduced. Bleeding during the surgical procedures, however, was very low, with a mean value of 69.6 ml. Laparoscopic surgery for colorectal disease is well standardized and we believe there should be no doubts as to its use in benign disease. Its use in oncological surgery, though theoretically correct, needs to be confirmed by the trials currently in progress. The results we have obtained in our experience, after completion of the learning curve, agree with the figures reported in the literature.
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Morpurgo E, Cadrobbi R, Morpurgo M, Rigotti P, Schiavon F, Schiavon O, Caliceti P, Ancona E, Veronese FM. Protective effect of superoxide dismutase and polyethylene glycol-linked superoxide dismutase against renal warm ischemia/reperfusion injury. Transplantation 1996; 62:1221-3. [PMID: 8932260 DOI: 10.1097/00007890-199611150-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [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: 02/03/2023]
Abstract
The protective effect of oxygen free radical scavenger superoxide dismutase (SOD) against the warm ischemic damage that occurs in kidneys harvested from non-heart-beating donors is controversial because of its short half-life. In this model, we compared the protective effect of SOD and two longer lasting polyethylene glycol (PEG)-linked forms of SOD in a model of renal ischemia induced by 60 min of arterial clamping in rats. Rats treated with PEG1-SOD and PEG2-SOD had a better renal function than controls, with significantly lower serum creatinine levels throughout the follow-up period and a significantly higher creatinine clearance on postoperative days 1, 2, and 4. In native SOD treated-rats, serum creatinine was lower than in controls, though not significantly so, and creatinine clearance was significantly higher on postoperative day 4. Our results indicate that the protective effect of SOD against renal warm ischemia can be enhanced by prolonging its half-life by binding the enzyme to PEG.
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Affiliation(s)
- E Morpurgo
- Istituto di Chirurgia Generale II, Ospedale Giustinianeo, University of Padova, Italy
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Kozlowski T, Tibell A, Morpurgo E, Sundberg B, Sundin U, Groth C. Suppression of immunoglobulin resynthesis after plasmapheresis: efficacy of various immunosuppressive drugs--a study in rats. Transplant Proc 1995; 27:3545-6. [PMID: 8540094] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- T Kozlowski
- Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Sweden
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Rigotti P, Ferraresso M, Morpurgo E, Cadrobbi R, Menon F, Bacelle L, Calabrese F, Valente ML, Gatta A, Ancona E. Prevention of renal ischemic damage by endothelial protecting agents. Transplant Proc 1995; 27:749-51. [PMID: 7879170] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P Rigotti
- Istituto Chirurgia Generale II, University of Padua Medical School, Italy
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Morpurgo E, Rigotti P, Ancona E. Is warm ischemia the main limiting factor in the use of non-heart-beating donors in renal transplantation? Transplant Proc 1993; 25:1509-10. [PMID: 8442168] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- E Morpurgo
- Institute of Semeiotica Chirurgica, University of Padova, Italy
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Morpurgo E, Rigotti P, Capalbo M, Baldan N, Pittoni G, Valente ML, Bindoli A, Ancona E. Transplantation of warm ischemia damaged kidneys: an experimental study in pigs. Ren Fail 1993; 15:581-5. [PMID: 8290703 DOI: 10.3109/08860229309069407] [Citation(s) in RCA: 8] [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: 01/29/2023] Open
Abstract
This study evaluated renal function and histological and oxidative injury in transplanted kidneys harvested after prolonged warm ischemia in pigs. In 8 donor pigs, kidneys were perfused in situ 120 min after cardiac arrest. One of each pair of kidneys was used for histological and biochemical studies while the other was transplanted into a recipient undergoing bilateral nephrectomy. In 6 cases, renal function was satisfactory 14 days after transplantation. Histologically, a reversible acute tubular necrosis was observed with partial recovery at the 14th postoperative day. A moderate oxidation was revealed by decreased glutathione and increased malondialdehyde levels. In spite of this ischemic injury, these findings suggest that kidneys harvested after prolonged warm ischemia can still recover after transplantation, and that non-heart-beating donors may be considered as an alternative organ source for kidney transplantation.
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Affiliation(s)
- E Morpurgo
- University of Padua, Institute of General Surgery II, Italy
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Rigotti P, Morpurgo E, Comandella MG, Pittoni G, Baldan N, Ganz E, Piazza L, Capalbo M, Valente ML, Ancona E. Non--heart-beating donors: an alternative organ source in kidney transplantation. Transplant Proc 1991; 23:2579-80. [PMID: 1926489] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P Rigotti
- Istituto di Semeiotica Chirurgica, Universitá di Padova, Italy
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Ancona E, Rigotti P, Zaninotto G, Comandella MG, Morpurgo E, Costantini M. Treatment of lymphocele following renal transplantation by laparoscopic surgery. Int Surg 1991; 76:261-3. [PMID: 1838103] [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: 12/29/2022] Open
Abstract
We describe a new technique for internal drainage of lymphocele following renal transplantation performed by laparoscopy. After induction of the pneumoperitoneum, using the cautery hook, a wide opening in the lymphocele peritoneal wall has been performed allowing the lymph flow to enter the peritoneal cavity. A portion of the omentum has been pushed inside the lymphocele cavity and fixed to the parietal peritoneum in order to avoid closure of the peritoneal window. A postoperative CT scan control has shown the complete disappearance of the fluid collection. Internal drainage of lymphocele performed by laparoscopy allows a radical treatment with minimal trauma for the patient and has therefore potential advantages over the other current procedures.
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Affiliation(s)
- E Ancona
- Institute of Semeiotica Chirurgica, University of Padua, Italy
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Rigotti P, Amodio P, Sacerdoti D, Ferraresso M, Borsato M, Morpurgo E, Menon F, Angeli P. Effects of defibrotide on renal function and urinary prostanoid excretion in ciclosporin-treated rats. Nephron Clin Pract 1991; 59:477-81. [PMID: 1758541 DOI: 10.1159/000186612] [Citation(s) in RCA: 2] [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] [Indexed: 12/28/2022] Open
Abstract
Defibrotide (DF) has been proposed as a new antithrombotic agent in renal transplantation. Because it was also found to increase prostacyclin synthesis, a reduction in ciclosporin (CS) nephrotoxicity could be supposed. To ascertain this hypothesis, renal function and urinary prostanoids were evaluated in four groups of rats after 10 days of oral treatment (doses in mg/kg/day): CS 50 (group A), CS 50 + DF 400 (group B), DF 400 (group C) and controls (group D). Compared to controls, creatinine clearance (CCR) was significantly lower in groups A and B (In CCr: A = 6.62 +/- 0.28, B = 6.83 +/- 0.24 vs. 8.17 +/- 0.13 microliters/min, p less than 0.01), whereas it did not change in group C (8.03 +/- 0.24 microliters/min). The urinary excretion of prostaglandin E2 (PGE2) was significantly (p less than 0.05) higher in group A (In PGE2: 3.98 +/- 0.98 nmol/mol Cr) and more evidently in groups B and C (6.89 +/- 0.38 and 6.01 +/- 0.32 nmol/mol Cr, respectively) compared to controls (1.43 +/- 0.45 nmol/mol Cr). The urinary excretion of 6-keto-PGF1 alpha and of thromboxane B2 (TxB2) were higher only in groups A and B (ln 6-keto-PGF1 alpha and ln TxB2: A = 6.45 +/- 0.22 and 4.97 +/- 0.20, B = 7.06 +/- 0.31 and 5.43 +/- 0.41 vs. group D = 5.53 +/- 0.22 and 3.79 +/- 0.42 nmol/mol Cr; p less than 0.05). The 6-keto-PGF1 alpha/Tx molar ratio was not significantly affected, although a trend for a reduction in the ratio was found in the treated rats.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Rigotti
- Institute of Semeiotica Chirurgica, University of Padua, Italy
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Morpurgo E. English Physicians-"Doctorati"-at the University of Padua in the "Collegio Veneto Artista" (1617-1771). Proc R Soc Med 1927; 20:1369-1380. [PMID: 19985950 PMCID: PMC2101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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