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Degiuli M, Azzolina D, Corcione F, Bracale U, Peltrini R, Baldazzi G, Sica GS, Muratore A, Jovine E, Anania G, Borin S, Persiani R, Reddavid R. ASO Author Reflections: Complete Mesocolic Excision Versus Conventional Surgery for Right Colon Cancer (CoME-in trial): An Interim Analysis of a Multicenter, Randomized, Controlled Trial. Ann Surg Oncol 2024; 31:1694-1695. [PMID: 38087137 DOI: 10.1245/s10434-023-14771-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024]
Affiliation(s)
- M Degiuli
- Department of Oncology, University of Turin, Torino, Italy
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - D Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - F Corcione
- Department of General and Oncological Minimally Invasive Surgery, University of Naples Federico II, Naples, Italy
| | - U Bracale
- Department of General and Oncological Minimally Invasive Surgery, University of Naples Federico II, Naples, Italy
| | - R Peltrini
- Department of General and Oncological Minimally Invasive Surgery, University of Naples Federico II, Naples, Italy
| | - G Baldazzi
- ASST OVEST MILANESE, P.O. Nuovo Ospedale di Legnano, Legnano, Italy
| | - G S Sica
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - A Muratore
- Edoardo Agnelli Hospital of Pinerolo, Pinerolo, Italy
| | - E Jovine
- University of Bologna, IRCCS AOU of Bologna, Bologna, Italy
| | - G Anania
- Departement of Medical Science, Faculty of Medicine Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - S Borin
- Digestive Surgery European Institute of Oncology - IRCCS, Milan, Italy
| | - R Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - R Reddavid
- Department of Oncology, University of Turin, Torino, Italy.
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy.
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Degiuli M, Aguilar HAR, Solej M, Azzolina D, Marchiori G, Corcione F, Bracale U, Peltrini R, Di Nuzzo MM, Baldazzi G, Cassini D, Sica GS, Pirozzi B, Muratore A, Calabrò M, Jovine E, Lombardi R, Anania G, Chiozza M, Petz W, Pizzini P, Persiani R, Biondi A, Reddavid R. ASO Visual Abstract: A Randomized Phase III Trial of Complete Mesocolic Excision in Comparison with Conventional Surgery for Right Colon Cancer: Interim Analysis of a Nationwide Multicenter Study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-In Trial). Ann Surg Oncol 2024; 31:1700-1701. [PMID: 38198001 DOI: 10.1245/s10434-023-14794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- M Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy
| | - H A Resendiz Aguilar
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy
| | - M Solej
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy
| | - D Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - G Marchiori
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - F Corcione
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - U Bracale
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - R Peltrini
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - M M Di Nuzzo
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - G Baldazzi
- ASST Ovest Milanese, P.O. Nuovo Ospedale di Legnano, Legnano, Italy
| | - D Cassini
- ASST Ovest Milanese, P.O. Nuovo Ospedale di Legnano, Legnano, Italy
| | - G S Sica
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - B Pirozzi
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - A Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - M Calabrò
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - E Jovine
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - R Lombardi
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - G Anania
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - M Chiozza
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - W Petz
- Digestive Surgery European Institute of Oncology IRCCS, Milan, Italy
| | - P Pizzini
- Digestive Surgery European Institute of Oncology IRCCS, Milan, Italy
| | - R Persiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Biondi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano, Italy.
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Sica GS, Sensi B, Siragusa L, Blasi F, Crispino B, Pirozzi B, Angelico R, Biancone L, Khan J. Surgical management of colon cancer in ulcerative colitis patients with orthotopic liver transplant for primary sclerosing cholangitis. A systematic review. Eur J Surg Oncol 2023; 49:106922. [PMID: 37210276 DOI: 10.1016/j.ejso.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Colon cancer in ulcerative colitis patients with liver transplant (UCCOLT) due to primary sclerosing cholangitis carries significant treatment challenges. Aim of this literature search is to review management strategies and provide a framework to facilitate the decisional process in this clinical setting. METHODS PRISMA-compliant systematic search was followed by critical expert commentary of the results and development of a surgical management algorithm. Endpoints included surgical management, operative strategies, functional and survival outcomes. Technical and strategics aspects with particular regard to the choice of reconstruction were evaluated to tentatively develop an integrated algorithm. RESULTS Ten studies reporting treatment of 20 UCCOLT patients were identified after screening. Nine patients underwent proctocolectomy and end-ileostomy (PC) and eleven had restorative ileal pouch-anal anastomosis (IPAA). Reported results for perioperative outcomes, oncological outcomes, and graft loss were comparable for both procedures. There were no reports of subtotal colectomies and ileo-rectal anastomosis (IRA). CONCLUSIONS Literature in the field is scarce and decision-making is particularly complex. PC and IPAA have been reported with good results. Nevertheless, IRA may also be considered in UCCOLT patients in selected cases, reducing the risks of sepsis, OLT and pouch failure; furthermore, in young patients, it has the advantage of preserving fertility or sexual function. The proposed treatment algorithm may represent a valuable support in guiding surgical strategy.
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Affiliation(s)
- G S Sica
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy.
| | - B Sensi
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - L Siragusa
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - F Blasi
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - B Crispino
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - B Pirozzi
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - R Angelico
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - L Biancone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - J Khan
- Portsmouth Hospitals, NHS Trust, Portsmouth, UK
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Pirozzi BM, Siragusa L, Baldini G, Pellicciaro M, Grande M, Efrati C, Finizio R, Formica V, Del Vecchio Blanco G, Sica GS. Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic. J Clin Med 2023; 12:jcm12041425. [PMID: 36835958 PMCID: PMC9962694 DOI: 10.3390/jcm12041425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020-28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018-29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions.
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Affiliation(s)
- B. M. Pirozzi
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Correspondence:
| | - L. Siragusa
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - G. Baldini
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Pellicciaro
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Grande
- Department of Emergency, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - C. Efrati
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - R. Finizio
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - V. Formica
- Department of Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - G. S. Sica
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Zwanenburg ES, Gehrels AM, Bastiaenen VP, Aalbers AGJ, Arjona-Sánchez A, Bellato V, van der Bilt JDW, D'Hoore AD, Espinosa-Redondo E, Klaver CEL, Kusters M, Nagtegaal ID, van Ramshorst B, van Santvoort HC, Sica GS, Snaebjornsson P, Wasmann KATGM, de Wilt JHW, Wolthuis AM, Tanis PJ. Metachronous peritoneal metastases in patients with pT4b colon cancer: An international multicenter analysis of intraperitoneal versus retroperitoneal tumor invasion. Eur J Surg Oncol 2022; 48:2023-2031. [PMID: 35729015 DOI: 10.1016/j.ejso.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It was hypothesized that colon cancer with only retroperitoneal invasion is associated with a low risk of peritoneal dissemination. This study aimed to compare the risk of metachronous peritoneal metastases (mPM) between intraperitoneal and retroperitoneal invasion. METHODS In this international, multicenter cohort study, patients with pT4bN0-2M0 colon cancer who underwent curative surgery were categorized as having intraperitoneal invasion (e.g. bladder, small bowel, stomach, omentum, liver, abdominal wall) or retroperitoneal invasion only (e.g. ureter, pancreas, psoas muscle, Gerota's fascia). Primary outcome was 5-year mPM cumulative rate, assessed by Kaplan-Meier analysis. RESULTS Out of 907 patients with pT4N0-2M0 colon cancer, 198 had a documented pT4b category, comprising 170 patients with intraperitoneal invasion only, 12 with combined intra- and retroperitoneal invasion, and 16 patients with retroperitoneal invasion only. At baseline, only R1 resection rate significantly differed: 4/16 for retroperitoneal invasion only versus 8/172 for intra- +/- retroperitoneal invasion (p = 0.010). Overall, 22 patients developed mPM during a median follow-up of 45 months. Two patients with only retroperitoneal invasion developed mPM, both following R1 resection. The overall 5-year mPM cumulative rate was 13% for any intraperitoneal invasion and 14% for retroperitoneal invasion only (Log Rank, p = 0.878), which was 13% and 0%, respectively, in patients who had an R0 resection (Log Rank, p = 0.235). CONCLUSION This study suggests that pT4b colon cancer patients with only retroperitoneal invasion who undergo an R0 resection have a negligible risk of mPM, but this is difficult to prove because of its rarity. This observation might have implications regarding individualized follow-up.
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Affiliation(s)
- E S Zwanenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - A M Gehrels
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - V P Bastiaenen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - A G J Aalbers
- Department of Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A Arjona-Sánchez
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital and GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, (IMIBIC), Cordoba, Spain
| | - V Bellato
- Department of Surgical Science, University Hospital Tor Vergata, Rome, Italy
| | - J D W van der Bilt
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - A D D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - E Espinosa-Redondo
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital and GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, (IMIBIC), Cordoba, Spain
| | - C E L Klaver
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - M Kusters
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - I D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B van Ramshorst
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - H C van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - G S Sica
- Department of Surgical Science, University Hospital Tor Vergata, Rome, Italy
| | - P Snaebjornsson
- Department of Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - K A T G M Wasmann
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J H W de Wilt
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Oncological and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands.
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Selvaggi L, Menegon Tasselli F, Sciaudone G, Kontovounisios C, Cosenza A, Sica GS, Selvaggi F, Pellino G. Shifting paradigms in two common abdominal surgical emergencies during the pandemic. Br J Surg 2021; 108:e127-e128. [PMID: 33793730 DOI: 10.1093/bjs/znaa158] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022]
Abstract
During the pandemic there was a reduction in access to the hospital and surgical treatment of appendicitis and cholecystitis at a global level. Some strategies adopted during this challenging time could be applied even after the emergency has been controlled.
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Affiliation(s)
- L Selvaggi
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - F Menegon Tasselli
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - G Sciaudone
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - C Kontovounisios
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - A Cosenza
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - G S Sica
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - F Selvaggi
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
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Siragusa L, Sensi B, Vinci D, Franceschilli M, Pathirannehalage Don C, Bagaglini G, Bellato V, Campanelli M, Sica GS. Volume-outcome relationship in rectal cancer surgery. Discov Oncol 2021; 12:11. [PMID: 35201453 PMCID: PMC8777490 DOI: 10.1007/s12672-021-00406-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR). METHODS A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short-term outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was estimated anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes. RESULTS 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.047). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p < 0.05) were also significantly reduced in Group A. CONCLUSION This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.
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Affiliation(s)
- L Siragusa
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - B Sensi
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - D Vinci
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - M Franceschilli
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - C Pathirannehalage Don
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - G Bagaglini
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - V Bellato
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - M Campanelli
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - G S Sica
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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Petagna L, Antonelli A, Ganini C, Bellato V, Campanelli M, Divizia A, Efrati C, Franceschilli M, Guida AM, Ingallinella S, Montagnese F, Sensi B, Siragusa L, Sica GS. Pathophysiology of Crohn's disease inflammation and recurrence. Biol Direct 2020; 15:23. [PMID: 33160400 PMCID: PMC7648997 DOI: 10.1186/s13062-020-00280-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
Chron’s Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which inflammation plays a key role. Crohn’s disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a TH1 response, through the production of cytokines such as IL-12 and TNF-α. IL-12 itself and IL-23 have been targeted for the medical treatment of CD. Giving the limited success of medical therapies, the treatment of the disease is invariably surgical. This review will highlight the role of inflammation in CD and describe the surgical approaches for the prevention of the almost inevitable recurrence.
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Affiliation(s)
- L Petagna
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - A Antonelli
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - C Ganini
- Torvergata Oncoscience Research Centre of Excellence, TOR, Department of Experimental Medicine, University Tor Vergata, Rome, Italy
| | - V Bellato
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - M Campanelli
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - A Divizia
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - C Efrati
- Ospedale Israelitico, Department of Gastroenterology, Rome, Italy
| | - M Franceschilli
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - A M Guida
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - S Ingallinella
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - F Montagnese
- Nuovo Ospedale dei Castelli, Endoscopy Unit, Rome, Italy
| | - B Sensi
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - L Siragusa
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - G S Sica
- Department of Surgical Science, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. .,Torvergata Oncoscience Research Centre of Excellence, TOR, Department of Experimental Medicine, University Tor Vergata, Rome, Italy.
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9
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Bellato V, Konishi T, Pellino G, An Y, Piciocchi A, Sensi B, Siragusa L, Khanna K, Pirozzi BM, Franceschilli M, Campanelli M, Efetov S, Sica GS. Impact of asymptomatic COVID-19 patients in global surgical practice during the COVID-19 pandemic. Br J Surg 2020; 107:e364-e365. [PMID: 32767367 PMCID: PMC7929295 DOI: 10.1002/bjs.11800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 02/05/2023]
Affiliation(s)
- V Bellato
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - T Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Y An
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - B Sensi
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - L Siragusa
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - K Khanna
- Department of Orthopaedic surgery, Rush university medical center, Chicago, IL
| | - B M Pirozzi
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - M Franceschilli
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - M Campanelli
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - S Efetov
- Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G S Sica
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
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10
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Divizia A, Sensi B, Sica GS. Ambulatory management of perianal Crohn's disease during the COVID-19 pandemic. Colorectal Dis 2020; 22:645-646. [PMID: 32348620 PMCID: PMC7267577 DOI: 10.1111/codi.15104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Affiliation(s)
- A. Divizia
- Minimally Invasive and GI SurgeryPoliclinico Tor VergataRomeItaly
| | - B. Sensi
- Minimally Invasive and GI SurgeryPoliclinico Tor VergataRomeItaly
| | - G. S. Sica
- Minimally Invasive and GI SurgeryPoliclinico Tor VergataRomeItaly
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11
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Milone M, Degiuli M, Allaix ME, Ammirati CA, Anania G, Barberis A, Belli A, Bianchi PP, Bianco F, Bombardini C, Burati M, Cavaliere D, Coco C, Coratti A, De Luca R, De Manzoni G, De Nardi P, De Rosa M, Delrio P, Di Cataldo A, Di Leo A, Donini A, Elmore U, Fontana A, Gallo G, Gentilli S, Giannessi S, Giuliani G, Graziosi L, Guerrieri M, Li Destri G, Longhin R, Manigrasso M, Mineccia M, Monni M, Morino M, Ortenzi M, Pecchini F, Pedrazzani C, Piccoli M, Pollesel S, Pucciarelli S, Reddavid R, Rega D, Rigamonti M, Rizzo G, Robustelli V, Rondelli F, Rosati R, Roviello F, Santarelli M, Saraceno F, Scabini S, Sica GS, Sileri P, Simone M, Siragusa L, Sofia S, Solaini L, Tribuzi A, Trompetto M, Turri G, Urso EDL, Vertaldi S, Vignali A, Zuin M, Zuolo M, D'Ugo D, De Palma GD. Mid-transverse colon cancer and extended versus transverse colectomy: Results of the Italian society of surgical oncology colorectal cancer network (SICO CCN) multicenter collaborative study. Eur J Surg Oncol 2020; 46:1683-1688. [PMID: 32220542 DOI: 10.1016/j.ejso.2020.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
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Affiliation(s)
- M Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
| | - M Degiuli
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - M E Allaix
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - C A Ammirati
- Oncologic Surgical Unit, Hospital Policlinic San Martino, Genova, Italy
| | - G Anania
- Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Italy
| | - A Barberis
- Unit of General and Hepatobiliopancreatic Surgery, Galliera Hospital, Genova, Italy
| | - A Belli
- Division of Surgical Oncology, Department of Abdominal Oncology, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - P P Bianchi
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - F Bianco
- Division of Surgical Oncology, Department of Abdominal Oncology, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - C Bombardini
- Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Italy
| | - M Burati
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - D Cavaliere
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - C Coco
- Department of General Surgery, Sacred Heart Catholic University, Rome, Italy
| | - A Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - R De Luca
- Department of Surgical Oncology, National Cancer Research Center, Giovanni Paolo II Tumor Institute, Bari, Italy
| | - G De Manzoni
- Department of Surgery, General and Upper GI, Surgery Division, University of Verona, Verona, Italy
| | - P De Nardi
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - M De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - P Delrio
- Colorectal Abdominal Surgery Division, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - A Di Cataldo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - A Di Leo
- Department of Surgery, General and Upper GI, Surgery Division, University of Verona, Verona, Italy
| | - A Donini
- Department of General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - U Elmore
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - A Fontana
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - S Gentilli
- Department of General Surgery, Maggiore della Carità Hospital, Novara, Italy
| | - S Giannessi
- Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy
| | - G Giuliani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - L Graziosi
- Department of General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - M Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - G Li Destri
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - R Longhin
- Unit of General and Hepatobiliopancreatic Surgery, Galliera Hospital, Genova, Italy
| | - M Manigrasso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - M Mineccia
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - M Monni
- Department of General Surgery, Maggiore della Carità Hospital, Novara, Italy
| | - M Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - M Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - F Pecchini
- Department of General and Emergency Surgery, Azienda Ospedaliera Universitaria Modena, Modena, Italy
| | - C Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of Colorectal Surgery, University of Verona, Verona, Italy
| | - M Piccoli
- Department of General and Emergency Surgery, Azienda Ospedaliera Universitaria Modena, Modena, Italy
| | - S Pollesel
- Department of General Surgery and Surgical Oncology, University of Siena, Italy
| | - S Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - R Reddavid
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - D Rega
- Colorectal Abdominal Surgery Division, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - M Rigamonti
- Operative Unit of General Surgery, Valli del Noce Hospital, Cles, Trento, Italy
| | - G Rizzo
- Department of General Surgery, Sacred Heart Catholic University, Rome, Italy
| | - V Robustelli
- Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy
| | - F Rondelli
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - R Rosati
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - F Roviello
- Department of General Surgery and Surgical Oncology, University of Siena, Italy
| | - M Santarelli
- Division of General and Emergency Surgery, Molinette Hospital, Turin, Italy
| | - F Saraceno
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S Scabini
- Oncologic Surgical Unit, Hospital Policlinic San Martino, Genova, Italy
| | - G S Sica
- Department of Minimally Invasive and GI Surgery, Policlinico Tor Vergata, Rome, Italy
| | - P Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M Simone
- Department of Surgical Oncology, National Cancer Research Center, Giovanni Paolo II Tumor Institute, Bari, Italy
| | - L Siragusa
- Department of Minimally Invasive and GI Surgery, Policlinico Tor Vergata, Rome, Italy
| | - S Sofia
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - L Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - A Tribuzi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - G Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of Colorectal Surgery, University of Verona, Verona, Italy
| | - E D L Urso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - S Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - A Vignali
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - M Zuin
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - M Zuolo
- Operative Unit of General Surgery, Valli del Noce Hospital, Cles, Trento, Italy
| | - D D'Ugo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G D De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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12
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Sibio S, Di Giorgio A, D'Ugo S, Palmieri G, Cinelli L, Formica V, Sensi B, Bagaglini G, Di Carlo S, Bellato V, Sica GS. Histotype influences emergency presentation and prognosis in colon cancer surgery. Langenbecks Arch Surg 2019; 404:841-851. [PMID: 31760472 DOI: 10.1007/s00423-019-01826-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 09/13/2019] [Indexed: 02/06/2023]
Abstract
AIM To investigate whether differences in histotype in colon cancer correlate with clinical presentation and if they might influence oncological outcomes and survival. METHODS Data regarding colon cancer patients operated both electively or in emergency between 2009 and 2014 were retrospectively collected from a prospectively maintained database and analyzed for the purpose of this study. Rectal cancer was excluded from this analysis. Statistical univariate and multivariate analyses were performed to investigate possible significant variables influencing clinical presentation, as well as oncological outcomes and survival. RESULTS Data from 219 patients undergoing colorectal resection for cancer of the colon only were retrieved. One hundred seventy-four patients had an elective procedure and forty-five had an emergency colectomy. Emergency presentation was more likely to occur in mucinous (p < 0.05) and signet ring cell (p < 0.01) tumors. No definitive differences in 5-year overall (44.7% vs. 60.6%, p = 0.078) and disease-free (51.2% vs. 64.4%, p = 0.09) survival were found between the two groups as a whole, but the T3 emergency patients showed worse prognosis than the elective (p < 0.03). Lymph node invasion, laparoscopy, histology, and blood transfusions were independent variables found to influence survival. Distribution assessed for pTNM stage showed T3 cancers were more common in emergency (p < 0.01). CONCLUSIONS AND DISCUSSION Mucinous and signet ring cell tumors are related to emergency presentation, pT3 stage, poorest outcomes, and survival. Disease-free survival in patients who had emergency surgery for T3 colon cancer seems related to the histotype.
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Affiliation(s)
- Simone Sibio
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. .,Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Via Lancisi 2, 00155, Rome, Italy.
| | - A Di Giorgio
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - S D'Ugo
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - G Palmieri
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - L Cinelli
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - V Formica
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - B Sensi
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - G Bagaglini
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - S Di Carlo
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
| | - V Bellato
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - G S Sica
- Department of Surgery, Tor Vergata Hospital, Tor Vergata University of Rome, Viale Oxford 81, 00133, Rome, Italy
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13
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De Simone V, Franzè E, Ronchetti G, Colantoni A, Fantini MC, Di Fusco D, Sica GS, Sileri P, MacDonald TT, Pallone F, Monteleone G, Stolfi C. Th17-type cytokines, IL-6 and TNF-α synergistically activate STAT3 and NF-kB to promote colorectal cancer cell growth. Oncogene 2015; 34:3493-503. [PMID: 25174402 PMCID: PMC4493653 DOI: 10.1038/onc.2014.286] [Citation(s) in RCA: 383] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 12/17/2022]
Abstract
Colorectal cancers (CRCs) often show a dense infiltrate of cytokine-producing immune/inflammatory cells. The exact contribution of each immune cell subset and cytokine in the activation of the intracellular pathways sustaining CRC cell growth is not understood. Herein, we isolate tumor-infiltrating leukocytes (TILs) and lamina propria mononuclear cells (LPMCs) from the tumor area and the macroscopically unaffected, adjacent, colonic mucosa of patients who underwent resection for sporadic CRC and show that the culture supernatants of TILs, but not of LPMCs, potently enhance the growth of human CRC cell lines through the activation of the oncogenic transcription factors signal transducer and activator of transcription 3 (STAT3) and nuclear factor-kappa B (NF-kB). Characterization of immune cell complexity of TILs and LPMCs reveals no differences in the percentages of T cells, natural killer T cells, natural killer (NK) cells, macrophages and B cells. However, T cells from TILs show a functional switch compared with those from LPMCs to produce large amounts of T helper type 17 (Th17)-related cytokines (that is, interleukin-17A (IL-17A), IL-17F, IL-21 and IL-22), tumor necrosis factor-α (TNF-α) and IL-6. Individual neutralization of IL-17A, IL-17F, IL-21, IL-22, TNF-α or IL-6 does not change TIL-derived supernatant-driven STAT3 and NF-kB activation, as well as their proproliferative effect in CRC cells. In contrast, simultaneous neutralization of both IL-17A and TNF-α, which abrogates NF-kB signaling, and IL-22 and IL-6, which abrogates STAT3 signaling, reduces the mitogenic effect of supernatants in CRC cells. IL-17A, IL-21, IL-22, TNF-α and IL-6 are also produced in excess in the early colonic lesions in a mouse model of sporadic CRC, associated with enhanced STAT3/NF-kB activation. Mice therapeutically given BP-1-102, an orally bioavailable compound targeting STAT3/NF-kB activation and cross-talk, exhibit reduced colon tumorigenesis and diminished expression of STAT3/NF-kB-activating cytokines in the neoplastic areas. These data suggest that strategies aimed at the cotargeting of STAT3/NF-kB activation and interaction between them might represent an attractive and novel approach to combat CRC.
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Affiliation(s)
- V De Simone
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - E Franzè
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - G Ronchetti
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - A Colantoni
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - M C Fantini
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - D Di Fusco
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - G S Sica
- Department of Surgery, University of Rome ‘Tor Vergata', Rome, Italy
| | - P Sileri
- Department of Surgery, University of Rome ‘Tor Vergata', Rome, Italy
| | - T T MacDonald
- Centre for Immunology and Infectious Disease, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
| | - F Pallone
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - G Monteleone
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | - C Stolfi
- Department of Systems Medicine, University of Rome ‘Tor Vergata', Rome, Italy
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14
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Caruso R, Marafini I, Franzè E, Stolfi C, Zorzi F, Monteleone I, Caprioli F, Colantoni A, Sarra M, Sedda S, Biancone L, Sileri P, Sica GS, MacDonald TT, Pallone F, Monteleone G. Defective expression of SIRT1 contributes to sustain inflammatory pathways in the gut. Mucosal Immunol 2014; 7:1467-79. [PMID: 24850427 DOI: 10.1038/mi.2014.35] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 04/15/2014] [Indexed: 02/04/2023]
Abstract
In inflammatory bowel disease (IBD), tissue damage is driven by an excessive immune response, poorly controlled by counter-regulatory mechanisms. SIRT1, a class III NAD+-dependent deacetylase, regulates negatively the expression of various proteins involved in the control of immune-inflammatory pathways, such as Stat3, Smad7, and NF-κB. Here we examined the expression, regulation, and function of SIRT1 in IBD. SIRT1 RNA and protein expression was less pronounced in whole biopsies and lamina propria mononuclear cells (LPMCs) of IBD patients in comparison with normal controls. SIRT1 expression was downregulated in control LPMC by tumor necrosis factor (TNF)-α and interleukin (IL)-21, and upregulated in IBD LPMC by neutralizing TNF-α and IL-21antibodies. Consistently, SIRT1 expression was increased in mucosal samples taken from IBD patients successfully treated with Infliximab. Treatment of IBD LPMC with Cay10591, a specific SIRT1 activator, reduced NF-κB activation and inhibited inflammatory cytokine synthesis, whereas Ex527, an inhibitor of SIRT1, increased interferon (IFN)-γ in control LPMC. SIRT1 was also reduced in mice with colitis induced by 2,4,6-trinitrobenzenesulphonic acid or oxazolone. Cay10591 prevented and cured experimental colitis whereas Ex527 exacerbated disease by modulating T cell-derived cytokine response. Data indicate that SIRT1 is downregulated in IBD patients and colitic mice and suggest that SIRT1 activation can help attenuate inflammatory signals in the gut.
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Affiliation(s)
- R Caruso
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - I Marafini
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - E Franzè
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - C Stolfi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - F Zorzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - I Monteleone
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - F Caprioli
- Unit of Gastroenterology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A Colantoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - M Sarra
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - S Sedda
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - L Biancone
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - P Sileri
- Department of Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - G S Sica
- Department of Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - T T MacDonald
- Barts and the London School of Medicine and Dentistry, London, UK
| | - F Pallone
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - G Monteleone
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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15
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Stolfi C, De Simone V, Colantoni A, Franzè E, Ribichini E, Fantini MC, Caruso R, Monteleone I, Sica GS, Sileri P, MacDonald TT, Pallone F, Monteleone G. A functional role for Smad7 in sustaining colon cancer cell growth and survival. Cell Death Dis 2014; 5:e1073. [PMID: 24556688 PMCID: PMC3944263 DOI: 10.1038/cddis.2014.49] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/09/2014] [Indexed: 02/07/2023]
Abstract
Initially identified as an inhibitor of transforming growth factor (TGF)-β mainly owing to its ability to bind TGF-β receptor type I and abrogate TGF-β-driven signaling, Smad7 can interact with additional intracellular proteins and regulate TGF-β-independent pathways, thus having a key role in the control of neoplastic processes in various organs. Genome-wide association studies have shown that common alleles of Smad7 influence the risk of colorectal cancer (CRC), even though the contribution of Smad7 in colon carcinogenesis is not fully understood. In this study, we assessed the expression and role of Smad7 in human and mouse models of sporadic CRC. We document a significant increase of Smad7 in human CRC relative to the surrounding nontumor tissues and show that silencing of Smad7 inhibits the growth of CRC cell lines both in vitro and in vivo after transplantation into immunodeficient mice. Knockdown of Smad7 results in enhanced phosphorylation of the cyclin-dependent kinase (CDK)2, accumulation of CRC cells in S phase and enhanced cell death. Smad7-deficient CRC cells have lower levels of CDC25A, a phosphatase that dephosphorylates CDK2, and hyperphosphorylated eukaryotic initiation factor 2 (eIF2)α, a negative regulator of CDC25 protein translation. Consistently, knockdown of Smad7 associates with inactivation of eIF2α, lower CDC25A expression and diminished fraction of proliferating cells in human CRC explants, and reduces the number of intestinal tumors in Apcmin/+ mice. Altogether, these data support a role for Smad7 in sustaining colon tumorigenesis.
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Affiliation(s)
- C Stolfi
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - V De Simone
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - A Colantoni
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - E Franzè
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - E Ribichini
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - M C Fantini
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - R Caruso
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - I Monteleone
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - G S Sica
- Department of Surgery, University of 'Tor Vergata', Rome, Italy
| | - P Sileri
- Department of Surgery, University of 'Tor Vergata', Rome, Italy
| | - T T MacDonald
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - F Pallone
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
| | - G Monteleone
- Department of Systems Medicine, University of 'Tor Vergata', Rome, Italy
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16
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Onali S, Calabrese E, Petruzziello C, Zorzi F, Sica GS, Lolli E, Ascolani M, Condino G, Pallone F, Biancone L. Endoscopic vs ultrasonographic findings related to Crohn's disease recurrence: a prospective longitudinal study at 3 years. J Crohns Colitis 2010; 4:319-28. [PMID: 21122521 DOI: 10.1016/j.crohns.2009.12.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 12/20/2009] [Accepted: 12/20/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Ileocolonoscopy (IC) is the gold standard for assessing Crohn's Disease (CD) recurrence after ileo-colonic resection. In a prospective longitudinal study we compared findings related to CD recurrence when using techniques visualizing either the luminal or the extraluminal surface (IC and small bowel follow through, SBFT vs Small Intestine Contrast Ultrasonography, SICUS). METHODS From 2003 to 2008, 25 CD patients undergoing ileo-colonic resection were enrolled. Clinical assessment (CDAI) was performed at 1, 2 and 3 years. IC was performed at 1 (n=25) and 3 years (n=15), SBFT at 2 years (n=21) and SICUS at 1 (n=25), 2 (n=21) and 3 years (n=15). Recurrence was assessed by SBFT and SICUS (bowel wall thickness, BWT) when using IC as gold standard. RESULTS At 1 year, all patients were inactive and recurrence was detected by IC in 24/25 (96%) and by SICUS in 25/25 patients. At 2 years, 6/21 patients (29%) were active and recurrence was detected by SBFT in 12/21 (57%) and by SICUS in 21/21 patients. At 3 years, 5/15 patients (33%) were active, IC showed recurrence in 14/15 (93%), and SICUS in 15/15 patients. The endoscopic score at 1 year was higher in patients developing relapse at 2 years (n=5) than in patients maintaining remission (n=10) (median: 4, range 3-4 vs 2, range 0-3; p=0.003). The same finding was not observed by using SICUS (median BWT at 1 year: 5, range 4-7 vs 3.7, range 3.5-6; p=0.19). CONCLUSIONS Although IC and SICUS provide a different view of the bowel wall, in experienced hands SICUS provides findings compatible with endoscopic recurrence after ileo-colonic resection for CD. Discrepant findings may be observed in a low proportion of patients with minor lesions related to CD recurrence.
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Affiliation(s)
- S Onali
- Unità di Gastroenterologia, Dipartimento di Medicina Interna, Università "Tor Vergata" di Roma, Italy
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Biancone L, Onali S, Calabrese E, Petruzziello C, Zorzi F, Condino G, Sica GS, Pallone F. Non-invasive techniques for assessing postoperative recurrence in Crohn's disease. Dig Liver Dis 2008; 40 Suppl 2:S265-70. [PMID: 18598999 DOI: 10.1016/s1590-8658(08)60536-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Postoperative recurrence after ileo-colonic resection is a feature of Crohn's Disease (CD), almost 73% of patients show endoscopic recurrence at 1 year and 90% at 3 years. After surgical resection for CD, symptoms may be related to the surgical resection itself. Moreover, the development of an early severe endoscopic recurrence within 1 year represents a risk factor for early clinical recurrence. On the basis of these observations, the early detection and assessment of asymptomatic endoscopic recurrence may allow a timely and appropriate treatment of CD patients after ileo-colonic resection. At this purpose, conventional colonoscopy with ileoscopy currently represents the gold standard for assessing CD recurrence, graded according to the Rutgeerts' score. Lesions compatible with CD recurrence can be also detected by conventional radiology, including small bowel follow through and enema, both associated with a high radiation exposure. Due to the ineluctable course of CD after resection, and to the need of a proper follow up for assessing CD recurrence, several alternative, non invasive techniques have been searched in order to assess the post-operative recurrence, including: faecal alpha 1-antitrypsin clearance, faecal calprotectin, 99Tc-HMPAO scintigraphy, virtual colonoscopy, ultrasonography and, more recently, wireless capsule endoscopy (WCE) and Small Intestine Contrast Ultrasonography (SICUS). Among these, current evidences suggest that in experienced hands, ultrasound examination by SICUS represents a non-invasive technique useful for assessing recurrence in CD patients under regular follow up after surgery. The same findings are suggested for WCE, although the impact risk related to the recurrence or to the surgical anastomosis itself limits the use of this non-invasive technique for assessing CD recurrence after surgery.
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Affiliation(s)
- L Biancone
- Departments of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
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Biancone L, Sica GS, Calabrese E, Onali S, Petruzziello C, Pallone F. Frequency and pattern of endoscopic recurrence in Crohn's disease patients with ileocolonic resection using a laparoscopic versus laparotomic approach: a prospective longitudinal study. Am J Gastroenterol 2008; 103:809-11. [PMID: 18341511 DOI: 10.1111/j.1572-0241.2007.01612_14.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Affiliation(s)
- G S Sica
- Department of Surgery, John Radcliffe Hospital, Headington, Oxford, UK.
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Sileri P, Sica GS, Gentileschi P, Venza M, Benavoli D, Jarzembowski T, Manzelli A, Gaspari AL. Melatonin reduces bacterial translocation after intestinal ischemia-reperfusion injury. Transplant Proc 2005; 36:2944-6. [PMID: 15686666 DOI: 10.1016/j.transproceed.2004.10.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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
Melatonin, the primary pineal hormone, has been reported to protect from oxidative injury after ischemia-reperfusion (IR). The aim of this study was to evaluate the effects of exogenous melatonin on intestinal integrity, ileal colonization, and bacterial translocation 45-minute after mesenteric IR. Sixteen male ACI rats randomly divided into two groups underwent 45-minutes intestinal ischemia by clamping the superior mesenteric artery. One hour prior to ischemia, study animals (n=8, group A) were treated with melatonin (10 mg/kg IP) while control animals (n=8, group B) received the same volume of saline solution. An additional six animals underwent laparotomy and served as a sham-operated group. Animals were sacrificed 24 hours after reperfusion; peritoneal swabs and biopsies of liver, spleen, lung, mesenteric lymph nodes, cecum, and terminal ileum were obtained for microbiology. The ileum samples were also processed for histopathological evaluation of IR-induced injury. Twenty-four hours after reperfusion bacterial translocation to the peritoneal cavity present in all group B animals was reduced to 37.5% among those that were melatonin-treated (group A; P <.05). Furthermore bacterial translocation to mesenteric lymph nodes, spleen, and liver was significantly lower in group A than group B (P <.05). Although cecal and ileal counts did not differ between the two groups, ileal counts from control animals showed increased colonization. Accordingly, a single injection of exogenous melatonin significantly reduced the intestinal IR injury and prevented bacterial translocation.
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Affiliation(s)
- P Sileri
- University of Rome "Tor Vergata." Rome, Italy.
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21
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Rossi P, Sileri P, Gentileschi P, Sica GS, Forlini A, Stolfi VM, De Majo A, Coscarella G, Canale S, Gaspari AL. Percutaneous liver biopsy using an ultrasound-guided subcostal route. Dig Dis Sci 2001; 46:128-32. [PMID: 11270776 DOI: 10.1023/a:1005571904713] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [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: 12/30/2022]
Abstract
Percutaneous biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. The introduction and widespread diffusion of ultrasounds in medical practice has improved percutaneous bioptic technique, while reducing postoperative complications. Although ultrasonography has become almost ubiquitous in prebiopsy investigation, only one third of biopsies are performed under ultrasound control. Moreover, the one-day procedure, reported in several studies to be safe and cost effective, accounted for only 4% of biopsies done. We report our experience of 142 percutaneous US-guided biopsies performed on 140 patients affected by chronic diffuse liver disease over a four-year period. Liver biopsies were performed under US guidance at the patient's bed using an anterior subcostal route. We evaluated postoperative pain, modifications of blood pressure and red cell count, hospital stay, morbidity and mortality rates, and adequacy of specimens for histologic examination. There was no operative mortality. As for major complications, one case of hemobilia occurred. As for minor complications, two cases of persistent postoperative pain required analgesic therapy. Patients were discharged the day following the procedure in all cases but two, who were discharged on the third and fifth postoperative days. Liver specimens were suitable for histologic diagnosis in all but one case, in which there were no portal spaces. According to our experience, we believe that hepatic biopsy guided by ultrasonography could replace blinded biopsy in the diagnosis of diffuse liver disease. The procedure is suitable to be performed safely on an outpatient basis.
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Affiliation(s)
- P Rossi
- University of Rome Tor Vergata, Department of General Surgery, Italy
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22
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Sica GS, Spiratou C, Sileri P, Lirosi F, Gentileschi P, Rossi P, Stolfi VM, Di Lorenzo N, Russo F, Forlini A, Gaspari AL. [Retrospective analysis of the use of prophylactic drainage of the pelvis after anterior resection of the rectum]. Ann Ital Chir 2000; 71:367-72. [PMID: 11014017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Although the use of drains is common in clinical practice, its real role in the prophylaxis and therapy of postoperative complications is still not clear. In the literature we can find both supporters of drains, and many opponents who consider their use unnecessary and sometimes even dangerous. In fact, during new experimental and clinical studies, it was impossible to determine the usefulness of prophylactic abdominal drain, at least in the case of colo-rectal anastomosis, it has been demonstrated that use of drains limits the risks of an anastomotic leakage but, in some cases, the same drains could be the cause of some of the complications that should be avoided. Although there is a considerable theoretical and practical evidences in favour of drainage, the dispute about "to drain or not to drain" the peritoneal cavity after elective colo-rectal surgery remains open. This retrospective study made on 150 patients operated on elective surgery for rectal cancer demonstrates that prophylactic drain does not significantly influence the general rate of leakage (3.15% for group A and 5.45% for group B, p > 0.1); in two of the three fistulas in patients with drains, the drains have permitted the diagnosis, but have not permitted the reduction of the number of operations for fistulas.
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Affiliation(s)
- G S Sica
- Cattedra di Chirurgia Generale, Università degli Studi di Roma Tor Vergata
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23
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Russo A, Scotto Di Clemente S, Prota V, Iorio B, Sica GS. [Radiopaque lesions of the jaws]. Minerva Stomatol 1999; 48:621-7. [PMID: 10822715] [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: 02/16/2023]
Abstract
This paper provides an overview of radiopaque lesions of the jaws after having outlined the various criteria for classification; depending on their etiology. Those lesions are generally separated into lesions with an unknown cause and lesions with a known etiology (phlogistic, dysplastic-dystrophic, tumoral). The authors give a general description of the clinical and radiographic symptoms of the main lesions. In many cases, with the exception of asymptomatic lesions with an unknown etiology, the patient presents a variable swelling that deforms the bone in question, resulting in asymmetry of the face and/or, depending on the site, nasal obstruction, mastication and speech disorders, exophthalmos with or without diplopia. The radiographic aspect of lesions and the associated laboratory and clinical findings often enable a diagnosis to be reached, but in doubtful cases diagnosis can only be confirmed by histological analysis.
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Affiliation(s)
- A Russo
- Scuola di Specializzazione in Chirurgia Maxillo-facciale, Facoltà di Medicina e Chirurgia, Università degli Studi Federico II, Napoli
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Gaspari A, Russo F, Sica GS, Coscarella G, Sileri P, Spina C, Di Lorenzo N. [Microsurgical repair of iatrogenic injuries of the recurrent laryngeal nerve]. MINERVA CHIR 1999; 54:795-803. [PMID: 10638153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
In this retrospective study the functional results of microsurgical repair of iatrogenic recurrent nerve lesions (10 patients) faced during years 1983 through 1995 have been analysed. Different parameters were considered (thyroid disease, previous thyroid surgery, microsurgical reconstruction technique, time between surgical damage and microsurgery). Furthermore, a thorough review has been made on the medical literature on subjects such as surgical anatomy of the cervical region, microsurgical nerve repair techniques, and clinical results of microsurgery in different authors experiences.
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Affiliation(s)
- A Gaspari
- Dipartimento di Chirurgia, Università degli Studi Tor Vergata, Roma
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25
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Sileri P, Sica GS, Rastellini C, Dicuonzo G, Gaspari AL, Cicalese L. [Bacterial translocation and its surgical implications]. G Chir 1999; 20:440-4. [PMID: 10555416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The passage of viable bacteria through epithelial mucosa into lamina propria and then to mesentheric lymphnodes, and possibly other tissues was defined bacterial translocation (BT) by Berg and Garlington. The transepithelial passage of bacteria out of the intestinal lumen seems to occur in a variety of surgical conditions, and it is suspected to be involved in systemic inflammatory response syndrome, sepsis and multiorgan failure. There is increasing evidence that many nosocomial infections are caused by enteric translocating microorganisms, although the exact incidence of BT in humans is difficult to establish. Consensus is emerging that the barrier function of the gut is relevant in established critical illness and in patients at risk of developing sepsis and clinical studies have provided strong evidence that systemic infections often originate from intestinal flora in high risk patients. So the suspect of BT is made when there is infection after trauma, burns, major surgery, chemotherapy and immuno suppression. Bacterial translocation is also associated with organ transplantation, especially with small bowel transplantation. The Authors have summarized published experimental and clinical studies that have tried to understand the occurrence, mechanisms and effects of this complex process. At the present time there is a near full understanding of the relevance of BT like an interplay of diverse factors in a physiologically, immunologically and microbiologically complex intestinal tract. However additional experimental and clinical studies are needed to clarify the relationship between these phenomena and the development of sepsis or multiple organ dysfunction syndrome.
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Affiliation(s)
- P Sileri
- Cattedra di Chirurgia Generale, II Università degli Studi Tor Vergata, Roma
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Abstract
We describe the case of a thoracoscopic approach to giant lymph node hyperplasia (Castleman's disease) located in the mediastinum. In our patient the initial diagnosis was substernal goiter, but at cervical exploration the mass was found not to be continuous with the thyroid. The mass was easily identified through a lateral thoracoscopic approach and carefully removed. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Histopathology revealed the features of Castleman's disease, mixed type. The prevalence, location, and pathogenesis of giant lymph node hyperplasia are described, together with the histology and clinical signs. Our report is proposed as the first case of an endoscopic approach to giant lymph node hyperplasia, which could be the best surgical approach for a mediastinal location.
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Affiliation(s)
- G S Sica
- Department of General Surgery, University Tor Vergata, Rome, Italy
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27
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Sica GS, Sileri P, Riccardelli F, Russo F, Stolfi VM, Rossi P, Forlini A, Gaspari AL. [Revascularization of the corpora cavernosa in vasculogenic impotence]. MINERVA UROL NEFROL 1999; 51:129-34. [PMID: 10429426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The vasculogenic erectile impotence, caused by occlusion and/or stenosis of arteries supplying the penis, is the most common cause of erectile failure in men over 40 years. The vasculogenic impotence is more found by peripheral vasculopathies like diabetes mellitus and nicotine abuse. It is important that the precise site of vascular lesion is established with selective arteriography of the hypogastric-internal pudendal axis. The specific aim of surgery is to increase the cavernosal arterial perfusion pressure and blood inflow in patients with vasculogenic erectile dysfunction secondary to pure arterial insufficiency. There have been multiple revascularization techniques described for the treatment of proximal or distal occlusion with variable results. Microsurgery is important for distal lesions and we think that the best candidates for the Michal II procedure seem to be those with localized obstruction of the internal pudendal, while venous arterialization is the preferred procedure for patients with pathological cavernous or dorsal penile arteries. In this paper the most important procedures to restore physiological erection are presented; however no single revascularization procedure has been generally accepted as a definitive answer to this problem. There is a need for further prospective studies with longer follow-up and more objective investigations.
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Affiliation(s)
- G S Sica
- Dipartimento di Chirurgia, Università degli Studi, Tor Vergata, Roma
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Russo F, Coscarella G, Prisco LA, Spina C, Sica GS, Sileri P, Neri A, Gaspari AL. [Cystadenolymphoma of the salivary glands: is there a familial role?]. Ann Ital Chir 1999; 70:233-7; discussion 237-8. [PMID: 10434456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The authors present two patients (mother and son) affected by cystadenolymphoma (Warthin's tumor) of the salivary glands, both surgically treated. A thorough review of the literature is conducted and the authors suggest that echographic screening of these neoplasia in first-degree relatives could be of value.
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Affiliation(s)
- F Russo
- Dipartimento di Chirurgia, Università di Roma Tor Vergata
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Sica GS, Forlini A, Sileri P, Russo F, Rulli F, Gaspari AL. [Deep venous insufficiency of the lower extremities]. Minerva Cardioangiol 1998; 46:435-44. [PMID: 10207291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lower limbs chronic venous insufficiency (CVI) is a widespread pathologic condition. Prevalence of venous ulcer in Europe ranges between 0.5% and 1.0%. Venous ulceration can be due to insufficiency of the superficial system, although deep venous insufficiency is responsible for 75% of the cases. Morbidity and socio-economic costs are exceedingly high especially because of frequent recurrences. CVI recognises mainly two causes: 1) increased influx, due to arteriovenous fistulas; 2) difficult outflow usually secondary to postphlebitic or primitive valvular incompetence. The prevalence of CVI and venous ulceration is difficult to assess. Surgical treatment tends to cure the underlying hemodynamic problem. Homans in 1916 first introduced surgical treatment of CVI and venous ulceration: excision of the cutaneous lesion and ligature suprafascial of the communicating veins. Since then different various techniques have been introduced in the clinical practice: Linton in 1938 supported subfascial interruption of the perforating veins but still reported a recurrence rate of 47%. Stripping of internal saphenous vein associated with division of perforating veins is still controversial, because lacks evidence of its real effectiveness in preventing recurrences. Felder's surgical technique is preferred by some authors to Linton's technique, because of the possibility to divide and section incompetent perforating veins without a cutaneous incision in the severely diseased postphlebitic tissues. In personal experience (56 patients) treated by Felder's techniques, we reached a cutaneous ulceration healing rate of 36% has been obtained. Subfascial interruption of perforating veins under endoscopic vision associated to the stripping of the internal saphenous vein could be a valuable option in the treatment of CVI because of the shorter duration of the operation and hospital stay and lesser postoperative complications. Repair and/or replacement of deep venous valves, originally described by Kistner in 1968, could be curative of venous hypertension due to primitive valvular insufficiency (primitive or postphlebitic): the same author in 1975 reported positive results (80% at 5 years). Major advantages of indirect valvuloplastic surgical technique are: 1) venotomy is not necessary; 2) it does not introduce extraneous material in the vasal lumen; 3) clamping of the vein is avoided; 4) heparine or other antithrombotic measures are usually not necessary. Although preliminary encouraging results, subsequent clinical experiences have demonstrated that correction of the reflux of the main axial venous system alone is not curative and durable resolution of venous symptoms also depends on the concomitant correction of all incompetent perforating veins. Venous valves transplantation is theoretically good to correct the deep long reflux and to improve calf pump function, although clinical results are still limited and follow-up not prolonged enough in terms of symptoms resolution and complete ulcer healing.
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Affiliation(s)
- G S Sica
- Cattedra di Chirurgia Generale, Università degli Studi di Roma Tor Vergata
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Di Lorenzo N, Sica GS, Sileri P, Gaspari AL. Thoracoscopic sympathectomy for vasospastic diseases. JSLS 1998; 2:249-53. [PMID: 9876748 PMCID: PMC3015307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vasospastic disorders (acrocyanosis, Raynaud's syndrome, causalgia) can arise from different etiologic factors, but the pathogenesis is always represented by an altered mechanism of vasal motility. Upper dorsal sympathectomy has been demonstrated to be an effective treatment for these disorders by decreasing peripheral resistances. Surgical technique has shown long-lasting results, and it can now be performed by endoscopic approach. METHODS Our experience with six cases of sympathectomy is illustrated. The indications, thoracoscopic technique, complications and long-term results are evaluated. Four women with Raynaud's syndrome and two men with causalgia were treated in this series. After an accurate preoperative evaluation, the second, third, fourth and fifth thoracic ganglia of the sympathetic chain were identified and excised. RESULTS All patients experienced relief of symptoms with very limited pain and discomfort. They did not require further medical therapy and are relapse-free at follow-up. CONCLUSIONS We conclude that thoracoscopic sympathectomy can be considered an effective, safe and simple treatment for selected cases of vasospastic phenomenon.
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Affiliation(s)
- N Di Lorenzo
- Cattedra di Chirurgia Generale, Università di Roma, Tor Vergata, Italy.
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Russo A, Dell'Aquila A, Prota V, Sica GS. [Necrotizing sialometaplasia of the submandibular gland. Report of a case]. Minerva Stomatol 1998; 47:273-7. [PMID: 9738361] [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: 02/08/2023]
Abstract
A case report of swelling of the right submandibular gland, with spontaneous remission, is described. Clinical, ultrasonographical and cytological features suggest that the swelling could be ascribed to a necrotizing sialometaplasia. The etiopathological hypothesis and pathology of the lesion are presented, and the differential diagnosis with other spreading lesions of the submandibular gland is discussed.
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Affiliation(s)
- A Russo
- Cattedra di Chirurgia Maxillo-Facciale, Facoltà di Medicina e Chirurgia, Università degli Studi Federico II, Napoli
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32
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Russo A, Dell'Aquila A, De Rosa I, Russo S, Sica GS. [Odontogenic fibroma of the jaws. Report of a clinical case and etiopathogenic considerations]. Minerva Stomatol 1998; 47:231-4. [PMID: 9677820] [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: 02/08/2023]
Abstract
A case of peripheral odontogenic fibroma is reported and its epidemiology, clinical aspects and etiopathogenesis are discussed. It is supposed that the epithelial component may be related to odontogenic embrionary tissue inclusions: These inclusions may stimulate a local mesenchymal reaction giving place to a proliferative lesion, as observed.
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Affiliation(s)
- A Russo
- Cattedra di Chirurgia Maxillo-Facciale, Facolità di Medicina e Chirurgia, Università degli Studi do Napoli Federico II
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Russo F, Barone Adesi TL, Di Lorenzo N, Sica GS, Spina C, Sileri P, Arturi A, Coscarella G, Gaspari AL. [Hürthle cell neoplasms of the thyroid gland]. G Chir 1998; 19:103-8. [PMID: 9577083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
From 1986 to 1996 the Authors have surgically treated 34 patients affected with Hürthle cell neoplasm of the thyroid (23 benign and 11 malignant). Preoperative diagnosis was obtained mainly by fine needle aspiration biopsy. In thyroid surgery we routinely prepare laryngeal nerve and take great care to avoid devascularization fo the parathyroid glands. Operative procedures performed were hemithyroidectomy plus isthmectomy (18), subtotal thyroidectomy (2) and total thyroidectomy (14). No cervical lymph node dissection was requested, neither we observed post-operative morbidity. Mean follow-up was 116 months. During observation period we documented. No hematogenous metastasis was observed. All patients are now well and alive free of disease. This series stresses the favourable behavior of Hürthle cell neoplasm of the thyroid--even through a prolonged follow-up. A thorough review of the Literature on the topic is conducted. The Authors are in favour of total thyroidectomy as first choice procedure for lesions larger than 40 mm in order to reduce the need of completion thyroidectomy and the potential morbidity.
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Affiliation(s)
- F Russo
- Dipartimento di Chirurgia, Università degli Studi Tor Vergata, Roma
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34
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Russo A, Dell'Aquila A, Errico ME, Sica GS. [Etio-pathogenic considerations on the development of multiple bone cysts in the mandible. Report of a clinical case]. Minerva Stomatol 1997; 46:487-490. [PMID: 9446022] [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: 05/22/2023]
Abstract
A case of a mandibular cyst, missing of wall lining and containing some solid material is described. The histologic examination showed that this material consisted of osteofibrous tissue with regressive phenomena, inflammatory cells and hyperplastic nervous tissue. On the basis of clinical and histologic findings it is suggested to be a solitary cyst and the solid material due to a local response to an injury suffered by the patient who is a sport practitioner.
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Affiliation(s)
- A Russo
- Facoltà di Medicina e Chirurgia, Cattedra di Chirurgia Maxillo-Facciale, Università degli Studi di Napoli Federico II
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Cortese A, Letizia N, Gargiulo M, Bergaminelli F, Sica GS. [Angiomas of the maxillofacial area: a clinical study with MR and angio-MR]. Minerva Stomatol 1996; 45:415-9. [PMID: 8999305] [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: 02/03/2023]
Abstract
Reporting 3 cases of hemangiomas of the maxillo-facial area the authors describe, proper use, of RBc scintigraphy, CT with contrast media, MR, angio-MR. Comparing these methods it will results that RBc scintigraphy is a very useful method in a screening phase providing data concerning kind of blood flow, morphology of lesions and also detecting unknown lesions by total body scanning. CT imaging with contrast media is a useful method in a presurgical phase providing the exact anatomical limits of the lesions especially when involving bone tissue. MR imaging provides precise anatomic limits specially for low flow lesions; it also provides a vascular map of the arterial afferent vessels in high flow vascular lesions, without any use of ionogenic radiations. For these reasons MR is advisable in pediatric age and allergic patients. Super-selective embolization, sclerosant therapy and surgery therapy are indicated for treatment of high flow and low flow hemangiomas.
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Affiliation(s)
- A Cortese
- Facoltà di Medicina e Chirurgia, Università degli Studi Federico II, Napoli
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Sica GS, Di Lorenzo N, Sileri P, Gaspari AL. Microsurgery and changes in the testicular and epididymal production of spermatozoa. Ann Ital Chir 1996; 67:677-80; discussion 681. [PMID: 9008977] [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: 04/10/2023]
Abstract
The researchers studied a group of azoospermic patients with obstructions of the seminal canals and a group of oligoasthenospermic patients suffering from varicocele in order to analyze the factors that influence the success of surgery aimed at recovering fertility. In the 46 patients suffering from obstructions of the deferent duct and the extremity of the epididymis, the time factor proved decisive if the obstruction lasted longer than 6 years: in this case, damage to the seminiferous tubules is not reversible. With obstructions dating back less than 4 years, the causes and the location of the obstruction are more incisive. Success was achieved in 100% of vasectomy cases and in 37.5% of epididymal-deferential anastomoses. In research literature, the superiority of microsurgery for treating these types of pathologies is taken for granted. In patients affected by oligoasthenospermia the effectiveness of laparoscopic ligation of the spermatic veins was compared to that of the Belgrano I technique. Of the 30 patients with bilateral varicocele and oligoasthenospermia dating back less than 4 years, 73.3% of the 15 patients operated on using the Belgrano 1 technique experienced sperm normalization; in the 15 cases operated on using laparoscopic ligation of the spermatic canals, normalization was much less frequent. Seventy-five percent of another group of 40 patients whose infertility did not have a duration of longer than 4 years and were operated on using microsurgery techniques were normalized. The percentage of the 60 oligoasthenospermic patients for longer than 6 years normalized was 16.6%.
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Affiliation(s)
- G S Sica
- Department of Surgery, Faculty of Medicine and Surgery, University of Rome, Tor Vergata
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Sica GS, Di Lorenzo N, Sileri P, Gaspari AL. Experimental microvascular anastomoses performed with CO2, Argon and Nd.YAG lasers. Ann Ital Chir 1996; 67:571-3; discussion 574. [PMID: 8962524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The researchers used 60 rats and effected 120 femoral artery anastomoses. They studied the effect of welding performed by CO2, Argon and Nd. YAG lasers with and without the use of fibrin glue. The laser does not make the execution of vascular microanastomoses easier or safer than could be obtained with manual suturing. In fact, the exact opposite is the case. The CO2 laser is not suitable for the execution of microvascular anastomoses. Argon and Nd. YAG lasers are more effective and with the use of fibrin glue, results near, but are not superior to, those obtainable by manual suturing; since laser energy is easily transferable with thin quartz fibers, its use in laparoscopic surgery could prove quite useful.
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Affiliation(s)
- G S Sica
- Department of Surgery, Faculty of Medicine, University of Rome Tor Vergata
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Abstract
Smooth muscle gastric tumors represent 2% of resected neoplasms of the stomach. Clinically, they are often silent and incidentally found at endoscopy or radiologic examination. These tumors can be histologically classified as benign (leiomyoma) or malignant (leiomyoblastoma), but clinical behavior is not strictly related to this classification. When symptomatic, they are present with anemia in 50% of cases due to mucosal ulceration. Surgical removal of the tumor is the accepted therapy, leaving a margin of surrounding free tissue: this treatment can be performed by laparoscopy, usefully associated with gastroscopy. We present one case of a patient with severe anemia due to bleeding from an ulcerated leiomyoblastoma 5 cm in diameter that we resected with combined gastroscopic-laparoscopic technique. We isolated the portion of gastric wall where the mass was located and resected the specimen under gastroscopic control. The postoperative period was uneventful, and the patient recovered promptly with minimal pain and discomfort.
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Affiliation(s)
- N Di Lorenzo
- Cattedra di Chirurgia Generale, Universita' Tor Vergata-Roma V.O. Raimondo - 00173 Roma, Italy
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Sica GS, Russo A, Dell'Aquila A. [Granular-cell tumor of the oral cavity (a case report and statistical notes)]. Minerva Stomatol 1995; 44:257-61. [PMID: 7476779] [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: 01/25/2023]
Abstract
The granular cell tumor is an uncommon benign lesion that may occur anywhere in the body presenting as a single nodular lesion. A case is reported with bilateral palatal lesions. This case, in authors' opinion, is exceptional both for its localization, near palatine foramina, suggesting a neural crest tissue origin, and bilaterality and symmetry pointing out its plurifocal potentiality.
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Affiliation(s)
- G S Sica
- Cattedra di Chirurgia Maxillo-Facciale, Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli Federico II
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Gaspari AL, Sica GS, Di Lorenzo N. [Surgical treatment of varicocele]. Ann Ital Chir 1994; 65:569-72. [PMID: 7733581] [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: 01/26/2023]
Abstract
The correlation between varicocele and infertility has been established for many years. Authors expose their twelve years experience on surgical treatment of varicocele. 213 cases have been treated: 105 had infertility associated to varicocele and a microsurgical treatment has been performed. A high legature of spermatic vein has been applied to 108 patients with normal spermiogram (the last 6 by laparoscopic technique). In the case in which there is alteration of the spermiogram the microsurgical treatment seems more efficient for the sperm quality because it is more valuable in eliminating the venous stasis, and the operation Belgrano 1 seems to be the best compared to the others. Correlating the treatment efficiency to the simplicity of the application and to the treatment expense and reduced morbility we think it is advisable to treat the spermatic vein with laparoscopic ligature in patients with normal fertility indexes, even on the basis of our recent experience. Physiopathology, economic reasons and efficacy have been demonstrated.
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Affiliation(s)
- A L Gaspari
- Dipartimento di Chirurgia, Università degli Studi Tor Vergata, Roma
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Sica GS, Di Lorenzo N, Lania M, Ipri D, Magnacca F, Gaspari AL. [Treatment of traumatic lesions of the hepatic artery]. Ann Ital Chir 1994; 65:131-3; discussion 134. [PMID: 7978740] [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: 01/28/2023]
Abstract
Injuries to the porta hepatis, which are difficult to diagnose and require variable treatment, are rare. The mortality for the vascular injuries is directly correlated to the uncontrolled intraabdominal hemorrhage and the treatment requires primarily bleeding control. This paper reports a case of a laceration of the left hepatic artery in a young multi traumatized patient (due to a car accident). The hepatic artery injury was successfully managed by primary closure. Even if the treatment of the extra hepatic injuries of the hepatic artery is still controversial, standardized therapy approaches have been proposed. The repair of the hepatic artery is an occasional option. The simple ligation is the most common option, in fact the oxygen extraction from the portal venous blood increases if the artery is ligated and this is sufficient for a adequate hepatocellular function in a healthy liver. In reality, in literature, damages to the liver due to artery ligatures are described even in the case of a good portal flow. Repairing hepatic artery injuries should always be taken into consideration after having made necessary evaluations on the general conditions of the patient because it is preferable to attempt to bring the patient back to the "status quo ante" and therefore avoid possible complications.
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Affiliation(s)
- G S Sica
- Dipartimento di Chirurgia, Università degli Studi di Roma, Tor Vergata
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Di Lorenzo N, Lania M, Sica GS, Magnacca F, Ritucci V, Gaspari AL. [Partial resection of the spleen for echinococcus cysts with ultrasonic surgical aspirator]. MINERVA CHIR 1993; 48:871-3. [PMID: 8247302] [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: 01/29/2023]
Abstract
The superior extremity of the spleen was resected in a 52-year-old male patient due to a calcified echinococcus cyst, using an ultrasonic surgical aspirator (Cavitron). Blood loss was limited and no postoperative morbidity was reported. This method appears to be useful in all cases in which it is possible to avoid splenectomy in order to reduce the risk of uncontrolled postoperative infections.
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Affiliation(s)
- N Di Lorenzo
- Cattedra di Microchirurgia, Università Tor Vergata, Roma
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Sica GS, Savastano G, Russo A, Cangiano R. [Cystic adamantinoma of the mandible: therapeutic principles]. Arch Stomatol (Napoli) 1983; 24:19-27. [PMID: 6584091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Savastano G, Sica GS, Cozzolino A, Russo A. [Surgical therapy of eyelid lesions]. Arch Stomatol (Napoli) 1982; 23:379-87. [PMID: 6964815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Savastano G, Sica GS. [Congenital malformations of the external ear. Our surgical technic for the correction of the absence of the helical fold]. Arch Stomatol (Napoli) 1982; 23:369-78. [PMID: 6964814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sica GS, Savastano G, Cozzolino A. [Pleomorphic adenoma of salivary glands. Nosologic and etiopathologic grouping]. Arch Stomatol (Napoli) 1978; 19:39-46. [PMID: 231419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Giardino C, Sica GS. [So-called command interventions. Note 1. Gingival cancer with neoplastic bone infiltration]. Arch Stomatol (Napoli) 1977; 18:15-26. [PMID: 294852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sica GS, Teramo A, Ruggiero A. [On gynecomastia: clinical, anatomohistological and therapeutic aspects]. G Ital Chir 1970; 26:145-57. [PMID: 5519807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Teramo A, Ruggiero A, Sica GS. [Anatomo--surgical data on fibrocystic mastopathy]. G Ital Chir 1970; 26:65-83. [PMID: 5519876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Teramo A, Sica GS. [Some considerations on thyroid carcinomata in the young age]. G Ital Chir 1967; 23:369-85. [PMID: 5614632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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