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Mistrangelo M, Naldini G, Morino M. Do we really need guidelines for HRA during the COVID-19 pandemic? Colorectal Dis 2020; 22:647-648. [PMID: 32379928 PMCID: PMC7267492 DOI: 10.1111/codi.15116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Affiliation(s)
- M. Mistrangelo
- Surgical Science DepartmentCittà della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - G. Naldini
- STI Proctological and Perineal Surgical UnitCisanello University HospitalPisaItaly
| | - M. Morino
- Surgical Science DepartmentCittà della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
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Gallo G, Martellucci J, Sturiale A, Clerico G, Milito G, Marino F, Cocorullo G, Giordano P, Mistrangelo M, Trompetto M. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24:145-164. [PMID: 31993837 PMCID: PMC7005095 DOI: 10.1007/s10151-020-02149-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication.The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE.These guidelines are inclusive and not prescriptive.The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - A Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - G Clerico
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - F Marino
- Operative Unit of General Surgery, IRCCS de Bellis, Castellana Grotte, Bari, Italy
| | - G Cocorullo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, Barts Health, London, UK
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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3
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Arezzo A, Lo Secco G, Passera R, Esposito L, Guerrieri M, Ortenzi M, Bujko K, Perez RO, Habr-Gama A, Stipa F, Picchio M, Restivo A, Zorcolo L, Coco C, Rizzo G, Mistrangelo M, Morino M. Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study. Tech Coloproctol 2019; 23:831-842. [PMID: 31388861 DOI: 10.1007/s10151-019-02049-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND An organ-preserving strategy may be a valid alternative in the treatment of selected patients with rectal cancer after neoadjuvant radiotherapy. Preoperative assessment of the risk for tumor recurrence is a key component of surgical planning. The aim of the present study was to increase the current knowledge on the risk factors for tumor recurrence. METHODS The present study included individual participant data of published studies on rectal cancer surgery. The literature was reviewed according to according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data checklist (PRISMA-IPD) guidelines. Series of patients, whose data were collected prospectively, having neoadjuvant radiotherapy followed by transanal local excision for rectal cancer were reviewed. Three independent series of univariate/multivariate binary logistic regression models were estimated for the risk of local, systemic and overall recurrence, respectively. RESULTS We identified 15 studies, and 7 centers provided individual data on 517 patients. The multivariate analysis showed higher local and overall recurrences for ypT3 stage (OR 4.79; 95% CI 2.25-10.16 and OR 6.43 95% CI 3.33-12.42), tumor size after radiotherapy > 10 mm (OR 5.86 95% CI 2.33-14.74 and OR 3.14 95% CI 1.68-5.87), and lack of combined chemotherapy (OR 3.68 95% CI 1.78-7.62 and OR 2.09 95% CI 1.10-3.97), while ypT3 was the only factor correlated with systemic recurrence (OR 5.93). The analysis of survival curves shows that the overall survival is associated with ypT and not with cT. CONCLUSIONS Local excision should be offered with caution after neoadjuvant chemoradiotherapy to selected patients with rectal cancers, who achieved a good response to neoadjuvant chemoradiotherapy.
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Affiliation(s)
- A Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
| | - G Lo Secco
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - R Passera
- Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - L Esposito
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - M Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - K Bujko
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - R O Perez
- Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - A Habr-Gama
- Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - F Stipa
- Department of Surgery, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - M Picchio
- Department of Surgery, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - A Restivo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - L Zorcolo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - C Coco
- Department of Surgical Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - G Rizzo
- Department of Surgical Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - M Mistrangelo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
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4
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Binda GA, Gagliardi G, Dal Conte I, Verra M, Cassoni P, Cavazzoni E, Stocco E, Delmonte S, De Nardi P, Sticchi L, Mistrangelo M. Practice parameters for the diagnosis and treatment of anal intraepithelial neoplasia (AIN) on behalf of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2019; 23:513-528. [PMID: 31243606 DOI: 10.1007/s10151-019-02019-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022]
Abstract
Squamous cell carcinoma (SCC) of the anus is a human papilloma virus (HPV) related malignancy that is preceded by anal intraepithelial neoplasia (AIN) making this cancer, at least theoretically, a preventable disease. In the past 10 years the diagnosis, management and nomenclature of AIN has dramatically changed. Increased life expectancy in human immunodeficiency virus (HIV) positive patients due to highly active antiretroviral therapy (HAART) has caused an increase in the incidence of SCC of the anus. While many experts recommend screening and treatment of anal high-grade squamous intraepithelial lesion (HSIL), there is no consensus on the optimal management these lesions. Therefore, there is a need to review the current evidence on diagnosis and treatment of AIN and formulate recommendations to guide management. Surgeons who are members of the Italian Society of Colorectal Surgery (SICCR) with a recognized interest in AIN were invited to contribute on various topics after a comprehensive literature search. Levels of evidence were classified using the Oxford Centre for Evidence-based Medicine of 2009 and the strength of recommendation was graded according to the United States (US) preventive services task force. These recommendations are among the few entirely dedicated only to the precursors of SCC of the anus and provide an evidence-based summary of the current knowledge about the management of AIN that will serve as a reference for clinicians involved in the treatment of patients at risk for anal cancer.
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Affiliation(s)
- G A Binda
- Coloproctological Surgery, Biomedical Institute, Via Prà 1/b, 16157, Genoa, Italy.
| | - G Gagliardi
- Department of Surgery, University of Illinois at Chicago, Chicago, USA
| | - I Dal Conte
- Sexually Transmitted Infection Clinic, ASL Città di Torino, Turin, Italy
| | - M Verra
- Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - P Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Cavazzoni
- Department of Surgery, University of Perugia School of Medicine, Perugia, Italy
| | - E Stocco
- Department of Surgery, ASS-5 Friuli Venezia Giulia, 33078, San Vito al Tagliamento, Italy
| | - S Delmonte
- Medical Science Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - P De Nardi
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - L Sticchi
- Hygiene Unit, Department of Health Sciences (DISSAL), IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - M Mistrangelo
- Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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5
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Affiliation(s)
- M Mistrangelo
- Surgical Science Department, Città della Salute e della Scienza Hospital, Turin, Italy.
| | - A Salzano
- Surgical Science Department, Città della Salute e della Scienza Hospital, Turin, Italy
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6
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Franco P, Montagnani F, Arcadipane F, Casadei C, Andrikou K, Franco G, Scartozzi M, Mistrangelo M, Fornaro L, Cassoni P, Cascinu S, Ricardi U, Casadei Gardini A. Immune Inflammation Indicators Predict Outcome in Anal Cancer Patients Undergoing Concurrent Chemoradiation. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7
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Franco P, Arcadipane F, Mistrangelo M, Cassoni P, Martini S, Iorio G, Elisabetta T, Racca P, Morino M, Ricardi U. Comparing simultaneous vs sequential boost strategies during concurrent chemo-radiation for anal cancer: Results of a retrospective observational study. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Aims and Background Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases. Methods and Study Design To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous anal carcinoma. Results Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases. Conclusions We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.
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Affiliation(s)
- M Mistrangelo
- Sugical Oncology Department, University of Turin, Italy.
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Sandrucci S, Casalegno PS, Percivale P, Mistrangelo M, Bombardieri E, Bertoglio S. Sentinel Lymph Node Mapping and Biopsy for Breast Cancer: A Review of the Literature Relative to 4791 Procedures. Tumori 2018; 85:425-34. [PMID: 10774561 DOI: 10.1177/030089169908500602] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The status of axillary nodes is the most important prognostic factor in breast cancer to select patient subgroups for adjuvant chemotherapy; the current standard of care for surgical management of invasive breast cancer is complete removal of the tumor by either mastectomy or lumpectomy followed by axillary lymph node dissection (ALND). The recent introduction of intraoperative lymphatic mapping and sentinel lymph node biopsy (SLND) represents a major new opportunity for appropriate and less invasive surgical management of many tumors. There is an almost uniformly enthusiasm concerning the potential of this technique in breast carcinoma management, shown by published data. A peculiar attention to the so-called “sentinel node debate” in breast cancer surgery is a constant in the last years issues of the major medical journals. Even patients have become more aware about medical enthusiasm and their request of concise information on the topic and the possibilities of this approach is an increasing reality in medical practice. The aim of this paper is to review recent literature to offer an overview about the main controversial methodological aspects and a wide analysis of reported results. The most significative international literature papers from Medline were retrieved from 1993 to September 1999, and 4782 procedures were analysed. This extensive review of the literature has confirmed accuracy, feasibility and reliability of the SN detecting technique in axillary mapping. Provided a good proficiency in SN localisation and pathological evaluation, human resources and efforts should be mainly focused on its clinical validation as an alternative to ALND instead of on further phase I–-II clinical studies.
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Affiliation(s)
- S Sandrucci
- Dipartimento di Oncologia, Unità Operativa di Chirurgia Esofagea ed Oncologica, ASO San Giovanni Battista, Turin, Italy
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Franco P, Montagnani F, Arcadipane F, Casadei C, Andrikou K, Martini S, Iorio G, Scartozzi M, Mistrangelo M, Fornaro L, Cassoni P, Cascinu S, Ricardi U, Casadei Gardini A. EP-1461: Immune inflammation indicators in anal cancer patients treated with concurrent chemo-radiation. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Martini S, Iorio G, Franco P, Montagnani F, Arcadipane F, Casadei C, Andrikou K, Scartozzi M, Mistrangelo M, Fornaro L, Cassoni P, Cascinu S, Ricardi U, Casadei Gardini A. EP-1487: The prognostic role of haemoglobin in patients undergoing concurrent chemo-radiation for anal cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31796-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Castellano I, Metovic J, Balmativola D, Francia Di Celle P, Riera L, Bertetto O, Mistrangelo M, Cassoni P, Marchiò C, Sapino A. The ENDOPREDICT® molecular test for breast cancer prognosis: clinical-pathological correlations and therapeutic implications on a selected cohort of patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Mistrangelo M, Gallo F, Giordano L, Solerio D, Bau M, Romaniello I, Pietribiasi F, Pacquola M, Castiglione F, Sarli F, Monagheddu C, Ceccarelli M, Ciccone G, Mistrangelo M, Viale M, Bertetto O. The follow-up and lifestyle (FUCSAM project). Oncology Network of Piemonte and Valle d'Aosta: update 2017. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx433.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Galassi C, Ceccarelli M, Monagheddu C, Pagano E, Rosato R, Ivaldi P, Bollito E, Zitella A, De Luca S, Camilli M, Munoz F, Bellissimo A, Bongiovanni F, Ponti di Sant'Angelo F, Mistrangelo M, Ciccone G, Bertetto O. Start (active surveillance or radical treatment for newly diagnosed patients with a localized, low risk, prostate cancer): an epidemiological study of the Oncology Network of Piemonte and Valle d’Aosta. Update 2017. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx423.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Franco P, Arcadipane F, Racca P, Mistrangelo M, Cassoni P, Morino M, Ricardi U. Image-guided SIB-IMRT for the treatment of anal cancer patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Satolli M, Finocchiaro C, Durelli P, Spadi R, Ponzetti A, Monge T, Brossa L, Agnello E, Franco P, Strignano P, Storto S, Mistrangelo M, Viale M, Ciuffreda L, Bertetto O. Pancreatic cancer: sharing a nutrition education project with the patients and their care givers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Viale M, Mistrangelo M, Caristo T, Carobene A, Grietti E, Pezzin M, Bertetto O. The continuing training program of oncology network of Piemonte and Valle d'Aosta: a model for improving the management of oncologic patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arcadipane F, Lepinoy A, Franco P, Ceccarelli M, De Bari B, Lestrade L, Furfaro G, Mistrangelo M, Créhange G, Ricardi U. EP-1258: High precision SIB-IMRT versus conventional radiotherapy in anal cancer: a propensity score analysis. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arcadipane F, Franco P, Martini S, Furfaro G, Ceccarelli M, Mistrangelo M, Rondi N, Cassoni P, Racca P, Ricardi U. EP-1265: Image-guided SIB-IMRT for the treatment of anal cancer patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Franco P, Arcadipane F, Ragona R, Lesca A, Gallio E, Mistrangelo M, Cassoni P, Baccega M, Racca P, Faletti R, Rondi N, Morino M, Ricardi U. PV-0324: FDG-PET based pelvic bone marrow dose predicts for blood cell nadirs in CT-RT for anal cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Mistrangelo M, Tonello P, Brachet Contul R, Arnone G, Passera R, Grasso L, Rapetti L, Borroni R, Pozzo M, Roveroni M, Morino M, Perinotti R. Perineal stapled prolapse resection for full-thickness external rectal prolapse: a multicentre prospective study. Colorectal Dis 2016; 18:1094-1100. [PMID: 26969880 DOI: 10.1111/codi.13328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/11/2016] [Indexed: 02/08/2023]
Abstract
AIM Many different surgical techniques have been reported for the surgical treatment of full-thickness external rectal prolapse. Perianal stapled prolapse resection (PSP) is a relatively newly reported technique for full thickness external rectal prolapse. The aim of this prospective multicentre study was to evaluate the results of this procedure. METHOD Consecutive patients who underwent a PSP resection for full-thickness external rectal prolapse at five centres were recruited to the study. Median operating time, hospital stay, complications, recurrence and functional results according to the Wexner Incontinence Scale and obstructive defaecation syndrome score were recorded. RESULTS There were 27 patients treated by PSP. The median Wexner incontinence score improved from 10 presurgery to 5 after surgery (P < 0.001); the median obstructed defaecation syndrome score improved from 12 presurgery to 5 (range 4-10) after surgery (P < 0.001). A laparoscopically assisted procedure was performed in three patients (11.1%). The median number of cartridges used was six (range four to nine). The median operating time was 48 min. Early complications occurred in six patients (22.2%) and late complications in two (7.4%). The median length of hospital stay was 5 days. The recurrence rate at a median follow-up of 30.3 months was 14.8%. CONCLUSION PSP appears to be an easy, fast and safe procedure. Early functional results are good. The recurrence rate compares favourably with other perineal procedures like the Delorme or the Altemeier operations. Long-term functional results need to be investigated further.
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Affiliation(s)
- M Mistrangelo
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy.
| | - P Tonello
- Department of Surgery, Koelliker Hospital, Turin, Italy
| | | | - G Arnone
- Department of Surgery, Martini Hospital, Turin, Italy
| | - R Passera
- Nuclear Medicine Department, University of Turin, Turin, Italy
| | - L Grasso
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - L Rapetti
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - R Borroni
- Department of Surgery, Koelliker Hospital, Turin, Italy
| | - M Pozzo
- Department of Surgery, Biella Hospital, Biella, Italy
| | - M Roveroni
- Department of Surgery, Aosta Hospital, Aosta, Italy
| | - M Morino
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - R Perinotti
- Department of Surgery, Biella Hospital, Biella, Italy
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22
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Alabiso I, Ballari A, Brignardello E, Numico G, Sperti E, Cristofano A, Russi E, Oliva C, Mistrangelo M, Levis M, Gallo M, Di Costanzo G, Bertetto O. Activation of Palliative Cares by hospital oncologists: first results of a survey conducted by Rete Oncologica del Piemonte e della Valle d'Aosta. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw336.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Sarli F, Giordano L, Gallo F, Romaniello I, Pietribiasi F, Solerio D, Pacquola M, Castiglione F, Bellingeri P, De Piccoli N, Fedi A, Gattino S, Finocchiaro C, Mano M, Monagheddu C, Ceccarelli M, Ciccone G, Senore C, Mistrangelo M, Bertetto O. The follow-up and lifestyle (FUCSAM project). Oncology Network of Piemonte and Valle d'Aosta (ROPVdA): update 2016. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Mistrangelo M, Galassi C, Ceccarelli M, Monagheddu C, Pagano E, Rosato R, Ivaldi P, Bollito E, Zitella A, De Luca S, Camilli M, Munoz F, Bellissimo A, Bongiovanni F, Dell'Aquila M, Ponti di Sant'Angelo F, Ciccone G, Bertetto O. START (Active Surveillance or Radical Treatment for newly diagnosed patients with a localized, low risk, prostate cancer): an epidemiological study of the Oncology Network of Piemonte and Valle d'Aosta. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw334.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Franco P, Arcadipane F, Ragona R, Mistrangelo M, Cassoni P, Di Muzio J, Rondi N, Morino M, Racca P, Ricardi U. OC-0240: Lumbarsacral bone marrow modeling of acute hematological toxicity in chemoradiation for anal cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Franco P, Ragona R, Arcadipane F, Mistrangelo M, Cassoni P, Rondi N, Morino M, Racca P, Ricardi U. Dosimetric predictors of acute hematologic toxicity during concurrent intensity-modulated radiotherapy and chemotherapy for anal cancer. Clin Transl Oncol 2016; 19:67-75. [PMID: 27037814 DOI: 10.1007/s12094-016-1504-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed at investigating whether the irradiated volume of pelvic bone marrow (PBM) and specific subsites may predict the occurrence of acute hematologic toxicity (HT) in anal cancer patients undergoing concurrent chemo-radiation. METHODS 50 patients, submitted to IMRT and concurrent chemotherapy, were analyzed. Several bony structures were defined on planning-CT: PBM and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. On dose-volume histograms, dosimetric parameters were taken. Endpoints included white blood-cell-count (WBC), absolute-neutrophil-count (ANC), hemoglobin (Hb) and platelet nadirs and acute hematologic toxicity (HT) according to RTOG scoring scale. Generalized linear modeling was used to find correlations between dosimetric variables and blood cell nadirs, while logistic regression analysis was used to test correlation with ≥G3 HT. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the optimal cut-off points for predictive dosimetric variables with the Youden method. RESULTS Maximum detected acute HT comprised 38 % of ≥G3 leukopenia and 32 % of ≥G3 neutropenia. Grade 2 anemia was observed in 4 % of patients and ≥G3 thrombocytopenia in 10 %. On multivariate analysis a higher PBM-V 20 was associated with lower WBC nadir. Increased LSBM-V 40 was correlated with a higher likelihood to develop ≥G3 HT. A cut-off point at 41 % for LSBM-V 40 was found. Patients with LSBM-V 40 ≥41 % were more likely to develop ≥G3 HT (55.3 vs. 32.4 %; p < 0.01). CONCLUSIONS Increased low-dose to pelvic bony structures significantly predicted for WBC decrease. Medium-high dose to specific osseous subsites was associated with a higher probability of HT. LSBM-V 40 was a strong predictor of ≥G3 HT. A threshold at 41 % for LSBM-V 40 could be used to limit HT.
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Affiliation(s)
- P Franco
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
| | - R Ragona
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy
| | - F Arcadipane
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy
| | - M Mistrangelo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - P Cassoni
- Department of Medical Sciences, Pathology Unit, University of Torino, Turin, Italy
| | - N Rondi
- Department of Medical Imaging and Radiotherapy, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - M Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - P Racca
- Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy
| | - U Ricardi
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy
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Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C. Erratum to: Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol 2016; 20:201. [PMID: 26728606 DOI: 10.1007/s10151-015-1416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G F Cocorullo
- Unit of Emergency and General Surgery, Department of Surgical Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Barts Health, London, UK
| | - F Marino
- Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy
| | - J Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - C Ratto
- Proctology Unit, University Hospital "A Gemelli", Catholic University, Rome, Italy
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Giordano P, Mistrangelo M, Cracco N, D'Elia A, Creperio G, Digito F, Paduano R, Tapparo A, Quinto S, Villa E, Pagano C. Topical application of LEVORAG® as first-line treatment for chronic anal fissures: a preliminary multicentric study. MINERVA CHIR 2015; 70:319-325. [PMID: 26013762] [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: 06/04/2023]
Abstract
AIM The aim of the present study was to assess the safety and efficacy of this new topical agent as a first line treatment in patients with chronic anal fissures. METHODS Nine centres were involved in the study. Patients with chronic anal fissures were recruited and received Levorag® for 40 days. Follow-up visits were conducted at 10, 20 and 40 days from the recruitment. Primary outcome was the healing rate, secondary outcome the reduction of pain at the end of the treatment measured with a VAS scale. RESULTS Fifty patients completed the treatment. No adverse events were recorded. 60% of patients healed completely at the end of the treatment. In those that did not heal the reduction of mean VAS values was 60%. CONCLUSION The use of Levorag® on patients affected by chronic anal fissures achieved in the short term results similar to those experienced by more classic local treatments without any side effect.
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Bertetto O, Pacquola M, Romaniello I, Castiglione F, Bellingeri P, De Piccoli N, Fedi A, Gattino S, Finocchiaro C, Mistrangelo M, Mano M, Monagheddu C, Viale M, Ciccone G, Senore C, Giordano L. The follow-up and lifestyle (FUCSAM project). Oncology Network of Piemonte and Valle d'Aosta (ROPVdA): preliminary data. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C. Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol 2015; 19:567-75. [PMID: 26403234 DOI: 10.1007/s10151-015-1371-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/05/2015] [Indexed: 02/07/2023]
Abstract
Hemorrhoids are one of the most common medical and surgical diseases and the main reason for a visit to a coloproctologist. This consensus statement was drawn up by the Italian society of colorectal surgery in order to provide practice parameters for an accurate assessment of the disease and consequent appropriate treatment. The authors made a careful search in the main databases (MEDLINE, PubMed, Embase and Cochrane), and all results were classified on the basis of the grade of recommendation (A-C) of the American College of Chest Physicians.
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Affiliation(s)
- M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G F Cocorullo
- Unit of Emergency and General Surgery, Department of Surgical Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Barts Health, London, UK
| | - F Marino
- Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy
| | - J Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - C Ratto
- Proctology Unit, University Hospital "A Gemelli", Catholic University, Rome, Italy
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31
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Franco P, Arcadipane F, Segantin M, Munoz F, Migliaccio F, Sciacero P, Mistrangelo M, Angelini V, Racca P, Morino M, Cassoni P, Ricardi U. EP-1217: SIB-IMRT combined with concurrent chemotherapy for anal cancer: 4-year results of a consecutive case series. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Dal Conte I, Mistrangelo M, Cariti C, Chiriotto M, Lucchini A, Vigna M, Morino M, Di Perri G. Lymphogranuloma venereum: an old, forgotten re-emerging systemic disease. Panminerva Med 2014; 56:73-83. [PMID: 24518282] [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: 06/03/2023]
Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted infection endemic in parts of Africa, Asia, South America, and the Caribbean, but once was rarely observed in Western countries, where most cases were considered to be imported. However, recent outbreaks have been reported in Europe, Australia, New Zealand, the United States and Canada, mainly among HIV positive men who have sex with men, signaling LGV re-emergence. The etiological agent of LGV is Chlamydia trachomatis serotypes L1, L2 and L3, and current outbreaks are mostly sustained by L2b type. The clinical course can be classically divided into three stages: an initial papule, which may ulcerate at the site of inoculation, followed by regional lymphoadenopathy (second stage, generally unilateral). In the tertiary stage, lymphatic obstruction, with elephantiasis of genitalia, and rectal involvement can lead to the formation of strictures and fistulae that may require surgical treatment. Recent cases are observed mainly among HIV positive people, often co-infected with HCV and others STIs, engaging in high-risk sexual practices. The main clinical picture is a relative new entity characterized by progressive ulcerative proctitis, the so called anorectal syndrome. Diagnosis is often delayed, requires a high index of clinical suspicion and must rely on the use of nucleic acid amplification tests. The differential diagnosis of proctitis should include LGV infection. Gastroenterologists, coloproctologists, dermatologists and other specialists need to be aware of LGV proctitis to avoid diagnostic delay and progression of disease to the tertiary stage.
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Affiliation(s)
- I Dal Conte
- STI Clinic, Infectious Diseases Department Amedeo di Savoia Hospital, ASL TO2, Turin, Italy -
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Mistrangelo M, Senetta R, Racca P, Castellano I, Chiusa L, Bellò M, Ricardi U, Morino M, Cassoni P. A novel biomarker-based analysis reliably predicts nodal metastases in anal carcinoma: preliminary evidence of therapeutic impact. Colorectal Dis 2013; 15:1382-91. [PMID: 23692332 DOI: 10.1111/codi.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/15/2013] [Indexed: 12/26/2022]
Abstract
AIM Routine prophylactic inguinal irradiation in anal cancer may cause significant toxicity associated with overtreatment bias. The aim of this study was to determine the risk of regional node metastases in anal carcinoma by identifying predictive molecular biomarkers. METHOD Clinicohistopathological data from 50 pretreatment anal carcinoma biopsies were collected. Immunohistochemical analyses with antibodies against Ki67, p53, epidermal growth factor receptor (EGFR) and YKL-40 were performed. Statistical correlations between biomarkers and clinicopathological features and outcomes were studied. Sentinel lymph node biopsy was performed in a subset of 36 patients. RESULTS All patients had undergone synchronous radiochemotherapy; tumour recurrence had developed in 26%, and 16% had died. YKL-40 tumour expression correlated with lymph node metastasis, whereas no inguinal node metastases were found in any of the (14%) patients presenting with a YKL-40/EGFR-negative tumour. YKL-40 expression and node metastasis were both significantly associated with shorter overall and disease-free survival. Tumour grade significantly correlated with disease-free survival only. HIV, tumour histological type, Ki67, p53 and EGFR were not associated with outcome. CONCLUSION YKL-40 expression in anal carcinoma is correlated with a poor outcome and can predict lymph node metastases. The combined absence of YKL-40 and EGFR expression in a first biopsy of anal carcinoma reliably selects a subset of patients without inguinal metastases. Such patients could be spared sentinel lymph node biopsy and/or inguinal radiotherapy.
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Affiliation(s)
- M Mistrangelo
- Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, University of Turin, Molinette Hospital, Turin, Italy
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34
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Affiliation(s)
- M Mistrangelo
- Department of Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, San Giovanni Battista Hospital, and University of Turin, Italy.
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35
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Mistrangelo M, Bellò M, Ricardi U, Cassoni P, Baccega M, Racca P, Lesca A, Munoz F, Morino M. 332. To PET or Not to PET in Anal Cancer. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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36
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Mistrangelo M, Conte ID, Cassoni P, Senetta R, Delmonte S, Rondoletti S, Famiglietti F, Perotto L, Codognotto E, Morino M. 334. Anal Malignancies Associated to Condyloma Acuminata - Differences Between HIV+ and HIV- Patients. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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37
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Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M. Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 2011; 98:1635-43. [PMID: 21713758 DOI: 10.1002/bjs.7584] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Of the few studies that have investigated quality-of-life (QoL) outcomes after transanal endoscopic microsurgery (TEM), the majority have reported only short-term follow-up data. This study assessed long-term clinical and instrumental outcomes (QoL, sexual, urinary and sphincter function) after TEM for extraperitoneal rectal cancer. METHODS Preoperative and postoperative anorectal function was assessed in consecutive patients with benign rectal lesions or early rectal cancer, based on clinical scores and anorectal manometry. RESULTS Between January 2000 and July 2005, 93 patients undergoing TEM completed the 60-month study protocol. The mean Wexner continence score increased from baseline at 3 months, began to decline within 12 months, and had returned to the preoperative value at 60 months. Urgency was reported by 65·0, 30·0 and 5 per cent of patients at 3, 12 and 60 months respectively (P < 0·050). A significant improvement was noted in various clinical and QoL scores at 12 and 60 months. Postoperative manometry values at 3 months were significantly lower than at baseline (P < 0·050), but had returned to preoperative values at 12 months. Tumour size of 4 cm or above was the only factor that significantly (P = 0·008) affected the rectal sensitivity threshold, the urge to defaecate threshold and the maximum tolerated volume at 3 months after TEM. CONCLUSION TEM had no long-term effect on anorectal function or QoL. Lower anal resting pressure at early follow-up was not associated with defaecation problems in patients who were continent before surgery.
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Affiliation(s)
- M E Allaix
- Department of Digestive Surgery and Centre for Minimally Invasive Surgery, University of Turin, 14 Corso Achille Mario Dogliotti, 10126 Turin, Italy
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38
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Mistrangelo M, Cornaglia S, Pizzio M, Rimonda R, Gavello G, Dal Conte I, Mussa A. Immunostimulation to reduce recurrence after surgery for anal condyloma acuminata: a prospective randomized controlled trial. Colorectal Dis 2010; 12:799-803. [PMID: 19548899 DOI: 10.1111/j.1463-1318.2009.01960.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Human papillomavirus is the most common cause of sexually transmitted disease. It is associated with immunosuppression and shows a marked tendency to recur. We investigated a natural immunostimulant aimed to reduce recurrence. METHOD A randomized controlled study was carried out including 261 patients allocated to surgical excision alone (control group; n = 122) and surgical excision plus postoperative immunostimulation for 30 days with a natural product (STET; study group; n = 139). Patients with HIV positivity were excluded. All patients gave fully informed consent. RESULTS The patients were followed for 6 months after surgery. Recurrence occurred in 7.2% (10/139) in the study group and in 27.1% (33/122) in the control group (P < 0.0001). There were no significant differences in the sex, sexual orientation, number of lesions, time to diagnosis and treatment or localization of lesions in the two groups. CONCLUSIONS Immunostimulation using a natural product significantly reduced the incidence of recurrence of anal condylomata in patients undergoing surgical excision.
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Affiliation(s)
- M Mistrangelo
- Oncological Surgical Department, University of Turin, 10126 Turin, Italy.
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Sarzo G, Del Mistro A, Finco C, Frayle-Salamanca H, Marino F, Franzetti M, Ferrara R, Mistrangelo M, Savastano S, Vecchiato M, Merigliano S, Merigliano S. Extensive anal condylomatosis: prognosis in relation to viral and host factors. Colorectal Dis 2010; 12:e128-34. [PMID: 19508521 DOI: 10.1111/j.1463-1318.2009.01902.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the clinical course of extensive anal condylomatosis in relation to treatment modalities, patient comorbidity and immune function, and associated papillomavirus (HPV) sequences. METHOD Clinical data, treatment modalities and follow-up were recorded and analysed in relation to host and viral type. Histology, immunohistochemistry and molecular analyses for HPV search and typing were performed on formalin-fixed paraffin-embedded samples. RESULTS Sixteen patients [14 males, median age 41.8 years (range 19-66)] affected by extensive anal condylomatosis [10 Buschke-Lowenstein Tumors (BLT) and 6 condylomatosis] treated in three different Italian institutions were included. There was associated preoperative anal intraepithelial neoplasia grade 3 (AIN3) in one and invasive carcinoma in three patients. After radical resection (n = 16) recurrence occurred in 4/10 (40%) BLT patients. Malignancy before or after treatment developed in 5/16 (31.25%) patients. HPV sequences were present in all the samples of 15 evaluable patients (types 6 or 11, 9 patients; type 16, 6 patients). A statistically significant association was found between presence of HPV type 16 and both malignancy and recurrence. Viral variant L83V was present in 3/4 HPV 16 positive recurrent cases. CONCLUSION Radical resection resulted in a favourable clinical course. Typing of HPV sequences in the management of patients affected by extensive anal condylomatosis may be useful.
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Affiliation(s)
- G Sarzo
- Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica III, Unità di Chirurgia Colo-Proctologica, Università di Padova, Padova, Italy
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Corno F, Volpatto S, Borasi A, Barberis A, Mistrangelo M. [Treatment of functional diseases after rectum anal surgery: effectiveness of rehabilitation of the pelvic pavement]. MINERVA CHIR 2009; 64:197-203. [PMID: 19365320] [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: 05/27/2023]
Abstract
AIM Anorectal dysfunction is routinely treated at the Center for Pelvic Floor Rehabilitation, San Giovanni University Hospital, Turin, Italy. Of a total of 147 patients treated between April 2007 and May 2008, 44 (30%) received pelvic floor rehabilitation following anorectal surgery. With this study we wanted to evaluate the response of patients with constipation and/or fecal incontinence to postsurgical pelvic floor rehabilitation designed to regain full or partial anorectal function and so improve their quality of life. MATERIAL AND METHODS The study population was 44 patients, subdivided into 3 groups. One group (n=25) consisted of patients with fecal incontinence, which was further split into two subgroups: subgroup A (n=10) with direct involvement of the anal sphincter at surgery and subgroup B (n=15) without sphincter involvement. The second group (n=12) included patients with constipation. The third group (n=7) included patients with constipation and incontinence; this group was further split into 2 subgroups: those in which constipation (n=5) and those in which incontinence (n=2) was predominant. Pre- and postrehabilitation anorectal function was compared using two types of assessment: 1) clinical evaluation with the Wexner incontinence scale and 2) diagnostic evaluation with anorectal manometry in patients with fecal incontinence (plus transanal sonography to determine anatomic damage in the subgroups in which the sphincter had been involved) and defecography in those with constipation (plus transit radiography to exclude intestinal colic-associated constipation). RESULTS The number of patients classified as having severe incontinence decreased from 8 to 1 (-87.5%), those with moderate incontinence decreased from 8 to 4 (-50%); 20 out of 25 patients presented with mild dysfunction at the end of the rehabilitation program. No difference in response to treatment was found between the two subgroups of patients with fecal incontinence nor among those with constipation. Of those with predominant constipation, none were classified as having severe dysfunction; the number of those with moderate dysfunction decreased from 13 to 7 (-54%). CONCLUSIONS The study results show that, when sufficiently motivated, patients with fecal incontinence and constipation following anorectal surgery respond positively to pelvic floor rehabilitation.
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Affiliation(s)
- F Corno
- Clinica Chirurgica, Azienda Ospedaliero-Universitaria S. Giovanni Battista di Torino, Torino, Italia
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41
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Affiliation(s)
- M Mistrangelo
- Department of Surgery, Centre of Minimal Invasive Surgery, Molinette Hospital, University of Turin, Cso A.M. Dogliotti 14, 10126 Turin, Italy.
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Mistrangelo M, Bellò M, Mobiglia A, Beltramo G, Cassoni P, Milanesi E, Cornaglia S, Pelosi E, Giunta F, Sandrucci S, Mussa A. Feasibility of the sentinel node biopsy in anal cancer. Q J Nucl Med Mol Imaging 2009; 53:3-8. [PMID: 18337684] [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: 05/26/2023]
Abstract
AIM Anal cancer is a rare neoplasm. According to a European Organization for Research and Treatment of Cancer multivariate analysis, synchronous inguinal lymph node metastasis occurs in 10-25% of patients and constitutes an independent prognostic factor for local failure and overall mortality. METHODS Inguinal lymph node status was assessed using the sentinel node technique in 35 patients with anal cancer. RESULTS Histology revealed 23 squamous carcinomas, 10 basaloid carcinomas, 1 squamous carcinoma with basaloid areas and 1 spinocellular epithelioma associated with areas of Bowen's disease. Disease stage was T1 in 5 patients, T2 in 18, T3 in 11 and T4 in 1 patient. Lympho-scintigraphy using a GE Millennium gamma camera was performed after peritumoral injection of 37 MBq of 99mTc colloid. Surgical sentinel node biopsy with a portable Scintiprobe MR 100 (Politech, Carsoli, Italy) had a detection rate of 97.1%. Inguinal metastases were detected in 7 (20%) patients, in 2 of which metastasis was bilateral. CONCLUSIONS Given the correlation between prognosis and node involvement, sentinel node biopsy can be considered a simple method for adequate pretreatment staging of anal carcinoma. Use of the technique could avert the need for prophylactic inguinal radiotherapy in N0-N1 patients, thus reducing the morbidity associated with inguinal radiotherapy. Consistent follow-up is required to evaluate long-term results:
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Affiliation(s)
- M Mistrangelo
- Surgical and Oncological Department, University of Turin, Molinette Hospital, Turin, Italy.
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Beano A, Signorino E, Polimeni MA, Mistrangelo M, Ardine M, Spadi R, Donadio M, Ciuffreda L, Matera L. Correlation between NK function and response to trastuzumab in metastatic breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3036 Background: Trastuzumab is a monoclonal antibody selectively directed against Her2 approved for the treatment of Her2 overexpressing breast cancer patients. Its proposed mechanisms of action include also a role in mediating antibody-dependent cellular cytotoxicity (ADCC), through the triggering of the FcγRIII on natural killer (NK) cells. This study addressed the correlation between overall NK function and clinical trastuzumab activity. Methods: Between March and September 2006 22 metastatic patients in treatment with trastuzumab alone (8 mg/kg load and then 6 mg/kg every 3 weeks until disease progression) as maintaining therapy after chemotherapy were analyzed for clinical and immunological responses. According to RECIST criteria, 14 patients obtained a response to trastuzumab, while 8 patients had a disease progression. Patient’s peripheral blood mononuclear cells were tested for cytotoxic activity against standard NK target (the MHC class I-negative K562 cell line) and trastuzumab-coated MCF7 (Her2-negative) and SKBR3 (Her2-positive) human cell lines in a 4-h 51Cr-release cytotoxicity assay in the presence of grading concentrations of effector cells. Results: NK activity was significantly (p<0.05) higher in responder compared to non responder patients at all the four effector:target (50:1 to 6:1) ratios tested. NK activity of non responder patients was significantly lower than that of 25 sex and age matched controls (p<0.02) and this was not merely due to chemotherapy- or tumor-associated immunosuppression, since the values of responder patients did not significantly differ from those of controls. ADCC activity against Her2-positive SKBR3 cells was also significantly higher in responder compared to non responder patients (p<0.05) and markedly so when compared to controls (p<0.001). Conclusions: The fact that, as shown here, normal levels of FcγR- independent and higher than normal levels of FcγR-dependent cytotoxicity are required for trastuzumab response, lends support to a paramount role of NK cells in the mechanism of action of this drug. No significant financial relationships to disclose.
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Affiliation(s)
- A. Beano
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - E. Signorino
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - M. A. Polimeni
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - M. Mistrangelo
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - M. Ardine
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - R. Spadi
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - M. Donadio
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - L. Ciuffreda
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
| | - L. Matera
- ASO San Giovanni Battista, Torino, Italy; Laboratorio di Immunologia dei Tumori, Torino, Italy
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Mistrangelo M, Mobilia A, Bellò M, Cassoni P, Beltramo G, Milanesi E, Mussa B, Mussa A. 198 POSTER Sentinel node biopsy in patients affected by anal carcinoma. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Donadio M, Ardine M, Berruti A, Beano A, Bottini A, Mistrangelo M, Bonardi S, Castiglione F, Generali D, Polimeni MA, Bretti S, Alabiso O, Bertetto O. Weekly Cisplatin plus Capecitabine in Metastatic Breast Cancer Patients Heavily Pretreated with both Anthracycline and Taxanes. Oncology 2005; 69:408-13. [PMID: 16319512 DOI: 10.1159/000089995] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 07/21/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treating patients with anthracycline- and taxane-pretreated metastatic breast cancer is challenging. This study evaluated the activity and safety of a combination of cisplatin and capecitabine in this setting. PATIENTS AND METHODS Thirty-nine consecutive patients entered the study. All had experienced failures or relapse after previous treatment with anthracyclines and taxanes plus/minus other chemotherapeutic regimens. The present treatment consisted of intravenous cisplatin 20 mg/m(2) every week for 6 weeks, followed by 1 week of rest, and oral capecitabine 1,000 mg/m(2) twice daily for 14 days, followed by a 7-day rest period. RESULTS Objective response was obtained in 14 patients (35.9%), with complete remission in 3 (7.7%). Median time to progression was 5.2 months and survival was 10.9 months in the entire population and 8.7 and 16.5 months in the responding patients, respectively. The dose-limiting toxicity for the regimen was leucopenia, while gastrointestinal discomfort was the most frequent cause of capecitabine reduction or delay. CONCLUSIONS The cisplatin and capecitabine combination regimen is active and manageable. It seems to be non-cross resistant to anthracyclines and taxanes.
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Affiliation(s)
- M Donadio
- Oncologia Medica, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliera San Giovanni Battista, Torino, Italy.
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Mistrangelo M, Mobiglia A, Bellò M, Beltramo G, Cassoni P, Mussa A. [The technique of sentinel lymph nodes in patients with anus neoplasm]. Suppl Tumori 2005; 4:S32-3. [PMID: 16437886] [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: 05/06/2023]
Abstract
Anal cancer is a rare neoplasm, representing 1-2% of all large bowel cancers. Surgical excision by abdominoperineal resection has been the standard treatment. In the 1920s and 1930s inguinal node dissection was included in the surgical management of these patients. In the 1950s it was evident that the morbidity associated with lymphnode dissection was much greater than any survival benefit and this procedure was abandoned. Since 1974 "multimodality treatment" with a combination of radiation and chemotherapy has become the standard treatment. Synchronous inguinal lymph node metastases occur in 10-25% of patients and metachronous metastases have been reported in 5-25% of cases. Inguinal lymph node metastases are an independent prognostic factor for local failure and overall mortality by a multivariate analysis of EORTC. In order to assess inguinal lymph node status we applied the sentinel node technique to patients affected by anal cancer. Fifteen patients were studied with a lymphoscintigraphy after peritumoral injection of 37 MBq of Tc-99m colloid. A surgical biopsy of sentinel node was performed in all patients with a detection rate of 100%. Inguinal metastases occurred in 4 patients (26.6%), and in 2 cases metastases were located bilaterally. Twelve patients (80%) were treated in local anesthesia and they were dismissed the same day of surgical procedure. No major complication occurred. Considering the strong correlation between prognosis and node involvement, we consider this technique an important and simple method for evaluating the lymph node status and for an adequate pre-treatment staging of anal carcinoma. fundamental in the choice of radiation plane. In particular inguinal radiotherapy could be reserved for N1 patients only. avoiding the morbidity related to this procedure in N0 patients. Further studies are required to confirm these results and a consistent follow-up will be necessary to evaluate long-term results particularly in those patients (N0) who have not been treated with prophylactic inguinal radiotherapy.
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Affiliation(s)
- M Mistrangelo
- Sezione di Chirurgia Oncologica, Università degli Studi, Torino
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Mistrangelo M, Mobiglia A, Cassoni P, Castellano I, Maass J, Martina MC, Bellò M, Mussa A. [Verrucous carcinoma of the anus or Buschke-Lowenstein tumor of the anus: staging and treatment. Report of 3 cases]. Suppl Tumori 2005; 4:S29-30. [PMID: 16437884] [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: 05/06/2023]
Abstract
INTRODUCTION Giant condyloma acuminatum or Buschke Lowenstein tumor of the anorectal and perianal regions is an uncommon entity that commonly affects genitalia. These are slow-growing, expansive, cauliflower-like, destructive lesions that could propagate to vulvar and vaginal region, rectum and bladder. The hallmark of the disease is the high rate of recurrence (66%) and malignant transformation (56%). No distant metastases usually occur. The median number of recurrences are 2 (range, 1-7). MATERIALS AND METHODS At the Oncological Surgical Department, University of Turin, three patients were diagnosed with a Buschke Lowenstein tumor. In two cases immunodeficiency was evidentiated (HIV in one case and ciclosporin treatment in the second one). The lesions were up to 15 cm of diameter and in one case scrotum was invaded. In another case a lesion in sacral region was observed. All patients were studied with anoproctoscopy, CT scan, pelvic magnetic resonance and lymphoscintigraphy for following biopsy of inguinal sentinel node for potential malignancy. All patients were submitted to extensive local surgical treatment. RESULTS No mortality was observed. In one case we observed a late anal stenosis treated with local dilatations. No more complications were observed. One patient with a small persistence of the disease was treated with cryotherapy. All inguinal nodes revealed negative to definitive histological exam, that confirmed the diagnosis of Buschke Lowenstein tumor of the primary lesion. CONCLUSIONS Buschke Lowenstein tumors are rare but extensive lesions difficult to treat. Local surgery with elettrocautery or laser is the first treatment of choice, even if abdominoperineal amputation sec. Miles could be considered in case of extremely extensive lesions or multiple and extensive recurrences. Others treatments proposed are radiotherapy, chemotherapy, interferon, iniquimod and so on. Other studies are requested to value the best treatment.
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Affiliation(s)
- M Mistrangelo
- Sezione di Chirurgia Oncologica, Università degli Studi, Torino
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Abstract
BACKGROUND The authors investigated early radiological findings after gastric surgery for morbid obesity to evaluate their usefulness in avoiding complications or facilitating treatment. MATERIAL AND METHODS 413 patients underwent gastric bariatric surgery: 327 had vertical banded gastroplasty (VBG), 55 Roux-en-Y gastric bypass (RYGBP), 22 adjustable silicone gastric banding (ASGB), and 9 biliopancreatic diversion (BPD). A radiological upper gastrointestinal investigation employing water-soluble contrast medium was performed in each patient between the 2nd and 8th postoperative day. Several techniques were employed to assess different radiological findings related to the anatomic modifications after the bariatric surgery. RESULTS In VBGs, delayed emptying was found in 10 patients (3%), gastric leak in 3 patients (0.9%), vertical suture breakdown in 1 patients (0.3%), and a wide pouch in 4 patients (1.2%). In RYGBP, a leak was detected in 2 patients (3.6%), delayed emptying in 2 (3.6%), and a wide pouch in 5 (9.1%). ASGB required band enlargement for stomal stenosis in 6 patients (27.2%). Temporary delayed emptying from stomal stenosis was also observed in 2 BPDs (22.2%). Overall complications were 35/413 (8.2%). Two cases of gastric leak after VBG were reoperated. Stomal stenosis after ASGB were treated by percutaneous band deflation; other cases were medically treated until complete healing. CONCLUSIONS Early radiological study after gastric bariatric surgery is advisable, since it detected postoperative complications (gastric perforation, stomal stenosis, etc.) and modified the clinical approach. As the interpretation of these radiographs is often difficult, involving different projections or patient's positions or other technical managements, surgeons and radiologists must interact and be knowledgable.
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Affiliation(s)
- M Toppino
- Dipartimento Discipline Medico Chirurgiche, Clinica Chirurgica Generale ed Oncologica, c.so Dogliotti 14, Torino 10126, Italy.
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Panzera F, Ghisio S, Grosso A, Vigezzi P, Vitale M, Cariaggi RM, Mistrangelo M. [Laparoscopic appendectomy. Retrospective analysis of our experience compared with the literature]. MINERVA CHIR 2000; 55:577-80. [PMID: 11155469] [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: 02/18/2023]
Abstract
BACKGROUND The benefits of laparoscopic appendectomy (LA) remain controversial. This study reports a critical examination of our experience in a peripheral hospital. METHODS A total of 128 appendectomies have been performed since January 1996, of which 63 (49%) were laparoscopic. The patients included 52 (82.5%) females and 11 (17.5%) males with a mean age of 20.8 years (range 11-46). Emergency surgery was required in 6 cases (9.5%) and was elective in 57 (90.5%). Appendectomy was performed during another operation in 3 cases (laparoscopic cholecystectomy). RESULTS Mortality was nil. Morbidity was 1.7% (1 case). The index of conversion was 0%. Only one major complication occurred. This took the form of perforation of an ileal loop following accidental lesion during adhesiolysis. The intraoperative diagnosis was not confirmed in 12 (19%) cases: 9 ovarian cysts, 1 terminal ilieitis and 2 cases of acute salpingitis. In 10 cases (15%) surgery was associated with adhesiolysis, and in 6 cases (9.3%) the appendix was retrocecal. Mean operating time was 42 min (range 18-105 min). The mean hospitalisation was 3.3 days. CONCLUSIONS The authors emphasise the numerous advantages of laparoscopic techniques in their experience, including excellent cosmetic results, reduced PO pain, rapid functional recovery, lower incidence of adhesion, wound infection and laparocele, and more cost-effective when mechanical staplers are not used. Owing to the ability to explore the entire abdominal cavity, the main advantage of this technique consisted in a correct differential diagnostic balance, especially in young women of child-bearing age, between appendectomy and pathologies of the uterus and adnexa.
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Affiliation(s)
- F Panzera
- Divisione di Chirurgia Generale, Azienda Sanitaria N. 11, Vercelli
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Panzera F, Ghisio S, Grosso A, Vigezzi P, Vitale M, Cariaggi RM, Mistrangelo M. [Laparoscopic cholecystectomy. Our experience]. MINERVA CHIR 2000; 55:489-92. [PMID: 11140101] [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: 02/18/2023]
Abstract
BACKGROUND The many advantages and extreme versatility made laparoscopic cholecystectomy (L.C.) the gold standard for symptomatic cholelithiasis. The aim of this research is a retrospective analysis of personal experience with laparoscopic cholecystectomy in a peripheral hospital compared with the literature on the subject. METHODS Since June 1982, a total of 989 L.C. have been performed. The patients were: 691 (68.6%) women and 298 (29.4%) men with a mean age of 56 years (range 17-84). The indications were: 791 symptomatic cholelithiasis, 142 chronic cholecystitis, 45 empyema-hydrops and 11 adenomyomatosis. RESULTS No postoperative death have been observed and the conversion rate was of 24 cases (2.3%). The main complications were 3 cases of injury of the biliary tract and 2 cases of postoperative bleeding (1 from cystic artery and 1 from the umbilical wound). Minor complications observed were 12 cases (1.2%) of infections of the umbilical wound and 3 cases of umbilical hernia (0.3%). The elevation of stasis index was observed in 3 cases which solved spontaneously. The length of stay was 2 days in 957 cases (97%), 8 days in 24 cases and 4-5 days in 8 (0.7%). CONCLUSIONS No major trochar's lesions occurred, contrary to the percentages quoted in the literature (0.02%-0.9%). The selective use of the open technique and of the multiuse conic section trocar in the "closed" technique is suggested. The 3 cases of bile duct lesions did not occur during the training period, contrary to what quoted in the literature. In personal opinion, a careful surgical technique with a good Calot's triangle preparation, is necessary to prevent these inconveniences. Parietal complications (umbilical wound infections and laparocele) even if lesser than in the laparotomy technique, can be reduced by using the endobag and suturing the abdominal fascia of the 10 mm trocars. Moreover, the use of a systematic subhepatic drainage during the first 24 postoperative hours is suggested, since it can be useful to reveal possible bleeding.
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Affiliation(s)
- F Panzera
- Divisione di Chirurgia Generale, Presidio Ospedaliero di Santhià, Azienda Sanitaria n. 11, Vercelli
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