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Grossi U, Brun Peressut A, Piccino M, Pelizzo P, Cervesato P, Zanus G. Preserving anatomy, restoring function: urgent hemorrhoidopexy for massive grade IV thrombosed prolapse. Tech Coloproctol 2023; 28:4. [PMID: 38066304 DOI: 10.1007/s10151-023-02890-3] [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] [Received: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023]
Affiliation(s)
- U Grossi
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy.
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy.
| | | | - M Piccino
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy
| | - P Pelizzo
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy
| | - P Cervesato
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy
| | - G Zanus
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
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Piccino M, Hoxhaj I, Grossi U, Romano M, Brizzolari M, Scopelliti M, Finotti M, Zanus G. Bile Duct Lithiasis Mimicking a Perihilar Cholangiocarcinoma-An Endless Dilemma: A Case Report. J Clin Med 2023; 12:5104. [PMID: 37568507 PMCID: PMC10420143 DOI: 10.3390/jcm12155104] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Hilar bile duct strictures are mostly caused by malignant lesions. The morphological appearance of perihilar cholangiocarcinomas in various imaging modalities have other malignant and even benign mimics, which pose challenges to an accurate diagnosis and treatment and drive to futile surgery. Herein, we present the case of a 50-year-old woman admitted with jaundice and abdominal pain, elevated bilirubin level, liver function tests and carbohydrate antigen 19-9 level. Magnetic resonance cholangio-pancreatography (MR-CP) and the computed tomography with contrast enhancement revealed a suspected extrahepatic cholangiocarcinoma of the common bile duct. Further spontaneous resolution of the scenario, confirmed by diagnostic assessment, changed the clinical hypothesis in favor of a non-oncological disease. Indeed, the multidisciplinary evaluation supported a diagnosis of transient cholangitis secondary to non-evident intrahepatic lithiasis rather than cholangiocarcinoma. After a 26-month follow-up, the patient was asymptomatic with normal tumor markers and laboratory data. Consecutive MR-CPs showed no suspicion of malignancy. This case report underlines the need for an accurate preoperative assessment in patients with suspected cholangiocarcinoma.
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Affiliation(s)
- Marco Piccino
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
| | - Ilda Hoxhaj
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
| | - Ugo Grossi
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
- Surgical-Oncological-Gastroenterological Science Department (DISCOG), University of Padua, 35122 Padova, Italy
| | - Maurizio Romano
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
| | - Marco Brizzolari
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
| | - Michele Scopelliti
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
| | - Michele Finotti
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Giacomo Zanus
- 2nd Surgery Unit, “Ca’ Foncello” Regional Hospital, 31100 Treviso, Italy; (I.H.); (U.G.); (M.R.); (M.B.); (M.S.); (M.F.); (G.Z.)
- Surgical-Oncological-Gastroenterological Science Department (DISCOG), University of Padua, 35122 Padova, Italy
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Grossi U, Pelizzo P, Gallo G, Piccino M, Zanus G. Modified Karydakis procedure for sacrococcygeal pilonidal disease under local anaesthesia - a video vignette. Colorectal Dis 2023. [PMID: 36799036 DOI: 10.1111/codi.16524] [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] [Received: 01/03/2023] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Ugo Grossi
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy.,Department of Surgery, Oncology and Gastroenterology - DiSCOG, University of Padua, Padua, Italy
| | - Patrizia Pelizzo
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy.,Department of Surgery, Oncology and Gastroenterology - DiSCOG, University of Padua, Padua, Italy
| | - Gaetano Gallo
- Department of Surgical Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - Marco Piccino
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy
| | - Giacomo Zanus
- Surgery Unit 2, Regional Hospital Treviso, Treviso, Italy.,Department of Surgery, Oncology and Gastroenterology - DiSCOG, University of Padua, Padua, Italy
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Grossi U, Gallo G, Ortenzi M, Piccino M, Salimian N, Guerrieri M, Sammarco G, Felice C, Santoro GA, Di Saverio S, Di Tanna GL, Zanus G. Changes in hospital admissions and complications of acute appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis. Health Sci Rev (Oxf) 2022; 3:100021. [PMID: 35287332 PMCID: PMC8906891 DOI: 10.1016/j.hsr.2022.100021] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
Background Acute appendicitis (AA) is one of the most common emergencies in general surgery worldwide. During the pandemic, a significant decrease in the number of accesses to the emergency department for AA has been recorded in different countries. A systematic review of the current literature sought to determine the impact of Coronavirus Disease 2019 (COVID-19) on hospital admissions and complications of AA. Method A systematic search was undertaken to identify repeated cross-sectional studies reporting the management of AA during the COVID-19 pandemic (index period) as compared to the previous year, or at the turn of lockdown (reference period). Data were abstracted on article (country of origin) and patients characteristics (adults, children [i.e. non adults, <18-year-old]), or mixed population) within the two given timeframes, including demographics, number of admissions for AA, number of appendectomies, and complicated appendectomies. Results Of 201 full-text articles assessed for eligibility, 54 studies from 22 world countries were included. In total, 27 (50%) were conducted on adults, 12 (22%) on children, and 15 (28%) on a mixed patients population. The overall rate ratio of admissions for AA between the two periods was 0.94 (95%CI, 0.75-1.17), with significant differences between studies on adults (0.90 [0.74-1.09]), mixed population (0.50 [0.27-0.90]), and children (1.50 [1.01-2.22]). The overall risk ratio of complicated AA was 1.65 (1.32-2.07), ranging from 1.32 in studies on children, to 2.45 in mixed population. Conclusion The pandemic has altered the rate of admissions for AA and appendectomy, with parallel increased incidence of complicated cases in all age groups.
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Affiliation(s)
- Ugo Grossi
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy,Corresponding author at: National Bowel Research Centre, Queen Mary University of London, 2 Newark Street, London E1 2AT, United Kingdom
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Marco Piccino
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Nick Salimian
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Carla Felice
- I Medicine Unit, Treviso Regional Hospital, DIMED, University of Padua, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Giacomo Zanus
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
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Finotti M, Romano M, Auricchio P, Scopelliti M, Brizzolari M, Grossi U, Piccino M, Benvenuti S, Morana G, Cillo U, Zanus G. Target Therapies for NASH/NAFLD: From the Molecular Aspect to the Pharmacological and Surgical Alternatives. J Pers Med 2021; 11:499. [PMID: 34199535 PMCID: PMC8229090 DOI: 10.3390/jpm11060499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/11/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease represents an increasing cause of chronic hepatic disease in recent years. This condition usually arises in patients with multiple comorbidities, the so-called metabolic syndrome. The therapeutic options are multiple, ranging from lifestyle modifications, pharmacological options, to liver transplantation in selected cases. The choice of the most beneficial one and their interactions can be challenging. It is mandatory to stratify the patients according to the severity of their disease to tailor the available treatments. In our contribution, we review the most recent pharmacological target therapies, the role of bariatric surgery, and the impact of liver transplantation on the NAFLD outcome.
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Affiliation(s)
- Michele Finotti
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, 31100 Padua, Italy; (M.R.); (M.S.); (M.B.); (U.G.); (M.P.); (G.Z.)
| | - Maurizio Romano
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, 31100 Padua, Italy; (M.R.); (M.S.); (M.B.); (U.G.); (M.P.); (G.Z.)
| | - Pasquale Auricchio
- Hepatobiliary Surgery and Liver Transplantation Unit, DISCOG, University of Padua, 35121 Padua, Italy; (P.A.); (U.C.)
| | - Michele Scopelliti
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, 31100 Padua, Italy; (M.R.); (M.S.); (M.B.); (U.G.); (M.P.); (G.Z.)
| | - Marco Brizzolari
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, 31100 Padua, Italy; (M.R.); (M.S.); (M.B.); (U.G.); (M.P.); (G.Z.)
| | - Ugo Grossi
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, 31100 Padua, Italy; (M.R.); (M.S.); (M.B.); (U.G.); (M.P.); (G.Z.)
| | - Marco Piccino
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, 31100 Padua, Italy; (M.R.); (M.S.); (M.B.); (U.G.); (M.P.); (G.Z.)
| | - Stefano Benvenuti
- Gastroenterology Unit (IV), Cà Foncello Regional Hospital, 31100 Treviso, Italy;
| | - Giovanni Morana
- Division of Radiology, Treviso Regional Hospital, 31100 Treviso, Italy;
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, DISCOG, University of Padua, 35121 Padua, Italy; (P.A.); (U.C.)
| | - Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, 31100 Padua, Italy; (M.R.); (M.S.); (M.B.); (U.G.); (M.P.); (G.Z.)
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Vega EA, Newhook TE, Kawaguchi Y, Qiao W, De Bellis M, Okuno M, Panettieri E, Nishino H, Duwe G, Piccino M, De Rose AM, Ruzzenente A, Uemoto S, Vivanco M, Chun YS, Cao HST, Tzeng CWD, De Aretxabala X, Seo S, Giuliante F, Guglielmi A, Vinuela E, Vauthey JN. Conditional Recurrence-Free Survival after Oncologic Extended Resection for Gallbladder Cancer: An International Multicenter Analysis. Ann Surg Oncol 2021; 28:2675-2682. [PMID: 33666814 DOI: 10.1245/s10434-021-09626-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 12/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Data to guide surveillance following oncologic extended resection (OER) for gallbladder cancer (GBC) are lacking. Conditional recurrence-free survival (C-RFS) can inform surveillance. We aimed to estimate C-RFS and identify factors affecting conditional RFS after OER for GBC. PATIENTS AND METHODS Patients with ≥ T1b GBC who underwent curative-intent surgery in 2000-2018 at four countries were identified. Risk factors for recurrence and RFS were evaluated at initial resection in all patients and at 12 and 24 months after resection in patients remaining recurrence-free. RESULTS Of the 1071 patients who underwent OER, 484 met the inclusion criteria; 290 (60%) were recurrence-free at 12 months, and 199 (41%) were recurrence-free at 24 months. Median follow-up was 24.5 months for all patients and 47.21 months in survivors at analysis. Five-year RFS rates were 47% for the overall population, 71% for patients recurrence-free at 12 months, and 87% for the patients without recurrence at 24 months. In the entire cohort, the risk of recurrence peaked at 8 months. T3-T4 disease was independently associated with recurrence in all groups: entire cohort [hazard ratio (HR) 2.16, 95% confidence interval (CI) 1.49-3.13, P < 0.001], 12-month recurrence-free (HR 3.42, 95% CI 1.88-6.23, P < 0.001), and 24-month recurrence-free (HR 2.71, 95% CI 1.11-6.62, P = 0.029). Of the 125 patients without these risk factors, only 2 had recurrence after 36 months. CONCLUSION C-RFS improves over time, and only T3-T4 disease remains a risk factor for recurrence at 24 months after OER for GBC. For all recurrence-free survivors after 36 months, the probability of recurrence is similar regardless of T category or disease stage.
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Affiliation(s)
- Eduardo A Vega
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Gallbladder Consortium Chile, Sotero del Rio Hospital and Clinica Alemana, Santiago, Chile
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mario De Bellis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Masayuki Okuno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Elena Panettieri
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Hiroto Nishino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Gregor Duwe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marco Piccino
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Agostino M De Rose
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Ruzzenente
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Marcelo Vivanco
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Gallbladder Consortium Chile, Sotero del Rio Hospital and Clinica Alemana, Santiago, Chile
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xabier De Aretxabala
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Gallbladder Consortium Chile, Sotero del Rio Hospital and Clinica Alemana, Santiago, Chile
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Eduardo Vinuela
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Gallbladder Consortium Chile, Sotero del Rio Hospital and Clinica Alemana, Santiago, Chile
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Solaini L, Cucchetti A, Piccino M, Gardini A, La Barba G, Serenari M, Cescon M, Ercolani G. Critical systematic review on hepatic resection and transarterial chemoembolization for hepatocellular carcinoma. Future Oncol 2019; 15:439-449. [PMID: 30620230 DOI: 10.2217/fon-2018-0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Whether to submit to transarterial chemoembolization (TACE) or hepatic resection (HR) patients with hepatocellular carcinoma (HCC) is still a debated issue. We conducted a systematic review to critically analyze what evidence supports the use of TACE, in a specific clinical condition that can define HCC as 'intermediate'. In addition, we analyzed literature regarding the comparison between TACE and HR. Direct comparisons, between HR and TACE, strongly support the adoption of surgery for patients with large or multinodular HCCs since, albeit 'nonideal' surgical candidates, these patients can still obtain a survival benefit. Multidisciplinary teams can mitigate the different decision-making approach of surgeons and hepatologists with the aim of obtaining the best quality of care.
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Affiliation(s)
- Leonardo Solaini
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Forli, 47121, Italy.,Department of Medical & Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, 40138, Italy
| | - Alessandro Cucchetti
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Forli, 47121, Italy.,Department of Medical & Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, 40138, Italy
| | - Marco Piccino
- Division of General & Hepatobiliary Surgery, Department of Surgery, University of Verona Medical School, Verona, 37134, Italy
| | - Andrea Gardini
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Forli, 47121, Italy
| | - Giuliano La Barba
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Forli, 47121, Italy
| | - Matteo Serenari
- Department of Medical & Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, 40138, Italy
| | - Matteo Cescon
- Department of Medical & Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, 40138, Italy
| | - Giorgio Ercolani
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Forli, 47121, Italy.,Department of Medical & Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, 40138, Italy
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Ruzzenente A, Conci S, Ciangherotti A, Campagnaro T, Valdegamberi A, Bertuzzo F, Bagante F, Mantovani G, De Angelis M, Dorna AE, Piccino M, Pedrazzani C, Guglielmi A, Iacono C. Impact of age on short-term outcomes of liver surgery: Lessons learned in 10-years' experience in a tertiary referral hepato-pancreato-biliary center. Medicine (Baltimore) 2017; 96:e6955. [PMID: 28514317 PMCID: PMC5440154 DOI: 10.1097/md.0000000000006955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We investigate the surgical outcomes of patients undergoing hepatectomy according to different age intervals, identify the clinical factors related to surgical outcomes, and propose clinical risk scores for severe morbidity and mortality based on the clinical factors.Eight hundred three patients undergoing liver resection were divided into 3 groups: young patients (YP), <65 years (n = 387), elderly patients (EP), from 65 to 74 years (n = 279); very-elderly patients (VEP), ≥75 years (n = 137).Severe morbidity was 10.6%, 12.2%, and 17.5% (P = .103), and mortality was 0.3%, 1.4%, and 4.4% (P = .002) in group YP, EP, and VEP, respectively. Ischemic heart disease, cirrhosis, major hepatectomy, biliary tract-associated procedure, and red blood cells (RBC) transfusion ≥3 U were related with severe morbidity. Ischemic heart disease, cirrhosis, major hepatectomy, and RBC transfusion were independent risk factors for postoperative mortality. Age did not result an independent factor related to mortality and severe morbidity. Two different scores were developed and have proved to be statistically related with severe morbidity and mortality. Moreover, in patients with score ≥2, severe morbidity increased from 24.2% in YP, to 29.3% in EP, and to 40.0% in VEP, P = .047. Likewise, mortality increased from 2.3% in YP, to 7.0% in EP, and to 22.7% in VEP, in patients with score ≥2, P = .017.Age alone should not be considered a contraindication for hepatectomy. We identified factors and proposed 2 scores that can be useful to stratify the risk of morbidity and mortality after hepatectomy. Moreover, severe morbidity and mortality increases according to the different age intervals in patients with scores ≥2.
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9
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Conci S, Ruzzenente A, Sandri M, Bertuzzo F, Campagnaro T, Bagante F, Capelli P, D'Onofrio M, Piccino M, Dorna AE, Pedrazzani C, Iacono C, Guglielmi A. What is the most accurate lymph node staging method for perihilar cholangiocarcinoma? Comparison of UICC/AJCC pN stage, number of metastatic lymph nodes, lymph node ratio, and log odds of metastatic lymph nodes. Eur J Surg Oncol 2017; 43:743-750. [PMID: 28094085 DOI: 10.1016/j.ejso.2016.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 08/11/2016] [Revised: 10/20/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We compared the prognostic performance of the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) 7th edition pN stage, number of metastatic LNs (MLNs), LN ratio (LNR), and log odds of MLNs (LODDS) in patients with perihilar cholangiocarcinoma (PCC) undergoing curative surgery in order to identify the best LN staging method. METHODS Ninety-nine patients who underwent surgery with curative intent for PCC in a single tertiary hepatobiliary referral center were included in the study. Two approaches were used to evaluate and compare the predictive power of the different LN staging methods: one based on the estimation of variable importance with prediction error rate and the other based on the calculation of the receiver operating characteristic (ROC) curve. RESULTS LN dissection was performed in 92 (92.9%) patients; 49 were UICC/AJCC pN0 (49.5%), 33 pN1 (33.3%), and 10 pN2 (10.1%). The median number of LNs retrieved was 8. The prediction error rate ranged from 42.7% for LODDS to 47.1% for UICC/AJCC pN stage. Moreover, LODDS was the variable with the highest area under the ROC curve (AUC) for prediction of 3-year survival (AUC = 0.71), followed by LNR (AUC = 0.60), number of MLNs (AUC = 0.59), and UICC/AJCC pN stage (AUC = 0.54). CONCLUSIONS The number of MLNs, LNR, and LODDS appear to better predict survival than the UICC/AJCC pN stage in patients undergoing curative surgery for PCC. Moreover, LODDS seems to be the most accurate and predictive LN staging method.
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Affiliation(s)
- S Conci
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - A Ruzzenente
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - M Sandri
- Department of Economics and Management, Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy
| | - F Bertuzzo
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - T Campagnaro
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - F Bagante
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - P Capelli
- Department of Pathology and Diagnostics, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - M D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - M Piccino
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - A E Dorna
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - C Pedrazzani
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - C Iacono
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy.
| | - A Guglielmi
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
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