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Chiarelli M, De Simone M, Cioffi G, Cioffi U. New paradigm of oral rehydration in patients affected by irritable bowel syndrome with chronic diarrhea. World J Gastrointest Pharmacol Ther 2024; 15:90933. [PMID: 38590832 PMCID: PMC10999031 DOI: 10.4292/wjgpt.v15.i1.90933] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/20/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024] Open
Abstract
Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms. This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool. International surveys about this disease report a global prevalence of about 1.5%. A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea. It is composed of water, electrolytes, and five selected amino acids that function as sodium co-transporters without containing glucose. In recent years, some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis, reporting good results. Recently, a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome. The research was based on a real-life methodology minimizing the disruption of the routine care. One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on selected amino acids twice a day for 2 wk. Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction. Based on this data, we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea. It is certainly necessary to plan high-quality clinical trials comparing glucose based oral solutions and amino acid based solutions in patients with persisting diarrhea. Probably in the near future all oral rehydration solutions will contain amino acids.
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Affiliation(s)
- Marco Chiarelli
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital–ASST Lecco, Lecco 23900, Italy
| | - Matilde De Simone
- Department of Surgery, University of Milan, Via F. Sforza 35, 20122 Milano, Milano 20122, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, Unisannio, Benevento 82100, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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Abbaker N, Minervini F, Guttadauro A, Solli P, Cioffi U, Scarci M. The future of artificial intelligence in thoracic surgery for non-small cell lung cancer treatment a narrative review. Front Oncol 2024; 14:1347464. [PMID: 38414748 PMCID: PMC10897973 DOI: 10.3389/fonc.2024.1347464] [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: 11/30/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives To present a comprehensive review of the current state of artificial intelligence (AI) applications in lung cancer management, spanning the preoperative, intraoperative, and postoperative phases. Methods A review of the literature was conducted using PubMed, EMBASE and Cochrane, including relevant studies between 2002 and 2023 to identify the latest research on artificial intelligence and lung cancer. Conclusion While AI holds promise in managing lung cancer, challenges exist. In the preoperative phase, AI can improve diagnostics and predict biomarkers, particularly in cases with limited biopsy materials. During surgery, AI provides real-time guidance. Postoperatively, AI assists in pathology assessment and predictive modeling. Challenges include interpretability issues, training limitations affecting model use and AI's ineffectiveness beyond classification. Overfitting and global generalization, along with high computational costs and ethical frameworks, pose hurdles. Addressing these challenges requires a careful approach, considering ethical, technical, and regulatory factors. Rigorous analysis, external validation, and a robust regulatory framework are crucial for responsible AI implementation in lung surgery, reflecting the evolving synergy between human expertise and technology.
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Affiliation(s)
- Namariq Abbaker
- Division of Thoracic Surgery, Imperial College NHS Healthcare Trust and National Heart and Lung Institute, London, United Kingdom
| | - Fabrizio Minervini
- Division of Thoracic Surgery, Luzerner Kantonsspital, Lucern, Switzerland
| | - Angelo Guttadauro
- Division of Surgery, Università Milano-Bicocca and Istituti Clinici Zucchi, Monza, Italy
| | - Piergiorgio Solli
- Division of Thoracic Surgery, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Marco Scarci
- Division of Thoracic Surgery, Imperial College NHS Healthcare Trust and National Heart and Lung Institute, London, United Kingdom
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Re Cecconi E, Mangiameli G, De Simone M, Cioffi U, Marulli G, Testori A. Vats lobectomy for lung cancer. What has been the evolution over the time? Front Oncol 2024; 13:1268362. [PMID: 38260828 PMCID: PMC10800971 DOI: 10.3389/fonc.2023.1268362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung cancer. It is safe and effective compared to open surgery, as demonstrated by a large body of scientific evidence over the last few decades. VATS lobectomy's evolution was driven by the need to decrease post-operative pain by reducing the extent of surgical accesses, maintaining the same oncological efficacy of open lobectomy with less invasiveness. VATS lobectomy just turned 30 years old, evolving and changing significantly from its origins. The aim of this mini review is to retrace the history, starting from a multiport approach to a single port approach. At the end of this mini review, we will discuss the advanced and the future challenges of the technique that has revolutionized thoracic surgery.
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Affiliation(s)
- Emanuela Re Cecconi
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
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Raveglia F, Melfi F, Cioffi U, Lococo F, Ricciardi S, Pompili C, Cardillo G. Editorial: Current trends in endoscopic thoracic surgery: insights from the XXI SIET national meeting. Front Surg 2023; 10:1237928. [PMID: 37456149 PMCID: PMC10349549 DOI: 10.3389/fsurg.2023.1237928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
| | - Franca Melfi
- Thoracic Surgery, Robotic Multispecialty Centre for Surgery; Minimally Invasive and Robotic Thoracic Surgery; University Hospital of Pisa, Pisa, Italy
| | - Ugo Cioffi
- Thoracic Surgery, University of Milan, Milano, Italy
| | - Filippo Lococo
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Sara Ricciardi
- Thoracic Surgery, San Camillo Forlanini Hospital, Roma, Italy
| | - Cecilia Pompili
- Thoracic Surgery, Leeds Institute of Cancer & Pathology-University of Leeds, Leeds, United Kingdom
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Orlandi R, Scarci M, Cioffi U, Guttadauro A, Peschi G, Cassina EM, Filosso P, Raveglia F. Multi-level analysis and evaluation of organizational improvements in thoracic surgery according to a Value-Based HealthCare approach. J Thorac Dis 2023; 15:1046-1056. [PMID: 37065599 PMCID: PMC10089880 DOI: 10.21037/jtd-22-1294] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/23/2022] [Indexed: 03/18/2023]
Abstract
Background Value-Based HealthCare (VBHC), designed by Harvard University, is an evolving model of healthcare delivery that achieves better patient outcomes and greater financial sustainability for the healthcare professionals. According to this innovative approach, the value is determined by a panel of indicators and the ratio between results and costs. Our goal was to develop a panel of thoracic-fashioned key-performance indicators (KPIs) creating a model that could be applied in thoracic surgery for the first time, reporting our early experience. Methods Fifty-five indicators were developed based on literature review: 37 for outcomes and 18 for costs. Outcomes were measured by a 7 level Likert scale, while overall costs were defined through the sum of the individual economic performance on each resource indicator. An observational retrospective cross-sectional study was designed to make a cost-effective evaluation of the indicators. Therefore, the Patient Value in Thoracic Surgery (PVTS) score calculated value gained for every lung cancer patient undergoing lung resection at our surgical department. Results A total of 552 patients were enrolled. From 2017 to 2019 mean outcome indicators per patient were 109, 113 and 110 while mean costs per patient were 7.370, 7.536 and 7.313 euros respectively. Hospital stay and waiting time from consultation to surgery for lung cancer patients decreased from 7.3 to 5 and from 25.2 to 21.9 days, respectively. On the contrary, number of patients increased but overall costs decreased, despite cost of consumables has gone from 2.314 to 3.438 euros, since cost of hospitalization and occupancy of the operating room (OR) improved (from 4.288 to 3.158 euros). Variables analyzed showed that overall value delivered grew from 14.8 to 15. Conclusions Introducing a new concept of value, the VBHC theory applied to thoracic surgery may revolutionize traditional organizational management in lung cancer patients, showing how value delivered can increase in accordance with outcomes, despite the growth of part of the costs. Our panel of indicators has been created to provide an innovative score to successfully identify improvements needed and quantify their effectiveness in Thoracic Surgery and our early experience reports encouraging results.
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Affiliation(s)
- Riccardo Orlandi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, Istituti Clinici Zucchi, University of Milan-Bicocca, Monza, Italy
| | | | | | - Pierluigi Filosso
- Department of Thoracic Surgery, Ospedale San Giovanni Battista Molinette, University of Turin, Turin, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
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Gerosa M, Chiarelli M, Maggioni D, Cioffi U, Guttadauro A. Acute biliary pancreatitis: the current role of endoscopic and minimally invasive surgical procedures. Ann Ital Chir 2023; 94:36-44. [PMID: 36810368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
AIM This review aims to summarize the state of the art in endoscopic and other minimally invasive technique for the treatment of acute biliary pancreatitis. Current indications, advantages or disadvantages for each reported technique and future perspectives are discussed. BACKGROUND Acute biliary pancreatitis is one of the most common gastroenterological diseases. Its management range from medical to interventional treatment and involves gastroenterologists, nutritionists, endoscopists, interventional radiologists and surgeons. Interventional procedures are required in case of local complications, failure of medical treatment and definitive treatment of biliary gallstones. Endoscopic and minimally invasive procedures have progressively gained favor and wide diffusion in treating acute biliary pancreatitis reporting good results in terms of safety and minor morbidity and mortality. CONCLUSIONS Endoscopic retrograde cholangiopancreatography is advocated in case of cholangitis and persistent common biliary duct obstruction. Laparoscopic cholecystectomy is considered the definitive treatment for acute biliary pancreatitis. Endoscopic transmural drainage and necrosectomy have gained acceptance and diffusion in treating pancreatic necrosis reporting minor impact on morbidity respect surgery. A surgical approach to pancreatic necrosis progressively shifts towards minimally invasive technique like minimally access retroperitoneal pancreatic necrosectomy, video-assisted retroperitoneal debridement or laparoscopic necrosectomy. Open necrosectomy in necrotizing pancreatitis is reserved to failure of endoscopic or minimally invasive treatment or in case of wide necrotic collections. KEY WORDS Acute biliary pancreatitis, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy, Pancreatic necrosis.
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Passera E, Orlandi R, Calderoni M, Cassina EM, Cioffi U, Guttadauro A, Libretti L, Pirondini E, Rimessi A, Tuoro A, Raveglia F. Post-intubation iatrogenic tracheobronchial injuries: The state of art. Front Surg 2023; 10:1125997. [PMID: 36860949 PMCID: PMC9968843 DOI: 10.3389/fsurg.2023.1125997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Iatrogenic tracheobronchial injury (ITI) is an infrequent but potentially life-threatening disease, with significant morbidity and mortality rates. Its incidence is presumably underestimated since several cases are underrecognized and underreported. Causes of ITI include endotracheal intubation (EI) or percutaneous tracheostomy (PT). Most frequent clinical manifestations are subcutaneous emphysema, pneumomediastinum and unilateral or bilateral pneumothorax, even if occasionally ITI can occur without significant symptoms. Diagnosis mainly relies on clinical suspicion and CT scan, although flexible bronchoscopy remains the gold standard, allowing to identify location and size of the injury. EI and PT related ITIs more commonly consist of longitudinal tear involving the pars membranacea. Based on the depth of tracheal wall injury, Cardillo and colleagues proposed a morphologic classification of ITIs, attempting to standardize their management. Nevertheless, in literature there are no unambiguous guidelines on the best therapeutic modality: management and its timing remain controversial. Historically, surgical repair was considered the gold standard, mainly in high-grade lesions (IIIa-IIIb), carrying high morbi-mortality rates, but currently the development of promising endoscopic techniques through rigid bronchoscopy and stenting could allow for bridge treatment, delaying surgical approach after improving general conditions of the patient, or even for definitive repair, ensuring lower morbi-mortality rates especially in high-risk surgical candidates. Our perspective review will cover all the above issues, aiming at providing an updated and clear diagnostic-therapeutic pathway protocol, which could be applied in case of unexpected ITI.
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Affiliation(s)
- Eliseo Passera
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Matteo Calderoni
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Emanuele Pirondini
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonio Tuoro
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
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Cioffi U, Chiarelli M, Testori A, De Simone M, Ciulla MM, Calderoni M, Cassina E, Scarci M, Raveglia F. Editorial on research topic: Surgery and COVID-19 in oncologic patients: What does the recent coronavirus pandemic taught us? Front Surg 2023; 9:1081959. [PMID: 36704509 PMCID: PMC9872151 DOI: 10.3389/fsurg.2022.1081959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Ugo Cioffi
- Department of Surgery, University of Milan, Milano, Italy,Correspondence: Ugo Cioffi
| | - Marco Chiarelli
- Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Alberto Testori
- Department of General and Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
| | | | - Michele M. Ciulla
- Laboratory of Clinical Informatics and Cardiovascular Imaging, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Matteo Calderoni
- Scuola di Specializzazione Chirurgia Toracica, Università Degli Studi di Milano, Milano, Italy
| | | | - Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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Orlandi R, Raveglia F, Calderoni M, Cassina EM, Cioffi U, Guttadauro A, Libretti L, Pirondini E, Rimessi A, Tuoro A, Passera E. Management of COVID-19 related tracheal stenosis: The state of art. Front Surg 2023; 10:1118477. [PMID: 36891547 PMCID: PMC9986964 DOI: 10.3389/fsurg.2023.1118477] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
Tracheal stenosis (TS) is a debilitating disease promoted by pathologic narrowing of the trachea. The acute respiratory distress syndrome caused by COVID-19 has been demonstrated to trigger enhanced inflammatory response and to require prolonged invasive mechanical ventilation as well as high frequency of re-intubation or emergency intubation, thus increasing the rate and complexity of TS. The standard-of-care of COVID-19-related tracheal complications has yet to be established and this is a matter of concern. This review aims at collecting latest evidence on this disease, providing an exhaustive overview on its distinctive features and open issues, and investigating different diagnostic and therapeutic strategies to handle COVID-19-induced TS, focusing on endoscopic versus open surgical approach. The former encompasses bronchoscopic procedures: electrocautery or laser-assisted incisions, ballooning dilation, submucosal steroid injection, endoluminal stenting. The latter consists of tracheal resection with end-to-end anastomosis. As a rule, traditionally, the endoscopic management is restricted to short, low-grade, and simple TS, whereas the open techniques are employed in long, high-grade, and complex TS. However, the critical conditions or extreme comorbidities of several COVID-19 patients, as well as the marked inflammation in tracheal mucosa, have led some authors to apply endoscopic management also in complex TS, recording acceptable results. Although severe COVID-19 seems to be an issue of the past, its long-term complications are still unknown and considering the increased rate and complexity of TS in these patients, we strongly believe that it is worth to focus on it, attempting to find the best management strategy for COVID-19-related TS.
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Affiliation(s)
- Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Matteo Calderoni
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, Monza, Italy
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Emanuele Pirondini
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonio Tuoro
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Eliseo Passera
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
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Nachira D, Congedo MT, Calabrese G, Tabacco D, Petracca Ciavarella L, Meacci E, Vita ML, Punzo G, Lococo F, Raveglia F, Chiappetta M, Porziella V, Guttadauro A, Cioffi U, Margaritora S. Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes. Front Surg 2023; 10:1103101. [PMID: 36923380 PMCID: PMC10008900 DOI: 10.3389/fsurg.2023.1103101] [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: 11/19/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
Background Till now there are very few reports about surgical results of Uniportal-VATS esophagectomy and no one about long-term outcomes. This study is the first comparing surgical and oncological outcomes of Uniportal-VATS with open McKeown esophagectomy, with the largest reported series and longest oncological follow-up. Methods The prospectively collected clinical, surgical and oncological data of 75 patients, undergone McKeown esophagectomy at our Thoracic Surgery Department, from January 2012 to August 2022, were retrospectively analyzed. Nineteen patients underwent esophagectomy by thoracotomy and reconstruction according to McKeown technique while 56 by Uniportal-VATS approach. Gastric tubulization was performed totally laparoscopic or through a mini-laparatomic access and cervical anastomosis was made according to Orringer's technique. Results The mean operative thoracic time was similar in both accesses (102.34 ± 15.21 min in Uniportal-VATS vs. 115.56 ± 23.12 min in open, p: 0.646), with a comparable number of mediastinal nodes retrieved (Uniportal-VATS:13.40 ± 8.12 vs. open:15.00 ± 6.86, p: 0.275). No case needed conversion from VATS to open. The learning curve in Uniportal-VATS was completed after 34 cases, while the Mastery was reached after 40. Both approaches were comparable in terms of minor post-operative complications (like pneumonia, lung atelectasis, anemization, atrial fibrillation, anastomotic-leak, left vocal cord palsy, chylothorax), while the number of re-operation for major complications (bleeding or mediastinitis) was higher in open group (21.0% vs. 3.6%, p: 0.04). Both techniques were also effective in terms of surgical radicality and local recurrence but VATS approach allowed a significantly lower chest tube length (11.89 ± 9.55 vs. 25.82 ± 24.37 days, p: 0.003) and post-operative stay (15.63 ± 11.69 vs. 25.53 ± 23.33, p: 0.018). The 30-day mortality for complications related to surgery was higher in open group (p: 0.002). The 2-, 5- and 8-year survival of the whole series was 72%, 50% and 33%, respectively. Combined 2- and 5-year OS in Uniportal-VATS group was 76% and 47% vs. 62% and 62% in open group, respectively (Log-rank, p: 0.286; Breslow-Wilcoxon: p: 0.036). No difference in DFS was recorded between the two approaches (5 year-DFS in Uniportal-VATS: 86% vs. 72%, p: 0.298). At multivariate analysis, only pathological stage independently affected OS (p: 0.02), not the surgical approach (p: 0.276). Conclusions Uniportal-VATS seems to be a safe, feasible and effective technique for performing McKeown esophagectomy, with equivalent surgical and long-term oncological results to standard thoracotomy, but with a faster and unharmed recovery, and a quite short learning curve.
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Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diomira Tabacco
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Petracca Ciavarella
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Punzo
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Lococo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Venanzio Porziella
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
| | - Ugo Cioffi
- Doctorate Professor, University of Milan, Milan, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Mangiameli G, Testori A, Cioffi U, Alloisio M, Cariboni U. Extracorporeal membrane oxygenation support in oncological thoracic surgery. Front Oncol 2022; 12:1005929. [PMID: 36505824 PMCID: PMC9732715 DOI: 10.3389/fonc.2022.1005929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
The use of extracorporeal lung support (ECLS) during thoracic surgery is a recent concept that has been gaining increasing approval. Firstly introduced for lung transplantation, this technique is now increasingly adopted also in oncological thoracic surgical procedures. In this review, we focus on the cutting-edge application of extracorporeal membrane oxygenation (ECMO) during oncological thoracic surgery. Therefore, we report the most common surgical procedures in oncological thoracic surgery that can benefit from the use of ECMO. They will be classified and discussed according to the aim of ECMO application. In particular, the use of ECMO is usually limited to certain lung surgery procedures that can be resumed such as in procedures in which an adequate ventilation is not possible such as in single lung patients, procedures where conventional ventilation can cause conflict with the surgical field such as tracheal or carinal surgery, and conventional procedures requiring both ventilators and hemodynamic support. So far, all available evidence comes from centers with large experience in ECMO and major thoracic surgery procedures.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,*Correspondence: Alberto Testori,
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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12
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Ciulla MM, Cioffi U. Editorial: Contemporary Medicine: Making Sense of Implementation Models and Methods. Front Med (Lausanne) 2022; 9:912045. [PMID: 35655851 PMCID: PMC9152443 DOI: 10.3389/fmed.2022.912045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michele M Ciulla
- Smart Laboratory of Clinical Informatics and Cardiovascular Imaging, CLO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Surgery, University of Milan, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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13
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Abstract
Lung cancer (LC) is the second most commonly diagnosed cancer and the primary cause of cancer death worldwide in 2020. LC treatment is associated with huge costs for patients and society; consequently, there is an increasing interest in the prevention, early detection with screening, and development of new treatments. Its surgical management accounts for at least 90% of the activity of thoracic surgery departments. Surgery is the treatment of choice for early-stage non-small cell LC. In this article, we discuss the state of the art of thoracic surgery for surgical management of LC. We start by describing the milestones of LC treatment, which are lobectomy and an adequate lymphadenectomy, and then we focus on the traditional and innovative minimally invasive surgical approaches available: video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). A brief overview of the innovation and future perspective in thoracic surgery will close this mini-review.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Alberto Testori,
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14
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Raveglia F, Scarci M, Rimessi A, Orlandi R, Rebora P, Cioffi U, Guttadauro A, Ruffini E, Benvenuti M, Cardillo G, Patrini D, Vannucci F, Yusuf N, Jindal P, Cerfolio R. The Role of Surgery in Patients with COVID-19-Related Thoracic Complications. Front Surg 2022; 9:867252. [PMID: 35686209 PMCID: PMC9170983 DOI: 10.3389/fsurg.2022.867252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Patients with several thoracic complications induced by SARS-CoV-2 infection may benefit from surgery, but its role in this condition is largely unknown, and many surgeons’ advice against any surgical referrals. Our aim is to investigate the efficacy and safety of surgery in COVID-19 patients with thoracic complications requiring surgery. Methods We designed a multicenter observational study, involving nine thoracic surgery departments, evaluating patients who developed thoracic complications in hospital, surgically managed from March 1, 2020, to May 31, 2021. An overall 30-day mortality was obtained by using the Kaplan–Meier method. Multivariable Cox regression model and logistic models were applied to identify the variables associated with mortality and postoperative complications. Results Among 83 patients, 33 (40%) underwent surgery for complicated pneumothorax, 17 (20.5%) for pleural empyema, 13 (15.5%) for hemothorax, 8 (9.5%) for hemoptysis, 5 patients (6%) for lung abscess, 4 (5%) for infected pneumatoceles, and 3 (3.5%) for other causes. Within 30 days of surgery, 60 patients (72%) survived. At multivariable analysis, age (HR 1.05 [95% CI, 1.01, 1.09], p = 0.022), pulmonary hypertension (HR 3.98 [95% CI, 1.09, 14.5], p = 0.036), renal failure (HR 2.91 [95% CI, 1.19, 7.10], p-value 0.019), thoracotomy (HR 4.90 [95% CI, 1.84, 13.1], p-value 0.001) and infective affections (HR 0.17 [95% CI, 0.05, 0.58], p-value 0.004) were found to be independent prognostic risk factors for 30-day mortality. Age (OR 1.05 [95% CI, 1.01, 1.10], p = 0.023) and thoracotomy (OR 3.85 [95% CI, 1.35, 12.0] p = 0.014) became significant predictors for 30-day morbidity. Conclusion Surgical management of COVID-19-related thoracic complications is affected by high mortality and morbidity rates, but a 72% survival rate still seems to be satisfactory with a rescue intent. Younger patients without pulmonary hypertension, without renal insufficiency and undergoing surgery for infectious complications appear to have a better prognosis.
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Affiliation(s)
| | - Marco Scarci
- Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Arianna Rimessi
- Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Riccardo Orlandi
- Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre – B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | | | - Enrico Ruffini
- Thoracic Surgery, San Giovanni Battista Molinette Hospital, Turin, Italy
| | | | | | - Davide Patrini
- Thoracic Surgery, University College London Hospitals, London, United Kingdom
| | - Fernando Vannucci
- Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brasil
| | - Nasser Yusuf
- Thoracic Surgery, Chest Hospital, Calicut, India/Sunrise Hospital, Kochi, India
| | - Pramoj Jindal
- Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Robert Cerfolio
- Thoracic Surgery, NYU Langone Health, New York, NY, United States
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15
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Mangiameli G, Cioffi U, Alloisio M, Testori A. Lung Metastases: Current Surgical Indications and New Perspectives. Front Surg 2022; 9:884915. [PMID: 35574534 PMCID: PMC9098997 DOI: 10.3389/fsurg.2022.884915] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Pulmonary metastasectomy is an established treatment that can provide improved long- term survival for patients with metastatic tumor(s) in the lung. In this mini-review, we discuss the state of the art of thoracic surgery in surgical management of lung metastases which actually occurs for a large part of surgical activity in thoracic surgery department. We describe the principles of surgical therapy that have been defined across the time, and that should remain the milestones of lung metastases treatment: a radical surgery and an adequate lymphadenectomy. We then focus on current surgical indications and report the oncological results according to the surgical approach (open vs. mini-invasive), the histological type and number of lung metastases, and in case of re-metastasectomy. Finally, we conclude with a brief overview about the future perspectives in thoracic surgery in treatment of lung metastases.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Alberto Testori
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16
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Burati M, Tagliabue F, Lomonaco A, Chiarelli M, Zago M, Cioffi G, Cioffi U. Artificial intelligence as a future in cancer surgery. Artif Intell Cancer 2022; 3:11-16. [DOI: 10.35713/aic.v3.i1.11] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is defined as the theory and development of computer systems able to perform tasks normally requiring human intelligence, such as visual perception, speech recognition, and decision-making. Machine learning and deep learning (DL) are subfields of AI that are able to learn from experience in order to complete tasks. AI and its subfields, in particular DL, have been applied in numerous fields of medicine, especially in the cure of cancer. Computer vision (CV) system has improved diagnostic accuracy both in histopathology analyses and radiology. In surgery, CV has been used to design navigation system and robotic-assisted surgical tools that increased the safety and efficiency of oncological surgery by minimizing human error. By learning the basis of AI, surgeons can take part in this revolution to optimize surgical care of oncologic disease.
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Affiliation(s)
- Morena Burati
- Department of Robotic and Emergency Surgery, Ospedale A Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Fulvio Tagliabue
- Department of Robotic and Emergency Surgery, Ospedale A Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Adriana Lomonaco
- Department of Robotic and Emergency Surgery, Ospedale A Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Marco Chiarelli
- Department of Robotic and Emergency Surgery, Ospedale A Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Mauro Zago
- Department of Robotic and Emergency Surgery, Ospedale A Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, Unisannio, Benevento 82100, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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17
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Ripamonti L, Guttadauro A, Lo Bianco G, Rennis M, Maternini M, Cioffi G, Chiarelli M, De Simone M, Cioffi U, Gabrielli F. Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review. Front Surg 2022; 9:790287. [PMID: 35237648 PMCID: PMC8882820 DOI: 10.3389/fsurg.2022.790287] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo introduced a minimal invasive trans-anal approach known as Stapled Trans-Anal Rectal Resection (STARR) in order to correct mechanical disorders such as rectocele or rectal intussusception, two conditions present in more than 90% of patients with ODS. Considering the lack of a common view around ODS and STARR procedure. the aim of our study is to review the literature about preoperative assessment, operative features and outcomes of the STARR technique for the treatment of ODS. We performed a systematic search of literature, between January 2008 and December 2020 and 24 studies were included in this review. The total number of patients treated with STARR procedure was 4,464. In conclusion STARR surgical procedure has been proven to be safe and effective in treating symptoms of ODS and improving patients Quality of Life (QoL) and should be taken in consideration in the context of a holistic and multi modal approach to this complex condition. International guidelines are needed in order to optimize the diagnostic and therapeutic process and to improve outcomes.
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Affiliation(s)
- Lorenzo Ripamonti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
| | - Giulia Lo Bianco
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Maria Rennis
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Maternini
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, University of Sannio RCOST, Benevento, Italy
| | - Marco Chiarelli
- Department of Surgery, Ospedale Alessandro Manzoni, ASST Lecco, Lecco, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Francesco Gabrielli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
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18
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Raveglia F, Orlandi R, Guttadauro A, Cioffi U, Cardillo G, Cioffi G, Scarci M. How to Prevent, Reduce, and Treat Severe Post Sympathetic Chain Compensatory Hyperhidrosis: 2021 State of the Art. Front Surg 2022; 8:814916. [PMID: 35047551 PMCID: PMC8763307 DOI: 10.3389/fsurg.2021.814916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
The role of thoracic surgery in the management of hyperhidrosis is well-known and thoracoscopic sympathetic interruption is commonly accepted as being the most effective treatment. However, some concerns still remain regarding the potential to develop compensatory hyperidrosis (CH), the most troublesome and frequent side effect after surgery and its management. Compensatory hyperidrosis prevention may be achieved by identifying subjects at higher risk and/or targeting nerve interruption level on the base of single patient characteristics gathered during the preoperative survey. Furthermore, the surgical treatment may consist of different techniques aimed at reversing the effects of previous sympathetic interruption. To predict CH after sympathectomy, the most interesting proposals in recent literature are a temporary thoracoscopic sympathetic block and the introduction of new and targeted preoperative surveys. If the role of nerve clipping technique vs. the definitive cutting is still intensely under debated, new approaches have been recently proposed to reduce the incidence of CH. In particular, extended sympathicotomy has been described as an alternative to overcome severe forms. Last, among the techniques developed to reverse sympathetic interruption effect, diffuse sympathicotomy (DS) and microsurgical sympathetic trunk reconstruction represent advances in this field. An all-round review of these topics is strongly needed. Our aim is to cover all the above issues point by point. Although sympathectomy represents a small part of thoracic surgery, we believe that it is worthy of interest because of the profound effect that complications for a benign condition can have on patients.
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Affiliation(s)
- Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
- *Correspondence: Federico Raveglia
| | - Riccardo Orlandi
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, Istituti Clinici Zucchi Monza, University of Milano-Bicocca, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Roman, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
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19
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Chiarelli M, Zago M, Tagliabue F, Burati M, Riva C, Vanzati A, Dainese E, Gabrielli F, Guttadauro A, De Simone M, Cioffi U. Small Bowel Intussusception Due to Rare Cardiac Intimal Sarcoma Metastasis: A Case Report. Front Surg 2021; 8:743858. [PMID: 34671641 PMCID: PMC8521089 DOI: 10.3389/fsurg.2021.743858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Intimal sarcomas are rare malignant mesenchymal tumors arising from the heart and large blood vessels. Their intraluminal growth leads to vascular obstructive symptoms and peripheral neoplastic embolization. Direct infiltration of the lungs or metastases to the pulmonary system, occur in 40% of cases and extrathoracic spread is frequent, also in presentation. Intussusception is an unusual event in adults, accounting for <5% of bowel obstructions. In most cases it is caused by a malignancy and requires surgical resection. Case Presentation: We describe a rare case of a 50-year-old man suffering of bowel obstruction due to intussusception sustained by a small bowel metastasis of a primary cardiac intimal sarcoma. One year and a half before the onset of abdominal symptoms, a grade II intimal sarcoma was removed from his left atrium and consequently he followed a chemotherapy protocol. Four months later a CT scan revealed local recurrence. Eighteen months after heart surgery he referred to the ER with abdominal pain. CT scan showed an ileal intussusception and the patient was scheduled for surgery. A tract of 10 cm ileus was removed containing an intramural polypoid solid mass. Histological analyses revealed a grade II intimal sarcoma consistent with his first diagnosis. Conclusion: Primary heart tumors are late found and often partially resected, therefore metastatic pathways are to be expected. Adult small bowel intussusception is a rare event and caused by a malignancy in one third of cases. Therefore, our recommendation is to always resect the tract involved in order to perform a proper diagnosis.
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Affiliation(s)
- Marco Chiarelli
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Mauro Zago
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Fulvio Tagliabue
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Morena Burati
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Cristina Riva
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Alice Vanzati
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Emanuele Dainese
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Francesco Gabrielli
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano, Italy
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20
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Tagliabue F, Burati M, Chiarelli M, Cioffi U, Zago M. Robotic surgery in colon cancer: current evidence and future perspectives – narrative review. Artif Intell Gastrointest Endosc 2021; 2:110-116. [DOI: 10.37126/aige.v2.i4.110] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/14/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
In the last 10 years, surgery has been developing towards minimal invasiveness; therefore, robotic surgery represents the consequent evolution of laparoscopic surgery. Worldwide, surgeons’ performances have been upgraded by the ergonomic developments of robotic systems, leading to several benefits for patients. The introduction into the market of the new Da Vinci Xi system has made it possible to perform all types of surgery on the colon, an in selected cases, to combine interventions in other organs or viscera at the same time. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. From this perspective, single-port robotic colectomy, has reduced the number of robotic ports needed, allowing a better anesthetic outcome and faster recovery. The introduction on the market of new surgical robotic systems from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes.
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Affiliation(s)
- Fulvio Tagliabue
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital–ASST Lecco, Lecco 23900, Italy
| | - Morena Burati
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital–ASST Lecco, Lecco 23900, Italy
| | - Marco Chiarelli
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital–ASST Lecco, Lecco 23900, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
| | - Mauro Zago
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital–ASST Lecco, Lecco 23900, Italy
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21
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Cioffi U, Ciulla MM, De Simone M, Scarci M, Testori A, Raveglia F, Chiarelli M. Editorial: Surgery and COVID-19: Which Strategies to Apply in Oncologic Patients. Front Surg 2021; 8:718751. [PMID: 34368220 PMCID: PMC8339367 DOI: 10.3389/fsurg.2021.718751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Michele M Ciulla
- Laboratory of Clinical Informatics and Cardiovascular Imaging, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Marco Scarci
- Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Alberto Testori
- Department of General and Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
| | | | - Marco Chiarelli
- Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
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22
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Raveglia F, Orlandi R, Rimessi A, Minervini F, Cioffi U, De Simone M, Guttadauro A, Scarci M. Standardization of Procedures to Contain Cost and Reduce Variability of Care After the Pandemic. Front Surg 2021; 8:695341. [PMID: 34250010 PMCID: PMC8264450 DOI: 10.3389/fsurg.2021.695341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our private and professional routine. In particular, the lockdowns have severely affected the entire healthcare system and hospital activities, forcing it to rethink the protocols in force. We suggest that this scenario, in spite of the new challenges involving so far complex healthcare providers, may lead to the unique opportunity to rethink pathways and management of patients. Indeed, having to resume institutional activity after a long interruption that has completely canceled the previously existing schemes, healthcare providers have the unique opportunity to overcome obsolete and “we have always done in this way” model on the wave of the general desire to resume a normal life. Furthermore, the pandemic has highlighted some flaws in our health system, highlighting those critical issues that most need to be addressed. This article is a review of pre-pandemic literature addressing the use of Lean Six Sigma (LSS) and standardization processes in thoracic surgery to improve efficiency. Our goal is to identify the main issues that could be successfully improved along the entire pathway of a patient from the first referral to diagnosis, hospitalization, and surgical operation up to convalescence. Furthermore, we aim to identify the standardization processes that have been implemented to achieve significant improvements in patient outcomes while reducing costs. The methods and goals that could be used in the near future to modernize our healthcare systems are drawn up from a careful reading and interpretation in light of the pandemic of the most significant review articles in the literature.
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Affiliation(s)
- Federico Raveglia
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Riccardo Orlandi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Arianna Rimessi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Fabrizio Minervini
- Thoracic Surgery, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | | | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Marco Scarci
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
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23
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Romano F, Chiarelli M, Garancini M, Scotti M, Zago M, Cioffi G, De Simone M, Cioffi U. Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery? World J Gastroenterol 2021; 27:2784-2794. [PMID: 34135554 PMCID: PMC8173387 DOI: 10.3748/wjg.v27.i21.2784] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
According to Barcelona Clinic Liver Cancer recommendations, intermediate stage hepatocellular carcinomas (stage B) are excluded from liver resection and are referred to palliative treatment. Moreover, Child-Pugh B patients are not usually candidates for liver resection. However, many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection, maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function. Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification, and this treatment gives good results in the setting of multinodular, large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis. In this review we explore this controversial topic, and we show through the literature analysis how liver resection may improve the short- and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients. However, other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.
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Affiliation(s)
- Fabrizio Romano
- Department of Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco Chiarelli
- Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
| | - Mattia Garancini
- Department of General Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Mauro Scotti
- Department of General Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Mauro Zago
- Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, Università degli Studi del Sannio di Benevento, Benevento 82100, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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Testori A, Giudici VM, Alloisio M, Cioffi U. Case Report: COVID-19 Pneumonia Following Left Pneumonectomy for Lung Cancer Complicated by Empyema and Bronchopleural Fistula. Front Surg 2021; 8:679757. [PMID: 34095211 PMCID: PMC8177669 DOI: 10.3389/fsurg.2021.679757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/16/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Venous and arterial thromboembolism is commonly reported in critically ill COVID-19 patients, although there are still no definitive statistical data regarding its incidence. Case presentation: we report a case of a patient who fell ill with Covid during hospitalization for a pneumonectomy complicated by empyema and bronchopleural fistula. The patient, despite being cured of COVID, died after 14 days for pulmonary thromboembolism. Conclusion: Our case strengthens the suggestion of adequate thromboprophylaxis in all hospitalized COVID patients and of increasing prophylaxis in critically ill patients even in the absence of randomized studies
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Affiliation(s)
- Alberto Testori
- Department of General and Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Veronica M Giudici
- Department of General and Thoracic Surgery, Humanitas University, Milan, Italy
| | - Marco Alloisio
- Department of General and Thoracic Surgery, Humanitas University, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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25
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Baisi A, Mazzucco A, Caffarena G, Cioffi G, Guttadauro A, Cioffi U. Case Report: Mediastinal Mass in SARS-COV-2 Pandemic: A Word of Caution. Front Surg 2021; 8:648759. [PMID: 33732730 PMCID: PMC7959173 DOI: 10.3389/fsurg.2021.648759] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background: SARS-CoV-2 is a new disease with some manifestations not yet well-known. Sharing experiences in this topic is crucial for the optimal management of the patients. Case Presentation: Left upper extremity deep vein thrombosis (UEDVT) due to a mediastinal mass strongly suspected of lymphoproliferative disease in a patient affected by SARS-CoV-2, disappearing at the resolution of the viral infection. Conclusion: Before proceeding to surgical biopsy, mediastinal mass in SARS-CoV-2 patients must be revaluated after the resolution of the infection.
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Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, University of Milan-ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery Unit, University of Milan-ASST Santi Paolo e Carlo, Milan, Italy
| | - Giovanni Caffarena
- Thoracic Surgery Unit, University of Milan-ASST Santi Paolo e Carlo, Milan, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy
| | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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26
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Testori A, Perroni G, Carlo CD, Crepaldi A, Alloisio M, Cioffi U. Primary signet-ring cell carcinoma of the lung in an HIV-positive patient. Thorac Cancer 2021; 12:1122-1125. [PMID: 33594833 PMCID: PMC8017251 DOI: 10.1111/1759-7714.13887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/08/2020] [Revised: 01/30/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022] Open
Abstract
Primary lung signet-ring cell carcinomas are a rare entity and only a few cases of pure signet-ring cell carcinomas of the lung are reported in the English literature. They usually have an aggressive behavior and a poor prognosis because in most cases they are identified at an advanced stage. We present a unique case of primary signet-ring cell carcinoma of the lung because the patient was HIV positive, a heavy smoker, and also the tumor, discovered incidentally during chest x-ray, was a pure type of signet-ring cell carcinoma. Surgical therapy associated with chemoradiotherapy represents the gold standard in the care of these patients.
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Affiliation(s)
- Alberto Testori
- Department of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Gianluca Perroni
- Department of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Camilla De Carlo
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Alessandro Crepaldi
- Department of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marco Alloisio
- Department of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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27
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Gerosa M, Incarbone N, Di Fratta E, Mari GM, Guttadauro A, Cioffi U, Maggioni D. Incarcerated sigmoid large-cell neuroendocrine carcinoma in an inguinal hernia. J Surg Case Rep 2021; 2021:rjaa585. [PMID: 33604019 PMCID: PMC7880701 DOI: 10.1093/jscr/rjaa585] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Large-cell neuroendocrine carcinomas (NECs) of the colon are extremely rare aggressive tumors. A 79-year-old man presented at our hospital for muco-hematic diarrhea, weight loss and incarcerated hernia in his left groin. Colonoscopy revealed sigmoid stenosis. Computed tomography confirmed an incarcerated hernia containing sigmoid mass and massive abdominal adenopathy. In absence of colonic obstruction, the patient underwent elective palliative sigmoid resection and colostomy by laparoscopic approach, and direct hernia repair through inguinal access. Histopathological examination revealed a large cells sigmoid NEC. We report the first case of large-cell neuroendocrine colon cancer incarcerated in an inguinal hernia. Due to the advanced stage, we have performed a palliative laparoscopic resection in order to reduce surgical trauma, confirm pre-operative results and minimize post-operative complications, and direct hernia repair through inguinal access.
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Affiliation(s)
- Martino Gerosa
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Niccolò Incarbone
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Emanuele Di Fratta
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Giulio Maria Mari
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Angelo Guttadauro
- Department of Surgery, University of Milan Bicocca, Istituti Clinici Zucchi, Via Zucchi 24, Monza, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Via F. Sforza 35, Milan, Italy
| | - Dario Maggioni
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
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Raveglia F, Moneghini L, Cariati M, Baisi A, Guttadauro A, Cioffi U, Scarci M. Case Report: Multidisciplinary Approach for a Rare Case of Thymic Vascular Malformation. Front Surg 2021; 7:624615. [PMID: 33511152 PMCID: PMC7835703 DOI: 10.3389/fsurg.2020.624615] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022] Open
Abstract
We report the rare case of a 2.5 cm in size mass diagnostic for residual thymus associated with venous vascular malformation (ISSVA classification, 2008) in a 58 years old man. Diagnosis was obtained only after surgical removal that was complicated by a sudden massive bleeding (about 1,500 cc) requiring emergency conversion to median sternotomy. Difficulty in preoperative diagnosis, rarity of histologic pattern, and surgical challenges make this case very interesting for surgeons, pathologists and radiologist. Our message, dealing with mediastinal masses, is: (a) differential diagnosis between the more frequent solid antero-superior mediastinal tumors and vascular malformation should be always considered (b) preoperative angiography should always be performed in case of uncertain diagnosis (c) coil embolization should always be considered to reduce potentially fatal bleeding (d) histologic differentiation with other thymic neoplasms must be always considered.
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Affiliation(s)
- Federico Raveglia
- Department of Thoracic Surgery, Aziende Socio Sanitarie Territoriali-Monza, Monza, Italy
| | - Laura Moneghini
- Department of Pathology, Aziende Socio Sanitarie Territoriali Santi Paolo e Carlo, Milano, Italy
| | - Maurizio Cariati
- Department of Radiology, Aziende Socio Sanitarie Territoriali Santi Paolo e Carlo, Milano, Italy
| | - Alessandro Baisi
- Department of Thoracic Surgery, Aziende Socio Sanitarie Territoriali Santi Paolo e Carlo, Milano, Italy
| | | | - Ugo Cioffi
- Department of Thoracic Surgery, Aziende Socio Sanitarie Territoriali Santi Paolo e Carlo, Milano, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, Aziende Socio Sanitarie Territoriali-Monza, Monza, Italy
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29
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Testori A, Alloisio M, Cariboni U, Costa F, Voulaz E, Bottoni E, De Simone M, Rahal D, Cioffi U. Voluminous schwannoma type 'ancient' of the cervicothoracic district removed through a cervicotomic approach. J Surg Case Rep 2020; 2020:rjaa402. [PMID: 33024542 PMCID: PMC7524608 DOI: 10.1093/jscr/rjaa402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022] Open
Abstract
Schwannomas are generally benign tumors, well delimited, resulting from nerve sheaths that are frequently found in the thorax, mainly in the posterior mediastinum. We report a 58-year-old patient who carried out investigations following the appearance of a large right supraclavicular cervical mass associated with anisocoria and eyelid ptosis, histologically diagnosed as ancient schwannoma, completely removed through a cervicotomic approach without opening the chest.
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Affiliation(s)
- Alberto Testori
- Department of Thoracic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Marco Alloisio
- Department of Thoracic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Umberto Cariboni
- Department of Thoracic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Francesco Costa
- Department of Neurosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Emanuele Voulaz
- Department of Thoracic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Edoardo Bottoni
- Department of Thoracic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | | | - Daoud Rahal
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano, Italy
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30
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Testori A, Cioffi U, Ciulla MM, Bottoni E, Cariboni U, Perroni G, Alloisio M. Surgery at the frontline at the time of the COVID-19 outbreak. Thorac Cancer 2020; 11:3057-3059. [PMID: 32935917 PMCID: PMC7605992 DOI: 10.1111/1759-7714.13666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alberto Testori
- Department of General and Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Michele M Ciulla
- Laboratory of Clinical Informatics and Cardiovascular Imaging, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edoardo Bottoni
- Department of General and Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
| | - Umberto Cariboni
- Department of General and Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
| | - Gianluca Perroni
- Department of General and Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
| | - Marco Alloisio
- Department of General and Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
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31
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Raveglia F, De Pasquale L, Cioffi U, Ghilardi G, De Simone M, Falleni M, Baisi A. Unexpected thymoma in a challenging case of hyperparathyroidism. Clin Case Rep 2020; 8:1425-1428. [PMID: 32884767 PMCID: PMC7455415 DOI: 10.1002/ccr3.2842] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 12/02/2022] Open
Abstract
We report the case of a woman with primary hyperparathyroidism suspected of mediastinal ectopic parathyroid adenoma revealed to be a thymoma. Our aim was to focus on some possible criticisms in distinguishing between ectopic parathyroid and thymus.
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Affiliation(s)
- Federico Raveglia
- Thoracic SurgeryASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | | | - Ugo Cioffi
- Thoracic SurgeryASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | - Giorgio Ghilardi
- Thoracic SurgeryASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | - Matilde De Simone
- Thoracic SurgeryASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | - Monica Falleni
- PathologyASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | - Alessandro Baisi
- Thoracic SurgeryASST Santi Paolo e CarloUniversity of MilanMilanItaly
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32
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Tagliabue F, Burati M, Chiarelli M, Fumagalli L, Guttadauro A, Arborio E, De Simone M, Cioffi U. Robotic vs laparoscopic right colectomy – the burden of age and comorbidity in perioperative outcomes: An observational study. World J Gastrointest Surg 2020; 12:287-297. [PMID: 32774767 PMCID: PMC7385514 DOI: 10.4240/wjgs.v12.i6.287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several studies have shown the safety, feasibility and oncologic adequacy of robotic right hemicolectomy (RRH). Laparoscopic right hemicolectomy (LRH) is considered technically challenging. Robotic surgery has been introduced to overcome this technical limitation, but it is related to high costs. To maximize the benefits of such surgery, only selected patients are candidates for this technique. In addition, due to progressive aging of the population, an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities, who are usually more prone to post-operative complications.
AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.
METHODS We retrospectively analyzed 123 minimally invasive procedures (68 LRHs vs 55 RRHs) for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019. The surgical procedures were performed according to standardized techniques. The primary clinical outcome of the study was the length of hospital stay (LOS) measured in days. Secondary outcomes were time to first flatus (TFF) and time to first stool evacuation. The robotic technique was considered the exposure and the laparoscopic technique was considered the control. Routine demographic variables were obtained, including age at time of surgery and gender. Body mass index and American Society of Anesthesiologists physical status were registered. The age-adjusted Charlson Comorbidity Index (ACCI) was calculated; the tumor-node-metastasis system, intra-operative variables and post-operative complications were recorded. Post-operative follow-up was 180 d.
RESULTS LOS, TFF, and time to first stool were significantly shorter in the robotic group: Median 6 [interquartile range (IQR) 5-8] vs 7 (IQR 6-10.5) d, P = 0.028; median 2 (IQR 1-3) vs 3 (IQR 2-4) d, P < 0.001; median 4 (IQR 3-5) vs 5 (IQR 4-6.5) d, P = 0.005, respectively. Following multivariable analysis, the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function; in addition the dichotomous variables of age over 75 years and ACCI more than 7 were significant predictors of hospital stay. No outcomes were significantly associated with Clavien-Dindo grading. Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS (median 6 -IQR 5-8- vs 7 -IQR 6-12- d, P = 0.013) and later TFF (median 2 -IQR 1-3- vs 3 -IQR 2-4- d, P = 0.008), while patients with ACCI more than 7 were only associated with a prolonged hospital stay (median 7 -IQR 5-8- vs 7 -IQR 6-14.5- d, P = 0.036).
CONCLUSION RRH is related to shorter LOS when compared with the laparoscopic approach, but older age and several comorbidities tend to reduce its benefits.
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Affiliation(s)
- Fulvio Tagliabue
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Morena Burati
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Marco Chiarelli
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Luca Fumagalli
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Angelo Guttadauro
- Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Monza 20900, Italy
| | - Elisa Arborio
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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Leporati A, Raveglia F, Cioffi U, De Simone M, Ghelma F, Baisi A. Metastatic lung cancer presenting as thoracic empyema. A Case report. Clin Case Rep 2020; 8:484-486. [PMID: 32185041 PMCID: PMC7069862 DOI: 10.1002/ccr3.2566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/26/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022] Open
Abstract
Increased cancer risk in patients with inflammatory and infectious diseases has been reported in many studies and lung cancer-associated empyema in <0.3% patients. We present a patient with empyema in whom the final diagnosis was metastatic lung adenocarcinoma. Purulent pleural fluid obtained by drainage or thoracentesis must always been examined because the association of malignant tumors and empyema should be taken into consideration.
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Affiliation(s)
- Andrea Leporati
- Thoracic Surgery UnitASST Santi Paolo e CarloUniversità degli Studi di MilanoMilanoItaly
| | - Federico Raveglia
- Thoracic Surgery UnitASST Santi Paolo e CarloUniversità degli Studi di MilanoMilanoItaly
| | - Ugo Cioffi
- Department of SurgeryUniversità degli Studi di MilanoMilanoItaly
| | | | - Filippo Ghelma
- D.I.S.S. – Dipartimento scienze della saluteUniversità degli Studi di MilanoMilanoItaly
| | - Alessandro Baisi
- Thoracic Surgery UnitASST Santi Paolo e CarloUniversità degli Studi di MilanoMilanoItaly
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34
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Rizzi A, Raveglia F, Scarci M, Cioffi U, Baisi A. The best strategy to control pain after thoracic surgery: multimodal strategy against pain. Video-assist Thorac Surg 2019. [DOI: 10.21037/vats.2019.05.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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35
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Affiliation(s)
- Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Federico Raveglia
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Milan, Italy
| | | | - Alessandro Baisi
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Milan, Italy
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36
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Gerosa M, Costanzi ATM, Brenna F, Felisaz PF, Mari GM, Cioffi U, Maggioni D. Laparoscopic subtotal colectomy for synchronous colon high-grade dysplasia adenomas in intestinal malrotation: A case report and literature review. Clin Case Rep 2019; 7:1741-1746. [PMID: 31534739 PMCID: PMC6745350 DOI: 10.1002/ccr3.2368] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/17/2019] [Accepted: 07/14/2019] [Indexed: 11/12/2022] Open
Abstract
Intestinal malrotation is an embryologic anomaly rarely presenting in adults especially in association with colon cancer. Fully laparoscopic colonic resection has not yet described in literature for adenomas in malrotation. Preoperative assessment of vascular anatomy by computed tomography is considered mandatory to perform safely laparoscopic surgery.
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Affiliation(s)
- Martino Gerosa
- Laparoscopic and Oncological General Surgery DepartmentDesio Hospital‐ ASST MonzaDesioItaly
| | | | | | | | - Giulio Maria Mari
- Laparoscopic and Oncological General Surgery DepartmentDesio Hospital‐ ASST MonzaDesioItaly
| | - Ugo Cioffi
- Department of SurgeryUniversity of MilanMilanItaly
| | - Dario Maggioni
- Laparoscopic and Oncological General Surgery DepartmentDesio Hospital‐ ASST MonzaDesioItaly
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37
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Tagliabue F, Burati M, Chiarelli M, Marando A, Simone MD, Cioffi U. Left colonic metastasis from primary hepatocellular carcinoma: A case report. World J Clin Cases 2019; 7:2044-2048. [PMID: 31423436 PMCID: PMC6695552 DOI: 10.12998/wjcc.v7.i15.2044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/29/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) accounts for 5-6% of all human cancers. Considering the extrahepatic metastasis, the main organs involved are lymphnodes, lung, bone and adrenal gland. Usually colon metastasis is very rare, especially on the left sided colon.
CASE SUMMARY We report a case of a 70 years-old man hepatitis B carrier with HCC treated four times with trans-arterial chemoembolization, presented to our surgical department complaining of gastrointestinal bleeding. A colonoscopy revealed a mass of 4 cm of the sigmoid colon with signs of bleeding. The computed tomography showed a mass originated from the sigmoid colon of 3.5 cm, and the presence of HCC in segment VI and VII, without portal vein thrombosis. Due to the large size of the mass and the active bleeding, the patient underwent a left colectomy. The postoperative period was uneventful, and the patient was discharged in fifth post-operative day. Histological examination revealed that the neoplasm was characterized by a diffuse proliferation of epithelial cells with an hepatoid differentiation. So, the presence of a history of HCC of the liver and the histopathological features supported the diagnosis of metastasis from the liver.
CONCLUSION Although rare, colon metastasis from an HCC can be left-sided and can present with acute bleeding.
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Affiliation(s)
- Fulvio Tagliabue
- Department of Emergency and Robotic Surgery, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | - Morena Burati
- Department of Emergency and Robotic Surgery, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | - Marco Chiarelli
- Department of Emergency and Robotic Surgery, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | - Alessandro Marando
- Department of Pathology, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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38
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Raveglia F, Rizzi A, Cioffi U, Baisi A. Invited letter about wound retractor advantages in thoracic surgery. J Thorac Dis 2019; 11:S1438-S1440. [PMID: 31245155 DOI: 10.21037/jtd.2019.03.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy
| | - Alessandro Rizzi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy
| | - Ugo Cioffi
- Università degli Studi di Milano, Milano, Italy
| | - Alessandro Baisi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy.,Università degli Studi di Milano, Milano, Italy
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Raveglia F, Scarci M, Cioffi U, Baisi A. Ultimate management of post thoracotomy morbidities: a set of surgical technique and peri-operative precautions. J Thorac Dis 2019; 11:S370-S375. [PMID: 30997224 DOI: 10.21037/jtd.2018.12.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy
| | - Marco Scarci
- Thoracic Surgery, ASST Monza e Brianza, Ospedale San Gerardo, Monza, Italy
| | - Ugo Cioffi
- Università degli Studi di Milano, Milano, Italy
| | - Alessandro Baisi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy.,Università degli Studi di Milano, Milano, Italy
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40
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Baisi A, Raveglia F, De Simone M, Cioffi U. Uniportal Video-Assisted Thoracic Surgery for Pneumothorax: Real Alternative to Multiportal? Ann Thorac Surg 2019; 105:1281. [PMID: 29571336 DOI: 10.1016/j.athoracsur.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/27/2017] [Accepted: 07/02/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Via Di Rudinì 8, Milan 20142, Italy.
| | - Federico Raveglia
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Via Di Rudinì 8, Milan 20142, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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41
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Raveglia F, Scarci M, Cioffi U, Baisi A. Intra-operative conversion during video-assisted thoracoscopic surgery lobectomy is not a failure as long as emergency is avoided. J Thorac Dis 2019; 11:638-642. [PMID: 31019747 DOI: 10.21037/jtd.2019.02.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy
| | - Marco Scarci
- Thoracic Surgery, ASST Monza e Brianza, Ospedale San Gerardo, Monza, Italy
| | - Ugo Cioffi
- Università degli Studi di Milano, Milano, Italy
| | - Alessandro Baisi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy.,Università degli Studi di Milano, Milano, Italy
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42
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Testori A, De Simone M, Bottoni E, Alloisio M, Voulaz E, Cioffi U. Malignant pleural mesothelioma: Is reconstruction of the diaphragm necessary in left pleurectomy/decortication? A case report. Clin Case Rep 2019; 7:299-301. [PMID: 30847193 PMCID: PMC6389464 DOI: 10.1002/ccr3.1973] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/23/2018] [Accepted: 12/02/2018] [Indexed: 11/23/2022] Open
Abstract
We describe a case of complete intrathoracic stomach and intestinal herniation after pleurectomy/decortication due to diaphragm reconstruction without mesh. Is reconstruction with mesh always necessary? Can lung sparing obviate the tension on residual diaphragm? These are the questions not well described to which we try to give an answer.
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Affiliation(s)
- Alberto Testori
- Department of Thoracic SurgeryHumanitas Research HospitalMilanItaly
| | | | - Edoardo Bottoni
- Department of Thoracic SurgeryHumanitas Research HospitalMilanItaly
| | - Marco Alloisio
- Department of Thoracic SurgeryHumanitas Research HospitalMilanItaly
| | - Emanuele Voulaz
- Department of Thoracic SurgeryHumanitas Research HospitalMilanItaly
| | - Ugo Cioffi
- Department of SurgeryUniversity of MilanMilanItaly
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43
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Ciulla MM, Vivona P, Lemos A, Sozzi F, Cioffi U, Testori A. Atrial fibrillation, an epiphenomenon of acute Stanford type-A aortic dissection with suspected intimo-intimal intussusception. Clin Case Rep 2018; 6:1791-1794. [PMID: 30214765 PMCID: PMC6132104 DOI: 10.1002/ccr3.1701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/11/2018] [Revised: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 01/17/2023] Open
Abstract
Supraventricular arrhythmias can sometimes be "only" epiphenomena appearing during acute hypoxia, pneumonia, pulmonary embolism, and thrombosis. Indeed, atrial fibrillation is not rare in acute aortic dissection as it is estimated in about one half of patients and may be secondary to a perfusion deficit of the sinoatrial node artery.
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Affiliation(s)
- Michele M. Ciulla
- Laboratory of Clinical Informatics and Cardiovascular ImagingDepartment of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Patrizia Vivona
- Cardiovascular Diseases UnitFondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Alessandro Lemos
- Department of RadiologyFondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Fabiola Sozzi
- Cardiovascular Diseases UnitFondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Ugo Cioffi
- Department of SurgeryUniversity of MilanMilanItaly
| | - Alberto Testori
- General and Thoracic SurgeryHumanitas Research HospitalMilanItaly
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Raveglia F, De Simone M, Cioffi U, Baisi A. Lung Cancer Screening Feasibility Beyond Highly Specialized Centers. Ann Thorac Surg 2018; 107:327. [PMID: 30118706 DOI: 10.1016/j.athoracsur.2018.06.066] [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: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Federico Raveglia
- Thoracic Surgery Unit, Ospedale San Paolo, University of Milan, Milan, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Alessandro Baisi
- Thoracic Surgery Unit, Ospedale San Paolo, Via Di Rudinì 8, 20142 Milan, Italy.
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45
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Baisi A, Raveglia F, De Simone M, Cioffi U. Could Video-Assisted Thoracoscopic Surgery Operative Time Influence Conversion to Thoracotomy? Ann Thorac Surg 2018; 105:1576. [PMID: 29685234 DOI: 10.1016/j.athoracsur.2017.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Via Di Rudinì 8, 20142 Milan, Italy.
| | - Federico Raveglia
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Via Di Rudinì 8, 20142 Milan, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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Gerosa M, Chiarelli M, Guttadauro A, De Simone M, Tagliabue F, Costa M, Terragni S, Cioffi U. Wirsung atraumatic rupture in patient with pancreatic pseudocysts: a case presentation. BMC Gastroenterol 2018; 18:52. [PMID: 29685110 PMCID: PMC5913810 DOI: 10.1186/s12876-018-0781-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
Background Pancreatic duct disruption is a challenging condition leading to pancreatic juice leakage and consequently to pancreatic fluid collections. The manifestations of pancreatic main duct leak include pseudocysts, walled-off necrosis, pancreatic fistulas, ascites, pleural and pericardial effusions. Pseudocyst formation is the most frequent outcome of a pancreatic duct leak. Case presentation We describe a case of a 64-year old man with large multiple pancreatic cysts discovered for progressive jaundice and significant weight loss in the absence of a previous episode of acute pancreatitis. Computed tomography scan showed lesion with thick enhancing walls. The main cyst dislocated the stomach and the duodenum inducing intra and extrahepatic bile ducts enlargement. Magnetic resonance cholangiopancreatography revealed a communication between the main pancreatic duct and the cystic lesions due to Wirsung duct rupture. Endoscopic ultrasound guided fine needle aspiration cytology did not show neoplastic cells and cyst fluid analysis revealed high amylase concentration. Preoperative exams were suggestive but not conclusive for a benign lesion. Laparotomy was necessary to confirm the presence of large communicating pseudocysts whose drainage was performed by cystogastrostomy. Histology confirmed the inflammatory nature of the cyst wall. Subsequently, the patient had progressive jaundice resolution. Conclusion Pancreatic cystic masses include several pathological entities, ranging from benign to malignant lesions. Rarely pseudocysts present as complex cystic pancreatic lesions with biliary compression in absence of history of acute pancreatitis. We describe the rare case of multiple pancreatic pseudocysts due to Wirsung duct rupture in absence of previous trauma or acute pancreatitis. Magnetic resonance showed the presence of communication with the main pancreatic duct and endoscopic ultrasound fine needle aspiration suggested the benign nature of the lesion.
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Affiliation(s)
- Martino Gerosa
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Marco Chiarelli
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Angelo Guttadauro
- Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Via Zucchi 24, 20900, Monza, Italy
| | - Matilde De Simone
- Department of Surgery, University of Milan, Via F. Sforza 35, 20122, Milan, Italy
| | - Fulvio Tagliabue
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Melchiorre Costa
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Sabina Terragni
- Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Via Zucchi 24, 20900, Monza, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.
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Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Milan, Italy
| | - Federico Raveglia
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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Raveglia F, Cioffi U, De Simone M, Rizzi A, Leporati A, Tinelli C, Chiarelli M, Baisi A. Advantages of wound retractor device versus rigid trocar at camera port in video-assisted thoracic surgery-a single institution experience. J Vis Surg 2018; 4:66. [PMID: 29780712 DOI: 10.21037/jovs.2018.03.15] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 11/06/2022]
Abstract
Background rigid trocars are widely adopted in video-assisted thoracic surgery (VATS), despite some disadvantages: (I) cannula strong pressure on intercostal nerve stimulating postoperative pain; (II) limited movement of thoracoscopic devices on their fulcrum when extreme acute angles with the chest wall are needed. Wound retractor (WR) device, designed for laparoscopic surgery, it is also used in VATS, but to protect mini-thoracotomy. We compared the use of extra-small WR versus rigid trocar at camera port that is the most painful thoracostomy. The aim was to determine if WR is associated with less postoperative pain and better scope maneuverability. Methods This is a single institution prospective study recorded and approved by ethics committee at our hospital. From October 2016 to June 2017, we enrolled 40 patients (statistical power 88%), randomized into two different groups. Group A (20 patients) underwent VATS lung resection using WR at camera port, group B (20 patients) using rigid trocar. Intra-operative data collected were maximum acute angle obtained between the camera and chest wall and chest wall thickness. Pain was measured by numerical analog scales (NAS) at 6, 12, 24, 48 and 72 hours after surgery. We also measured total morphine consumption at 72 h administered by patient controlled analgesia (PCA) system. Results No statistical significance was found in the demographic traits of the two groups (P=1). Statistically significant differences were found in favor of group A for both pain control, morphine consumption (P<0.001) and camera maneuverability (described as maximum acute angle obtained/chest wall thickness) (P<0.001). Conclusions patients who had WR showed less postoperative pain. Moreover, WR presented other advantages: camera protection by small bleeding from chest wall, adaptability with every chest wall thickness, absence of skin injury around the port. We suggest its use instead of rigid trocar.
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Affiliation(s)
- Federico Raveglia
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Ugo Cioffi
- Department of Surgery, Università degli Studi di Milano, Milano, Italy
| | - Matilde De Simone
- Department of Surgery, Università degli Studi di Milano, Milano, Italy
| | - Alessandro Rizzi
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Andrea Leporati
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Carmine Tinelli
- Biometry and Medical Statistics, Policlinico San Matteo di Pavia, Pavia, Italy
| | - Marco Chiarelli
- Department of Surgery, Università degli Studi di Milano, Milano, Italy
| | - Alessandro Baisi
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
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49
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Baisi A, Raveglia F, De Simone M, Cioffi U. TNM Staging System and Surgical Resection for Partially Solid Lung Adenocarcinoma. Ann Thorac Surg 2018; 105:989-990. [PMID: 29455814 DOI: 10.1016/j.athoracsur.2017.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/24/2017] [Accepted: 05/05/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, Ospedale San Paolo, University of Milan, Via A. di Rudinì, 8, Milan, Italy.
| | - Federico Raveglia
- Thoracic Surgery Unit, Ospedale San Paolo, University of Milan, Via A. di Rudinì, 8, Milan, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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50
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Testori A, Voulaz E, Alloisio M, Errico V, Cariboni U, De Simone M, Cioffi U. Multicentric castleman's disease resembling metastatic lung carcinoma. A case report. Clin Case Rep 2018. [PMID: 29531720 PMCID: PMC5838266 DOI: 10.1002/ccr3.1381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 67‐year‐old patient presented for persistent cough. Computed tomography showed right lower lung opacity associated with mediastinal adenopathy. On suspicion of metastatic pulmonary neoplasm, the patient was submitted to right lower lobectomy with lymphadenectomy. Postoperative histopathology led to the diagnosis of multicentric Castleman's disease.
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Affiliation(s)
- Alberto Testori
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Emanuele Voulaz
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Marco Alloisio
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Valentina Errico
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Umberto Cariboni
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | | | - Ugo Cioffi
- Deparment of Surgery University of Milan Milan Italy
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