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Sartori A, Tfaily A, Botteri E, Andreuccetti J, Lauro E, Caliskan G, Verlato G, Di Leo A. Rectus muscle diastasis in Italian women: determinants of disease severity, and associated disorders. Front Surg 2024; 11:1360207. [PMID: 38529469 PMCID: PMC10961386 DOI: 10.3389/fsurg.2024.1360207] [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: 12/22/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders. Methods In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3-5, >5 cm) were evaluated by a multinomial regression model. Results Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m2 (range 16.0-40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity. Conclusion The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.
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Affiliation(s)
- Alberto Sartori
- U.O. Chirurgia Generale e d'Urgenza, Ospedale Montebelluna, Montebelluna, Italy
| | - Ahmad Tfaily
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili di Brescia, Montichiari, Italy
| | | | - Enrico Lauro
- U.O. Chirurgia Generale, Ospedale Civile Santa Maria del Carmine, Rovereto, Italy
| | - Gulser Caliskan
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Alberto Di Leo
- U.O. Chirurgia Generale e Mininvasiva, Ospedale San Camillo, Trento, Italy
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Brillantino A, Renzi A, Talento P, Iacobellis F, Brusciano L, Monaco L, Izzo D, Giordano A, Pinto M, Fantini C, Gasparrini M, Schiano Di Visconte M, Milazzo F, Ferreri G, Braini A, Cocozza U, Pezzatini M, Gianfreda V, Di Leo A, Landolfi V, Favetta U, Agradi S, Marino G, Varriale M, Mongardini M, Pagano CEFA, Contul RB, Gallese N, Ucchino G, D'Ambra M, Rizzato R, Sarzo G, Masci B, Da Pozzo F, Ascanelli S, Foroni F, Palumbo A, Liguori P, Pezzolla A, Marano L, Capomagi A, Cudazzo E, Babic F, Geremia C, Bussotti A, Cicconi M, Di Sarno A, Mongardini FM, Brescia A, Lenisa L, Mistrangelo M, Sotelo MLS, Vicenzo L, Longo A, Docimo L. The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure. BMC Surg 2023; 23:311. [PMID: 37833715 PMCID: PMC10576345 DOI: 10.1186/s12893-023-02223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. METHODS A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. CONCLUSIONS In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.
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Affiliation(s)
- Antonio Brillantino
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy.
| | - Adolfo Renzi
- "Buonconsiglio-Fatebenefratelli" Hospital, Naples, Italy
| | - Pasquale Talento
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Luigi Brusciano
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Luigi Monaco
- "Pineta Grande" Hospital, "Villa Esther" Clinic, Avellino, Italy
| | - Domenico Izzo
- Department of General and Emergency Surgery, AORN dei Colli Monaldi-Cotugno-CTO, CTO Hospital, Naples, Italy
| | - Alfredo Giordano
- Department of General and Emergency Surgery, University of Salerno, Hospital of Mercato San Severino, Salerno, Italy
| | | | - Corrado Fantini
- Department of Surgery, "Dei Pellegrini" Hospital, ASL Napoli 1, Naples, Italy
| | | | - Michele Schiano Di Visconte
- Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, "Santa Maria Dei Battuti" Hospital, Conegliano, TV, Italy
| | - Francesca Milazzo
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Ferreri
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Braini
- Department of General Surgery, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Umberto Cocozza
- Department of General Surgery, "S. Maria Degli Angeli" Hospital, Putignano (Bari), Italy
| | | | - Valeria Gianfreda
- Unit of Colonproctologic and Pelvic Surgery, "M.G. Vannini" Hospital, Rome, Italy
| | - Alberto Di Leo
- Department of General and Minivasive Surgery, "San Camillo" Hospital, Trento, Italy
| | - Vincenzo Landolfi
- Department of General and Specalist Surgery, AORN "S.G. Moscati", Avellino, Italy
| | - Umberto Favetta
- Unit of Proctology and Pelvic Surgery, "Città di Pavia" Clinic, Pavia, Italy
| | - Sergio Agradi
- Humanitas Gavazzeni/Castelli Bergamo, Bergamo, Italy
| | - Giovanni Marino
- Department of General Surgery, "Santa Marta e Santa Venera" Hospital of Acireale, Catania, Italy
| | - Massimilano Varriale
- Department of General and Emergency Surgery, "Sandro Pertini" Hospital, Asl Roma 2, Rome, Italy
| | | | | | | | - Nando Gallese
- Unit of Proctologic Surgery, "Sant'Antonio" Clinic, Cagliari, Italy
| | | | - Michele D'Ambra
- Department of General and Oncologic-Minivasive Surgery, "Federico II" University, Naples, Italy
| | - Roberto Rizzato
- Department of General Surgery, Hospital of Conegliano AULSS 2, Marca Trevigiana, Treviso, Italy
| | - Giacomo Sarzo
- Department of General Surgery, University of Padova, "Sant'Antonio" Hospital, Padova, Italy
| | | | - Francesca Da Pozzo
- Department of Surgery, "Santa Maria dei battuti" Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - Simona Ascanelli
- Department of Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Fabrizio Foroni
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Alessio Palumbo
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | | | | | - Luigi Marano
- Academy of Applied Medical and Social Sciences - AMiSNS: Akademia Medycznych i Spolecznych Nauk Stosowanych, Elbląg, Poland
| | | | - Eugenio Cudazzo
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Babic
- Department of Surgery, Hospital of Cattinara, ASUGI Trieste, Trieste, Italy
| | - Carmelo Geremia
- Unit of Proctology and Pelvic Surgery, "Città di Pavia" Clinic, Pavia, Italy
| | | | - Mario Cicconi
- Department of General Surgery, "Sant'Omero-Val Vibrata" Hospital, Teramo, Italy
| | | | - Federico Maria Mongardini
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Brescia
- Department of Oncologic Colorectal Surgery, University Hospital S. Andrea, "La Sapienza" University, Rome, Italy
| | - Leonardo Lenisa
- Department of Surgery, Humanitas San Pio X, Surgery Unit, Pelvic Floor Centre, Milano, Italy
| | | | | | - Luciano Vicenzo
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | | | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
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Crepaz L, Sartori A, Podda M, Ortenzi M, Di Leo A, Stabilini C, Carlucci M, Olmi S. Minimally invasive approach to incisional hernia in elective and emergency surgery: a SICE (Italian Society of Endoscopic Surgery and new technologies) and ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) online survey. Updates Surg 2023; 75:1671-1680. [PMID: 37069372 DOI: 10.1007/s13304-023-01505-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
Minimally invasive abdominal wall surgery is growing worldwide, with a constant and fast improvement of surgical techniques and surgeons' confidence in treating both primary and incisional hernias (IH). The Italian Society of Endoscopic Surgery and new technologies (SICE) and the ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) worked together to investigate state of the art in IH treatment in elective and emergency settings in Italy. An online open survey was designed, and Italian surgeons interested in abdominal wall surgery were invited to fill out a 20-point questionnaire on IH surgical procedures performed in their departments. Surgeons were asked to express their points of view on specific questions about technical and clinical variables in IH treatment. Preferred approach in elective IH surgery was minimally invasive (59.7%). Open surgery was the preferred approach in 40.3% of the responses. In emergency settings, open surgery was the preferred approach (65.4%); however, 34.5% of the involved surgeons declare to prefer the laparoscopic/endoscopic approach. Most respondents opted for conversion to open surgery in case of relevant surgical field contamination, with a non-mesh repair of abdominal wall defects. Among those that used the laparoscopic approach in the emergent setting, the majority (74%) used the size of the defect of 5 cm as a decisional cut-off. The spread of minimally invasive approaches to IH repair in emergency surgery in Italy is gaining relevance. Code-sharing through scientific societies can improve clinical practice in different departments and promote a tailored approach to IH surgery.
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Affiliation(s)
- Lorenzo Crepaz
- General and Mini-Invasive Surgery, San Camillo Hospital, Via Giovanelli 19, 38122, Trento, Italy.
| | - Alberto Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Via Palmiro Togliatti, 16, 31044, Montebelluna, Treviso, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Alberto Di Leo
- General and Mini-Invasive Surgery, San Camillo Hospital, Via Giovanelli 19, 38122, Trento, Italy
| | - Cesare Stabilini
- DISC (Department of Surgical Sciences), University of Genoa, Genoa, Italy
| | - Michele Carlucci
- General and Emergency Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefano Olmi
- Oncologic Surgery, Policlinico San Marco GSD, Zingonia (Bg), Corso Europa 7, 24040, Zingonia, Bg, Italy
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D'Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Correction: Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023:10.1007/s00464-023-10102-0. [PMID: 37160809 DOI: 10.1007/s00464-023-10102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy.
- Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- Clinica Chirurgica Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
- Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy
| | - Ugo Elmore
- Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132, Milan, Italy
| | - Francesca Pecchini
- Unita' Operativa di chirurgia generale, d'urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples "Federico II", Naples, Italy
| | - Roberta La Mendola
- General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- S.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- SCDU Clinica Chirurgica, General Surgery Department, AOU "Maggiore Della Carità" Hospital, Novara, Italy
| | - Francesco Marchegiani
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, "Valli del Noce" Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- Gastrointestinal Surgery, San Raffaele Hospital, 20132, Milan, Italy
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D'Ugo
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
- Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, "Valli del Noce" Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- SCDU Clinica Chirurgica, General Surgery Department, AOU "Maggiore Della Carità" Hospital, Novara, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell'umanesimo, 10, 00144, Rome, Italy
| | - Angelo Restivo
- Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- S.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples "Federico II", Naples, Italy
| | - Micaela Piccoli
- Unita' Operativa di chirurgia generale, d'urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132, Milan, Italy
| | - Antonino Spinelli
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
- Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060, Torino, Italy
| | - Marco Guerrieri
- Clinica Chirurgica Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D’Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023; 37:977-988. [PMID: 36085382 PMCID: PMC9944710 DOI: 10.1007/s00464-022-09547-6] [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: 03/26/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.
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Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy. .,Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- grid.7605.40000 0001 2336 6580BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.432329.d0000 0004 1789 4477Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- grid.417728.f0000 0004 1756 8807Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Francesca Pecchini
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Roberta La Mendola
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’Umanesimo, 10, 00144 Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Francesco Marchegiani
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- grid.18887.3e0000000417581884Gastrointestinal Surgery, San Raffaele Hospital, 20132 Milan, Italy
| | - Luca Ferraro
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- grid.9024.f0000 0004 1757 4641UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D’Ugo
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy ,grid.415928.3Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Alessandro Ferrero
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’umanesimo, 10, 00144 Rome, Italy
| | - Angelo Restivo
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Micaela Piccoli
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Antonino Spinelli
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56 Rozzano, 20089 Milan, Italy ,grid.452490.eDepartment of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.419555.90000 0004 1759 7675Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060 Torino, Italy
| | - Marco Guerrieri
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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6
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Lauro E, Corridori I, Luciani L, Di Leo A, Sartori A, Andreuccetti J, Trojan D, Scudo G, Motta A, Pugno NM. Stapled fascial suture: ex vivo modeling and clinical implications. Surg Endosc 2022; 36:8797-8806. [PMID: 35578046 DOI: 10.1007/s00464-022-09304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study aims to investigate the biomechanics of stapled sutures, simple (stapled), or oversewn (hybrid), in comparison with handsewn suture. From the results obtained, we tried to draw indications for their use in a clinical context. METHODS Human cadaver fascia lata specimens, sutured (handsewn, stapled, or hybrid) or not, underwent tensile tests. The data on strength (maximal stress), ultimate strain (deformability), Young's modulus (rigidity), and dissipated specific energy (ability to absorb mechanical energy up to the breaking point) were recorded for each type of specimens and analyzed. RESULTS Stapled and hybrid suture showed a significantly higher strength (handsewn 0.83 MPa, stapled 2.10 MPa, hybrid 2.68 MPa) and a trend toward a lower ultimate strain as compared to manual sutures (handsewn 344%, stapled 249%, hybrid 280%). Stapled and hybrid sutures had fourfold higher Young's modulus as compared to handsewn sutures (handsewn 1.779 MPa, stapled 7.374 MPa, hybrid 6.964 MPa). Handsewn and hybrid sutures showed significantly higher dissipated specific energy (handsewn 0.99 mJ-mm3, stapled 0.73 mJ-mm3, hybrid 1.35 mJ-mm3). CONCLUSION Stapled sutures can resist high loads, but are less deformable and rigid than handsewn suture. This suggests a safer employment in case of small defects or diastasis (< W1 in accord to EHS classification), where the presumed tissutal displacement is minimal. Oversewing a stapled suture improves its efficiency, becoming crucial in case of larger defects (> W1 in accord to EHS classification) where the expected tissutal displacement is maximal. Hybrid sutures seem to be a good compromise.
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Affiliation(s)
- Enrico Lauro
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy.
| | - Ilaria Corridori
- Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Lorenzo Luciani
- Robotic Unit and Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Alberto Di Leo
- Department of General Surgery, San Camillo Hospital, Trento, Italy
| | - Alberto Sartori
- Department of General Surgery, Montebelluna-Castelfranco Veneto Hospital, Treviso, Italy
| | - Jacopo Andreuccetti
- Department of General Surgery 2^, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Diletta Trojan
- Fondazione Banca dei Tessuti Treviso FBTV, Treviso, Italy
| | - Giovanni Scudo
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy
| | - Antonella Motta
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Nicola M Pugno
- Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy.
- School of Engineering and Material Science, Queen Mary University of London, London, UK.
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7
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Mengardo V, Weindelmayer J, Veltri A, Giacopuzzi S, Torroni L, de Manzoni G, Agresta F, Alfieri R, Alfieri S, Antonacci N, Baiocchi GL, Bencini L, Bencivenga M, Benedetti M, Berselli M, Biondi A, Capolupo GT, Carboni F, Casadei R, Casella F, Catarci M, Cerri P, Chiari D, Cocozza E, Colombo G, Cozzaglio L, Dalmonte G, Degiuli M, De Luca M, De Luca R, De Manzini N, De Pasqual CA, De Pascale S, De Ruvo N, Di Cosmo M, Di Leo A, Di Paola M, Elio A, Ferrara F, Ferrari G, Fiscon V, Fumagalli U, Garulli G, Gennai A, Gentile I, Germani P, Gualtierotti M, Guerini F, Gurrado A, Inama M, La Torre F, Laterza E, Losurdo P, Macrì A, Marano A, Marano L, Marchesi F, Marino F, Massani M, Menghi R, Milone M, Molfino S, Montuori M, Moretto G, Morgagni P, Morpurgo E, Abdallah M, Nespoli L, Olmi S, Palaia R, Pallabazer G, Parise P, Pasculli A, Pericoli Ridolfini M, Pesce A, Pinotti E, Pisano M, Poiasina E, Postiglione V, Rausei S, Rella A, Rosa F, Rosati R, Rossi G, Rossit L, Rovatti M, Ruspi L, Sacco L, Saladino E, Sansonetti A, Sartori A, Scaglione D, Scaringi S, Schoenthaler C, Sena G, Simone M, Solaini L, Strignano P, Tartaglia N, Testa S, Testini M, Tiberio GAM, Treppiedi E, Vagliasindi A, Valmasoni M, Viganò J, Zanchettin G, Zanoni A, Zardini C, Zerbinati A. Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy (ADiGe) survey. Updates Surg 2022; 74:1839-1849. [PMID: 36279038 DOI: 10.1007/s13304-022-01397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
Abstract
AbstractEvidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.
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8
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Milone M, Elmore U, Manigrasso M, Ortenzi M, Botteri E, Arezzo A, Silecchia G, Guerrieri M, De Palma GD, Agresta F, Agresta F, Pizza F, D’Antonio D, Amalfitano F, Selvaggi F, Sciaudone G, Selvaggi L, Prando D, Cavallo F, Guerrieri M, Ortenzi M, Lezoche G, Cuccurullo D, Tartaglia E, Sagnelli C, Coratti A, Tribuzi A, Di Marino M, Anania G, Bombardini C, Zago MP, Tagliabue F, Burati M, Di Saverio S, Colombo S, Adla SE, De Luca M, Zese M, Parini D, Prosperi P, Alemanno G, Martellucci J, Olmi S, Oldani A, Uccelli M, Bono D, Scaglione D, Saracco R, Podda M, Pisanu A, Murzi V, Agrusa A, Buscemi S, Muttillo IA, Picardi B, Muttillo EM, Solaini L, Cavaliere D, Ercolani G, Corcione F, Peltrini R, Bracale U, Lucchi A, Vittori L, Grassia M, Porcu A, Perra T, Feo C, Angelini P, Izzo D, Ricciardelli L, Trompetto M, Gallo G, Luc AR, Muratore A, Calabrò M, Cuzzola B, Barberis A, Costanzo F, Angelini G, Ceccarelli G, Rondelli F, De Rosa M, Cassinotti E, Boni L, Baldari L, Bianchi PP, Formisano G, Giuliani G, Ceretti AAP, Mariani NM, Giovenzana M, Farfaglia R, Marcianò P, Arizzi V, Piccoli M, Pecchini F, Pattacini GC, Botteri E, Vettoretto N, Guarnieri C, Laface L, Abate E, Casati M, Feo C, Fabri N, Pesce A, Maida P, Marte G, Abete R, Casali L, Marchignoli A, Dall’Aglio M, Scabini S, Pertile D, Aprile A, Andreuccetti J, Di Leo A, Crepaz L, Maione F, Vertaldi S, Chini A, Rosati R, Puccetti F, Maggi G, Cossu A, Sartori A, De Luca M, Piatto G, Perrotta N, Celiento M, Scorzelli M, Pilone V, Tramontano S, Calabrese P, Sechi R, Cillara N, Putzu G, Podda MG, Montuori M, Pinotti E, Sica G, Franceschilli M, Sensi B, Degiuli M, Reddavid R, Puca L, Farsi M, Minuzzo A, Gia E, Baiocchi GL, Ranieri V, Celotti A, Bianco F, Grassia S, Novi A. ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report. Surg Endosc 2022. [DOI: https:/doi.org/10.1007/s00464-022-09212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Abstract
Background
Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery. However, it is difficult to obtain full adherence to the protocol into clinical practice and has still not been identified the threshold beyond which improved functional results can be reached.
Methods
The ERCOLE (ERas and COLorectal Endoscopic surgery) study was as a cohort, prospective, multi-centre national study evaluating the association between adherence to ERAS items and clinical outcomes after minimally invasive colorectal surgery. The primary endpoint was to associate the percentage of ERAS adherence to functional recovery after minimally invasive colorectal cancer surgery. The secondary endpoints of the study was to validate safety of the ERAS programme evaluating complications’ occurrence according to Clavien-Dindo classification and to evaluate the compliance of the Italian surgeons to each ERAS item.
Results
1138 patients were included. Adherence to the ERAS protocol was full only in 101 patients (8.9%), > 75% of the ERAS items in 736 (64.7%) and > 50% in 1127 (99%). Adherence to > 75% was associated with a better functional recovery with 90.2 ± 98.8 vs 95.9 ± 33.4 h (p = 0.003). At difference, full adherence to the ERAS components 91.7 ± 22.1 vs 92.2 ± 31.6 h (p = 0.8) was not associated with better recovery.
Conclusions
Our results were encouraging to affirm that adherence to the ERAS program up to 75% could be considered satisfactory to get the goal. Our study could be considered a call to simplify the ERAS protocol facilitating its penetrance into clinical practice.
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9
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Sartori A, De Luca M, Noaro G, Piatto G, Pignata G, Di Leo A, Lauro E, Andreuccetti J. Rare Intraoperative and Postoperative Complications After Transabdominal Laparoscopic Hernia Repair: Results from the Multicenter Wall Hernia Group Registry. J Laparoendosc Adv Surg Tech A 2020; 31:290-295. [PMID: 32808863 DOI: 10.1089/lap.2020.0459] [Citation(s) in RCA: 4] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Inguinal hernioplasty is the most frequently performed operation in the Western world today. Although the laparoscopic approach for inguinal hernia repair has shown excellent results in terms of complications and recurrences, the anterior approach is still the most used. Postoperative pain and recurrences are the most widely studied complications in both approaches, but there is little information about the often more troublesome rare complications of laparoscopic surgery and their treatment. Methods: In the period from January 1, 2014 to December 31, 2019, 1874 hernioplasty operations were performed with the transabdominal approach and recorded prospectively in the Wall Hernia Group database. The mean follow-up was 47 months (range 3-64 months). All less frequent complications were analyzed and a literature review was carried out to assess the presence of similar cases and their treatment in other series. Results: Eight cases of rare complications were identified and subdivided according to the Clavien-Dindo classification. They included a bowel perforation, 4 cases of bleeding, 2 bowel obstructions, and an injury to the motor branch of the obturator nerve. The postoperative course in these patients was significantly longer than in patients with a regular postoperative course. In 2 cases the complication occurred during the first admission, while the remaining 6 patients had to be readmitted within 30 days after discharge. Conclusions: Although serious postoperative complications in laparoscopic inguinal hernioplasty are rare, all surgeons, also those who have completed the learning curve, should be aware of their possible occurrence.
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Affiliation(s)
- Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Maurizio De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giulia Noaro
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giacomo Piatto
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili, Brescia, Italy
| | - Alberto Di Leo
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
| | - Enrico Lauro
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy
| | - Jacopo Andreuccetti
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
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10
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Di Leo A, Corvasce A, Weindelmayer J, Mason EJ, Casella F, de Manzoni G. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in pseudomyxoma peritonei of appendiceal origin: result of a single centre study. Updates Surg 2020; 72:1207-1212. [PMID: 32410159 DOI: 10.1007/s13304-020-00788-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/07/2020] [Accepted: 05/02/2020] [Indexed: 12/25/2022]
Abstract
Pseudomyxoma peritonei (PMP) is a rare condition characterized by the intraperitoneal accumulation of mucus derived mostly by appendiceal mucinous neoplasm. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can offer a favourable overall survival. In this study, we report a single-institute outcomes following CRS and HIPEC in patients with this condition. This is a review of prospectively collected data from 32 patients (11 men and 21 women) affected by PMP of appendiceal origin who underwent CRS and HIPEC from 2008 to 2016 in our Surgical Unit of General and Esophagogastric Surgery. The median age of the patients was 53 years (range 25-77 years). After CRS, all patients underwent HIPEC (mytomicin C 3.3 mg/m2/L and cisplatin 25 mg/m2/L at 41 °C for 60 min) with closed abdomen technique. The median (range) follow-up time for surviving patients was 43 (18-119) months. The median peritoneal cancer index (PCI) was 17. Complete cytoreductive surgery (CC0) was achieved in in 22 patients (69%). The majority of patients (88%) had grade I-II complications, 3 (9%) had grade III complications, and 1 (3%) patient had a grade IV complication. There were no perioperative mortalities. The median hospital stay was 9.5 (range 9-24) days. One year and 5-year overall survival (OS) were 90% and 58%, respectively. Regardless of histotype, disease-free survival was 95% at 1 year and 46% at 5 years. CRS in combination with HIPEC is a feasible treatment strategy and can achieve a satisfactory outcome in patients with PMP of appendiceal origin.
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Affiliation(s)
- Alberto Di Leo
- General and Upper GI Surgery Division, University of Verona, Piazzale Stefani, 1, 37124, Verona, Italy.
| | - Arianna Corvasce
- General and Upper GI Surgery Division, University of Verona, Piazzale Stefani, 1, 37124, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper GI Surgery Division, University of Verona, Piazzale Stefani, 1, 37124, Verona, Italy
| | - Elena Jane Mason
- General and Upper GI Surgery Division, University of Verona, Piazzale Stefani, 1, 37124, Verona, Italy
| | - Francesco Casella
- General and Upper GI Surgery Division, University of Verona, Piazzale Stefani, 1, 37124, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, University of Verona, Piazzale Stefani, 1, 37124, Verona, Italy
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11
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Belluco C, Forlin M, Delrio P, Rega D, Degiuli M, Sofia S, Olivieri M, Pucciarelli S, Zuin M, De Manzoni G, Di Leo A, Scabini S, Zorcolo L, Restivo A. Elevated platelet count is a negative predictive and prognostic marker in locally advanced rectal cancer undergoing neoadjuvant chemoradiation: a retrospective multi-institutional study on 965 patients. BMC Cancer 2018; 18:1094. [PMID: 30419864 PMCID: PMC6233528 DOI: 10.1186/s12885-018-5022-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/21/2018] [Accepted: 10/31/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In patients with locally advanced rectal cancer treated by neoadjuvant chemoradiation, pathological complete response in the surgical specimen is associated with favourable long-term oncologic outcome. Based on this observation, nonoperative management is being explored in the subset of patients with clinical complete response. Whereas, patients with poor response have a high risk of local and distant recurrence, and appear to receive no benefit from standard neoadjuvant chemoradiation. Therefore, in order to develop alternative treatment strategies for non responding patients, predictive and prognostic factors are highly needed. Accumulating clinical observations indicate that elevated platelet count is associated with poor outcome in different type of tumors. In this study we investigated the predictive and prognostic impact of elevated platelet count on pathological response and long-term oncologic outcome in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. METHODS A total of 965 patients were selected from prospectively maintained databases of seven Centers within the SICO Colorectal Cancer Network. Patients were divided into two groups based on a pre-neoadjuvant chemoradiation platelet count cut-off value of 300 × 109/L identified by receiver operating characteristic curve considering complete pathological response as the outcome. RESULTS Complete pathological response rate was lower in patients with elevated platelet count (12.8% vs. 22.1%, p = 0.001). Mean follow-up was 50.1 months. Comparing patients with elevated platelet count with patients with not elevated platelet count, 5-year overall survival was 69.5% vs.76.5% (p = 0.016), and 5-year disease free survival was 63.0% vs. 68.9% (p = 0.019). Local recurrence rate was higher in patients with elevated platelet count (11.1% vs. 5.3%, p = 0.001), as higher was the occurrence of distant metastasis (23.9% vs. 16.4%, p = 0.007). At multivariate analysis of potential prognostic factors EPC was independently associated with worse overall survival (HR 1.40, 95% CI 1.06-1.86), and disease free survival (HR 1.37, 95% CI 1.07-1.76). CONCLUSIONS In locally advanced rectal cancer elevated platelet count before neoadjuvant chemoradiation is a negative predictive and prognostic factor which might help to identify subsets of patients with more aggressive tumors to be proposed for alternative therapeutic strategies.
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Affiliation(s)
- Claudio Belluco
- Department of Surgical Oncology, CRO-IRCCS, National Cancer Institute, Aviano Via Franco Gallini 2, 33081, Aviano, Italy.
| | - Marco Forlin
- Department of Surgical Oncology, CRO-IRCCS, National Cancer Institute, Aviano Via Franco Gallini 2, 33081, Aviano, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, National Cancer Institute - IRCCS - G. Pascale Foundation, Naples, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, National Cancer Institute - IRCCS - G. Pascale Foundation, Naples, Italy
| | - Maurizio Degiuli
- School of Medicine, Department of Oncology, Head, Digestive, University of Torino, Torino, Italy.,Surgical Oncology, San Luigi University Hospital, Orbassano, Torino, Italy
| | - Silvia Sofia
- School of Medicine, Department of Oncology, Head, Digestive, University of Torino, Torino, Italy.,Surgical Oncology, San Luigi University Hospital, Orbassano, Torino, Italy
| | - Matteo Olivieri
- Department of Surgical Oncology, CRO-IRCCS, National Cancer Institute, Aviano Via Franco Gallini 2, 33081, Aviano, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Matteo Zuin
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I., Surgery Division, University of Verona, Verona, Italy
| | - Alberto Di Leo
- Department of Surgery, General and Upper G.I., Surgery Division, University of Verona, Verona, Italy
| | - Stefano Scabini
- Oncologic Surgery and Implantable Systems Unit, Department of Emergency, IRCCS San Martino IST, Genoa, Italy
| | - Luigi Zorcolo
- Colorectal Surgery Unit, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Angelo Restivo
- Colorectal Surgery Unit, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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12
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Leo AD, Biganzoli L, Bohm S, Lupi G, Oriana S, Riboldi G, Spatti G, Vicario G, Di Re F, Bajetta E. An Intensive Treatment with Mitoxantrone and Ifosfamide in Second-Line Therapy of Epithelial Ovarian Cancer. Tumori 2018; 80:443-7. [PMID: 7900234 DOI: 10.1177/030089169408000607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Both mitoxantrone (DHAD) and ifosfamide (IFO) have given promising results when administered as single agents in advanced ovarian cancer pretreated with platinum compounds. The aim of this I.T.M.O. group pilot trial was to evaluate, in a selected population of ovarian cancer patients, the efficacy and tolerability of the following intensive second-line regimen: DHAD, 12 mg/m2 i.v., day 1; IFO, 4,000 mg/m2 i.v., days 1 and 2; Mesna, 800 mg/m2 i.v. t.i.d., days 1 and 2. Filgrastim (5 μg/kg/day i.m.) was given from day 6 to day 19 to reduce the expected neutropenia. Cycles were repeated every 21 days. Methods Nineteen platinum-pre-treated patients were enrolled and 14 were evaluated for tumor response; the disease of 5 patients was not measurable clinically or radiologically. Results Seven responses were observed (3 CRs), with a median response duration of 5 months. The median time to treatment failure and overall survival for all 19 patients was respectively 8 and 13 months. Anemia was observed in all of the treated patients (grade 3–4 in 9 cases). Only 6 of the 19 patients ended the five planned cycles of chemotherapy without any delay. Conclusions Although DHAD plus IFO induced a considerable number of objective responses, the limited response duration time to treatment failure, and overall survival as well as the reported side effects suggest that this is not a recommended regimen for the palliative treatment of ovarian cancer patients undergoing second-line chemotherapy.
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Affiliation(s)
- A D Leo
- Division of Medical Oncology B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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13
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Marrelli D, Ferrara F, Giacopuzzi S, Morgagni P, Di Leo A, De Franco L, Pedrazzani C, Saragoni L, De Manzoni G, Roviello F. Incidence and Prognostic Value of Metastases to "Posterior" and Para-aortic Lymph Nodes in Resectable Gastric Cancer. Ann Surg Oncol 2017; 24:2273-2280. [PMID: 28405772 DOI: 10.1245/s10434-017-5857-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this retrospective study was to evaluate the incidence and prognostic value of metastases to "posterior" (8p, 12b/p, 13) and para-aortic lymph nodes in a large cohort of Western patients submitted to D2 plus lymphadenectomy. METHODS Removal of "posterior" nodes was performed in 743 patients, and para-aortic lymphadenectomy in a subgroup of 390 patients. After lymph node mapping and retrieval on the fresh specimen, a median number of 41 total lymph nodes were analyzed. The median follow-up period was 37 months for the entire series and 68 months for survivors. RESULTS Of 743 included patients, 23 (3.1%) had metastases in station 8p, 12 (1.6%) in station 12b/p, and 19 (2.6%) in station 13. On the whole, 47 of 743 patients (6.3%) had positive "posterior" nodes. Para-aortic metastases were present in 42 of 390 patients (10.8%). Metastases to "posterior" stations were significantly related to depth of invasion, number of positive nodes, and surgical radicality. Distal tumors showed higher trend to metastasize to "posterior" nodes than upper third, whereas for para-aortic metastases it was the reverse. 5-year survival in patients with positivity to "posterior" nodes was 17%, with no significant difference according to 8p, 12b/p, and 13 stations; long-term outcome was overlapping to pN3b stage. 5-year survival in para-aortic positive cases was 11%, and a trend to better outcome was observed in proximal tumors. CONCLUSIONS Although metastases to "posterior" and para-aortic nodes are expression of an advanced nodal stage, not negligible survival rates are observed in subgroups of patients.
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Affiliation(s)
- Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - Francesco Ferrara
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Simone Giacopuzzi
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Alberto Di Leo
- Unit of General Surgery, Rovereto Hospital, Trento, Italy
| | - Lorenzo De Franco
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Luca Saragoni
- Department of Pathology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giovanni De Manzoni
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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14
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Chow LWC, Biganzoli L, Leo AD, Kuroi K, Han HS, Patel J, Huang CS, Lu YS, Zhu L, Chow CYC, Loo WTY, Glück S, Toi M. Toxicity profile differences of adjuvant docetaxel/cyclophosphamide (TC) between Asian and Caucasian breast cancer patients. Asia Pac J Clin Oncol 2017; 13:372-378. [PMID: 28371190 DOI: 10.1111/ajco.12682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/30/2017] [Indexed: 12/01/2022]
Abstract
AIM For early-stage breast cancer, four cycles of docetaxel and cyclophosphamide (TC) was proven superior to doxorubicin plus cyclophosphamide in the US Oncology 9375 trial. Given primary prophylactic antibiotics, 5% febrile neutropenia was recorded in a population comprising 75.5% Caucasians. Smaller trials and retrospective studies reviewing TC use in Asian patients did not produce similar incidence rates. This study aims to discover the variable hematological toxicities with TC use in Caucasian and Asian patients. METHODS Breast cancer data was retrospectively reviewed for patients receiving adjuvant docetaxel 60-75 mg/m2 plus cyclophosphamide 600 mg/m2 from six countries (China, Hong Kong, Japan, Taiwan, Italy, and United States). Similar number of patients with relatively balanced baseline characteristics were chosen for analysis of hematological and nonhematological toxicities and survival data. RESULTS From March 2004 to July 2013, data of 227 patients (127 Asians and 100 Caucasian) patients were analyzed for treatment-related toxicities. During the four cycles of TC, Asians had a significantly higher rate of grade ≥2 neutropenia than Caucasians (45.7% vs 6.0%; P <0.001) and significantly more grade ≥3 neutropenia events were documented (respectively 30.7% vs 4.0%, P <0.001). The prophylactic use of G-CSF was similar; 26.0% in Asians and 28.0% in Caucasian (P = 0.764). There were no differences in nonhematological toxicities. No significant difference in disease-free survival was observed between Asians and Caucasians (log-rank P = 0.910). CONCLUSIONS Ethnic differences in toxicity profile exist between Asian and Caucasian patients given adjuvant TC. Over 30% Asians but less than 5% Caucasians experienced grade ≥3 neutropenia.
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Affiliation(s)
- L W C Chow
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute of Applied Medicine and Health, Macau University of Science and Technology, Macau.,Organisation for Oncology and Translational Research, Hong Kong.,UNIMED Medical Institute, Hong Kong
| | - L Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Italy
| | - A D Leo
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Italy
| | - K Kuroi
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - H S Han
- Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, USA
| | - J Patel
- Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, USA
| | - C S Huang
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Y S Lu
- Department of Oncology, National Taiwan University Hospital, Taiwan
| | - L Zhu
- Department of Surgery, Shanghai Jiao Tong University, Shanghai, China
| | | | - W T Y Loo
- Organisation for Oncology and Translational Research, Hong Kong.,UNIMED Medical Institute, Hong Kong
| | - S Glück
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, USA
| | - M Toi
- Organisation for Oncology and Translational Research, Hong Kong.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Abstract
Siewert III cancer, although representing around 40% of EGJ cancers and being the EGJ cancer with worst prognosis, does not have a homogenous treatment, has few dedicated studies, and is often not considered in study protocols. Although staged as an esophageal cancer by the TNM 7th ed., it is considered a gastric cancer by new TNM 8th ed. Our aim was to consolidate the current literature on the indications and treatment options for Siewert III adenocarcinoma. A review of the literature was performed to better delineate treatment indications (according to stage, surgical margins, type of lymphatic spread and lymphadenectomy) and treatment strategy. The treatment approach is strictly dependent on cancer site and nodal diffusion. T1m cancers have insignificant risk of nodal metastases and can be safely treated with endoscopic resections. The risk of nodal metastases increases markedly starting from T1sm cancers and requires surgery with lymphadenectomy. The site of this type of cancer and the nodal diffusion require a total gastrectomy and distal esophagectomy, with 5 cm of clear proximal and distal margins and a D2 abdominal and inferior mediastinal lymphadenectomy. Multimodal treatments are indicated in all locally advanced and node positive cancers. Siewert III cancers are gastric cancers with some peculiarities and require dedicated studies and deserve more consideration in the current literature, especially because their treatment is particularly challenging.
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Affiliation(s)
- Alberto Di Leo
- Unit of General Surgery, Rovereto Hospital, APSS of Trento, Corso Verona 4, 38068, Rovereto, TN, Italy.
| | - Andrea Zanoni
- Unit of General Surgery, Rovereto Hospital, APSS of Trento, Corso Verona 4, 38068, Rovereto, TN, Italy
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16
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De Manzoni G, Marrelli D, Baiocchi GL, Morgagni P, Saragoni L, Degiuli M, Donini A, Fumagalli U, Mazzei MA, Pacelli F, Tomezzoli A, Berselli M, Catalano F, Di Leo A, Framarini M, Giacopuzzi S, Graziosi L, Marchet A, Marini M, Milandri C, Mura G, Orsenigo E, Quagliuolo V, Rausei S, Ricci R, Rosa F, Roviello G, Sansonetti A, Sgroi G, Tiberio GAM, Verlato G, Vindigni C, Rosati R, Roviello F. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer 2017; 20:20-30. [PMID: 27255288 DOI: 10.1007/s10120-016-0615-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/01/2016] [Indexed: 02/07/2023]
Abstract
This article reports the guidelines for gastric cancer staging and treatment developed by the GIRCG, and contains comprehensive indications for clinical management, including radiological, endoscopic, surgical, pathological, and oncological paths.
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Affiliation(s)
- Giovanni De Manzoni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Daniele Marrelli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy.
| | - Gian Luca Baiocchi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Paolo Morgagni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Luca Saragoni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Maurizio Degiuli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Annibale Donini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Uberto Fumagalli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Maria Antonietta Mazzei
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Fabio Pacelli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Anna Tomezzoli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Mattia Berselli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Filippo Catalano
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Alberto Di Leo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Massimo Framarini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Simone Giacopuzzi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Luigina Graziosi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Alberto Marchet
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Mario Marini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Carlo Milandri
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Gianni Mura
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Elena Orsenigo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Vittorio Quagliuolo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Stefano Rausei
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Riccardo Ricci
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Fausto Rosa
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giandomenico Roviello
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Andrea Sansonetti
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giovanni Sgroi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Guido Alberto Massimo Tiberio
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giuseppe Verlato
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Carla Vindigni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Riccardo Rosati
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Franco Roviello
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
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17
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Zanoni A, Verlato G, Giacopuzzi S, Motton M, Casella F, Weindelmayer J, Ambrosi E, Di Leo A, Vassiliadis A, Ricci F, Rice TW, de Manzoni G. ypN0: Does It Matter How You Get There? Nodal Downstaging in Esophageal Cancer. Ann Surg Oncol 2016; 23:998-1004. [PMID: 27480358 DOI: 10.1245/s10434-016-5440-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND ypN0 following induction treatment for advanced esophageal cancer improves survival. Importance of how ypN0 is achieved is unknown. This study evaluates survival in "natural" N0 (cN0/ypN0) and "downstaged" N0 (cN+/ypN0) patients. METHODS Among patients treated with induction treatment and surgery, 83 CT scans were retrieved in digital format and re-evaluated by a radiologist, blinded to pathological nodal status: 28 natural N0, 37 downstaged N0, and 18 ypN+. Impact of N0 classification on survival and associations with survival were identified. RESULTS Survival varied with ypN: 3-year survival was 84 % for natural N0 patients, 59 % for downstaged N0, and 20 % for ypN+ (p < .001). Compared with natural N0 patients, risk of cancer mortality was 3.8 for downstaged N0 and 7.6 for ypN+ (p = .01). Survival was also stratified by ypT: compared with ypT0 natural N0, who had the best survival, intermediate survival was seen in ypT+ natural N0 [hazard ratio (HR), 1.3] and ypT0 downstaged N0 (HR, 1.8), and poor survival in ypT+ downstaged N0 (HR, 9.5) and ypN+ (HR, 12.0) (p = .026). CONCLUSIONS Natural N0 and downstaged N0 patients are different clinical entities: downstaging cN+ with induction treatment producing downstaged N0 improves survival only if there is concomitant primary cancer downstaging to ypT0. Intermediate survival is seen in downstaged N0 patients with complete tumor response. Natural N0 patients experience intermediate survival with incomplete response (ypT+). Complete response in natural N0 patients produces the best survival. Means of obtaining ypN0 status matters and requires a complete response for downstaged N0 patients to benefit from induction treatment.
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Affiliation(s)
- Andrea Zanoni
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy.
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | | | - Francesco Casella
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Jacopo Weindelmayer
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Elena Ambrosi
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Alberto Di Leo
- Department of Surgery, Hospital of Rovereto, Trento, Italy
| | | | | | - Thomas W Rice
- Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Giovanni de Manzoni
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
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18
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Degiuli M, De Manzoni G, Di Leo A, D’Ugo D, Galasso E, Marrelli D, Petrioli R, Polom K, Roviello F, Santullo F, Morino M. Gastric cancer: Current status of lymph node dissection. World J Gastroenterol 2016; 22:2875-2893. [PMID: 26973384 PMCID: PMC4779911 DOI: 10.3748/wjg.v22.i10.2875] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/09/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023] Open
Abstract
D2 procedure has been accepted in Far East as the standard treatment for both early (EGC) and advanced gastric cancer (AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials (RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council (MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recurrence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC.
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Verlato G, Marrelli D, Accordini S, Bencivenga M, Di Leo A, Marchet A, Petrioli R, Zoppini G, Muggeo M, Roviello F, de Manzoni G. Short-term and long-term risk factors in gastric cancer. World J Gastroenterol 2015; 21:6434-43. [PMID: 26074682 PMCID: PMC4458754 DOI: 10.3748/wjg.v21.i21.6434] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/28/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
While in chronic diseases, such as diabetes, mortality rates slowly increases with age, in oncological series mortality usually changes dramatically during the follow-up, often in an unpredictable pattern. For instance, in gastric cancer mortality peaks in the first two years of follow-up and declines thereafter. Also several risk factors, such as TNM stage, largely affect mortality in the first years after surgery, while afterward their effect tends to fade. Temporal trends in mortality were compared between a gastric cancer series and a cohort of type 2 diabetic patients. For this purpose, 937 patients, undergoing curative gastrectomy with D1/D2/D3 lymphadenectomy for gastric cancer in three GIRCG (Gruppo Italiano Ricerca Cancro Gastrico = Italian Research Group for Gastric Cancer) centers, were compared with 7148 type 2 diabetic patients from the Verona Diabetes Study. In the early/advanced gastric cancer series, mortality from recurrence peaked to 200 deaths per 1000 person-years 1 year after gastrectomy and then declined, becoming lower than 40 deaths per 1000 person-years after 5 years and lower than 20 deaths after 8 years. Mortality peak occurred earlier in more advanced T and N tiers. At variance, in the Verona diabetic cohort overall mortality slowly increased during a 10-year follow-up, with ageing of the type 2 diabetic patients. Seasonal oscillations were also recorded, mortality being higher during winter than during summer. Also the most important prognostic factors presented a different temporal pattern in the two diseases: while the prognostic significance of T and N stage markedly decrease over time, differences in survival among patients treated with diet, oral hypoglycemic drugs or insulin were consistent throughout the follow-up. Time variations in prognostic significance of main risk factors, their impact on survival analysis and possible solutions were evaluated in another GIRCG series of 568 patients with advanced gastric cancer, undergoing curative gastrectomy with D2/D3 lymphadenectomy. Survival curves in the two different histotypes (intestinal and mixed/diffuse) were superimposed in the first three years of follow-up and diverged thereafter. Likewise, survival curves as a function of site (fundus vs body/antrum) started to diverge after the first year. On the contrary, survival curves differed among age classes from the very beginning, due to different post-operative mortality, which increased from 0.5% in patients aged 65-74 years to 9.9% in patients aged 75-91 years; this discrepancy later disappeared. Accordingly, the proportional hazards assumption of the Cox model was violated, as regards age, site and histology. To cope with this problem, multivariable survival analysis was performed by separately considering either the first two years of follow-up or subsequent years. Histology and site were significant predictors only after two years, while T and N, although significant both in the short-term and in the long-term, became less important in the second part of follow-up. Increasing age was associated with higher mortality in the first two years, but not thereafter. Splitting survival time when performing survival analysis allows to distinguish between short-term and long-term risk factors. Alternative statistical solutions could be to exclude post-operative mortality, to introduce in the model time-dependent covariates or to stratify on variables violating proportionality assumption.
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Di Leo A, Pedrazzani C, Bencivenga M, Coniglio A, Rosa F, Morgani P, Marrelli D, Marchet A, Cozzaglio L, Giacopuzzi S, Tiberio GAM, Doglietto GB, Vittimberga G, Roviello F, Ricci F. Gastric stump cancer after distal gastrectomy for benign disease: clinicopathological features and surgical outcomes. Ann Surg Oncol 2014; 21:2594-600. [PMID: 24639193 DOI: 10.1245/s10434-014-3633-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of the present study was to analyze clinicopathologic features and long-term prognosis of gastric stump cancer (GSC) arising in the remnant stomach 5 years or later after partial gastrectomy for benign disease. METHODS We reviewed the results of 176 patients resected with curative intent for GSC at 8 Italian centers belonging to the Italian Research Group for Gastric Cancer (GIRCG). The median (range) follow-up time for surviving patients was 71.2 (6-207) months. RESULTS One hundred forty-six patients were men, the mean age at the time of diagnosis was 69.2 years, and the great majority (167 cases) underwent Billroth II reconstruction. R0 resection was achieved in 158 (90 %) patients, and in 94 (53 %) lymph node dissection was ≥D2. Postoperative mortality and complication rates were 6.2 and 43.2 %, respectively. T1 tumor was diagnosed in 45 (25 %) cases. Lymph node metastases were evident in 86 patients (49 %). Thirteen patients had involvement of the jejunal mesentery nodes (pJN+); five cases were T2-T3 and eight cases were T4. Overall 5-year survival rate was 53.1 %. Five-year survival rates were 68.1, 37.8, and 33.1 % for pT1, pT2-3, and pT4 tumors, respectively (P = 0.001). Five-year survival rate was 56.5 % for node-negative tumors (pN0), 32.3 % for tumors with nodal metastases without involvement of jejunal mesentery nodes (pN+), and 17.1 % for tumors with involvement of jejunal mesentery nodes (pJN+) (P = 0.002). CONCLUSIONS Our study suggests that an aggressive surgical approach can achieve a satisfactory outcome in GSC.
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Affiliation(s)
- Alberto Di Leo
- Unit of General Surgery, Rovereto Hospital, APSS of Trento, Trento, Italy,
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21
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Baiocchi GL, Marrelli D, Verlato G, Morgagni P, Giacopuzzi S, Coniglio A, Marchet A, Rosa F, Capponi MG, Di Leo A, Saragoni L, Ansaloni L, Pacelli F, Nitti D, D'Ugo D, Roviello F, Tiberio GAM, Giulini SM, De Manzoni G. Follow-up after gastrectomy for cancer: an appraisal of the Italian research group for gastric cancer. Ann Surg Oncol 2014; 21:2005-11. [PMID: 24526547 DOI: 10.1245/s10434-014-3534-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Italian Research Group for Gastric Cancer supports the practice of follow-up after radical surgery for gastric cancer. METHODS This multicenter, retrospective study (1998-2009) included patients with T1-4N0-3M0 gastric cancer who had undergone D2 gastrectomy and lymphadenectomy, with at least 15 lymph nodes examined, and who had developed recurrent disease. Timing and site of recurrence were correlated to the actual scheduled follow-up timing and modalities. RESULTS From eight centers, 814 patients with recurrent cancer and over 1,754 (46.4 %) patients undergoing gastrectomy were investigated (median follow-up 31 months). The most frequent sites of recurrence were local/regional lymph nodes (35.4 %), liver (24.3 %), peritoneum (30.3 %), lung (10.4 %) and intraluminal (7.5 %). Ninety-four percent of the recurrences were diagnosed within 2 years and 98 % within 3 years. Thoracoabdominal computed tomography (CT) scan and (18)F-fluoro-2-deoxy-D-glucose positron emission tomography (18-FDG-PET) detected more than 90 % of recurrences, abdominal ultrasound detected 70 % and tumor markers detected 40 %, while <10 % were identified by physical examination, chest X-ray, and upper gastrointestinal endoscopy. Twenty-six percent of patients with recurrence were treated, but only 3.2 % were treated with potentially radical intent. CONCLUSION Oncological follow-up after radical surgery for gastric cancer should be focused in the first 3 years, and based mainly on thoracoabdominal CT scan and 18-FDG-PET.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, Brescia University, Brescia, Italy,
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22
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de Manzoni G, Di Leo A. Esophageal Cancer Surgery: The Importance of Hospital Volume. Updates Surg 2012. [DOI: 10.1007/978-88-470-2330-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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23
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de Manzoni G, Di Leo A, Roviello F, Marrelli D, Giacopuzzi S, Minicozzi AM, Verlato G. Tumor site and perigastric nodal status are the most important predictors of para-aortic nodal involvement in advanced gastric cancer. Ann Surg Oncol 2011; 18:2273-80. [PMID: 21286941 DOI: 10.1245/s10434-010-1547-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study was designed to identify pathological predictors of para-aortic nodal invasion in advanced gastric cancer. METHODS Between 1990 and 2007, 294 patients with advanced gastric cancer underwent gastrectomy with D2 lymphadenectomy + para-aortic nodal dissection in Siena and Verona, Italy. RESULTS Forty-seven (16%) patients had para-aortic node metastases. Of these, 91%, 88%, and 74%, respectively, also had metastases at stations No. 3, No. 1, and No. 7. Para-aortic node metastases were never observed when stations No. 1 and No. 3 were both negative. Patients were divided into three groups, according to the risk of para-aortic node invasion: (1) high-risk group (n = 24, 8.2%), presenting a 42% risk and comprising T3/T4 cancers with mixed/nonintestinal histology, arising from the upper third; (2) low-risk group (n = 138, 46.9%), presenting a 0-10% risk and including middle-lower third tumors-either T2 irrespective of histology, or T3/T4 with intestinal histology; (3) intermediate-risk group, comprising all other patients (n = 132, 44.9%). Their risk ranged between 16% and 30%, but increased up to 21-37.5% after excluding 33 patients with negative No. 1 and No. 3 stations. CONCLUSIONS The combination of tumor site, histology, and T stage with perigastric nodal status allowed identification of patients at higher risk of para-aortic nodal invasion who could benefit from para-aortic nodal dissection.
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Di Leo A, Piffer S, Ricci F, Manzi A, Poggi E, Porretto V, Fambri P, Piccini G, Patrizia T, Fabbri L, Busetti R. Surgical Site Infections in an Italian Surgical Ward: A Prospective Study. Surg Infect (Larchmt) 2009; 10:533-8. [DOI: 10.1089/sur.2009.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Alberto Di Leo
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Silvano Piffer
- Department of Epidemiology, APSS of Trento, Trento, Italy
| | - Francesco Ricci
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Alberto Manzi
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Elena Poggi
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Vincenzo Porretto
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Paolo Fambri
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Giannina Piccini
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Trentini Patrizia
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Luca Fabbri
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Rosanna Busetti
- Laboratory of Clinical Pathology, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
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Di Leo A, Busetti R, Pusiol T, Piscioli F, Franceschetti I, Ricci F. Intestinal obstruction associated with chronic peritonitis caused by Sphingomonas paucimobilis. Clin J Gastroenterol 2009; 2:178-182. [PMID: 26192291 DOI: 10.1007/s12328-009-0066-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 01/23/2009] [Indexed: 11/25/2022]
Abstract
We describe a very rare case of chronic peritonitis with secondary adhesive intestinal obstruction caused by Sphingomonas paucimobilis in a healthy 28-year-old Chinese man. This bacillus has not been described as a cause of spontaneous peritonitis in healthy people. It was an asymptomatic, generalized, and slow-growing peritonitis causing peritoneal adherens and at the end intestinal occlusion that needed surgical adhesiolysis.
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Affiliation(s)
- Alberto Di Leo
- Operative Unit of Surgery, APSS of Trento, Arco Hospital, Via Capitelli 50/52, 38062, Arco (TN), Italy.
| | - Rosanna Busetti
- Laboratory of Clinical Pathology, APSS of Trento, Arco Hospital, Arco (TN), Italy
| | - Teresa Pusiol
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Francesco Piscioli
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Ilaria Franceschetti
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Francesco Ricci
- Operative Unit of Surgery, APSS of Trento, Arco Hospital, Via Capitelli 50/52, 38062, Arco (TN), Italy
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26
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Di Leo A, Marrelli D, Roviello F, Bernini M, Minicozzi A, Giacopuzzi S, Pedrazzani C, Baiocchi LG, de Manzoni G. Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg 2007; 11:1146-53. [PMID: 17576611 DOI: 10.1007/s11605-006-0062-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of lymphadenectomy is to clear all the metastatic nodes achieving a complete removal of the tumor; nevertheless, its role in gastric cancer has been very much debated. MATERIALS AND METHODS The frequency of node metastasis in each lymphatic station according to the International Gastric Cancer Association, was studied in 545 patients who underwent D2 or D3 lymphadenectomy from June 1988 to December 2002. RESULTS Upper third early cancers have shown an involvement of N2 celiac nodes in 25%. In advanced cancers, there was a high frequency of metastasis in the right gastroepiploic (from 10% in T2 to 50% in T4) and in the paraaortic nodes (26% in T2, 32% in T3, 38 % in T4). N3 left paracardial nodes involvement was observed in an important share of middle third tumors (17% in T3, 36% in T4). Splenic hilum nodes metastasis were common in T3 and T4 cancers located in the upper (39%) and middle (17%) stomach. N2 nodal involvement was frequent in lower third advanced cancers. Metastasis in M left paracardial and short gastric nodes were observed in a small percentage of cases. CONCLUSION Given the nodal diffusion in our gastric cancer patients, extended lymphadenectomy is still a rationale to obtain radical resection.
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Affiliation(s)
- Alberto Di Leo
- First Division of General Surgery, University of Verona, Verona, Italy.
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27
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Morgagni P, Garcea D, Marrelli D, de Manzoni G, Natalini G, Kurihara H, Marchet A, Vittimberga G, Saragoni L, Roviello F, Di Leo A, De Santis F, Panizza V, Nitti D. Does Resection Line Involvement Affect Prognosis in Early Gastric Cancer Patients? An Italian Multicentric Study. World J Surg 2006; 30:585-9. [PMID: 16547613 DOI: 10.1007/s00268-005-7975-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Resection line involvement has been indicated as an important prognostic factor for gastric cancer. Its late detection renders the choice of treatment difficult for surgeons. MATERIALS AND METHODS We describe the multicenter experience of a group of 11 patients with early gastric carcinoma (EGC) and positive resection confirmed at histological examination who did not undergo surgical retreatment for reasons of associated disease, surgical considerations on duodenal stump, or patient refusal. RESULTS The gastric margin was involved in 4 patients, and 7 patients had duodenal resection line involvement. No surgical complications or postoperative deaths were observed. Five and 8-year survival was 100% and 86%, respectively. The only patient who relapsed did not have lymph node involvement and died from liver metastases, without local recurrence. CONCLUSIONS It is sometimes difficult to accurately define the resection line in gastric cancer surgery, especially in the early stages of disease, but because of the strongly negative prognostic value of an infiltrated margin, frozen sections are recommended if neoplastic invasion is suspected and a new resection is always recommended if possible. Nevertheless, the good prognosis of resected EGC patients with resection line involvement must be considered before submitting patients with associated diseases to radical surgical retreatment.
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Affiliation(s)
- Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, 47100, Italy.
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Marrelli D, De Stefano A, de Manzoni G, Morgagni P, Di Leo A, Roviello F. Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from a prospective multicenter study. Ann Surg 2005; 241:247-55. [PMID: 15650634 PMCID: PMC1356909 DOI: 10.1097/01.sla.0000152019.14741.97] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this prospective multicenter study was to define a scoring system for the prediction of tumor recurrence after potentially curative surgery for gastric cancer. SUMMARY BACKGROUND DATA The estimation of the risk of recurrence in individual patient may be relevant in clinical practice, to apply adjuvant therapies after surgery, and plan an adequate follow-up program. Only a few studies, most of which were retrospective or performed on a limited number of patients, have developed a prognostic score in patients with gastric cancer. METHODS A total of 536 patients who underwent UICC R0 resection between 1988 and 1998 at 3 surgical departments in Italy were considered. All patients were followed up using a standard protocol after discharge from the hospital. The mean follow-up period was 56 +/- 44 months, and 94 +/- 29 months for surviving patients. The scoring system was calculated on the basis of a logistic regression model, where the presence of the recurrence was the dependent variable, and clinicopathologic variables were the covariates. RESULTS Recurrence occurred in 272 of 536 patients (50.7%). The scoring system for the prediction of the risk in individual cases gave values ranging from 1.4 to 99.9; the model distributed most cases in the extremes of the range. The risk of recurrence increased remarkably with score values; it was only 5% in patients with a score below 10, up to 95.4% in patients with a score of 91 to 100. No recurrence was observed in 43 patients with a score below 4, whereas all of the 56 patients with a score over 97 presented a recurrence. The model correctly predicted recurrence in 227 of 272 patients (sensitivity, 83.5%), whereas the absence of recurrence was correctly predicted in 214 of 264 patients (specificity, 81.1%); the overall accuracy was 82.2%. Prognostic score was clearly superior to UICC tumor stage in predicting recurrence. The high effectiveness of the score was confirmed in preliminary data of a validation study. CONCLUSIONS The scoring system obtained with a regression model on the basis of our follow-up data is useful for defining subgroups of patients at a very low or very high risk of tumor recurrence after radical surgery for gastric cancer. Final results of the validation study are essential for a clinical application of the model.
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Affiliation(s)
- Daniele Marrelli
- Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
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29
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De Manzoni G, Verlato G, Roviello F, Di Leo A, Marrelli D, Morgagni P, Pasini F, Saragoni L, Tomezzoli A. Subtotal versus total gastrectomy for T3 adenocarcinoma of the antrum. Gastric Cancer 2004; 6:237-42. [PMID: 14716518 DOI: 10.1007/s10120-003-0261-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Accepted: 09/17/2003] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of subtotal or total gastrectomy in the treatment of advanced gastric cancer of the antrum with serosal invasion was investigated. METHODS The investigation involved 117 patients with a cancer of the lower third of the stomach invading the serosa (pT3) who underwent R0 resection with at least D2 lymphadenectomy between 1988 and 1998 at three different Italian centers. The choice of surgical procedure (40 total gastrectomies and 77 subtotal gastrectomies) was based on the preference of the surgeon; none of the patients underwent splenectomy. The Cox regression model was used to evaluate the prognostic significance of the type of surgery (subtotal versus total gastrectomy), controlling for age, sex, histology, nodal involvement, and surgical center. RESULTS The morbidity and mortality rates did not vary significantly according to the type of surgery. Patients undergoing subtotal gastrectomy presented a better disease-related survival than patients undergoing total gastrectomy ( P = 0.011): the median survival times were, respectively, 38 months and 23 months, and the overall cumulative 5-year survival rates (95% confidence intervals [CI]) were, respectively, 36% (22%-50%) and 22% (11%-37%). On univariate analysis, the relative risk (RR) of disease-related death was 1.84 (1.14-2.97) after total gastrectomy, with respect to subtotal gastrectomy. This difference was blunted on multivariate analysis (RR, 1.66; 0.99-2.78): in the final model, only nodal metastasis was a significant prognostic factor, while type of surgery had a borderline significance ( P = 0.057). CONCLUSIONS Survival after subtotal gastrectomy is not lower than that after total gastrectomy in patients with tumor of the antrum invading the serosa. The role of subtotal or total gastrectomy in the treatment of advanced gastric cancer of the antrum with serosal invasion was investigated.
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Roviello F, Marrelli D, Morgagni P, De Manzoni G, Di Leo A, Vindigni C, Nastri G, Saragoni L, Tomezzoli A, Kurihara H, De Stefano A. [Benefits of extended lymphadenectomy in patients with gastric carcinoma with metastasis to second level lymph nodes. An Italian multicenter study]. Chir Ital 2003; 55:491-8. [PMID: 12938593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The actual benefit of extended lymphadenectomy in terms of survival in the surgical treatment of gastric cancer is still a debated issue. The aim of this non-randomized prospective multicentre study was to evaluate long-term survival in a group of patients with involvement of the second level lymph nodes, which would not have been removed with a limited lymphadenectomy. From 1991 to 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy in three italian surgical departments. Lymph node stations were removed and classified according to the rules of the Japanese Research Society for Gastric Cancer; in all cases, retrieval of the lymph nodes was performed by the surgeon on the fresh specimen. Metastases to lymph node stations 7-12 were found in 126 patients out of 451 (27.9%). A mean number of 13 +/- 9 positive lymph nodes (range: 1-42) was found in these cases. Lymph node stations 7 and 8 showed the highest incidence of metastases (61.1% and 44.4%, respectively). Morbidity and mortality rates were 17.1% and 2% in 451 cases treated by extended lymphadenectomy, and 21.4% and 3.2%, respectively, in 126 cases with involvement of second level lymph nodes. In this group of patients, the five-year survival rate was 32 +/- 4%. Multivariate analysis, identified depth of invasion (P < 0.0001, relative risk (RR) 2.4) and the number of positive lymph nodes (P < 0.001, RR 1.6) as significant predictors of a poor prognosis. Japanese-type extended lymphadenectomy is associated with low morbidity and mortality rates if performed in specialised centres. The incidence of metastases in lymph node stations removed with this technique is by no means negligible. This procedure could be beneficial as regards long-term survival even in patients with involvement of regional lymph nodes.
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Affiliation(s)
- Franco Roviello
- U.O. Chirurgia Oncologica Dipartimento di Patologia Umana e Oncologia, Università di Siena
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Zerman G, Bonfiglio M, Borzellino G, Guglielmi A, Tasselli S, Valloncini E, Di Leo A, de Manzoni G. Liver abscess due to acute cholecystitis. Report of five cases. Chir Ital 2003; 55:195-8. [PMID: 12744093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Acute cholecystitis is one of the most frequent causes of admissions to surgical departments. The development of liver abscesses is an uncommon and underrated complication of acute cholecystitis. In this study we report on our experience with the treatment of 5 cases of liver abscesses secondary to acute cholecystitis. All 5 cases were characterised by a lengthy period between the onset of acute cholecystitis symptoms and the subsequent diagnosis of a secondary liver abscess. In 4 out of 5 patients, admission for liver abscess occurred 12, 30, 50 and 120 days, respectively, after the acute cholecystitis episode. The liver abscesses were successfully treated with percutaneous drainage under US guidance (4 cases) and 4 patients underwent percutaneous cholecystostomy to treat the acute cholecystitis. After resolution of the acute phase, an elective cholecystectomy was performed in 4 out of 5 cases. Failure to diagnose acute cholecystitis at onset or inappropriate treatment of the condition could lead to the development of liver abscesses.
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Affiliation(s)
- Germana Zerman
- I Divisione Clinicizzata di Chirurgia Generale, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Verona
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Roviello F, Marrelli D, Morgagni P, de Manzoni G, Di Leo A, Vindigni C, Saragoni L, Tomezzoli A, Kurihara H. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg Oncol 2003. [PMID: 12417512 DOI: 10.1245/aso.2002.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The survival benefit of extended lymphadenectomy in the surgical treatment of gastric cancer is still being debated. The aim of this longitudinal multicenter study was to evaluate long-term survival in a group of patients with involvement of second level lymph nodes, which would not have been removed in the case of a limited lymphadenectomy. Results were compared with those in patients with involvement of first level lymph nodes. METHODS Between 1991 and 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy at three surgical departments in Italy according to the rules of the Japanese Research Society for Gastric Cancer. RESULTS In 451 cases treated by extended lymphadenectomy, morbidity and mortality rates were 17.1% and 2%, respectively. In 126 patients (27.9%) (group A), metastases were found in lymph node stations 7 to 12; 109 patients (24.2%) had metastases confined to the first level (group B). Lymph node stations 7 and 8 showed the highest incidence of metastases in the second level (17.1% and 12.4%, respectively). A significant difference in 5-year survival was observed between group A and group B (32% vs. 54%; P =.0005). This difference disappeared when cases were stratified according to the number of positive lymph nodes. By multivariate analysis, only the number of positive lymph nodes (relative risk, 1.8; P <.0001) and the depth of invasion (relative risk, 2.1; P <.0001), but not the level of involved nodes, showed to be independent predictors of poor prognosis. CONCLUSIONS Japanese-type extended lymphadenectomy yields low morbidity and mortality rates if performed in specialized centers. This procedure could provide a good probability of long-term survival, even for patients with involvement of regional lymph nodes.
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Roviello F, Marrelli D, Morgagni P, de Manzoni G, Di Leo A, Vindigni C, Saragoni L, Tomezzoli A, Kurihara H. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg Oncol 2002; 9:894-900. [PMID: 12417512 DOI: 10.1007/bf02557527] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The survival benefit of extended lymphadenectomy in the surgical treatment of gastric cancer is still being debated. The aim of this longitudinal multicenter study was to evaluate long-term survival in a group of patients with involvement of second level lymph nodes, which would not have been removed in the case of a limited lymphadenectomy. Results were compared with those in patients with involvement of first level lymph nodes. METHODS Between 1991 and 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy at three surgical departments in Italy according to the rules of the Japanese Research Society for Gastric Cancer. RESULTS In 451 cases treated by extended lymphadenectomy, morbidity and mortality rates were 17.1% and 2%, respectively. In 126 patients (27.9%) (group A), metastases were found in lymph node stations 7 to 12; 109 patients (24.2%) had metastases confined to the first level (group B). Lymph node stations 7 and 8 showed the highest incidence of metastases in the second level (17.1% and 12.4%, respectively). A significant difference in 5-year survival was observed between group A and group B (32% vs. 54%; P =.0005). This difference disappeared when cases were stratified according to the number of positive lymph nodes. By multivariate analysis, only the number of positive lymph nodes (relative risk, 1.8; P <.0001) and the depth of invasion (relative risk, 2.1; P <.0001), but not the level of involved nodes, showed to be independent predictors of poor prognosis. CONCLUSIONS Japanese-type extended lymphadenectomy yields low morbidity and mortality rates if performed in specialized centers. This procedure could provide a good probability of long-term survival, even for patients with involvement of regional lymph nodes.
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Marrelli D, Roviello F, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, De Stefano A, Folli S, Cordiano C, Pinto E. Different patterns of recurrence in gastric cancer depending on Lauren's histological type: longitudinal study. World J Surg 2002; 26:1160-5. [PMID: 12209247 DOI: 10.1007/s00268-002-6344-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this multicenter longitudinal study was to evaluate the pattern of recurrence in patients submitted to potentially curative surgery for intestinal-type and diffuse-type gastric cancer. The study included 412 patients surgically treated at three Italian surgical departments, subdivided into 273 intestinal-type cases (group A) and 139 diffuse-type cases (group B). Recurrence of disease was found in 41% of group A cases and 65% of group B cases (p < 0.0001). The incidence of locoregional, hematogenous, and peritoneal recurrence was 20%, 19%, and 9% in group A, and 27%, 16%, and 34% in group B, respectively; the difference between the two groups was statistically significant for peritoneal recurrence (p < 0.0001). Multivariate analysis identified as prognostic variables lymph node status, depth of invasion, extent of lymphadenectomy, advanced age, and male gender in group A; depth of invasion, extent of lymphadenectomy, tumor size, and lymph node status, in group B. Whereas in group A the incidence of peritoneal recurrence was limited in all subgroups examined, in group B very high rates were observed in cases with infiltration of the serosa, involvement of second-level lymph nodes, or large tumor size. The notable difference in the risk of peritoneal recurrence between the intestinal and diffuse types should be taken into consideration in the therapeutic approach to gastric cancer.
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Affiliation(s)
- Daniele Marrelli
- Chirurgia Oncologica, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
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Cenni E, Granchi D, Ciapetti G, Savarino L, Vancini M, Leo AD. Effect of CMW 1 bone cement on transforming growth factor-beta 1 expression by endothelial cells. J Biomater Sci Polym Ed 2002; 12:1011-25. [PMID: 11787519 DOI: 10.1163/156856201753252534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The present study examined the effects of in vitro challenge with an acrylic bone cement CMW 1 on the expression of transforming growth factor-beta 1 (TGF-beta 1) in human umbilical vein endothelial cells (HUVEC). The extracts in cell culture medium of the cements were tested, after 1 h and 7-day curing. Some cultures were also stimulated with interleukin-1 beta (IL-1 beta) or all-trans retinoic acid (ATRA). The expression of mRNA was evaluated by RT-PCR with specific primers. The release of TGF-beta 1 into the conditioned medium was evaluated by enzyme immunoassay. TGF-beta 1 mRNA was constitutively expressed by endothelial cells in the culture medium after 24 h. The incubation with the extracts of CMW 1, cured both for 1 h and 7 days, induced changes neither in mRNA expression, nor in the release of TGF-beta 1 into the conditioned medium, compared to the unstimulated cells. Even stimulation with ATRA, alone or added to the extracts at both curing times, affected neither mRNA expression nor TGF-beta 1 release, compared to the cells incubated with the cement alone or with the unstimulated cultures. The mRNA expression and the release were not changed by the stimulation with IL-1beta alone or added to the extract cured for 1 h. A significant decrease compared to the unstimulated cells was observed after the addition of IL-1 beta to the extract cured for 7 days. It was concluded that CMW 1 extract did not significantly modify TGF-beta 1 expression after 1-h curing, or after 7-day curing. Incubation with CMW 1 added with ATRA did not produce any changes in TGF-beta 1 synthesis. Incubation with cement extract after 7-day curing added with IL-beta 1 produced a significant reduction in TGF-beta 1 release.
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Affiliation(s)
- E Cenni
- Laboratorio di Fisiopatologia degli Impianti Ortopedici, Istituti Ortopedici Rizzoli, Bologna, Italy.
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Abstract
BACKGROUND Comparison among different studies regarding adenocarcinoma of the cardia has been difficult since the Siewert classification was introduced. This study analyzed the experience of a single institution in the treatment of gastric cardia cancer with the aim of assessing principal prognostic factors and long-term outcome. METHODS The results of 96 patients who underwent resection with curative intent for gastric cardia cancer at the First Division of General Surgery, University of Verona, from January 1988 to February 2000, were analyzed statistically with special reference to Siewert type. RESULTS Despite a high number of curative resections (85.4%), the 5-year survival rate was poor (24%) for all Siewert types (p = 0.8), and for early tumors (51%) also. Chance of cure was limited to pN0 and pN1 patients. Multivariate analysis showed that microscopic or macroscopic residual tumor and pN-positive categories had a significantly higher risk of death (risk ratio, 2.18 and 2.68, respectively) and the pN2 and pN3 category had the most negative prognostic factor (risk ratio, 7.6). CONCLUSIONS The long-term prognosis for gastric cardia cancer remains poor and is independent of Siewert type, with cure limited to pN0 and pN1 patients.
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de Manzoni G, Di Leo A, Tomezzoli A, Pedrazzani C, Piubello Q, Bonfiglio M, Valloncini E, Veraldi GF. [Prognostic value of peritoneal lavage cytology in gastric cancer]. Chir Ital 2002; 54:1-6. [PMID: 11941998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The microscopic detection of free peritoneal tumour cells in peritoneal lavage fluid in gastric cancer patients is a useful predictor of peritoneal recurrence and poor prognosis. The aim of this study was to verify the prognostic significance of intraoperative peritoneal lavage cytology and its value as a predictor of peritoneal recurrence. We evaluated the presence of free peritoneal tumour cells with extemporary cytological examination in a series of 170 peritoneal washing samples from patients undergoing gastrectomy for gastric cancer over the period from January 1992 to June 2001. Twenty-eight patients (16%) had positive extemporary lavage cytology and there were no false-negatives as compared with the final examination. All patients with positive cytology presented serosal infiltration (T3/T4). Positive peritoneal lavage cytology was a predictor of poor prognosis and peritoneal recurrence: the 24 month survival rate was 17% for positive and 60% for negative cases (P = 0.003); in positive cases 71% of recurrences were located in the peritoneum. Intraoperative cytological examination of peritoneal washings can detect the presence of free malignant cells in the peritoneal cavity and can be used to select patients who may benefit from intraperitoneal chemotherapy.
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Affiliation(s)
- Giovanni de Manzoni
- Divisione Clinicizzata di Chirurgia Generale, Università di Verona, Ospedale Civile Maggiore, 37126 Verona
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Awada A, Leo AD, Piccart MJ. [Therapeutic update on cancer of the breast]. Bull Cancer 2000; 87:49-62. [PMID: 10673632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- A Awada
- Unité de chimiothérapie, institut Jules-Bordet, centre des tumeurs de l'université libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
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de Manzoni G, Morgagni P, Roviello F, Di Leo A, Saragoni L, Marrelli D, Guglielmi A, Carli A, Folli S, Cordiano C. Nodal abdominal spread in adenocarcinoma of the cardia. Results of a multicenter prospective study. Gastric Cancer 1998; 1:146-151. [PMID: 11957059 DOI: 10.1007/s101200050009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND: Precise knowledge of the abdominal nodal spread of cardia adenocarcinoma in relation to the depth of invasion of the tumor and its longitudinal extension may be very important for the surgeon as a guide in choosing the type of resection and lymphadenectomy.METHODS: The frequency of node metastases in each abdominal station of the first and second tier was prospectively studied in 101 patients with type II and III cardia cancer (defined as approved by the consensus conference held during the second International Gastric Cancer Conference in Munich in April, 1997) who underwent total gastrectomy with D2 lymphadenectomy during the period January 1994 to April 1998. Lymph nodes were retrieved immediately after operation by the surgeon and assigned to the appropriate station according to the classification of the Japanese Research Society for Gastric Cancer.RESULTS: In early gastric cancer, of both type II and type III, lymph node involvement was limited to the perigastric nodes of the upper half of the stomach and to the lymph node station of the celiac trunk. In advanced cancers, whether of type II or type III, there was a fairly high frequency of metastases to the perigastric nodes of the lower half of the stomach; there was also high frequency of metastases at N2 stations, without differences in frequency between pT2 and pT3 tumors (staged according to the classification of the Japanese Research Society for Gastric Cancer).CONCLUSIONS: The results of our study provide evidence for the need to perform a total gastrectomy with D2 lymphadenectomy in all patients with advanced cardia cancer type II or type III. In early cancers, a less extensive resection (proximal gastrectomy) with D2 lymphadenectomy may be indicated.
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Affiliation(s)
- Giovanni de Manzoni
- Istituto di Semeiotica Chirurgica, 1a Divisione Clinicizzata di Chirurgia Generale, Università di Verona, Ospedale Civile Maggiore, Piazzale Stefani, 1 Verona, Italy
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