Publications by authors named "Andrea Polistena"

73 Publications

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project.

World J Emerg Surg 2021 Jul 2;16(1):35. Epub 2021 Jul 2.

UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy.

Background And Aims: Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients.

Methods: The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations.

Conclusions: The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.
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http://dx.doi.org/10.1186/s13017-021-00378-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254305PMC
July 2021

Robotic Transanal Total Mesorectal Excision (RTaTME): State of the Art.

J Pers Med 2021 Jun 21;11(6). Epub 2021 Jun 21.

Department of General and Robotic Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, 06034 Foligno, Italy.

Total mesorectal excision (TME) is the gold standard technique for the surgical management of rectal cancer. The transanal approach to the mesorectum was introduced to overcome the technical difficulties related to the distal rectal dissection. Since its inception, interest in transanal mesorectal excision has grown exponentially and it appears that the benefits are maximal in patients with mid-low rectal cancer where anatomical and pathological features represent the greatest challenges. Current evidence demonstrates that this approach is safe and feasible, with oncological and functional outcome comparable to conventional approaches, but with specific complications related to the technique. Robotics might potentially simplify the technical steps of distal rectal dissection, with a shorter learning curve compared to the laparoscopic transanal approach, but with higher costs. The objective of this review is to critically analyze the available literature concerning robotic transanal TME in order to define its role in the management of rectal cancer and to depict future perspectives in this field of research.
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http://dx.doi.org/10.3390/jpm11060584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233761PMC
June 2021

An unusual case of genital filariasis of the testicular tunics in an Italian patient.

Ann Saudi Med 2021 May-Jun;41(3):186-189. Epub 2021 Jun 1.

From the Department of Surgery Pietro Valdoni, Umberto I Policlinico, Roma, Italy.

At least 27 million men present with urogenital manifestations of genital filariasis (GF). Although there is a large burden of GF in residents in endemic regions, infection in short-term travellers and in non-endemic areas is rare. We report the case of a 75-year-old Italian man referred to our institution for a testicular discomfort. Clinical examination and ultrasound detected a mass of 40×18 mm in the scrotum without signs of varicocele, hydrocele and testicular or epididymal abnormalities. After ineffective medical treatment, the patient underwent surgical excision. Histology demonstrated filarial granuloma with thick cuticles pathognomonic of an adult worm in the testicular tunics. Surgery has a fundamental role in localized cases of GF to remove nematodes from the fibrotic nodules. The present manuscript describes a singular case of GF observed in Italy in a non-immigrant patient with evidence of remnants of an adult worm in the testicular tunics. SIMILAR CASES PUBLISHED: 11.
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http://dx.doi.org/10.5144/0256-4947.2021.186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176374PMC
June 2021

Metastases to the breast. A clinical series from a single institution experience with review of the literature.

Ann Ital Chir 2021 ;92:141-148

Introduction: Breast metastases although rare are challenging for diagnostic difficulties and management. Treatment differs according to morphological, immunophenotipycal and biologic features of the primary tumor and their general behaviour is extremely different compared to primary breast cancer. The most frequent primary tumors include melanoma, lymphomas, gynecological, pulmonary, head and neck, gastroenteric and urinary tract cancers. Patient's prognosis is poor being generally associated to disseminated systemic disease with limited survival despite the effects of systemic treatment.

Patients And Methods: We report the analysis of the diagnostic and therapeutic approach on the institutional experience of four cases of breast metastases originating from melanoma, pulmonary adenocarcinoma and differentiated thyroid carcinomas.

Conclusions: The management of breast secondarisms requires focused diagnosis and evaluation in order to provide an adequate treatment with a multidisciplinary approach especially when the primary tumor is unknown.

Key Words: Breast metastases, Melanoma, Pulmonary, Thyroid.
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January 2021

Ischemic colitis with non-gangrenous, stenotic evolution following hemorrhagic shock A case report and review of the literature.

Ann Ital Chir 2021 Mar 16;10. Epub 2021 Mar 16.

Introduction: Ischemic colitis (IC) accounts for more of the half of total diagnosis of gastrointestinal ischemia. It is a challenging condition due to non-specificity of the symptoms at onset, inconstant behaviour and a wide range of clinical gravity with a different therapeutic approach. A classification of IC into gangrenous, stricturing and transient forms can be considered.

Case Report: In the presented case, due to hypovolemic hemorrhagic shock, the patient developed a progressive IC without gangrene but slowly evolving in multiple colonic strictures with general serious clinical condition. Endoscopy was used to confirm diagnosis and to tempt a pneumatic stricture dilation which resulted ineffective. A diverting stoma was required and an elective subtotal colectomy was carried out after resolution of the acute phase.

Conclusions: IC may present with a large spectrum of clinical conditions. In acute shocked patients it must be always considered when a complicated abdominal picture is present. Immediate surgery is not always required considering the spontaneous resolutions of the milder forms. Strictures are the most frequent evolution following the intermediate nongangrenous presentation and initially they can be treated conservatively with postponed tailored resection after the healing of the diffuse mucosal injuries.

Key Words: Ischemic, colitis, Shock, Stricture.
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March 2021

Role of Leptin in Neoplastic and Biliary Tree Disease.

In Vivo 2020 Sep-Oct;34(5):2485-2490

Department of Surgery "Pietro Valdoni", Policlinico Umberto I, Università degli studi "La Sapienza", Rome, Italy

Background/aim: Leptin is a small hormone of protein nature, it is strongly involved in the regulation of lipid metabolism and its functioning mechanism is not yet well known or whether or not it is actually secreted by cholangiocytes, nor if the biliary tree expresses its receptors. In the past, various studies have tried to correlate leptin levels with certain neoplasms. The aim of this study was to demonstrate that serum leptin values can become a new sensitive and specific serum marker for cholangiocarcinoma.

Materials And Methods: Seventy-two patients with gallbladder stones, hepatolithiasis with benign biliary stenosis, cholangiocarcinoma, and a group of patients without hepato-biliary diseases were enrolled in the study. In all cases blood and bile samples were collected for evaluation of leptin levels and liver biopsies were performed to confirm diagnosis. In all patients, both ultrasound and cholangio-magnetic resonance imaging (MRI) were performed to complete the diagnostic procedure.

Results: Twenty-two patients were affected by cholangiocarcinoma, 50 by benign biliary disease (35 cholelithiasis and 6 hepatolithiasis and 9 by inflammatory biliary stenosis). The mean values of serum leptin in patients with cholangiocarcinoma were 19.28±8.76 ng/ml, significantly higher than those observed in non-neoplastic biliary diseases.

Conclusion: Serum leptin levels might be a useful marker to differentiate patients with cholangiocarcinoma from those with biliary lithiasis and inflammatory stenosis.
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http://dx.doi.org/10.21873/invivo.12064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652476PMC
June 2021

The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study.

BMC Surg 2019 Apr 24;18(Suppl 1):110. Epub 2019 Apr 24.

Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy.

Background: Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population.

Methods: A retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged ≥ 65 years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74 years old and over 75 years old.

Results: Total thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75 years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B).

Conclusions: The role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75 years old, advocating a tailored surgical approach in elderly population.
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http://dx.doi.org/10.1186/s12893-018-0433-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402571PMC
April 2019

Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation.

BMC Surg 2019 Apr 24;18(Suppl 1):125. Epub 2019 Apr 24.

Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy.

Background: Breast cancer is the most frequent neoplasm in women. Axillary lymph nodes dissection represents the treatment of choice in locally advanced breast cancer for prognostic and curative purposes. Seroma formation, an abnormal collection of fluid in the dead space of the axilla, is described in Literature with a wide range of incidence (3-85%). It is a source of significant morbidity and discomfort. The aim of the study is to compare the different haemostasis devices used in breast surgery, investigating the eventual superiority of an instrument among the others in terms of intraoperative and postoperative outcome, especially of seroma formation.

Methods: Clinical cases of female patients undergone axillary lymph nodes dissection for local advanced breast cancer between January 2013 and July 2017 at the Surgery Unit of University of Campania "Luigi Vanvitelli" were retrospectively reviewed. Patients were divided into four groups, according to device utilized during surgery: Electrocautery, Harmonic Scalpel, LigaSure and Thunderbeat. All patients underwent II level axillary lymph nodes dissection associated to radical mastectomy or quadrantectomy.

Results: One hundred consecutives patients were enrolled in the study. Intra-operative blood loss resulted statistically significant different (P < 0,01) between the Electrocautery group (94,7 ml) and the Thunderbeat group (57,2 ml), while the Harmonic Scalpel group and the Ligasure group, despite presented a lower amount of blood loss, did not differ significantly. Drainage volume resulted significantly lower (P = 0,002) in the comparison between the Electrocautery group and the Thunderbeat group; the Ligasure group and Harmonic Scapel group showed no difference between them and Electrocautery group. About the seroma formation, the Electrocautery group resulted affected by the highest seroma formation rate (64%). Seroma incidence in Harmonic Scalpel group was 24%, in Ligasure group was 44%, while Thunderbeat group showed the lowest presentation of seroma with 16%.

Conclusions: In patients affected by breast cancer requiring axillary lymphnodes dissection, the use of advanced hemostasis devices is highly desirable. Among the non-traditional tools, Thunderbeat resulted to be superior in terms of reduction of intra-operative blood loss and post-operative drainage output, moreover associated to a substantial reduction of postoperative seroma incidence.
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http://dx.doi.org/10.1186/s12893-018-0454-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402581PMC
April 2019

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy.

BMC Surg 2019 Apr 24;18(Suppl 1):22. Epub 2019 Apr 24.

General Surgery and Surgical Specialties Unit, S. Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy.

Background: TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic mutations usually may influences the surgical approach.

Methods: We retrospectively analyzed 52 cases of TIR3B underwent between 2015 and 2017 total thyroidectomy (TT) and lobectomy (L), focusing mainly on the observed rate of malignancy. Chi-squared test and Fisher's exact probability test were used for analysis, considering a P values less than 0.05 as significant.

Results: Out of 52 patients 49 underwent TT and 3 L. In TT group a multinodular goiter was associated in 67.3% of patients. Malignancy rate was 81.6 and 33.3% respectively after TT and L (P 0.003). Multicentric and contralateral tumors were detected respectively in 36.7% and in 32.6% of patients underwent TT. No main post-operative complications were registered.

Conclusions: Ultrasound and elastography are useful to define within the TIR3B group those lesions at higher risk and therefore requiring a more radical approach. TT seems an appropriate approach to TIR3B lesions, especially in multinodular goiter, considering the incidence of malignancy with probably higher rate than previously reported.
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http://dx.doi.org/10.1186/s12893-019-0485-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402575PMC
April 2019

Clinical signs of retroperitoneal abscess from colonic perforation: Two case reports and literature review.

Medicine (Baltimore) 2018 Nov;97(45):e13176

Department and Clinic of Gastrointestinal and General Surgery, Medical University, Wroclaw. Poland.

Rationale: Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the retroperitoneal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess. We reported 2 cases of colonic retroperitoneal perforation from diverticulitis and locally advanced colon cancer, respectively. Aim of this report is to improve differential diagnosis based on clinical signs.

Patients' Concerns: A 71-year-old man presented with pain in his left side, fatigue, fever, nausea, massive subcutaneous emphysema of the neck, and Blumberg sign in the left iliac fossa. A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign.

Diagnosis: In the first patient the computerized tomography revealed pneumoperitoneum, gas in the mesosigma, pneumomediastinum, wall thickening of the descending colon, and retroperitoneal collection from diverticular perforation. In the second patient abdominal CT scan found thickening of the sigmoid colon adherent to the iliopsoas and fluid collection.

Interventions: In the first patient, a left hemicolectomy extending to the transverse colon, followed by a toilette and debridement of the retroperitoneum were performed. In the second patient, tumor of descending colon perforated in the retroperitoneum with iliopsoas abscess was treated with left hemicolectomy and a drainage of the abscess.

Outcomes: The first patient underwent right colectomy with ileostomy in the 7 postoperative day for large bowel necrosis. He died of sepsis 2 days after. The second patient had regular postoperative and he is still alive.

Lessons: The spread of retroperitoneal abscess in complicated colonic diverticulitis is different from that in advanced colonic cancer. The former can present with a subcutaneous emphysema, the latter with a groin mass. Hence a thorough clinical examination and radiological studies are needed to diagnose these conditions.
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http://dx.doi.org/10.1097/MD.0000000000013176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250550PMC
November 2018

Perforated vs. nonperforated acute appendicitis: evaluation of short-term surgical outcomes in an elderly population.

Minerva Chir 2019 Oct 9;74(5):374-378. Epub 2018 Oct 9.

Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy.

Background: Acute appendicitis is a common acute surgical abdominal condition and despite the majority of cases are observed in children and young adults, its occurrence in the elderly seems to be increasing, with a higher risk of perforation. The aim of this study was to evaluate the surgical outcomes following appendectomy for acute appendicitis in the elderly, making a comparison between perforated and nonperforated groups regarding operative time, hospital stay and postoperative complications.

Methods: The medical records of 48 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis from January 2011 to December 2016 were retrospectively reviewed. Patients were grouped into those with perforated and those with non-perforated appendicitis (NPA) and a comparison was made between both groups regarding demography, operative time, length of hospital stay and postoperative complications.

Results: From 48 patients over 60 years diagnosed with acute appendicitis, a PA was removed from 10 patients (20.8%). The PA group consisted of 3 males and 7 females, and their mean age was 71.6 years (range 65-84). The NPA group included 22 males and 16 females, and their mean age was 76.5 years (range 63-96). The mean operative time was 58±18.7 minutes and 43.3±9.9 minutes in the perforated and nonperforated groups respectively, with statistically significant difference (P=0.0013). The mean length of hospital stay was similar in the PA group and in the NPA group, being 6.5±1.8 days and 5.4±1.8 days respectively, but these differences were not statistically significant (P=0.093). The frequency of postoperative complications was similar in both groups as they were observed in 3 patients (30%) of the PA group and 10 patients (26%) of the NPA group (P=0.2488). No postoperative intraabdominal abscess was observed in both groups and there was no death after the surgery.

Conclusions: PA, despite requiring a longer mean operative time, in our series is not producing a longer hospital stay or more postoperative complications compared to NPA. The non-operative management of uncomplicated appendicitis is a reasonable option in frail patients in order to avoid the burden of morbidity related to operation, nevertheless surgery remains the standard of care in all age groups.
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http://dx.doi.org/10.23736/S0026-4733.18.07715-5DOI Listing
October 2019

Modified Paul-Mikulicz jejunostomy in frail geriatric patients undergoing emergency small bowel resection.

Minerva Chir 2019 Apr 24;74(2):121-125. Epub 2018 May 24.

Section for Surgical Research, Medical University of Graz, Graz, Austria.

Background: Proximal or extended bowel resections are sometimes necessary during emergency surgery of the small bowel and call for creating a high small bowel stomy as a part of damage control surgery. Secondary restoration of intestinal continuity in the frail geriatric patient, further weakened by subsequent severe malabsorption may be prohibitive.

Methods: Six patients underwent emergency small bowel resection for proximal jejunal disease (83.3% high-grade adhesive SBO and 16.7% jejunal diverticulitis complicated with perforation). With the intention to avoid end jejunostomy and the need for repeat laparotomy for bowel continuity restoration we modified the classic Paul-Mikulicz jejunostomy.

Results: The postoperative course was uneventful in four patients whose general condition improved considerably. At six-month follow-up, neither patients required parenteral nutrition.

Conclusions: This modified stoma can have the advantage of allowing a partial passage of the enteric contents, reducing the degree of malabsorption, and rendering jejunostomy reversal easy to perform later.
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http://dx.doi.org/10.23736/S0026-4733.18.07714-3DOI Listing
April 2019

Sigmoid diverticulitis in elderly patients: a rare cause of right iliac fossa pain.

Minerva Chir 2018 08 30;73(4):444-447. Epub 2018 Mar 30.

Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy.

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http://dx.doi.org/10.23736/S0026-4733.18.07722-2DOI Listing
August 2018

Predictivity of clinical, laboratory and imaging findings in diagnostic definition of palpable thyroid nodules. A multicenter prospective study.

Endocrine 2018 07 22;61(1):43-50. Epub 2018 Mar 22.

Istituto Nazionale per lo studio e la Cura dei Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy.

Purpose: To assess the role of clinical, biochemical, and morphological parameters, as added to cytology, for improving pre-surgical diagnosis of palpable thyroid nodules.

Methods: Patients with a palpable thyroid nodule were eligible if surgical intervention was indicated after a positive or suspicious for malignancy FNAC (TIR 4-5 according to the 2007 Italian SIAPEC-IAP classification), or two inconclusive FNAC at a ≥3 months interval, or a negative FNAC associated with one or more risk factor. Reference standard was histological malignancy diagnosis. Likelihood ratios of malignancy, sensitivity, specificity, negative (NPV), and positive predictive value (PPV) were described. Multiple correspondence analysis (MCA) and logistic regression were applied.

Results: Cancer was found in 433/902 (48%) patients. Considering TIR4-5 only as positive cytology, specificity, and PPV were high (94 and 91%) but sensitivity and NPV were low (61 and 72%); conversely, including TIR3 among positive, sensitivity and NPV were higher (88 and 82%) while specificity and PPV decreased (52 and 63%). Ultrasonographic size ≥3 cm was independently associated with benignity among TIR2 cases (OR of malignancy 0.37, 95% CI 0.18-0.78). In TIR3 cases the hard consistency of small nodules was associated with malignity (OR: 3.51, 95% CI 1.84-6.70, p < 0.001), while size alone, irrespective of consistency, was not diagnostically informative. No other significant association was found in TIR2 and TIR3.

Conclusions: The combination of cytology with clinical and ultrasonographic parameters may improve diagnostic definition of palpable thyroid nodules. However, the need for innovative diagnostic tools is still high.
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http://dx.doi.org/10.1007/s12020-018-1577-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997121PMC
July 2018

Single center experience with laparoscopic adrenalectomy on a large clinical series.

BMC Surg 2018 Jan 11;18(1). Epub 2018 Jan 11.

Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy.

Background: Laparoscopic adrenalectomy is considered the gold standard technique for the treatment of benign small and medium size adrenal masses (<6 cm), due to low morbidity rate, short hospitalization and patient rapid recovery. The aim of our study is to analyse the feasibility and efficiency of this surgical approach in a broad spectrum of adrenal gland pathologies.

Methods: Pre-operative, intra-operative and post-operative data from 126 patients undergone laparoscopic adrenalectomy between January 2003 and December 2015 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in case of pheochromocytoma while spironolactone and potassium were employed to treat Conn's disease. Laparoscopic adrenalectomies were all performed by the same surgeon (CG). First 30 procedures were considered as learning curve adrenalectomies.

Results: One hundred twenty-six patients were included in the study. Functioning tumors were diagnosed in 84 patients, 27 patients were affected by pheochromocytomas, 29 by Conn's disease, 28 by Cushing disease. Surgery mean operative time was 137.33 min (range 100-180) during the learning curve adrenalectomies and 96.5 min (range 75-110) in subsequent procedures. Mean blood loss was respectively 160.2 ml (range 60-280) and 90.5 ml (range 50-200) in the first 30 procedures and the subsequent ones. Only one conversion to open surgery occurred. No post-operative major complications were observed, while minor complications occurred in 8 patients (0,79%). In 83 out of 84 functioning neoplasms, laparoscopic adrenalectomy was effective in normalization of endocrine profile.

Conclusions: Laparoscopic adrenalectomy is a safe and feasible procedure, even for functioning masses and pheochromocytomas. A multidisciplinary team including endocrinologists, endocrine surgeons and anaesthesiologists, is recommended in the management of adrenal pathology, and adrenal surgery should be performed in referral high volume centers. A thirty-procedures learning curve is recommended to improve surgical outcomes.
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http://dx.doi.org/10.1186/s12893-017-0333-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765650PMC
January 2018

MMP7 Modulation by Short- and Long-term Radiotherapy in Patients with Rectal Cancer.

In Vivo 2018 Jan-Feb;32(1):133-138

Division of Colorectal Surgery, Department of Clinical Sciences, Skåne University Hospital/Malmö, Lund University, Malmö, Sweden

Background/aim: Matrix metalloproteinase 7 (MMP7) expression is highly associated with colorectal cancer and modulates tumour growth and invasion. Radiation injury induces inflammation with increases in MMP7 and in transforming growth factor beta (TGFβ). The aim of this study was to investigate the effect on MMP7 and TGFβ. expression in patients with rectal cancer undergoing different regimens of neoadjuvant radiotherapy (RT).

Patients And Methods: We studied 53 patients in three RT treatment groups receiving RT of 25 Gy, long-term RT 50 Gy and controls receiving no RT. Three biopsies were obtained from each patient during the treatments: before RT, after RT and after surgery. Tissue samples were formalin fixed, paraffin embedded and tissue microarrays were constructed and stained for MMP7 and TGFβ. Mann-Whitney U-tests and Wilcoxon Z-tests were used to determine differences between patients before and after RT, and after surgery, as well as between the RT groups.

Results: In all three patient groups, increases of MMP7 and TGFβ expression were observed after surgery. MMP7 expression was significantly increased in patients receiving short-term RT but TGFβ expression was not affected by RT.

Conclusion: 50 Gy Irradiation of rectal cancer gives less tumour activation of MMP7, whilst it is up-regulated by 25 Gy and surgery regardless of RT.
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http://dx.doi.org/10.21873/invivo.11215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892640PMC
August 2018

Timing and extension of lymphadenectomy in medullary thyroid carcinoma: A case series from a single institution.

Int J Surg 2017 May;41 Suppl 1:S70-S74

University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address:

Background: Medullary thyroid carcinoma is an aggressive tumor and presents with significant morbidity and mortality and a high rate of lymph node metastases. The combination of total thyroidectomy and cervical lymphadenectomy is the essential treatment for those patients presenting with cervical lymph node metastases.

Materials And Methods: A retrospective analysis of 117 patients operated for medullary thyroid carcinoma over a period of 15 years at a single institution. Surgical complications and calcitonin levels were noted.

Results: Nodal metastases were detected in the central compartment in 72.6% patients. Positive lymph nodes were detected in the lateral compartment of 34 patients who had undergone ipsilateral dissection and in all 10 patients of those with bilateral surgery. We found 3 cases of unilateral transient recurrent laryngeal nerve palsy, 15 cases of temporary hypoparathyroidism, a permanent accessory nerve lesion and a case of chylous fistula. Normalization of post-operative calcitonin was found in 82.6% and of patients who underwent total thyroidectomy and central neck dissection alone compared to 35.4% in those with ipsilateral and bilateral neck dissection.

Conclusions: Total thyroidectomy and cervical lymphadenectomy planned on the ultrasound preoperative study and on the calcitonin level represent the standard of treatment for medullary thyroid carcinoma.
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http://dx.doi.org/10.1016/j.ijsu.2017.04.026DOI Listing
May 2017

Genetics of medullary thyroid cancer: An overview.

Int J Surg 2017 May;41 Suppl 1:S2-S6

Department of Neurological, Metabolic and Geriatric Science, University of Campania "Luigi Vanvitelli", Naples, Italy. Electronic address:

Medullary thyroid carcinoma (MTC) represents 3-5% of thyroid cancers. 75% is sporadic and 25% is the dominant component of the hereditary multiple endocrine neoplasia (MEN) type 2 syndromes. Three different subtypes of MEN2, such as MEN2A, MEN2B, and Familial MTC (FMTC) have been defined, based on presence or absence of hyperparathyroidism, pheocromocytoma and characteristic clinical features. Mutations of the RET proto-oncogene are implicated in the pathogenesis of MTC, but there are many other mutational patterns involved. In MEN2A, Codon 634 in exon 11 (Cys634Arg), corresponding to a cysteine in the extracellular cysteine-rich domain, is the most commonly altered codon. Many other mutations include codons 611, 618, 620. In the genetical testing of RET mutations in MTCs, Next-Generation Sequencing (NGS) is taking an increasingly important role. One of the most important benefit is the comprehensive analysis of molecular alterations in MTC, which allows rapidly to select patients with different risk levels. There is a difference in miRNA expression pathway between sporadic and hereditary MTCs. Among sporadic cases, expression of miR-127 was significantly lower in those who harbor somatic RET mutations than those with wild-type RET. CDKN1B mutations are associated with many clinical pictures of cancers, such as MEN4. V109G polymorphism is associated with sporadic MTCs negative for RET mutations, and might influence the clinical course of the patients affected by MTC. Although surgery (i.e. total thyroidectomy with neck lymph node dissection) is the elective treatment for MTCs, about 80% of patients have distant metastases at diagnosis and in this cases surgery is not enough and an additional treatment is needed. Interesting results come from two large phase III clinical trials with two targeted tyrosine kinase inhibitors (TKIs), vandetanib and cabozantinib.

Conclusions: New genetical testings and therapeutical approaches open new perspectives in MTC management.
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http://dx.doi.org/10.1016/j.ijsu.2017.02.064DOI Listing
May 2017

Locally invasive thyroid cancer: options for a treatment.

Updates Surg 2017 Jun 13;69(2):249-253. Epub 2017 Apr 13.

Thoracic Surgery Unit, University of Perugia Medical School, Loc. Sant'Andrea delle Fratte, 06134, Perugia, Italy.

Local invasion to neighbor organs by thyroid cancer is an important prognosticator and requires different therapeutic approach. Which one is the possible best treatment option and results are evaluated in this study. A single-institution experience in thyroid cancer invading the airway is evaluated retrospectively (1990-2016). Facts regarding patients' demographics, disease history, comorbidities, condition at first evaluation and reason for referral are analyzed. Hospital records and treatment details are extracted from charts and Institutional folders. Therapeutic indication and treatment option details are assessed. A total of 2203 thyroid cancer patients undergoing evaluation and treatment are found in the Institutional records. According to the current staging system, T4a cancers are 309. Airway has been compromised in 144 cases. All patients have been referred after receiving indicative workup imaging or airway-related symptoms. Well-differentiated histology is reported in 97; non-differentiated pattern is described in the remaining ones. Airway endoscopy is performed in all patients prior to every treatment planned. In 37 cases, the airway is found to get benefit from resection with curative intent; stenting has been indicated in 41 cases while tracheostomy has been performed in 44 cases as permanent treatment option. Rigid bronchoscopy is apparently a mandatory preliminary step for patients undergoing resection and reconstruction of a segmental airway tract. Tracheostomy is performed when the disease could not be submitted to exeresis or when the tumor biology shows a tumultuous disease. Forty patients had a stable symptoms relief after stenting. The rate of patients presenting with respiratory symptoms due to thyroid cancer infiltrating the airway is decreasing thank to screening programs and the greater attention to early detection. When possible, the segmental resection and reconstruction of the compromised airway produces good outcome and represents a surgical subspecialty requiring a multidisciplinary approach with specific technical competences. Stenting and tracheotomy are end-stage treatment with possible stable outcome for highly variable time span.
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http://dx.doi.org/10.1007/s13304-017-0439-7DOI Listing
June 2017

Medicolegal implications of surgical errors and complications in neck surgery: A review based on the Italian current legislation.

Open Med (Wars) 2016 2;11(1):298-306. Epub 2016 Aug 2.

University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.

Aim of the present paper is the review of the principal complications associated to endocrine neck surgery considering how expertise, full adoption of guidelines, appropriate technology and proper informed consent may limit the medicolegal claims at the light of the incoming new regulation of the medical professional legal responsibility. A literature search, using the Medline/PubMed database for full-length papers, was used. Postoperative recurrent laryngeal nerve (RLN) palsy and hypoparathy-roidism remain the principal causes of surgical malpractice claims . In the procedure of neck lymphadenctomy intra-operative haemorrhage, thoracic duct injury, injuries to loco-regional nerves can be observed and can be source of claims. After many years of increased medicolegal litigations, the Italian government is proposing a drastic change in the regulations of supposed medical malpractice in order to guarantee the patient's right to a safe treatment and in the meantime to defend clinicians from often unmotivated and prejudicial legal cases. Surgical errors and complications in neck surgery are a relevant clinical issue. Only the combination of surgical and clinical expertise, application of guidelines, appropriate technology and a routinely use of specific informed consent can contain potential medicolegal implications.
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http://dx.doi.org/10.1515/med-2016-0058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329845PMC
August 2016

Current Indications for Surgical Treatment of Primary Hyperparathyroidism in the Elderly.

Am Surg 2017 Mar;83(3):296-302

This study presents the results of surgery in the elderly for primary hyperparathyroidism (PHPT) from a single institution's experience. We retrospectively analyzed 898 cases of surgically treated PHPT, divided into two groups: 135 elderly patients (A) and 763 patients younger than 65 years (B). PHPT was symptomatic in 68.8 per cent patients in group A and in 81.6 per cent in group B. Unilateral temporary recurrent laryngeal nerve palsy was observed in 0.9 per cent in group A and 0.1 per cent in group B (P > 0.05). No cervical hematomas, mortality or major cardiovascular, neurological, respiratory or metabolic postoperative complications were registered. All the patients evaluated at one year had improvement in the quality of life, with increase of bone mineral density (BMD) in 85.6 per cent and 79.8 per cent of patients in groups A and B, with no significant differences between symptomatic and asymptomatic patients. Parathyroidectomy in elderly PHPT patients is safe, with rate of morbidity similar to what observed in younger individuals. Further investigations are recommended to confirm the role of surgery as an effective approach in elderly PHPT patients.
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March 2017

Laparoscopic hepatectomy for HCC in elderly patients: risks and feasibility.

Aging Clin Exp Res 2017 Feb 2;29(Suppl 1):179-183. Epub 2016 Dec 2.

General Surgery and Surgical Specialties Unit, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy.

Background: Laparoscopic liver resection (LLR) appears to be safe and effective as open liver resection (OLR) for hepatocellular carcinoma (HCC). However, studies comparing LLR with ORL in elderly patients are limited. The purpose of this study is to compare the clinical outcomes of LLR versus OLR for HCC in elderly patients.

Methods: A retrospective analysis was made comparing laparoscopic (n = 11) and open (n = 18) liver resections in elderly patients performed at the University of Naples "Federico II" between January 2010 and December 2014. Demographic data, operative and postoperative outcomes were analyzed.

Results: Demographic and tumor characteristics of laparoscopic and OLRs were similar. There were also no significant differences in operating room time. Patients undergoing OLR had increased rate of minor complications (33 vs. 0%), longer lengths of stay (6 vs. 3 days) and higher blood loss (310 ± 84 vs. 198 ± 34 ml). There were no significant differences in major complication rates or 90-day mortality.

Discussion: LLR is safe and feasible as OLR for treatment of HCC in selected elderly patients.
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http://dx.doi.org/10.1007/s40520-016-0675-6DOI Listing
February 2017

Laparoscopic distal pancreatectomy in elderly patients: is it safe?

Aging Clin Exp Res 2017 Feb 22;29(Suppl 1):41-45. Epub 2016 Nov 22.

Division of General Surgery, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, via S. Pansini, 5, 80131, Naples, Italy.

Background: Laparoscopic distal pancreatectomy (LDP) appears to be safe and effective as open distal pancreatectomy (ODP) for benign or borderline malignant lesion. However, studies comparing LDP with ODP in elderly patients are limited. The purpose of this study is to compare the clinical outcomes of these two several approaches in elderly patients.

Methods: A retrospective analysis was carried out by comparing laparoscopic (n = 7) and open (n = 15) distal pancreatectomy in elderly patients performed at the University of Naples "Federico II" and University of Perugia between January 2012 and December 2015. Demographic data, operative and postoperative outcomes were analyzed.

Results: Demographic and tumor characteristics of laparoscopic and ODP were similar. There were also no significant differences in operating room time. Patients undergoing LDP had lower blood loss, first flatus time, diet start time and postoperative hospital stay. There were no significant differences in complication rates or 90-day mortality.

Discussion: LDP is safe and feasible as ODP in selected elderly patients.
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http://dx.doi.org/10.1007/s40520-016-0677-4DOI Listing
February 2017

Urgency surgical treatment for duodenal GISTs: analysis of aged patients and review of the literature.

Aging Clin Exp Res 2017 Feb 14;29(Suppl 1):1-6. Epub 2016 Nov 14.

Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy.

Introduction: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms (85%) of the gastrointestinal (GI) tract; duodenal GISTs constitute 3-5% of all GISTs and represent 10-30% of all malignant tumours of the duodenum. Rarely, patients present severe bowel obstruction, perforation or severe bleeding. The radical resection with complete removal of the tumour remains the main therapeutic approach. We performed a local resection in patients with suspected GIST admitted for emergency treatment for GI bleeding.

Cases: We present three cases of patients admitted for GI bleeding. The cause could be a GIST bleeding. In all cases, local resection was performed without a pancreaticoduodenectomy. Histological examination on surgical preparations showed that in two cases it was a GIST and in one case, it was a leiomyoma.

Discussion: Surgery remains the treatment of choice in the case of a GIST primitive without evidence of metastases, even for patients who are hospitalized for a bleeding emergency. Wide resections are not needed; it is important to remove completely the disease. In the case of duodenal GIST, it is important to get negative margins near the head of the pancreas, and this could take a PD. According to our experience and to the literature review, we believe that if the duodenal papilla or the periampullary region is not interested, you must perform a local resection. This is also because non-malignant tumours may present as GISTs and in these cases it is not recommended to run a PD.

Conclusion: The treatment of choice for duodenal GISTs is complete surgical resection with negative resection margins. When the papilla or the periampullary region is involved we choose to perform pancreaticoduodenectomy; otherwise it is better to perform a local resection. In fact, local resection has lower morbidity and mortality, with a comparable outcome.
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http://dx.doi.org/10.1007/s40520-016-0641-3DOI Listing
February 2017

Surgery for colorectal cancer in elderly: a comparative analysis of risk factor in elective and urgency surgery.

Aging Clin Exp Res 2017 Feb 11;29(Suppl 1):65-71. Epub 2016 Nov 11.

Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy.

Introduction: Colon cancer therapy is primarily surgical. Advanced age does not represent a contraindication to surgery. We analyse the results of surgery in ultra 75 patients undergoing surgery for colorectal cancer by examining the correlation between the comorbidity and any post-operative complications.

Materials And Methods: We surgically treated 66 patients for colorectal cancer, aged over 75. The examined subjects were compromised for various reasons. We have evaluated the different influences of risk factors in elective and urgency operation.

Discussion: Several studies have shown that age alone is not a significant prognostic factor in survival after colonic surgery. The assessment of general conditions in elderly patients, as demonstrated by the literature, is a fundamental moment in the management of colorectal cancer.

Conclusions: The surgical choice should be made case by case (custom-made), not based on age only.
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http://dx.doi.org/10.1007/s40520-016-0642-2DOI Listing
February 2017

Pancreatic stump closure after pancreatoduodenectomy in elderly patients: a retrospective clinical study.

Aging Clin Exp Res 2017 Feb 11;29(Suppl 1):35-40. Epub 2016 Nov 11.

Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.

Background: Pancreatic fistula (PF) after pancreatoduodenectomy (PD) represents the major source of morbidity. Derivative procedures are preferred by pancreatic surgeons, but the optimal management of remnant pancreatic stump remains controversial.

Aims: The purpose of this retrospective study is to evaluate the efficacy and safety of pancreatic stump closure in selected elderly patients (>65 years).

Methods: Clinical data of 44 PD undergone mechanical closure of the pancreatic stump performed between 2001 and 2014 in two department of general and oncologic surgery were retrospectively collected. Considering the age, patients were divided into two groups: 21 patients of less than 65 years (Group A) and 23 patients of more than 65 years (Group B).

Results: A soft pancreatic parenchyma with a not-dilated duct (diameter <3 mm) was reported in all the 44 patients. A grade-A PF, which did not required further treatments, developed in 20 cases (45.4%; 13 in group A and 7 in group B; p < 0.05), grade-B in 5 patients (11.4%; 3 in group A and 2 in group B; statistically not significant) and a grade-C PF was observed only in one patient (2.2%; 1 in group A and 0 in group B).

Discussion: In selected "high risk" elderly patients (>65 years) with soft pancreatic texture, the closure of the pancreatic stump can be a useful tool in the surgical armamentarium with the aim to reduce the incidence of age-related complications.

Conclusions: Prospective randomized controlled trial to better evaluate PF risk factors is needed.
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http://dx.doi.org/10.1007/s40520-016-0657-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334406PMC
February 2017

Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.

Aging Clin Exp Res 2017 Feb 9;29(Suppl 1):23-28. Epub 2016 Nov 9.

UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.

Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated.

Aim: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism.

Methods: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed.

Results: In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy.

Discussion: Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients.

Conclusions: Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.
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http://dx.doi.org/10.1007/s40520-016-0669-4DOI Listing
February 2017

Is it safe and useful, laparoscopic peritoneal lavage in the treatment of acute diverticulitis of octogenarian patients? A multicenter retroprospective observational study.

Aging Clin Exp Res 2017 Feb 9;29(Suppl 1):83-89. Epub 2016 Nov 9.

Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 1, 05100, Terni, Italy.

Background: Diverticular disease of the colon also affects older people. Generally, older patients with diverticulitis may be regarded as too risky to undergo surgery. This retroprospective multicentric observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage (LPL) in elderly patients with perforated sigmoid diverticulitis.

Patients And Method: We hospitalized in urgency 100 patients, aged over 75, for sigmoid diverticulitis. Sixty-nine patients were treated with conservative medical therapy, while 31 were treated surgically, in which the surgery was performed in urgency in 18 cases, while in election in 13 cases. Laparoscopic peritoneal lavage was made in urgency in five cases.

Results: The mean age of the sample was 81.72. Thirty-one patients underwent surgery, and five patients were treated in urgency with laparoscopic peritoneal lavage. Perioperative mortality was zero. None of the patients who underwent laparoscopic peritoneal lavage showed recurrent disease.

Conclusion: Diagnostic laparoscopy can be useful in elderly patient, since these patients may benefit from a more conservative surgical strategy. The selection of patients to be subjected to laparoscopic lavage must be very rigorous.
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http://dx.doi.org/10.1007/s40520-016-0644-0DOI Listing
February 2017

Pancreas preserving surgery for duodenal gastrointestinal stromal tumor removal.

Minerva Chir 2016 Oct 29;71(5):281-5. Epub 2016 Jun 29.

Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy -

Background: We reported our experience with high-risk, non-metastatic second portion duodenal gastrointestinal stromal tumor (GIST)s in patients who underwent 1-month neoadjuvant cycles with imatinib therapy followed by pancreas-preserving surgery and 12-month of adjuvant chemotherapic regimen including imatinib. This study was conducted to evaluate the short and long-term results.

Methods: The study was conducted between January 2010 and May 2015. Medical charts and operative logbooks of patients were retrospectively reviewed.

Results: Nine patients form the basis of the current analysis. All patients underwent curative resection with pancreas preservation, and all specimens had histologically negative margins. The median follow-up was 35 months. Eight patients were alive, 1 patient died for myocardial infarction at a mean follow-up of 10 months, 1 patient had a recurrence at a mean follow-up of 32 months and no patients developed distant metastases.

Conclusions: We are confident to suggest the use of neoadjuvant and adjuvant Imatinib therapy to those patients affected with D2, high-risk, duodenal GISTs to allow a limited resection.
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October 2016

Breast cancer and reconstruction: can surgical technique, reconstructive time and adjuvant treatment influence the result?

Ann Ital Chir 2016 29;87. Epub 2016 Feb 29.

Introduction: Some techniques for the total reconstruction of the breast, regardless of the complexity, have specific complications, with varying degrees of morbidity. Therefore, we wanted to identify the most frequent complications of the main techniques used for breast reconstruction, and compare the relation to the relevant independent variables.

Methods: Our study was conducted by examining the medical records of patients who had received complete reconstruction of the breast after a mastectomy due to breast cancer from January 2008 to December 2010, with a minimum follow-up of 3 years postoperatively. The data collected, such as the time of intervention, reconstruction techniques, operating time, and adjuvant treatment, were statistically correlated to the presence of complications.

Results: Of the 40 total breast reconstructions analyzed, the technique in which they were used expanders followed by replacement with implants showed the lowest prevalence of complications (16.7%, p <0.000). Some surgical techniques have shown particular complications. The operative time for transplant transverse rectus abdominis musculocutaneous flap (363.57 ± 59.91 min) was significantly higher than that required for the techniques that use alloplastic materials (155.71 ± 38.02 min, p = 0, 01), but similar to that for the latissimus dorsi flap (309.69 ± 77.66 min). The operative time, the timing of reconstructive surgery, and type of adjuvant treatment was not correlated with the incidence of complications.

Conclusions: Each technique has its indications, contraindications and complications. The application of each technique must be tailored to the individual characteristics of each patient.

Key Words: Adjuvant treatment, Reconstructive surgery, Results, Surgical procedure.
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February 2016
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