32 results on '"Lodoli, Claudio"'
Search Results
2. Robotic Recto-Sigmoid Resection with Total Intracorporeal Colorectal Anastomosis (TICA) in Recurrent Ovarian Cancer.
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Palmieri L, Santullo F, Lodoli C, Certelli C, Abatini C, Rosati A, Oliva R, Fagotti A, Scambia G, and Gallotta V
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Background: About 70% of women affected by ovarian cancer experience relapse within 2 years of diagnosis. Traditionally, the standard treatment for recurrent ovarian cancer (ROC) has been represented by systemic chemotherapy.
1 Recently, several retrospective studies have suggested that secondary cytoreductive surgery could provide better clinical outcomes than chemotherapy alone, in the case of complete tumor cytoreduction.2,3 About 50% of patients with ROC have a pelvic component of the disease and 22% of patients present isolated pelvic recurrence, often involving the rectum.4,5 Minimally invasive secondary cytoreductive surgery is a feasible option and is associated with favorable perioperative outcomes.6-8 It is crucial to fully explore the peritoneal cavity before starting cytoreductive procedures in order to confirm the absence of carcinomatosis.9 The robotic system facilitates the identification of anatomical structures and makes it easier to perform complex surgical steps in narrow spaces. It also allows the integrated use of surgical tools such as intraoperative ultrasound and indocyanine green application., Methods: In this video, we present the case of a 64-year-old woman who experienced a rectal recurrence of ovarian cancer after a platinum-free interval of 12 months. We describe, in a step-by-step manner, the surgical procedure of a robotic rectosigmoid resection with totally intracorporeal colorectal anastomosis (TICA).10-12 RESULTS: Robotic secondary cytoreduction with complete gross resection was achieved. The patient did not report any intraoperative or postoperative complications. Final histology confirmed ROC., Conclusion: Totally robotic rectosigmoid resection is a feasible option in isolated bowel recurrences. Thanks to continuous technical evolution, robot-assisted surgery has the potential to have a central role in the fight against solid tumors. Integration of multiple pre- and intraoperative technologies allows personalized surgery to be performed for each different patient.13,14 ., (© 2024. The Author(s).)- Published
- 2024
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3. Robotic approach for the treatment of gynecological cancers recurrences: A ten-year single-institution experience.
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Certelli C, Palmieri L, Federico A, Oliva R, Conte C, Rosati A, Vargiu V, Tortorella L, Chiantera V, Foschi N, Ardito F, Lodoli C, Bruno M, Santullo F, De Rose AM, Fagotti A, Fanfani F, Scambia G, and Gallotta V
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- Humans, Female, Middle Aged, Retrospective Studies, Aged, Adult, Operative Time, Endometrial Neoplasms surgery, Endometrial Neoplasms pathology, Postoperative Complications epidemiology, Peritoneal Neoplasms secondary, Peritoneal Neoplasms surgery, Ovarian Neoplasms surgery, Ovarian Neoplasms pathology, Blood Loss, Surgical statistics & numerical data, Lymphatic Metastasis, Obesity complications, Aged, 80 and over, Robotic Surgical Procedures methods, Neoplasm Recurrence, Local, Genital Neoplasms, Female surgery, Genital Neoplasms, Female pathology, Cytoreduction Surgical Procedures methods
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Introduction: Although the management of gynecological cancers recurrences may be challenging, due to the heterogeneity of recurrent disease, the aim of this work is to present a descriptive analysis of gynecological malignancies recurrences in our institution treated by robotic approach., Materials and Methods: We performed a retrospective review and analysis of data of patients who underwent robotic surgery for recurrent gynecological malignancies at Catholic University of the Sacred Hearth, Rome, from January 2013 to January 2024., Results: A total of 54 patients underwent successful robotic cytoreductive surgery. The median age was 63 years; the median BMI was 33 kg/m
2 and most of the patients (59 %) were obese. In 12 cases (22 %) the relapse presented was the second or third relapse. The most frequent patterns of recurrence were represented by lymph nodes (41 %), followed by peritoneal (26 %), pelvic (22 %) and parenchymal (11 %). In all patients complete cytoreduction was achieved. In 29 patients (54 %) the surgical field was previous treated. The median operative time and estimated blood loss were, respectively, 270 min and 100 ml. There were 2 intraoperative complications, managed endoscopically; 10 early postoperative complications, and 3 late postoperative complications. The 2-year progression-free-survival and overall survival were, respectively, 39.8 % and 72.3 %., Conclusion: Robotic approach in the treatment of recurrent gynecological cancers should be considered in selected patients with oligometastatic disease, in high-volume centers with expert surgeons, particularly in obese patients., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)- Published
- 2024
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4. How to Implement Pressurized Intraperitoneal Aerosol Chemotherapy into a National Health System Scenario: A Single-Center Retrospective Analysis of Costs and Economic Sustainability at a High-Volume Italian Hospital.
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Aulicino M, Orsini C, D'Annibale G, Barberis L, Catania P, Abatini C, Attalla El Halabieh M, Ferracci F, Lodoli C, Santullo F, Pacelli F, and Di Giorgio A
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PIPAC is a new surgical procedure and a viable treatment option for PSM patients, due to promising therapeutic outcomes, minimal invasiveness, limited surgical morbidity, and systemic toxicity side effects. However, its implementation throughout hospitals is hard to obtain due to its fragile economical sustainability. A retrospective health economic analysis was conducted in order to evaluate the cost of hospitalization for patients undergoing PIPAC treatment at Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, in Rome. The average cost of a PIPAC procedure was defined based on the cost of surgery (cost of surgical material, operating room, intraperitoneal chemotherapy), hospital stay, diagnostic examinations, and drugs used during the stay. A total of 493 PIPAC procedures were performed on 222 patients with peritoneal metastases or primary peritoneal cancer from 2017 to 2023. Since the mean remuneration for each PIPAC hospitalization is €5916 and the mean expenditure per hospitalization is €6538, this results in an operating profit per PIPAC hospitalization of -€622. The reimbursement of PIPAC treatment by the Italian National Health System currently only partially covers the hospital's costs. Development of specific codes and adequate reimbursement for PIPAC by recognizing this procedure as a proper treatment for peritoneal carcinomatosis is essential.
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- 2024
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5. Robotic resection of left renal vein with preservation of left kidney for leiomyosarcoma: Case report and review of the literature.
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Lodoli C, El Halabieh MA, Santullo F, Abatini C, Gallotta V, and Pacelli F
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Introduction: Radical surgical resection with negative margins is the mainstay of treatment for retroperitoneal vascular leiomyosarcomas. Given the retroperitoneal location of these tumors, open surgery is, historically, the chosen surgical approach, however, it is burdened with high postoperative morbidity. In selected cases, the small dimension of the tumor and a favorable location, allow to perform a minimally invasive treatment., Presentation of Case: A 67-year-old female patient with a diagnosis of a leiomyosarcoma arising from the left renal vein underwent a robotic resection of the left renal vein with preservation of the left kidney and a relative outflow trough the gonadal vessels. The patient was discharged on the fourth postoperative day without any complications and there was no tumor recurrence noted during the 24-month follow-up period., Discussion: Vascular retroperitoneal leiomyosarcomas are very rare tumors requiring a complete en bloc gross tumor resection in order to achieving microscopically negative margins on the vein of origin. Thanks to the preoperative histological diagnosis and radiological study of the neoplasm, it was possible to proceed to a highly personalized and minimally invasive treatment with respect of oncological criteria., Conclusion: In selected cases, a minimally invasive surgery of vascular leiomyosarcoma could be a feasible and safe treatment option., Competing Interests: Conflict of interest statement The authors do not have any potential conflicts of interest with respect to this manuscript., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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6. Vascular- and nerve-sparing bowel resection for deep endometriosis: A retrospective single-center study.
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Ianieri MM, De Cicco Nardone A, Benvenga G, Greco P, Pafundi PC, Alesi MV, Campolo F, Lodoli C, Abatini C, Attalla El Halabieh M, Pacelli F, Scambia G, and Santullo F
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- Humans, Female, Retrospective Studies, Quality of Life, Treatment Outcome, Postoperative Complications epidemiology, Postoperative Complications etiology, Rectal Diseases, Endometriosis complications, Laparoscopy methods
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Objective: Surgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve- and vascular-sparing approach., Methods: A single-center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles-Eccersley-Scott-Symptom [KESS] questionnaire and Gastro-Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery., Results: Sixty-one patients were enrolled. No patients had Clavien-Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self-catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity., Conclusion: Our vascular- and nerve-sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)
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- 2024
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7. Splenic abscess with spontaneous gastrosplenic fistula: case report and review of the literature.
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Campisi A, Rocca L, Altieri G, Fico V, Pepe G, and Lodoli C
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Gastrosplenic fistula (GSF) is an unusual event that might occur in patients with various gastric or splenic diseases. While GSF related to gastric and splenic malignancies is well-documented in the literature, cases of GSF due to a splenic abscess are extremely rare. We experienced the case of a 49-year-old man with a medical history of tricuspid cardiac valve replacement for infective endocarditis who presented with a sudden onset of anemia and melena. With the assistance of imaging and endoscopy, a primary splenic abscess complicated by spontaneous GSF was diagnosed. A prompt splenectomy with partial gastrectomy was performed. GSF is a serious occurrence associated with a high risk of morbidity and mortality. The early recognition of GSF related to a splenic abscess is crucial to prevent major complications. Surgical resection with splenectomy and partial gastrectomy is frequently preferred for the treatment of large abscesses with GSF., Competing Interests: None of the authors has any relevant potential financial conflicts of interest related to this study., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.)
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- 2023
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8. Corrigendum to "Robotic surgery in ovarian cancer" [Best Pract Res Clin Obst Gynaecol Volume 90 (August 2023) 102391].
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Gallotta V, Certelli C, Oliva R, Rosati A, Federico A, Loverro M, Lodoli C, Foschi N, Lathouras K, Fagotti A, and Scambia G
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- 2023
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9. Gastric cancer with peritoneal metastases: a single center outline and comparison of different surgical and intraperitoneal treatments.
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Santullo F, Ferracci F, Abatini C, Halabieh MAE, Lodoli C, D'Annibale G, Di Cesare L, D'Agostino L, Pecere S, Di Giorgio A, Strippoli A, and Pacelli F
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- Humans, Combined Modality Therapy, Retrospective Studies, Chemotherapy, Cancer, Regional Perfusion, Cytoreduction Surgical Procedures, Postoperative Complications therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Survival Rate, Stomach Neoplasms pathology, Peritoneal Neoplasms drug therapy, Hyperthermia, Induced
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Introduction: Gastric cancer with peritoneal metastasis (GCPM) has an unfavourable prognosis. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) are promising treatment options that have been shown to improve survival. The aim of this study was to assess the impact of different treatments such as systemic chemotherapy, systemic chemotherapy + PIPAC, and CRS + HIPEC in patients with GCPM., Material and Methods: This single-centre retrospective study included 82 patients with GCPM treated between January 2016 and June 2021. After first-line chemotherapy, depending on disease response and burden, the patients were divided into three treatment groups: chemotherapy alone, chemotherapy + PIPAC, and CRS + HIPEC. The primary outcome was overall survival (OS) from diagnosis, which was compared among the treatment groups., Results: Thirty-seven (45.1%) patients were administered systemic chemotherapy alone, 25 (30.4%) received chemotherapy + PIPAC, and 20 (24.4%) underwent CRS + HIPEC. The CRS + HIPEC group had better OS (median 24 months) than the PIPAC group (15 months, p = 0.01) and chemotherapy group (5 months, p = 0.0001). Following CRS + HIPEC, the postoperative grade 3-4 complication rate was 25%, and no postoperative in-hospital deaths occurred. The median disease-free survival (DFS) was 12 months. Multivariate analysis identified peritoneal carcinomatosis index (PCI) > 7 as an independent predictor of worse DFS. No independent predictors of OS were identified., Conclusion: Among patients with GCPM, we identified a highly selected population with oligometastatic disease. In this group, CRS + HIPEC provided a significant survival advantage with an acceptable major complication rate compared with other available therapies (systemic chemotherapy alone or in combination with PIPAC)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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10. Robotic surgery in ovarian cancer.
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Gallotta V, Certelli C, Oliva R, Rosati A, Federico A, Loverro M, Lodoli C, Foschi N, Lathouras K, Fagotti A, and Scambia G
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- Humans, Female, Quality of Life, Neoplasm Recurrence, Local surgery, Neoplasm Recurrence, Local drug therapy, Carcinoma, Ovarian Epithelial surgery, Neoadjuvant Therapy, Chemotherapy, Adjuvant, Cytoreduction Surgical Procedures, Neoplasm Staging, Robotic Surgical Procedures, Ovarian Neoplasms pathology
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Ovarian cancer (OC) represents one of the most lethal cancers in women. The aim of surgical treatment is complete cytoreduction in advanced stages and a surgical staging in early stages. Although the guidelines still suggest laparotomy as the standard approach, in recent years minimally invasive surgery (MIS) has become increasingly popular in the treatment of OC, especially in early stages, because the 5-year relative survival exceeds 90% and the patients' quality of life cannot be overshadowed. However, MIS has been demonstrated to have a role even in advanced stages, in the prediction of optimal cytoreduction, identification patients who may benefit from neoadjuvant chemotherapy, and, more recently, in the interval debulking surgery, as in selected cases of secondary cytoreduction for recurrent ovarian cancer. The aim of this review is to describe the MIS (especially robotic surgery), with its advantages and pitfalls, in the treatment of OC., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2023
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11. ASO Author Reflections: Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery-What We Know and Future Perspectives.
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Vargiu V, Santullo F, Rosati A, Costantini B, Gallotta V, Lodoli C, Pacelli F, Scambia G, and Fagotti A
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- Carcinoma, Ovarian Epithelial complications, Cytoreduction Surgical Procedures adverse effects, Female, Humans, Risk Factors, Anastomotic Leak etiology, Ovarian Neoplasms complications, Ovarian Neoplasms surgery
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- 2022
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12. Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery: A Large Single-Center Experience.
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Costantini B, Vargiu V, Santullo F, Rosati A, Bruno M, Gallotta V, Lodoli C, Moroni R, Pacelli F, Scambia G, and Fagotti A
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- Anastomosis, Surgical adverse effects, Anastomotic Leak etiology, Carcinoma, Ovarian Epithelial complications, Carcinoma, Ovarian Epithelial surgery, Female, Humans, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Colorectal Neoplasms complications, Ovarian Neoplasms complications, Ovarian Neoplasms surgery, Rectal Neoplasms surgery
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Background: Cytoreductive surgery is currently the main treatment for advanced epithelial ovarian cancer (OC), and several surgical maneuvers, including colorectal resection, are often needed to achieve no residual disease. High surgical complexity carries an inherent risk of postoperative complications, including anastomosis leakage (AL). Albeit rare, AL is a life-threatening condition. The aim of this single-center retrospective study is to assess the AL rate in patients undergoing colorectal resection and anastomosis during primary surgery for advanced epithelial OC through a standardized surgical technique and to evaluate possible pre/intra- and postoperative risk factors to identify the population at greatest risk., Methods: A retrospective analysis of clinical and surgical characteristics of 515 patients undergoing colorectal resection and anastomosis during primary or interval debulking surgery between December 2011 and October 2019 was performed. Several pre/intra- and postoperative variables were evaluated by multivariate analysis as potential risk factors for AL., Results: The overall anastomotic leakage rate was 2.9% (15/515) with a significant negative impact on postoperative course. Body mass index < 18 kg/m
2 , preoperative albumin value lower than 30 mg/dL, section of the inferior mesenteric artery at its origin, and medium-low colorectal anastomosis (< 10 cm from the anal verge) were identified as independent risk factors for AL on multivariate analysis., Conclusions: AL is confirmed to be an extremely rare but severe postoperative complication of OC surgery, being responsible for increased early postoperative mortality. Preoperative nutritional status and surgical characteristics, such as blood supply and anastomosis level, appear to be the most significant risk factors., (© 2022. The Author(s).)- Published
- 2022
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13. The Road to Technical Proficiency in Cytoreductive Surgery for Peritoneal Carcinomatosis: Risk-Adjusted Cumulative Summation Analysis.
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Santullo F, Abatini C, Attalla El Halabieh M, Ferracci F, Lodoli C, Barberis L, Giovinazzo F, Di Giorgio A, and Pacelli F
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Background: Cytoreductive surgery (CRS) is a technically demanding procedure, and there is considerable debate about its safe application. This study investigated the learning curve for CRS and the clinical outcomes of consecutive patients treated by a single surgeon at a single institution., Methods: We collected 251 consecutive patients who underwent CRS for peritoneal metastases by a single surgeon at Fondazione Policlinico Universitario A. Gemelli IRCCS, between January 2016 and December 2020. The learning curve was estimated using the cumulative summation analysis (CUSUM) for operative time (OT). Risk-adjusted CUSUM (RA-CUSUM) charts were developed using a composite variable (surgical failure), defined as the occurrence of at least one of the following events: major postoperative complications (Clavien-Dindo grade ≥3), blood loss ≥500 mL, incomplete cytoreduction. Three learning phases were thus derived from the RA-CUSUM analysis, and were compared in terms of perioperative outcomes., Results: CUSUM-OT showed that the operation time improved significantly after the 161
th case. RA-CUSUM analysis allowed to break the CRS learning curve into three different phases: phase 1, "the learning phase" (cases 1-99), phase 2 "the experienced phase" (cases 100-188), and phase 3, "the mastership phase" (cases 189-251). The rate of major postoperative complications decreased significantly over the three phases ( p = 0.019). Operative time decreased significantly as well ( p = 0.031) and was significantly shorter in phase 3 with respect to the other two phases (phase 3 vs phase 2: 420 min vs 500 min, p = 0.017; phase 3 vs phase 1: 420 min vs 503 min, p = 0.021). Blood loss consistently decreased throughout the three phases ( p = 0.001). The rate of incomplete cytoreduction was significantly lower in phase 3 than in phase 2 (4.8% vs 14.6%, p = 0.043)., Conclusion: The CRS failure rate stabilized after the first 99 cases, and the complete surgical proficiency was achieved after 189 cases. A standardised and mentored learning model is a safer strategy to shorten the learning process, to reduce morbidity and mortality, to improve oncologic outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Santullo, Abatini, Attalla El Halabieh, Ferracci, Lodoli, Barberis, Giovinazzo, Di Giorgio and Pacelli.)- Published
- 2022
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14. Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis.
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Lodoli C, Covino M, Attalla El Halabieh M, Santullo F, Di Giorgio A, Abatini C, Rotolo S, Rodolfino E, Giovinazzo F, Fagotti A, Scambia G, Franceschi F, and Pacelli F
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Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation. Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis. Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease ( P = 0.015), absence of bowel obstruction ( P < 0.001), absence of bowel distension ( P < 0.001), and mesenteric involvement ( P = 0.001) and retraction (P < 0.001). The absence of bowel distension ( P = 0.046) and bowel obstruction ( P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure. Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lodoli, Covino, Attalla El Halabieh, Santullo, Di Giorgio, Abatini, Rotolo, Rodolfino, Giovinazzo, Fagotti, Scambia, Franceschi and Pacelli.)
- Published
- 2021
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15. Clinical and Molecular Features in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Colorectal Cancer.
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Di Giorgio A, Santullo F, Attalla El Halabieh M, Lodoli C, Abatini C, Calegari MA, Martini M, Rotolo S, and Pacelli F
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- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Cytoreduction Surgical Procedures, Humans, Hyperthermic Intraperitoneal Chemotherapy, Prognosis, Retrospective Studies, Survival Rate, Colorectal Neoplasms drug therapy, Hyperthermia, Induced, Percutaneous Coronary Intervention, Peritoneal Neoplasms drug therapy
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Purpose: Careful patient selection plays a crucial role in avoiding overtreatment and further increases survival rates in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer (CRC) with peritoneal metastases (PM)., Methods: The clinical and molecular factors influencing survival in patients who had undergone CRS with HIPEC between January 2015 and December 2018 were analyzed., Results: Sixty-six patients underwent CRS with HIPEC during the study period. The median overall survival (OS) was 36 months, with a 3-year OS of 43%. Multivariate analysis revealed increased PCI (HR: 1.21; 95% CI: 1.02-1.41; p = 0.020), right-sided primary tumor (HR: 3.01; 95% CI: 1.27-7.13; p = 0.017), and BRAF V600E mutation (HR: 4.55; 95% CI: 1.21-17.21; p = 0.025) as independent predictors for worse OS., Conclusion: In addition to confirming the prognostic role of PCI, our study extends the role of BRAF mutation and right primary tumor location as markers for worse prognosis., (© 2021. The Society for Surgery of the Alimentary Tract.)
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- 2021
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16. Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin: A Single Center Experience.
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Santullo F, Pacelli F, Abatini C, Attalla El Halabieh M, Fortunato G, Lodoli C, Giovinazzo F, Rotolo S, and Di Giorgio A
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Background: Pseudomyxoma peritonei (PMP) originating from appendiceal mucinous neoplasm is a rare peritoneal malignancy characterized by the progressive intraperitoneal accumulation of mucus leading to death if left untreated. In recent years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offered increased survival rates. This study aims to identify the clinical, pathological, and surgical features influencing safety and survival outcomes of patients undergoing CRS and HIPEC for PMP of appendiceal origin. Methods: A retrospective analysis of all patients undergoing CRS and HIPEC for PMP of appendiceal origin from January 2015 to May 2019 was conducted at our institution. Results: Study population included 50 patients (74% female, 26% male). The median age at CRS was 60 (38-84). The median peritoneal cancer index (PCI) was 17. Complete cytoreductive surgery (CC 0-1) was achieved in 47 patients (94%). HIPEC chemotherapeutic regimen was based on oxaliplatin for 13 (28%) patients and mitomycin for 34 (72%) patients. We experienced a total of 19 (38%) postoperative complications, of which 14 (74%) of grade I-II and 5 (26%) of grade III-IV, according to the Clavien-Dindo classification. The median follow-up period was 27 months (12-107) from the date of cytoreductive surgery. The mean survival rate was 100 months, with a 5-year OS of 91%. The mean progression-free survival rate was 77 months (0-107), with a 5-year PFS of 63%. Multivariate analysis identified adenocarcinoma histotype and incomplete cytoreduction to significantly worsen progression-free survival, while incomplete cytoreduction was the only independent predictor of poorer overall survival. Conclusion: Complete cytoreduction and appendiceal neoplasm histotype play a crucial role in the survival of patients affected by PMP of appendiceal origin. The rates of morbidity associated with CRS and HIPEC for PMP are acceptable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Santullo, Pacelli, Abatini, Attalla El Halabieh, Fortunato, Lodoli, Giovinazzo, Rotolo and Di Giorgio.)
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- 2021
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17. Cytoreductive surgery and mitomycin C hyperthermic intraperitoneal chemotherapy with CO 2 recirculation (HIPEC-CO 2 ) for colorectal cancer peritoneal metastases: analysis of short-term outcomes.
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Rotolo S, Di Giorgio A, Santullo F, Attalla El Halabieh M, Lodoli C, Abatini C, and Pacelli F
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- Antineoplastic Combined Chemotherapy Protocols, Carbon Dioxide, Combined Modality Therapy, Cytoreduction Surgical Procedures, Humans, Hyperthermic Intraperitoneal Chemotherapy, Mitomycin therapeutic use, Prognosis, Retrospective Studies, Survival Rate, Colorectal Neoplasms therapy, Hyperthermia, Induced, Peritoneal Neoplasms drug therapy
- Abstract
Peritoneal dissemination from colorectal cancer (CRC) has long been associated with unfavorable prognosis. However, in the last decades, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was able to obtain up to 30% 5-year survival rate in selected centers. Despite the wide diffusion of CRS and HIPEC, until now, there are no clear recommendations on the drug of choice for HIPEC nor its technique, and safety and efficacy data of HIPEC regimens and techniques are lacking. We performed a retrospective analysis of a prospectively maintained database of 26 CRS and mitomycin C HIPEC with CO
2 recirculation (HIPEC-CO2 ) for CRC peritoneal metastasis (PM) performed at our center. The main endpoints were morbidity, mortality, the temperature of perfusate during HIPEC and metabolic changes throughout the procedure. Morbidity was assessed by analysis of postoperative adverse events according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.0). Continuous variables of Arterial Blood Gas (ABG) analysis at three time-points were compared by the Student t test. There were no postoperative deaths. The overall grade 3-4 CTCAE complications rate at 30 days was 38.4%, with ten severe adverse events occurring to six (23.0%) patients. The temperature within HIPEC perfusion maintained between 41 and 42 °C in all cases and we experienced no HIPEC-related intraoperative complications. We observed a significant difference between all baseline and pre-HIPEC ABG parameters evaluated but no statistically significant differences between pre- and post-HIPEC ABG outcomes. This study shows that mitomycin C HIPEC-CO2 is feasible and has a safety profile comparable to that of other HIPEC techniques reported in the literature. Further research is needed to validate prospectively the safety and efficacy of this technique., (© 2021. Italian Society of Surgery (SIC).)- Published
- 2021
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18. Update on the secondary cytoreduction in platinum-sensitive recurrent ovarian cancer: a narrative review.
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Conte C, Fagotti A, Avesani G, Trombadori C, Federico A, D'Indinosante M, Giudice MT, Pelligra S, Lodoli C, Marchetti C, Ferrandina G, Scambia G, and Gallotta V
- Abstract
The ovarian cancer recurrence occurs in 75% of patients with advanced FIGO stage, and its treatment is a challenge for the oncologist in gynecology. The standard treatment of recurrent ovarian cancer (ROC) usually includes intravenous chemotherapy according to platinum sensitivity. Furthermore, maintenance treatment with target therapies [e.g., anti-angiogenic drug or PARP inhibitors (PARPi)], should be provided if not precedently administrated. In this scenario, secondary cytoreductive surgery (SCS) remains a practical but controversial option for platinum-sensitive ROC (PSROC). So far, several retrospective series and a Cochrane meta-analysis had concluded that SCS could determine better survival outcomes in ROC with favorable prognostic characteristics, such as the presence of a single anatomical site of recurrence, or when patients are accurately selected for surgery based on complete resection's predictive models. Recently, three randomized clinical trials (RCTs) investigated the role of SCS in PSROC patients selected with different criteria. All the three RCTs showed a significant statistical advantage in progression-free survival (PFS) in the SCS group, with an even more significant difference in patients with complete cytoreduction (about 7-month PFS increased). Data on overall survival (OS) are different in the two completed trials. The GOG213 study has documented a longer OS of PSROC patients who received chemotherapy alone compared to surgery plus chemotherapy. Contrarily, the DESKTOP III trial showed 7.7 months of increased OS in the surgery group vs. chemotherapy alone, with a more difference in the complete tumor cytoreduction (CTC) group (12 months). These RCTs thereby suggest that undergoing complete cytoreduction may not be the only key and that the disease biology may also matter. Few recent retrospective series investigated the role of SCS according to BRCA mutation status and the effect of SCS in patients receiving emerging PARPi. A consequence of the developments in SCS and knowledge of different molecular pathways influencing the recurrent disease is that the future research objective should be to individualize and personalize the surgical approach., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-4690). VG serves as an unpaid editorial board member of Annals of Translational Medicine from Mar 2020 to Feb 2022. The other authors have no conflicts of interest to declare., (2021 Annals of Translational Medicine. All rights reserved.)
- Published
- 2021
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19. Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb).
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Turco LC, Tortorella L, Tuscano A, Palumbo MA, Fagotti A, Uccella S, Fanfani F, Ferrandina G, Nicolotti N, Vargiu V, Lodoli C, Scaldaferri F, Scambia G, and Cosentino F
- Subjects
- Adult, Female, Humans, Middle Aged, Morbidity, Surveys and Questionnaires, Treatment Outcome, Young Adult, Colon surgery, Endometriosis surgery, Laparoscopy methods, Postoperative Complications mortality, Rectum surgery
- Abstract
Purpose: Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function., Methods: All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien-Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires., Results: Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months., Conclusions: Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.
- Published
- 2020
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20. Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A case report of a multimodal treatment for peritoneal metastases of pancreatic origin.
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Rotolo S, Ferracci F, Santullo F, Lodoli C, Inzani F, Abatini C, Pacelli F, and Di Giorgio A
- Abstract
Introduction: Pancreatic ductal adenocarcinoma (PDAC) with peritoneal metastases (PM) has a dismal prognosis and palliative systemic chemotherapy, which represents the standard treatment option, has significant pharmacokinetics limitations and low efficacy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new method of drug delivery that is expected to maximize exposure of peritoneal nodules to antiblastic agents. A combination of systemic chemotherapy and PIPAC may be valuable., Presentation of Case: A 55 years old male affected by PDAC with synchronous PM underwent a multimodal treatment comprising systemic chemotherapy and PIPAC without any procedural-related adverse events. Tumor genomic profiling evaluation from peritoneal biopsies addressed further tailored systemic chemotherapy., Discussion: The presented case illustrates the possibility of adding PIPAC to systemic chemotherapy with a fair tolerance profile and good quality of life while allowing monitoring of therapy-response and tailoring of the antiblastic treatment., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020. Published by Elsevier Ltd.)
- Published
- 2020
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21. Gastroblastoma in old age.
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Castri F, Ravegnini G, Lodoli C, Fiorentino V, Abatini C, Giustiniani MC, Angelini S, and Ricci R
- Subjects
- Aged, Humans, Male, Neoplasms, Complex and Mixed pathology, Stomach Neoplasms pathology
- Published
- 2019
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22. The role of robotic aortic lymphadenectomy in gynecological cancer: surgical and oncological outcome in a single institution experience.
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Gallotta V, Federico A, Gaballa K, D'Indinosante M, Conte C, Giudice MT, Naldini A, Lodoli C, Rotolo S, Gallucci V, Tortorella L, Romanò B, Scambia G, and Ferrandina G
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Genital Neoplasms, Female pathology, Genital Neoplasms, Female surgery, Humans, Lymph Nodes pathology, Middle Aged, Peritoneal Neoplasms secondary, Peritoneal Neoplasms surgery, Prognosis, Retrospective Studies, Survival Rate, Genital Neoplasms, Female mortality, Lymph Node Excision mortality, Lymph Nodes surgery, Peritoneal Neoplasms mortality, Robotic Surgical Procedures mortality
- Abstract
Background and Objective: This study aims to investigate the surgical outcomes observed in robotic transperitoneal aortic lymphadenectomy (AL) in gynecological cancer patients., Methods: Retrospective data were collected and analyzed on 71 patients undergoing robotic surgical procedures for gynecological cancers, including transperitoneal AL, between December 2014 and February 2018 at the Catholic University of the Sacred Heart, Rome, Italy., Results: Median age of the sample population was 50 years (range, 26-76 years). The median operative time was 210 minutes (range, 75-480 minutes), the median estimated blood loss was 50 ml (range, 20-300 ml). The number of para-aortic nodes removed was 12 (range, 7-43). In the whole series, 13 patients (18.3%) had at least one metastatic node. Overall, 10 patients (14.1%) experienced any grade early postoperative complications. Three patients experienced more than one complication. Three intraoperative complications occurred with two cases of vascular injury. Conversion to laparotomy was necessary for one patient (1.4%)., Conclusions: The present study shows the safety and adequacy of robotic transperitoneal AL as surgical staging step for gynecological cancers in terms of perioperative and postoperative outcomes., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2019
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23. Necrotizing Fasciitis Following Herpes Zoster Ophthalmicus in an Immunocompromised Patient.
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Cozzupoli GM, Gui D, Cozza V, Lodoli C, Pennisi MA, Caporossi A, and Falsini B
- Abstract
Necrotizing fasciitis (NF) is a rare infection that spreads rapidly along the subcutaneous soft tissue planes. NF rarely involves the periorbital region due to the excellent blood supply of this region. We report a case of periorbital necrotising fasciitis following herpes zoster (HZ) in an immunocompromised 70-year-old patient with a dramatically rapid evolution into septic shock. In our patient, the surprisingly rapid spread of the bacterial superinfection led the periorbital cellulitis to turn into frank NF within 2 hours, with an overwhelming evolution. Despite the prompt start of a systemic antibiotic therapy and the immediate surgical intervention, the patient had a septic shock; she was treated in ITU for 31 days and then discharged to a medical ward and eventually died for a mix of complications of the medical treatment and comorbidities. This case is unique because any documented cases of periorbital NF triggered by HZ had never led to a septic shock and death. Ophthalmologists should be aware that even common skin lesions caused by shingles can determine a dramatic clinical picture, in presence of predisposing factors.
- Published
- 2019
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24. Robotic Splenectomy for Isolated Splenic Recurrence of Endometrial Adenocarcinoma.
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Gallotta V, D'Indinosante M, Nero C, Giudice MT, Conte C, Lodoli C, Zannoni GF, Fagotti A, and Scambia G
- Subjects
- Carcinoma, Endometrioid secondary, Endometrial Neoplasms pathology, Endometrial Neoplasms surgery, Female, Humans, Hysterectomy methods, Lymph Node Excision methods, Middle Aged, Neoplasm Recurrence, Local surgery, Splenic Neoplasms secondary, Carcinoma, Endometrioid surgery, Robotic Surgical Procedures, Splenectomy methods, Splenic Neoplasms surgery
- Abstract
Study Objective: To demonstrate management of a rare case of an isolated intraparenchymal splenic metastasis of endometrial cancer with robotic-assisted surgery., Design: Case report (Canadian Task Force Classification III)., Setting: A 55-year-old patient with a history of endometrial cancer was found to have a splenic lesion on a follow-up examination. She underwent surgical staging, involving total hysterectomy, bilateral salpingo-oopherectomy, pelvic lymphadenectomy, and peritoneal washing, in 2014, and the final pathological findings showed an endometrioid endometrial adenocarcinoma, International Federation of Gynecology and Obstetrics stage IB G2. Multidisciplinary counseling was provided, and the patient opted for strict medical surveillance. At 20 months after the primary treatment, the patient experienced a vaginal cuff recurrence and refused radiation therapy. She instead underwent robotic surgery, followed by 6 cycles of carboplatin 6 AUC and paclitaxel 175 mg/m
2 . Seventeen months later, a positron emission tomography/computed tomography scan revealed a 3-cm intraparenchymal lesion of the spleen, and robotic splenectomy was scheduled. The Institutional Review Board approved this study., Intervention: The operative time was 90 minutes, and blood loss was <50 mL. The operation was performed successfully, with no intraoperative and postoperative complications. Histopathological analysis showed a 3-cm intraparenchymal splenic lesion. The patient was discharged on day +2, and 46 days later started adjuvant chemotherapy based on carboplatin 6 AUC and doxorubicin (Caelyx) 30 mg/m2 . At a 2-month follow-up, the patient was disease-free and in good general condition., Conclusion: This case demonstrates the successful robotic management of recurrent endometrial cancer., (Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.)- Published
- 2018
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25. Secondary Laparoscopic Cytoreduction in Recurrent Ovarian Cancer: A Large, Single-Institution Experience.
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Gallotta V, Conte C, Giudice MT, Nero C, Vizzielli G, Gueli Alletti S, Cianci S, Lodoli C, Di Giorgio A, De Rose AM, Fagotti A, Scambia G, and Ferrandina G
- Subjects
- Adult, Aged, Aged, 80 and over, Blood Loss, Surgical, Cohort Studies, Female, Humans, Italy epidemiology, Middle Aged, Neoplasm Recurrence, Local mortality, Operative Time, Ovarian Neoplasms mortality, Progression-Free Survival, Retrospective Studies, Cytoreduction Surgical Procedures methods, Laparoscopy, Neoplasm Recurrence, Local surgery, Ovarian Neoplasms surgery
- Abstract
Study Objective: To analyze the feasibility and safety of laparoscopic secondary cytoreductive surgery in a retrospective series of patients with platinum-sensitive recurrent ovarian cancer., Design: Retrospective cohort study (Canadian Task Force classification II-2)., Setting: Catholic University of the Sacred Heart, Rome, Italy., Patients: Between October 2010 and October 2016, 58 patients with recurrent ovarian cancer were selected for a retrospective analysis of data., Interventions: All patients underwent a laparoscopic secondary cytoreduction with single or multiple procedures., Results: The most frequent pattern of recurrence was peritoneal (48.3%); 6 patients (10.3%) experienced parenchymal disease (spleen, n = 5; liver, n = 1), and 24 patients (41.4%) had lymph node recurrence. Complete debulking was achieved in all patients. The median operative time was 204 minutes (range, 55-448 minutes), median estimated blood loss was 70 mL (range, 20-300 mL), and the median length of hospital stay was 4 days (range, 1-21 days). Four patients (6.8%) experienced intraoperative complications. Early postoperative complications were documented in 6 patients (10.3%), but only 1 G3 complication was noted. The median duration of follow-up since secondary cytoreduction was 24 months (range, 9-71 months). Twenty-one patients (36.2%) experienced a second disease relapse. The median progression-free survival (PFS) was 28 months, and the 2-year PFS was 58.7%. Five patients died (8.6%); the 2-year overall survival was 90.7%., Conclusions: For selected patients, laparoscopy is a feasible and safe approach to optimal cytoreduction for patients with recurrent ovarian cancer., (Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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26. Clinical Impact of a Surgical Energy Device in Advanced Ovarian Cancer Surgery Including Bowel Resection.
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Vizzielli G, Conte C, Romano M, Fagotti A, Costantini B, Lodoli C, Gueli Alletti S, Gaballah K, Pacelli F, Ercoli A, Scambia G, and Gallotta V
- Subjects
- Adult, Aged, Analysis of Variance, Colectomy adverse effects, Female, Gynecologic Surgical Procedures adverse effects, Humans, Intraoperative Complications, Middle Aged, Neoplasm Staging, Postoperative Complications, Retreatment, Treatment Outcome, Colectomy instrumentation, Colectomy methods, Gynecologic Surgical Procedures instrumentation, Gynecologic Surgical Procedures methods, Ovarian Neoplasms pathology, Ovarian Neoplasms surgery
- Abstract
Aim: To evaluate the clinical impact of the use of the Caiman® articulating energy device in advanced ovarian cancer (AOC) including rectosigmoid resection [e.g. modified posterior exenteration (MPE)]., Patients and Methods: This was a prospective single-institution observational study with women undergoing MPE where all soft-tissue dissections and vessel ligations were performed using the Caiman® device. Intraoperative and postoperative surgical data were collected. Bladder function after nerve-sparing surgery was analyzed before and 6 months after surgery., Results: Forty patients were registered in the study. The median time for specimen removal using Caiman® was 86 min (range=70-120 min). Major vessel ligation was successful in all patients with a median of a single (range=1-4) Caiman® application to seal major vessels. No intraoperative or postoperative complications or bladder dysfunctions associated with the use of Caiman® were noted., Conclusion: Caiman® can be safely used in AOC surgery and may save time through faster dissection. However, comparative studies with other energy devices are needed to confirm this finding., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)
- Published
- 2018
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27. Laparoscopic Splenectomy for Secondary Cytoreduction in Ovarian Cancer Patients With Localized Spleen Recurrence: Feasibility and Technique.
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Gallotta V, Nero C, Lodoli C, Chiantera V, Pacelli F, Fagotti A, Costantini B, and Scambia G
- Subjects
- Adult, Aged, Chemotherapy, Adjuvant, Feasibility Studies, Female, Follow-Up Studies, Humans, Italy epidemiology, Length of Stay, Middle Aged, Operative Time, Splenic Neoplasms secondary, Treatment Outcome, Cytoreduction Surgical Procedures methods, Laparoscopy methods, Neoplasm Recurrence, Local surgery, Ovarian Neoplasms pathology, Ovarian Neoplasms surgery, Splenectomy methods, Splenic Neoplasms surgery
- Abstract
Study Objective: To investigate the feasibility of laparoscopic splenectomy in patients with recurrent ovarian cancer with isolated spleen metastasis., Design: (Canadian Task Force classification III)., Setting: Tertiary referral centre in Rome, Italy., Patients: Eight women with an isolated platinum-sensitive splenic relapse of ovarian cancer., Intervention: Between February 2013 and May 2015, 8 women with an isolated platinum-sensitive splenic relapse of ovarian cancer were submitted to laparoscopic splenectomy., Measurements and Main Results: All patients underwent laparoscopic splenectomy without conversion to an open approach. The median estimated intraoperative blood loss was 100 mL (range, 50-200 mL). The median operating room time was 200 minutes (range, 80-275 mL). No intraoperative complication occurred, and no intraoperative blood transfusions were required. The median length of hospital stay was 3 days (range, 2-5 days). Complete tumor resection was achieved in all patients. The median interval from surgery to adjuvant chemotherapy was 16 days (range, 14-24 days). After a median follow-up of 23 months (range, 6-32 months), no secondary recurrence or death of disease has been observed., Conclusion: Our findings indicate that a laparoscopic approach for spleen removal is feasible in selected patients with a splenic relapse of ovarian cancer when performed in a tertiary referral center by a well-trained surgeon., (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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28. Laparoscopic Management of a Small Bowel Recurrence of Endometrial Cancer.
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Gallotta V, Nero C, Callari C, Lodoli C, Fanfani F, Fagotti A, and Scambia G
- Subjects
- Anastomosis, Surgical, Blood Loss, Surgical, Endometrial Neoplasms pathology, Female, Humans, Intestinal Neoplasms secondary, Italy, Lymph Nodes pathology, Middle Aged, Neoplasm Recurrence, Local pathology, Operative Time, Treatment Outcome, Endometrial Neoplasms surgery, Intestinal Neoplasms surgery, Intestine, Small pathology, Laparoscopy methods, Neoplasm Recurrence, Local surgery
- Abstract
Study Objective: We present a very rare case of focal metastasis of endometrial cancer to the small bowel entirely managed laparoscopically., Design: Case report (Canadian Task Force Classification Study design III)., Setting: Tertiary referral centre in Rome, Italy., Patients: A 58 year-old patient with a FIGO Stage IB G2 N0 endometrial cancer was found to have a vaginal cuff recurrence and an isolated distant metastasis to the small bowel 13 months after primary treatment., Intervention: In this video we show a fully laparoscopic management mainly focusing on small bowel resection with intracorporeal anastomosis. A laparoscopic partial colpectomy was also performed. Our institutional review board approved this study., Measurements and Main Results: Operative time was 180 minutes. Intraoperative blood loss was less than 100 mL. The operation was performed successfully with no intraoperative complications. Pathologic findings showed recurrent disease in the vaginal cuff and in the resected small bowel segment with free resection margins in both specimens and 3 mesenteric local nodes negative for metastasis. The patient was discharged on day 3 and 26 days later started adjuvant chemotherapy. After a 16-month follow-up period, the patient is still disease free and in good general conditions., Conclusions: This case shows a successful laparoscopic management of recurrent endometrial cancer equiring complex surgical procedures., (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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29. Recurrent renal hyperparathyroidism due to parathyromatosis.
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Vulpio C, D'Errico G, Mattoli MV, Bossola M, Lodoli C, Fadda G, Bruno I, Giordano A, and Castagneto M
- Abstract
Parathyromatosis is the most severe type of recurrent secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX) in haemodialysis patients. It is difficult to completely remove all foci of parathyroid tissue and neck re-explorations are often required. Here, we report for the first time a case of recurrent SHPT due to parathyromatosis treated by radio-guided PTX. A haemodialysed 48-year-old woman with recurrent SHPT due to parathyromatosis was treated by radio-guided PTX. Preoperatively Ultrasonography, (99)Tc-SestaMIBI scintigraphy and magnetic resonances of the neck and thorax were performed. The preoperative imaging techniques detected four parathyroid nodules, while intraoperative gamma probe identified six nodules (three in atypical site). No frozen sections were performed during surgery. Post-operative intact parathyroid hormone levels were stabilized in the range 300-500 pg/mL during the 26 month follow-up by means of cinacalcet and paricalcitol therapy. In cases of parathyromatosis, the preoperative imaging techniques are inadequate, while intraoperative gamma probe is useful to detect the parathyroid tissue and allows a more extensive cytoreduction because it ensures the removal of undetectable and ectopic parathyroid foci. The operative time is reduced and frozen sections are unnecessary. However, the radio-guided PTX do not rule out parathyromatosis recurrence and complementary medical treatment is appropriate.
- Published
- 2011
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30. An unusual case of acute unilateral parotitis following abdominal surgery. Report of a case and review of the literature.
- Author
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Sermoneta D, Lodoli C, Di Mugno M, De Cosmo G, and Gui D
- Subjects
- Acute Disease, Female, Humans, Middle Aged, Hernia, Ventral surgery, Laparotomy adverse effects, Parotitis etiology
- Abstract
Background: Postoperative parotitis is a well known entity which can develop in patients who undergo major abdominal surgery., Methods: We present a case of postoperative parotitis which occurred after a laparotomy for incisional hernia repair., Results: After establishing diagnosis by ultrasonography assessment and blood chemical tests, patient was successfully treated by morphine discontinuing and antibiotics therapy., Conclusion: Beside sialolithiasis, sitting position or dehydratation we suggest that morphine could play a substantial role in the development of postoperative parotitis.
- Published
- 2009
31. Congenital tumors of the retrorectal space in the adult: report of two cases and review of the literature.
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Coco C, Manno A, Mattana C, Verbo A, Sermoneta D, Franceschini G, De Gaetano A, Larocca LM, Petito L, Pedretti G, Rizzo G, Lodoli C, and D'Ugo D
- Subjects
- Adult, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Perineum surgery, Rectum, Retroperitoneal Space, Dermoid Cyst congenital, Dermoid Cyst diagnosis, Dermoid Cyst surgery, Pelvic Neoplasms congenital, Pelvic Neoplasms diagnosis, Pelvic Neoplasms surgery, Teratoma congenital, Teratoma diagnosis, Teratoma surgery
- Abstract
Aims and Background: To describe and discuss, on the basis of the authors' experience and a review of the literature, the main aspects regarding the etiology, diagnosis, treatment and prognosis of congenital tumors of the retrorectal space., Methods: We present 2 cases of congenital retrorectal tumors, a sacrococcygeal teratoma and a dermoid cyst, which represent, from the pathogenetic point of view, the most frequent presentation of the rare tumors of the retrorectal space., Results: The reported cases are typical. The teratoma presented as an encapsulated, mixed mass located in the pelvic cavity behind the rectum and the vaginal canal, without signs of sacral involvement. The dermoid cyst appeared as a unilocular lesion filled with sebum and hair, which extended laterally to the iliopubic branch, medially to the urethra and anal canal, and posteriorly to the adipose tissue of the right buttock. Pelvic MRI produced a precise picture of the extension of the lesion and of the relationship between the mass and the pelvic organs and surrounding bony structures. Both lesions were completely removed via the perineal approach without coccygectomy. No recurrences were observed at 2 years of follow-up., Conclusions: Congenital retrorectal tumors are rare. MRI is crucial for diagnosis and preoperative planning. Complete surgical removal is the treatment of choice. Resection of the coccyx is necessary only in case of its involvement by the neoplastic mass or suspected malignant transformation.
- Published
- 2008
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32. Laparoscopic approach to recurrent incisional hernia repair: a 3-year experience.
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Verbo A, Petito L, Manno A, Coco C, Mattana C, Lurati M, Pedretti G, Rizzo G, Sermoneta D, Lodoli C, Nunziata J, and D'Ugo D
- Subjects
- Adult, Aged, Female, Hernia, Ventral diagnostic imaging, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Polytetrafluoroethylene, Postoperative Complications, Prospective Studies, Recurrence, Reoperation, Surgical Mesh, Treatment Outcome, Ultrasonography, Hernia, Ventral surgery, Laparoscopy methods
- Abstract
Background: Incisional hernias are one of the most frequent complications of open abdominal surgery. The incidence of relapses after a conventional repair procedure is higher in recurrent than in primary cases (30%-50% vs. 11%-20%). The laparoscopic approach can prevent the complications associated with the conventional approach when dealing with recurrent incisional hernias. The aim of this study was to evaluate the efficacy of laparoscopic treatment in such cases., Materials and Methods: We prospectively analyzed data from 41 consecutive patients with recurrent incisional hernias, who submitted to a laparoscopic repair procedure with an expanded polytetrafluoroethylene Dual Mesh (Gore-Tex Dual Mesh Plus Biomaterial; W.L. Gore 8 Associates) from December 2001 to December 2004. All of the patients underwent clinical follow-up at 1, 6, and 12 months and then yearly. An ultrasound scan of the abdominal wall was performed at 6 and 12 months after the procedure. The parameters considered for the analysis were: mesh size, operating time, hospital stay, postoperative complications, and recurrences., Results: The defects were usually localized along midline laparotomies. The mean mesh size was 400 cm2, the mean operating time was 68 minutes, and the mean length of hospital stay was 2.7 days. Complications were encountered in 17% of patients. The mean follow-up was 38 months (range, 18-54). Recurrence was reported in 1 case only (2.4%), which occurred within the first 6 months after the operation., Conclusions: The laparoscopic repair of recurrent incisional hernia seems to be an effective alternative to the conventional approach, as it can give lower recurrence and complication rates.
- Published
- 2007
- Full Text
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