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1. Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study

Author

De Rai, Paolo, Zerbi, Alessandro, Castoldi, Laura, Bassi, Claudio, Frulloni, Luca, Uomo, Generoso, Gabbrielli, Armando, Pezzilli, Raffaele, Cavallini, Giorgio, Di Carlo, Valerio, Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazzoni, G., Bartolo, F., Della Papa, D., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Bugnano, L., Buonanno, G. M., Esposito, C., Cordovana, A., Cavina, E., Seccia, M., Lippolis, P., Musco, B., Barletta, M., Chilovi, E., De Guelfi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Casentini, A., Costamagna, G., Trincali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosiani, V., D'Ambrosio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L., Morelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacignola, S., Calandro, L., Mazzitelli, L., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salval, N., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Lecconi, L., Valeri, L., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., Cipolla, A., De Rai, P, Zerbi, A, Castoldi, L, Bassi, C, Frulloni, L, Uomo, G, Gabbrielli, A, Pezzilli, R, Cavallini, G, Di Carlo, V, Proinf, Aisp, and Testoni, PIER ALBERTO

Subjects
Male, Time Factors, Pancreatitis, Alcoholic, medicine.medical_treatment, Acute pancreatitis, Surgery, Aged, Biliary Tract Diseases, Chi-Square Distribution, Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic, Female, Guideline Adherence, Humans, Italy, Pancreatitis, Pancreatitis, Acute Necrotizing, Practice Guidelines as Topic, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Treatment Outcome, Cholecystectomy, Jejunostomy, Pancreatectomy, Practice Patterns, Physicians', Hepatology, Gastroenterology, Physician's Practice Patterns, Practice Patterns, surgery, Endoscopic Retrograde, Medicine, Cholangiopancreatography, Laparoscopic, Acute Necrotizing, Alcoholic, Prospective cohort study, health care economics and organizations, acute pancreatitis, Corrigendum, Risk assessment, medicine.medical_specialty, education, Severity of illness, Intensive care medicine, Physicians', business.industry, General surgery, Original Articles, medicine.disease, business
Abstract

OBJECTIVE: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. METHODS: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. RESULTS: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. DISCUSSION: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.

Published
2010
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2. Surgical treatment of pancreatic endocrine tumours in Italy: results of a prospective multicentre study of 262 cases

Author

Zerbi, A, Capitanio, V, Boninsegna, L, Pasquali, C, Rindi, G, Delle Fave, G, Del Chiaro, M, Casadei, R, Falconi, M, Di Carlo, V, Pederzoli, P, Pedrazzoli, S, Tomassetti, P, Garcea, D, Uomo, G, Colangelo, E, Mosca, F, Fronda, G, Bresadola, F, Cantore, M, Leone, B, Farinati, F, Toma, S, Luppi, G, Bene, A, Bajetta, E, Ruffini, L, Gebbia, V, Liguori, L, De Toma, G, Dogliotti, L, Massidda, B, Di Carlo V, Pederzoli P, Delle Fave G, Pedrazzoli S, Tomassetti P, Casadei R, Garcea D, Uomo G, Colangelo E, Mosca F, Fronda GR, Bresadola F, Cantore M, Leone BE, Farinati F, Toma SS, Luppi G, Bene A, Bajetta E, Ruffini L, Gebbia V, Liguori L, De Toma G, Dogliotti L, Massidda B, Zerbi, A, Capitanio, V, Boninsegna, L, Pasquali, C, Rindi, G, Delle Fave, G, Del Chiaro, M, Casadei, R, Falconi, M, Di Carlo, V, Pederzoli, P, Pedrazzoli, S, Tomassetti, P, Garcea, D, Uomo, G, Colangelo, E, Mosca, F, Fronda, G, Bresadola, F, Cantore, M, Leone, B, Farinati, F, Toma, S, Luppi, G, Bene, A, Bajetta, E, Ruffini, L, Gebbia, V, Liguori, L, De Toma, G, Dogliotti, L, Massidda, B, Di Carlo V, Pederzoli P, Delle Fave G, Pedrazzoli S, Tomassetti P, Casadei R, Garcea D, Uomo G, Colangelo E, Mosca F, Fronda GR, Bresadola F, Cantore M, Leone BE, Farinati F, Toma SS, Luppi G, Bene A, Bajetta E, Ruffini L, Gebbia V, Liguori L, De Toma G, Dogliotti L, and Massidda B

Abstract

Background: Information on the treatment of pancreatic endocrine tumours (PETs) comes mostly from small, retrospective, uncontrolled studies. Methods: Newly diagnosed, histologically proven PETs, observed from June 2004 to March 2007 in 24 Italian centres, were included in a specific dataset. Results: Three-hundred and ten patients (mean age 57.6 years, females 46.6%) were analysed. At the time of recruitment, 262 (84.5%) underwent surgery. The percentage of operated patients was 91.9% and 62.0% in surgical and non-surgical centres, respectively. A curative resection was carried out in 83.6% (n=219) of cases, a palliative resection (debulking) in 10.7% (n=28), an exploratory laparotomy in 4.6% (n=12), and a bypass procedure in 1.1% (n=3). Laparoscopy was performed in 8.0% (n=21) of cases. Resection consisted of a pancreatoduodenectomy in 46 cases (21.0%), a distal pancreatectomy in 95 (43.4%), an enucleation in 50 (22.8%), a middle pancreatectomy in 16 (7.3%) and a total pancreatectomy in 12 (5.5%). Liver resection was associated with pancreatic resection in 26 cases (9.9%). Post-operative mortality was 1.5% and morbidity 39.7%, respectively. A curative resection was performed more frequently in asymptomatic, small, non-metastatic, benign and at uncertain behaviour tumours, with low Ki67 values. Conclusions: This study strongly indicates the fact that surgical resection represents the cornerstone treatment of PETs

Published
2011

3. Clinicopathological features of pancreatic endocrine tumors: A prospective multicenter study in italy of 297 sporadic cases

Author

Zerbi, A, Falconi, M, Rindi, G, Delle Fave, G, Tomassetti Casadei, P, Pasquali, C, Di Carlo, V, Capitanio, V, Boninsegna, L, Pederzoli, P, Pedrazzoli, S, Garcea, D, Uomo, G, Colangelo, E, Mosca, F, Fronda, G, Bresadola, F, Cantore, M, Farinati, F, Leone, B, Toma, S, Luppi, G, Bene, A, Bajetta, E, Ruffini, L, Gebbia, V, Liguori, L, De Toma, G, Dogliotti, L, Massidda, B, Zerbi A, Falconi M, Rindi G, Delle Fave G, Tomassetti Casadei PR, Pasquali C, Di Carlo V, Capitanio V, Boninsegna L, Pederzoli P, Pedrazzoli S, Garcea D, Uomo G, Colangelo E, Mosca F, Fronda GR, Bresadola F, Cantore M, Farinati F, Leone BE, Toma SS, Luppi G, Bene A, Bajetta E, Ruffini L, Gebbia V, Liguori L, De Toma G, Dogliotti L, Massidda B., Zerbi, A, Falconi, M, Rindi, G, Delle Fave, G, Tomassetti Casadei, P, Pasquali, C, Di Carlo, V, Capitanio, V, Boninsegna, L, Pederzoli, P, Pedrazzoli, S, Garcea, D, Uomo, G, Colangelo, E, Mosca, F, Fronda, G, Bresadola, F, Cantore, M, Farinati, F, Leone, B, Toma, S, Luppi, G, Bene, A, Bajetta, E, Ruffini, L, Gebbia, V, Liguori, L, De Toma, G, Dogliotti, L, Massidda, B, Zerbi A, Falconi M, Rindi G, Delle Fave G, Tomassetti Casadei PR, Pasquali C, Di Carlo V, Capitanio V, Boninsegna L, Pederzoli P, Pedrazzoli S, Garcea D, Uomo G, Colangelo E, Mosca F, Fronda GR, Bresadola F, Cantore M, Farinati F, Leone BE, Toma SS, Luppi G, Bene A, Bajetta E, Ruffini L, Gebbia V, Liguori L, De Toma G, Dogliotti L, and Massidda B.

Abstract

Objectives: Information on pancreatic endocrine tumors (PETs) comes mostly from small, retrospective, uncontrolled studies conducted on highly selected patients. The aim of the study was to describe the clinical and pathological features of PETs in a prospective, multicenter study.Methods: Newly diagnosed, histologically proven, sporadic PETs observed from June 2004 to March 2007 in 24 Italian centers were included in a specific data set.Results: Two hundred ninety-seven patients (mean age 58.614.7 years, females 51.2%, males 48.8%) were analyzed. In 73 cases (24.6%), the tumor was functioning (F) (53 insulinomas, 15 gastrinomas, 5 other syndromes) and in 232 (75.4%) it was non-functioning (NF); in 115 cases (38.7%), the diagnosis was incidental. The median tumor size was 20 mm (range 2-150). NF-PETs were significantly more represented among carcinomas (P0.001). Nodal and liver metastases were detected in 84 (28.3%) and 85 (28.6%) cases, respectively. The presence of liver metastases was significantly higher in the NF-PETs than in the F-PETs (32.1% vs. 17.8%; P0.05), and in the symptomatic than in the asymptomatic patients (34.6% vs. 19.1%; P<0.005). At the time of recruitment, the majority of patients (251, 84.5%) had undergone surgery, with complete resection in 209 cases (83.3%).Conclusions: This study points out the high number of new cases of PETs observed in Italy, with a high prevalence of NF and incidentally discovered forms. The size of the tumor was smaller and the rate of metastasis was lower than usually reported, suggesting a trend toward an earlier diagnosis. © 2010 by the American College of Gastroenterology

Published
2010

4. Clinicopathological features of pancreatic endocrine tumors: a prospective multicenter study in Italy of 297 sporadic cases

Author

Zerbi A, Falconi M, Rindi G, Delle Fave G, Tomassetti Casadei PR, Pasquali C, Di Carlo V, Capitanio V, Boninsegna L, Pederzoli P, Pedrazzoli S, Garcea D, Uomo G, Colangelo E, Mosca F, Fronda GR, Bresadola F, Cantore M, Farinati F, Leone BE, Toma SS, Luppi G, Bene A, Bajetta E, Ruffini L, Gebbia V, Liguori L, De Toma G, Dogliotti L, Massidda B., A., Zerbi, Falconi, Massimo, G., Rindi, G. D., Fave, P., Tomassetti, C., Pasquali, V., Capitanio, L., Boninsegna, V. D., Carlo, A. I. S. P., Network Study Group, Zerbi A, Falconi M, Rindi G, Delle Fave GF, Tomassetti P, Pasquali C, Capitanio V, Boninsegna L, Di Carlo V, and the members of the AISP-Network Study Group, Zerbi, A, Falconi, M, Rindi, G, Delle Fave, G, Tomassetti Casadei, P, Pasquali, C, Di Carlo, V, Capitanio, V, Boninsegna, L, Pederzoli, P, Pedrazzoli, S, Garcea, D, Uomo, G, Colangelo, E, Mosca, F, Fronda, G, Bresadola, F, Cantore, M, Farinati, F, Leone, B, Toma, S, Luppi, G, Bene, A, Bajetta, E, Ruffini, L, Gebbia, V, Liguori, L, De Toma, G, Dogliotti, L, and Massidda, B

Subjects
Adult, Male, medicine.medical_specialty, Pancreatic disease, Gastroenterology, Pancreatic tumor, Internal medicine, medicine, Carcinoma, Endocrine system, Humans, Prospective Studies, Prospective cohort study, Aged, Islet Cell, Female, Insulinoma, Italy, Middle Aged, Pancreatic Neoplasms, PANCREAS, Hepatology, business.industry, Pancreatic Neoplasm, medicine.disease, medicine.anatomical_structure, Multicenter study, Clinicopathological features, Carcinoma, Islet Cell, Pancreas, business, Human
Abstract

Objectives: Information on pancreatic endocrine tumors (PETs) comes mostly from small, retrospective, uncontrolled studies conducted on highly selected patients. The aim of the study was to describe the clinical and pathological features of PETs in a prospective, multicenter study.Methods: Newly diagnosed, histologically proven, sporadic PETs observed from June 2004 to March 2007 in 24 Italian centers were included in a specific data set.Results: Two hundred ninety-seven patients (mean age 58.614.7 years, females 51.2%, males 48.8%) were analyzed. In 73 cases (24.6%), the tumor was functioning (F) (53 insulinomas, 15 gastrinomas, 5 other syndromes) and in 232 (75.4%) it was non-functioning (NF); in 115 cases (38.7%), the diagnosis was incidental. The median tumor size was 20 mm (range 2-150). NF-PETs were significantly more represented among carcinomas (P0.001). Nodal and liver metastases were detected in 84 (28.3%) and 85 (28.6%) cases, respectively. The presence of liver metastases was significantly higher in the NF-PETs than in the F-PETs (32.1% vs. 17.8%; P0.05), and in the symptomatic than in the asymptomatic patients (34.6% vs. 19.1%; P

Published
2010

5. Diagnostic assessment and outcome of acute pancreatitis in Italy: results of a prospective multicentre study. ProInf-AISP: Progetto informatizzato pancreatite acuta, Associazione Italiana Studio Pancreas, phase II

Author

Uomo, G, Pezzilli, R., Gabbrielli, A., Castoldi, L., Zerbi, A., Frulloni, L., De Rai, P., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirrino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L. M., Murelli, Federica, Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzì, S., and Cipolla, A.

Subjects
Adult, Male, Pancreatic necrosis, Severity of Illness Index, Body Mass Index, Acute Pancreatitis, Clinical outcome, Computed tomography, Diagnosis, Pancreatitis, Prognosis, Ultrasonography, Aged, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Creatinine, Female, Humans, Italy, Middle Aged, Prospective Studies, Treatment Outcome, Hepatology, Gastroenterology, Endoscopic Retrograde, 80 and over, treatment, Medicine (all), Cholangiopancreatography, acute pancreatitis, diagnosis
Abstract

Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy.The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating centre was furnished with an ad hoc software including 530 items along with subsequent collection, tabulation and quality control of the data.One thousand five hundred and forty case report forms of patients affected by acute pancreatitis were collected but 367 of them (24%) were subsequently eliminated from the final analysis. Therefore, 1173 patients (581 females and 592 males) were recruited. Mean age of patients was 62.0+/-18.2 years (95% confidence interval, 60.9-63.0). On the basis of Atlanta classification, 1006 patients (85.8%) were defined as mild and 167 (14.2%) as severe pancreatitis. Biliary forms represented the most frequent aetiological category (813 cases, 69.3%) while alcoholic forms only 6.6% (77 cases); the remaining aetiologies accounted for 7.1% (83 cases) while 200 cases (17.1%) remained without a definite aetiological factor. Complete recovery was achieved in 1016 patients (86.6%) whereas morphological sequelae were found in 121 patients (10.3%) and mortality in 36 patients (3.1%; 0.4% in mild and 19.2% in severe acute pancreatitis). Ultrasonography was largely utilised as a first line diagnostic tool in all patients, with valuable visualisation of the pancreas in 85% of patients. Computer tomography scan was also widely used, with 66.7% of exams in mild and 33.3% in severe pancreatitis. Patients affected by biliary pancreatitis presented more severe (p=0.004) and necrotizing forms (p=0.021). Mortality was significantly related (p0.001) with the extension of pancreatic necrosis and with an age of over 70 years. Body mass index presented significantly greater values in severe than in mild forms (p0.001).Association of creatinine serum level over 2mg/dl with an abnormal chest X-ray showed a high significant correlation with a more severe outcome in terms of morphological sequelae and mortality (p=0.0001). Acute pancreatitis in Italy more commonly presents biliary aetiology and favourable outcome with low rate of complications and mortality. From a cost-effectiveness standpoint, diagnostic approach to this disease needs to be better standardised.

Published
2007

7. A prospective multicentre survey on the treatment of acute pancreatitis in Italy

Author

Pezzilli, R, Uomo, G., Gabbrielli, A., Zerbi, A., Frulloni, L., De Rai, P., Castoldi, L., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, Piero, Caronna, Roberto, Scozzafava, S., Cardi, Maurizio, Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, D., Mariani, L. M., Murelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., and Cipolla, A.

Subjects
Adult, Male, medicine.medical_specialty, ERCP, Pancreatitis, Pancreatitis acute necrotising, Aged, Aged, 80 and over, Analgesics, Anti-Bacterial Agents, Digestive System Surgical Procedures, Female, Histamine Antagonists, Humans, Italy, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Medicine (all), Hepatology, Gastroenterology, Therapeutic approach, Internal medicine, Severity of illness, 80 and over, Medicine, Prospective cohort study, business.industry, medicine.disease, Surgery, medicine.anatomical_structure, Acute pancreatitis, Tramadol, business, Pancreas, medicine.drug
Abstract

The Italian Association for the Study of the Pancreas released a diagnostic and therapeutic algorithm for acute pancreatitis in 1999.This study focused on the analysis of the therapeutic approach for the treatment of acute pancreatitis in Italy.One thousand, one hundred and seventy-three patients were recruited: 1006 patients (85.8%) had mild acute pancreatitis (MAP) and 167 (14.2%) had the severe acute pancreatitis (SAP); 161 patients showed pancreatic necrosis at computed tomography; 121 patients (10.3%) had sequelae and 36 (3.1%) died.Non-steroidal anti-inflammatory drugs and tramadol were used more frequently in patients with the MAP whereas opioids and the association schedules were used more frequently in patients with the SAP (P0.001). Gabexate mesilate was utilised in 831 out of 1173 patients (70.8%); in particular, gabexate mesilate was used in 70.6% patients with MAP and in 73.1% of those with SAP (P=0.521). The duration of the drug administration was significantly shorter in those having MAP than in those having the SAP (P0.001). The antibiotics most frequently used for the prophylaxis against infection from pancreatic necrosis (43.1%) were carbapenems. Only a small number of patients received enteral nutrition (4.7%). Endoscopic retrograde cholangiopancreatography was carried out in 344 of the 1173 patients (29.3%). Surgery was performed in 48 with SAP (19 had elective biliary surgery and 29 had pancreatic surgery).The results of this survey indicate a lack of compliance with the guidelines which regard the indications mainly for interventional endoscopy and surgery.

Published
2007

8. Long term outcome of acute pancreatitis in Italy: Results of a multicentre study

Author

Castoldi, L, De Rai, P, Zerbi, A, Frulloni, L, Uomo, G, Gabbrielli, A, Bassi, C, Pezzilli, R, Agugiaro, S, Turri, L, Bartoli, A, Barberini, F, Cavazzoni, G, Bartolo, F, Papa, D, Bassi, N, Massani, M, Benedetti, A, Macarri, G, Piergallini, L, Briani, G, Bartolasi, L, Bugnano, L, Buonanno, G, Esposito, C, Cordovana, A, Cavina, E, Seccia, M, Musco, B, Barletta, M, Chilovi, E, De Guelfi, A, Chirletti, P, Caronna, R, Scozzafava, S, Cardi, M, Cirino, E, Buffone, A, Colangelo, E, Caracino, V, Cortese, F, Casentini, A, Costamagna, G, Trincali, A, Curzio, M, Clivio, S, Segato, S, D'Alessandro, A, Ambrosiani, V, D'Ambrosio, B, Chiodo, C, Dicillo, M, Reale, L, Grandolfo, A, Fabbrucci, P, Bruscino, A, Mugnaini, P, Ferrarese, S, Ugenti, I, Forte, G, Rocco, P, Franzè, A, Bertelè, A, Sereni, G, Friedman, D, Mariani, L, Morelli, F, Gai, V, Antro, C, Garcea, D, Gardini, A, Lucci, E, Giulianotti, P, Sbrana, F, Balestracci, T, Giulini, S, Pellizzari, A, Ronconi, M, Cimaschi, S, Grassini, M, Lacignola, S, Martina, C, Mazzitelli, L, Costarella, S, Reggio, E, Mello Teggia P., N, Stefano, E, Cassini, P, Modica, G, Lupo, F, Giraci, G, Mosca, F, Del Chiaro, M, Mosella, G, Benassai, G, Nanni, M, D'Aristotile, A, Negro, P, Pirazzoli, A, Rabitti, P, Romano, C, Gerardi, G, Troianello, B, Ruscello, D, Di Stefano, A, Avelli, S, Salval, N, Bellini, N, Scalon, P, Staudacher, C, Parolini, D, Strazzabosco, M, Signorelli, S, Tedeschi, U, Testoni, P, Masci, E, Mariani, A, Torelli, E, Garcea, M, Lombardi, V, Lecconi, L, Valeri, L, Presenti, L, Alessio, F, Ventrucci, M, Virzi, S, Cipolla, A, FERRARESE, SAMUELE, Mello Teggia P. , n, Cipolla, A., STRAZZABOSCO, MARIO, Castoldi, L, De Rai, P, Zerbi, A, Frulloni, L, Uomo, G, Gabbrielli, A, Bassi, C, Pezzilli, R, Agugiaro, S, Turri, L, Bartoli, A, Barberini, F, Cavazzoni, G, Bartolo, F, Papa, D, Bassi, N, Massani, M, Benedetti, A, Macarri, G, Piergallini, L, Briani, G, Bartolasi, L, Bugnano, L, Buonanno, G, Esposito, C, Cordovana, A, Cavina, E, Seccia, M, Musco, B, Barletta, M, Chilovi, E, De Guelfi, A, Chirletti, P, Caronna, R, Scozzafava, S, Cardi, M, Cirino, E, Buffone, A, Colangelo, E, Caracino, V, Cortese, F, Casentini, A, Costamagna, G, Trincali, A, Curzio, M, Clivio, S, Segato, S, D'Alessandro, A, Ambrosiani, V, D'Ambrosio, B, Chiodo, C, Dicillo, M, Reale, L, Grandolfo, A, Fabbrucci, P, Bruscino, A, Mugnaini, P, Ferrarese, S, Ugenti, I, Forte, G, Rocco, P, Franzè, A, Bertelè, A, Sereni, G, Friedman, D, Mariani, L, Morelli, F, Gai, V, Antro, C, Garcea, D, Gardini, A, Lucci, E, Giulianotti, P, Sbrana, F, Balestracci, T, Giulini, S, Pellizzari, A, Ronconi, M, Cimaschi, S, Grassini, M, Lacignola, S, Martina, C, Mazzitelli, L, Costarella, S, Reggio, E, Mello Teggia P., N, Stefano, E, Cassini, P, Modica, G, Lupo, F, Giraci, G, Mosca, F, Del Chiaro, M, Mosella, G, Benassai, G, Nanni, M, D'Aristotile, A, Negro, P, Pirazzoli, A, Rabitti, P, Romano, C, Gerardi, G, Troianello, B, Ruscello, D, Di Stefano, A, Avelli, S, Salval, N, Bellini, N, Scalon, P, Staudacher, C, Parolini, D, Strazzabosco, M, Signorelli, S, Tedeschi, U, Testoni, P, Masci, E, Mariani, A, Torelli, E, Garcea, M, Lombardi, V, Lecconi, L, Valeri, L, Presenti, L, Alessio, F, Ventrucci, M, Virzi, S, Cipolla, A, FERRARESE, SAMUELE, Mello Teggia P. , n, Cipolla, A., and STRAZZABOSCO, MARIO

Abstract

Background: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. Aim: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. Methods: Data of 631 patients admitted to 35 Italian hospitals were retrospectively evaluated 51.7 ± 8.4 months after discharge. Results: The average recovery time after mild or severe pancreatitis was 28.2 and 53.4 days respectively. Fourteen sequelae were not resolved and 9 cases required late surgical intervention. Eighty patients (12.7%) had a second hospital admission. Of the patients with mild biliary pancreatitis, 67.9% underwent a cholecystectomy. The overall incidence of relapse was 12.7%. Mortality was 9.8% and no death was related to pancreatitis. Three patients died from carcinoma of the pancreas. Conclusion: Reported recovery time after an attack of pancreatitis was longer than expected in the mild forms. The treatment of sequelae was delayed beyond one year after discharge. The incidence of relapse of biliary pancreatitis in patients not undergoing a cholecystectomy was low, due to endoscopic treatment. Mortality from pancreatic-related causes is low, but there is an association with malignant pancreatic or ampullary tumours not diagnosed during the acute phase of the illness. © 2013 Editrice Gastroenterologica Italiana S.r.l

Published
2013

9. Effects of morphine on human pancreatic secretion: studies on pure pancreatic juice.

Author

Gullo, L, Priori, P, Costa, P L, Garcea, D, Baldoni, F, Mattioli, G, and Labo, G

Abstract

Data concerning the effects of morphine on human pancreatic secretion are fragmentary and inconclusive. In the present study, we evaluated the effects of morphine on pure pancreatic secretion in nine subjects with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery. Intravenous infusion of a small dose of morphine, 40 microgram/kg/h, during pancreatic stimulation with secretin and cholecystokinin, caused a significant increase in volume, bicarbonate, and calcium secretion, and a significant decrease in protein secretion. The stimulatory effect on water and electrolyte secretion was rapid and much more pronounced, reaching about 45-50% of the control levels, whereas the inhibition of protein output was slightly delayed and of lesser magnitude, reaching about 20-25% of the control values. Both effects were long-lasting. The addition of naloxone, potent opiate antagonist, prevented in part the effects of morphine on pancreatic secretion, suggesting that specific opiate receptors might be involved in these effects. [ABSTRACT FROM PUBLISHER]

Published
1982

10. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients

Author

Luca Baiocchi, Franco Roviello, Donato Nitti, Alessandro Ambrosi, Domenico Garcea, Francesco De Santis, Giovanni de Manzoni, Arianna Coniglio, Paolo Morgagni, G. Natalini, Simone Mocellin, Annamaria Minicozzi, Daniele Marrelli, Alberto Marchet, Marchet, A, Mocellin, S, Ambrosi, Alessandro, Morgagni, P, Garcea, D, Marrelli, D, Roviello, F, de Manzoni, G, Minicozzi, A, Natalini, G, De Santis, F, Baiocchi, L, Coniglio, A, and Nitti, D.

Subjects
STAGE MIGRATION, Male, medicine.medical_specialty, RESECTION, CARCINOMA, medicine.medical_treatment, MODELS, TNM staging system, Gastroenterology, TNM, Metastasis, surgery, Stomach Neoplasms, STOMACH, Internal medicine, N-ratio, Gastric cancer, Prognosis, medicine, Humans, RECURRENCE, Stomach cancer, DISSECTION, Lymph node, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, business.industry, Cancer, RESIDUALS, Retrospective cohort study, TNM CLASSIFICATION, Original Articles, medicine.disease, Surgery, prognosis, lymphadenectomy, medicine.anatomical_structure, Italy, Lymphatic Metastasis, Multivariate Analysis, SURVIVAL, Lymph Node Excision, Lymphadenectomy, Female, Lymph, business
Abstract

Purpose: To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) is a better prognostic factor as compared with traditional staging systems in patients with gastric cancer regardless of the extension of lymph node dissection. Patients & Methods: We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma at 6 Italian centers. Patients with >15 (group 1, n = 1421) and those with 25%) were determined by the best cut-off approach. Results: After a median follow-up of 45.5 months (range, 4-182 months), the 5-year overall survival of N0, N1, and N2 patients of group 1 versus group 2 was 83.4% versus 74.2% (P = 0.0026), 54.3% versus 44.3% (P = 0.018), and 32.7% versus 14.7% (P = 0.004), respectively, suggesting that a low number of excised lymph nodes can lead to the understaging of patients. N ratio identified subsets of patients with significantly different survival rates within NI and N2 stages in both groups. At multivariate analysis, the N ratio (but not N stage) was retained as an independent prognostic factor both in group I and group 2 (HR for N ratio 1, N ratio 2, and N ratio 3 = 1.67, 2.96, and 6.59, and 1.56, 2.68, and 4.28, respectively). In our series, the implementation of N ratio led to the identification of subgroups of patients prognostically more homogeneous than those classified by the TNM system. Conclusion: N ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer also in case of limited lymph node dissection. These data may represent the rational for improving the prognostic power of current UICC TNM staging system and ultimately the selection of patients who may most benefit from adjuvant treatments.

Published
2007

11. Lymph node pick up by separate stations: Option or necessity.

Author

Morgagni P, Nanni O, Carretta E, Altini M, Saragoni L, Falcini F, and Garcea D

Abstract

Aim: To evaluate whether lymph node pick up by separate stations could be an indicator of patients submitted to appropriate surgical treatment., Methods: One thousand two hundred and three consecutive gastric cancer patients submitted to radical resection in 7 general hospitals and for whom no information was available on the extension of lymphatic dissection were included in this retrospective study., Results: Patients were divided into 2 groups: group A, where the stomach specimen was directly formalin-fixed and sent to the pathologist, and group B, where lymph nodes were picked up after surgery and fixed for separate stations. Sixty-two point three percent of group A patients showed < 16 retrieved lymph nodes compared to 19.4% of group B (P < 0.0001). Group B (separate stations) patients had significantly higher survival rates than those in group A [46.1 mo (95%CI: 36.5-56.0) vs 27.7 mo (95%CI: 21.3-31.9); P = 0.0001], independently of T or N stage. In multivariate analysis, group A also showed a higher risk of death than group B (HR = 1.24; 95%CI: 1.05-1.46)., Conclusion: Separate lymphatic station dissection increases the number of retrieved nodes, leads to better tumor staging, and permits verification of the surgical dissection. The number of dissected stations could potentially be used as an index to evaluate the quality of treatment received.

Published
2015
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12. Is a clear benefit in survival enough to modify patient access to the surgery service? A retrospective analysis in a cohort of gastric cancer patients.

Author

Altini M, Carretta E, Morgagni P, Carradori T, Ciotti E, Prati E, Garcea D, Amadori D, Falcini F, and Nanni O

Subjects
Aged, Cohort Studies, Female, Gastrectomy statistics & numerical data, Hospital Mortality, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume statistics & numerical data, Humans, Italy, Lymph Nodes pathology, Lymph Nodes surgery, Male, Middle Aged, Outcome Assessment, Health Care, Proportional Hazards Models, Retrospective Studies, Stomach Neoplasms pathology, Survival Rate, Treatment Outcome, Hospitals statistics & numerical data, Stomach Neoplasms mortality, Stomach Neoplasms surgery
Abstract

Background: Surgery has become an important tool for cancer treatment, requiring many available resources and a good organization of the surgery service. The aim of this study was to provide robust data for policymakers on the impact of hospital volume on survival, taking into account different sources of information., Methods: We performed a retrospective study in a cohort of patients with gastric cancer submitted to partial or total gastrectomy. Data for the analysis were retrieved from regional administrative databases, the regional death registry, and histological reports. The main outcome measures were operative mortality and long-term survival. The associations between hospital volume and risk of mortality were calculated using a Cox multiple regression analysis., Results: The estimated relationship between operative mortality and volume was not statistically significant. Conversely, high-volume hospitals had an increased likelihood of long-term survival compared to low-volume institutions: hazard ratio 0.79 (95% confidence interval, 0.66-0.94, p = 0.01). The percentage variation between crude and adjusted HRs using only administrative data or administrative and histological data was very small. However, the combined use of administrative and clinical data provided a more accurate model for estimating risk-adjusted mortality., Conclusions: A positive association between hospital volume and survival was evident for long-term outcome after adjusting for patient and tumor confounding. Moreover, the patient's choice of hospital was not guided by specific care pathways or screening programs, and prognosis was not poorer for patients in high-volume hospitals. These findings suggest that there is leeway for improving access to surgery for gastric cancer patients.

Published
2015
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14. Early gastric cancer: diagnosis, staging, and clinical impact. Evaluation of 530 patients. New elements for an updated definition and classification.

Author

Saragoni L, Morgagni P, Gardini A, Marfisi C, Vittimberga G, Garcea D, and Scarpi E

Subjects
Follow-Up Studies, Humans, Prognosis, Retrospective Studies, Stomach Neoplasms mortality, Survival Rate, Lymph Nodes pathology, Neoplasm Staging standards, Stomach Neoplasms classification, Stomach Neoplasms diagnosis
Abstract

Background: The prevention and early diagnosis of gastric cancer permit clinicians to discover the tumor in the initial phase, during which time it can be completely eradicated, endoscopically or surgically. Since Murakami gave the definition of early gastric cancer (EGC) in 1971, many authors have identified various subtypes of EGC with different morphological characteristics and clinical behaviour., Methods: We evaluated retrospectively 530 patients: the median follow-up time was 10.4 months (range 0.3-29.2). All tumors were classified according to the macroscopic and microscopic criteria proposed by the Japanese Society of Gastroenterology and Endoscopy and Lauren, respectively. The infiltrative growth pattern was evaluated according to Kodama's classification. Only tumor-related death was considered as an endpoint of interest for the survival analysis., Results: The overall survival rates of our patients were 94 % (95 % CI, 92-96) and 90 % (95 % CI, 87-93) at 5 and 10 years, respectively. Only 44 patients (8.3 %) died of the disease. Kodama's type (p < 0.0001), lymph node status, both for number and pathological stage according to the 7th Edition of TNM (p < 0.0001), and depth of infiltration (p = 0.0006) were significant prognostic factors in univariate analysis. The multivariate analysis identified Kodama's PENA type (HR, 3.91; 95 % CI, 2.08-7.33; p < 0.0001) and lymph node status for more than three positive nodes versus negative nodes (HR, 12.78; 95 % CI, 5.37-30.43; p < 0.0001) as the only independent prognostic factors in our series., Conclusion: Lymph node status, especially when more than three lymph nodes are involved, is the most important prognostic factor in EGC. However, it is also important to evaluate the infiltrative growth pattern of the cancers in their early phase according to Kodama's classification, considering PEN A type lesions to be more aggressive than the other EGC types. Then, we propose new elements for an updated definition and classification of EGC, with an important clinical impact on the treatment of patients.

Published
2013
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15. Operating room data management: improving efficiency and safety in a surgical block.

Author

Agnoletti V, Buccioli M, Padovani E, Corso RM, Perger P, Piraccini E, Orelli RL, Maitan S, Dell'amore D, Garcea D, Vicini C, Montella TM, and Gambale G

Subjects
Database Management Systems trends, Efficiency, Organizational trends, Humans, Operating Rooms organization & administration, Database Management Systems standards, Efficiency, Organizational standards, Operating Rooms methods, Operating Rooms standards, Safety standards
Abstract

Background: European Healthcare Systems are facing a difficult period characterized by increasing costs and spending cuts due to economic problems. There is the urgent need for new tools which sustain Hospitals decision makers work. This project aimed to develop a data recording system of the surgical process of every patient within the operating theatre. The primary goal was to create a practical and easy data processing tool to give hospital managers, anesthesiologists and surgeons the information basis to increase operating theaters efficiency and patient safety., Methods: The developed data analysis tool is embedded in an Oracle Business Intelligence Environment, which processes data to simple and understandable performance tachometers and tables. The underlying data analysis is based on scientific literature and the projects teams experience with tracked data. The system login is layered and different users have access to different data outputs depending on their professional needs. The system is divided in the tree profile types Manager, Anesthesiologist and Surgeon. Every profile includes subcategories where operators can access more detailed data analyses. The first data output screen shows general information and guides the user towards more detailed data analysis. The data recording system enabled the registration of 14.675 surgical operations performed from 2009 to 2011., Results: Raw utilization increased from 44% in 2009 to 52% in 2011. The number of high complexity surgical procedures (≥120 minutes) has increased in certain units while decreased in others. The number of unscheduled procedures performed has been reduced (from 25% in 2009 to 14% in 2011) while maintaining the same percentage of surgical procedures. The number of overtime events decreased in 2010 (23%) and in 2011 (21%) compared to 2009 (28%) and the delays expressed in minutes are almost the same (mean 78 min). The direct link found between the complexity of surgical procedures, the number of unscheduled procedures and overtime show a positive impact of the project on OR management. Despite a consistency in the complexity of procedures (19% in 2009 and 21% in 2011), surgical groups have been successful in reducing the number of unscheduled procedures (from 25% in 2009 to 14% in 2011) and overtime (from 28% in 2009 to 21% in 2011)., Conclusions: The developed project gives healthcare managers, anesthesiologists and surgeons useful information to increase surgical theaters efficiency and patient safety. In difficult economic times is possible to develop something that is of some value to the patient and healthcare system too.

Published
2013
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16. Preoperative multidetector-row computed tomography scan staging for lymphatic gastric cancer spread.

Author

Morgagni P, Petrella E, Basile B, Mami A, Soro A, Gardini A, Calzolari F, Garcea D, and Bertocco M

Subjects
Butylscopolammonium Bromide, Female, Gastrectomy, Humans, Lymph Nodes pathology, Lymphatic Metastasis, Male, Muscarinic Antagonists, Neoplasm Staging, Preoperative Period, Sensitivity and Specificity, Stomach Neoplasms surgery, Lymph Nodes diagnostic imaging, Multidetector Computed Tomography methods, Stomach Neoplasms pathology
Abstract

Background: Multidetector-row computed tomography (MDCT) is commonly used to stage patients with gastric cancer, even though the technique often shows low specificity for lymph-node involvement., Methods: In this study, 111 patients with gastric cancer who consecutively underwent MDCT scan followed by radical surgical treatment at our hospital were retrospectively evaluated., Results: In total, 3632 lymph nodes from 643 lymphatic stations were studied and then correlated with radiological features. Lymph-node size was not always associated with infiltration. Of the 261 lymph-node stations that were not radiologically detected, 60 (22.9%) were infiltrated. There were 108 stations with lymph nodes larger than 10 mm seen on MDCT, of which 67 (62%) had lymphatic invasion. The sensitivity was 32.6%, specificity 90.6%, positive predictive value 62.0%, negative predictive value 74.2%, and accuracy 72.1%. When three lymph nodes, at least one of which was larger than 10 mm, were detected in the same station, infiltration was confirmed with 99% specificity in 93.8% of patients. Moreover, all of the 13 patients in whom three lymph nodes larger than 10 mm were detected in different neighboring stations had lymphatic invasion., Conclusions: Although presence of lymph nodes greater than 10 mm in size is not, in itself, sufficient to confirm lymphatic invasion, nodal involvement can be hypothesized when associated images are detected by MDCT.

Published
2012
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17. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients.

Author

Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, Roviello F, de Manzoni G, Minicozzi A, Natalini G, De Santis F, Baiocchi L, Coniglio A, and Nitti D

Subjects
Aged, Female, Humans, Italy, Male, Multivariate Analysis, Proportional Hazards Models, Retrospective Studies, Stomach Neoplasms surgery, Lymph Node Excision methods, Lymphatic Metastasis, Neoplasm Staging methods, Stomach Neoplasms mortality, Stomach Neoplasms pathology
Abstract

Purpose: To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) is a better prognostic factor as compared with traditional staging systems in patients with gastric cancer regardless of the extension of lymph node dissection., Patients & Methods: We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma at 6 Italian centers. Patients with >15 (group 1, n = 1421) and those with 25%) were determined by the best cut-off approach., Results: After a median follow-up of 45.5 months (range, 4-182 months), the 5-year overall survival of N0, N1, and N2 patients of group 1 versus group 2 was 83.4% versus 74.2% (P = 0.0026), 54.3% versus 44.3% (P = 0.018), and 32.7% versus 14.7% (P = 0.004), respectively, suggesting that a low number of excised lymph nodes can lead to the understaging of patients. N ratio identified subsets of patients with significantly different survival rates within N1 and N2 stages in both groups. At multivariate analysis, the N ratio (but not N stage) was retained as an independent prognostic factor both in group 1 and group 2 (HR for N ratio 1, N ratio 2, and N ratio 3 = 1.67, 2.96, and 6.59, and 1.56, 2.68, and 4.28, respectively). In our series, the implementation of N ratio led to the identification of subgroups of patients prognostically more homogeneous than those classified by the TNM system., Conclusion: N ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer also in case of limited lymph node dissection. These data may represent the rational for improving the prognostic power of current UICC TNM staging system and ultimately the selection of patients who may most benefit from adjuvant treatments.

Published
2007
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18. A case of primary extramedullary plasmacytoma of the colon.

Author

Lattuneddu A, Farneti F, Lucci E, Garcea D, Ronconi S, and Saragoni L

Subjects
Aged, Aged, 80 and over, Antigens, CD analysis, Colonic Neoplasms surgery, Humans, Immunoglobulin kappa-Chains analysis, Male, Plasma Cells immunology, Plasmacytoma surgery, Colonic Neoplasms diagnosis, Plasmacytoma diagnosis
Published
2004
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19. Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial.

Author

Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, Ballario E, Becchi G, Bonilauri S, Carobbi A, Cavaliere P, Garcea D, Giuliani L, Morziani E, Mosca F, Mussa A, Pasqualini M, Poddie D, Tonetti F, Zardo L, and Rosso R

Subjects
Adenocarcinoma mortality, Aged, Colonic Neoplasms mortality, Female, Follow-Up Studies, Humans, Lymph Nodes pathology, Male, Middle Aged, Neoplasm Staging, Prognosis, Survival Rate, Time Factors, Adenocarcinoma pathology, Adenocarcinoma surgery, Colonic Neoplasms pathology, Colonic Neoplasms surgery, Lymph Node Excision, Outcome Assessment, Health Care
Abstract

Objective: To determine if the extent of lymphadenectomy (number of recovered lymph nodes) was associated with long-term outcome in patients operated on for stage B and C colon cancer., Summary Background Data: Lymphatic spreading is the main prognostic indicator in colon cancer patients, although the optimal extent of lymphadenectomy and its prognostic impact are still unknown., Methods: In 3,648 patients (median follow-up 3.6 years) enrolled in two consecutive INTACC multicentric trials on adjuvant therapy for colon cancer, we studied the association of the number of recovered nodes with overall survival and relapse free survival by means of univariate and Cox regression analysis., Results: The worst overall survival was related to ages > 65 (risk ratio [RR] = 1.30), higher grading (RR = 1.96). Better overall survival was related to female gender (RR = 0.80) and to higher number of recovered nodes (8-12 nodes, RR = 0.46, 13-17 nodes, RR = 0.76, nodes > or = 18, RR = 0.79). The same pattern was observed for relapse free survival. Longer overall and relapse free survival were related to a higher number of recovered nodes with P =.034 and P =.003 respectively (stratified analysis for absence or presence of positive nodes). Stage B patients with fewer than 7 nodes in the specimen had both shorter overall survival (P =.0000) and relapse free survival (P =.0016) than the other B patients. Outcome of stage C patients was not related to the number of recovered nodes (P =.28 and 0.12 respectively). The interaction test between stage of disease and number of recovered nodes was statistically significant (P =.017)., Conclusions: Stage B patients with a small number of examined nodes may be understaged. Thus, these patients might be considered for adjuvant therapy because of their poorer life expectancy than other stage B patients. For stage C patients, the number of recovered nodes does not seem to affect long-term outcome.

Published
2002
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20. Adjuvant chemotherapy with fluorouracil and CCNU in colon cancer. Results of a multicentric randomized study.

Author

Marangolo M, Pezzuoli G, Marubini E, Amadori D, Boracchi P, Cocconi G, Cunsolo A, Garcea D, Germiniani R, and Luporini G

Subjects
Aged, Antineoplastic Combined Chemotherapy Protocols adverse effects, Clinical Trials as Topic, Colonic Neoplasms mortality, Colonic Neoplasms surgery, Combined Modality Therapy, Female, Fluorouracil administration & dosage, Follow-Up Studies, Humans, Italy, Lomustine administration & dosage, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Recurrence, Local surgery, Random Allocation, Statistics as Topic, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Colonic Neoplasms drug therapy
Abstract

To establish the effectiveness of adjuvant chemotherapy in patients with colon cancer after radical surgery, from 1980 to December 1983, 263 patients were randomized in a multicentric study to no further treatment (131 patients) or to a combination of fluorouracil (5-FU) (400 mg/m2 i.v., days 1-5) and lomustine (CCNU) (100 mg/m2 per os on day 5) every 6 weeks for 9 cycles (132 patients). The two groups were well balanced for age, sex, histology, tumor and nodal extent. Chemotherapy was not given to 30 of the 132 randomized patients, and of 98 treated patients only 38 completed the entire protocol. Analysis, as intention to treat, at 54 months did not show any significant difference between the two treatment groups in terms of relapse-free survival (surgery alone, 74.5%; surgery + adjuvant chemotherapy, 70.9%; p = 0.91). In contrast, a significant difference was observed in overall survival (surgery alone, 78.8%; surgery + adjuvant chemotherapy, 60.8%; p = 0.04). The sites of relapse were identical in the two treatment arms. In conclusion, from this study it appears that adjuvant chemotherapy with 5-FU and CCNU seems to have no efficacy in the cure rate of colon cancer patients.

Published
1989
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