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1. Human seminal plasma stimulates the migration of CD11c+ mononuclear phagocytes to the apical side of the colonic epithelium without altering the junctional complexes in an ex vivo human intestinal model

Author

Marco Baratella, Valeria Iannone, Mariangela Cavarelli, Chiara Foglieni, Paola Viganò, Christiane Moog, Ugo Elmore, Silvia Nozza, Massimo Alfano, Andrea Salonia, Stefania Dispinseri, and Gabriella Scarlatti

Subjects
HIV-1 transmission, intestinal mucosa, human seminal plasma, mononuclear phagocytes, CD11c+ cells migration, Immunologic diseases. Allergy, RC581-607
Abstract

IntroductionHuman immunodeficiency virus type 1 (HIV) transmission mostly occurs through the genital and intestinal mucosae. Although HIV-1 transmission has been extensively investigated, gaps remain in understanding the initial steps of HIV entry through the colonic mucosa. We previously showed that HIV can selectively trigger mononuclear phagocytes (MNP) to migrate within colonic epithelial cells to sample virions. Mucosal exposure to human seminal plasma (HSP), rich in pro- and anti-inflammatory cytokines, chemokines and growth factors, may as well induce alterations of the colonic mucosa and recruit immune cells, hence, affecting pathogen sampling and transmission.MethodsHere, we studied the role of HSP on the paracellular intestinal permeability by analyzing the distribution of two proteins known to play a key role in controlling the intestinal barrier integrity, namely the tight junctions-associated junctional adhesion molecule (JAM-A) and the adherents junction associated protein E-cadherin (E-CAD), by immunofluorescence and confocal microscopy. Also, we evaluated if HSP promotes the recruitment of MNP cells, specifically, the CD11c and CD64 positive MNPs, to the apical side of the human colonic mucosa. At this scope, HSP of HIV-infected and uninfected individuals with known fertility status was tested for cytokines, chemokines and growth factors concentration and used in an ex vivo polarized colonic tissue culture system to mimic as closely as possible the physiological process.ResultsHSP showed statistically significant differences in cytokines and chemokines concentrations between the three groups of donors, i.e. HIV infected, or uninfected fertile or randomly identified. Nevertheless, we showed that in the ex vivo tissue culture HSP in general, neither affected the morphological structure of the colonic mucosa nor modulated the paracellular intestinal permeability. Interestingly, CD11c+ MNP cells migrated to the apical surface of the colonic epithelium regardless, if incubated with HIV-infected or -uninfected HSPs, while CD64+ MNP cells, did not change their distribution within the colonic mucosa.DiscussionIn conclusion, even if HSP did not perturb the integrity of the human colonic mucosa, it affected the migration of a specific subset of MNPs that express CD11c towards the apical side of the colonic mucosa, which in turn may be involved in pathogen sampling.

Published
2023
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2. Patient-Reported Outcomes and Return to Intended Oncologic Therapy After Colorectal Enhanced Recovery Pathway

Author

The Italian ColoRectal Anastomotic Leakage (iCral3) study group, Marco Catarci, MD, FACS, Giacomo Ruffo, MD, Massimo Giuseppe Viola, MD, Ferdinando Ficari, MD, Paolo Delrio, MD, Felice Pirozzi, MD, Felice Borghi, MD, Raffaele De Luca, MD, Alberto Patriti, MD, Gianluca Garulli, MD, Walter Siquini, MD, Stefano D’Ugo, MD, PhD, FEBS, FACS, Stefano Scabini, MD, Marco Caricato, MD, FACS, Giusto Pignata, MD, Andrea Liverani, MD, Roberto Campagnacci, MD, Pierluigi Marini, MD, Ugo Elmore, MD, Francesco Corcione, MD, Roberto Santoro, MD, Massimo Carlini, MD, FACS, Antonio Giuliani, MD, Mario Sorrentino, MD, Giovanni Ferrari, MD, Gianandrea Baldazzi, MD, Alberto Di Leo, MD, Augusto Verzelli, MD, Giuseppe Sica, MD, Stefano Rausei, MD, Davide Cavaliere, MD, Gian Luca Baiocchi, MD, FACS, Marco Milone, MD, Giovanni Ciaccio, MD, Giovanni Domenico Tebala, MD, FACS, FRCS, Marco Scatizzi, MD, Luigi Boni, MD, FACS, Stefano Mancini, MD, Mario Guerrieri, MD, Roberto Persiani, MD, Andrea Lucchi, MD, FACS, Dario Parini, MD, Antonino Spinelli, MD, Michele Genna, MD, Vincenzo Bottino, MD, Andrea Coratti, MD, Dario Scala, MD, Andrea Muratore, MD, Maurizio Pavanello, MD, Umberto Rivolta, MD, Micaela Piccoli, MD, FACS, Carlo Talarico, MD, Alessandro Carrara, MD, Stefano Guadagni, MD, Mauro Totis, MD, Franco Roviello, MD, Alessandro Anastasi, MD, Gianluca Guercioni, MD, Giuseppe Maria Ettorre, MD, Mauro Montuori, MD, Pierpaolo Mariani, MD, Nicolò de Manzini, MD, Annibale Donini, MD, Mariano Fortunato Armellino, MD, Lucio Taglietti, MD, Gabriele Anania, MD, Mariantonietta Di Cosmo, MD, Carlo Vittorio Feo, MD, Paolo Millo, MD, Corrado Pedrazzani, MD, Silvio Guerriero, MD, Andrea Costanzi, MD, Nereo Vettoretto, MD, Federico Marchesi, MD, Massimo Basti, MD, Graziano Longo, MD, Moreno Cicetti, MD, Paolo Ciano, MD, Michele Benedetti, MD, Leonardo Antonio Montemurro, MD, Maria Sole Mattei, MD, Elena Belloni, MD, Elisa Bertocchi, MD, Gaia Masini, MD, Amedeo Altamura, MD, Francesco Rubichi, MD, Francesco Giudici, MD, Fabio Cianchi, MD, Gabriele Baldini, MD, Ugo Pace, MD, Andrea Fares Bucci, MD, Antonio Sciuto, MD, Desirée Cianflocca, MD, Marco Migliore, MD, Michele Simone, MD, Marcella Lodovica Ricci, MD, Francesco Monari, MD, Alessandro Cardinali, MD, Massimo Sartelli, MD, Marcello Spampinato, MD, PhD, FEBS (HPB), Alessandra Aprile, MD, Domenico Soriero, MD, Gabriella Teresa Capolupo, MD, FACS, Jacopo Andreuccetti, MD, Ilaria Canfora, MD, Andrea Scarinci, MD, Angela Maurizi, MD, Grazia Maria Attinà, MD, Giulia Maggi, MD, Umberto Bracale, MD, Roberto Peltrini, MD, Pietro Amodio, MD, Domenico Spoletini, MD, PhD, FACS, Rosa Marcellinaro, MD, Giovanni Del Vecchio, MD, Massimo Stefanoni, MD, Carmelo Magistro, MD, Diletta Cassini, MD, Lorenzo Crepaz, MD, Andrea Budassi, MD, Bruno Sensi, MD, Silvia Tenconi, MD, Leonardo Solaini, MD, Giorgio Ercolani, MD, Sarah Molfino, MD, Giovanni Domenico De Palma, MD, Paolo Locurto, MD, Antonio Di Cintio, MD, Lorenzo Pandolfini, MD, Alessandro Falsetto, MD, Elisa Cassinotti, MD, Andrea Sagnotta, MD, PhD, Monica Ortenzi, MD, Alberto Biondi, MD, Giacomo Martorelli, MD, Maurizio De Luca, MD, Francesco Carrano, MD, Annalisa Maroli, PhD, Francesca Fior, MD, Antonio Ferronetti, MD, Giuseppe Giuliani, MD, Roberto Benigni, MD, Graziella Marino, MD, Patrizia Marsanic, MD, Nicoletta Sveva Pipitone Federico, MD, Carlo Di Marco, MD, Camillo Leonardo Bertoglio, MD, PhD, Francesca Pecchini, MD, Vincenzo Greco, MD, Michele Motter, MD, Giuseppe Tirone, MD, Marco Clementi, MD, Nicolò Tamini, MD, Riccardo Piagnerelli, MD, Giuseppe Canonico, MD, Simone Cicconi, MD, Marco Colasanti, MD, Enrico Pinotti, MD, Roberta Carminati, MD, Edoardo Osenda, MD, Luigina Graziosi, MD, Ciro De Martino, MD, Giovanna Ioia, MD, Arianna Birindelli, MD, Matteo Chiozza, MD, Daniele Zigiotto, MD, Fioralba Pindozzi, MD, Manuela Grivon, MD, Cristian Conti, MD, Lorenzo Organetti, MD, Michela Monteleone, MD, Emanuele Botteri, MD, Giorgio Dalmonte, MD, Diletta Frazzini, MD, Simone Santoni, MD, Gabriele La Gioia, MD, and Diana Giannarelli, MS, PhD

Subjects
Surgery, RD1-811
Abstract

Objective:. To evaluate the influence of enhanced recovery pathway (ERP) on patient-reported outcome measures (PROMs) and return to intended oncologic therapy (RIOT) after colorectal surgery. Background:. ERP improves early outcomes after colorectal surgery; however, little is known about its influence on PROMs and on RIOT. Methods:. Prospective multicenter enrollment of patients who underwent colorectal resection with anastomosis was performed, recording variables related to patient-, institution-, procedure-level data, adherence to the ERP, and outcomes. The primary endpoints were PROMs (administered before surgery, at discharge, and 6 to 8 weeks after surgery) and RIOT after surgery for malignancy, defined as the intended oncologic treatment according to national guidelines and disease stage, administered within 8 weeks from the index operation, evaluated through multivariate regression models. Results:. The study included 4529 patients, analyzed for PROMs, 1467 of which were analyzed for RIOT. Compared to their baseline preoperative values, all PROMs showed significant worsening at discharge and improvement at late evaluation. PROMs values at discharge and 6 to 8 weeks after surgery, adjusted through a generalized mixed regression model according to preoperative status and other variables, showed no association with ERP adherence rates. RIOT rates (overall 54.5%) were independently lower by aged > 69 years, ASA Class III, open surgery, and presence of major morbidity; conversely, they were independently higher after surgery performed in an institutional ERP center and by ERP adherence rates > median (69.2%). Conclusions:. Adherence to the ERP had no effect on PROMs, whereas it independently influenced RIOT rates after surgery for colorectal cancer.

Published
2023
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3. Identification of CX3CR1+ mononuclear phagocyte subsets involved in HIV-1 and SIV colorectal transmission

Author

Mariangela Cavarelli, Chiara Foglieni, Naima Hantour, Tilo Schorn, Antonello Ferrazzano, Stefania Dispinseri, Delphine Desjardins, Ugo Elmore, Nathalie Dereuddre-Bosquet, Gabriella Scarlatti, and Roger Le Grand

Subjects
Physiology, Molecular biology, Immunology, Science
Abstract

Summary: The difficulty to unambiguously identify the various subsets of mononuclear phagocytes (MNPs) of the intestinal lamina propria has hindered our understanding of the initial events occurring after mucosal exposure to HIV-1.Here, we compared the composition and function of MNP subsets at steady-state and following ex vivo and in vivo viral exposure in human and macaque colorectal tissues.Combined evaluation of CD11c, CD64, CD103, and CX3CR1 expression allowed to differentiate lamina propria MNPs subsets common to both species. Among them, CD11c+ CX3CR1+ cells expressing CCR5 migrated inside the epithelium following ex vivo and in vivo exposure of colonic tissue to HIV-1 or SIV. In addition, the predominant population of CX3CR1high macrophages present at steady-state partially shifted to CX3CR1low macrophages as early as three days following in vivo SIV rectal challenge of macaques.Our analysis identifies CX3CR1+ MNPs as novel players in the early events of HIV-1 and SIV colorectal transmission.

Published
2022
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4. Expression levels of circulating miRNAs as biomarkers during multimodal treatment of rectal cancer - TiMiSNAR-mirna: a substudy of the TiMiSNAR Trial (NCT03962088)

Author

Igor Monsellato, Elisabetta Garibaldi, Elisa Cassinotti, Ludovica Baldari, Luigi Boni, Ugo Elmore, Roberto Delpini, Riccardo Rosati, Roberto Perinotti, Filippo Alongi, Elisa Bertocchi, Stefania Gori, Giacomo Ruffo, Graziano Pernazza, Fabio Pulighe, Carlo De Nisco, Emilio Morpurgo, Tania Contardo, Enzo Mammano, Federico Perna, Benedetta Menegatti, Andrea Coratti, Piero Buccianti, Riccardo Balestri, Cristina Ceccarelli, Davide Cavaliere, Leonardo Solaini, Giorgio Ercolani, Elena Traverso, Vittorio Fusco, Valter Torri, and Sara Orecchia

Subjects
Colorectal cancer, miRNA, Neoadjuvant treatment, Biomarkers, Translational research, Medicine (General), R5-920
Abstract

Abstract Background Neoadjuvant chemoradiotherapy followed by surgery is the mainstay treatment for locally advanced rectal cancer, leading to significant decrease in tumor size (downsizing) and a shift towards earlier disease stage (downstaging). Extensive histopathological work-up of the tumor specimen after surgery including tumor regression grading and lymph node status helped to visualize individual tumor sensitivity to chemoradiotherapy, retrospectively. As the response to neoadjuvant chemoradiotherapy is heterogeneous, however, valid biomarkers are needed to monitor tumor response. A relevant number of studies aimed to identify molecular markers retrieved from tumor tissue while the relevance of blood-based biomarkers is less stringent assessed. MicroRNAs are currently under investigation to serve as blood-based biomarkers. To date, no screening approach to identify relevant miRNAs as biomarkers in blood of patients with rectal cancer was undertaken. The aim of the study is to investigate the role of circulating miRNAs as biomarkers in those patients included in the TiMiSNAR Trial (NCT 03465982). This is a biomolecular substudy of TiMiSNAR Trial (NCT03962088). Methods All included patients in the TiMiSNAR Trial are supposed to undergo blood collection at the time of diagnosis, after neoadjuvant treatment, after 1 month from surgery, and after adjuvant chemotherapy whenever indicated. Discussion TiMiSNAR-MIRNA will evaluate the association of variation between preneoadjuvant and postneoadjuvant expression levels of miRNA with pathological complete response. Moreover, the study will evaluate the role of liquid biopsies in the monitoring of treatment, correlate changes in expression levels of miRNA following complete surgical resection with disease-free survival, and evaluate the relation between changes in miRNA during surveillance and tumor relapse. Trial registration Clinicaltrials.gov NCT03962088 . Registered on 23 May 2019.

Published
2020
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5. Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis

Author

Francesco Vito Mandarino, Alberto Barchi, Ferdinando D’Amico, Lorella Fanti, Francesco Azzolini, Edi Viale, Dario Esposito, Riccardo Rosati, Gionata Fiorino, Willem Adrianus Bemelman, Ugo Elmore, Lavinia Barbieri, Francesco Puccetti, Sabrina Gloria Giulia Testoni, and Silvio Danese

Subjects
endoscopic vacuum therapy, esophagectomy, leakages, meta-analysis, stenting, Science
Abstract

Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the “gold standard” for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery. Methods: A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for the treatment of leaks after upper gastro-intestinal surgery for malignant or benign pathologies. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori-defined subgroup analysis for the oncologic surgery group. Results: Eight retrospective studies with 357 patients were eligible. Overall, the EVT group showed a higher success rate (odd ratio [OR] 2.58, 95% CI 1.43–4.66), a lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08–6.71), shorter treatment duration (pmd −9.18, 95% CI −17.05–−1.32), lower short-term complication (OR 0.35, 95% CI 0.18–0.71) and mortality rates (OR 0.47, 95% CI 0.24–0.92) compared to stenting. In the oncologic surgery subgroup analysis, no differences in the success rate were found (OR 1.59, 95% CI 0.74–3.40, I2 = 0%). Conclusions: Overall, EVT has been revealed to be more effective and less burdened by complications compared to stenting. In the oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data need to define a unique management algorithm for anastomotic leaks.

Published
2023
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6. Standard (8 weeks) vs long (12 weeks) timing to minimally-invasive surgery after NeoAdjuvant Chemoradiotherapy for rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR)

Author

Igor Monsellato, Filippo Alongi, Elisa Bertocchi, Stefania Gori, Giacomo Ruffo, Elisa Cassinotti, Ludovica Baldarti, Luigi Boni, Graziano Pernazza, Fabio Pulighe, Carlo De Nisco, Roberto Perinotti, Emilio Morpurgo, Tania Contardo, Enzo Mammano, Ugo Elmore, Roberto Delpini, Riccardo Rosati, Federico Perna, Andrea Coratti, Benedetta Menegatti, Sergio Gentilli, Paolo Baroffio, Piero Buccianti, Riccardo Balestri, Cristina Ceccarelli, Valter Torri, Davide Cavaliere, Leonardo Solaini, Giorgio Ercolani, Elena Traverso, Vittorio Fusco, Maura Rossi, Fabio Priora, G. Numico, Paola Franzone, and Sara Orecchia

Subjects
Radiation therapy, Minimally invasive surgery, Rectal cancer, Neoadjuvant treatment, Robotic surgery, TaTME, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background The optimal timing of surgery in relation to chemoradiation is still controversial. Retrospective analysis has demonstrated in the recent decades that the regression of adenocarcinoma can be slow and not complete until after several months. More recently, increasing pathologic Complete Response rates have been demonstrated to be correlated with longer time interval. The purpose of the trial is to demonstrate if delayed timing of surgery after neoadjuvant chemoradiotherapy actually affects pathologic Complete Response and reflects on disease-free survival and overall survival rather than standard timing. Methods The trial is a multicenter, prospective, randomized controlled, unblinded, parallel-group trial comparing standard and delayed surgery after neoadjuvant chemoradiotherapy for the curative treatment of rectal cancer. Three-hundred and forty patients will be randomized on an equal basis to either robotic-assisted/standard laparoscopic rectal cancer surgery after 8 weeks or robotic-assisted/standard laparoscopic rectal cancer surgery after 12 weeks. Discussion To date, it is well-know that pathologic Complete Response is associated with excellent prognosis and an overall survival of 90%. In the Lyon trial the rate of pCR or near pathologic Complete Response increased from 10.3 to 26% and in retrospective studies the increase rate was about 23–30%. These results may be explained on the relationship between radiation therapy and tumor regression: DNA damage occurs during irradiation, but cellular lysis occurs within the next weeks. Study results, whether confirmed that performing surgery after 12 weeks from neoadjuvant treatment is advantageous from a technical and oncological point of view, may change the current pathway of the treatment in those patient suffering from rectal cancer. Trial registration ClinicalTrials.gov NCT3465982.

Published
2019
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7. Tracheoesophageal Fistula in a COVID-19 Ventilated Patient: A Challenging Therapeutic Decision

Author

Riccardo Rosati, Paola De Nardi, Antonio Dell’Acqua, Maria Rosa Calvi, Ugo Elmore, Elena Scarparo, and Luigi Beretta

Subjects
Surgery, RD1-811
Abstract

COVID-19 associated severe respiratory failure frequently requires admission to an intensive care unit, tracheal intubation, and mechanical ventilation. Among the risks of prolonged mechanical ventilation under these conditions, there is the development of tracheoesophageal fistula. We describe a case of a severe COVID-19 associated respiratory failure, who developed a tracheoesophageal fistula. We hypothesized that one of the mechanisms for tracheoesophageal fistula, along with other local and general risk factors, is the local infection due to the location of the virus itself in the tracheobronchial tree. The patient was managed successfully with surgical intervention. This case highlights the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and suggests a management strategy.

Published
2021
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8. Sellado electrotérmico de vasos bipolares versus recorte de los vasos mesentéricos inferiores durante la proctectomía mínimamente invasiva

Author

Mohamed Zuhdy, Islam H. Metwally, Ugo Elmore, Sameh Roshdy, and Riccardo Rosati

Subjects
Energy devices. Ligasure. Rectal cancer. Minimally invasive surgery. Total mesorectal excision., Surgery, RD1-811
Abstract

Introduction: The introduction of new energy vessel sealing devices in minimally invasive proctectomy led to better hemostatic effect, less blood loss, and shorter operating time. At present, the available evidence from literature about the use of electro-thermal bipolar vessel sealers (EBVS) in laparoscopic rectal cancer surgery is weak where most studies are retrospective with non-homogenous patient groups. Methods: This is a retrospective cohort study where 40 rectal cancer patients operated by laparoscopic TME or laparoscopic assisted transanal total mesorectal excision were classified in two groups according to approach of inferior mesenteric vessels ligation (EBVS versus Clipping). Results: The operative time was significantly longer and the blood loss was significantly more in the EBVS group. However, hospital stay, time to oral, time to starting stoma function, and number of retrieved lymph nodes were not significantly affected by the method of vascular control. Conclusion: Both methods for control of vascular pedicle during minimally invasive rectal cancer surgery are safe, as such it is at the discretion of the operating surgeon to which method to use. Prospective well-designed trials are awaited to provide stronger evidence.

Published
2020
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9. Correction to: Standard (8 weeks) vs long (12 weeks) timing to minimally-invasive surgery after NeoAdjuvant Chemoradiotherapy for rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR)

Author

Igor Monsellato, Filippo Alongi, Elisa Bertocchi, Stefania Gori, Giacomo Ruffo, Elisa Cassinotti, Ludovica Baldari, Luigi Boni, Graziano Pernazza, Fabio Pulighe, Carlo De Nisco, Roberto Perinotti, Emilio Morpurgo, Tania Contardo, Enzo Mammano, Ugo Elmore, Roberto Delpini, Riccardo Rosati, Federico Perna, Andrea Coratti, Benedetta Menegatti, Sergio Gentilli, Paolo Baroffio, Piero Buccianti, Riccardo Balestri, Cristina Ceccarelli, Valter Torri, Davide Cavaliere, Leonardo Solaini, Giorgio Ercolani, Elena Traverso, Vittorio Fusco, Maura Rossi, Fabio Priora, G. Numico, Paola Franzone, and Sara Orecchia

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Following publication of the original article [1], the authors reported that the family name of the author, Ludovica Baldari, was misspelled.

Published
2020
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10. Pulmonary Complications after Surgery for Rectal Cancer in Elderly Patients: Evaluation of Laparoscopic versus Open Approach from a Multicenter Study on 477 Consecutive Cases

Author

Marco Milone, Ugo Elmore, Andrea Vignali, Alfredo Mellano, Nicola Gennarelli, Michele Manigrasso, Francesco Milone, Giovanni Domenico De Palma, Andrea Muratore, and Riccardo Rosati

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Aim. To evaluate the impact of open or laparoscopic rectal surgery on pulmonary complications in elderly (>75 years old) patients. Methods. Data from consecutive patients who underwent elective laparoscopic or open rectal surgery for cancer were collected prospectively from 3 institutions. Pulmonary complications were defined according to the ACS/NSQUIP definition. Results. A total of 477 patients (laparoscopic group: 242, open group: 235) were included in the analysis. Postoperative pulmonary complications were significantly more common after open surgery (8 out of 242 patients (3.3%) versus 23 out of 235 patients (9.8%); p=0.005). In addition, PPC occurrence was associated with the increasing of postoperative pain (5.04 ± 1.62 versus 5.03 ± 1.58; p=0.001) and the increasing of operative time (270.06 ± 51.49 versus 237.37 ± 65.97; p=0.001). Conclusion. Our results are encouraging to consider laparoscopic surgery a safety and effective way to treat rectal cancer in elderly patients, highlighting that laparoscopic surgery reduces the occurrence of postoperative pulmonary complications.

Published
2017
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11. Protective ileostomy creation after anterior resection of the rectum

Author

Andrea, Balla, Federica, Saraceno, Marika, Rullo, Salvador, Morales-Conde, Eduardo M, Targarona Soler, Salomone, Di Saverio, Mario, Guerrieri, Pasquale, Lepiane, Nicola, Di Lorenzo, Michel, Adamina, Isaias, Alarcón, Alberto, Arezzo, Jesus, Bollo Rodriguez, Luigi, Boni, Sebastiano, Biondo, Francesco Maria, Carrano, Manish, Chand, John T, Jenkins, Justin, Davies, M, Chir, Salvadora Delgado, Rivilla, Paolo, Delrio, Ugo, Elmore, Eloy, Espin-Basany, Alessandro, Fichera, Blas Flor, Lorente, Nader, Francis, Marcos Gómez, Ruiz, Dieter, Hahnloser, Eugenio, Licardie, Carmen, Martinez, Monica, Ortenzi, Yves, Panis, Carlos, Pastor Idoate, Alessandro M, Paganini, Miguel, Pera, Roberto, Perinotti, Daniel A, Popowich, Timothy, Rockall, Riccardo, Rosati, Alberto, Sartori, Daniele, Scoglio, Mostafa, Shalaby, Vicente, Simó Fernández, Neil J, Smart, Antonino, Spinelli, Patricia, Sylla, Pieter J, Tanis, Javier, Valdes Hernandez, Steven D, Wexner, Pierpaolo, Sileri, Surgery, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
SDG 3 - Good Health and Well-being, Anterior resection of the rectum, Defunctioning stoma, Gastroenterology, Humans, Rectum/surgery, Rectum/pathology, Ileostomy/adverse effects, Rectal Neoplasms/pathology, Anastomotic Leak/etiology, Anastomosis, Surgical/adverse effects, Retrospective Studies, Adenocarcinoma, Decision-making process, Protective ileostomy, adenocarcinoma, anterior resection of the rectum, decision-making process, defunctioning stoma, protective ileostomy, Settore MED/18
Abstract

Aim: The choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. Method: Fifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed. Results: Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%). Conclusion: The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma.

Published
2023
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12. Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study

Author

Marco Milone, Sara Vertaldi, Marie Sophie Alfano, Antonino Agrusa, Gabriele Anania, Gian Luca Baiocchi, Pietro Paolo Bianchi, Alberto Biondi, Umberto Bracale, Salvatore Buscemi, Matteo Chiozza, Francesco Corcione, Domenico D’Ugo, Maurizio Degiuli, Giuseppe De Simone, Ugo Elmore, Federica Galli, Giuseppe Giuliani, Pietro Maida, Francesco Maione, Michele Manigrasso, Giampaolo Marte, Stefano Olmi, Stefano Rausei, Rossella Reddavid, Riccardo Rosati, Matteo Uccelli, Giovanni Domenico De Palma, Elisa Cassinotti, Luigi Boni, Milone, Marco, Vertaldi, Sara, Alfano, Marie Sophie, Agrusa, Antonino, Anania, Gabriele, Baiocchi, Gian Luca, Bianchi, Pietro Paolo, Biondi, Alberto, Bracale, Umberto, Buscemi, Salvatore, Chiozza, Matteo, Corcione, Francesco, D'Ugo, Domenico, Degiuli, Maurizio, De Simone, Giuseppe, Elmore, Ugo, Galli, Federica, Giuliani, Giuseppe, Maida, Pietro, Maione, Francesco, Manigrasso, Michele, Marte, Giampaolo, Olmi, Stefano, Rausei, Stefano, Reddavid, Rossella, Rosati, Riccardo, Uccelli, Matteo, De Palma, Giovanni Domenico, Cassinotti, Elisa, and Boni, Luigi

Subjects
Gastroenterology, Surgery
Abstract

Introduction: Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis. Methods: All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread. Results: Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029). Conclusions: Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.

Published
2022
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13. Team Strategy Optimization in Combined Resections for Synchronous Colorectal Liver Metastases. A Comparative Study with Bootstrapping Analysis

Author

Luca Aldrighetti, Ecoline Tribillon, Riccardo Rosati, Matteo Cescon, Matteo Ravaioli, Michele Masetti, Matteo Serenari, Francesca Ratti, Ugo Elmore, Elio Jovine, Brice Gayet, Matteo Rottoli, David Fuks, Matteo Zanello, Ratti F., Serenari M., Zanello M., Fuks D., Rottoli M., Masetti M., Tribillon E., Ravaioli M., Elmore U., Rosati R., Gayet B., Cescon M., Jovine E., Aldrighetti L., Ratti, Francesca, Serenari, Matteo, Zanello, Matteo, Fuks, David, Rottoli, Matteo, Masetti, Michele, Tribillon, Ecoline, Ravaioli, Matteo, Elmore, Ugo, Rosati, Riccardo, Gayet, Brice, Cescon, Matteo, Jovine, Elio, and Aldrighetti, Luca

Subjects
medicine.medical_specialty, Multivariate analysis, Referral, Blood Loss, Surgical, Colorectal Neoplasm, Postoperative Complications, medicine, Hepatectomy, Humans, business.industry, Incidence (epidemiology), Liver Neoplasms, Perioperative, Vascular surgery, medicine.disease, Primary tumor, Surgery, Treatment Outcome, Cardiothoracic surgery, Laparoscopy, Postoperative Complication, Colorectal Neoplasms, business, Human, Abdominal surgery
Abstract

The aim of the study was to evaluate perioperative outcomes and to evaluate factors influencing rative morbidity and adoption of minimally invasive technique in 1-team (1-T) versus two teams (2-T) management of synchronous colorectal liver metastases. Background: The aim of the study was to evaluate perioperative outcomes and to evaluate factors influencing rative morbidity and adoption of minimally invasive technique in 1-team (1-T) versus two teams (2-T) management of synchronous colorectal liver metastases. Methods: Within four referral centers, a group of 234 patients treated in 1-T centers was identified and compared with a group of 253 patients treated in 2-T. A nonparametric bootstrap process was applied to the original cohorts of 1-T group and 2-T group as a resampling method to obtain bootstrapped cohorts (155 patients per group). Results: 33.5% of patients in 1-T boot group and 38.1% in the 2-T boot group were operated by laparoscopic approach. Multivariate analysis revealed that approach to primary tumor (laparoscopic or open) and intraoperative blood loss were independent prognostic factors for morbidity. Team approach did not show any significant correlation with incidence of postoperative complications nor with choice for laparoscopic approach. Conclusion: The optimization of team strategy for patients with SCRLM is not solely based on the adoption of a 1-T or 2-T approach, but should instead be based on the implementation of a standard protocol for management of these patients.

Published
2021
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14. Applicative Limitations of Indocyanine Green Fluorescence Assistance to Laparoscopic Lymph Node Dissection in Total Gastrectomy for Cancer

Author

Francesco Puccetti, Lorenzo Cinelli, Luana Genova, Silvia Battaglia, Lavinia A. Barbieri, Elio Treppiedi, Andrea Cossu, Ugo Elmore, Riccardo Rosati, Puccetti, Francesco, Cinelli, Lorenzo, Genova, Luana, Battaglia, Silvia, Barbieri, Lavinia A, Treppiedi, Elio, Cossu, Andrea, Elmore, Ugo, and Rosati, Riccardo

Subjects
Indocyanine Green, Oncology, Gastrectomy, Stomach Neoplasms, Humans, Lymph Node Excision, Surgery, Laparoscopy, Lymph Nodes, Retrospective Studies
Abstract

Background Indocyanine green (ICG) fluorescence has been recently introduced as a novel imaging technique improving the accuracy of lymph node (LN) dissection in gastric cancer (GC) surgery, although procedure standardization and achievements have not been clearly defined. This study analyzed the feasibility and effectiveness of ICG-guidance for laparoscopic D2-lymphadenectomy during total gastrectomy for cancer. Methods This study retrospectively analyzed a single-center series of patients who underwent laparoscopic total gastrectomy for cancer between April 2015 and August 2021. All patients underwent surgery with standard D2 LN dissection. Intraoperative ICG-fluorescence was institutionally implemented in April 2018 and was performed routinely afterward. Primary outcomes were LN harvest and ratio. Secondary endpoints included operative time and subgroup analysis to assess variables potentially affecting LN retrieval. Results The study population included 102 patients, and ICG-fluorescence was applied in 38 (37.3%). ICG and no-ICG groups presented similar median age, gender proportions, ASA score and comorbidities (age-adjusted Charlson Comorbidity Index), body mass index, and advanced pathological stage. The median of LNs retrieved was significantly higher after the intraoperative ICG-guidance (44 vs. 32; p = 0.004), although this association was not significant after neoadjuvant therapy or among patients with positive LNs. Lymph node ratio and operative time were not significantly impacted by ICG fluorescence. Multivariate analysis identified the ICG-assistance as the only independent determinant for LN harvest (p = 0.029). Conclusions ICG-guidance contributes to a significantly wider LN retrieval after laparoscopic D2-lymphadenectomy during total gastrectomy for cancer. However, neoadjuvant therapy and positive LN stage appeared to limit the procedural effectiveness to ICG-assisted LN identification.

Published
2022

16. Sterile carbon particle suspension vs India ink for endoscopic tattooing of colonic lesions: a randomized controlled trial

Author

Nicola Gennarelli, Giovanni Aprea, Ugo Elmore, Marco Milone, G. De Simone, Andrea Vignali, Giovanni Sarnelli, Francesco Maione, Michele Manigrasso, G.D. De Palma, Nunzio Velotti, Milone, M., Vignali, A., Manigrasso, M., Velotti, N., Sarnelli, G., Aprea, G., De Simone, G., Maione, F., Gennarelli, N., Elmore, U., and De Palma, G. D.

Subjects
Male, medicine.medical_specialty, Abdominal pain, Randomization, Colon, Colonoscopy, Sterile carbon particle suspension, Body Temperature, Injections, India ink, law.invention, Leukocyte Count, Suspensions, Randomized controlled trial, law, Clinical endpoint, medicine, Humans, Coloring Agents, Aged, Cancer, Inflammation, Tattooing, medicine.diagnostic_test, business.industry, Gastroenterology, Fibrinogen, Endoscopy, Middle Aged, Carbon, Colorectal surgery, Abdominal Pain, Surgery, C-Reactive Protein, Colonic Neoplasms, Female, Laparoscopy, medicine.symptom, business, Abdominal surgery
Abstract

Background: Different markers have been used preoperatively to mark colonic lesions, especially India ink. In recent years, another kind of marker has been developed: sterile carbon particle suspension (SCPS). No comparison between these two markers has yet been made. The aim of the present study was to compare the pyrogenic, inflammatory and intraperitoneal effect of these two markers. Methods: From September 2015 to December 2018, adult patients who were candidates for elective laparoscopic colon resection were randomized to the SCPS or conventional India ink injection group using computer-based randomization. The primary endpoint of the study was the presence of intraoperative adhesions related to the endoscopic tattoo. Secondary endpoints were differences in white blood cell, C-reactive protein, and fibrinogen levels as well as, abdominal pain and body temperature at baseline (before endoscopic tattooing) and 6 and 24h after colonoscopy. Finally, the visibility of the tattoo during the minimally invasive intervention was assessed. Results: Ninety-four patients were included in the study, 47 for each arm. There were 45/94 females (47.9%) and 49/94 males (52.1%), with a median age of 67.85 ± 9.22years. No differences were found between groups in WBC, fibrinogen levels, body temperature or VAS scores, but we documented significantly higher CRP values at 6 and 24h after endoscopic tattooing with India ink injection. There were significantly fewer adhesions in the SCPS Endoscopic Marker group. All the endoscopic tattoos were clearly visible. Conclusions: SCPS is an effective method for tattooing colonic lesions and has a better safety profile than traditional India ink in terms of post-procedure inflammatory response and intraoperative bowel adhesions. Clinical trial registration: clinicaltrials.gov (ID: NCT03637933).

Published
2019
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17. OC.07.6 DIET AND LIFESTYLE HABITS IN EARLY-ONSET COLORECTAL CANCER: A PILOT CASE CONTROL STUDY

Author

Riccardo Rosati, S. Cascinu, Francesco Azzolini, Ilaria Ditonno, Giulia Martina Cavestro, Edi Viale, Marta Puzzono, Chiara Notaristefano, Giuseppe Pantaleo, Raffaella Alessia Zuppardo, Alessandro Mannucci, Ugo Elmore, M. Di Leo, Lorella Fanti, and M. Russo

Subjects
medicine.medical_specialty, Hepatology, business.industry, Colorectal cancer, Internal medicine, Gastroenterology, medicine, Case-control study, business, Lifestyle habits, medicine.disease, Early onset
Published
2021
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18. Standard (8 weeks) vs long (12 weeks) Timing to Minimally-Invasive Surgery after NeoAdjuvant Chemoradiotherapy for Rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR)

Author

Igor Monsellato, Gianmauro Numico, Elisa Cassinotti, Elisa Bertocchi, Ugo Elmore, Luigi Boni, Valter Torri, Elena Traverso, Paolo Baroffio, Filippo Alongi, Enzo Mammano, Fabio Pulighe, Emilio Morpurgo, Fabio Priora, Roberto Perinotti, Paola Franzone, Giacomo Ruffo, Sergio Gentilli, and Graziano Pernazza

Subjects
Group trial, medicine.medical_specialty, Oncology, Colorectal cancer, business.industry, Invasive surgery, medicine, Surgery, General Medicine, medicine.disease, business, Neoadjuvant chemoradiotherapy
Published
2020
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19. PO-0816 Adaptive radiotherapy concomitant with chemotherapy as preoperative treatment for rectal cancer

Author

N. Di Muzio, Anna Palmisano, Claudio Fiorino, Paolo Passoni, A. Vignali, Ugo Elmore, Valentina Burgio, Riccardo Calandrino, A. Fasolo, Najla Slim, F. De Cobelli, P. De Nardi, C. Gumina, Andrea Tamburini, Riccardo Rosati, and Monica Ronzoni

Subjects
Chemotherapy, medicine.medical_specialty, business.industry, Colorectal cancer, medicine.medical_treatment, Hematology, medicine.disease, Oncology, Concomitant, Medicine, Radiology, Nuclear Medicine and imaging, Radiology, Adaptive radiotherapy, business, Preoperative treatment
Published
2019
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20. Laparoscopic Anterior Resection with Transanal Total Mesorectal Excision for Rectal Cancer: Preliminary Experience and Impact on Postoperative Bowel Function

Author

Matias F. Sosa, Uberto Fumagalli Romario, Riccardo Rosati, Andrea Vignali, Maria Rachele Angiolini, and Ugo Elmore

Subjects
Male, medicine.medical_specialty, Colorectal cancer, Operative Time, Anastomotic Leak, Adenocarcinoma, Resection, Rectal Adenocarcinoma, Humans, Medicine, Postoperative Period, Prospective Studies, Bowel function, Prospective cohort study, Aged, Transanal Endoscopic Surgery, Rectal Neoplasms, business.industry, Middle Aged, medicine.disease, Total mesorectal excision, Surgery, Feasibility Studies, Lymph Node Excision, Operative time, Female, Laparoscopy, sense organs, business, Fecal Incontinence, Grading scale
Abstract

Transanal total mesorectal excision (TME) and the "down-to-up" mobilization concept might be possible alternatives to the standard TME, particularly in cases of narrow pelvis or bulky tumors in obese patients. Our aim was to test the feasibility and safety of transanal TME and to evaluate its impact on short-term functional outcome.Six consecutive patients with histologically proven low/middle rectal adenocarcinoma were prospectively enrolled. All patients underwent laparoscopic anterior resection with transanal TME. Intraoperative complications, postoperative morbidity, and oncologic adequacy of the surgical specimen were evaluated in all patients. A bowel function questionnaire using information from the Wexner's score continence grading scale was administered to all patients 1 week before surgery and 6 months following operation.Laparoscopically assisted transanal TME was successful in all patients. Mean operative time was 236 minutes (range, 200-270 minutes). There were no intraoperative complications. The anastomotic leak rate was 16.6%. Clear distal and circumferential margins and proper lymphadenectomy were obtained in all surgical specimens (mean number of nodes harvested, 32; range, 19-68). In no patients was a major incontinence observed; the median (range) Wexner score at 6 months after surgery was 3 (1-7).Transanal TME is safe and feasible. Preliminary outcomes meet oncologic criteria. Moreover, the transanal approach does not have an adverse impact on functional outcome. Further long-term evaluation of results and clinical trials should be performed.

Published
2015
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21. OC.13.1 ASSOCIATION OF GERMLINE GENE MUTATIONS IN EARLY ONSET GASTROINTESTINAL CANCERS WITH NEGATIVE FAMILY HISTORY

Author

Michele Reni, Alessandro Mannucci, P.A. Testoni, Riccardo Rosati, Ugo Elmore, Luca Gianni, Stefano Crippa, M. Di Leo, A. Russo Raucci, Paolo Parise, Maria Grazia Patricelli, Giulia Martina Cavestro, Massimo Falconi, Monica Ronzoni, Valentina Burgio, Elena Mazza, Raffaella Alessia Zuppardo, and M. Lemma

Subjects
Genetics, Hepatology, business.industry, Gastroenterology, Medicine, Family history, Gene mutation, business, Germline, Early onset
Published
2018
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22. PS01.227: THE IMPACT OF ELDERLY ON SURGICAL OUTCOMES AFTER IVOR-LEWIS ESOPHAGECTOMY: REVIEW OF A SINGLE INSTITUTION EXPERIENCE

Author

Andrea Cossu, Paolo Parise, Francesco Puccetti, Leonardo Garutti, Carlo Ferrari, Ugo Elmore, and Riccardo Rosati

Subjects
Gastroenterology, General Medicine
Abstract

Background Esophagectomy is a surgical procedure burdened by a high morbidity rate. The effect of minimally invasive (MI) approach on elderly patients is still not clear. Aim of this study was to analyze the impact of MI approach on post-operative course according to the patient age. Methods A consecutive series of 692 patients underwent to elective oncological esophagectomy between 1997 and 2017. All data were entered into a prospective database. Patients submitted to 3-flield or trans-hiatal esophagectomy were excluded and only Ivor-Lewis open, hybrid or totally minimally invasive esophagectomy were evaluated. Patients were stratified according to age in 3 groups: Group A (≤ 50 years) 53 patients, Group B (> 51 and Results As expected outcomes worsened with patients age (CD ≥ 3b: 7.5% group A, 13% group B and 21% group C. P = 0.001), mortality (0% group A, 3% group B and 5.5% group C. P = 0.035) and length of stay (10 days group A, 11 days group B and 13 days group C. P = 0.001). A statistically significant higher incidence of anastomotic leaks was observed among patients submitted to totally MI esophagectomy in group C vs A and B that were respectively 12,5%, 0% and 7%. Major respiratory complications were not statistically different among these 3 three sub-groups. Conclusion Old age has a significant impact on outcomes after esophagectomy. In this subset of patients a MI approach could also increase postoperative morbidity. Elderly patients should be carefully selected before to be submitted to MI esophagectomy. Disclosure All authors have declared no conflicts of interest.

Published
2018
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23. PS02.181: RISK FACTORS AND TREATMENT OF DIAPHRAGMATIC HERNIA FOLLOWING IVOR-LEWIS OESOPHAGECTOMY FOR CANCER

Author

Riccardo Rosati, Francesco Puccetti, Stefano De Pascale, Paolo Parise, Andrea Cossu, Uberto Fumagalli Romario, Ugo Elmore, and Gianluca Marcocci

Subjects
medicine.medical_specialty, business.industry, General surgery, Gastroenterology, medicine, Cancer, Ivor lewis, Diaphragmatic hernia, General Medicine, medicine.disease, business
Abstract

Background Oesophagectomy is the mainstay of curative treatment for oesophageal cancer and post-oesophagectomy diaphragmatic hernia (PODH) represents a potentially life-threatening surgical complication characterized by an underestimated occurrence rate and unknown related risk factors. This study analyses the experience of two tertiary designated centers in order to evaluate key elements concerning development and treatment of PODH. Methods A cohort of consecutive patients affected by a clinically resectable oesophageal cancer (any T, any N and M0) underwent Ivor-Lewis oesophagectomy between March 1997 and April 2017 according to three different approaches: totally open incision procedure (OILO), hybrid (HILO) and totally mininvasive to esophagectomy (MILO). All patients were retrospectively observed in the context of a postoperative calendarised follow-up in order to record the incidence and postrepair results of PODH. Results 414 patients underwent Ivor-Lewis oesophagectomy for cancer and 22 (5.3%) developed PODH within a median follow-up period of 16 months (6 - 177). Surgical repair was generally applied by the mean of laparoscopic cruroplasty (77%) with a conversion rate of 24%. Postoperative morbidity did not include early recurrences but exclusively cardio-pulmonary complications (5 patients) with one case of respiratory failure leading to death. The discharge was reached after a median hospital stay of 6 days (2 - 95) while 3 recurrences (14%) occurred over a median follow-up period of 10.1 months. A wide univariate analysis identified statistically significant associations between PODH occurrence and the administration of preoperative chemoradiotherapy, the complete pathological response (CPR) and a lymph node harvest (LNH) larger than 33 stations (p-value of 0.016, 0.001 and 0.024 respectively). The strong influence of an extended LNH was confirmed by the multivariable analyses (0.026) along with CPR which should however be considered as longer survival-related bias. Conclusion The minimally invasive surgery and the neoadjuvant chemoradiotherapy represent a considerable part of multimodal treatment for oesophageal cancer presenting a not statistically significant association with PODH development while a LNH including more than 33 nodes resulted to be an independent risk factor mirroring the extent of surgical demolition in oesophagectomy. Disclosure All authors have declared no conflicts of interest.

Published
2018
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24. PS01.204: ANASTOMOTIC LEAKS AFTER IVOR-LEWIS ESOPHAGECTOMY: INDOCYANINE GREEN NEAR-INFRERED ANGIOGRAPHY FOR GASTRIC CONDUIT BLOOD SUPPLY EVALUATION

Author

Riccardo Rosati, Paolo Parise, Francesco Puccetti, Ugo Elmore, Leonardo Garutti, and Andrea Cossu

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Gastric conduit, Gastroenterology, General Medicine, Surgery, chemistry.chemical_compound, chemistry, Anastomotic leaks, Angiography, medicine, Ivor lewis, Blood supply, business, Indocyanine green
Abstract

Background Indocyanine Green—Angiography (ICG-A) has been recently introduced for visceral perfusion evaluation. Aim of this study is to assess whether the intraoperative use of ICG-A can improve the evaluation of blood supply of the gastric conduit in Ivor-Lewis esophagectomy for cancer. Methods This is an interim analysis of a prospective interventional study ongoing at our Institution, on 160 Ivor-Lewis esophagectomy patients. After an intravenous bolus of ICG during the abdominal and thoracic stage, the gastric conduit perfusion was evaluated by means of a near infrared ICG-A and graded as ‘well’, ‘hypo-perfused’ or ‘ischemic’. If present, the ischemic or hypo-perfused area was resected. Demographic and clinical parameters and others, such as conduit perfusion speed, intra or post-operative hypotensive episodes have been analyzed. Results Currently 26 patients have been enrolled. An anastomotic leak of any grade was identified in 7 patients. Patients were divided in Group A (7 patients) who developed a leak and Group B (19 patients) who do not. No statistically significant differences were evidenced on demographic and preoperative clinical features, except for higher cigarette smoking history incidence in Group A. Those who developed a leak had an ‘hypo-perfused’ conduit at ICG-A in 71.4% and those who do not in only 15.8% (p 0.014). Median time from ICG injection to appearance of fluorescence at the basis of the gastric conduit was significantly longer in Group A than in Group B, 36 sec. (32–43.5) vs 28 sec. (20–39.8) (p 0.04) but median gastric conduit perfusion speed was similar. Patients in Group B had a higher median width of the conduit than Group A, 5cm (5.0–6.0) vs 4 (4.0–5.0) (p 0.032). Post-operative prolonged hypotensive episodes were seen more frequently in Group A than Group B (p 0.028). No differences were evidenced in terms of fluids infusions, blood loss, conduit length or intraoperative hypotensive episodes. Conclusion Preliminary results seem to show the usefulness of ICG-A in identifying patients at risk of leakage. Nevertheless no reduction of leakage incidence was induced by surgical strategy modification, probably because post-operative events may affect clinical course too. Definitive data have to be awaited. Disclosure All authors have declared no conflicts of interest.

Published
2018
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25. VS03.02: TOTALLY MINIMALLY INVASIVE IVORL LEWIS ESOPHAGECTOMY (TMIE) INDOCYANINE COLOR GREEN (ICG) FLUORESCENCE ANGIOGRAPHY ASSISTED

Author

Francesco Puccetti, Andrea Cossu, Riccardo Rosati, Carlo Ferrari, Paolo Parise, Ugo Elmore, and Leonardo Garutti

Subjects
Esophagectomy, business.industry, Fluorescence angiography, medicine.medical_treatment, Gastroenterology, medicine, General Medicine, business, Nuclear medicine
Abstract

Description Totally Minimally Invasive Ivor Lewis Esophagectomy has been proven feasible and safe in terms of overall mortality, morbidity and oncologic outcomes. Technical problems still exist in anastomotic fashioning and esophagogastric leakage represents the most feared complication. Its incidence is strictly related to technical difficulties and to the ischemia of the tissue involved in the anastomosis. We think angiography with Indocyanine Color Green can help the experienced surgeon to better evaluate the adequacy of the gastric tube therefore reducing the incidence of anastomotic leak. Disclosure All authors have declared no conflicts of interest.

Published
2018
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26. McKittrick–Wheelock syndrome: a rare cause of acute renal failure and hypokalemia not to be overlooked

Author

Claudio Angelini, Manuel Alfredo Podestà, Elisa Merizzoli, David Cucchiari, Ugo Elmore, and Salvatore Badalamenti

Subjects
Diarrhea, Male, Villous adenoma, medicine.medical_specialty, Hypokalemia, Critical Care and Intensive Care Medicine, Gastroenterology, Pathogenesis, Internal medicine, Adenoma, Villous, medicine, Humans, Intensive care medicine, McKittrick-Wheelock syndrome, Aged, Acidosis, Aged, 80 and over, Rectal Neoplasms, business.industry, nutritional and metabolic diseases, Metabolic acidosis, Syndrome, General Medicine, Acute Kidney Injury, medicine.disease, Nephrology, Female, medicine.symptom, business, Hyponatremia, Mucous diarrhea
Abstract

McKittrick-Wheelock syndrome is a rare disorder in which a colorectal tumor (usually a villous adenoma) determines secretory mucous diarrhea, which in turn leads to prerenal acute renal failure, hyponatremia, hypokalemia and metabolic acidosis. Even though the outcome is usually favorable with complete recovery after surgery, the diagnosis is often delayed, making the patient susceptible to life-threatening complications, mainly severe acidosis and hypokalemia. We present two paradigmatic cases with extreme electrolytes imbalance and complete recovery following the appropriate treatment. The pathogenesis of this degenerative condition is discussed in detail.

Published
2014
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27. Virtual Gastroduodenoscopy: A New Look at the Bypassed Stomach and Duodenum After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

Author

Nicola Basso, Paolo Gentileschi, Carlo Catalano, Michel Gagner, Angelo Restuccia, Gianfranco Silecchia, and Ugo Elmore

Subjects
Adult, Male, medicine.medical_specialty, Percutaneous, Endocrinology, Diabetes and Metabolism, Gastric bypass, Gastric Bypass, Morbid obesity, Gastroscopy, medicine, Humans, Postoperative Period, Duodenoscopy, Nutrition and Dietetics, business.industry, Stomach, digestive, oral, and skin physiology, Anastomosis, Roux-en-Y, Roux-en-Y anastomosis, Obesity, Morbid, Surgery, medicine.anatomical_structure, Gastrostomy tube, Duodenum, Female, Laparoscopy, bariatric surgery, laparoscopic gastric bypass, morbid obesity, roux-eh-y, roux-en-y, virtual endoscopy, Distal stomach, business, Colonography, Computed Tomographic
Abstract

Background: After open or laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity, the bypassed stomach and duodenum are not readily available for radiological and endoscopic evaluation. Furthermore, little is known about the long-term physiologic and histologic changes that occur in the bypassed GI segments following these procedures. Many alternative radiological and endoscopic techniques have been described to access the distal gastric pouch and the duodenum after RYGBP. Apart from percutaneous gastrografin® studies, all these techniques require the insertion of a gastrostomy tube in the distal stomach. Methods: a new diagnostic method to access the bypassed segments by virtual CT gastroscopy (VG) was used in 5 morbidly obese patients who underwent laparoscopic RYGBP (LRYGBP). Results: All patients tolerated the procedure well, which appears safe and suitable for an outpatient setting.The virtual images offered an excellent intraluminal view of the stomach and duodenum. Conclusions: VG holds promise as the method of choice in the follow-up of LRYGB patients, having the potential to detect inflammatory changes and cancer in the excluded segments early.

Published
2002
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