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151. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

Author: Salvador Navarro, Giorgio Giraudo, Harry van Goor, Sergio Aloia, Saila Kauhanen, Luca Ansaloni, Miran Rems, Cyrille Huchon, Rodolfo Scibé, Stefano Rausei, Ihor Herych, Damien Massalou, Ferdinando Agresta, Gianluca Guercioni, Fausto Catena, Cristian Mesina, Olivier Pittet, Ionut Negoi, Konstantinos Bouliaris, Cristian Tranà, Elia Poiasina, András Vereczkei, Marco Catani, Jorge Pereira, Mario Dente, Vladimir Khokha, Zoran Krivokapic, Alessandro Ferrero, Daniele Marrelli, Federico Coccolini, Pietro Coletta, Athanasios Marinis, Radu Moldovanu, Dmitry Smirnov, Dimitrios Giakoustidis, Daniel Lazzareschi, Jelena Petrović, Matej Skrovina, Samipetteri Laine, Fabio Cesare Campanile, Ludwig Ney, Martin Hutan, P. Pletinckx, Michele Cucchi, Adam Dziki, Korhan Taviloğlu, Günter Weiss, Mirjami Uotila-Nieminen, Salomone Di Saverio, Pierluigi Viale, Davide Corbella, Avdyl Krasniqi, Dragoljub Zivanovic, Elio Jovine, Piotr Major, Nikola Vladov, Ari Leppäniemi, Nurkan Törer, Sergio Colizza, Carlo De Werra, Charalampos Seretis, Orestis Ioannidis, Nereo Vettoretto, Jaan Tepp, Eliane Angst, Konstantinos Lasithiotakis, Jakub Kenig, Massimo Sartelli, Goran Augustin, Giorgio Vasquez, Helen Tzerbinis, Tadeja Pintar, Miguel Leon, Renato Bessa Melo, Halil Alis, Rafael Díaz-Nieto, Roberto Bini, Boris Sakakushev, David van Dellen, Samir Delibegovic, [Sartelli,M, Lazzareschi,DV, Scibè,R] Department of Surgery, Macerata Hospital, Macerata, Italy. [Catena,F, Cucchi,M] Emergency Surgery, Maggiore Parma Hospital, Parma, Italy. [Ansaloni,L, Coccolini,F, Poiasina,E] Department of General Surgery, Ospedali Riuniti, Bergamo, Italy. [Leppaniemi,A] Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland. [Taviloglu,K] Department of Surgery, Sisli Florence Nigtingale Hospital, Istanbul, Turkey. [van Goor,H] Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. [Viale,P] Department of Internal Medicine Geriatrics and Nephrologic Diseases, Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy. [Corbela,D] Department of Anestesiology, Ospedali Riuniti, Bergamo, Italy. [de Werra,C, Aloia,S] General, Oncological, Geriatrical Surgery and advanced Technology, University Federico II, Naples, Italy. [Marrelli,D] Department of Human Pathology and Oncology, Policlinico le Scotte, University Hospital, Siena, Italy. [Colizza,S] Department of Surgery, Fatebenefratelli Isola Tiberina hospital, Rome, Italy. [Alis,H] Department of General Surgery, Bakirkoy Training Research Hospital, Istanbul, Turkey. [Torer,N] Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey. [Navarro,S] Department of Surgery, Parc Tauli University Hospital, Barcelona, Spain. [Sakakushev,B] First General Surgery Clinic, University Hospital St. George/Chair of Surgical Propedeutics, Medical Faculty, Medical University Plovdiv, Plovdic, Bulgaria. [Massalou,D] Department of Emergency Surgery, University Hospital of Nice, University of Nice Sophia-Antipolis, Sophia-Antipolis, France. [Augustin,G] Department of Surgery, University Hospital Center, Zagreb, Croatia. [Catani,M] Emergency Department, Umberto I Hospital, 'La Sapienza' University of Rome, Rome, Italy. [Kauhanen,S] Department of Gastroenterological surgery Turku, University Central Hospital, Turku, Finland. [Pletinckx,P] Department of Surgery, AZ Maria Middelares, Ghent, Belgium. [Kenig,J] 3rd Department of Generał Surgery, Narutowicz Hospital, Krakow, Połand. [Di Saverio,S, Jovine,E] Department of Surgery, Maggiore Hospital, Bologna, Italy. [Guercioni,G] Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy. [Skrovina,M] Department of Surgery Hospital and Oncological Centre Novy Jicin, Novy Jicin, Czech republic. [Díaz-Nieto,R] Department of General and Digestive Surgery, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Ferrero,A] Department of Surgery, Mauriziano Hospital, Torino, Italy. [Rausei,S] Department of Surgery (Chief Renzo Dionigi), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. [Laine,S] Department GI-surgery, Kuopio University Hospital, Kuopio, Finland. [Major,P] 2nd Department of Surgery, Jagiellonian University, Krakow, Poland. [Angst,E] Department of Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland. [Pittet,O] Department of Visceral Surgery Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland. [Herych,I] Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine. [Agresta,F] Department of General Surgery, Ospedale Civile, Adria (RO), Italy. [Vettoretto,N] General and Vascular Surgery, M.Mellini Hospital, Chiari, Italy. [Tepp,J] First General Surgery, North Estonia Regional Hospital, Tallinn, Estonia. [Weiss,G] Intensive Care Klinikum, Magdeburg gGmbH, Magdeburg, Germany. [Vasquez,G] Department of Emergency Surgery Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy. [Vladov,N] Department of Hepato-biliary and Pancreatic surgery and Transplantology, Military Medical Hospital, Sofia, Bulgaria. [Tranà,C] Department of Surgery, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy. [Delivegovic,S] Department of surgery, University Clinic Center Tuzla, Tuzla, Bosnia and Herzegovina. [Dziki,A] Department of General and Colorectal Surgery, University Hospital, Central Veterans Hospital, Lodz, Poland. [Giraudo,G] Surgical Department Santa Croce e Carle hospital, Cuneo, Italy. [Pereira,J] Department of Surgery, São Teotónio Hospital, Viseu, Portugal. [Tzerbinis,H] Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom. [van Dellen,D] Department of Surgery, Manchester Royal Infirmare, Manchester, UK. [Hutan,M] IInd Surgical department of Medical faculty Comenius University, University Hospital Bratislava, st. Cyril and Methodius Hospital, Bratislava, Slovakia. [Vereczkei,A] Department of Surgery, Medical School University of Pécs, Pécs, Hungary. [Krasniqi,A] Department of Abdominal Surgery, University Clinical Centre of Kosovo, Prishtina, Kosovo. [Seretis,Ch] 2nd Department of Surgery, General Army Hospital of Athens, Athens, Greece. [Mesina,C] Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Roumanie. [Rems,M] Surgical Department, General hospital Jesenice, Jesenice, Slovenia. [Campanile,FC] Department of surgery, Andosilla Hospital, Civita Castellana, Italy. [Coletta,P] Department of Surgery, Jesi Hospital, Jesi, Italy. [Uotila-Nieminen,M] Department of Gastrointestinal Surgery, North Carelian Central Hospital, Joensuu, Finland. [Dente,M] Oncologic, Digestive and Emergency Surgery, Bocage Hospital, Dijon, France. [Bouliaris,K] Surgical Department General Hospital of Larissa, Larissa, Greece. [Lasithiotakis,K] Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece. [KhoKha,V] Surgical Department, Mozyr, Belarus. [Zivanovic,D] Department of Pediatric surgery, Paediatric surgery and orthopaedic Clinic, Nis, Serbia. [Smirnov,D] General Surgery, Clinical Hospital at Chelyabinsk Station OJSC 'Russian Railroads', Chelyabinsk City, Russian Federation. [Marinis,A] First Department of Surgery, Tzanion General Hospital, Piraeus, Greece. [Negoi,I] Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania. [Ney,L] Deparment of Surgery, Downtown Campus, University Hospital of Munich, Munich, Germany. [Bini,R] General and emergency surgery, SG Bosco Hospital, Torino, Italy. [León,M] Department of General Surgery, Hospital La Paz, Madrid, Spain. [Huchon,C] Department of Gynecology and Obstetrics, CHI Poissy-St-Germain-En-Laye, France and University Versailles Saint-Quentin, Versailles, France. [Moldovanu,R] Chirurgie Viscerale, Digestive et Oncologique Hospital Prive, Arras les Bonnettes, Arras, France. [de Melo,RB] Department of General Surgery, Hospital São João Porto, Porto, Portugal. [Giakoustidis,D] Division of Transplantation, Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece. [Ioannidis,O] 1st Surgical Department, General Regional Hospital 'George Papanikolaou', Thessaloniki, Greece. [Pintar,T] Department of Abdominal Surgery, umc Ljubljana, Ljubljana, Slovenia. [Krivokapic,Z, Petrovic,J] First Surgical clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade 8, Belgrade, Serbia., and II kirurgian klinikka
Subjects: Infecciones Intraabdominales, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Digestive System Surgical Procedures [Medical Subject Headings], Diseases::Bacterial Infections and Mycoses::Infection::Cross Infection [Medical Subject Headings], Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial [Medical Subject Headings], 030230 surgery, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drainage [Medical Subject Headings], Abceso Abdominal, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Reoperation [Medical Subject Headings], 0302 clinical medicine, Epidemiology, Farmacoresistencia Microbiana, Medicine, Diseases::Bacterial Infections and Mycoses::Infection::Sepsis [Medical Subject Headings], PRIMARY ANASTOMOSIS, Publication Characteristics::Study Characteristics::Multicenter Study [Medical Subject Headings], Adulto, Mortality rate, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Diverticulitis, 3. Good health, Humanos, Procedimientos Quirúrgicos del Sistema Digestivo, 030220 oncology & carcinogenesis, Emergency Medicine, Diseases::Digestive System Diseases::Peritoneal Diseases::Peritonitis [Medical Subject Headings], Reoperación, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness [Medical Subject Headings], Research Article, medicine.medical_specialty, Perforation (oil well), education, Infección Hospitalaria, lcsh:Surgery, APPENDECTOMY, Enfermedad Crítica, Diseases::Bacterial Infections and Mycoses::Infection::Suppuration::Abscess::Abdominal Abscess [Medical Subject Headings], Sepsis, 03 medical and health sciences, Internal medicine, HARTMANNS PROCEDURE, MANAGEMENT, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], Estudio Multicéntrico, Diseases::Bacterial Infections and Mycoses::Infection::Intraabdominal Infections [Medical Subject Headings], business.industry, Septic shock, Abdominal Infection, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, PRIMARY RESECTION, Emergency medicine, Observational study, Surgery, business, DIVERTICULITIS
Abstract: The CIAO Study (“Complicated Intra-Abdominal infection Observational” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012). Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152). According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.
Published: 2012
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152. Is Node Ratio Superior to Numeric Criterion in Evaluating Lymph Node Involvement in Gastric Cancer?

Author: V. Dadomo, Federica Galli, Gianlorenzo Dionigi, Luisa Giavarini, Laura Ruspi, Francesco Frattini, Marco Franchin, Renzo Dionigi, and Stefano Rausei
Subjects: medicine.medical_specialty, medicine.anatomical_structure, Oncology, business.industry, Node (networking), medicine, Cancer, Surgery, General Medicine, Radiology, medicine.disease, business, Lymph node
Published: 2012

153. Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy: what about the costs?

Author: Luigi Boni, Stefano Rausei, Renzo Dionigi, Alessandro Bacuzzi, Gianlorenzo Dionigi, and Francesca Rovera
Subjects: medicine.medical_specialty, genetic structures, business.industry, medicine.medical_treatment, Thyroid, Gold standard, Thyroid Gland, Thyroidectomy, Vascular surgery, Surgery, Cardiac surgery, medicine.anatomical_structure, Cardiothoracic surgery, Monitoring, Intraoperative, Recurrent Laryngeal Nerve Injuries, Recurrent laryngeal nerve, Humans, Medicine, Hospital Costs, business, Abdominal surgery
Abstract: The objective of the present study was to evaluate costs for thyroidectomy performed with the aid of intraoperative neural monitoring (IONM), which has gained widespread acceptance during thyroid surgery as an adjunct to the gold standard of visual nerve identification.Through a micro-costing approach, the thyroidectomy patient-care process (with and without IONM) was analyzed by considering direct costs (staff time, consumables, equipment, drugs, operating room, and general expenses). Unit costs were collected from hospital accounting and standard tariff lists. To assess the impact of the IONM technology on hospital management, three macro-scenarios were considered: (1) traditional thyroidectomy; (2) thyroidectomy with IONM in a high-volume setting (5 procedures per week); and (3) thyroidectomy with IONM in a low-volume setting (1 procedure per week). Energy-based devices (EBD) for hemostasis and dissection in thyroidectomy were also evaluated, as well as the reimbursement made by the Italian Healthcare System on the basis of diagnosis related groups (DRGs), about €2,600.Comparison between costs and the DRG fee shows an underfunding of total hospitalization costs for all thyroidectomies, regardless of IONM use (scenario 1: €3,471). The main cost drivers are consumables and technologies (25%), operating room (16%), and staff (14%). Hospitalization costs for a thyroidectomy with IONM range from €3,713 to €3,770 (scenarios 2 and 3), 5–7% higher than those for traditional thyroidectomy. Major economic differences emerge when an EBD is used (€3,969).The regional DRG tariff for thyroid surgery is barely sufficient to cover conventional surgery costs. Intraoperative neural monitoring accounts for 5–7% of the hospitalization costs for a thyroidectomy.
Published: 2012

154. Femoral vessel blood flow dynamics after totally extraperitoneal versus Stoppa procedure in bilateral inguinal hernias: the need for evidence-based surgery

Author: Alberto Mangano, Stefano Rausei, and Gianlorenzo Dionigi
Subjects: Male, medicine.medical_specialty, Femoral vein, Hernia, Inguinal, Femoral artery, Evidence based surgery, medicine.artery, medicine, Humans, Hernia, Ultrasonography, Doppler, Color, business.industry, Femoral vessel, General Medicine, Blood flow, Femoral Vein, Surgical Mesh, medicine.disease, Surgery, Femoral Artery, Surgical mesh, medicine.anatomical_structure, Female, Radiology, Ultrasonography, business, Blood Flow Velocity
Published: 2011

155. Evaluation of the Seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in camparison with the sixth classification

Author: Gianlorenzo Dionigi, Stefano Rausei, and Luigi Boni
Subjects: Gynecology, Cancer Research, Cancer classification, medicine.medical_specialty, business.industry, General surgery, Cancer, medicine.disease, Gastric adenocarcinoma, Oncology, medicine, Adenocarcinoma, Neoplasm staging, business
Published: 2011

156. Single access cholecystectomy using standard laparoscopic instruments

Author: Francesca Rovera, Antonio Biondi, Stefano Rausei, Fabrizio Cantore, Renzo Dionigi, Gianlorenzo Dionigi, Matteo Di Giuseppe, Luigi Boni, and E.M. Colombo
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Visual analogue scale, medicine.medical_treatment, Pain, surgery, Laparoscopic, Cholelithiasis, medicine, Operating time, Humans, Cholecystectomy, Prospective Studies, Postoperative, Prospective cohort study, Laparoscopy, Pain Measurement, instrumentation, Pain, Postoperative, medicine.diagnostic_test, business.industry, General surgery, Pain scale, Length of Stay, Middle Aged, Surgical Instruments, Surgery, Single incision laparoscopic, statistics /&/ numerical data, Treatment Outcome, Cholecystectomy, Laparoscopic, Operative time, Feasibility Studies, Female, epidemiology, business, Adult, Cholecystectomy, instrumentation, Cholelithiasis, surgery, Feasibility Studies, Female, Humans, Length of Stay, statistics /&/ numerical data, Male, Middle Aged, Pain Measurement, Pain, epidemiology, Prospective Studies, Surgical Instruments, Time Factors, Treatment Outcome
Abstract: The aim of this study was to verify feasibility and safety of single incision laparoscopic cholecystectomy using conventional surgical instruments. Twenty patients underwent single incision laparoscopic cholecystectomy. Indications for cholecystectomy were symptomatic cholelithiasis. Operative time, postoperative length of stay, intraoperative and postoperative complications, postoperative pain (by visual analogue scale), and patient cosmetic satisfaction were considered. All 20 procedures were successfully concluded without additional skin incisions. The mean operative time was 69 ± 16 min with a trend toward a reduction in operating time with increasing surgical experience. Intraoperative bile leakages for gallbladder rupture were observed in only three cases. No postoperative complications were recorded. The median pain scale value was 3 and the median value of cosmetic satisfaction was 3. The mean postoperative length of stay was 1.3 ± 0.9 days. Single incision laparoscopic cholecystectomy with conventional surgical instruments is a feasible and safe procedure, but additional studies in larger series are needed to confirm our results.
Published: 2011

157. Struma ovarii in breast cancer

Author: Stefano Rausei, Antonio Biondi, Francesca Rovera, Gianlorenzo Dionigi, Francesco Frattini, Luigi Boni, and Renzo Dionigi
Subjects: Oncology, endocrine system, medicine.medical_specialty, endocrine system diseases, Ectopic thyroid tissue, Breast Neoplasms, Asymptomatic, Diagnosis, Differential, Breast cancer, Internal medicine, medicine, Mature cystic ovarian teratoma, Humans, skin and connective tissue diseases, Benign Struma Ovarii, Surgical treatment, Ovarian Neoplasms, Struma ovarii, business.industry, Middle Aged, medicine.disease, female genital diseases and pregnancy complications, Struma Ovarii, Surgery, Female, Radiology, medicine.symptom, business
Abstract: We described a case of benign struma ovarii associated to bilateral mature cystic ovarian teratoma in an asymptomatic post-menopausal woman with breast cancer. The patient synchronously underwent surgical treatment of breast and ovarian tumors.
Published: 2011

158. Implemanetation of systematic neuromonitoring training for thyroid surgery

Author: Antonio Biondi, Luigi Boni, Alessandro Bacuzzi, Rosario Sacco, Gianlorenzo Dionigi, Marcin Barczyński, Gregory W. Randolph, Fy Chiang, Stefano Rausei, Antonio Sitges-Serra, and Henning Dralle
Subjects: medicine.medical_specialty, business.industry, Training course, Vagal nerve, Medical school, Troubleshooting, Perioperative, Demographic data, Checklist, Surgery, Anesthesiology, General Surgery, Monitoring, Intraoperative, Peripheral Nervous System, Thyroidectomy, medicine, Humans, Education, Medical, Continuing, business, Algorithms, Reimbursement
Abstract: Neural monitoring is increasingly applied to thyroid surgery and yet few surgeons have received formal training in intraoperative neuromonitoring (IONM). Standardized application of neural monitoring is an expected outcome of formal training programs in IONM. This study was designed to document a systematic training course that focuses on standardized state-of-art IONM knowledge. Seventeen 1-day courses were organized by the Department of Surgical Sciences, University of Insubria Medical School (Varese-Como, Italy), between 2009-2010. The course included didactic and practical training sessions. Some specific steps and checklist identified for courses included: knowledge of IONM technology and troubleshooting algorithms; IONM anesthetic perspectives, standards of IONM equipment set up and technique. A total of 75 trainees completed a questionnaire after completion of the respective courses. Questions probed demographic data, operative IONM experience and evaluation of course content. Data gathered showed that 97% of participants had no prior experience with the standardized approach of IONM technique (i.e. stimulation of the vagal nerve). The most useful parts of the course were judged to be (a) algorithms for perioperative IONM problem solving (30%), (b) live surgery with hands-on training (25%), (c) standardization of IONM technique (25%), and (d) IONM equipment set-up (20%). Poor reimbursement for hospital thyroid procedures is the main reason of limitation of IONM technology. The course offered participants novel knowledge and training and gave participants a systematic and standard approach to IONM technique.
Published: 2011

159. Predictors of loco-regional recurrence and cancer-related death after breast cancer surgery

Author: Stefano, Rausei, Francesca, Rovera, Gianlorenzo, Dionigi, Deborah, Tornese, Anna, Fachinetti, Luigi, Boni, and Renzo, Dionigi
Subjects: Adult, Aged, 80 and over, Breast Neoplasms, Middle Aged, Mastectomy, Segmental, Combined Modality Therapy, Multivariate Analysis, Humans, Female, Lymph Nodes, Neoplasm Recurrence, Local, Receptors, Progesterone, Aged, Retrospective Studies
Abstract: To determine which tumor-related factors might predispose the patient to loco-regional recurrence or death and the impact of these factors on the different types of events. We retrospectively analyzed the data of 1991 women between January 1998 and March 2010 for a first primary nonmetastatic breast cancer and treated with surgery and neo-adjuvant/adjuvant therapy. The overall survival distribution was estimated using the Kaplan-Meier method. The prognostic impact of several factors on cumulative overall and loco-regional recurrence free survival was evaluated by univariate (log-rank test) and multivariate analysis (Cox regression). At log-rank test, pT, nodal status, histotype, grading, lymphangioinvasive growth, tumor diameter, estrogen receptors (ER) status, progesterone receptors (PR) status, expression of Ki67, and expression of Her2/neu had a prognostic value on loco-regional recurrence or overall survival. In the multivariate analysis grading remained the only independent predictor of loco-regional recurrences. With regard to overall survival, the Cox model selected grading along with nodal status and PR status. Loco-regional recurrences after breast cancer surgery are not frequent events. They are markers of tumor aggressiveness and predictor of an increased likelihood of cancer-related death. However, loco-regional recurrence and systemic tumor progression are partially independent events, since some prognostic factors differ.
Published: 2010

160. Breast cancer in pregnancy

Author: Francesca, Rovera, Francesco, Frattini, Alessandra, Coglitore, Marina, Marelli, Stefano, Rausei, Gianlorenzo, Dionigi, Luigi, Boni, and Renzo, Dionigi
Subjects: Antineoplastic Agents, Hormonal, Contraindications, Biopsy, Fine-Needle, Carcinoma, Ductal, Breast, Breast Neoplasms, Mastectomy, Segmental, Chemotherapy, Adjuvant, Pregnancy, Humans, Lymph Node Excision, Female, Radiotherapy, Adjuvant, Breast, Abortion, Therapeutic, Pregnancy Complications, Neoplastic, Mastectomy
Abstract: Pregnancy-related breast cancer (PBC) is one of the most common malignancies during pregnancy (approx. one in 3,000 pregnancies); up to 3% of breast cancers are diagnosed in pregnancy. As maternal age at the time of pregnancy continues to increase as the incidence of breast cancer, the incidence of PBC is expected to increase. A review of the literature was performed in order to identify optimal treatment strategies. Most of the data surrounding the diagnosis and treatment PBC is small cohort studies, and there are no randomized controlled trials. Diagnostic delays are common. Preoperative histologic confirmation is required. Conservative surgery can be proposed at the end of second and third trimester, and radiotherapy is delayed after childbirth. The safety of sentinel lymph node biopsy has yet to be confirmed, and the axillary dissection is the traditional treatment of choice. The chemotherapeutic agents utilized are the same as those used in non-pregnant patients, but they should not be administered in the first trimester. Radiotherapy and endocrine therapy are recommended to be avoided during pregnancy. The treatment of PBC is multidisciplinary and necessitates active communication among the patient, obstetrician, medical, surgical, and radiation oncologists. Diagnosis is often delayed because of physiologic changes of the breast; obstetricians should perform a thorough breast examination at the first prenatal visit and maintain a high index of suspicion for cancer. Other therapies may need to be considered, although their usage now is not currently recommended owing to the paucity of safety data.
Published: 2010

161. The role of micrometastatic disease in sentinel lymph node in breast cancer

Author: Francesca, Rovera, Francesco, Frattini, Corrado, Chiappa, Cristiano, Piscopo, Veronica, Bianchi, Gianlorenzo, Dionigi, Stefano, Rausei, Luigi, Boni, and Renzo, Dionigi
Subjects: Sentinel Lymph Node Biopsy, Lymphatic Metastasis, Axilla, Humans, Lymph Node Excision, Breast Neoplasms, Female, Neoplasm Recurrence, Local, Prognosis, Randomized Controlled Trials as Topic
Abstract: Sentinel lymph node (SLN) biopsy is the standard procedure for axillary node staging in breast cancer. Improvements in histopathological analysis and immunohistochemistry have recently increased the rate of detection of lymph nodal micrometastases. The clinical implications and prognostic significance of micrometastases in SLN still remain a controversial issue. Literature review was analyzed by searches of Medline and PubMed data bases. Whereas most studies carried on small groups of patients did not show differences in survival, recently some studies with longer follow-up and with larger populations demonstrated that prognosis of patients with micrometastases is worse compared to that of patients with SLN free of disease. To date, completion axillary dissection remains the standard option when a macro or micrometastasis (0.2-2 mm) in the SLN is found. However, in absence of level-1 evidence guidelines, each case requires discussion in the context of a multi-disciplinary team.
Published: 2010

162. How does the 7th TNM edition fit in gastric cancer management?

Author: Francesca Rovera, Renzo Dionigi, Gianlorenzo Dionigi, Stefano Rausei, and Luigi Boni
Subjects: Oncology, medicine.medical_specialty, medicine.diagnostic_test, business.industry, General surgery, Cancer, Intraperitoneal chemotherapy, TNM staging system, medicine.disease, digestive system diseases, Surgical oncology, Postoperative treatment, Stomach Neoplasms, Internal medicine, Cancer management, medicine, Humans, Surgery, Endoscopic resection, business, Laparoscopy, Neoplasm Staging
Abstract: The latest revision of TNM staging system, presented in the 7th edition in 2009, supplanted the 6th edition, in use since 2002. In the 7th TNM, gastric cancer is one of the most reassessed solid tumors. Both T and N evaluation, as well as M assessment, have seen major changes, and these changes result in relevant clinical implications for gastric cancer management. Certainly, the prognostic assumptions of this TNM update will be useful for oncologists interested in planning postoperative treatment and in predicting survival. However, many new rules summon the surgeons: they must take account of modern strategies of staging (i.e., laparoscopy and EUS) and treatment (i.e., endoscopic resection, neoadjuvant chemotherapy, intraperitoneal chemotherapy) in order to highlight the prognostic implications of new UICC/AJCC recommendations.
Published: 2010

163. Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

Author: Feng-Yu Chiang, Luigi Boni, Gianlorenzo Dionigi, Giovanni Cantone, Che-Wei Wu, Francesca Rovera, Alessandro Bacuzzi, Stefano Rausei, and Ka-Wo Lee
Subjects: Adult, Male, medicine.medical_specialty, Vagus Nerve Stimulation, medicine.medical_treatment, Neurophysiology, Cohort Studies, Young Adult, Monitoring, Intraoperative, Recurrent laryngeal nerve, Medicine, Humans, Aged, Aged, 80 and over, business.industry, Electromyography, Recurrent Laryngeal Nerve, Thyroid, Thyroidectomy, Vagus Nerve, Vascular surgery, Middle Aged, Thyroid Diseases, Electric Stimulation, Vagus nerve, Cardiac surgery, Surgery, medicine.anatomical_structure, Treatment Outcome, Cardiothoracic surgery, Anesthesia, Female, business, Vocal Cord Paralysis, Abdominal surgery
Abstract: Standardisation of the intraoperative neuromonitoring (IONM) technique is a fundamental aspect in monitored thyroid surgery. Vagal nerve (VN) stimulation is essential for problem solving, recognition of any inferior laryngeal nerve (ILN) lesions and prediction of ILN post-operative function. Issues that have been overlooked in the literature, particularly in terms of prospective approaches, are the topographic relationship of the VN with the carotid and jugular vessels as well as the neurophysiology of the VN and ILN that have been studied, with a prospective approach, in patients with various thyroid diseases.Cooperation with the Human Morphology Department resulted in the completion of a dedicated anatomy report, with the clear objective of providing a detailed anatomic and neurophysiologic description of the VN (n = 263).VN identification and stimulation was feasible in all cases and did not result in increased morbidity or operative time. Most VNs lay on the posterior region of the carotid ship (73%), i.e. the P position in accordance with our model. Mean amplitudes of EMG signals obtained from VN stimulation were 750 ± 279 μV, lower than those obtained with direct INL stimulation (1,086 ± 349 μV).A better understanding of the variability in the VN may be useful not only to minimise complications but also to guarantee an accurate IONM.
Published: 2010

164. The technique of intraoperative neuromonitoring in thyroid surgery

Author: Gianlorenzo, Dionigi, Alessandro, Bacuzzi, Luigi, Boni, Francesca, Rovera, Stefano, Rausei, Francesco, Frattini, and Renzo, Dionigi
Subjects: Electromyography, Monitoring, Intraoperative, Recurrent Laryngeal Nerve Injuries, Thyroidectomy, Humans, Electric Stimulation
Abstract: Recurrent laryngeal nerve (RLN) palsy during thyroidectomy is associated with multiple risk factors as patient- and surgeon-related bailiff. The risk is greater for thyroid cancer, Graves' disease, re-operation, and mediastinal goiter in less experienced centers and in patients in whom the RLN could not be identified during operation. Anatomical landmarks exist to identify RLN. Nevertheless, transient and permanent RLN injuries still exist. Intraoperative neuromonitoring (IONM) has been introduced to facilitate identification and verify functional integrity of the RLN in thyroid surgery. In this chapter, we present relevant medical literature and personal experience on thyroid surgery with IONM. Technical, medical, and legal aspects of monitoring are discussed.
Published: 2010

165. Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring

Author: Stefano Rausei, Luigi Boni, and Gianlorenzo Dionigi
Subjects: Parathyroidectomy, medicine.medical_specialty, business.industry, medicine.medical_treatment, Thyroid, lcsh:Surgery, lcsh:RD1-811, lcsh:Otorhinolaryngology, lcsh:RF1-547, Surgery, Video assisted thyroidectomy, medicine.anatomical_structure, medicine, Recurrent laryngeal nerve, business, Surgical endoscopy, Letter to the Editor
Abstract: Dr. Kandil [1] reported their experience in intraoperative neuromonitoring (IONM) in endoscopic thyroid surgery. I have carefully read this paper. These colleagues have made a similar contribution in respect of our previous paper (published online on Surgical Endoscopy on September 21, 2008) [2].
Published: 2010

166. Unusual rectal stenosis

Author: Francesca Rovera, Francesco Frattini, Gianlorenzo Dionigi, Stefano Rausei, Luigi Boni, and Mario Diurni
Subjects: medicine.medical_specialty, business.industry, Rectal stenosis, MEDLINE, General Medicine, medicine.disease, Constriction, Text mining, Oncology, medicine, Carcinoma, Surgery, Radiology, business
Published: 2010

167. Intraoperative neuromonitoring for thyroid malignancy surgery: technical notes and results from a retrospective series

Author: Stefano Rausei, Gianlorenzo Dionigi, Luigi Boni, Alberto Mangano, Francesco Frattini, and Antonio Biondi
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Thyroid, Thyroidectomy, Cancer, medicine.disease, Surgery, Resection, medicine.anatomical_structure, Monitoring, Intraoperative, Anesthesia, Thyroid malignancy, Recurrent Laryngeal Nerve Injuries, Recurrent laryngeal nerve, medicine, Paralysis, Humans, medicine.symptom, business, Thyroid cancer, Retrospective Studies
Abstract: This study evaluates the role of intraoperative neuromonitoring (IONM) for thyroidectomy performed in cancer patients with emphasis on postoperative recurrent laryngeal nerve paralysis (RLNP). The study is a retrospective series comprising 76 thyroidectomy alone (control group) versus 76 thyroidectomy with IONM. In the control group the laryngeal nerves have been identified by visualization solely. In the IONM group both vagal nerve and RLN have been localized and monitored during thyroid resection. The main surgical outcome was RLN morbidity. All patients undergo pre- and postoperative laryngeal examination. Overall RLN morbidity was 3.9% in the IONM group and 9.2% in the control group (P < 0.05). There have been two cases of permanent RLNP (2.6%) in the control group and one in the IONM group (1.3%), one case of bilateral RLN injury in the control group. The incidences of temporary RLNP in the IONM group have been 2.6 versus 6.5% in the control group. IONM is an effective procedure in thyroid cancer patients.
Published: 2010

168. Single incision laparoscopic right colectomy

Author: Matteo Di Giuseppe, Luigi Boni, Elisa Cassinotti, Renzo Dionigi, Gianlorenzo Dionigi, Fabrizio Cantore, Mario Diurni, and Stefano Rausei
Subjects: Laparoscopic surgery, medicine.medical_specialty, medicine.medical_treatment, Endoscopic surgery, methods, surgery, medicine, Humans, Laparoscopy, Colectomy, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, General surgery, Surgery, Endoscopy, Single incision laparoscopic, Colorectal Neoplasms, Aged, Colectomy, methods, Colorectal Neoplasms, surgery, Humans, Laparoscopy, methods, Retrospective Studies, Right Colectomy, business, Abdominal surgery
Abstract: This study was designed to describe the surgical technique for single-incision laparoscopic right colectomy and present preliminary short-term results. Laparoscopic surgery has been fully validated as alternative, minimally invasive treatment for different benign and malignant conditions. In the attempt to reduce even more the surgical trauma, natural orifices transluminal endoscopic surgery (NOTES™) and single-incision laparoscopic surgery (SILS) have been proposed. Although the lack of proper instrumentations makes NOTES™ not fully suitable for advanced procedures, SILS might play a significant role, although, to date, only limited series and few case reports of single-incision right colectomy are present in the literature.After signed, informed consent was obtained, patients with malignant tumors or large polyps of the right colon underwent single-incision colonic resection through a 3-cm incision using two different single-port devices and articulated or coaxial curved instruments. Preliminary results were analyzed retrospectively.A total of 36 patients were selected for SILS procedure. There were no intraoperative complications or conversions to the standard laparoscopic procedure. One patient had a postoperative urinary tract infection and one prolonged ileum that did not required any surgical intervention. No complications were reported in all the remaining cases. The mean postoperative stay was 5 ± 1.2 days (range, 4-14), and mean lymph node retrieval and tumor-free margins was 24 ± 7 (range, 29-15) and 8 ± 3 (range, 6-12) cm, respectively.Our preliminary results show that single-incision laparoscopic right colectomies are feasible and safe from the oncological point of view; nevertheless larger, randomized experiences are needed to demonstrate the benefits of SILS compared with standard laparoscopic resections.
Published: 2010

169. Surgical Classification of Open Abdomen: Which Clinical Implications?

Author: Gianlorenzo Dionigi, Stefano Rausei, Luigi Boni, Renzo Dionigi, and Francesca Rovera
Subjects: medicine.medical_specialty, business.industry, Abdominal wall defect, Vascular surgery, medicine.disease, Surgery, Cardiac surgery, Cardiothoracic surgery, medicine, Radiology, Secondary Peritonitis, Iatrogenic complication, business, Open abdomen, Abdominal surgery
Published: 2010

170. Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury

Author: Francesca Rovera, Stefano Rausei, Luigi Boni, Gianlorenzo Dionigi, Paolo Castelnuovo, and Renzo Dionigi
Subjects: Adult, Male, Larynx, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Laryngoscopy, Thyroid Gland, Young Adult, medicine, Recurrent laryngeal nerve, Humans, Trauma, Nervous System, Postoperative Period, Vocal cord paralysis, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Thyroidectomy, Middle Aged, medicine.disease, Thyroid Diseases, Surgery, Cardiac surgery, medicine.anatomical_structure, Cardiothoracic surgery, Anesthesia, Recurrent Laryngeal Nerve Injuries, Female, business, Vocal Cord Paralysis, Abdominal surgery
Abstract: There is currently a lack of consensus to support the proper timing for postoperative laryngoscopy that is reliable to diagnose recurrent laryngeal nerve palsy (RLNP) after thyroid surgery. The purpose of this study was to investigate the impact of different time intervals of fiber-optic nasolaryngoscopy (FNL) on the diagnosis of RLNP. FNL was performed postoperatively at day 0 (T1), at second day post-op (T2), and +2 weeks (T3). For patients with RLNP, repeated examinations were performed at +2 (T4), +6 (T5), and +12 months (T6). Four hundred thirty-four patients appear for postoperative FNL, providing 825 nerves at risk. Permanent RLNP occurred in 0.7%, temporary RLNP in 6.7%. RLNP rate was 6.4% at T1, 6.7% at T2, 4.8% at T3, 2.5% at T4, 0.8% at T5, and 0.7% at T6. Full recovery of vocal cord function was confirmed after rehabilitation in 87.5% of cases at T5 and 89% in T6. T2 was significantly superior to T3 in terms of diagnosis of RLNP (P
Published: 2010

171. Lymph Node Status and Depth of Invasion in Early Gastric Cancer Staging: Two Sides of the Same Coin

Author: Gianlorenzo Dionigi, Renzo Dionigi, and Stefano Rausei
Subjects: Oncology, medicine.medical_specialty, Text mining, medicine.anatomical_structure, Depth of invasion, business.industry, Internal medicine, Medicine, Surgery, business, Lymph node, Early Gastric Cancer
Published: 2010

172. Harlequin Syndrome

Author: Ferdinando Carlo Maria Cananzi, Alberto Biondi, Marco Bertucci Zoccali, Roberto Persiani, Domenico D'Ugo, and Stefano Rausei
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Lung Neoplasms, Harlequin syndrome, Settore MED/18 - CHIRURGIA GENERALE, Remission, Spontaneous, Sweating, Functional Laterality, Rare Diseases, Carcinoma, Non-Small-Cell Lung, medicine, Flushing, Humans, Aged, business.industry, General surgery, Syndrome, Combined Modality Therapy, Magnetic Resonance Imaging, Autonomic Nervous System Diseases, Lymphatic Metastasis, Positron-Emission Tomography, Surgery, Neoplasm Recurrence, Local, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed
Published: 2009

173. Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer

Author: Renzo Dionigi, Gianlorenzo Dionigi, Alessandro Bacuzzi, Stefano Rausei, Francesca Rovera, Salvatore Cuffari, Giovanni Cantone, and Luigi Boni
Subjects: medicine.medical_specialty, Blood transfusion, Carcinoma, Hepatocellular, Preoperative autologous blood donation, Hepatocellular carcinoma, medicine.medical_treatment, Intraoperative isovolemic hemodilution, Blood products, Allogeneic blood transfusion, Intraoperative autotransfusion, Infectious complications, Liver resection, Liver resections, Medical Oncology, Resection, Blood Transfusion, Autologous, Postoperative Complications, Risk Factors, medicine, Humans, Intensive care medicine, business.industry, Incidence (epidemiology), Incidence, Liver Neoplasms, Gastroenterology, Cancer, Transfusion Reaction, Immunosuppression, General Medicine, Perioperative, medicine.disease, Surgery, Editorial, Treatment Outcome, Liver, Hepatic surgery, Blood transfusion, Blood products, Allogeneic blood transfusion, Intraoperative autotransfusion, Preoperative autologous blood donation, Intraoperative isovolemic hemodilution, Infectious complications, Liver resection, Hepatocellular carcinoma, business
Abstract: Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.
Published: 2009

174. Perioperative chemotherapy for gastric cancer: how should we measure the efficacy?

Author: Roberto Persiani, Stefano Rausei, Domenico D'Ugo, and Alberto Biondi
Subjects: Oncology, medicine.medical_specialty, business.industry, medicine.medical_treatment, Patient Selection, Settore MED/18 - CHIRURGIA GENERALE, Treatment outcome, Cancer, Antineoplastic Agents, medicine.disease, Neoadjuvant Therapy, Perioperative Care, Treatment Outcome, Surgical oncology, Chemotherapy, Adjuvant, Stomach Neoplasms, Internal medicine, Perioperative chemotherapy, Perioperative care, medicine, Humans, Surgery, business, Neoadjuvant therapy
Published: 2009

175. [Surgical anatomy of the anterior mediastinum]

Author: Alberto, Biondi, Stefano, Rausei, Ferdinando C M, Cananzi, Marco, Zoccali, Stefano, D'Ugo, and Roberto, Persiani
Subjects: Surgical Procedures, Operative, Mediastinum, Humans
Abstract: The mediastinum is located from the thoracic inlet to the diaphragm between the left and right pleural cavities and contains vital structures of the circulatory, respiratory, digestive, and nervous system. Over the years, since there are no fascial or anatomic planes, anatomists and radiologists have suggested various schemes for subdividing the mediastinum and several anatomical and radiological classifications of the mediastinum are reported in the literature. The most popular of these scheme divides medistinum, for purposes of description, into two parts: an upper portion, above the upper level of the pericardium, which is named the superior mediastinum; and a lower portion, below the upper level of the pericardium. For clinical purposes, the mediastinum may be subdivided into three major areas, i.e. anterior, middle, and posterior compartments. The anterior mediastinum is defined as the region posterior to the sternum and anterior to the heart and brachiocephalic vessels. It extends from the thoracic inlet to the diaphragm and contains the thymus gland, fat, and lymph nodes. This article will review surgical anatomy of the anterior mediastinum and will focus on the surgical approch to anterior mediastinum and thymic diseases.
Published: 2008

176. Large bowel auto-amputation and passage of a colon 'cast' after left hemicolectomy

Author: Amorino Vecchioli, Roberto Persiani, Ferdinando Carlo Maria Cananzi, Marco Bertucci Zoccali, Stefano Rausei, Alberto Biondi, and Domenico D'Ugo
Subjects: Male, medicine.medical_specialty, Colon, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Treatment outcome, Adenocarcinoma, Ileostomy, Ischemia, medicine, Humans, Ligation, Colectomy, business.industry, Anastomosis, Surgical, Gastroenterology, Mesenteric Artery, Inferior, Middle Aged, Surgery, Sigmoid Neoplasms, Treatment Outcome, Amputation, Infarction, Granulation Tissue, Left hemicolectomy, business
Published: 2008

177. Seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up

Author: Francesca Rovera, Stefano Rausei, Francesco Frattini, Laura Ruspi, Gianlorenzo Dionigi, Giuseppe Di Rocco, Francesco Martignoni, Luigi Boni, Vincenzo Pappalardo, and Federica Galli
Subjects: Male, medicine.medical_specialty, Esophageal Neoplasms, medicine.medical_treatment, Disease, Clinical practice, Adenocarcinoma, Prognostic factors, 03 medical and health sciences, Esophagus, 0302 clinical medicine, Gastrectomy, Stomach Neoplasms, Tumornode-metastasis, medicine, Humans, In patient, Tumor node metastasis, Gastric cancer, Staging system, Gastroenterology, Neoplasm Staging, Tumor-node-metastasis, business.industry, General surgery, Stomach, Five year follow up, Cancer, Minireviews, General Medicine, Prognosis, medicine.disease, Surgery, Clinical Practice, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Lymph Node Excision, Female, 030211 gastroenterology & hepatology, Lymphadenectomy, Esophagogastric Junction, Lymph Nodes, Peritoneum, business, Follow-Up Studies
Abstract: Seventh tumor-node-metastasis (TNM) classification for gastric cancer, published in 2010, introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity, due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases, positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however, its search in clinical practice is still far from being routinely performed, as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently, many controversies on lymph node staging are still ongoing, with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.
Published: 2016
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178. [Maximum gastric cancer diameter: prognostic factor or important clinical feature?]

Author: Roberto, Persiani, Domenico, D'Ugo, Stefano, Rausei, Ferdinando Carlo Maria, Cananzi, Alberto, Biondi, and Aurelio, Picciocchi
Subjects: Male, Survival Rate, Evaluation Studies as Topic, Gastrectomy, Stomach Neoplasms, Preoperative Care, Humans, Female, Prognosis, Algorithms, Aged, Neoplasm Staging, Retrospective Studies
Abstract: Maximum tumor diameter (DMAX) is considered by many Authors as an im prognostic factor in gastric cancer (GC) correlated with tumor depth (pT). Aim of this retrospective study was to evaluate the prognostic value of DMAX and its predictive role of tumor stage in a series of 164 gastric cancer patients. One hundred and sixty-four patients underwent gastrectomy between January 1994 and December 2004. DMAX value was measured on resected specimens fixed in 10% formalin solution with cut-off of 40 mm. Tumors according to these measurements were classified in DMAX1or = mm and DMAX240 mm. The prognostic significance of DMAX along with other factors was evaluated with log-rank test and Cox regression. The correlation between DMAX and other variables was calculated by Spearman test. Overall 5-year survival rate is 56.6%. DMAX resulted significantly linked to survival at univariate analysis (p = 0.0001). The Spearman correlation test showed that DMAX is strongly correlated with tumor stage (positive predictive value of 88.5%), pT, pN, residual of tumor and grading. Our results showed that patients with large tumor at an increased risk for tumor advancement and, therefore, DMAX could represent a useful parameter for selection of patients for neoadjuvant protocols.
Published: 2006

179. The role of surgical staging in esophageal carcinoma

Author: Stefano, Rausei, Alberto, Biondi, Ferdinando Carlo Maria, Cananzi, Carmela, La Greca, and Roberto, Persiani
Subjects: Diagnostic Imaging, Esophageal Neoplasms, Lymphatic Metastasis, Thoracoscopy, Humans, Minimally Invasive Surgical Procedures, Laparoscopy, Lymph Nodes, Neoplasm Staging
Abstract: Given the overall poor prognosis of patients with esophageal carcinoma and considering the new therapeutic options, surgeons should accurately stage patients preoperatively to appropriately tailor their treatment. CT, MRI, PET and EUS are still inaccurate in evaluating local surgical resectability and in detecting abdominal and thoracic lymph node metastases. Minimally invasive surgical staging is a promising adjunct to esophageal cancer staging. The thoracoscopic and laparoscopic staging provide more accurate information for evaluating local invasion, lymph node and distant metastasis. The greater accuracy afforded by minimally invasive staging is essential for patients who should undergo radical surgical or multimodal treatment. According to data reported by many authors, it seems most useful to combine nonoperative staging procedures as CT/MRI and EUS with minimally invasive staging techniques.
Published: 2006

180. Response to neoadjuvant chemotherapy and effects of tumor regression in gastric cancer

Author: Stefano Rausei, Roberto Persiani, Domenico D'Ugo, Vincenzo Vigorita, Alberto Biondi, Riccardo Ricci, and Stefania Boccia
Subjects: Oncology, Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Gastrectomy, Stomach Neoplasms, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, Tumor regression, Medicine, Pathologic Response, Humans, Survival rate, Neoadjuvant therapy, Aged, Epirubicin, Etoposide, Chemotherapy, business.industry, Cancer, General Medicine, Middle Aged, medicine.disease, Prognosis, Laparoscopic staging, Neoadjuvant Therapy, Survival Rate, Lymph Node Excision, Surgery, Female, Cisplatin, business
Abstract: Aims Aim of this study is the evaluation of the effects induced by neoadjuvant chemotherapy (NACT) and its impact on survival on a series of locally advanced gastric carcinomas. Methods Downstaging was assessed comparing pre-treatment clinical and laparoscopic staging with post-operative pathologic staging on 30 consecutive patients who completed a 3-year follow-up. Tumor downstaging and the grade of pathologic response were included in a statistical correlation between tumor regression induced by NACT and 3-year survival. Results In this series tumor downstaging was obtained in 13 out of 30 patients. After the completion of 3-year follow-up, overall survival was >37.5 months with an overall survival rate of 56.7%; this figure reached up to 70.8% in those cases who benefited from a R0-resection (24/30 patients: R0-resection rate 80.0%). Conclusions In this study the 3-year survival for locally advanced gastric cancer treated by NACT prior to “D2” surgical resection, compares favourably with historical series treated by surgery alone. Patients who obtained T-downstaging and subsequently benefited from a R0-resection had a definitely better chance of cure, according to a complete 3-year follow-up.
Published: 2006

181. Prognostic indicators in locally advanced gastric cancer (LAGC) treated with preoperative chemotherapy and D2-gastrectomy

Author: Carlo Barone, Stefano Rausei, Daniel Sermoneta, Domenico D'Ugo, Riccardo Ricci, Aurelio Picciocchi, Carmelo Pozzo, Roberto Persiani, and Giuseppe La Torre
Subjects: Oncology, medicine.medical_specialty, r0 resection, medicine.medical_treatment, chemotherapy, Preoperative care, Drug Administration Schedule, adjuvant, Gastrectomy, Stomach Neoplasms, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, Preoperative Care, medicine, Humans, gastric carcinoma, Laparoscopy, prognostic factor, Survival rate, Neoadjuvant therapy, Epirubicin, Etoposide, Neoplasm Staging, Proportional Hazards Models, medicine.diagnostic_test, Proportional hazards model, business.industry, Cancer, General Medicine, Middle Aged, medicine.disease, Prognosis, Neoadjuvant Therapy, laparoscopic staging, Survival Rate, Chemotherapy, Adjuvant, Lymphatic Metastasis, neoadjuvant chemotherapy, antineoplastic combined chemotherapy protocols, chemotherapy, adjuvant, cisplatin, drug administration schedule, epirubicin, etoposide, fluorouracil, gastrectomy, humans, lymph nodes, lymphatic metastasis, middle aged, neoadjuvant therapy, neoplasm staging, preoperative care, prognosis, proportional hazards models, stomach neoplasms, survival rate, laparoscopy, Surgery, Fluorouracil, Lymph Nodes, Cisplatin, business, medicine.drug
Abstract: Background and Objectives Neoadjuvant chemotherapy is increasingly considered an effective treatment option for patients with gastric carcinoma. Aim of the study is to evaluate the prognostic significance of the pathological response and of known prognostic factors in a group of accurately staged locally advanced gastric cancer (LAGC) patients. Methods Thirty-three patients with LAGC, staged by laparoscopy, underwent D2-gastrectomy after preoperative chemotherapy. Survival was calculated by Kaplan–Meier method and differences were assessed by the Log-rank and Breslow test. Multivariate analysis was performed using the Cox proportional hazard model in backward stepwise regression. Results Curative resection (R0) was achieved in 81.8% of patients. A complete or subtotal pathological response was documented in 3 and 6%, respectively. Nineteen out of thirty-three (57.6%) patients were alive and 16 of them were free of relapse at last follow-up. Survival rates were 81, 67, and 59% at 12, 24, and 36 months, respectively. At univariate and multivariate analysis, only R0 resection was found to be an independent prognostic factor. Conclusions In the current study, R0 resection is the most important prognostic factor for resectable LAGC; according to our results we feel encouraged to consider neoadjuvant chemotherapy a promising modality for increasing the R0-percentage of gastric carcinoma patients who could benefit from a curative surgery. J. Surg. Oncol. 2005;89:227–236. © 2005 Wiley-Liss, Inc.
Published: 2005

182. History of splenectomy

Author: Stefano Rausei, Luigi Boni, Francesca Rovera, Renzo Dionigi, and Gianlorenzo Dionigi
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Gold standard, Splenectomy, History, 19th Century, Spleen, General Medicine, History, 20th Century, Laparoscopic splenectomy, History, 21st Century, Surgery, History, 17th Century, medicine.anatomical_structure, History, 16th Century, medicine, Humans, History of splenectomy, business, Medical literature
Abstract: Background The spleen has been considered for millennia a fascinating and mysterious organ with multiple functions. The spleen has long been an organ of interest in popular as well as medical literature. Methods A literature (Pubmed) and historical review about splenectomy has been performed. Results The importance of spleen and the related surgical procedure of splenectomy has been an important topic of scientific interest since the Ancient Greece culture to more modern times. Conclusions Spleen and splenectomy have important roles in the medical literature and popular tradition. Nowadays laparoscopic splenectomy is increasingly popular and for certain indications it is considered the gold standard therapy.
Published: 2013
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183. To our Master …

Author: Francesca Rovera, Gianlorenzo Dionigi, Stefano Rausei, and Luigi Boni
Subjects: business.industry, Medicine, Surgery, General Medicine, business, Management
Published: 2013
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184. Methylation profile of plasma DNA as a biomarker in colorectal cancer

Author: Alessandro Marzorati, Victor Levenson, Gianlorenzo Dionigi, Luigi Boni, Renzo Dionigi, Elisa Cassinotti, and Stefano Rausei
Subjects: business.industry, Colorectal cancer, Plasma dna, Cancer research, Biomarker (medicine), Medicine, Surgery, Methylation, business, medicine.disease
Published: 2012
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185. Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

Author: Roberto Bini, Boris Sakakushev, Martin Hutan, Samir Delibegovic, Piotr Major, Nikola Vladov, Ari Leppäniemi, Miran Rems, Harry van Goor, Konstantinos Bouliaris, Cristian Tranà, Miguel Leon, Marco Catani, Charalampos Seretis, Adam Dziki, Mario Dente, P. Pletinckx, Helen Tzerbinis, Damien Massalou, Daniele Marrelli, Konstantinos Lasithiotakis, Dimitrios Giakoustidis, Elia Poiasina, Pierluigi Viale, Goran Augustin, Carlo De Werra, Fabio Cesare Campanile, Ludwig Ney, Stefano Rausei, Saila Kauhanen, Fausto Catena, Gianluca Guercioni, Salvador Navarro, András Vereczkei, Dmitry Smirnov, Rodolfo Scibé, Halil Alis, Rafael Díaz-Nieto, Giorgio Giraudo, Olivier Pittet, Pietro Coletta, Luca Ansaloni, Orestis Ioannidis, Ionut Negoi, Radu Moldovanu, Vladimir Khokha, Avdyl Krasniqi, Giorgio Vasquez, Tadeja Pintar, Daniel Lazzareschi, Guenter Weiss, Ihor Gerych, Jaan Tepp, Michele Cucchi, Dragoljub Zivanovic, Jorge Pereira, Nereo Vettoretto, Cyrille Huchon, Matej Skrovina, Eliane Angst, Samipetteri Laine, Massimo Sartelli, Mirjami Uotila-Nieminen, Sergio Aloia, Salomone Di Saverio, Elio Jovine, Renato Bessa Melo, Ferdinando Agresta, Cristian Mesina, Nurkan Törer, Jakub Kenig, Athanasios Marinis, Sergio Colizza, Korhan Taviloğlu, and II kirurgian klinikka
Subjects: medicine.medical_specialty, surgical treatment, education, lcsh:Surgery, Peritonitis, Disease, APPENDECTOMY, 030230 surgery, Malignancy, community-acquired infections, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, MANAGEMENT, medicine, risk factors, intra-abdominal infections, ANASTOMOSIS, business.industry, Septic shock, Abdominal Infection, Mortality rate, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RD1-811, lcsh:RC86-88.9, Diverticulitis, healthcare-associated infections, postoperative mortality, multicenter study, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, 3. Good health, PRIMARY RESECTION, 030220 oncology & carcinogenesis, Emergency medicine, Emergency Medicine, Surgery, Observational study, Evaluation of complex medical interventions Tissue engineering and pathology [NCEBP 2], DIVERTICULITIS, business, Research Article
Abstract: Contains fulltext : 110654.pdf (Publisher’s version ) (Open Access) ABSTRACT: The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38 degrees C or less than 36 degrees C by the third post-operative day were statistically significant indicators of patient mortality.
Published: 2012
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186. Pre-operative splenic vein diameter: A risk factor for portal-splenic vein thrombosis after laparoscopic splenectomy?

Author: Gianlorenzo Dionigi, Stefano Rausei, Luigi Boni, Silvia Maria Tenconi, and Francesca Rovera
Subjects: medicine.medical_specialty, Splenic vein, business.industry, medicine, Surgery, Splenic vein thrombosis, Risk factor, Laparoscopic splenectomy, business, Pre operative
Published: 2010
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187. Unusual acute abdomen: to operate or not to operate?

Author: Stefano Rausei, Nicolò Gentiloni Silveri, Alberto Biondi, Francesco Buccelletti, and Roberto Persiani
Subjects: Abdomen, Acute, medicine.medical_specialty, business.industry, Radiography, Decision Making, General Medicine, Surgery, Acute abdomen, Humans, Medicine, Female, cardiovascular diseases, Radiology, medicine.symptom, business, Aged
Abstract: 9 ), with 77% neutrophils (40-74%), and a haematocrit of 46% (37-47%). Results of other blood tests, chest radiography, and an ECG were normal. We treated the patient with intravenous fl uids and analgesia
Published: 2006
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188. Capsule Endoscopy Findings and Clinical Outcome in Patients with Obscure Gastrointestinal Bleeding M.E.Riccioni, S.Shah, A.Bizzotto, G.P.Lecca, C.Spada,∗S.Rausei, G.Costamagna Digestive Endoscopy Unit, ∗General Surgery Unit - Catholic University- Rome, Italy

Author: Piera Giuseppina Lecca, Stefano Rausei, Alessandra Bizzotto, Cristiano Spada, Syed Shah, Guido Costamagna, and Maria Elena Riccioni
Subjects: medicine.medical_specialty, business.industry, General surgery, Gastroenterology, Surgery, law.invention, Digestive endoscopy, Capsule endoscopy, law, medicine, Radiology, Nuclear Medicine and imaging, In patient, business, Obscure gastrointestinal bleeding
Published: 2006
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189. Prognostic indicators in locally advanced gastric cancer (LAGC) treated with preoperative chemotherapy and D2‐gastrectomy.

Author: Roberto Persiani, Domenico D'Ugo, Stefano Rausei, Daniel Sermoneta, Carlo Barone, Carmelo Pozzo, Riccardo Ricci, Giuseppe La Torre, and Aurelio Picciocchi
Published: 2005
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190. Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection

Author: Luigi Boni, Stefano Rausei, Elisa Cassinotti, Abe Fingerhut, Gianlorenzo Dionigi, and Giulia David
Subjects: Male, medicine.medical_treatment, Anastomotic Leak, Diverticulitis, Colonic, chemistry.chemical_compound, 0302 clinical medicine, Crohn Disease, Germany, Anastomotic leaks, Prospective Studies, Fluorescein Angiography, Coloring Agents, Laparoscopy, Colectomy, Digestive System Surgical Procedures, Aged, 80 and over, medicine.diagnostic_test, Anastomosis, Surgical, Optical Imaging, Middle Aged, Colorectal surgery, medicine.anatomical_structure, Colorectal resection, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Radiology, Colorectal Neoplasms, Perfusion, Adenoma, Indocyanine Green, medicine.medical_specialty, Colon, Rectum, Anastomosis, Article, Fluorescence, 03 medical and health sciences, medicine, Humans, Aged, ICG, business.industry, Carcinoma, Surgery, chemistry, business, Indocyanine green, Bowel perfusion, Abdominal surgery
Abstract: Aims Anastomotic leakage after colorectal surgery is a severe complication. One possible cause of anastomotic leakage is insufficient vascular supply. The aim of this study was to evaluate the feasibility and the usefulness of intraoperative assessment of vascular anastomotic perfusion in colorectal surgery using indocyanine green (ICG)-enhanced fluorescence. Methods Between May 2013 and October 2014, all anastomosis and resection margins in colorectal surgery were investigated using fluorescence angiography (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany) intraoperatively to assess colonic perfusion prior to and after completion of the anastomosis, both in right and left colectomies. Results A total of 107 patients undergoing colorectal laparoscopic resections were enrolled: 40 right colectomies, 10 splenic flexure segmental resections, 35 left colectomies, and 22 anterior resections. In 90 % of cases, the indication for surgery was cancer and high ligation of vessels was performed. Based on the fluorescence intensity, the surgical team judged the distal part of the proximal bowel to be anastomosed insufficiently perfused in 4/107 patients (two anterior, one sigmoid and one segmental splenic flexure resections for cancer), and consequently, further proximal “re-resection” up to a “fluorescent” portion was performed. None of these patients had a clinical leak. The overall morbidity rate was 30 %; one patient undergoing right colectomy had an anastomotic leakage, apparently unrelated to ischemia; there were no clinical evident anastomotic leakages in colorectal resections including all low anterior resections. Conclusions ICG-enhanced fluorescent angiography provides useful intraoperative information about the vascular perfusion during colorectal surgery and may lead to change the site of resection and/or anastomosis, possibly affecting the anastomotic leak rate. Larger further randomized prospective trials are needed to validate this new technique.
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191. Laparoscopic caecal wedge resection with intraoperative endoscopic assistance

Author: Elisa Cassinotti, Camillo Claudio Cortellezzi, Gianlorenzo Dionigi, Stefano Rausei, Renzo Dionigi, Luigi Boni, Francesca Rovera, Sebastiano Spampatti, Alessandro Marzorati, Luisa Giavarini, Sergio Segato, and Daniele Sambucci
Subjects: medicine.medical_specialty, Adenomatous polyps, Colorectal cancer, Colonoscopy, Complete resection, digestive system, Resection, Intraoperative colonoscopy, Laparoscopic caecal wedge resection, medicine, otorhinolaryngologic diseases, Humans, Cecum, neoplasms, medicine.diagnostic_test, business.industry, Laparoscopic wedge resection, Endoscopic assistance, General Medicine, medicine.disease, digestive system diseases, Surgery, surgical procedures, operative, Laparoscopy, Colorectal Neoplasms, business, Wedge resection (lung)
Abstract: Background and Purpose Cancer is a potential evolution of adenomatous polyps, that is why nowadays screening programs for colorectal cancer are widely diffused. Colonoscopy is the gold standard procedure for identifying and resecting polyps; however, for some polyps resection during colonoscopy is not possible. The aim of the present study is to identify a fast and safe procedure for endoscopically resecting unresectable polyps. Methods Patients with endoscopically unresectable polyps were scheduled for laparoscopic wedge resection under colonoscopic assistance. Results From November 2010 to November 2012 we treated 15 patients with endoscopically unresectable adenomatous polyps. All patients underwent a laparoscopic caecal wedge resection with intraoperative endoscopic assistance. All procedures were completed without complications and in all cases complete resection of the polyps was achieved. Conclusions Laparoscopic wedge caecal resection with intraoperative colonoscopy is a fast and safe procedure that can be performed for large polyps that could not be treated endoscopically.
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192. Continuous monitoring of the recurrent laryngeal nerve in thyroid surgery: a critical appraisal

Author: Luigi Boni, Piero F. Alesina, Hoon Yub Kim, Gianlorenzo Dionigi, Stefano Rausei, Feng-Yu Chiang, Alberto Mangano, Francesco Rulli, Gianluca Donatini, Che-Wei Wu, Renzo Dionigi, Maria Laura Tanda, and Francesca Rovera
Subjects: medicine.medical_specialty, Traction injury, Vagal nerve, Recurrent Laryngeal Nerve Injury, Medizin, Thyroid Gland, Monitoring, Intraoperative, medicine, Recurrent laryngeal nerve, Humans, IONM, business.industry, Recurrent Laryngeal Nerve, C-IONM, continuous intraoperative neuromonitoring, thyroid surgery, Thyroid, Continuous monitoring, General Medicine, Continuous intraoperative neuromonitoring, Thyroid surgery, Surgery, Critical appraisal, Settore MED/18 - Chirurgia Generale, medicine.anatomical_structure, Recurrent Laryngeal Nerve Injuries, business
Abstract: Background and Purpose: Intraoperative neuromonitoring (IONM) contributes in several ways to recurrent laryngeal nerve (RLN) protection. Notwithstanding these advantages, surgeons must be aware that the current, intermittent, mode of IONM (I-IONM) has relevant limitations. To overcome these I-IONM limitations, a continuous IONM (C-IONM) technology has been proposed. Methods: A PubMed indexed literature review of the current limitations of I-IONM is presented and a commentary about C-IONM is provided presenting the preliminary results of research on this topic. Main findings: I-IONM, despite the advantages it produces, presents some important limitations; to overcome these drawbacks a C-IONM technology has been introduced. Conclusions: RLN traction injury is still the most common cause of RLN injury and is difficult to avoid with the application of I-IONM in thyroid surgery. C-IONM is useful to prevent the imminent traction injury by detecting progressive decreases in electromyographic amplitude combined with progressive latency increases. C-IONM seems to be a technological improvement. Likely, C-IONM by vagal nerve stimulation should enhance the standardization process, RLN intraoperative information, documentation, protection, training, and research in modern thyroid surgery. Although C-IONM is a promising technology at the cutting edge of research in thyroid surgery, we need more studies to assess in an evidence-based way all its advantages. © 2013 Elsevier Ltd and Surgical Associates Ltd.
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193. Erratum to: IROA: International Register of Open Abdomen, preliminary results

Author: Giuseppe Novelli, Fernando Hernández, Giovanni Bellanova, Massimo Chiarugi, Luca Ansaloni, Mahir Gachabayov, Asri Che Jusoh, Boris Sakakushev, Mirco Nacoti, Savino Occhionorelli, Francesco Salvetti, Giulia Montori, Gustavo Pereira Fraga, Zaza Demetrashvili, Guillermo Perez Chagerben, Gianluca Costa, Wagih Ghannam, Athanasios Marinis, Monica Zese, Davide Corbella, Rao R. Ivatury, Sefa Ozyazici, Federico Coccolini, Michael Sugrue, Vinicius Cordeiro Fonseca, Kuo-Ching Yuan, Wellington Fernandes, Orestis Ioannidis, Paola Fugazzola, Stefano Costa, Miklosh Bala, Ionut Negoi, Desmond Khor, Daniele Dondossola, Bruno M. Pereira, Yovcho Yovtchev, Rafael L. Curado, Arda Isik, Sandeep Singh, Sergei Shlyapnikov, Stefano Rausei, Dimitrios Damaskos, Stefano Maccatrozzo, Aleix Martínez-Pérez, Miguel Leon Arellano, Massimo Sartelli, Ohad Guetta, Christian Galatioto, Demetrios Demetriades, Marco Ceresoli, Kenji Inaba, Agron Dogjani, Tugan Tezcaner, Fausto Catena, András Vereczkei, Torsten Kaussen, Francesco Trotta, and Martha Quiodettis
Subjects: MEDLINE, Peritonitis, 030230 surgery, Trauma, Barker, 03 medical and health sciences, 0302 clinical medicine, Ischemia, Medicine, Open abdomen, Skin, Compartment, business.industry, Commercial, Published Erratum, Bogotà bag, Vascular emergencies, Register, medicine.disease, Negative pressure, IROA, Register (music), Non-commercial, Emergency Medicine, Surgery, Medical emergency, business, Research Article, Witmann
Abstract: Background No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). Methods A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Results Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p
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194. Laparoscopic intragastric resection of melanoma cardial lesion.

Author: Stefano, Rausei, Vincenzo, Pappalardo, Luigi, Boni, and Gianlorenzo, Dionigi
Subjects: *LAPAROSCOPY, *MELANOMA, *GASTROINTESTINAL diseases, *PEMBROLIZUMAB, *JEHOVAH'S Witnesses
Abstract: Background Gastrointestinal tract involvements of metastatic melanoma are rare; 7% of gastrointestinal tract metastases of melanoma concerns the stomach [1]. Actually, bleeding from gastric melanoma metastasis is very rare. For the first time in Literature, this video shows a laparoscopic intragastric resection [2] of a cardial lesion of melanoma. A 64-year old patient with history of a skin melanoma resection with lung and liver metastatic disease confirmed by FDG PET, stable after repeated cycles of Pembrolizumab, presented anemia with gastrointestinal bleeding signs. Endoscopy and CT scans documented a 4-cm subcardial metastatic melanoma lesion. Endoscopic ultrasound evaluation confirmed no full-thickness involvement of gastric wall. Patient refused blood transfusions because Jehovah's Witness. Since the tumor position so close to the cardias contraindicated both typical endoscopic and laparoscopic approaches, we proposed laparoscopic intragastric solution in order to avoid risk related to a total gastrectomy. Methods Procedure was performed by 3 intragastric trocars placed under endoscopic view. The primary surgical intent was to excise the tumor in order to avoid further bleeding. Actually, during dissection we verified the possibility to radically resect the lesion. After removal (with partial fragmentation) of the lesion, residual free fragments have been accurately removed to reduce the risks of tumor implantation on gastric mucosa and a mucosal suture was completed. Two-layer running sutures were applied on gastric holes. After completion of procedure, suture and cardial gastric wall were tested for leakage with satisfying result. Finally, lesser sac was opened up to expose the right diaphragmatic pillar in order to exclude eventual posterior gastric wall damage. Results Pathologic evaluation demonstrated a diffuse submucosal invasion by melanoma, confirming that R0 resection was achieved. Conclusions In the general strategy of a palliation treatment of a largely metastastic tumor, the specific aim of this procedure was to stop gastric bleeding and to allow the continuation of systemic therapies effective in the disease control. After 6 months from surgery, patient resumed chemotherapy without any documented gastric recurrence. [ABSTRACT FROM AUTHOR]
Published: 2018
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195. Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

Author: Bracale, U., Podda, Maria Vittoria, Castiglioni, S., Peltrini, R., Sartori, Alessandra, Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, Sergio, Rosa, Fausto, Altomare, D. F., Picciariello, A., Parisi, Carmelo Maria Antonio, Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, Andrea, Izzo, Filippo, Bertolino, F., Brunetti, Maria Mercede, Bianco, Flaviana, Cappiello, A., Boccia, L., Boffi, B., Perna, Francesco, Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, Giuseppe, Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, Matteo, Contine, A., Chiara, Osvaldo, Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, Maria Francesca, Danelli, P., Guerci, C., Scala, D., Marino, Giuseppe, De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Berta, G., Bono, D., Fabozzi, Simone Michele, Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, Anna Maria, Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, Maria, Ferrari, G., Magistro, C., Giuliani, Antonio, Di Natale, Maria Grazia, Brisinda, Giuseppe, Cavallaro, G., Sammarco, G., Gallo, Giuseppe, Goletti, O., Macchini, D., Greco, Viviana, Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, Roberto, La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, Emilio Fabrizio, Maggioni, D., Martino, G., Manca, Gavina, Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, Maria Chiara, Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, Maria Stella, Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, Martina, Muratore, A., Musella, Martina, Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, Alberto, Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Formisano, Capelli, P., Baldini, E., Festa, P., Mottola, Armando, Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, Roberto, Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, Gabriele, Fransvea, P., Testa, S., De Rosa, Maria Cristina, Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, Eliana, Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, Miriam, Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, Umberto, Podda, Mauro, Castiglioni, Simone, Peltrini, Roberto, Sartori, Alberto, Arezzo, Alberto, Corcione, Francesco, Agresta, Ferdinando, Rosati, Riccardo, Umberto, Bracale, Mauro, Podda, Simone, Castiglioni, Roberto, Peltrini, Alberto, Sartori, Alberto, Arezzo, Francesco, Corcione, Ferdinando, Agresta, CLOUD-19 Collaborative Group Adelmo Antonucci, Claudia, Zanframundo, Fabio, Cavallo, Giorgio, Mazzarolo, Antonio, Agrusa, Giuseppe Di Buono, Luca, Aldrighetti, Guido, Fiorentini, Alessandro, Lucianetti, Stefano, Magnone, Sergio, Alfieri, Fausto, Rosa, Altomare, Donato F., Arcangelo, Picciariello, Amilcare, Parisi, Antonio Di Cintio, Marco Francesco Amisano, Francesca, Cravero, Michele, Ammendola, Giorgio, Ammerata, Alessandro, Anastasi, Giuseppe, Canonico, Andra, Gattolin, Elisabetta, Travaglio, Andrea, Sartori, Massimiliano De Palma, Pierluigi, Angelini, Francesco, Galante, Angelo, Benevento, Stefano, Rausei, Angelo, Serao, Francesca, Abbatini, Mario, Annecchiarico, Antonio, Varricchio, Valerio, Annessi, David, Tumiati, Alfredo, Annicchiarico, Antonello, Mirabella, Marino, Marco V., Antonino, Spinelli, Antonio, Braun, Hong Tham Santi, Lucia, Romano, Michele, Antoniutti, Mariano Fortunato Armellino, Giulio, Argenio, Augusto, Verzelli, Andrea, Budassi, Gianluca, Baiocchi, Marie Sophie Alfano, Alessandro, Balani, Marco, Barone, Gianandrea, Baldazzi, Diletta, Cassini, Ruben Carlo Balzarotti Canger, Gianpietro, Zabbialini, Andrea, Belli, Francesco, Izzo, Franco, Bertolino, Marco, Brunetti, Francesco, Bianco, Antonio, Cappiello, Luigi, Boccia, Bernardo, Boffi, Federico, Perna, Stefano, Bonilauri, Giuseppe, Frazzetta, Pierpaolo, Bordoni, Francesco, Flere, Felice, Borghi, Giorgio, Giraudo, Vincenzo, Bottino, Alfonso, Canfora, Fabrizio Briganti Piccoli, Luca, Calligari, Bruno, Nipote, Aniello Gennaro Nasti, Andrea, Bufalari, Francesca, Bettarini, Massimo, Buononato, Marco, Greco, Pietro Giorgio Calò, Fabio, Meda, Eugenia, Cardamone, Pasquale, Castaldo, Massimo, Carlini, Domenico, Spoletini, Carlo De Nisco, Fabio, Pulighe, Feo, Carlo V., Nicolò, Fabbri, Carmine, Antropoli, Fabrizio, Foroni, Maurizio, Carnazza, Salvatore, Ragazzi, Elisa, Cassinotti, Luigi, Boni, Fausto, Catena, Mario, Giuffrida, Gennaro, Perrone, Christian, Ccotsoglou, Stefano, Granieri, Graziano, Ceccarelli, Walter, Bugiantella, Carla, Cedolini, Luca, Seriau, Maurizio, Cesari, Alessandro, Contine, Osvaldo, Chiara, Stefania, Cimbanassi, Eugenio, Cocozza, Mattia, Berselli, Corrado, Fantini, Renato, Costi, Lorenzo, Casali, Andrea, Morini, Francesco, Crafa, Serafino, Vanela, Giuseppe, Currò, Vincenzo, Orsini, Corrado Da Lio, Mario, Biral, Piergiorgio, Danelli, Claudio, Guerci, Dario, Scala, Graziella, Marino, Luciano De Carlis, Andrea, Lauterio, Donato De Giorgi, Gianluca, Sciannamea, Nicolo De Manzini, Pasquale, Losurdo, Maurizio De Palma, Nicola, Sangiuliano, Maurizio, Degiuli, Franco, Caterina, Paolo Del Rio, Elena, Bonati, Stefano Di Lernia, Marco Vittorio Rossi Ardizzone, Salomone Di Saverio, Caterina, Franchi, Beatrice Di Venere, Rosanna, Miglio, Diego, Cuccurullo, Carlo, Sagnelli, Docimo, Ludovico, Tolone, Salvatore, Mauro, Longoni, Giuseppe, Faillace, Fabio, Rondelli, Francesca Pennetti Pennella, Vincenzo, Colucci, Teresa, Carfora, Irnerio Angelo Muttillo, Biagio, Picardi, Rossi, Stefano, Roberto, Campagnacci, Angela, Maurizi, Fausto, Tricarico, Marco, Montagna, Elio, Amedeo, Scollica, Michela C., Enrico, Lauro, Ernesto, Laterza, Enrico, Molinari, Berta, G., Dario, Bono, Massimiliano, Fabozzi, Mafalda, Romano, Enzo, Facci, Dario, Parini, Roberto, Farfaglia, Valeria, Arizzi, Marco, Farsi, Egidio, Miranda, Fei, Landino, Giordano, Flavio, Felice, Pirozzi, Antonio, Sciuto, Alessandro, Ferrero, Marco, Palisi, Marco, Filauro, Andrea, Barberi, Antonio, Azzinnaro, Valentino, Fiscon, Silvia, Vigna, Michele, D’Ambra, Emanuele, Pontecorvi, Gabriele, Anania, Cristina, Bombardini, Galizia, Gennaro, Auricchio, Annamaria, Cardella, Francesca, Michele, Genna, Sergio, Gentilli, Nikaj, Herald, Giampaolo, Castagnoli, Alberto, Bartoli, Luca, Gianotti, Mattia, Garancini, Giovanni, Bellanova, Paola, Palazzo, Giovanni De Palma, Marco, Milone, Giovanni, Ferrari, Carmelo, Magistro, Antonio, Giuliani, Giuseppe Di Natale, Giuseppe, Brisinda, Giuseppe, Cavallaro, Giuseppe, Sammarco, Gaetano, Gallo, Orlando, Goletti, Daniele, Macchini, Vincenzo, Greco, Vincenzo, Amoroso, Gianluca, Guercioni, Michele, Benedetti, Guglielmo, Guzzo, Francesco, Pata, Ildo, Scandroglio, Francesco, Roscio, Elio, Jovine, Raffaele, Lombardi, Francesco La Rocca, Francesca Di Capua, Carmine, Lanci, Renzo, Leli, Andrea, Borasi, Pasquale, Lepiane, Andrea, Balla, Edoardo, Liberatore, Luca, Morelli, Gregorio Di Franco, Andrea, Lucchi, Laura, Vittori, Luigi, Bonavina, Emanuele, Asti, Dario, Maggioni, Gerosa, Martino, Giuseppe, Manca, Antonella, Delvecchio, Manfredo, Tedesco, Denise, Gambardella, Salvatore, Marafioti, Maria Luisa De Marco, Marco Azzola Guicciardi, Massimo, Motta, Marco, Calgaro, Vincenzo, Adamo, Mario, Guerrieri, Pietro, Coletta, Monica, Ortenzi, Gennaro, Martine, Giuliano, Lantone, Mario, Martinotti, Giuseppe, Fassardi, Maurizio, Castriconi, Simone, Squillante, Maurizio De Luca, Maurizio, Pavanello, Carlo Di Marco, Maurizio, Ronconi, Silvia, Casiraghi, Vincenzo, Mazzaferro, Carlo, Battiston, Michele, Perrotta, Carmine, Ripa, Micheletto, Giancarlo, Valerio, Panizzo, Paolo, Millo, Riccardo Brachet Contul, Valentina, Ferraro, Carlo, Molino, Enrico, Crolla, Gianluigi, Moretto, Matilde, Bacchion, Mario, Morino, Marco Ettore Allaix, Enrico, Motterlini, Michele, Petracca, Andrea, Muratore, Mario, Musella, Antonio, Vitiello, Bruno, Nardo, Veronica, Crocco, Giuseppe, Navarra, Salvatore, Lazzara, Giuseppe Giovanni Navarra, Manuela, Cuoghi, Stefano, Olmi, Alberto, Oldani, Matteo, Uccelli, Enrico, Opocher, Marco, Giovenzana, Paolo De Paolis, Mauro, Santarelli, Paolo, Delrio, Fabio, Carbone, Paolo Pietro Giampaolo Bianchi, Formisano, Patrizio, Capelli, Edoardo, Baldini, Patrizio, Festa, Arianna, Mottola, Giovanni, Merola, Nicola, Perrotta, Marta, Celiento, Eraldo, Personnettaz, Stefania, Muzio, Tommaso, Petitti, Antonietta, Melchiorre, Micaela, Piccoli, Francesca, Pecchini, Alice, Frontali, Anna, Maffioli, Pietro, Maida, Pasquale, Tammaro, Giusto, Pignata, Jacopo, Andreuccetti, Vincenzo, Pilone, Michele, Renzulli, Salvatore, Pintaldi, Andrea Pisani Ceretti, Nicolò Maria Mariani, Adolfo, Pisanu, Roberto, Polastri, Fabio, Maiello, Alberto, Porcu, Teresa, Perra, Felice, Mucilli, Mirko, Barone, Roberto, Troisi, Roberto, Montalti, Fabrizio, Scognamillo, Daniele, Delogu, Raffaele, Galleano, Michele, Malerba, Raffaele, Salfi, Marcello, Pisano, Raffaele, Sechi, Nicola, Cillara, Salvatore, Ramuscello, Eugenio De Leo, Enrico, Restini, Rocco, Tumolo, Pasquale, Cianci, Sabino, Capuzzolo, Maurizio, Rizzo, Alfonso, Recordare, Roberto, Santoro, Pietro Maria Amodio, Aldo, Rocca, Giuseppe, Cecere, Raffaele, Romito, Luca, Portigliotti, Riccardo, Rosati, Ugo, Elmore, Domenico, Russello, Saverio, Latteri, Salvatore Maria Costarella, Salvatore, Massa, Lorenzo, Capasso, Michele, Santangelo, Maurizio, Sodo, Giuliano, Sarro, Umberto, Rivolta, Stefano, Scabini, Davide, Pertile, Federico, Selvaggi, Selene, Rossi, Selvaggi, Francesco, Pellino, Gianluca, Gabriele, Sganga, Pietro, Fransvea, Silvio, Testa, Clemente De Rosa, Walter, Siquini, Cristian, Tranà, Mario, Solej, Stefano, Bolzon, Enrico, Guerra, Marco, Stella, Francesco, Ferrara, Francesco, Stipa, Enrico, Stringhi, Andrea, Celotti, Lucio, Taglietti, Roberto Del Giudice, Carlo Alessandro Talarico, Michele, Ruggiero, Giuseppe, Tirone, Uberto Fumagalli Romario, Wanda, Petz, Valerio, Caracino, Valentina, Rossetti, Luca Andrea Verza, Lorenzo, Vescovi, Michele, Marini, Nereo, Vettoretto, Emanuele, Botteri, Leonardo, Vincenti, Giusy, Giannandrea, Tiziana, Viora, Lorenzo, Maganuco, Paolo, Veronesi, Bruno, Zani, Giacomo, Zanu, Marco, Brizzolari, Federico, Zanzi, Anna, Guariniello, Marco Antonio Zappa, Elisa, Galfrascoli, Sandro, Zonta, Luigi, Oragano, Walter Zuliani &amp, Damiano, Chiari, de Manzini, Nicolo', Agresta, Ferdinando, Agrusa, Antonino, Di Buono, Giuseppe, Bracale, U., Podda, M., Castiglioni, S., Peltrini, R., Sartori, A., Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, S., Rosa, F., Altomare, D. F., Picciariello, A., Parisi, A., Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, A., Izzo, F., Bertolino, F., Brunetti, M., Bianco, F., Cappiello, A., Boccia, L., Boffi, B., Perna, F., Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, G., Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, M., Contine, A., Chiara, O., Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, M., Danelli, P., Guerci, C., Scala, D., Marino, G., De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Bono, D., Fabozzi, M., Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, A., Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, M., Ferrari, G., Magistro, C., Giuliani, A., Di Natale, G., Brisinda, G., Cavallaro, G., Sammarco, G., Gallo, G., Goletti, O., Macchini, D., Greco, V., Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, R., La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, E., Maggioni, D., Martino, G., Manca, G., Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, M., Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, S., Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, M., Muratore, A., Musella, M., Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, A., Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Capelli, P., Baldini, E., Festa, P., Mottola, A., Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, R., Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, G., Fransvea, P., Testa, S., De Rosa, C., Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, E., Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, M., Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, U, Podda, M, Castiglioni, S, Peltrini, R, Sartori, A, Arezzo, A, Corcione, F, Agresta, F, Antonucci, A, Zanframundo, C, Cavallo, F, Mazzarolo, G, Agrusa, A, Di Buono, G, Aldrighetti, L, Fiorentini, G, Lucianetti, A, Magnone, S, Alfieri, S, Rosa, F, Altomare, D, Picciariello, A, Parisi, A, Di Cintio, A, Amisano, M, Cravero, F, Ammendola, M, Ammerata, G, Anastasi, A, Canonico, G, Gattolin, A, Travaglio, E, De Palma, M, Angelini, P, Galante, F, Benevento, A, Rausei, S, Serao, A, Abbatini, F, Annecchiarico, M, Varricchio, A, Annessi, V, Tumiati, D, Annicchiarico, A, Mirabella, A, Marino, M, Spinelli, A, Braun, A, Santi, H, Romano, L, Antoniutti, M, Armellino, M, Argenio, G, Verzelli, A, Budassi, A, Baiocchi, G, Alfano, M, Balani, A, Barone, M, Baldazzi, G, Cassini, D, Canger, R, Zabbialini, G, Belli, A, Izzo, F, Bertolino, F, Brunetti, M, Bianco, F, Cappiello, A, Boccia, L, Boffi, B, Perna, F, Bonilauri, S, Frazzetta, G, Bordoni, P, Fleres, F, Borghi, F, Giraudo, G, Bottino, V, Canfora, A, Piccoli, F, Calligaris, L, Nipote, B, Nasti, A, Bufalari, A, Bettarini, F, Buononato, M, Greco, M, Calo, P, Medas, F, Cardamone, E, Castaldo, P, Carlini, M, Spoletini, D, De Nisco, C, Pulighe, F, Feo, C, Fabbri, N, Antropoli, C, Foroni, F, Carnazza, M, Ragazzi, S, Cassinotti, E, Boni, L, Catena, F, Giuffrida, M, Perrone, G, Ccotsoglou, C, Granieri, S, Ceccarelli, G, Bugiantella, W, Cedolini, C, Seriau, L, Cesari, M, Contine, A, Chiara, O, Cimbanassi, S, Cocozza, E, Berselli, M, Fantini, C, Costi, R, Casali, L, Morini, A, Crafa, F, Vanela, S, Curro, G, Orsini, V, Da Lio, C, Biral, M, Danelli, P, Guerci, C, Scala, D, Marino, G, De Carlis, L, Lauterio, A, De Giorgi, D, Sciannamea, G, De Manzini, N, Losurdo, P, Sangiuliano, N, Degiuli, M, Caterina, F, Del Rio, P, Bonati, E, Di Lernia, S, Ardizzone, M, Di Saverio, S, Franchi, C, Di Venere, B, Miglio, R, Cuccurullo, D, Sagnelli, C, Docimo, L, Tolone, S, Longoni, M, Faillace, G, Rondelli, F, Pennella, F, Colucci, V, Carfora, T, Muttillo, I, Picardi, B, Stefano, R, Campagnacci, R, Maurizi, A, Tricarico, F, Montagna, M, Amedeo, E, Scollica, M, Lauro, E, Laterza, E, Molinari, E, Berta, G, Bono, D, Fabozzi, M, Romano, M, Facci, E, Parini, D, Farfaglia, R, Arizzi, V, Farsi, M, Miranda, E, Fei, L, Flavio, G, Pirozzi, F, Sciuto, A, Ferrero, A, Palisi, M, Filauro, M, Barberis, A, Azzinnaro, A, Fiscon, V, Vigna, S, D'Ambra, M, Pontecorvi, E, Anania, G, Bombardini, C, Galizia, G, Auricchio, A, Cardella, F, Genna, M, Gentilli, S, Herald, N, Castagnoli, G, Bartoli, A, Gianotti, L, Garancini, M, Bellanova, G, Palazzo, P, De Palma, G, Milone, M, Ferrari, G, Magistro, C, Giuliani, A, Di Natale, G, Brisinda, G, Cavallaro, G, Sammarco, G, Gallo, G, Goletti, O, Macchini, D, Greco, V, Amoroso, V, Guercioni, G, Benedetti, M, Guzzo, G, Pata, F, Scandroglio, I, Roscio, F, Jovine, E, Lombardi, R, La Rocca, F, Di Capua, F, Lanci, C, Leli, R, Borasi, A, Lepiane, P, Balla, A, Liberatore, E, Morelli, L, Di Franco, G, Lucchi, A, Vittori, L, Bonavina, L, Asti, E, Maggioni, D, Martino, G, Manca, G, Delvecchio, A, Tedesco, M, Gambardella, D, Marafioti, S, De Marco, M, Guicciardi, M, Motta, M, Calgaro, M, Adamo, V, Guerrieri, M, Coletta, P, Ortenzi, M, Martines, G, Lantone, G, Martinotti, M, Fassardi, G, Castriconi, M, Squillante, S, De Luca, M, Pavanello, M, Di Marco, C, Ronconi, M, Casiraghi, S, Mazzaferro, V, Battiston, C, Perrotta, M, Ripa, C, Giancarlo, M, Panizzo, V, Millo, P, Contul, R, Ferraro, V, Molino, C, Crolla, E, Moretto, G, Bacchion, M, Morino, M, Allaix, M, Motterlini, E, Petracca, M, Muratore, A, Musella, M, Vitiello, A, Nardo, B, Crocco, V, Navarra, G, Lazzara, S, Cuoghi, M, Olmi, S, Oldani, A, Uccelli, M, Opocher, E, Giovenzana, M, De Paolis, P, Santarelli, M, Delrio, P, Carbone, F, Bianchi, P, Capelli, P, Baldini, E, Festa, P, Mottola, A, Merola, G, Perrotta, N, Celiento, M, Personnettaz, E, Muzio, S, Petitti, T, Melchiorre, A, Piccoli, M, Pecchini, F, Frontali, A, Maffioli, A, Maida, P, Tammaro, P, Pignata, G, Andreuccetti, J, Pilone, V, Renzulli, M, Pintaldi, S, Ceretti, A, Mariani, N, Pisanu, A, Polastri, R, Maiello, F, Porcu, A, Perra, T, Mucilli, F, Troisi, R, Montalti, R, Scognamillo, F, Delogu, D, Galleano, R, Malerba, M, Salfi, R, Pisano, M, Sechi, R, Cillara, N, Ramuscello, S, De Leo, E, Restini, E, Tumolo, R, Cianci, P, Capuzzolo, S, Rizzo, M, Recordare, A, Santoro, R, Amodio, P, Rocca, A, Cecere, G, Romito, R, Portigliotti, L, Rosati, R, Elmore, U, Russello, D, Latteri, S, Costarella, S, Massa, S, Capasso, L, Santangelo, M, Sodo, M, Sarro, G, Rivolta, U, Scabini, S, Pertile, D, Selvaggi, F, Rossi, S, Pellino, G, Sganga, G, Fransvea, P, Testa, S, De Rosa, C, Siquini, W, Trana, C, Solej, M, Bolzon, S, Guerra, E, Stella, M, Ferrara, F, Stipa, F, Stringhi, E, Celotti, A, Taglietti, L, Del Giudice, R, Talarico, C, Ruggiero, M, Tirone, G, Romario, U, Petz, W, Caracino, V, Rossetti, V, Verza, L, Vescovi, L, Marini, M, Vettoretto, N, Botteri, E, Vincenti, L, Giannandrea, G, Viora, T, Maganuco, L, Veronesi, P, Zani, B, Zanus, G, Brizzolari, M, Zanzi, F, Guariniello, A, Zappa, M, Galfrascoli, E, Zonta, S, Oragano, L, Zuliani, W, and Chiari, D
Subjects: Laparoscopic surgery, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, laparoscopy, COVID-19, Elective surgery, Emergency surgery, Survey, Oral Health, cross infection (MeSH), Surveys and Questionnaires, Epidemiology, Pandemic, Infection control, Practice Patterns, Physicians', emergency surgery, Laparoscopy, humans, medicine.diagnostic_test, General Commentary, laparoscopic surgery, infection control, Italy, physicians', Original Article, Elective Surgical Procedure, Human, heating ventilation air conditioning, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), fallow period, elective surgical procedures, pandemics, NO, aerosol generating procedures, elective surgery, survey, practice patterns, physicians', SARS-CoV-2, surveys and questionnaires, medicine, Infection Control, business.industry, General surgery, practice patterns, Surgery, business
Abstract: Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. Methods The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020). Results Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency ( Conclusion This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.
Published: 2021

196. Seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up.

Author: Rausei S, Ruspi L, Galli F, Pappalardo V, Di Rocco G, Martignoni F, Frattini F, Rovera F, Boni L, and Dionigi G
Subjects: Adenocarcinoma diagnosis, Adenocarcinoma pathology, Esophageal Neoplasms pathology, Esophagogastric Junction pathology, Esophagus pathology, Female, Follow-Up Studies, Gastrectomy, Humans, Lymph Node Excision, Lymph Nodes pathology, Male, Peritoneum pathology, Prognosis, Stomach pathology, Lymphatic Metastasis diagnosis, Lymphatic Metastasis pathology, Neoplasm Staging methods, Stomach Neoplasms diagnosis, Stomach Neoplasms pathology
Abstract: Seventh tumor-node-metastasis (TNM) classification for gastric cancer, published in 2010, introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity, due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases, positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however, its search in clinical practice is still far from being routinely performed, as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently, many controversies on lymph node staging are still ongoing, with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world., Competing Interests: Conflict-of-interest statement: None to declare.
Published: 2016
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197. Prognosis and treatment of patients with positive peritoneal cytology in advanced gastric cancer.

Author: Frattini F, Rausei S, Chiappa C, Rovera F, Boni L, and Dionigi G
Abstract: Positive peritoneal cytology in gastric cancer is classified as M1 disease by the 7(th) Edition of American Joint Committee on Cancer staging system. With the introduction of laparoscopy and peritoneal washing cytology in the staging of gastric cancer a new category of patients has been identified. These are patients with no macroscopic peritoneal metastases but with peritoneal cytology positive (P0C1). Prognosis and treatment of such patients represent a controversial issue. We evaluate the state of the art of staging system in gastric cancer and discuss standardisation in staging and treatment procedures. There is still a lack of uniformity in the use of laparoscopy with peritoneal cytology in clinical decision making and in the surgical treatment for gastric cancer. Survival of this patient subset remains poor. Multimodal therapies and new therapeutic strategies are required to improve the survival of these patients.
Published: 2013
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198. A decade in gastric cancer curative surgery: Evidence of progress (1999-2009).

Author: Rausei S, Dionigi G, Rovera F, Boni L, Valerii C, Giavarini L, Frattini F, and Dionigi R
Abstract: To investigate the progress in evidence-based surgical treatment of non-metastatic gastric cancer, we reviewed the last ten years' literature. The data used in this review were identified by searches made on MEDLINE, Current Contents, PubMed, and other references taken from relevant original articles (on prospective and retrospective studies) concerning gastric cancer surgery. Only papers published in English between January 1999 and December 2009 were selected. Data from ongoing studies were obtained in December 2009, from the trials registry of the United States National Institutes of Health (http://www.clinicaltrial.gov). The citations list was presented according to evidence based relevance (i.e., randomized controlled trials, prospective studies, retrospective series). In the last ten years, many challenges have been faced relating to the extension of gastric resection and nodal dissection as well as surgical timing, but we found only limited evidence, regardless of latitude of study. The ongoing phase-III trials may provide answers that will be valid for the coming decades, and which may bring definitive answers for the currently unresolved questions.
Published: 2012
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