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Background: Parathyroid cancer (PC) is a rare sporadic or hereditary malignancy whose histologic features were redefined with the 2022 WHO classification. A total of 24 Italian institutions designed this multicenter study to specify PC incidence, describe its clinical, functional, and imaging characteristics and improve its differentiation from the atypical parathyroid tumour (APT)., Methods: All relevant information was collected about PC and APT patients treated between 2009 and 2021., Results: Among 8361 parathyroidectomies, 351 patients (mean age 59.0 ± 14.5; F = 210, 59.8%) were divided into the APT (n = 226, 2.8%) and PC group (n = 125, 1.5%). PC showed significantly higher rates ( p < 0.05) of bone involvement, abdominal, and neurological symptoms than APT (48.8% vs. 35.0%, 17.6% vs. 7.1%, 13.6% vs. 5.3%, respectively). Ultrasound (US) diameter >3 cm (30.9% vs. 19.3%, p = 0.049) was significantly more common in the PC. A significantly higher frequency of local recurrences was observed in the PC (8.0% vs. 2.7%, p = 0.022). Mortality due to consequences of cancer or uncontrolled hyperparathyroidism was 3.3%., Conclusions: Symptomatic hyperparathyroidism, high PTH and albumin-corrected serum calcium values, and a US diameter >3 cm may be considered features differentiating PC from APT. 2022 WHO criteria did not impact the diagnosis.

Aim: Acute cholecystitis (AC) is one of the most frequent pathologies treated in urgency. An immediate surgical intervention for frail patients who are ineligible for surgery as a result of severe co-morbidities is questionable. The aim of this study is to investigate the safety and the management of percutaneous cholecistostomy (PC) in high-risk surgical patients., Materials and Methods: In the period of time January 2015 - May 2021 we observed 1105 patients admitted with acute cholecystitis in our Department. In the group with severe cholecystitis (160 patients, 14.48%), 137 (12.39%) were submitted to immediate surgery, and 23 (4.8%) were treated with PC. All these patients were non-responding to conservative management. Initially, we used PC as a definitive treatment; from the second half of 2018 PC was implemented as a bridge to surgery., Results: Clinically, symptoms resolved in all the 23 patients. Mortality was nihil and no complication was recorded. PC was used as definitive treatment in 14 cases, wheres in 9 patients PC was intended as a-bridge-to-surgery treatment, and was followed by cholecystectomy., Discussion: 2017 guidelines, of World Society of Emergency Surgery recommended PC as a safe and effective management of AC in patients with multiple comorbidities. In this group of patients PC achieves a prompt resolution of clinical symptoms and is superior to conservative management. There are no absolute contraindications to PC., Conclusions: PC is a safe and less invasive treatment of AC for patients with prohibitive surgical risk. It may be used as bridge to surgery to switch high-risk for moderate-risk patients, more suitable for a safe and definitive surgical treatment., Key Words: Acute cholecystitis, High-risk surgical patients, Percutaneous cholecystostomy.

Aim: The ideal level of ligation of the inferior mesenteric artery (IMA) during resection for colorectal cancer is still controversial. The aim of this study was to demonstrate the real advantages and, above all, the adequacy of oncological staging after a low ligation of the IMA with additional LN retrieval in patients undergoing surgery for colorectal cancer., Materials and Methods: Between January 2013 and December 2020, 157 patients who underwent curative resection of a primary colorectal tumor were retrospectively included: 64 patients underwent high ligation of the IMA and 93 patients underwent low ligation of the IMA with additional LN retrieval. Results - Mean number of lymphnodes harvested (the median number of harvested nodes was 16.2 in "high ligation" group vs 15.4 in "low ligation" group), operation time (272 minutes vs 293 minutes), intraoperative blood loss (40 cc vs 53 cc) and recovery time (median postoperative hospitalization was 6.4 days in both groups) were not significantly different between the groups., Discussion: High ligation of the IMA preserves an adequate length of the colon to perform a successful anastomosis and facilitates apical LN dissection. However, it may be associated with an increased risk of anastomotic leakage. Low ligation of the IMA is less invasive and it is associated with a better preservation of genitourinary function and, futhermore, with an accurate oncological clearance., Conclusion: Low ligation of the IMA with additional LN retrieval might be an oncologically safe and less invasive procedure in the surgical management of patients with colorectal cancer., Key Words: Colorectal cancer, Inferior mesenteric artery, Ligation.

Aim: To evaluate the advantages and potential risks of "Non Operative Management" (NOM) in order to redifine the technique into the true gold standard and to extend its application to the emergency care of blunt splenic trauma., Materials and Methods: Blunt trauma cases treated between 2004 and 2019 have been retrospectively evaluated. Every patient has been distributed at the hospital admission in 3 different groups: stable, unstable and transient responder according to ATLS. NOM exclusion criteria were only introduced in 2013: we therefore assessed datas before and after this year., Results: Over a period of 15 years, approximately 6 patients per year were admitted to our hospital with a spleen injury. After the introduction of the NOM protocol in 2013, the proportion of splenectomies progressively decreased. This rate also increased for higher injury grades. The overall number of patients who underwent NOM was 40 (43%), but while between 2004 and 2012 only 25% of patients were managed with NOM, between 2013 and 2019 70.3% of patients were treated with NOM., Conclusions: Nowadays any blunt splenic trauma could, theoretically, undergo NOM, regardless of the grade of the injury; the only strict criteria for OM should be haemodynamic instability; this assumption depends, of course, on hospital's human and technological resources., Key Words: Non operative management, Splenic trauma, Splenectomy.

Pilar tumors, commonly called trichilemmal cysts, are usually benign in nature, malignant transformation (so called proliferating pilar tumors or proliferating trichilemmal cysts [PTCs]) with high recurrence rates, local invasion and metastases have been described. A 64-year-old women presented to our hospital with a recurrent ulcerated mass lesion of the scalp. Non-contrast-enhanced computed tomography scan of the head was performed. The mass was managed by complete excisional biopsy and the defect closure was achieved by using a full-thickness skin graft. Histopathological analysis revealed the characteristic structures of PTC; in addition foci of squamous pearls, squamous cells with pleomorphic nuclei suggestive of cellular atypia and increased typical mitotic activity were also noticed. PTCs are related to high recurrency rates, local invasion and possible metastases. Radical surgical treatment and precise histological analysis are essential in order to achieve a fast and complete healing. Cooperation of the clinician and the pathologist is essential for accurate diagnosis, treatment and follow-up planning.

Thyroid surgery is a clean procedure and therefore antibiotic prophylaxis is not routinely recommended by most international guidelines. However, antibiotics are often used in clinical practice. We enrolled 2926 patients who performed a thyroid surgical operation between the years 2009 and 2011 in the 38 centers of endocrine surgery that joined the UEC--Italian Endocrine Surgery Units Association. Antibiotic prophylaxis was used in 1132 interventions (38.7%). In case of antibiotic prophylaxis, cephalosporins or aminopenicillins ± beta lactamase inhibitors were employed. At logistic regression analysis the use of drainage or device and the presence of malignancy were independent predictors of antibiotic prophylaxis employment. In conclusion our study shows that antibiotic prophylaxis was not rarely used in clinical practice in the setting of thyroid surgery. Drainage apposition, use of device, and malignant disease were independent predictors for antibiotic prophylaxis employment. More data on everyday practice and infection rate in well-designed studies are warranted to provide definitive recommendations on the utility of antibiotic prophylaxis in this setting. According to our experience, we don't consider to be strictly necessary the antibiotic prophylaxis employment in order to reduce infection rate in thyroid surgery.

Unlabelled: Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection (3-15%). The objective of this study was to evaluate the advantages antibiotic prophylaxis in patients undergoing breast surgery. A multicenter randomized controlled study was performed between January 2008 and November 2008. One thousand four hundred patients were enrolled in prospective randomized study; surgical wound infection was found in 41 patients (2.93%). In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection (17 patients, 2.42%, subjected to antibiotic prophylaxis vs 24 patients, 3.43%, without antibiotic prophylaxis) (P = 0.27). In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis (5 patients, 0.92%, subjected to antibiotic prophylaxis vs 14 patients, 3.09%, without antibiotic prophylaxis) (P = 0.02)., Conclusion: This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant.

Background: Intrathyroid metastases (ITM) are rare and usually have a dismal prognosis. The aim of this study was to detect which neoplasms metastasize most often to the thyroid gland, their clinical features and treatment options., Materials and Methods: Retrospective analysis of clinical files of 17,122 patients submitted to surgery for thyroid disease between 1995 and 2005. Twenty-five patients (median age 61 years) were affected by ITM., Results: The site of the primary tumor was: kidney (15), lung (4), colon (3), breast (1), melanoma (1), and unknown in 1 patient. Ten patients (40%) complained of preoperative symptoms, in the others, thyroid involvement was incidentally discovered during the follow-up for the primary cancer. Twenty patients (80%) underwent total thyroidectomy, 3 received thyroid lobectomy and 2 palliative procedures. Morbidity was 16%, mortality was nil. The median follow-up was 24 months., Conclusion: ITM should always be suspected in any patient with a previous history of malignancy. Fine-needle agobiopsy (FNAB) with immunohistochemical stains may help in preoperative workup. A long delay between the primary tumor and the recurrence warrants surgery and total thyroidectomy seems to be the treatment of choice because of the multifocality of metastasis to the thyroid gland.

Neuroendocrine tumours (NET) are a heterogeneous group of neoplasms deriving from a system of diffuse neuroendocrine cells in organs and tissues, defined as the "diffuse neuroendocrine system". Over the period from 1996 to 2005 42 patients with gastroenteropancreatic (GEP) NET were observed (M.F ratio: 1.5:1; mean age 58 years; > 60 years for all localisations except the appendix [< 39 years]). Twenty-three were tumours of the appendix, colon and rectum, corresponding to 55% of all those affecting the digestive tract: 8 appendix (35%), 6 right colon (26%), 4 left colon (17%) and 5 rectum (22%). The NET diagnosis was formulated in all cases on the basis of histological and immunohistochemical examinations. The mean follow-up period was 5 years (range: 1-10). In the RO-RI cases no relapses occurred and those who were not disease-free were treated with somatostatin analogues and/or chemotherapy. NET of the appendix, colon and rectum are rare, despite being the most frequent among the GEP tumours, and are difficult to diagnose, and therefore sometimes pose problems of surgical therapy, which, when performed in time, may be curative. NET of the appendix measuring <2 cm, localised in the distal part without local infiltration, can be treated by simple appendicectomy and removal of the mesenteriole; otherwise, right hemicolectomy is indicated. The surgical treatment of tumours of the colon, except for well differentiated cases measuring <2 cm with a pedunculate structure such as to allow safe endoscopic removal, consists in radical hemicolectomy with lymphadenectomy. Carcinoids of the rectum measuring <1 cm and 1 cm to 2 cm, in the absence of other negative prognostic factors, can be treated locally by transanal endoscopic microsurgery (TEM) or minimally invasive transanal surgery (MITAS). Tumours measuring >2 cm or presenting muscular invasion and/or lymph-node metastases (malignant carcinoids), regardless of tumour diameter, are submitted to radical operations, as in the case of carcinoma of the rectum. Extensive disease which is no longer curable with surgery alone is treated with chemotherapy and bio-chemotherapy, but it is above all treatment with somatostatin analogues that plays a major role in symptom control.

The aim of the study was to draw up a management protocol in thyroid surgery promoted by the Italian Association of Endocrine Surgery Units (Club delle UEC), shared by the experts and applied by the operators in the sector. The management protocols already presented in February 2002 and drawn up by the first Author of the present publication on the occasion of the current review were examined by the I Consensus Conference called on the topic by the Italian Endocrine Surgery Units. The conference comprised two distinct sessions, the first on 18 June 2005 within the framework of the 4th National Congress of the Club delle UEC in Naples, and the second on 17 September 2005 within the framework of the 8th Multidisciplinary Scanno Prize Meeting. A selected board of endocrinologists and endocrine surgeons, chaired by Aldo Pinchera and comprising the first nine Authors of this paper, examined the individual chapters in close collaboration with the other Authors, comparing their findings with the opinions of the experts cited in the text and submitting the consensus text for the approval of all those present. The diagnostic, therapeutic and healtcare management protocols in thyroid surgery approved by the I Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (Club delle UEC) and are subject to review by October 1, 2007.

The range of indications for total thyroidectomy in the treatment of thyroid disease is steadily increasing, but any attempt to assess its real efficacy necessarily calls for a knowledge of the incidence of complications, amongst other things in order to provide the patient with complete information regarding the operation before obtaining his or her consent. Retrospective and observational analysis of 14,934 thyroidectomies performed in 42 Endocrine Surgery Units in Italy has made it possible to compare total thyroidectomy (TT) versus subtotal thyroidectomy with a bilateral remnant (ST-BR), subtotal thyroidectomy with a unilateral remnant (ST-UR) and total lobectomy-isthmectomy (TLI). The correlation between the number of total thyroidectomies and each of the other surgical procedures and the number of complications occurring with each of them was also assessed in order to quantify the effective risk of complications by determining the Odds Ratios on the basis of univariate analysis of the variables considered. The cases reviewed consisted of 9,599 TT (64%), 3,130 TLI (21%), 1,448 ST-UR (22%) and 757 ST-BR (5%); 13,023 (87%) cases were suffering from benign disease and 1,911 (13%) from malignancies. Recurrent laryngeal nerve injuries were present in 4.3% of the TT cases with 2.4% transient and 1.3% definitive (as against 3% in ST-BR and 2% in ST-UR with 1.4% and 1.1% transient, and 1% and 0.6% definitive, respectively; and 1.4% transient and 0.6% definitive in TLI). Hypocalcaemia after TT was transient in 14% and definitive in 2.2% (as against transient rates of 5% in ST-BR and ST-UR and 0.4 in TLI; and definitive hypocalcaemia in 0.6%, 0.8% and 0.07%, respectively). Haemorrhage occurred in 1.6% of TT cases (as against 2.1%, 0.5% and 0.4% in ST-BR, ST-UR and TLI, respectively). The Odds Ratios showed that TT presented a 16% higher complication rate than ST-UR which was assigned a value of 1, a 3% higher rate than ST-BR and a 5% lower rate than TLI. This greater incidence of complications with TT is attributable mainly to the greater incidence of transient hypoglycaemia and to a lesser extent to the slightly higher incidence of definitive hypoglycaemia, whereas the incidences of recurrent laryngeal nerve injuries were very similar in TT and ST-BR. Haemorrhagic complications were more frequent in ST-BR than in TT. Bearing in mind that TT is the absolute indication in the more demanding thyroid diseases (tumours, retrosternal goitre, Basedow's disease, recurrences) and in view of its fairly low complication rate, we believe that TT is a safe, reliable procedure, provided it is performed in a technically scrupulous manner. ST-BR is a technique which should be abandoned owing to the fact that its complication rate is comparable to that of TT and to the recurrences it may give rise to. ST-UR may be indicated if the surgeon is not sure of safeguarding the anatomical integrity of the recurrent nerve on one side.