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1. Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy (ADiGe) survey

Author

Mengardo, V, Weindelmayer, J, Veltri, A, Giacopuzzi, S, Torroni, L, de Manzoni, G, Agresta, F, Alfieri, R, Alfieri, S, Antonacci, N, Baiocchi, G, Bencini, L, Bencivenga, M, Benedetti, M, Berselli, M, Biondi, A, Capolupo, G, Carboni, F, Casadei, R, Casella, F, Catarci, M, Cerri, P, Chiari, D, Cocozza, E, Colombo, G, Cozzaglio, L, Dalmonte, G, Degiuli, M, De Luca, M, De Luca, R, De Manzini, N, De Pasqual, C, De Pascale, S, De Ruvo, N, Di Cosmo, M, Di Leo, A, Di Paola, M, Elio, A, Ferrara, F, Ferrari, G, Fiscon, V, Fumagalli, U, Garulli, G, Gennai, A, Gentile, I, Germani, P, Gualtierotti, M, Guerini, F, Gurrado, A, Inama, M, La Torre, F, Laterza, E, Losurdo, P, Macri, A, Marano, A, Marano, L, Marchesi, F, Marino, F, Massani, M, Menghi, R, Milone, M, Molfino, S, Montuori, M, Moretto, G, Morgagni, P, Morpurgo, E, Abdallah, M, Nespoli, L, Olmi, S, Palaia, R, Pallabazer, G, Parise, P, Pasculli, A, Pericoli Ridolfini, M, Pesce, A, Pinotti, E, Pisano, M, Poiasina, E, Postiglione, V, Rausei, S, Rella, A, Rosa, F, Rosati, R, Rossi, G, Rossit, L, Rovatti, M, Ruspi, L, Sacco, L, Saladino, E, Sansonetti, A, Sartori, A, Scaglione, D, Scaringi, S, Schoenthaler, C, Sena, G, Simone, M, Solaini, L, Strignano, P, Tartaglia, N, Testa, S, Testini, M, Tiberio, G, Treppiedi, E, Vagliasindi, A, Valmasoni, M, Vigano, J, Zanchettin, G, Zanoni, A, Zardini, C, Zerbinati, A, Mengardo V., Weindelmayer J., Veltri A., Giacopuzzi S., Torroni L., de Manzoni G., Agresta F., Alfieri R., Alfieri S., Antonacci N., Baiocchi G. L., Bencini L., Bencivenga M., Benedetti M., Berselli M., Biondi A., Capolupo G. T., Carboni F., Casadei R., Casella F., Catarci M., Cerri P., Chiari D., Cocozza E., Colombo G., Cozzaglio L., Dalmonte G., Degiuli M., De Luca M., De Luca R., De Manzini N., De Pasqual C. A., De Pascale S., De Ruvo N., Di Cosmo M., Di Leo A., Di Paola M., Elio A., Ferrara F., Ferrari G., Fiscon V., Fumagalli U., Garulli G., Gennai A., Gentile I., Germani P., Gualtierotti M., Guerini F., Gurrado A., Inama M., La Torre F., Laterza E., Losurdo P., Macri A., Marano A., Marano L., Marchesi F., Marino F., Massani M., Menghi R., Milone M., Molfino S., Montuori M., Moretto G., Morgagni P., Morpurgo E., Abdallah M., Nespoli L., Olmi S., Palaia R., Pallabazer G., Parise P., Pasculli A., Pericoli Ridolfini M., Pesce A., Pinotti E., Pisano M., Poiasina E., Postiglione V., Rausei S., Rella A., Rosa F., Rosati R., Rossi G., Rossit L., Rovatti M., Ruspi L., Sacco L., Saladino E., Sansonetti A., Sartori A., Scaglione D., Scaringi S., Schoenthaler C., Sena G., Simone M., Solaini L., Strignano P., Tartaglia N., Testa S., Testini M., Tiberio G. A. M., Treppiedi E., Vagliasindi A., Valmasoni M., Vigano J., Zanchettin G., Zanoni A., Zardini C., Zerbinati A., Mengardo, V, Weindelmayer, J, Veltri, A, Giacopuzzi, S, Torroni, L, de Manzoni, G, Agresta, F, Alfieri, R, Alfieri, S, Antonacci, N, Baiocchi, G, Bencini, L, Bencivenga, M, Benedetti, M, Berselli, M, Biondi, A, Capolupo, G, Carboni, F, Casadei, R, Casella, F, Catarci, M, Cerri, P, Chiari, D, Cocozza, E, Colombo, G, Cozzaglio, L, Dalmonte, G, Degiuli, M, De Luca, M, De Luca, R, De Manzini, N, De Pasqual, C, De Pascale, S, De Ruvo, N, Di Cosmo, M, Di Leo, A, Di Paola, M, Elio, A, Ferrara, F, Ferrari, G, Fiscon, V, Fumagalli, U, Garulli, G, Gennai, A, Gentile, I, Germani, P, Gualtierotti, M, Guerini, F, Gurrado, A, Inama, M, La Torre, F, Laterza, E, Losurdo, P, Macri, A, Marano, A, Marano, L, Marchesi, F, Marino, F, Massani, M, Menghi, R, Milone, M, Molfino, S, Montuori, M, Moretto, G, Morgagni, P, Morpurgo, E, Abdallah, M, Nespoli, L, Olmi, S, Palaia, R, Pallabazer, G, Parise, P, Pasculli, A, Pericoli Ridolfini, M, Pesce, A, Pinotti, E, Pisano, M, Poiasina, E, Postiglione, V, Rausei, S, Rella, A, Rosa, F, Rosati, R, Rossi, G, Rossit, L, Rovatti, M, Ruspi, L, Sacco, L, Saladino, E, Sansonetti, A, Sartori, A, Scaglione, D, Scaringi, S, Schoenthaler, C, Sena, G, Simone, M, Solaini, L, Strignano, P, Tartaglia, N, Testa, S, Testini, M, Tiberio, G, Treppiedi, E, Vagliasindi, A, Valmasoni, M, Vigano, J, Zanchettin, G, Zanoni, A, Zardini, C, Zerbinati, A, Mengardo V., Weindelmayer J., Veltri A., Giacopuzzi S., Torroni L., de Manzoni G., Agresta F., Alfieri R., Alfieri S., Antonacci N., Baiocchi G. L., Bencini L., Bencivenga M., Benedetti M., Berselli M., Biondi A., Capolupo G. T., Carboni F., Casadei R., Casella F., Catarci M., Cerri P., Chiari D., Cocozza E., Colombo G., Cozzaglio L., Dalmonte G., Degiuli M., De Luca M., De Luca R., De Manzini N., De Pasqual C. A., De Pascale S., De Ruvo N., Di Cosmo M., Di Leo A., Di Paola M., Elio A., Ferrara F., Ferrari G., Fiscon V., Fumagalli U., Garulli G., Gennai A., Gentile I., Germani P., Gualtierotti M., Guerini F., Gurrado A., Inama M., La Torre F., Laterza E., Losurdo P., Macri A., Marano A., Marano L., Marchesi F., Marino F., Massani M., Menghi R., Milone M., Molfino S., Montuori M., Moretto G., Morgagni P., Morpurgo E., Abdallah M., Nespoli L., Olmi S., Palaia R., Pallabazer G., Parise P., Pasculli A., Pericoli Ridolfini M., Pesce A., Pinotti E., Pisano M., Poiasina E., Postiglione V., Rausei S., Rella A., Rosa F., Rosati R., Rossi G., Rossit L., Rovatti M., Ruspi L., Sacco L., Saladino E., Sansonetti A., Sartori A., Scaglione D., Scaringi S., Schoenthaler C., Sena G., Simone M., Solaini L., Strignano P., Tartaglia N., Testa S., Testini M., Tiberio G. A. M., Treppiedi E., Vagliasindi A., Valmasoni M., Vigano J., Zanchettin G., Zanoni A., Zardini C., and Zerbinati A.

Abstract

Evidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.

Published
2022

2. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

Author

Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, Giacopuzzi, S, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, Giacopuzzi, Simone, Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, Giacopuzzi, S, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, and Giacopuzzi, Simone

Abstract

Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p=0.02 and p=0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.

Published
2023

3. The sentinel node biopsy

Author

Rossit, L., Sattin, E., Di Benedetto, F., Molaro, R., and Cedolini, C.

Subjects
Sentinel limph node, Breast cancer, Axillary dissection
Published
2007

5. Quadrantectomy

Author

Sattin, E., Di Benedetto, F., Rossit, L., Luvisetto, F., and Cedolini, C.

Subjects
Breast cancer, Breast conservative surgery, Quadrantectomy
Published
2007

11. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

Author

Marco Milone, Anna D’Amore, Sergio Alfieri, Maria Raffaella Ambrosio, Jacopo Andreuccetti, Luca Ansaloni, Adelmo Antonucci, Marco Arganini, Gianluca Baiocchi, Mirko Barone, Lapo Bencini, Maria Bencivenga, Luigi Boccia, Luigi Boni, Marco Braga, Fabio Cianchi, Chiara Cipollari, Alessandro Contine, Christian Cotsoglou, Simone D’Imporzano, Giovanni De Manzoni, Stefano De Pascale, Nicola De Ruvo, Maurizio Degiuli, Annibale Donini, Ugo Elmore, Giorgio Ercolani, Giovanni Ferrari, Romario Uberto Fumagalli, Gianluca Garulli, Roberta Gelmini, Luigina Graziosi, Monica Gualtierotti, Alfredo Guglielmi, Marco Inama, Federica Maffeis, Francesco Maione, Michele Manigrasso, Federico Marchesi, Daniele Marrelli, Andrea Massobrio, Gianluigi Moretto, Aballah Moukachar, Giuseppe Navarra, Giuseppe Nigri, Stefano Olmi, Raffaele Palaia, Davide Papis, Paolo Parise, Corrado Pedrazzani, Roberto Petri, Giusto Pignata, Michele Pisano, Stefano Rausei, Rossella Reddavid, Giuseppe Rocco, Fausto Rosa, Riccardo Rosati, Luca Rossit, Matteo Rottoli, Franco Roviello, Stefano Santi, Stefano Scabini, Stefano Scaringi, Leonardo Solaini, Fabio Staderini, Lucio Taglietti, Beatrice Torre, Paolo Ubiali, Matteo Uccelli, Fabio Uggeri, Sara Vertaldi, Jacopo Viganò, Giovanni Domenico De Palma, Simone Giacopuzzi, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, Giacopuzzi, Simone, Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, and Giacopuzzi, S

Subjects
GIRCG, Gastric cancer, Minimally invasive surgery, Upper GI surgery, Settore MED/18 - CHIRURGIA GENERALE, Surgery
Abstract

Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.

Published
2022

12. Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy ({ADiGe}) survey

Author

Mengardo, Valentina, Weindelmayer, Jacopo, Veltri, Alessandro, Giacopuzzi, Simone, Torroni, Lorena, DE MANZONI, Giovanni, Ferdinando, Agresta, Rita, Alfieri, Sergio, Alfieri, Nicola, Antonacci, Gian Luca Baiocchi, Lapo, Bencini, Bencivenga, Maria, Benedetti, Michele, Mattia, Berselli, Alberto, Biondi, Gabriella Teresa Capolupo, Fabio, Carboni, Riccardo, Casadei, Casella, Francesco, Catarci, Marco, Paolo, Cerri, Damiano, Chiari, Eugenio, Cocozza, Giovanni, Colombo, Luca, Cozzaglio, Giorgio, Dalmonte, Maurizio, Degiuli, Maurizio De Luca, Raffaele De Luca, Nicol(`(o)) De Manzini, DE PASQUAL, CARLO ALBERTO, Stefano De Pascale, Nicola De Ruvo, DI COSMO, Mariantonietta, DI LEO, Alberto, Massimiliano Di Paola, Amedeo, Elio, Francesco, Ferrara, Giovanni, Ferrari, Valentino, Fiscon, Uberto, Fumagalli, Gianluca, Garulli, Andrea, Gennai, Irene, Gentile, Paola, Germani, Monica, Gualtierotti, Guerini, Francesca, Angela, Gurrado, Inama, Marco, Filippo La Torre, Ernesto, Laterza, Pasquale, Losurdo, Antonio, Macr(`(i)), Alessandra, Marano, Luigi, Marano, Federico, Marchesi, Fabio, Marino, Marco, Massani, Roberta, Menghi, Marco, Milone, Sarah, Molfino, Mauro, Montuori, Moretto, Gianluigi, Paolo, Morgagni, Emilio, Morpurgo, Moukchar, Abdallah, Luca, Nespoli, Stefano, Olmi, Raffaele, Palaia, Giovanni, Pallabazer, Parise, Paolo, Alessandro, Pasculli, Marco Pericoli Ridolfini, Antonio, Pesce, Enrico, Pinotti, Michele, Pisano, Elia, Poiasina, Vittorio, Postiglione, Stefano, Rausei, Antonio, Rella, Fausto, Rosa, Riccardo, Rosati, Gianmaria, Rossi, Luca, Rossit, Massimo, Rovatti, Laura, Ruspi, DAL SACCO, Luca, Saladino, Edoardo, Andrea, Sansonetti, Sartori, Alberto, Donatella, Scaglione, Stefano, Scaringi, Christian, Schoenthaler, Giuseppe, Sena, Michele, Simone, Leonardo, Solaini, Paolo, Strignano, Nicola, Tartaglia, Silvio, Testa, Mario, Testini, Guido Alberto Massimo Tiberio, Treppiedi, Elio, Alessio, Vagliasindi, Michele, Valmasoni, Jacopo, Vigan(`(o)), Gianpietro, Zanchettin, Andrea, Zanoni, Zardini, Claudio, Antonio Zerbinati and, Mengardo, V, Weindelmayer, J, Veltri, A, Giacopuzzi, S, Torroni, L, de Manzoni, G, Agresta, F, Alfieri, R, Alfieri, S, Antonacci, N, Baiocchi, G, Bencini, L, Bencivenga, M, Benedetti, M, Berselli, M, Biondi, A, Capolupo, G, Carboni, F, Casadei, R, Casella, F, Catarci, M, Cerri, P, Chiari, D, Cocozza, E, Colombo, G, Cozzaglio, L, Dalmonte, G, Degiuli, M, De Luca, M, De Luca, R, De Manzini, N, De Pasqual, C, De Pascale, S, De Ruvo, N, Di Cosmo, M, Di Leo, A, Di Paola, M, Elio, A, Ferrara, F, Ferrari, G, Fiscon, V, Fumagalli, U, Garulli, G, Gennai, A, Gentile, I, Germani, P, Gualtierotti, M, Guerini, F, Gurrado, A, Inama, M, La Torre, F, Laterza, E, Losurdo, P, Macri, A, Marano, A, Marano, L, Marchesi, F, Marino, F, Massani, M, Menghi, R, Milone, M, Molfino, S, Montuori, M, Moretto, G, Morgagni, P, Morpurgo, E, Abdallah, M, Nespoli, L, Olmi, S, Palaia, R, Pallabazer, G, Parise, P, Pasculli, A, Pericoli Ridolfini, M, Pesce, A, Pinotti, E, Pisano, M, Poiasina, E, Postiglione, V, Rausei, S, Rella, A, Rosa, F, Rosati, R, Rossi, G, Rossit, L, Rovatti, M, Ruspi, L, Sacco, L, Saladino, E, Sansonetti, A, Sartori, A, Scaglione, D, Scaringi, S, Schoenthaler, C, Sena, G, Simone, M, Solaini, L, Strignano, P, Tartaglia, N, Testa, S, Testini, M, Tiberio, G, Treppiedi, E, Vagliasindi, A, Valmasoni, M, Vigano, J, Zanchettin, G, Zanoni, A, Zardini, C, Zerbinati, A, Mengardo, Valentina, Weindelmayer, Jacopo, Veltri, Alessandro, Giacopuzzi, Simone, Torroni, Lorena, de Manzoni, Giovanni, and de Manzini, Nicolo

Subjects
Surgeons, Postoperative Complications, Gastrectomy, Stomach Neoplasms, Surveys and Questionnaires, Drain, Drainage, Gastric cancer, Survey, Humans, Surgery
Abstract

Evidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.

Published
2022

13. Anti-tumor activity of all-trans retinoic acid in gastric-cancer: gene-networks and molecular mechanisms.

Author

Guarrera L, Kurosaki M, Garattini SK, Gianni' M, Fasola G, Rossit L, Prisciandaro M, Di Bartolomeo M, Bolis M, Rizzo P, Nastasi C, Foglia M, Zanetti A, Paroni G, Terao M, and Garattini E

Subjects
Humans, Tretinoin pharmacology, Tretinoin therapeutic use, Retinoids, Transcriptome, RNA, Stomach Neoplasms drug therapy, Stomach Neoplasms genetics, Antineoplastic Agents pharmacology
Abstract

Background: Gastric-cancer is a heterogeneous type of neoplastic disease and it lacks appropriate therapeutic options. There is an urgent need for the development of innovative pharmacological strategies, particularly in consideration of the potential stratified/personalized treatment of this tumor. All-Trans Retinoic-acid (ATRA) is one of the active metabolites of vitamin-A. This natural compound is the first example of clinically approved cyto-differentiating agent, being used in the treatment of acute promyelocytic leukemia. ATRA may have significant therapeutic potential also in the context of solid tumors, including gastric-cancer. The present study provides pre-clinical evidence supporting the use of ATRA in the treatment of gastric-cancer using high-throughput approaches., Methods: We evaluated the anti-proliferative action of ATRA in 27 gastric-cancer cell-lines and tissue-slice cultures from 13 gastric-cancer patients. We performed RNA-sequencing studies in 13 cell-lines exposed to ATRA. We used these and the gastric-cancer RNA-sequencing data of the TCGA/CCLE datasets to conduct multiple computational analyses., Results: Profiling of our large panel of gastric-cancer cell-lines for their quantitative response to the anti-proliferative effects of ATRA indicate that approximately half of the cell-lines are characterized by sensitivity to the retinoid. The constitutive transcriptomic profiles of these cell-lines permitted the construction of a model consisting of 42 genes, whose expression correlates with ATRA-sensitivity.  The model predicts that 45% of the TCGA gastric-cancers are sensitive to ATRA. RNA-sequencing studies performed in retinoid-treated gastric-cancer cell-lines provide insights into the gene-networks underlying ATRA anti-tumor activity. In addition, our data demonstrate that ATRA exerts significant immune-modulatory effects, which seem to be largely controlled by IRF1 up-regulation. Finally, we provide evidence of a feed-back loop between IRF1 and DHRS3, another gene which is up-regulated by ATRA., Conclusions: ATRA is endowed with significant therapeutic potential in the stratified/personalized treatment gastric-cancer. Our data represent the fundaments for the design of clinical trials focusing on the use of ATRA in the personalized treatment of this heterogeneous tumor. Our gene-expression model will permit the development of a predictive tool for the selection of ATRA-sensitive gastric-cancer patients. The immune-regulatory responses activated by ATRA suggest that the retinoid and immune-checkpoint inhibitors constitute rational combinations for the management of gastric-cancer., (© 2023. The Author(s).)

Published
2023
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14. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG.

Author

Milone M, D'Amore A, Alfieri S, Ambrosio MR, Andreuccetti J, Ansaloni L, Antonucci A, Arganini M, Baiocchi G, Barone M, Bencini L, Bencivenga M, Boccia L, Boni L, Braga M, Cianchi F, Cipollari C, Contine A, Cotsoglou C, D'Imporzano S, De Manzoni G, De Pascale S, De Ruvo N, Degiuli M, Donini A, Elmore U, Ercolani G, Ferrari G, Fumagalli RU, Garulli G, Gelmini R, Graziosi L, Gualtierotti M, Guglielmi A, Inama M, Maffeis F, Maione F, Manigrasso M, Marchesi F, Marrelli D, Massobrio A, Moretto G, Moukachar A, Navarra G, Nigri G, Olmi S, Palaia R, Papis D, Parise P, Pedrazzani C, Petri R, Pignata G, Pisano M, Rausei S, Reddavid R, Rocco G, Rosa F, Rosati R, Rossit L, Rottoli M, Roviello F, Santi S, Scabini S, Scaringi S, Solaini L, Staderini F, Taglietti L, Torre B, Ubiali P, Uccelli M, Uggeri F, Vertaldi S, Viganò J, De Palma GD, and Giacopuzzi S

Subjects
Humans, Gastrectomy methods, Surveys and Questionnaires, Minimally Invasive Surgical Procedures methods, Stomach Neoplasms surgery, Robotic Surgical Procedures methods, Laparoscopy methods
Abstract

Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach., (© 2022. Italian Society of Surgery (SIC).)

Published
2023
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15. Minimally invasive esophagectomy: thoracoscopic esophageal mobilization for esophageal cancer with the patient in prone position.

Author

Petri R, Zuccolo M, Brizzolari M, Rossit L, Rosignoli A, Durastante V, Petrin G, De Cecchis L, and Sorrentino M

Subjects
Aged, Blood Loss, Surgical statistics & numerical data, Critical Care statistics & numerical data, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Neoadjuvant Therapy, Postoperative Complications etiology, Prone Position, Retrospective Studies, Adenocarcinoma surgery, Carcinoma, Squamous Cell surgery, Esophageal Neoplasms surgery, Esophagectomy methods, Thoracoscopy methods
Abstract

Background: Surgical resection is the mainstay treatment for resectable esophageal cancer. Minimally invasive esophagectomy is performed with increasing frequency and proves to be a safe and effective surgical alternative to the open technique. Minimally invasive esophagectomy using thoracoscopic esophageal mobilization with the patient in prone position seems to offer some advantages with regard to surgeon ergonomics and clinical outcome., Methods: Between July 2005 and September 2010, 46 patients (35 men and 11 women) underwent minimally invasive esophagectomy in the prone position at the authors' institution. Three patients had previously undergone a thoracic intervention (one patient had previously undergone left pneumonectomy because of lung cancer). The preoperative indication was squamous cell carcinoma for 35 patients and adenocarcinoma for 11 patients. In one case, the histology of the biopsy samples showed a squamous cell carcinoma with neuroendocrine differentiation. Neoadjuvant treatment was administered to 15 patients., Results: All 46 patients underwent esophagectomy using minimally invasive thoracic mobilization of the esophagus with the patient in prone position. The abdominal stage of intervention was performed by laparoscopy for 37 patients and by laparotomy for 9 patients. No thoracotomic conversion was performed. In all cases, a cervical end-to-side anastomosis was performed using a circular stapler. The mean operative time was 263 min. The median intensive care unit stay was 2 days, and the median postoperative hospital stay was 15 days. The mean number of procured lymph nodes was 13. The perioperative morbidity rate was 37%, and the perioperative mortality rate was 4.4%., Conclusions: Minimally invasive esophagectomy is safe and technically feasible. It entails a lower mortality rate and a shorter hospital stay than those reported in most open series. Thoracoscopy with the patient in prone position offers results comparable with those obtained using other minimally invasive techniques regarding the number of procured lymph nodes. This technique shows considerable advantages such as improved surgeon ergonomics, increased operative field exposure, and satisfactory respiratory results.

Published
2012
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16. Surgery in hepatic and extrahepatic colorectal metastases.

Author

Favero A, Benzoni E, Zompicchiatti A, Rossit L, Bresadola F, De Anna D, and Uzzau A

Subjects
Aged, Female, Humans, Male, Middle Aged, Colorectal Neoplasms pathology, Liver Neoplasms secondary, Liver Neoplasms surgery
Abstract

Extrahepatic disease (EHD) has been considered a contraindication to hepatectomy. Over the last few years, some series reported interesting 5-year survival rates after resection with hepatic colorectal metastases and EHD free margins. Between August 1989 and October 2005, 116 patients underwent liver resection for colorectal metastases at Surgical Department of the University of Udine, Italy. Among these, we reviewed the data of 5 patients affected by EHD. In 3 patients there were also an anastomotic recurrence of the primary tumor, in 3 patients diaphragm was infiltrated by contiguous liver metastases. We performed in all the patients minor liver resections. We have associated the radiofrequence ablation of a lesion not surgically resectable with liver resection in one case. The surgical procedure was always considered as curative. We observed no case of operative mortality. The mean survival of the entire cohort is 23.2 months (range 4-42 months). Our study, even if based upon a limited number of patients, supports the thesis that extrahepatic disease in patients affected by colorectal cancer with hepatic metastases should not be considered as an absolute contraindication to liver resection especially for the cases in with local radical cure exeresis is achievable.

Published
2007

17. Analysis of survival after pancreatic resection for oncological pathologies.

Author

Benzoni E, Rossit L, Cojutti A, Favero A, Saccomano E, Zompicchiatti A, Noce L, Bresadola F, and Intini S

Subjects
Aged, Humans, Italy epidemiology, Kaplan-Meier Estimate, Middle Aged, Multivariate Analysis, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms mortality, Retrospective Studies, Pancreatectomy methods, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods
Abstract

Surgical treatment of pancreatic cancer is to date the only modality that offers a chance of long-term survival. Potentially curative surgery is an option for only about 15% of patients with pancreatic adenocarcinoma. The aim of this study was to determine the survival and to assess the association of clinical, pathological, and treatment features with survival of patients who underwent resection of pancreatic cancer at the Department of Surgery of Udine University Hospital. From November 1989 to December 2005, 137 consecutive patients, who underwent surgical procedures for pancreatic cancer, were followed in our department. We performed 76 pancreatico-duodenectomy, 26 distal pancreatectomies and 35 total pancreatectomies. The surgical reconstruction after pancreatico-duodenectomy was as follows: 11 closures of the main duct with manual nonabsorbable stitches, 24 closures of the main duct with a linear stapler, 17 occlusions of the main duct with neoprene glue and 24 duct-to-mucosa anastomoses. Mean survival time was 27.7 +/- 26.93 months (mean +/- SD) and mean disease-free survival time was 25.4 +/- 23.06 months (mean +/- SD). 1, 3, 5, 7 and 9-year survival rates were 63.9, 33.7, 21.17, 12.7 and 10.2%, respectively. Significant differences in survival were recorded by the Log-rank test for age > 70 (p = 0.001), surgical procedures (p = 0.00046) and presence of metastases (p = 0.0055) The treatment of pancreatic cancer is undertaken with two different aims. The first is radical surgery for patients with early-stage disease, mainly stage I and partly stage II. In all other cases, the aim of treatment is the palliation of the several distressing symptoms related to this cancer. The standard treatment option for resectable tumours is radical pancreatic resection according to the Whipple procedure or total pancreatectomy.

Published
2007

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