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1. Optimized Treatment of Nosocomial Peritonitis

Author

Jan J. De Waele, Federico Coccolini, Leonel Lagunes, Emilio Maseda, Stefano Rausei, Ines Rubio-Perez, Maria Theodorakopoulou, and Kostoula Arvaniti

Subjects
antibiotics, antimicrobials, sepsis, peritonitis, nosocomial infection, abdominal sepsis, Therapeutics. Pharmacology, RM1-950
Abstract

This comprehensive review aims to provide a practical guide for intensivists, focusing on enhancing patient care associated with nosocomial peritonitis (NP). It explores the epidemiology, diagnosis, and management of NP, a significant contributor to the mortality of surgical patients worldwide. NP is, per definition, a hospital-acquired condition and a consequence of gastrointestinal surgery or a complication of other diseases. NP, one of the most prevalent causes of sepsis in surgical Intensive Care Units (ICUs), is often associated with multi-drug resistant (MDR) bacteria and high mortality rates. Early clinical suspicion and the utilization of various diagnostic tools like biomarkers and imaging are of great importance. Microbiology is often complex, with antimicrobial resistance escalating in many parts of the world. Fungal peritonitis and its risk factors, diagnostic hurdles, and effective management approaches are particularly relevant in patients with NP. Contemporary antimicrobial strategies for treating NP are discussed, including drug resistance challenges and empirical antibiotic regimens. The importance of source control in intra-abdominal infection management, including surgical and non-surgical interventions, is also emphasized. A deeper exploration into the role of open abdomen treatment as a potential option for selected patients is proposed, indicating an area for further investigation. This review underscores the need for more research to advance the best treatment strategies for NP.

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

Author

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

Subjects
Surgery, RD1-811
Abstract

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

Published
2023
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3. Esophageal Stent in Sleeve Gastrectomy Leak Treatment: Observations Based on a Challenging Surgical Case and Literature

Author

Francesco Frattini, Andrea Rizzi, Sergio Segato, Claudio Camillo Cortellezzi, Gian Luca Rota Bacchetta, Andrea Cassinotti, Simone Gianazza, Lorenzo Conti, Francesco Maria Carrano, and Stefano Rausei

Subjects
sleeve gastrectomy, gastric leak, esophageal stent, Surgery, RD1-811
Abstract

Gastric leak is a serious complication of sleeve gastrectomy with a well-documented morbidity and mortality. Depending on the series the leak rate ranges between 1 and 5%. The treatment of sleeve gastrectomy leak is still challenging. Different procedures have been described in management of gastric leak, both surgical and endoscopic. The treatment of gastric leaks depends on the extent of the staple-line leak, the site of the leak and its association with stenosis. As published data are limited, there are no still standardized guidelines on best treatment. One of the most commonly used option in the treatment of gastric leak is esophageal stent. Its success rate reaches 70–80% but it is burdened by some complications. Stent migration is the most common complication in the placement of esophageal stent.We present a challenging surgical in which case the use of an esophageal stent for the treatment of a sleeve gastrectomy leak gained the resolution of the leak but was complicated by bowel obstruction due to migration of the stent.

Published
2021
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5. Aggressive surgery for advanced ovarian cancer performed by a multidisciplinary team: A retrospective analysis on a large series of patients

Author

Stefano Rausei, Stefano Uccella, Valentina D'Alessandro, Baldo Gisone, Francesco Frattini, Georgios Lianos, Francesca Rovera, Luigi Boni, Gianlorenzo Dionigi, and Fabio Ghezzi

Subjects
Surgery, RD1-811
Abstract

Background: To evaluate the impact of extended surgical treatment performed by a team of gynecologists and general surgeons on postoperative morbidity and survival of patients with advanced ovarian cancer. Methods: We collected data of 156 patients with advanced ovarian cancer stage IIb-III-IV according to International Federation of Gynecology and Obstetrics classification and treated with primary cytoreduction. End points were perioperative and postoperative complications and cancer-related survival. Results: In 51 cases (51/156, 32.7%) a multivisceral resection was completed. Postoperative complications occurred in 52 cases (33.3%). The duration of the surgical procedure as well as the need for diaphragmatic peritonectomy were the factors independently associated with the development of postoperative complications. Five-year cancer-related survival rate was of 50.7%: only histotype and residual tumor resulted significantly associated. Conclusions: Our results highlight the importance of a team of gynecologists and general surgeons with specific interests and skills to achieve cytoreduction as rapidly as possible, even when it implies very complex maneuvers.

Published
2019
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6. Rituximab Treatment Prevents Lymphoma Onset in Gastric Cancer Patient-Derived Xenografts

Author

Simona Corso, Marilisa Cargnelutti, Stefania Durando, Silvia Menegon, Maria Apicella, Cristina Migliore, Tania Capeloa, Stefano Ughetto, Claudio Isella, Enzo Medico, Andrea Bertotti, Francesco Sassi, Ivana Sarotto, Laura Casorzo, Alberto Pisacane, Monica Mangioni, Antonino Sottile, Maurizio Degiuli, Uberto Fumagalli, Giovanni Sgroi, Sarah Molfino, Giovanni De Manzoni, Riccardo Rosati, Michele De Simone, Daniele Marrelli, Luca Saragoni, Stefano Rausei, Giovanni Pallabazzer, Franco Roviello, Paola Cassoni, Anna Sapino, Adam Bass, and Silvia Giordano

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

Patient-Derived Xenografts (PDXs), entailing implantation of cancer specimens in immunocompromised mice, are emerging as a valuable translational model that could help validate biologically relevant targets and assist the clinical development of novel therapeutic strategies for gastric cancer.More than 30% of PDXs generated from gastric carcinoma samples developed human B-cell lymphomas instead of gastric cancer. These lymphomas were monoclonal, Epstein Barr Virus (EBV) positive, originated tumorigenic cell cultures and displayed a mutational burden and an expression profile distinct from gastric adenocarcinomas. The ability of grafted samples to develop lymphomas did not correlate with patient outcome, nor with the histotype, the lymphocyte infiltration level, or the EBV status of the original gastric tumor, impeding from foreseeing lymphoma onset. Interestingly, lymphoma development was significantly more frequent when primary rather than metastatic samples were grafted.Notably, the development of such lympho-proliferative disease could be prevented by a short rituximab treatment upon mice implant, without negatively affecting gastric carcinoma engraftment.Due to the high frequency of human lymphoma onset, our data show that a careful histologic analysis is mandatory when generating gastric cancer PDXs. Such care would avoid misleading results that could occur if testing of putative gastric cancer therapies is performed in lymphoma PDXs. We propose rituximab treatment of mice to prevent lymphoma development in PDX models, averting the loss of human-derived samples.

Published
2018
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10. Supplementary Table S1 from A Comprehensive PDX Gastric Cancer Collection Captures Cancer Cell–Intrinsic Transcriptional MSI Traits

Author

Silvia Giordano, Adam J. Bass, Bruce M. Wollison, Samantha D. Drinan, Anwesha Nag, Aaron R. Thorner, Eirini Pectasides, Anna Sapino, Paola Cassoni, Enzo Medico, Antonino Sottile, Silvia Marsoni, Dario Ribero, Michele De Simone, Giovanni Pallabazzer, Stefano Rausei, Paolo Morgagni, Daniele Marrelli, Riccardo Rosati, Valentina Mengardo, Maria Bencivenga, Andrea Sartore-Bianchi, Salvatore Siena, Federica Morano, Filippo Pietrantonio, Sarah Molfino, Gian Luca Baiocchi, Emanuele Rausa, Giovanni Sgroi, Stefano De Pascale, Uberto Fumagalli, Rossella Reddavid, Maurizio Degiuli, Caterina Marchiò, Antonella Balsamo, Tiziana Venesio, Jessica Giordano, Daniela Conticelli, Tânia Capelôa, Marilisa Cargnelutti, Daniel Moya-Rull, Silvia Menegon, Laura D’Errico, Stefano Ughetto, Cristina Migliore, Stefania Durando, Maria Apicella, Sara E. Bellomo, Claudio Isella, and Simona Corso

Abstract

Baseline characteristics of the 349 enrolled patients.

Published
2023
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11. Supplementary Figure S3 from A Comprehensive PDX Gastric Cancer Collection Captures Cancer Cell–Intrinsic Transcriptional MSI Traits

Author

Silvia Giordano, Adam J. Bass, Bruce M. Wollison, Samantha D. Drinan, Anwesha Nag, Aaron R. Thorner, Eirini Pectasides, Anna Sapino, Paola Cassoni, Enzo Medico, Antonino Sottile, Silvia Marsoni, Dario Ribero, Michele De Simone, Giovanni Pallabazzer, Stefano Rausei, Paolo Morgagni, Daniele Marrelli, Riccardo Rosati, Valentina Mengardo, Maria Bencivenga, Andrea Sartore-Bianchi, Salvatore Siena, Federica Morano, Filippo Pietrantonio, Sarah Molfino, Gian Luca Baiocchi, Emanuele Rausa, Giovanni Sgroi, Stefano De Pascale, Uberto Fumagalli, Rossella Reddavid, Maurizio Degiuli, Caterina Marchiò, Antonella Balsamo, Tiziana Venesio, Jessica Giordano, Daniela Conticelli, Tânia Capelôa, Marilisa Cargnelutti, Daniel Moya-Rull, Silvia Menegon, Laura D’Errico, Stefano Ughetto, Cristina Migliore, Stefania Durando, Maria Apicella, Sara E. Bellomo, Claudio Isella, and Simona Corso

Abstract

ROC curves of Lee MSI signature predicting MSI genetic status in PDXs and TCGA samples cohorts.

Published
2023
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12. Supplementary Methods from A Comprehensive PDX Gastric Cancer Collection Captures Cancer Cell–Intrinsic Transcriptional MSI Traits

Author

Silvia Giordano, Adam J. Bass, Bruce M. Wollison, Samantha D. Drinan, Anwesha Nag, Aaron R. Thorner, Eirini Pectasides, Anna Sapino, Paola Cassoni, Enzo Medico, Antonino Sottile, Silvia Marsoni, Dario Ribero, Michele De Simone, Giovanni Pallabazzer, Stefano Rausei, Paolo Morgagni, Daniele Marrelli, Riccardo Rosati, Valentina Mengardo, Maria Bencivenga, Andrea Sartore-Bianchi, Salvatore Siena, Federica Morano, Filippo Pietrantonio, Sarah Molfino, Gian Luca Baiocchi, Emanuele Rausa, Giovanni Sgroi, Stefano De Pascale, Uberto Fumagalli, Rossella Reddavid, Maurizio Degiuli, Caterina Marchiò, Antonella Balsamo, Tiziana Venesio, Jessica Giordano, Daniela Conticelli, Tânia Capelôa, Marilisa Cargnelutti, Daniel Moya-Rull, Silvia Menegon, Laura D’Errico, Stefano Ughetto, Cristina Migliore, Stefania Durando, Maria Apicella, Sara E. Bellomo, Claudio Isella, and Simona Corso

Abstract

Supplementary Methods

Published
2023
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13. Data from A Comprehensive PDX Gastric Cancer Collection Captures Cancer Cell–Intrinsic Transcriptional MSI Traits

Author

Silvia Giordano, Adam J. Bass, Bruce M. Wollison, Samantha D. Drinan, Anwesha Nag, Aaron R. Thorner, Eirini Pectasides, Anna Sapino, Paola Cassoni, Enzo Medico, Antonino Sottile, Silvia Marsoni, Dario Ribero, Michele De Simone, Giovanni Pallabazzer, Stefano Rausei, Paolo Morgagni, Daniele Marrelli, Riccardo Rosati, Valentina Mengardo, Maria Bencivenga, Andrea Sartore-Bianchi, Salvatore Siena, Federica Morano, Filippo Pietrantonio, Sarah Molfino, Gian Luca Baiocchi, Emanuele Rausa, Giovanni Sgroi, Stefano De Pascale, Uberto Fumagalli, Rossella Reddavid, Maurizio Degiuli, Caterina Marchiò, Antonella Balsamo, Tiziana Venesio, Jessica Giordano, Daniela Conticelli, Tânia Capelôa, Marilisa Cargnelutti, Daniel Moya-Rull, Silvia Menegon, Laura D’Errico, Stefano Ughetto, Cristina Migliore, Stefania Durando, Maria Apicella, Sara E. Bellomo, Claudio Isella, and Simona Corso

Abstract

Gastric cancer is the world's third leading cause of cancer mortality. In spite of significant therapeutic improvements, the clinical outcome for patients with advanced gastric cancer is poor; thus, the identification and validation of novel targets is extremely important from a clinical point of view. We generated a wide, multilevel platform of gastric cancer models, comprising 100 patient-derived xenografts (PDX), primary cell lines, and organoids. Samples were classified according to their histology, microsatellite stability, Epstein–Barr virus status, and molecular profile. This PDX platform is the widest in an academic institution, and it includes all the gastric cancer histologic and molecular types identified by The Cancer Genome Atlas. PDX histopathologic features were consistent with those of patients' primary tumors and were maintained throughout passages in mice. Factors modulating grafting rate were histology, TNM stage, copy number gain of tyrosine kinases/KRAS genes, and microsatellite stability status. PDX and PDX-derived cells/organoids demonstrated potential usefulness to study targeted therapy response. Finally, PDX transcriptomic analysis identified a cancer cell–intrinsic microsatellite instability (MSI) signature, which was efficiently exported to gastric cancer, allowing the identification, among microsatellite stable (MSS) patients, of a subset of MSI-like tumors with common molecular aspects and significant better prognosis. In conclusion, we generated a wide gastric cancer PDX platform, whose exploitation will help identify and validate novel “druggable” targets and optimize therapeutic strategies. Moreover, transcriptomic analysis of gastric cancer PDXs allowed the identification of a cancer cell–intrinsic MSI signature, recognizing a subset of MSS patients with MSI transcriptional traits, endowed with better prognosis.Significance:This study reports a multilevel platform of gastric cancer PDXs and identifies a MSI gastric signature that could contribute to the advancement of precision medicine in gastric cancer.

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

Author

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

Subjects
Gastroenterology, Surgery
Abstract

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

Published
2022
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15. Laparoscopic distal gastrectomy in old-old patients: the first Western experience

Author

Luigi Boni, Angelo Benevento, Elisa Cassinotti, Gianlorenzo Dionigi, Giovanni Domenico De Palma, Georgios D Lianos, Federica Galli, Stefano Rausei, and Marco Milone

Subjects
medicine.medical_specialty, Distal gastrectomy, medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, Gastrectomy, Stomach Neoplasms, Humans, Medicine, Retrospective Studies, Aged, 80 and over, Old patients, Univariate analysis, Surgical approach, business.industry, Significant difference, Cancer, medicine.disease, Surgery, Treatment Outcome, 030220 oncology & carcinogenesis, Lymph Node Excision, Laparoscopy, 030211 gastroenterology & hepatology, Lymphadenectomy, business, Laparoscopic distal gastrectomy
Abstract

This is the first Western study presenting short-term results on patients older than 80 years affected by gastric cancer and treated with laparoscopic distal gastrectomy. A multicentre prospective database on patients suffering from distal gastric cancer with age of ≥ 80 undergone to distal gastrectomy was analysed retrospectively. End points were length of hospital stay (LoS) after surgery, and times to stool passage and solid diet initiation, as well as postoperative complications. Univariate analysis of the differences between “laparoscopic” and “open” groups was performed with non-parametric tests. Forty-six patients (median age: 83 years, median CCI: 5) undergone to distal gastrectomy were analysed. Seventeen out 46 patients (36.9%) underwent laparoscopic distal gastrectomy and extended lymphadenectomy was achieved in 25 cases (25/46, 54.3%). Median number of removed and examined nodes was higher in laparoscopic than in open group. Median LoS was significantly lower in the laparoscopic group (8 vs. 11 days). Complications occurred in 12 patients (26.1%): no significant differences between the two groups. There was a significant difference between the two surgical approaches in term of times for stool passage. Laparoscopic approach seems to reduce the effect of the surgical trauma without compromising lymphadenectomy also in octogenarian patients with distal gastric cancer.

Published
2021
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16. 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

17. Neoadjuvant chemotherapy for gastric cancer. Has the time to decelerate the enthusiasm passed us by?

Author

Christina Bali, Georgios D Lianos, and Stefano Rausei

Subjects
0301 basic medicine, medicine.medical_specialty, media_common.quotation_subject, medicine.medical_treatment, Locally advanced, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Stomach Neoplasms, law, medicine, Humans, Neoadjuvant therapy, media_common, Enthusiasm, Chemotherapy, business.industry, General surgery, Treatment options, Cancer, Hematology, medicine.disease, Neoadjuvant Therapy, Regimen, 030104 developmental biology, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, business
Abstract

Neoadjuvant therapy for locally advanced gastric cancer is a treatment option well recognized in international guidelines. However, neither completed randomized trials nor ongoing studies (will) offer definitive answers about the efficacy of neoadjuvant therapy. With extensive experience confirming the safety and some efficacy for this approach most current studies are focused on identifying the best preoperative treatment regimen. We try to clarify if is really the time to slow down the enthusiasm about neoadjuvant approach.

Published
2020
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18. Dramatic decrease of surgical emergencies during COVID-19 outbreak

Author

Giuliano Sarro, Francesco Ferrara, Tommaso Zurleni, Stefano Rausei, Collected Data Contributors, Andrea Pietrabissa, Francesco Frattini, and Osvaldo Chiara

Subjects
Adult, medicine.medical_specialty, Gastrointestinal bleeding, COVID-19 outbreak, emergency department, Gastrointestinal Diseases, Pneumonia, Viral, Disease, Critical Care and Intensive Care Medicine, Betacoronavirus, Gastrointestinal perforation, Epidemiology, medicine, Humans, surgical emergencies, Surgical emergency, Letters to the Editor, Pandemics, Aged, Aged, 80 and over, SARS-CoV-2, business.industry, COVID-19, Emergency department, Original Articles, Middle Aged, medicine.disease, Hospitals, Hospitalization, Bowel obstruction, Italy, Abdominal trauma, General Surgery, Emergency medicine, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Surgery, Coronavirus Infections, Emergency Service, Hospital, business
Abstract

Supplemental digital content is available in the text., BACKGROUND During the coronavirus disease 2019 (COVID-19) outbreak, a general decrease in surgical activity was observed. There is perception that this phenomenon has involved also surgical emergency, but no extensive data have been presented to date. The aim of this study was to analyze the real number of admissions and procedures for emergency surgical disease during COVID-19 pandemic. METHODS This is a multicenter study including 18 general surgery units performing emergency surgery in hospitals of the “Red Zone” in Lombardy. Data about admissions from emergency department and surgical emergency procedures performed during March 2019 and March 2020 were collected in an online database. Additional data were collected according to the different indications for surgical treatment. The primary outcomes were the overall rate of admissions for emergent surgical disease and the overall rate of emergency surgical procedures in the study periods. The secondary outcome was the overall surgical rates (among all the diagnosed surgical diseases). RESULTS Emergency surgical admissions and surgical operations significantly decreased with a fall in value of 45% (p < 0.001) and 41% (p = 0.001), respectively. This reduction was confirmed by the analysis according to different surgical indications, with the exceptions of admissions and operations for gastrointestinal bleeding and operations for abdominal trauma. The overall ratio between surgical procedures and diseases was not significantly different (54% vs. 63%; p = 0.619). This ratio was significantly different only for bowel obstruction and for gastrointestinal perforation. CONCLUSIONS It seems correct to consider “true” the dramatic decrease of surgical problems during COVID-19 outbreak, despite any therapeutic strategies and logistic difficulties. LEVEL OF EVIDENCE Epidemiological, level III.

Published
2020

19. Prognostic significance of neutrophil-to-lymphocyte ratio in several malignancies: where do we stand?

Author

Spyridon Voulgaris, Christos Exarchos, Georgios D Lianos, George A. Alexiou, Stefano Rausei, and Michail Mitsis

Subjects
Oncology, medicine.medical_specialty, Hepatocellular cancer, Neutrophils, business.industry, Colorectal cancer, Biochemistry (medical), Clinical Biochemistry, Prognosis, medicine.disease, Surgical oncology, Neoplasms, Internal medicine, Drug Discovery, Humans, Medicine, Lymphocyte Count, Lymphocytes, Neutrophil to lymphocyte ratio, business
Published
2020
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20. 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

21. Development of the PERI-Gastric (PEritoneal Recurrence Index) and PERI-Gram (Peritoneal Recurrence Index NomoGRAM) for predicting the risk of metachronous peritoneal carcinomatosis after gastrectomy with curative intent for gastric cancer

Author

Alberto Biondi, Stefano De Pascale, Uberto Fumagalli, Maurizio De Giuli, Federica Galli, Federico Sicoli, Roberto Persiani, Stefano Rausei, Annamaria Agnes, Rossella Reddavid, Antonio Laurino, Domenico D'Ugo, Laura Lorenzon, and Ferdinando Carlo Maria Cananzi

Subjects
Cancer Research, medicine.medical_specialty, Linitis plastica, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Population, Logistic regression, Gastroenterology, Gastric cancer, HIPEC, Nomogram, Peritoneal carcinomatosis, Linitis Plastica, Gastrectomy, Risk Factors, Stomach Neoplasms, Internal medicine, medicine, Humans, education, Peritoneal Neoplasms, Retrospective Studies, education.field_of_study, business.industry, Area under the curve, Cancer, General Medicine, medicine.disease, Prognosis, Nomograms, Oncology, business, Abdominal surgery
Abstract

A model that quantifies the risk of peritoneal recurrence would be a useful tool for improving decision-making in patients undergoing curative-aim gastrectomy for gastric cancer (GC). Five Italian centers participated in this study. Two risk scores were created according to the two most widely used pathologic classifications of GC (the Lauren classification and the presence of signet-ring-cell features). The risk scores (the PERI-Gastric 1 and 2) were based on the results of multivariable logistic regressions and presented as nomograms (the PERI-Gram 1 and 2). Discrimination was assessed with the area under the curve (AUC) of receiver operating curves. Calibration graphs were constructed by plotting the actual versus the predicted rate of peritoneal recurrence. Internal validation was performed with a bootstrap resampling method (1000 iterations). The models were developed based on a population of 645 patients (selected from 1580 patients treated from 1998 to 2018). In the PERI-Gastric 1, significant variables were linitis plastica, stump GC, pT3–4, pN2–3 and the Lauren diffuse histotype, while in the PERI-Gastric 2, significant variables were linitis plastica, stump GC, pT3–4, pN2–3 and the presence of signet-ring cells. The AUC was 0,828 (0.778–0.877) for the PERI-Gastric 1 and 0,805 (0.755–0.855) for the PERI-Gastric 2. After bootstrap resampling, the PERI-Gastric 1 had a mean AUC of 0.775 (0.721–0.830) and a 95%CI estimate for the calibration slope of 0.852–1.505 and the PERI-Gastric 2 a mean AUC of 0.749 (0.693–0.805) and a 95%CI estimate for the slope of 0.777–1.351. The models are available at www.perigastric.org . We developed the PERI-Gastric and the PERI-Gram as instruments to determine the risk of peritoneal recurrence after curative-aim gastrectomy. These models could direct the administration of prophylactic intraperitoneal treatments.

Published
2022

23. Surgical Treatment in Elderly Patients

Author

Federica Galli, Angelo Benevento, and Stefano Rausei

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Incidence (epidemiology), medicine.medical_treatment, Prehabilitation, Social change, Population, Cancer, Disease, medicine.disease, medicine, Lymphadenectomy, Intensive care medicine, education, Older people, business
Abstract

Gastric cancer (GC) mostly affects older people and the world’s population is aging. Therefore, although there is large evidence of a declining incidence of GC, management of the disease in older patients will remain a growing challenge for clinicians and surgeons. Since older persons are increasingly seen as effective resources for social development, the growing concerns about their well-being impose increasing pressure on public healthcare systems. A cancer diagnosis in an elderly subject can no longer imply a “simple” support therapy for symptom relief. It needs to be carefully assessed according to tumor- and patient-related therapeutic possibilities. In older people the onset of a cancer suddenly alters the multifaceted and continuous passage among physiological changes and chronic multimorbidities: an understanding of the basic state of equilibrium of each elderly woman/man allows these possibilities to be verified and “measured”, regardless of her/his year of birth. Hence, comorbidities and frailty are key to a truly patient-tailored (rather than stage-adapted) approach. In bearing with this view, this chapter will specifically analyze the surgical aspects of GC treatment (as extension of lymphadenectomy, minimally invasive surgery, and palliation) and provide some tools to be used in clinical practice.

Published
2021
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24. Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

Author

Vincenzo Pappalardo, Luigi Boni, Stefano Rausei, Gianlorenzo Dionigi, and Vincenzo Ardita

Subjects
medicine.medical_specialty, Abdominal compartment syndrome, business.industry, Peritoneal fluid, Mortality rate, Fistula, General Medicine, medicine.disease, Surgery, medicine, Closure (psychology), Secondary Peritonitis, business, Open abdomen
Abstract

AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

Published
2021
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25. Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy

Author

S. Kargar, J. Jafari, Hoon Yub Kim, N. Liang, Tie Wang, P. Del Rio, Hui Sun, Gianlorenzo Dionigi, Luigi Boni, Y. Fu, D. Park, L. Zhou, Maria Laura Tanda, Daqi Zhang, and Stefano Rausei

Subjects
Male, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Thyroid Gland, Iran, Surgical practice, Postoperative Complications, 0302 clinical medicine, Endocrinology, Pandemic, Recurrent laryngeal nerve palsy, Stage (cooking), Cancer, Thyroid, medicine.diagnostic_test, Covid19, Middle Aged, Surgery, SARS-CoV-2, Thyroidectomy, Morbidity, Surgical Practice, recurrent laryngeal nerve palsy, Italy, China, South Korea, medicine.anatomical_structure, Fine-needle aspiration, 030220 oncology & carcinogenesis, Female, Original Article, Vocal Cord Paralysis, Adult, medicine.medical_specialty, Biopsy, Fine-Needle, Operative Time, 030209 endocrinology & metabolism, 03 medical and health sciences, Republic of Korea, medicine, Humans, Thyroid Neoplasms, Vocal cord paralysis, Pandemics, Aged, Neoplasm Staging, business.industry, COVID-19, Perioperative, Length of Stay, medicine.disease, Thyroid Diseases, Recurrent Laryngeal Nerve Injuries, business
Abstract

Objective We compared demographic and clinic-pathological variables related to the number of surgeries for thyroid conditions or for cancer, morbidity, and fine needle aspiration (FNA) practices among Covid19 pandemic phases I, II, III and the same seasonal periods in 2019. Methods The prospective database of the Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China was used for this study. Covid19 emergency levels were stratified according to the World Health Organization: phase I (January 25–February 25, 2020), phase II (February 26–March 19), phase III (March 20–April 20). Results There were fewer outpatient FNAs and surgeries in 2020 than in 2019. There were no thyroid surgeries during phase I. There were also fewer surgeries for cancer with a significant reduction of advanced stage cancer treatments, mainly stage T1b N1a in phase II and T3bN1b in phase III. Operative times and postoperative stays were significantly shorter during the pandemic compared to our institutional baseline. In phase III, vocal cord paralysis (VCP) increased to 4.3% of our baseline numbers (P = 0.001). There were no cases of Covid19-related complications during the perioperative period. No patients required re-admission to the hospital. Conclusion The Covid19 outbreak reduced thyroid surgery patient volumes. The decrease of Covid19 emergency plans contributed to unexpected outcomes (reduction of early stage cancer treatment, decreased operative times and hospital stays, increased VCP rate). Electronic supplementary material The online version of this article (10.1007/s40618-020-01407-1) contains supplementary material, which is available to authorized users.

Published
2021

26. Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

Author

Vincenzo, Pappalardo, Stefano, Rausei, Vincenzo, Ardita, Luigi, Boni, and Gianlorenzo, Dionigi

Subjects
Abdomen, Humans, Surgical Wound Infection, Abdominal Wound Closure Techniques, Peritonitis, Negative-Pressure Wound Therapy
Abstract

To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis.We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition.The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days).NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer's instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

Published
2021

27. Structured and shared CT radiological report of gastric cancer: a consensus proposal by the Italian Research Group for Gastric Cancer (GIRCG) and the Italian Society of Medical and Interventional Radiology (SIRM)

Author

Uberto Fumagalli Romario, Giulio Bagnacci, Giovanni de Manzoni, Guido A. M. Tiberio, Roberto Petrioli, Salvatore Cappabianca, Iacopo Capitoni, Maria Antonietta Mazzei, Andrea Laghi, Marco De Prizio, Luigi Funicelli, Luca Brunese, Franco Roviello, Paolo Morgagni, Daniele Marrelli, Laura Romanini, Frida Pittiani, Maurizio Degiuli, Stefano Rausei, Roberto Grassi, Francesco Gentili, Giuseppe Minetti, Gianni Mura, Annibale Donini, Luca Volterrani, Riccardo Rosati, Marco Catarci, Enrico Petrella, Amato Antonio Stabile Ianora, Mazzei, Maria Antonietta, Bagnacci, Giulio, Gentili, Francesco, Capitoni, Iacopo, Mura, Gianni, Marrelli, Daniele, Petrioli, Roberto, Brunese, Luca, Cappabianca, Salvatore, Catarci, Marco, Degiuli, Maurizio, De Manzoni, Giovanni, De Prizio, Marco, Donini, Annibale, Romario, Uberto Fumagalli, Funicelli, Luigi, Laghi, Andrea, Minetti, Giuseppe, Morgagni, Paolo, Petrella, Enrico, Pittiani, Frida, Rausei, Stefano, Romanini, Laura, Rosati, Riccardo, Ianora, Amato Antonio Stabile, Tiberio, Guido A M, Volterrani, Luca, Roviello, Franco, Grassi, Roberto, Mazzei, M. A., Bagnacci, G., Gentili, F., Capitoni, I., Mura, G., Marrelli, D., Petrioli, R., Brunese, L., Cappabianca, S., Catarci, M., Degiuli, M., De Manzoni, G., De Prizio, M., Donini, A., Romario, U. F., Funicelli, L., Laghi, A., Minetti, G., Morgagni, P., Petrella, E., Pittiani, F., Rausei, S., Romanini, L., Rosati, R., Ianora, A. A. S., Tiberio, G. A. M., Volterrani, L., Roviello, F., and Grassi, R.

Subjects
CT scan, Gastrointestinal, medicine.medical_specialty, Consensus, Referral, Report, Stomach neoplasms, Delphi method, Consensu, Radiology, Interventional, medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, Tomography, Neuroradiology, Interventional, medicine.diagnostic_test, business.industry, Cancer, Interventional radiology, Stomach neoplasm, General Medicine, Tailored treatment, medicine.disease, X-Ray Computed, Radiology report, Italy, Radiological weapon, Radiology, Tomography, X-Ray Computed, business, Human
Abstract

Objectives: Written radiological report remains the most important means of communication between radiologist and referring medical/surgical doctor, even though CT reports are frequently just descriptive, unclear, and unstructured. The Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Research Group for Gastric Cancer (GIRCG) promoted a critical shared discussion between 10 skilled radiologists and 10 surgical oncologists, by means of multi-round consensus-building Delphi survey, to develop a structured reporting template for CT of GC patients. Methods: Twenty-four items were organized according to the broad categories of a structured report as suggested by the European Society of Radiology (clinical referral, technique, findings, conclusion, and advice) and grouped into three “CT report sections” depending on the diagnostic phase of the radiological assessment for the oncologic patient (staging, restaging, and follow-up). Results: In the final round, 23 out of 24 items obtained agreement (≥ 8) and consensus (≤ 2) and 19 out 24 items obtained a good stability (p > 0.05). Conclusions: The structured report obtained, shared by surgical and medical oncologists and radiologists, allows an appropriate, clearer, and focused CT report essential to high-quality patient care in GC, avoiding the exclusion of key radiological information useful for multidisciplinary decision-making. Key Points: • Imaging represents the cornerstone for tailored treatment in GC patients. • CT-structured radiology report in GC patients is useful for multidisciplinary decision making.

Published
2021

28. An Improved Recurrent Laryngeal Nerve-Monitoring Device: Technical Note for Nim Vital™

Author

Antonella, Pino, Francesco, Frattini, Hui, Sun, Daqi, Zhang, Ozer, Makay, Stefano, Rausei, Che Wei, Wu, Hoon Yub, Kim, Per Giorgio, Calò, Paolo, Del Rio, Gabriele, Materazzi, and Gianlorenzo, Dionigi

Subjects
Intraoperative, Monitoring, Electromyography, Recurrent Laryngeal Nerve, Monitoring, Intraoperative, Thyroidectomy, Humans
Abstract

A new device for monitoring the laryngeal nerves during thyroid surgery has been developed. NIM Vital™ (Medtronic Xomed, Inc., Jacksonville, FL, USA) incorporates (a) a new wireless design, (b) NIM NerveTrendTM (Medtronic Xomed) EMG reporting, (c) intelligent noise-reduction technology that suppresses artifacts, (d) smart troubleshooting pop-up alerts, and (e) NIM Nervassure ™ (Medtronic Xomed) for continuous monitoring. This device offers enhanced stability and flexibility for both intermittent and continuous laryngeal nerve monitoring. The new NIM NerveTrend ™ EMG reporting makes it possible to track the recurrent laryngeal nerve condition throughout a procedure, even when using intermittent nerve monitoring. During both continuous and intermittent monitoring, green, yellow and red status bars provide visual information and associated tones provide audible cues, making it easy to monitor nerve function and interpret EMG trends. This new tool for laryngeal nerve monitoring has the potential to augment nerve dissection during surgery. Measurements of long-term outcome are needed to establish their efficacy.

Published
2021

29. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Author

Benedetto, Ielpo, Mauro, Podda, Gianluca, Pellino, Pata, Francesco, Gianpiero, Gravante, Salomone Di Saverio, Gallo, Gaetano, Rashid, Lui, Adam, Orengia, Aditya, Chowdary, Aditya, Kulkarni, Adnan, Kuvvetli, Adolfo, Navarro, Adolfo, Pisanu, Adrian, Smith, Adriana Cavero Ibiricu, Aeris Jane, D Nacion, Ahmad, Alsaleh, Ahmad, Alhazmi, Ahmad, Elmabri, Ajaz, Wani, Ahmet, Rencuzogullari, Aingeru Sarriugarte Lasarte, Ainhoa Valle Rubio, Akshay, Bavikatte, Akshay, Kumar, Al-Radjid, Jamiri, Alain Michel Alvarado Padilla, Alban, Cacurri, Alberto de San Ildefonso, Alberto, Porcu, Alberto, Sartori, Aldo, Rocca, Alejandro Paz Yáñez, Alejandro, Becaria, Alejandro, Solís-Peña, Aleksandar, Sretenović, Alex, Urbistondo, Alfonso, Bandin, Alfonso, Najar, Alessandro De Luca, Alex, Boddy, Alexandros, Charalabopoulos, Alexios, Tzivanakis, Alfonso, Amendola, Alfredo Ramirez-Gutierrez de Velasco, Ali Cihat Yildirim, Alice, Frontali, Alpha Oumar Toure, Alvaro, García-Granero, Amaia Martínez Roldan, Amaia Sanz Larrainzar, Amila Sanjiva Ratnayake, Ana María Gonzalez-Ganso, Ana, M Minaya-Bravo, Andre, Das, Andrea, Bondurri, Andrea, Costanzi, Andrea, Lucchi, Andrea, Mazzari, Andrea, Musig, Andrea, Peloso, Andrea, Piano, Andrea, Police, Andrei, Mihailescu, Andrés, Pouy, Angela, Romano, Iossa, Angelo, Anna Carmen Leonetti, Anna, Guariniello, Anna, Isaac, Anna Pia Delli Bovi, Antonella, Chessa, Antonella, Tromba, Antonio Álvarez Martínez, Antonio, Brillantino, Antonio, Caira, Antonio, Castaldi, Antonio, Ferronetti, Antonio, Giuliani, Antonio, Prestera, Antonio Ramos-De la Medina, Antonio, Tarasconi, Antonino, Tornambè, Arcangelo, Picciariello, Argyrios, Ioannidis, Ari, Leppäniemi, Arshad, Khan, Arshad, Rashid, Arteaga Luis Eduardo Pérez-Sánchez, Ashok, Mittal, Ashrarur Rahman Mitul, Asif, Mehraj, Asim, Laharwal, Asnel, Dorismé, Athanasios, Marinis, Atif, Iqbal, Augusto, Moncada, Bartolomeo, Braccio, Basim, Alkhafaji, Beatriz de Andrés Asenjo, Beatriz, Martin-Perez, Belinda Sánchez Pérez, Ben, Creavin, Benedetto, Calì, Beniamino, Pascotto, Benjamin, Stubbs, Benjamin Zavala Retes, Branislav, Jovanovic, Brian Kp Goh, Bruno, Sensi, Carlo, Biddau, Carlo, Gazia, Carlo, Vallicelli, Carlos Alberto Fagundes, Carlos Cerdán Santacruz, Carlos, Chirico, Carlos Javier Gómez, Carlos, Petrola, Carlos Sánchez Rodriguez, Carlos Yánez Benítez, Carmelisa, Dammaro, Carmelo Lo Faro, Caroline, Reinke, Casandra Dominguez Paez, Catalina, Oliva, Charudutt, Paranjape, Charlotte, Thomas, Chi Fung Chia, Chi Kwan Kong, Chiara De Lucia, Christian Ovalle Chao, Claudio, Arcudi, Claudio, Guerci, Clement, Chia, Cristiano, Parise, Cristina, Folliero, Cristopher, Varela, Dalya, M Ferguson, Daniel, Camacho, Daniel, Popowich, Daniel Souza Lima, Daniela, Rega, Daniele, Delogu, Daniele, Zigiotto, Danilo, Vinci, Dario, D'Antonio, Dario, Parini, David Alessio Merlini, David DE Zimmerman, David, Moro-Valdezate, Davide, Pertile, Deborah Maria Giusti, Deborah, S Keller, Delko, Tarik, Denis, Kalivaçi, Dennis, Mazingi, Diana Gabriela Maldonado-Pintado, Diego, Sasia, Dimitrios, Linardoutsos, Dixon, Osilli, Domenico, Murrone, Domenico, Russello, Edgar, Rodas, Edisson Alberto Acuña Roa, Edoardo, Ricciardi, Edoardo, Rosso, Edoardo, Saladino, Eduardo, Flores-Villalba, Eduardo Ruiz Ajs, Eduardo, Smith-Singares, Efstratia, Baili, Efstratios, Kouroumpas, Eirini, Bourmpouteli, Eleftheria, Douka, Elena, Martin-Perez, Eleonora, Guaitoli, Elgun, Samadov, Elisa, Francone, Elisa, Vaterlini, Emilio, Morales, Emilio, Peña, Enhao, Zhao, Eneko Del Pozo Andres, Enrico, Benzoni, Enrico, Erdas, Enrico, Pinotti, Enrique, Colás-Ruiz, Erman, Aytac, Ernesto, Laterza, Ervis, Agastra, Esteban, Foianini, Esteban, Moscoso, Estefania, Laviano, Ester, Marra, Eugenia, Cardamone, Eugenio, Licardie, Eustratia, Mpaili, Eva, Pinna, Evaristo, Varo, Fabian Martín Navarro, Fabio, Marino, Fabio, Medas, Fabio, Romano, Fatlum, Maraska, Fatmir, Saliu, Fausto, Madrid, Fausto, Rosa, Federica, Mastella, Federico, Gheza, Federico, Luvisetto, Felipe, Alconchel, Felipe Monge Vieira, Felipe, Pareja, Ferdinando, Agresta, Fernanda, Luna, Fernando, Bonilla, Fernando, Cordera, Fernando, Burdió, Fernando, Mendoza-Moreno, Fernando Muñoz Flores, Fernando Pardo Aranda, Fiona, Taylor, Flavia, L Ramos, Flavio, Fernandes, Francesca Paola Tropeano, Francesco, Balestra, Francesco, Bianco, Francesco, Ceci, Francesco, Colombo, Francesco Di Marzo, Francesco, Ferrara, Francesco, Lancellotti, Francesco, Lazzarin, Francesco, Litta, Francesco, Martini, Francesco, Pizza, Francesco, Roscio, Francesco, Virdis, Francisco Blanco Antona, Francisco Cervantes Ramírez, Francisco Miguel Fernandez, Francisco Oliver Llinares, Francisco, Quezada, Francisco, Schlottmann, Gabriel, Herrera-Almario, Gabriel, Massaferro, Gabriele, Bislenghi, Gabrielle van Ramshorst, Gaetano, Gallo, Gaetano, Luglio, Georgios, Bointas, Georgios, Kampouroglou, Georgios, Papadopoulos, Gerardo Arredondo Manrique, Giacomo, Calini, Giacomo, Nastri, Giampaolo, Formisano, Giampaolo, Galiffa, Gian Marco Palini, Gianluca, Colucci, Gianluca, Pagano, Gianluca, Vanni, Gianmaria Casoni Pattacini, Gilda De Paola, Giorgio, Lisi, Giovanna, Partida, Giovanni, Bellanova, Giovanni De Nobili, Giovanni Sammy Necchi, Giovanni, Sinibaldi, Giovanni, Tebala, Giulia, Bagaglini, Giuliano, Izzo, Giulio, Argenio, Giuseppe, Brisinda, Giuseppe, Candilio, Giuseppe Di Grezia, Giuseppe, Esposito, Giuseppe, Faillace, Giuseppe, Frazzetta, Giuseppe La Gumina, Giuseppe, Nigri, Giuseppe, Romeo, Gloria Chocarro Amatriaín, Gloria, Ortega, Gonzalo, Martin-Martin, Gregor, A Stavrou, Gunadi, Gustavo Armand Ugon, Gustavo, Machain, Gustavo, Marcucci, Gustavo, Martínez-Mier, Gustavo Miguel Machain, Gustavo, Nari, Haydée, Calvo, Hamada, Fathy, Hamilto, Hazem, Ahmed, Hazem, Faraj, Hector, Nava, Hector Ordas Macias, Herald, Nikaj, Heriberto, Solano, Huma Ahmed Khan, Humberto Sánchez Alarcón, Husam, Ebied, Iacopo, Giani, Ibabe Villalabeitia Ateca, Ignacio, Neri, Igor Alberdi San Roman, Iliya, Fidoshev, Iñaki Martinez Rodriguez, Ionut, Negoi, Irene, Ortega, Irina, Bernescu, Iris Shari Russo, Irune Vincente Rodríguez, Irving, Palomares, Isaac, Baltazar, Isabel Jaén Torrejimeno, Isabel María Cornejo Jurado, Isabella, Reccia, Ishtiyaq, Hussain, Ismael Brito Toledo, Ismael, Mora-Guzmán, Iulia, Dogaru, Ivan, Romic, Izaskun, Balciscueta, J Cleo Kenington, Jackison, Sagolsem, Jae, Y Jang, James, Olivier, Jan, Lammel-Lindemann, Jana, Dziakova, Javier Ismael Roldán Villavicencio, Javier, Salinas, Jelena, Pejanovic, Jose Gustavo Parreira, Jovanovic, Jeny Rincón Pérez, Jeryl, Asreyes, Jesus Antonio Medina Luque, Joanna, Mak, Joanne Salas Rodriguez, Johnn Henry Herrera Kok, Jon, Krook, Jose Antonio Diaz-Elizondo, Jose, Castell, José Eduardo García-Flores, José María Jover Navalón, Jose Mauro Silva Rodrigues, José, Pereira, José Tomas Castell Gómez, Juan Bellido Luque, Juan Carlos Martín Del Olmo, Juan Carlos Salamea, Juan Francisco Coronel Olivier, Juan Luis Blas Laina, Juliana Maria Ordoñez, Julieta, Gutierrez, Julio, Abba, Junaid Ahmad Sofi, Kashaf, Sherafgan, Kapil, Sahnan, Katsuhiko, Yanaga, Kevin, Beatson, Laharwal, Asim, Laura, Alvarez, Leandro, Siragusa, Lee, Farber, Lester, Ong, Liarakos, Athanasios, Lorena, García-Bruña, Luca De Martino, Luca, Ferrario, Luca, Giordano, Luca, Gordini, Luca, Pio, Luca, Ponchietti, Lucia, Moletta, Luciano, Curella, Luciano, Poggi, Lucio, Taglietti, Luigi, Bonavina, Luigi, Conti, Luigi, Goffredi, Luis Angel Garcia Ruiz, Luis, Barrionuevo, Luis Enrique Fregoso, Luis, F Cabrera, Luis, G Rodriguez, Luis, Grande, Luis Gregorio Osoria, Luis Javier Kantun Gonzalez, Luis, Sánchez-Guillén, Luis, Tallon-Aguilar, Luis, Tresierra, Luisa, Giavarini, Mahmoud, Hasabelnabi, Maja, Odovic, Mamoru, Uemura, Mansoor, Khan, Manuel, Artiles-Armas, Mara, David, Marcello Di Martino, Marcello Giuseppe Spampinato, Marcelo A, F Ribeiro, Marcelo, Viola, Marco, Angrisani, Marco, Calussi, Marco, Cannistrà, Marco, Catarci, Marco, Cereda, Marco, Conte, Marco, Giordano, Marco, Pellicciaro, Marco Vito Marino, Maria, E Vaterlini, María, F Jiménez, María Giulia Lolli, Bellini, MARIA IRENE, Maria, Lemma, Maria Michela Chiarello, Maria, Nicola, Mario, Arrigo, Mario Caneda Mejia, Mario Montes Manrique, Mario, Rodriguez-Lopez, Mario, Serradilla-Martín, Mario Zambrano Lara, Marisa, Martínez, Mark, Bagnall, Mark, Peter, Marta Cañón Lara, Marta Jimenez Gomez, Marta, Paniagua-Garcia-Señorans, Marta Perez Gonzalez, Martin, Rutegård, Martin, Salö, Marzia, Franceschilli, Massimiliano, Silveri, Massimiliano, Veroux, Massimo, Pezzulo, Matteo, Nardi, Matteo, Rottoli, Matti, Tolonen, Mauricio Pedraza Ciro, Mauricio, Zuluagua, Maurizio, Cannavò, Maurizio, Cervellera, Maurizio, Iacobone, Mauro, Montuori, Melody García Domínguez, Meltem, Bingol-Kologlu, Mian, Tahir, Michael, Lim, Michael Sj Wilson, Michael, Wilson, Michela, Campanelli, Michele, Bisaccia, Michele De Rosa, Michele, Maruccia, Michele, Paterno, Michele, Pisano, Michele, Torre, Michele, Treviño, Michele, Zuolo, Miguel, A Hernandez Bartolome, Miguel, Farina, Miguel, Pera, Miguel Prieto Calvo, Milagros, Sotelo, Min Myat Thway, Mohamed, Hassan, Mohamed Salah Eldin Hassan, Mohammad, Azfar, Mohammad, Bouhuwaish, Mohammad, Taha, Mohammad, Zaieem, Mohammed, Korkoman, Montserrat, Guraieb, Mostafa, Shalaby, Muhammad Asif Raza, Muhammad Umar Younis, Muhammed, Elhadi, Mujahid Zulfiqar Ali, Nadeem, Quazi, Nagendra, N Dudi-Venkata, Nahar, Alselaim, Natasha, Loria, Nathalie Villan Ramírez, Nay Win Than, Neil, Smart, Nelson, Trelles, Nicanor, Pinto, Niccolò, Allievi, Niccolo, Petrucciani, Nicola, Antonacci, Nicola, Cillara, Nicolae, Gica, Nicolaescu Diana Cristiana, Nicolás, Nicolás, Nicolò, Falco, Nicolò, Pecorelli, Nicolò, Tamini, Nikolaos Andreas Dallas, Nikolaos, Machairas, Noelia, Brito, Nura Ahmed Fieturi, Nuria, Ortega, Octavio, Avilamercado, Oktay, Irkorucu, Omar, Alsherif, Orestes, Valles, Orestis, Ioannidis, Oscar Hernández Palmas, Oscar Isaac Hernandez Palmas, Oscar Sanz Guadarrama, Osman, Bozbiyik, Pablo, Omelanczuk, Pablo, Ottolino, Pablo, Rodrigues, Pablo, Ruiz, Paola, Campenni, Paola, Chiarade, Paola Prieto Olivares, Paolo, Baroffio, Pascal, Wintringer, Pasquale Di Fronzo, Pasquale, Talento, Pasqualino, Favoriti, Patricia, Sendino, Patrizia, Marsanic, Patricia, Mifsut, Paúl, Andrade, Pawel, Ajawin, Valentina, Ferri, Giuseppe Massimiliano de Luca, Sara, Ingallinella, Eva, Pueyo, Francesco, Palmieri, Jesus, Silva, Ken Min Chin, Nicholas, Syn, Brian K, P Goh, Ye Xin Koh, Valeria, Tonini, Ana, Gonzales-Ganso, Vicente, Simó, Maria Victoria Diago, Pedro, Abadía-Barnó, Pedro Alfonso Najar Castañeda, Pedro Omar Sillas Arevalos, Pedro Palazón Bellver, Peng Soon Koh, Petry, Souza, Piotr, Major, Rajandeep Singh Bali, Rakesh Mohan Khattar, Renato Bessa Melo, Reza, Ebrahiminia, Ricardo, Azar, Ricardo López Murga, Riccardo, Caruso, Riccardo, Pirolo, Richard, Brady, Richard Justin Davies, Rishi, Dholakia, Rishi, Rattan, Rishi, Singhal, Robert, Lim, Roberta, Angelico, Roberta Maria Isernia, Roberta, Tutino, Roberto, Faccincani, Roberto, Peltrini, Rocío, Carrera-Ceron, Rodrigo, Tejos, Rohit, Kashyap, Roosevelt, Fajardo, Rosa, Lozito, Royer Madariaga Pareja, Sabrina, Garbarino, Salvador, Morales-Conde, Sami, Benli, Sami, Mansour, Samir, Flores, Samuel Limon Suarez, Santiago Lopez Ben, Sara, Fuentes, Sara, Napetti, Sara Ortiz de Guzmán, Selmy, Awad, Sergio, A Weckmann Luján, Sergio, Gentilli, Sergio, Grimaldi, Sergio Olivares Pizarro, Serkan, Tayar, Shakeeb, Nabi, Shannon, M Chan, Sheikh, Junaid, Sidney, Rojas, Silvana, Monetti, Silvia, García, Silvia, Salvans, Silvia, Tenconi, Simon, Shaw, Simone, Santoni, Sofia Andrea Parra, Sofía, Cárdenas, Sonia, Pérez-Bertólez, Sonja, Chiappetta, Sophie, Dessureault, Spiros, Delis, Stefano Amore Bonapasta, Stefano, Rausei, Stefano, Scaringi, Sundeep, Keswani, Syed Muhammad Ali, Süleyman, Cetinkunar, Tak Lit Derek Fung, Tariq, Rawashdeh, Tatiana Nicolás López, Tercio De Campos, Teresa Calderon Duque, Teresa, Perra, Theodore, Liakakos, Theodoros, Daskalakis, Theodoros, Liakakos, Thomas, Barnes, Tijmen, Koëter, Tiku, Zalla, Tomás, E González, Tomás, Elosua, Tommaso, Campagnaro, Tommy, Brown, Topi, Luoto, Touré Alpha Oumar, Ugo, Giustizieri, Ugo, Grossi, Umberto, Bracale, Uriel, Rivas, Valentina, Sosa, Valentina, Testa, Valeria, Andriola, Valerio, Balassone, Valerio, Celentano, Valerio, Progno, Varun, Raju, Vanessa, Carroni, Venera, Cavallaro, Venkateswara Rao Katta, Veronica De Simone, Vicent Primo Romaguera, Victor Hugo García Orozco, Victor, Luraschi, Victor, Rachkov, Victor, Turrado-L, Victor, Visag-Castillo, Victoria, Dowling, Victoria, Graham, Vincenzo, Papagni, Vincenzo, Vigorita, Vinicius Cordeiro Fonseca, Virginia Jimenez Carneros, Vittoria, Bellato, Walyson, Gonçalves, William, F Powers, William, Grigg, Wolf, O Bechstein, Yu Bing Lim, Yuksel, Altinel, Zoran, Golubović, Zutoia, Balciscueta, Ielpo B., Podda M., Pellino G., Pata F., Caruso R., Gravante G., Di Saverio S., Gallo G., Lui R., Orengia A., Chowdary A., Kulkarni A., Kuvvetli A., Navarro A., Pisanu A., Smith A., Ibiricu A.C., Nacion A.J.D., Alsaleh A., Alhazmi A., Elmabri A., Wani A., Rencuzogullari A., Lasarte A.S., Rubio A.V., Bavikatte A., Kumar A., Jamiri A.-R., Padilla A.M.A., Cacurri A., de San Ildefonso A., Porcu A., Sartori A., Rocca A., Yanez A.P., Becaria A., Solis-Pena A., Sretenovic A., Urbistondo A., Bandin A., Najar A., De Luca A., Boddy A., Charalabopoulos A., Tzivanakis A., Amendola A., de Velasco A.R.-G., Yildirim A.C., Frontali A., Toure A.O., Garcia-Granero A., Roldan A.M., Larrainzar A.S., Ratnayake A.S., Gonzalez-Ganso A.M., Minaya-Bravo A.M., Das A., Bondurri A., Costanzi A., Lucchi A., Mazzari A., Musig A., Peloso A., Piano A., Police A., Mihailescu A., Pouy A., Romano A., Iossa A., Leonetti A.C., Guariniello A., Isaac A., Bovi A.P.D., Chessa A., Tromba A., Martinez A.A., Brillantino A., Caira A., Castaldi A., Ferronetti A., Giuliani A., Prestera A., la Medina A.R.-D., Tarasconi A., Tornambe A., Picciariello A., Ioannidis A., Leppaniemi A., Khan A., Rashid A., Perez-Sanchez A.L.E., Mittal A., Mitul A.R., Mehraj A., Laharwal A., Dorisme A., Marinis A., Iqbal A., Moncada A., Braccio B., Alkhafaji B., de Andres Asenjo B., Martin-Perez B., Perez B.S., Creavin B., Cali B., Pascotto B., Stubbs B., Retes B.Z., Jovanovic B., Goh B.K.P., Sensi B., Biddau C., Gazia C., Vallicelli C., Fagundes C.A., Santacruz C.C., Chirico C., Diaz C.J.G., Petrola C., Rodriguez C.S., Benitez C.Y., Dammaro C., Faro C.L., Reinke C., Paez C.D., Oliva C., Paranjape C., Thomas C., Chia C.F., Kong C.K., De Lucia C., Chao C.O., Arcudi C., Guerci C., Chia C., Parise C., Folliero C., Varela C., Ferguson D.M., Camacho D., Popowich D., Lima D.S., Rega D., Delogu D., Zigiotto D., Vinci D., D'Antonio D., Parini D., Merlini D.A., Zimmerman D.D.E., Moro-Valdezate D., Pertile D., Giusti D.M., Keller D.S., Tarik D., Kalivaci D., Mazingi D., Maldonado-Pintado D.G., Sasia D., Linardoutsos D., Osilli D., Murrone D., Russello D., Rodas E., Roa E.A.A., Ricciardi E., Rosso E., Saladino E., Flores-Villalba E., Ajs E.R., Smith-Singares E., Baili E., Kouroumpas E., Bourmpouteli E., Douka E., Martin-Perez E., Guaitoli E., Samadov E., Francone E., Vaterlini E., Morales E., Pena E., Zhao E., Andres E.D.P., Benzoni E., Erdas E., Pinotti E., Colas-Ruiz E., Aytac E., Laterza E., Agastra E., Foianini E., Moscoso E., Laviano E., Marra E., Cardamone E., Licardie E., Mpaili E., Pinna E., Varo E., Navarro F.M., Marino F., Medas F., Romano F., Maraska F., Saliu F., Madrid F., Rosa F., Mastella F., Gheza F., Luvisetto F., Alconchel F., Vieira F.M., Pareja F., Agresta F., Luna F., Bonilla F., Cordera F., Burdio F., Mendoza-Moreno F., Flores F.M., Aranda F.P., Taylor F., Ramos F.L., Fernandes F., Tropeano F.P., Balestra F., Bianco F., Ceci F., Colombo F., Di Marzo F., Ferrara F., Lancellotti F., Lazzarin F., Litta F., Martini F., Pizza F., Roscio F., Virdis F., Antona F.B., Ramirez F.C., Fernandez F.M., Llinares F.O., Quezada F., Schlottmann F., Herrera-Almario G., Massaferro G., Bislenghi G., van Ramshorst G., Luglio G., Bointas G., Kampouroglou G., Papadopoulos G., Manrique G.A., Calini G., Nastri G., Formisano G., Galiffa G., Palini G.M., Colucci G., Pagano G., Vanni G., Pattacini G.C., De Paola G., Lisi G., Partida G., Bellanova G., De Nobili G., Necchi G.S., Sinibaldi G., Tebala G., Bagaglini G., Izzo G., Argenio G., Brisinda G., Candilio G., Di Grezia G., Esposito G., Faillace G., Frazzetta G., La Gumina G., Nigri G., Romeo G., Amatriain G.C., Ortega G., Martin-Martin G., Stavrou G.A., Gunadi, Ugon G.A., Machain G., Marcucci G., Martinez-Mier G., Machain G.M., Nari G., Calvo H., Fathy H., Hamilto, Ahmed H., Faraj H., Nava H., Macias H.O., Nikaj H., Solano H., Khan H.A., Alarcon H.S., Ebied H., Giani I., Ateca I.V., Neri I., Roman I.A.S., Fidoshev I., Rodriguez I.M., Negoi I., Ortega I., Bernescu I., Russo I.S., Rodriguez I.V., Palomares I., Baltazar I., Torrejimeno I.J., Jurado I.M.C., Reccia I., Hussain I., Toledo I.B., Mora-Guzman I., Dogaru I., Romic I., Balciscueta I., Kenington J.C., Sagolsem J., Jang J.Y., Olivier J., Lammel-Lindemann J., Dziakova J., Villavicencio J.I.R., Salinas J., Parreira J.P.J.G., Jovanovic, Perez J.R., Reyes J.A.S., Luque J.A.M., Mak J., Rodriguez J.S., Kok J.H.H., Krook J., Diaz-Elizondo J.A., Castell J., Garcia-Flores J.E., Navalon J.M.J., Rodrigues J.M.S., Pereira J., Gomez J.T.C., Luque J.B., del Olmo J.C.M., Salamea J.C., Olivier J.F.C., Laina J.L.B., Ordonez J.M., Gutierrez J., Abba J., Sofi J.A., Sherafgan K., Sahnan K., Yanaga K., Beatson K., Asim L., Alvarez L., Siragusa L., Farber L., Ong L., Athanasios L., Garcia-Bruna L., De Martino L., Ferrario L., Giordano L., Gordini L., Pio L., Ponchietti L., Moletta L., Curella L., Poggi L., Taglietti L., Bonavina L., Conti L., Goffredi L., Ruiz L.A.G., Barrionuevo L., Fregoso L.E., Cabrera L.F., Rodriguez L.G., Grande L., Osoria L.G., Gonzalez L.J.K., Sanchez-Guillen L., Tallon-Aguilar L., Tresierra L., Giavarini L., Hasabelnabi M., Odovic M., Uemura M., Khan M., Artiles-Armas M., David M., Di Martino M., Spampinato M.G., Ribeiro M.A.F., Viola M., Angrisani M., Calussi M., Cannistra M., Catarci M., Cereda M., Conte M., Giordano M., Pellicciaro M., Marino M.V., Vaterlini M.E., Jimenez M.F., Lolli M.G., Bellini M.I., Lemma M., Chiarello M.M., Nicola M., Arrigo M., Mejia M.C., Manrique M.M., Rodriguez-Lopez M., Serradilla-Martin M., Lara M.Z., Martinez M., Bagnall M., Peter M., Lara M.C., Gomez M.J., Paniagua-Garcia-Senorans M., Gonzalez M.P., Rutegard M., Salo M., Franceschilli M., Silveri M., Veroux M., Pezzulo M., Nardi M., Rottoli M., Tolonen M., Ciro M.P., Zuluagua M., Cannavo M., Cervellera M., Iacobone M., Montuori M., Dominguez M.G., Bingol-Kologlu M., Tahir M., Lim M., Wilson M.S., Wilson M., Campanelli M., Bisaccia M., De Rosa M., Maruccia M., Paterno M., Pisano M., Torre M., Trevino M., Zuolo M., Hernandez Bartolome M.A., Farina M., Pera M., Calvo M.P., Sotelo M., Thway M.M., Hassan M., Hassan M.S.E., Azfar M., Bouhuwaish M., Taha M., Zaieem M., Korkoman M., Guraieb M., Shalaby M., Raza M.A., Younis M.U., Elhadi M., Ali M.Z., Quazi N., Dudi-Venkata N.N., Alselaim N., Loria N., Ramirez N.V., Than N.W., Smart N., Trelles N., Pinto N., Allievi N., Petrucciani N., Antonacci N., Cillara N., Gica N., Cristiana N.D., Krystek N., Falco N., Pecorelli N., Tamini N., Dallas N.A., Machairas N., Brito N., Fieturi N.A., Ortega N., Mercado O.A., Irkorucu O., Alsherif O., Valles O., Ioannidis O., Palmas O.H., Palmas O.I.H., Guadarrama O.S., Bozbiyik O., Omelanczuk P., Ottolino P., Rodrigues P., Ruiz P., Campenni P., Chiarade P., Olivares P.P., Baroffio P., Panaccio P., Wintringer P., Di Fronzo P., Talento P., Favoriti P., Sendino P., Marsanic P., Mifsut P., Andrade P., Ajawin P., Abadia-Barno P., Castaneda P.A.N., Arevalos P.O.S., Bellver P.P., Koh P.S., Souza P., Major P., Bali R.S., Khattar R.M., Melo R.B., 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M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Andres, E. D. P., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, F., Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, G., Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., Roman, I. A. S., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Parreira, J. P. J. G., Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pereira, J., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Hernandez Bartolome, M. A., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Ali, M. Z., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Than, N. W., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., Gica, N., Cristiana, N. D., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Ben, S. L., Fuentes, S., Napetti, S., de Guzman, S. O., Awad, S., Weckmann Lujan, S. A., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Katta, V. R., De Simone, V., Romaguera, V. P., Orozco, V. H. G., Luraschi, V., Rachkov, V., Turrado-L, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Ielpo, B, Podda, M, Pellino, G, Pata, F, Caruso, R, Gravante, G, Di Saverio, S, and Luglio, G

Subjects
medicine.medical_specialty, Anti-Bacterial Agents, Appendectomy, Appendicitis, COVID-19 Testing, Hospital Administration, Humans, Pandemics, Personal Protective Equipment, Practice Patterns, Physicians', Surveys and Questionnaires, Attitude of Health Personnel, COVID-19, Surgeons, Coronavirus disease 2019 (COVID-19), Settore MED/18 - CHIRURGIA GENERALE, COVID-19 pandemic. Acute appendicitis, MEDLINE, Practice Patterns, 030230 surgery, Health administration, 03 medical and health sciences, 0302 clinical medicine, Anti-Bacterial Agent, Pandemic, medicine, Surveys and Questionnaire, Appendiciti, General, Laparoscopy, Personal protective equipment, Physicians', medicine.diagnostic_test, business.industry, General surgery, Original Articles, medicine.disease, Anti-bacterial agents, appendectomy, appendicitis, COVID-19 testing, hospital administration, humans, pandemics, personal protective equipment, practice patterns physicians', surveys and questionnaires, attitude of health personnel, surgeons, appendicitis - COVI-19 - ACIE study - management, Acute appendicitis, Original Article, Surgery, Covid-19, business, Human
Abstract

Background Surgical strategies are being adapted to face the COVID‐19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X‐ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P, The COVID‐19 pandemic required reorganization of surgical services, affecting patients with common surgical diseases including acute appendicitis. No evidence is available on the topic. This study found global variation in screening policies, use of personal protective equipment and intraoperative directives. There has been increased adoption of non‐operative management and open appendicectomy. Hands off

Published
2021

30. Conversion surgery for gastric cancer patients: A review

Author

Stefano Rausei, Tommaso Zurleni, Michele Altomare, and Elson Gjoni

Subjects
medicine.medical_specialty, medicine.medical_treatment, law.invention, Conversion surgery, R0 resection, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Stage IV gastric cancer, Unresectable gastric cancer, law, medicine, Conversion therapy, Cause of death, Chemotherapy, business.industry, Gastroenterology, Induction chemotherapy, Cancer, Minireviews, Retrospective cohort study, Multimodal therapy, medicine.disease, Surgery, Palliative chemotherapy, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Gastric cancer, business, Metastatic gastric cancer
Abstract

Gastric cancer (GC) is the third most common cancer-related cause of death worldwide. In locally advanced tumors, neoadjuvant chemotherapy has recently been introduced in most international Western guidelines. For metastatic and unresectable disease, there is still debate regarding correct management and the role of surgery. The standard approach for stage IV GC is palliative chemotherapy. Over the last decade, an increasing number of M1 patients who responded to palliative regimens of induction chemotherapy have been subsequently undergone surgery with curative intent. The objective of the present review is to analyze the literature regarding this approach, known as "conversion surgery", which has become one of the most commonly adopted therapeutic options. It is defined as a treatment aiming at an R0 resection after chemotherapy in initially unresectable tumors. The 13 retrospective studies analyzed, with a total of 411 patients treated with conversion therapy, clearly show that even if standardization of unresectable and metastatic criteria, post-chemotherapy resectability evaluation and timing of surgery has not yet been established, an R0 surgery after induction chemotherapy with partial or complete response seems to offer superior survival results than chemotherapy alone. Additional larger sample-size randomized control trials are needed to identify subgroups of well-stratified patients who could benefit from this multimodal approach.

Published
2018
Full Text
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31. Prognostic Indicators in Stage IV Surgically Treated Gastric Cancer Patients: A Retrospective Multi-Institutional Study

Author

Francesco Belia, Laura Ruspi, Roberto Persiani, Stefano Rausei, Antonio Laurino, Vittorio Quagliuolo, Francesco Santullo, Federico Sicoli, Alberto Biondi, Ferdinando Carlo Maria Cananzi, and Domenico D'Ugo

Subjects
Male, medicine.medical_specialty, Neoplasm, Residual, Multivariate analysis, Settore MED/18 - CHIRURGIA GENERALE, Gastric carcinoma, Disease, Adenocarcinoma, Gastroenterology, Metastatic disease, 03 medical and health sciences, 0302 clinical medicine, Gastrectomy, Stomach Neoplasms, Internal medicine, medicine, Humans, Elective surgery, Lymph node, Aged, Neoplasm Staging, Retrospective Studies, Advanced stage, business.industry, Cancer, Non-curative gastrectomy, Middle Aged, Prognosis, medicine.disease, Survival Rate, Dissection, medicine.anatomical_structure, Chemotherapy, Adjuvant, Gastric cancer, Surgery, 030220 oncology & carcinogenesis, Lymph Node Excision, Female, 030211 gastroenterology & hepatology, Neoplasm Grading, Stage iv, business
Abstract

Introduction: The role of gastric resection in treating metastatic gastric adenocarcinoma is controversial. In the present study, we reviewed the short- and long-term outcomes of stage IV patients undergoing surgery. Methods: A retrospective review was conducted that assessed patients undergoing elective surgery for incurable gastric carcinoma. Short- and long-term results were evaluated. Results: A total of 122 stage IV gastric cancer patients were assessed. Postoperative mortality was 5.7%, and the overall rate of complications was 35.2%. The overall survival rate at 1 and 3 years was 58 and 19% respectively; the median survival was 14 months. Improved survival was observed for the factors age less than 60 years (p = 0.015), site of metastases (p = 0.022), extended lymph node dissection (p = 0.044), absence of residual disease after surgery (p = 0.001), and administration of adjuvant chemotherapy (p = 0.016). Multivariate analysis showed that residual disease and adjuvant chemotherapy were independent prognostic factors. Conclusions: The results of this study suggest that surgery combined with systemic chemotherapy in selected patients with stage IV gastric cancer can improve survival.

Published
2018
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32. Rituximab Treatment Prevents Lymphoma Onset in Gastric Cancer Patient-Derived Xenografts

Author

Ivana Sarotto, Andrea Bertotti, Francesco Sassi, Michele De Simone, Monica Mangioni, Stefano Rausei, Maurizio Degiuli, Alberto Pisacane, Sarah Molfino, Anna Sapino, Daniele Marrelli, Tania Capeloa, Uberto Fumagalli, Enzo Medico, Laura Casorzo, Franco Roviello, Luca Saragoni, Antonino Sottile, Marilisa Cargnelutti, Claudio Isella, Simona Corso, Stefania Durando, Cristina Migliore, Riccardo Rosati, Silvia Menegon, Silvia Giordano, Giovanni de Manzoni, Maria Apicella, Adam J. Bass, Paola Cassoni, Stefano Ughetto, Giovanni Sgroi, Giovanni Pallabazzer, Corso, Simona, Cargnelutti, Marilisa, Durando, Stefania, Menegon, Silvia, Apicella, Maria, Migliore, Cristina, Capeloa, Tania, Ughetto, Stefano, Isella, Claudio, Medico, Enzo, Bertotti, Andrea, Sassi, Francesco, Sarotto, Ivana, Casorzo, Laura, Pisacane, Alberto, Mangioni, Monica, Sottile, Antonino, Degiuli, Maurizio, Fumagalli, Uberto, Sgroi, Giovanni, Molfino, Sarah, De Manzoni, Giovanni, Rosati, Riccardo, De Simone, Michele, Marrelli, Daniele, Saragoni, Luca, Rausei, Stefano, Pallabazzer, Giovanni, Roviello, Franco, Cassoni, Paola, Sapino, Anna, Bass, Adam, and Giordano, Silvia

Subjects
0301 basic medicine, Cancer Research, Lymphoma, Carcinogenesis, Disease, SCID, medicine.disease_cause, lcsh:RC254-282, Mice, 03 medical and health sciences, 0302 clinical medicine, Stomach Neoplasms, hemic and lymphatic diseases, medicine, Animals, Humans, B-Lymphocytes, Transplantation, Heterologous, Animal, business.industry, B-Cell, Cancer, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Epstein–Barr virus, 030104 developmental biology, Disease Models, Animal, Female, Heterografts, Lymphoma, B-Cell, Mice, Inbred NOD, Mice, SCID, Neoplasm Transplantation, Rituximab, Transplantation, Heterologous, 030220 oncology & carcinogenesis, Disease Models, Monoclonal, Cancer research, Inbred NOD, business, medicine.drug
Abstract

Patient-Derived Xenografts (PDXs), entailing implantation of cancer specimens in immunocompromised mice, are emerging as a valuable translational model that could help validate biologically relevant targets and assist the clinical development of novel therapeutic strategies for gastric cancer. More than 30% of PDXs generated from gastric carcinoma samples developed human B-cell lymphomas instead of gastric cancer. These lymphomas were monoclonal, Epstein Barr Virus (EBV) positive, originated tumorigenic cell cultures and displayed a mutational burden and an expression profile distinct from gastric adenocarcinomas. The ability of grafted samples to develop lymphomas did not correlate with patient outcome, nor with the histotype, the lymphocyte infiltration level, or the EBV status of the original gastric tumor, impeding from foreseeing lymphoma onset. Interestingly, lymphoma development was significantly more frequent when primary rather than metastatic samples were grafted. Notably, the development of such lympho-proliferative disease could be prevented by a short rituximab treatment upon mice implant, without negatively affecting gastric carcinoma engraftment. Due to the high frequency of human lymphoma onset, our data show that a careful histologic analysis is mandatory when generating gastric cancer PDXs. Such care would avoid misleading results that could occur if testing of putative gastric cancer therapies is performed in lymphoma PDXs. We propose rituximab treatment of mice to prevent lymphoma development in PDX models, averting the loss of human-derived samples.

Published
2018

33. Assessing safety and feasibility of ‘pure’ laparoscopic total gastrectomy for advanced gastric cancer in the West. Review article

Author

Stefano Rausei, Georgios D Lianos, Natasha Hasemaki, Georgios K. Glantzounis, and Michail Mitsis

Subjects
medicine.medical_specialty, Population, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Gastrectomy, Stomach Neoplasms, Surgical oncology, medicine, Humans, Laparoscopic total gastrectomy, education, Laparoscopy, education.field_of_study, medicine.diagnostic_test, business.industry, General surgery, Cancer, Laparoscopic gastrectomy, General Medicine, Advanced gastric cancer, medicine.disease, Review article, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, Patient Safety, business
Abstract

Background Gastric cancer is reported to be the fourth most common cancer and the second leading cause of cancer-related death worldwide. Minimally invasive surgical treatment for gastric cancer is a very challenging approach which offers undoubtedly important advantages. Materials and methods There is intense debate concerning the minimally invasive surgical approach for advanced gastric cancer especially in the Western population. A careful literature search was conducted in order to clarify the feasibility and safety of pure laparoscopic total gastrectomy in the West. Results Herewith we aim to summarize the current scientific evidence assessing the feasibility and short-term outcomes of laparoscopic gastrectomy for advanced gastric cancer in the West. A lack of data from Western institutions regarding minimally invasive surgical approach for gastric cancer is yet a reality. Nevertheless, the laparoscopic procedure appears to provide satisfactory short-term oncologic outcomes and improved postoperative outcomes. Conclusion It is obvious that future well-conducted trials on long-term results are necessary for Western patients in order safe conclusions to be reached regarding a potential definitive ‘place' for laparoscopy in the curative gastric cancer treatment.

Published
2018
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34. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference

Author

Antonio Galfano, Giovanni Gordini, Desiree Pantalone, S Miniello, Sharon Henry, Francesca Bindi, Maurizio Castriconi, Walter L. Biffl, Luca Fattori, Ari Leppäniemi, Gregorio Tugnoli, Sergio Ribaldi, Antonio Rampoldi, Fausto Catena, Elvio De Blasio, Massimiliano Mutignani, Salomone Di Saverio, Marilena Celano, Arturo Chieregato, Luca Ansaloni, Federica Renzi, Thomas M. Scalea, Stefano Rausei, Fabrizio Sammartano, Massimo Massi, Kathirkamanathan Shanmuganathan, Sebastian Sgardello, Osvaldo Chiara, Stefania Cimbanassi, Federico Coccolini, and Festa P

Subjects
Adult, medicine.medical_specialty, Consensus Development Conferences as Topic, MEDLINE, NOM, injiuries, blunt trauma, solid organs, trauma, Abdominal Injuries, Wounds, Nonpenetrating, Conservative Treatment, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Nonpenetrating, Nonoperative management, business.industry, General surgery, Consensus conference, 030208 emergency & critical care medicine, Blunt trauma, 030220 oncology & carcinogenesis, Wounds, Surgery, Solid organ, business
Published
2018
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35. Reply to: 'A multifaceted virus. Nonreducible and strangulated effects of COVID-19'

Author

Francesco Ferrara and Stefano Rausei

Subjects
2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, Hernia, Inguinal, Critical Care and Intensive Care Medicine, Virology, Virus, Disease Outbreaks, Medicine, Humans, Surgery, Emergencies, business, Letters to the Editor
Published
2021

36. Risk factors for complications after robotic adrenalectomy: a review

Author

Livia Manfredini, Federica Galli, Stefano Rausei, Davide Inversini, Gianlorenzo Dionigi, and Dai Zhang

Subjects
Complications, Risk factors, Robotic adrenalectomy (RA), medicine.medical_specialty, Tumor size, complications, business.industry, Adrenalectomy, medicine.medical_treatment, Review Article on Robotic Adrenalectomy, Specific risk, Malignancy, medicine.disease, risk factors, Surgery, Blood loss, medicine, Robotic surgery, Complication, business, Body mass index
Abstract

The application of adrenal surgery has been spreading steadily in recent years. With the increased use of robotics in surgery, robotic adrenalectomy (RA), especially for the posterior retroperitoneoscopic approach, has been taken on by many high-volume institutions as a good option over the standard laparoscopic approach (LA). This paper reviews the recent literature from May 2010 up to November 2019 with the aim of analyzing RA complications in order to identify risk factors for complications after RA. We analyzed 7 principal risk factors for complication: body mass index (BMI), age, tumor size, tumor side, pathology, previous surgery, and surgeon experience. In the review, some studies identified tumor size, malignancy type, completion of learning curve and, and less clearly, previous ipsilateral upper mesocolic or retroperitoneal surgery, as risk factors for postoperative complications and failure of robotic surgery. Whether RA is meaningfully superior to the standard minimally invasive approach is still a subject of discussion. RA appears safer by virtue of its reduction in hospital stay, lower blood loss, and equivalent complication rates, and surgeons should prefer adrenalectomy over the LA. Despite these advantages, the operative time and the overall cost of the robotic procedure are higher than the LA. Further high-quality trials, especially those analyzing the specific risk factors for complications in robotic surgery, should be conducted in order to optimize the stratification of patients eligible for robotic surgery.

Published
2020

37. Open abdomen management for severe peritonitis in elderly. Results from the prospective International Register of Open Abdomen (IROA): Cohort study

Author

Stefano Rausei, Vincenzo Pappalardo, Marco Ceresoli, Fausto Catena, Massimo Sartelli, Massimo Chiarugi, Yoram Kluger, Andrew Kirkpatrick, Luca Ansaloni, Federico Coccolini, Giulia Montori, Fracensco Salvetti, Paola Fugazzola, Ionut Negoi, Monica Zese, Savino Occhionorelli, Sergei Shlyapnikov, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M. Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federico Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Rao Ivatury, Jimmy Xiao, Andrea Lippi, Mario Improta, Francesca Gubbiotti, Andrey Zharikov, Vincent Dubuisson, Michael Sugrue, Rausei, S, Pappalardo, V, Ceresoli, M, Catena, F, Sartelli, M, Chiarugi, M, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Coccolini, F, Montori, G, Salvetti, F, Fugazzola, P, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Lippi, A, Improta, M, Gubbiotti, F, Zharikov, A, Dubuisson, V, and Sugrue, M

Subjects
Male, medicine.medical_specialty, Sepsi, Peritonitis, NO, Sepsis, 03 medical and health sciences, Elderly, Intra-abdominal infection, Open abdomen management, Source control, 0302 clinical medicine, Postoperative Complications, Abdomen, Medicine, Humans, Prospective Studies, Registries, Open abdomen, Aged, Aged, 80 and over, Univariate analysis, business.industry, Potential risk, Age Factors, Mean age, General Medicine, medicine.disease, Surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Observational study, Female, business, Cohort study
Abstract

Background Analyzing the data of the International Register of Open Abdomen (IROA), the feasibility of open abdomen treatment has been demonstrated at every age. This new analysis on the IROA database investigates the risk factors for mortality in elderly patients treated with open abdomen for intra-abdominal infection. Methods Data were derived from the IROA, a prospective observational international cohort study that enrolled patients treated with open abdomen worldwide. A univariate analysis of potential risk factors was performed. Inclusion criteria were patients older than 65 years and treated with open abdomen for intra-abdominal infection. End point was overall mortality, calculated within 30 days after open abdomen management, after 1-month and 1-year follow-up. Results A total of 116 patients was analyzed with mean age of 76 ± 7 years. Definitive closure was achieved in 93 patients (93/116, 80.2%) for a mean open abdomen duration of 5.0 ± 5.0 days. Complicated patients were 101 (101/116, 87.1%) for a total of 201 complications. Overall, 62 out of 116 patients (53.4%) died: 23 patients (23/62, 37.1%) during open abdomen management, 29 patients (46.8%) within 30 days after abdominal closure, 9 patients (14.5%) after 1-month follow-up, and 1 patient (1.6%) after 1-year follow-up. Age did not affect mortality (75 ± 6 years in alive patients versus 77 ± 7 years in dead patients, p = 0.773). Definitive abdominal closure was the most important factor to prevent mortality. Conclusions This study confirmed that age alone cannot be considered a determinant for death, even in elderly patients managed with open abdomen for severe intra-abdominal infection.

Published
2020

38. Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Author

Marco Ceresoli, Francesco Salvetti, Yoram Kluger, Marco Braga, Jacopo Viganò, Paola Fugazzola, Massimo Sartelli, Luca Ansaloni, Fausto Catena, Federico Coccolini, Ionut Negoi, Monica Zese, Savino Occhionorelli, Francesca Gubbiotti, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federic Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Alice Nigro, Andrew Kirkpatrick, Anton Parfenov, Giulia Montori, Paolo Dionigi, Michael Sugrue, Vincent Dubuisson, Joel Noutakdie Tochie, Rao Ivatury, Ceresoli, M, Salvetti, F, Kluger, Y, Braga, M, Viganò, J, Fugazzola, P, Sartelli, M, Ansaloni, L, Catena, F, Coccolini, F, Negoi, I, Zese, M, Occhionorelli, S, Gubbiotti, F, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Che Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Cordeiro Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Pereira Fraga, G, M Pereira, B, Gachabayov, M, Perez Chagerben, G, Leon Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Nigro, A, Kirkpatrick, A, Parfenov, A, Montori, G, Dionigi, P, Sugrue, M, Dubuisson, V, Noutakdie Tochie, J, and Ivatury, R

Subjects
Adult, Male, medicine.medical_specialty, Abdominal compartment syndrome, Fistula, open abdomen, NO, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Acute care, Abdomen, Female, Humans, Intensive Care Units, Length of Stay, Middle Aged, Obesity, Registries, medicine, business.industry, Fascia, medicine.disease, Cardiac surgery, Surgery, medicine.anatomical_structure, Cardiothoracic surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Trauma surgery, Abdominal surgery
Abstract

Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p < 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770.

Published
2019

39. Negative Pressure Therapy (NPWT) for Management of Surgical Wounds: Effects on Wound Healing and Analysis of Devices Evolution

Author

Vincenzo, Pappalardo, Francesco, Frattini, Vincenzo, Ardita, and Stefano, Rausei

Subjects
Wound Healing, Surgical Wound, Surgical Wound Dehiscence, Humans, Surgical Wound Infection, Negative-Pressure Wound Therapy
Abstract

Infection and wound dehiscence are common complications after surgery and open surgical wounds are difficult to manage. Usually surgical incisions are closed by fixing the edges together. However, in case of significant tissue loss, infected surgical field, or particular cases, wounds may be left open. In recent years, negative pressure wound therapy (NPWT) has been widely used for management of various complicated wounds and to support postoperative tissue healing. Another emerging indication for NPWT, applied directly to the closed incisions, is to prevent infections or dehiscences in patients with increased risk of surgical-site complications (iNPWT). Furthermore, the combination of negative pressure with intermittent instillation of solution (NPWTi) seems to be effective in the treatment of a variety of complex wounds. Even if the role of NPWT in promoting wound healing has been largely accepted, there is a lack of evidence (few high-level clinical studies) regarding its effectiveness and further research is needed to better understand the mechanisms of action. This article contains a review of recent scientific and clinical research related to indications, contraindications, and mechanisms of action of NPWT to clarify current knowledge, technological evolutions, and future perspectives of devices.

Published
2019

40. Sentinel Node Navigation in Gastric Cancer: Where Do We Stand?

Author

Georgios D Lianos, Michail Mitsis, Stefano Rausei, Georgios K. Glantzounis, Natasha Hasemaki, and Christina Bali

Subjects
medicine.medical_specialty, medicine.medical_treatment, Sentinel lymph node, Metastasis, 03 medical and health sciences, Intraoperative Period, 0302 clinical medicine, Stomach Neoplasms, Biopsy, medicine, Humans, Minimally Invasive Surgical Procedures, Clinical Trials as Topic, medicine.diagnostic_test, business.industry, Sentinel Lymph Node Biopsy, Gastroenterology, Cancer, Sentinel node, medicine.disease, Early Gastric Cancer, Radiation therapy, Oncology, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Lymph Node Excision, 030211 gastroenterology & hepatology, Lymphadenectomy, Radiology, Sentinel Lymph Node, business
Abstract

Early gastric cancer (EGC) is more common nowadays and is related a to low percentage of lymph node metastasis. For this reason, there is enormous interest to implicate minimally invasive approaches. Recently, special efforts have been made towards a potential intraoperative (real-time) lymph node metastasis (LNM) assessment, as nodal disease status could not be identified with precision before or during surgery. In this direction, accurate prediction of the LNM status through sentinel LN mapping has been attempted, as an approach to the intraoperative detection of sentinel lymph nodes (SLNs). A careful literature search was conducted in order to clarify the potential clinical application of SN biopsy in the gastric cancer field. The real clinical application of SN biopsy in gastric cancer treatment has been more than challenging due to the “complicated” nature of gastric lymphatic drainage and the high possibility of “skip” metastasis phenomenon. Notably, sophisticated technical aspects, such as the preferred tracer used and the potential “ideal” method to verify the presence of metastases in the resected SLNs, made SN biopsy application in gastric cancer field extremely demanding. Assessing the potential role of SN navigation for gastric cancer treatment in the era of advanced technology, where the minimally invasive surgical approaches are in the top of the scientific interest, it has to be highlighted that SN navigation for gastric cancer is a topic that remains highly controversial, and the need for future clinical trials on this topic is obvious.

Published
2019

41. Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Author

Ceresoli, M, Salvetti, F, Kluger, Y, Braga, M, Viganò, J, Fugazzola, P, Sartelli, M, Ansaloni, L, Catena, F, Coccolini, F, Negoi, I, Zese, M, Occhionorelli, S, Gubbiotti, F, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Che Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Cordeiro Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Pereira Fraga, G, M Pereira, B, Gachabayov, M, Perez Chagerben, G, Leon Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Nigro, A, Kirkpatrick, A, Parfenov, A, Montori, G, Dionigi, P, Sugrue, M, Dubuisson, V, Noutakdie Tochie, J, Ivatury, R, Marco Ceresoli, Francesco Salvetti, Yoram Kluger, Marco Braga, Jacopo Viganò, Paola Fugazzola, Massimo Sartelli, Luca Ansaloni, Fausto Catena, Federico Coccolini, Ionut Negoi, Monica Zese, Savino Occhionorelli, Francesca Gubbiotti, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federic Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Alice Nigro, Andrew Kirkpatrick, Anton Parfenov, Giulia Montori, Paolo Dionigi, Michael Sugrue, Vincent Dubuisson, Joel Noutakdie Tochie, Rao Ivatury, Ceresoli, M, Salvetti, F, Kluger, Y, Braga, M, Viganò, J, Fugazzola, P, Sartelli, M, Ansaloni, L, Catena, F, Coccolini, F, Negoi, I, Zese, M, Occhionorelli, S, Gubbiotti, F, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Che Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Cordeiro Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Pereira Fraga, G, M Pereira, B, Gachabayov, M, Perez Chagerben, G, Leon Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Nigro, A, Kirkpatrick, A, Parfenov, A, Montori, G, Dionigi, P, Sugrue, M, Dubuisson, V, Noutakdie Tochie, J, Ivatury, R, Marco Ceresoli, Francesco Salvetti, Yoram Kluger, Marco Braga, Jacopo Viganò, Paola Fugazzola, Massimo Sartelli, Luca Ansaloni, Fausto Catena, Federico Coccolini, Ionut Negoi, Monica Zese, Savino Occhionorelli, Francesca Gubbiotti, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federic Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Alice Nigro, Andrew Kirkpatrick, Anton Parfenov, Giulia Montori, Paolo Dionigi, Michael Sugrue, Vincent Dubuisson, Joel Noutakdie Tochie, and Rao Ivatury

Abstract

Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p < 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770.

Published
2020

42. Indocyanine green-enhanced fluorescence for assessing parathyroid perfusion during thyroidectomy

Author

Xiaoli Liu, Francesco Frattini, Luigi Boni, Matteo Lavazza, Davide Inversini, Angkoon Anuwong, Che-Wei Wu, Gregory W. Randolph, Stefano Rausei, Hoon Yub Kim, Gianlorenzo Dionigi, and Renbin Liu

Subjects
Laparoscopic surgery, medicine.medical_specialty, Parathyroid, medicine.medical_treatment, Indocyanine green (ICG), Review Article, 030230 surgery, Fluorescence, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Surgical removal, medicine, Hypocalcemia, Thyroidectomy, business.industry, Thyroid, Intraoperative angiography, Surgery, medicine.anatomical_structure, chemistry, 030220 oncology & carcinogenesis, Parathyroid gland, business, Indocyanine green, Perfusion
Abstract

Identification of the parathyroid glands during thyroid surgery may prevent their inadvertent surgical removal and thus provide a better postoperative quality of life. Nevertheless, the most common “technique” for intraoperative evaluation of perfusion of parathyroid gland tissues during thyroid surgery is visual inspection of the physical condition of tissues, e.g., their color and bleeding edges. Another technique is measurement of intact parathyroid hormone. Recently, indocyanine green-enhanced fluorescence has been used in various surgical techniques, particularly laparoscopic surgery, to improve visualization and to provide detailed anatomical information. Fluorescent optical guidance helps surgeons to avoid inadvertent tissue injury while enhancing procedural efficiency. This technique has potential use for evaluating perfusion of the parathyroid gland in real-time intraoperative angiography.

Published
2016
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43. New endoscopic procedures for diabetes mellitus type 2 and obesity treatment

Author

Francesco Frattini, Stefano Rausei, Angkoon Anuwong, Xiaoli Liu, Hoon Yub Kim, Gianlorenzo Dionigi, Renbin Liu, Matteo Lavazza, and Giacomo Borroni

Subjects
Gastric pouch, Weight loss, medicine.medical_specialty, Gastric bypass, 030209 endocrinology & metabolism, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, medicine, Obesity, Bariatric surgery, medicine.diagnostic_test, business.industry, General surgery, Endoscopy, Multimodal therapy, Surgery, medicine.disease, Original Article, 030211 gastroenterology & hepatology, medicine.symptom, business, Endoscopic treatment
Abstract

Background: Obesity continues to be a growing epidemic worldwide. Obese patients have severe comorbidities that make risky and technically demanding the execution of bariatric surgery from both surgical and anesthetic point of view; therefore, the focus of bariatric surgeons is increasingly moving towards minimally invasive, endoscopic techniques. Methods: The present review presents and discusses recent endoscopic techniques employed in obesity treatment, their features and results. Results: Endoscopic treatment can be primary or revisional; we can mainly divide the endoscopic devices into five categories: space-occupying devices, restrictive procedures, bypass liner, aspiration therapy and endoscopic revision of gastric bypass for dilated gastric pouch. Conclusions: Endoscopic treatments for obesity are promising techniques for selected patients but each procedure should be tailored on the patient in a multimodal approach.

Published
2016
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44. Early intact PTH (iPTH) is an early predictor of postoperative hypocalcemia for a safer and earlier hospital discharge: an analysis on 260 total thyroidectomies

Author

Cesare Carlo Ferrari, Xiaoli Liu, Gianlorenzo Dionigi, Hoon Yub Kim, Renbin Liu, Wen Tian, Francesco Frattini, Angkoon Anuwong, Stefano Rausei, Chei Wei Wu, and Davide Inversini

Subjects
Intact PTH (iPTH), musculoskeletal diseases, endocrine system, medicine.medical_specialty, endocrine system diseases, medicine.medical_treatment, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Hospital discharge, Hypocalcemia, Thyroid surgery, Histological diagnosis, Medicine, Early discharge, Surgery, business.industry, Thyroidectomy, Intact pth, Editorial, 030220 oncology & carcinogenesis, Clinical diagnosis, Lymphadenectomy, Complication, business, human activities, hormones, hormone substitutes, and hormone antagonists
Abstract

Background: Hypocalcemia is the most frequent complication after thyroidectomy. Serum calcium levels are reliable only 48–72 hours postoperatively. Early intact PTH (iPTH) has been proposed as early predictor of postoperative hypocalcemia. Our aim is to assess the ability of iPTH in predicting postoperative hypocalcemia. Methods: Two hundred and sixty patients underwent thyroidectomy with postoperative iPTH evaluation. The iPTH samplings were early performed after thyroidectomy. The calcium levels were dosed postoperatively. Age, sex, clinical diagnosis, obesity, comorbidities, previous neck surgery, preoperative therapy, type of surgery, dissectors used, lymphadenectomy, post-operative complications, reoperation and histological diagnosis were considered. The primary end-point was the postoperative hospital stay. The secondary end-points were serum calcium and iPTH. Three iPTH cut-offs were tested to assess which was the best value (10.0, 15.0, and 20.0 pg/mL). Results: The iPTH cut-off value of 10.0 pg/mL was the most accurate and specific for hypocalcemia. Comparing the iPTH value with the different values of calcium respectively 24 and 48 hours after surgery, a statistically stronger association with the serum calcium levels 48 hours postoperatively has been shown. iPTH ≥10 pg/mL 3–6 hours after surgery was strongly correlated to early discharge. Conclusions: The correlation of iPTH with hypocalcemia is significant since a few hours after surgery and the value of iPTH ≥10 pg/mL is able to select those patients for a safe and early discharge. The use of the iPTH might avoid unnecessary extensions of hospitalization.

Published
2016
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45. Breast cancer and thyroid diseases: analysis of 867 consecutive cases

Author

Hoon Yub Kim, V. Marchionini, Eliana Piantanida, Gianlorenzo Dionigi, Corrado Chiappa, Veronica Arlant, Angkoon Anuwong, Anna Fachinetti, Stefano Rausei, S. Del Ferraro, Matteo Lavazza, Francesca Rovera, and Maria Laura Tanda

Subjects
Male, Autoimmune thyroiditis, Breast cancer, Breast surgery, Breast treatment, Thyroid disease, Oncology, endocrine system, medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Estrogen receptor, Breast Neoplasms, 030209 endocrinology & metabolism, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, Biomarkers, Tumor, medicine, Humans, business.industry, Carcinoma, Ductal, Breast, Thyroid, Cancer, Middle Aged, Prognosis, medicine.disease, Thyroid Diseases, Carcinoma, Lobular, medicine.anatomical_structure, Receptors, Estrogen, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, Neoplasm Grading, Receptors, Progesterone, business, Breast carcinoma, Follow-Up Studies
Abstract

The aim of this study was to evaluate the association of breast cancer with thyroid diseases. Many authors have already studied the possible relationship between these two diseases, but the results are nowadays conflicting. Our study examining 867 patients with breast cancer (862 women and 5 men, average age = 61 years old) of whom 141 also had thyroid disease evaluated the recurrence of thyroid diseases and their association with different types of breast cancer. Statistical analyses were performed using SPSS software for Windows; we used nonparametric tests (Chi-square and Mann–Whitney), and the level of significance was set at p

Published
2016
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46. Recurrent laryngeal nerve injury in thyroid surgery: Clinical pathways and resources consumption

Author

Feng-Yu Chiang, Luigi Boni, Cesare Carlo Ferrari, Gianlorenzo Dionigi, Hoon Yub Kim, Francesco Amico, Stefano Rausei, and Che-Wei Wu

Subjects
Consumption (economics), medicine.medical_specialty, business.industry, Thyroid, Recurrent Laryngeal Nerve Injury, Head neck, 030230 surgery, medicine.disease, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Otorhinolaryngology, 030220 oncology & carcinogenesis, medicine, Recurrent laryngeal nerve, Vocal cord paralysis, Resource consumption, business, Medical costs
Abstract

Background The impact of recurrent laryngeal nerve (RLN) injury management in thyroid surgery seems to be relevant to patients, National Healthcare System (NHS), and society. Methods We studied resource consumption in the management of patients with RLN injury versus noninjured patients investigating 3 perspectives (patients, NHS, and society) in 5 clinical pathways. Results Direct medical costs supported by the NHS range from a minimum of euro (€) 79.46 to a maximum of € 3261.95. From the patient's perspective, the direct medical costs supported by the patient increased from a minimum of € 3.60 to a maximum of € 499.45. Productivity losses were accounted in € 156 per day per patient. From the NHS perspective, the percentage increase ranged from 43.25% to 98.14%. From the patient's perspective, it ranged from 51.52% to 80.60%. Conclusion The analysis shows a significant economic impact of RLN injury management, which varies depending on the damage, duration, and severity. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Published
2016
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47. Preoperative or Perioperative Docetaxel, Oxaliplatin, and Capecitabine (GASTRODOC Regimen) in Patients with Locally-Advanced Resectable Gastric Cancer: A Randomized Phase-II Trial

Author

Luigina Graziosi, Uberto Fumagalli Romario, Maria Bencivenga, Franco Roviello, Oriana Nanni, Daniele Marrelli, Giovanni de Manzoni, Silvia Bozzarelli, Francesca Steccanella, Stefano Rausei, Massimo Framarini, Giovanni Sgroi, Annibale Donini, Stefano Santi, Luca Saragoni, Andrea Rinnovati, Giorgio Ercolani, Lorenza Rimassa, Flavia Foca, Paolo Morgagni, Ilaria Proserpio, Valentina Mengardo, Giovanni Luca Frassineti, Carlo Milandri, Manlio Monti, Sarah Molfino, Emilio Parma, Roberto Petrioli, Gian Luca Baiocchi, Gianni Mura, Dino Amadori, Linda Valmorri, Alessandra Signorini, Verena De Angelis, J. Viganò, Silvia Brugnatelli, Monti M., Morgagni P., Nanni O., Framarini M., Saragoni L., Marrelli D., Roviello F., Petrioli R., Romario U.F., Rimassa L., Bozzarelli S., Donini A., Graziosi L., De Angelis V., De Manzoni G., Bencivenga M., Mengardo V., Parma E., Milandri C., Mura G., Signorini A., Baiocchi G., Molfino S., Sgroi G., Steccanella F., Rausei S., Proserpio I., Vigano J., Brugnatelli S., Rinnovati A., Santi S., Ercolani G., Foca F., Valmorri L., Amadori D., and Frassineti G.L.

Subjects
0301 basic medicine, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, lcsh:RC254-282, Gastroenterology, Article, Capecitabine, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Chemotherapy, Medicine, Perioperative, Progression-free survival, Preoperative, Gastric cancer, business.industry, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Oxaliplatin, Regimen, 030104 developmental biology, Oncology, Docetaxel, 030220 oncology & carcinogenesis, business, Febrile neutropenia, medicine.drug
Abstract

Docetaxel associated with oxaliplatin and 5-fluorouracil (FLOT) has been reported as the best perioperative treatment for gastric cancer. However, there is still some debate about the most appropriate number and timing of chemotherapy cycles. In this randomized multicenter phase II study, patients with resectable gastric cancer were staged through laparoscopy and peritoneal lavage cytology, and randomly assigned (1:1) to either four cycles of neoadjuvant chemotherapy (arm A) or two preoperative + two postoperative cycles of docetaxel, oxaliplatin, and capecitabine (DOC) chemotherapy (arm B). The primary endpoint was to assess the percentage of patients receiving all the planned preoperative or perioperative chemotherapeutic cycles. Ninety-one patients were enrolled between September 2010 and August 2016. The treatment was well tolerated in both arms. Thirty-three (71.7%) and 24 (53.3%) patients completed the planned cycles in arms A and B, respectively (p = 0.066), reporting an odds ratio for early interruption of treatment of 0.45 (95% confidence interval (CI): 0.18&ndash, 1.07). Resection was curative in 39 (88.6%) arm A patients and 35 (83.3%) arm B patients. Five-year progression-free survival (PFS) was 51.2% (95% CI: 34.2&ndash, 65.8) in arm A and 40.3% (95% CI: 28.9&ndash, 55.2) in arm B (p = 0.300). Five-year survival was 58.5% (95% CI: 41.3&ndash, 72.2) and 53.9% (95% CI: 35.5&ndash, 69.3) (p = 0.883) in arms A and B, respectively. The planned treatment was more frequently completed and was more active, albeit not significantly, in the neoadjuvant arm than in the perioperative group.

Published
2020
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48. Treatment of Gastric Cancer

Author

Georgios D Lianos and Stefano Rausei

Subjects
0301 basic medicine, Oncology, Curative intent, Cancer Research, medicine.medical_specialty, business.industry, digestive, oral, and skin physiology, MEDLINE, Cancer, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, lcsh:RC254-282, digestive system diseases, 03 medical and health sciences, Editorial, n/a, 030104 developmental biology, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, business
Abstract

Surgery represents the only method for potentially curative intent for gastric cancer (GC) [...]

Published
2020
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49. How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion

Author

Francesco Martignoni, Andrea Cossu, Sergio Alfieri, Riccardo Rosati, Uberto Fumagalli, Fausto Rosa, Ferdinando Carlo Maria Cananzi, Roberto Persiani, Georgios D Lianos, Domenico D'Ugo, Stefano Rausei, Vittorio Quagliuolo, Alberto Biondi, Federica Galli, Rausei, Stefano, Galli, Federica, Lianos, Georgio, Rosa, Fausto, Cossu, Andrea, Biondi, Alberto, Martignoni, Francesco, Cananzi, Ferdinando Carlo Maria, Fumagalli, Uberto, Alfieri, Sergio, Persiani, Roberto, Quagliuolo, Vittorio, D'Ugo, Domenico, and Rosati, Riccardo

Subjects
Adult, Male, medicine.medical_specialty, Quality Assurance, Health Care, Cancer-related survival, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Adenocarcinoma, 03 medical and health sciences, 0302 clinical medicine, Gastrectomy, Stomach Neoplasms, Tumor stage, medicine, Humans, In patient, Locally advanced gastric cancer, Survival rate, Aged, Retrospective Studies, Aged, 80 and over, D2 lymphadenectomy, business.industry, Gastroenterology, Cancer, Lymphadenectomy, Middle Aged, medicine.disease, Prognosis, Radiation therapy, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Number of removed lymph nodes, Lymph Node Excision, 030211 gastroenterology & hepatology, Female, Radiology, Lymph, Lymph Nodes, business, Follow-Up Studies
Abstract

To compare anatomical with numerical criterion to measure the quality of lymphadenectomy for gastric cancer. We analyzed 447 gastric cancer patients with resectable tumor stage (R0 resection) with at least 16 examined lymph nodes. Of 447 patients, 82.6% underwent D2 lymphadenectomy for a median of total examined lymph nodes of 28. The 7-year disease-specific survival rate for the whole sample was 71.4%. Survival was significantly different between patients treated with D2 and D1 lymphadenectomy (77.4% versus 44.3%; p < 0.001) and between patients with total examined lymph nodes ≥ 28 and < 28 (74.5% versus 62.3%; p = 0.041). Anatomical criterion significantly differentiated 7-year survival in patients stratified according to a numerical parameter. We should still consider the anatomical criterion as the best item to measure the quality of lymphadenectomy for gastric cancer.

Published
2019

50. Association Between Compliance to an Enhanced Recovery Protocol and Outcome After Elective Surgery for Gastric Cancer. Results from a Western Population-Based Prospective Multicenter Study

Author

Andrea Sansonetti, Lapo Bencini, Luca Gianotti, Andrea Coratti, Francesco Casella, Riccardo Rosati, Federica Galli, Jacopo Weindelmayer, Giovanni Colombo, Marta Sandini, Andrea Costanzi, Paolo Parise, Davide Paolo Bernasconi, Stefano De Pascale, Andrea Cossu, Uberto Fumagalli Romario, Giovanni de Manzoni, Stefano Rausei, Dario Maggioni, Valentina Mengardo, Gianotti, L, Fumagalli Romario, U, De Pascale, S, Weindelmayer, J, Mengardo, V, Sandini, M, Cossu, A, Parise, P, Rosati, R, Bencini, L, Coratti, A, Colombo, G, Galli, F, Rausei, S, Casella, F, Sansonetti, A, Maggioni, D, Costanzi, A, Bernasconi, D, De Manzoni, G, Gianotti, Luca, Fumagalli Romario, Uberto, De Pascale, Stefano, Weindelmayer, Jacopo, Mengardo, Valentina, Sandini, Marta, Cossu, Andrea, Parise, Paolo, Rosati, Riccardo, Bencini, Lapo, Coratti, Andrea, Colombo, Giovanni, Galli, Federica, Rausei, Stefano, Casella, Francesco, Sansonetti, Andrea, Maggioni, Dario, Costanzi, Andrea, Bernasconi, Davide P, and De Manzoni, Giovanni

Subjects
Male, medicine.medical_specialty, Comorbidity, 030230 surgery, Logistic regression, 03 medical and health sciences, symbols.namesake, Postoperative Complications, 0302 clinical medicine, Stomach Neoplasms, Stomach Neoplasm, Gastrectomy, Internal medicine, Humans, Medicine, Age Factor, Prospective Studies, Poisson Distribution, Postoperative Period, Poisson regression, ERAS, Elective surgery, Prospective cohort study, Aged, Elective Surgical Procedure, business.industry, gastric cancer, Age Factors, Middle Aged, Length of Stay, Vascular surgery, medicine.disease, Patient Discharge, Prospective Studie, Italy, Elective Surgical Procedures, 030220 oncology & carcinogenesis, symbols, Patient Compliance, Female, Surgery, Observational study, Postoperative Complication, business, Human, Abdominal surgery
Abstract

Background: The association between compliance to an enhanced recovery protocol (ERAS) and outcome after surgery for gastric cancer has been poorly investigated, particularly in Western patients. The aim of the study was to evaluate whether the rate of adherence to the ERAS program was correlated with outcome and time of discharge. Methods: A prospective, observational, multicenter study was designed to be performed at Italian referral centers for gastric surgery. The protocol was discussed and approved by the Italian Research Group on Gastric Cancer. Twenty-three ERAS domains were applied. A multivariate logistic regression was used to assess the association between ERAS compliance and overall and major complication rates. The Poisson regression model (measured as mean ratios) was used to assess the association of ERAS compliance rate and length of stay (LOS). Results: Eight centers participated and 290 subjects with a median age of 73 years were enrolled. The overall rates of adherence to pre-, intra-, and postoperative ERAS items were 69.8%, 60.3%, and 82.5%, respectively. At the multivariate model, there was an association between overall rate of morbidity and an overall ERAS compliance rate greater than 70% (OR 0.413; 95% CI 0.235–0.7240; P 0.002). A similar association was found for major complications (OR 0.328; 95% CI 0.151–0.709; P 0.005). The Poisson regression showed that in patients with ERAS compliance rate >70%, LOS was reduced of approximately 20% (mean ratio 0.812; 95% CI 0.694–0.950; P 0.009). Conclusions: These results suggest a moderate compliance to an ERAS program and a significant association between adherence and outcomes.

Published
2019

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