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1. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Author

De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., Sommacale D., De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., and Sommacale D.

Abstract

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Published
2021

2. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis

Author

De'Angelis, N., Martinez-Perez, A., Winter, D. C., Landi, F., Vitali, G. C., Le Roy, B., Coccolini, F., Brunetti, F., Celentano, V., Di Saverio, S., Ris, F., Fuks, D., Espin, E., Bianchi, G., Pham, J., Genova, P., Sobhani, I., Gomez, S. A., Torres, M. T., Paya, C., Gonzalvez, P., Stakelum, A., Zaborowski, A., Sueiras-Gil, A., Hevia, R., Assalino, M., Pezet, D., Abdallah, M., Ansaloni, L., Birindelli, A., Denet, C., Solis, A., Kraft, M., Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CHU Henri Mondor, Addenbrooke's Hospital, Cambridge University NHS Trust, CHU Amiens-Picardie, de'Angelis N., Martinez-Perez A., Winter D.C., Landi F., Vitali G.C., Le Roy B., Coccolini F., Brunetti F., Celentano V., Di Saverio S., Ris F., Fuks D., Espin E., Bianchi G., Pham J., Genova P., Sobhani I., Gomez S.A., Torres M.T., Paya C., Gonzalvez P., Stakelum A., Zaborowski A., Sueiras-Gil A., Hevia R., Assalino M., Pezet D., Abdallah M., Ansaloni L., Birindelli A., Denet C., Solis A., and Kraft M.

Subjects
Male, Extended right colectomy, 0302 clinical medicine, Postoperative Complications, Colectomy, ComputingMilieux_MISCELLANEOUS, Splenic fexure carcinoma, Aged, 80 and over, ddc:617, Middle Aged, 3. Good health, Treatment Outcome, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Colonic Neoplasms, 030211 gastroenterology & hepatology, Female, Left colectomy, Colon, Transverse, Adult, medicine.medical_specialty, Operative Time, Segmental left colectomy, Disease-Free Survival, Resection, 03 medical and health sciences, Postoperative complications, Propensity score matching, Splenic flexure carcinoma, Internal medicine, medicine, Carcinoma, Humans, Propensity Score, Aged, Retrospective Studies, Splenic flexure, business.industry, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, Hepatology, Length of Stay, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Surgery, Postoperative complication, Laparoscopy, Lymph Nodes, business, Abdominal surgery
Abstract

Background: The surgical resection of the splenic flexure carcinoma (SFC)is challenging and the optimal surgical procedure for SFCs remains a matter of debate. The present study aimed to compare in a multicenter European sample of patients the short- and long-term outcomes of extended right (ERC) vs. left (LC) vs. segmental left colectomy (SLC) for SFCs. Methods: This retrospective multicenter study analyzed the surgical and oncological outcomes of SFC patients undergoing elective curative intent surgery between 2000 and 2018. Descriptive and exploratory analyses were first conducted on the whole sample. Outcomes of the different procedures (ERC vs. LC vs. SLC) were then compared using propensity score matching for multilevel treatment. Overall (OS) and disease-free survival (DFS) were evaluated by Kaplan–Meier method. Results: From a total of 399 SFC patients, 143 (35.8%) underwent ERC, 131 (32.8%) underwent LC, and 125 (31.4%) underwent SLC. Overall, 297 (74.4%) were laparoscopic procedures. An increase in operative time, time to flatus, time to regular diet, and hospital stay was observed with the progressive extension of SFC resection. ERC was associated with significantly increased risk of postoperative ileus compared to both LC and SLC. A significantly greater number of lymph nodes were retrieved by ERC, but the objective of at least 12 retrieved lymph nodes was achieved in 85% of patients, without procedure-related differences. No differences were observed in OS or DFS between ERC, LC, and SLC. Conclusion: The present study supports the resection of SFCs by colon-sparing surgical techniques, such as SLC.

Published
2020
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3. Assessing surgical difficulty in locally advanced mid-low rectal cancer: the accuracy of two MRI-based predictive scores

Author

De'Angelis, N., Pigneur, F., Martinez-Perez, A., Vitali, G. C., Landi, F., Gomez-Abril, S. A., Assalino, M., Espin, E., Ris, F., Luciani, A., Brunetti, F., Alani, R., Aupin, L., Bianchi, G., Memeo, R., Petrucciani, N., Marti-Martinez, E., Ripolles, T., Breguet, R., Puppa, G., Terraz, S., Armario, D., Rodrigues, V., and Vera, M.

Subjects
Male, medicine.medical_specialty, Databases, Factual, Colorectal cancer, mri, rectal cancer, score, surgical difficulty, Anastomosis, Sensitivity and Specificity, External validity, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, medicine, Humans, Stage (cooking), Rectal cancer, Retrospective Studies, Proctectomy, Receiver operating characteristic, Rectal Neoplasms, business.industry, Patient Selection, Rectum, Gastroenterology, Retrospective cohort study, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Total mesorectal excision, Treatment Outcome, ROC Curve, Area Under Curve, 030220 oncology & carcinogenesis, Female, Laparoscopy, 030211 gastroenterology & hepatology, Radiology, business, Body mass index, MRI
Abstract

Aim Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluates the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and additionally proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery. Methods This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L-TME) with primary anastomosis. For all patients, pretreatment and restaging MRI were available. Surgical difficulty was graded as high and low based upon a composite outcome, including operative (e.g. duration of surgery) and postoperative variables (e.g. hospital stay). Score accuracy was assessed by estimating sensitivity, specificity and area under the receiver operating characteristic curve (AROC). Results In a total of 136 LARC patients, 17 (12.5%) were graded as high surgical difficulty. The previously published score (calculated on body mass index, intertuberous distance, mesorectal fat area, type of anastomosis) showed low predictive value (sensitivity 11.8%; specificity 92.4%; AROC 0.612). The new EuMaRCS score was developed using the following significant predictors of surgical difficulty: body mass index > 30, interspinous distance < 96.4 mm, ymrT stage >= T3b and male sex. It demonstrated high accuracy (AROC 0.802). Conclusion The EuMaRCS score was found to be more sensitive and specific than the previous score in predicting surgical difficulty in LARC patients who are candidates for L-TME. However, this score has yet to be externally validated.

Published
2019

5. Aggressive digital papillary adenocarcinoma.

Author

Rastrelli, M., Soteldo, J., Vitali, G. C., Mazzarol, G., Trifirò, G., Tosti, G., and Testori, A.

Subjects
LETTERS to the editor, ADENOCARCINOMA, DIAGNOSIS
Abstract

A letter to the editor is presented in response to a medical case of a 45-year-old male with aggressive digital papillary adenocarcinoma (ADPAca).

Published
2011
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6. Laparoscopic surgery versus radiofrequency ablation for the treatment of single hepatocellular carcinoma ≤3 cm in the elderly: a propensity score matching analysis

Author

Taiga Wakabayashi, Patrick Pessaux, Riccardo Memeo, Nicola de’Angelis, Emanuele Felli, Tullio Piardi, Delgado F. Javier Briceno, Alexis Laurent, Antonio Rampoldi, Paolo Magistri, Giulio Cesare Vitali, Maria Conticchio, René Adam, Giacomo Assirati, Maximiliano Gelli, Ferdinando M. Anelli, Luca Aldrighetti, Daniel Cherqui, Antonella Delvecchio, Fabrizio Di Benedetto, Francesca Ratti, Conticchio, M., Delvecchio, A., Ratti, F., Gelli, M., Anelli, F. M., Laurent, A., Vitali, G. C., Magistri, P., Assirati, G., Felli, E., Wakabayashi, T., Pessaux, P., Piardi, T., Di Benedetto, F., De'Angelis, N., Javier Briceno, D. F., Rampoldi, A. G., Adam, R., Cherqui, D., Aldrighetti, L., and Memeo, R.

Subjects
Laparoscopic surgery, medicine.medical_specialty, Carcinoma, Hepatocellular, Radiofrequency ablation, medicine.medical_treatment, Resection, law.invention, law, medicine, Hepatectomy, Humans, Laparoscopic resection, Propensity Score, Aged, Retrospective Studies, Radiofrequency Ablation, Hepatology, business.industry, Liver Neoplasms, Gastroenterology, Retrospective cohort study, medicine.disease, Surgery, Treatment Outcome, Hepatocellular carcinoma, Propensity score matching, Catheter Ablation, Operative time, Laparoscopy, business
Abstract

Background Laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) represented potential treatments for patients with a single hepatocellular carcinoma (HCC) smaller than 3 cm. As the aging population soared, our study aimed to examine the advantage/drawback balance for these treatments, which should be reassessed in elderly patients. Methods A multicentric retrospective study compared 184 elderly patients (aged >70 years) (86 patients underwent LLR and 98 had RFA) with single ≤3 cm HCC, observed from January 2009 to January 2019. Results After propensity score matching (PSM), the estimated 1- and 3-year overall survival rates were 96.5 and 87.9% for the LLR group, and 94.6 and 68.1% for the RFA group (p = 0.001) respectively. The estimated 1- and 3-year disease-free survival rates were 92.5 and 67.4% for the LLR group, and 68.5 and 36.9% for the RFA group (p = 0.001). Patients with HCC of anterolateral segments were more often treated with laparoscopic resection (47 vs. 36, p = 0.04). The median operative time in the resection group was 205 min and 25 min in the RFA group (p = 0.01). Length of hospital stay was 5 days in the resection group and 3 days in the RFA group (p = 0.03). Conclusion Despite a longer length of hospital stay and operative time, LLR guarantees a comparable postoperative course and a better overall and disease-free survival in elderly patients with single HCC (≤3 cm), located in anterolateral segments.

Published
2022

7. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis

Author

Maria Conticchio, Francesca Ratti, Giulio Cesare Vitali, Taiga Wakabayashi, Paolo Magistri, Valentina Ferraro, Giacomo Assirati, Fabrizio Di Benedetto, Tullio Piardi, Umberto Riccelli, Emanuele Felli, Javier Briceño-Delgado, Alexis Laurent, Nicola de’Angelis, Patrick Pessaux, Daniel Cherqui, Ferdinando M. Anelli, Riccardo Memeo, Antonella Delvecchio, René Adam, Maximiliano Gelli, Luca Aldrighetti, Delvecchio, A., Conticchio, M., Riccelli, U., Ferraro, V., Ratti, F., Gelli, M., Anelli, F. M., Laurent, A., Vitali, G. C., Magistri, P., Assirati, G., Felli, E., Wakabayashi, T., Pessaux, P., Piardi, T., Di Benedetto, F., De'Angelis, N., Briceno-Delgado, J., Adam, R., Cherqui, D., Aldrighetti, L., and Memeo, R.

Subjects
medicine.medical_specialty, Carcinoma, Hepatocellular, Resection, Postoperative Complications, Overall survival, Medicine, Hepatectomy, Humans, In patient, Propensity Score, Aged, Retrospective Studies, Open liver resection, Hepatology, business.industry, Liver Neoplasms, Gastroenterology, Perioperative, Length of Stay, medicine.disease, Surgery, Treatment Outcome, Hepatocellular carcinoma, Propensity score matching, Matched group, Laparoscopy, business
Abstract

Background: Surgical resection is a first-line curative option for hepatocellular carcinoma, but its role is still unclear in elderly patients. The aim of our study was to compare short- and long-term outcomes of laparoscopic and open liver resection in elderly patients with hepatocellular carcinoma. Methods: The study included 665 consecutive hepatocellular carcinoma liver resection cases in patients with ≥70 years of age treated in eight European hospital centres. Patients were divided into laparoscopic and open liver resection groups. Perioperative and long-term outcomes were compared between these groups. Results: After a 1:1 propensity score matching, 219 patients were included in each group. Clavien-Dindo grades III/IV (6 vs. 20%, p = 0.04) were lower in the laparoscopic than in the open matched group. Hospital stay was shorter in the laparoscopic than in the open matched group (5 vs. 7 days, p < 0.001). There were no significant differences between laparoscopic and open groups regarding overall survival and disease-free survival at 1-, 3- and 5- year periods. Conclusion: Laparoscopic liver resection for hepatocellular carcinoma is associated with good short-term outcomes in patients with ≥70 years of age compared to open liver resection. Laparoscopic liver resection is safe and feasible in elderly patients with hepatocellular carcinoma.

Published
2021

8. Laparoscopic major hepatectomy for hepatocellular carcinoma in elderly patients: a multicentric propensity score‑based analysis

Author

Nicola de’Angelis, Giacomo Assirati, René Adam, Maria Conticchio, Maximiliano Gelli, Francesca Ratti, Ferdinando M. Anelli, Antonella Delvecchio, Alexis Laurent, Paolo Magistri, Javier Briceño-Delgado, Luca Aldrighetti, Taiga Wakabayashi, Patrick Pessaux, Fabrizio Di Benedetto, Tullio Piardi, Riccardo Memeo, Daniel Cherqui, Emanuele Felli, Giulio Cesare Vitali, Delvecchio, A., Conticchio, M., Ratti, F., Gelli, M., Anelli, F. M., Laurent, A., Vitali, G. C., Magistri, P., Assirati, G., Felli, E., Wakabayashi, T., Pessaux, P., Piardi, T., Di Benedetto, F., De'Angelis, N., Briceno-Delgado, J., Adam, R., Cherqui, D., Aldrighetti, L., and Memeo, R.

Subjects
medicine.medical_specialty, Carcinoma, Hepatocellular, Major hepatectomy, Hepatocellular carcinoma, 030230 surgery, Elderly, Laparoscopy, Liver cirrhosis, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Internal medicine, medicine, Hepatectomy, Humans, Propensity Score, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Liver Neoplasms, Retrospective cohort study, Perioperative, Hepatology, Length of Stay, medicine.disease, Treatment Outcome, Propensity score matching, 030211 gastroenterology & hepatology, Surgery, business, Abdominal surgery
Abstract

Background: Considering the increase in overall life expectancy and the rising incidence of hepatocellular carcinoma (HCC), more elderly patients are considered for hepatic resection. Traditionally, major hepatectomy has not been proposed to the elderly due to severe comorbidities. Indeed, only a few case series are reported in the literature. The present study aimed to compare short-term and long-term outcomes between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients with HCC using propensity score matching (PSM). Methods: We performed a multicentric retrospective study including 184 consecutive cases of HCC major liver resection in patients aged ≥ 70years in _8 European Hospital Centers. Patients were divided into LMH and OMH groups, and perioperative and long-term outcomes were compared between the 2 groups. Results: After propensity score matching, 122 patients were enrolled, 38 in the LMH group and 84 in the OMH group. Postoperative overall complications were lower in the LMH than in the OMH group (18 vs. 46%, p < 0.001). Hospital stay was shorter in the LMH group than in the OMH group (5 vs. 7days, p = 0.01). Mortality at 90days was comparable between the two groups. There were no significant differences between the two groups in terms of overall survival (OS) and disease-free survival (DFS) at 1, 3, and 5years. Conclusion: LMH for HCC is associated with appropriate short-term outcomes in patients aged ≥ 70years as compared to OMH. LMH is safe and feasible in elderly patients with HCC.

Published
2020

9. Assessing surgical difficulty in locally advanced mid-low rectal cancer: the accuracy of two MRI-based predictive scores.

Author

de'Angelis N, Pigneur F, Martínez-Pérez A, Vitali GC, Landi F, Gómez-Abril SA, Assalino M, Espin E, Ris F, Luciani A, and Brunetti F

Subjects
Area Under Curve, Databases, Factual, Female, Humans, Laparoscopy methods, Male, Middle Aged, Predictive Value of Tests, Proctectomy methods, ROC Curve, Rectal Neoplasms surgery, Rectum diagnostic imaging, Retrospective Studies, Sensitivity and Specificity, Treatment Outcome, Laparoscopy statistics & numerical data, Magnetic Resonance Imaging statistics & numerical data, Patient Selection, Proctectomy statistics & numerical data, Rectal Neoplasms diagnostic imaging
Abstract

Aim: Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluates the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and additionally proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery., Methods: This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L-TME) with primary anastomosis. For all patients, pretreatment and restaging MRI were available. Surgical difficulty was graded as high and low based upon a composite outcome, including operative (e.g. duration of surgery) and postoperative variables (e.g. hospital stay). Score accuracy was assessed by estimating sensitivity, specificity and area under the receiver operating characteristic curve (AROC)., Results: In a total of 136 LARC patients, 17 (12.5%) were graded as high surgical difficulty. The previously published score (calculated on body mass index, intertuberous distance, mesorectal fat area, type of anastomosis) showed low predictive value (sensitivity 11.8%; specificity 92.4%; AROC 0.612). The new EuMaRCS score was developed using the following significant predictors of surgical difficulty: body mass index > 30, interspinous distance < 96.4 mm, ymrT stage ≥ T3b and male sex. It demonstrated high accuracy (AROC 0.802)., Conclusion: The EuMaRCS score was found to be more sensitive and specific than the previous score in predicting surgical difficulty in LARC patients who are candidates for L-TME. However, this score has yet to be externally validated., (Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.)

Published
2019
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10. Lymphoscintigraphy in clinical routine practice: reproducibility and accuracy in melanoma patients with a long-term follow-up.

Author

Vitali GC, Trifirò G, Zonta M, Pennacchioli E, Santoro L, Travaini LL, Barberis M, and Testori A

Subjects
Adult, Aged, Female, Follow-Up Studies, Humans, Lymph Node Excision, Lymph Nodes pathology, Lymphatic Metastasis, Male, Melanoma pathology, Melanoma surgery, Middle Aged, Reproducibility of Results, Sentinel Lymph Node Biopsy, Skin Neoplasms pathology, Skin Neoplasms surgery, Lymph Nodes diagnostic imaging, Lymphoscintigraphy, Melanoma diagnostic imaging, Skin Neoplasms diagnostic imaging
Abstract

Introduction: The sentinel node status is the most important single factor determining overall survival for patients with localized melanoma. Preoperative lymphoscintigraphy (LS) is essential in locating the correct sentinel lymph node (SN) and the reproducibility of the method determines the accuracy of the sentinel node biopsy (SNB). This study aims at determining the reproducibility and accuracy of LS in routine clinical practice after long-term follow-up., Patients and Methods: One hundred and eight melanoma patients with clinically unpredictable lymphatic drainage were prospectively enrolled to undergo two LS. The first LS was performed to determine the site and number of the lymphatic basins to plan SNB anesthesia and the second preoperative LS was to allow SN localization intra-operatively., Results: Lymphatic drainage was demonstrated in all patients. In 84 of 108 cases, both LSs were concordant in terms of site and number of nodal basins visualized. After a median follow-up of 80 months, no nodal recurrence was observed in the five patients with a decreased number of lymph node basins. In the group with increased number of lymph node basins, one patient developed nodal metastases in the same regional lymph node basin visualized by both LS studies., Conclusion: LS is an accurate and reproducible method to determine the localization of the sentinel node in the day-to-day routine to clinical practice when primary melanoma is also located in body sites with variable lymphatic drainage., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Published
2014
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11. Sentinel node biopsy for high-risk cutaneous nonanogenital squamous cell carcinoma: a preliminary result.

Author

Rastrelli M, Soteldo J, Zonta M, Trifirò G, Mazzarol G, Vitali GC, Mosconi M, and Testori A

Subjects
Aged, Aged, 80 and over, Arm, Carcinoma, Squamous Cell diagnosis, Female, Head and Neck Neoplasms diagnosis, Humans, Leg, Lymphatic Metastasis diagnostic imaging, Male, Middle Aged, Neoplasm Staging, Prognosis, Radionuclide Imaging, Retrospective Studies, Risk Factors, Thoracic Neoplasms diagnosis, Carcinoma, Squamous Cell secondary, Lymphatic Metastasis diagnosis, Sentinel Lymph Node Biopsy, Skin Neoplasms diagnosis
Abstract

Background: Certain patients with squamous cell carcinoma (SCC) have much higher rates of regional nodal metastases than is often reported. This study aims to further validate sentinel lymph node biopsy (SNB) for SCC and the outcome of these patients following SNB., Methods: 20 patients with high-risk nonanogenital SCC who underwent SNB between 1998 and 2007 were retrospectively reviewed. SNB was performed under local or general anesthesia following lymphoscintigraphy and blue dye injection., Results: The median follow-up from SNB was 24 months. Tumor location included the head and neck (n = 11), extremities (n = 9) and trunk (n = 1). One patient had a positive sentinel node. This patient developed parotid metastases 13 months after refusing a complete neck dissection and is alive with progressive disease after 31 months. Two patients developed regional recurrence after negative SNB (1 is alive and disease free, the other died of progressive disease). Of the remaining patients, 15 are alive and disease free, 1 died of another malignancy and 1 was lost to follow-up., Conclusion: SNB for high-risk SCC is feasible and allows early detection and treatment of nodal metastases. Currently, SNB for SCC is not a standard treatment and requires further investigation to determine which patients would benefit best from this procedure., ((c) 2010 S. Karger AG, Basel.)

Published
2010
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