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Roberta GELMINI

Professore Ordinario
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2024 - ASO Visual Abstract: Is Systemic Chemotherapy Useful in Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Colorectal Peritoneal Metastases? A Propensity-Score Analysis [Articolo su rivista]
Tonello, M.; Baratti, D.; Sammartino, P.; Di Giorgio, A.; Robella, M.; Sassaroli, C.; Framarini, M.; Valle, M.; Macri, A.; Graziosi, L.; Coccolini, F.; Lippolis, P. V.; Gelmini, R.; Deraco, M.; Biacchi, D.; Santullo, F.; Vaira, M.; Di Lauro, K.; D'Acapito, F.; Carboni, F.; Milone, E.; Donini, A.; Fugazzola, P.; Faviana, P.; Sorrentino, L.; Pizzolato, E.; Cenzi, C.; Del Bianco, P.; Sommariva, A.
abstract

2024 - Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group) [Articolo su rivista]
Anania, G.; Chiozza, M.; Campagnaro, A.; Bagolini, F.; Resta, G.; Azzolina, D.; Silecchia, G.; Cirocchi, R.; Agrusa, A.; Cuccurullo, D.; Guerrieri, M.; Adamo, V.; Ammendola, M.; Angelini, P.; Annecchiarico, M.; Aprea, G.; Autori, F.; Baldazzi, G.; Balla, A.; Baronio, G.; Bellio, G.; Bertelli, G.; Bima, C.; Bonomo, L. D.; Borreca, D.; Botteri, E.; Brescia, A.; Cafagna, L.; Capelli, P.; Caracino, V.; Caricato, M.; Carlini, M.; Cassinotti, E.; Catarci, M.; Chiaro, P.; Cillara, N.; Clementi, M.; Contul, R. B.; Curro, G.; De Manzini, N.; Degiuli, M.; Delogu, D.; Di Leo, A.; Elmore, U.; Ercolani, G.; Festa, F.; Galleano, R.; Gambino, G.; Gelmini, R.; Giordano, A.; La Mendola, R.; Laface, L.; Masoni, L.; Maurizi, A.; Memeo, R.; Mercantini, P.; Merola, G.; Milone, M.; Montuori, M.; Morelli, L.; Muttillo, I. A.; Nascimbeni, R.; Nelli, T.; Olmi, S.; Ortenzi, M.; Patriti, A.; Pavone, G.; Pisano, M.; Polastri, R.; Rega, D.; Rottoli, M.; Saladino, E; Santarelli, M.; Santoro, R.; Sartori, A.; Scatizzi, M.; Sica, G.; Siquini, W.; Sorrentino, M.; Staderini, F.; Vincentini, L.; Aizza, G.; Ammendola, M.; Amodio, P.; Aquilino, F.; Argenio, G.; Avanzolini, A.; Baldari, L.; Banchini, F.; Benedetti, M.; Bertino, V.; Bianco, A.; Blasi, F.; Bonariol, L.; Bono, D.; Bottari, A.; Buscemi, S.; Calini, G.; Campagnacci, R.; Cantafio, S.; Capolupo, G. T.; Capuano, M.; Carannante, F.; Casati, M.; Cassini, D.; Castiglioni, S.; Cecconi, C.; Cestino, L.; Chetta, N.; Chiappetta, F. M.; Cinelli, L.; Cojutti, A.; Colettta, D.; Corallino, D.; Crepaz, L.; Curcio, S.; Cuticone, G.; D’Agostino, F.; De Luca, M.; De Palma, G. D.; De Rosa, C.; De Serra, A.; Del Giudice, R.; Di Franco, G.; Foglio, F.; Fontani, G.; Fortuna, L.; Fortunato, M. R.; Frazzini, D.; Furbetta, N.; Gambino, E.; Garosio, I.; Germani, P.; Ghazouani, O.; Giannotti, D.; Gibin, E.; Grasso, A.; Grieco, M.; Izzo, D.; Laracca, G. G.; Lauteri, G.; Lepiane, P.; Li Causi, F. S.; Locci, E.; Lorenzo, G.; Madaro, A.; Madeddu, F.; Maggi, F.; Maiello, F.; Manigrasso, M.; Marcellinaro, R.; Marinello, P.; Mattei, M. S.; Mazzarella, G.; Merola, G.; Moroni, F.; Murgese, A.; Muttillo, E. M.; Oldani, A.; Paicilli, M.; Palmieri, M.; Palomba, G.; Paolini, G.; Parini, D.; Paroli, G. M.; Pellicciaro, M.; Petrucciani, N.; Picardi, B.; Piccolo, R.; Pinotti, E.; Pisanu, A.; Reddavid, R.; Resendiz, A.; Romano, G.; Rossi, E. G.; Saracco, R.; Scaramuzzo, R.; Serra, F.; Sgotto, E.; Solaini, L.; Spalluto, M.; Taglietti, L.; Tartaglia, E.; Tartaglia, N.; Torre, B.; Tutino, R.; Varesano, M.; Vettoretto, N.; Villamaina, E.; Viora, T.; Yusef, M.; Zago, M.; Zerbinati, A.
abstract

Background: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). Methods: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. Results: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). Conclusions: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951.

2024 - Prognostic factors in gastric cancer patients: a 10-year mono-institutional experience [Articolo su rivista]
De Ruvo, N.; Fenocchi, S.; Veronesi, L.; Missori, G.; Ricciardolo, A. A.; Rossi, E. G.; Sorrentino, L.; Cautero, N.; Serra, F.; Gelmini, R.
abstract

Introduction: Gastric cancer (GC) is one of the main causes of death from cancer globally. Long-term survival, especially in Western countries, remains dismal, with no significant improvements in recent years. Therefore, precise identification of clinical and pathological risk factors is crucial for prognosis, as it allows a better selection of patients suitable for oncologically radical treatments and contributes to longer survivals. Methods: We devised a retrospective observational longitudinal study over 10 years of experience with GC patients operated with curative intent. Results: Several factors were thoroughly investigated in a multivariate analysis to look for significance as independent risk factors for disease-free survival. Our results showed that only BMI, pTNM, and lymph node ratio expressed hazard ratios with implications for survival in our series of patients. Discussion: Although limited by the retrospective nature of the study, this is one of the few cancer reports from Northern Italy showing results over 10 years, which may in our view, have an impact on decision-making processes for multidisciplinary teams dedicated to the care of gastric cancer patients.

2023 - A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG [Articolo su rivista]
Milone, M.; D'Amore, A.; Alfieri, S.; Ambrosio, M. R.; 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. U.; 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.; Vigano, J.; De Palma, G. D.; Giacopuzzi, S.
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.

2023 - Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T) [Articolo su rivista]
Tartaglia, D.; Cremonini, C.; Annunziata, E.; Catena, F.; Sartelli, M.; Kirkpatrick, A. W.; Musetti, S.; Strambi, S.; Chiarugi, M.; Coccolini, F.; Salvetti, F.; Fugazzola, P.; Ceresoli, M.; Benedetti, F.; Elisa, N. G.; Litvin, A.; Lostoridis, E.; Ahmed, A. Y. Y. M.; Manatakis, D.; Negoi, I.; Ioannidis, O.; Uzunoglu, M. Y.; Tochie, J. N.; Cillara, N.; Tomadze, G.; Bala, M.; Isik, A.; Fonseca, V. C.; Bellanova, G.; Ghannam, W.; Yalkin, O.; Garcia, F. H.; Altintoprak, F.; Hadzhiev, D.; Chirica, M.; Zese, M.; Balalis, D.; Cui, Y.; Luppi, D.; Romeo, L.; Muratore, A.; Lunghi, E. G.; Yovtchev, Y.; Dimitrov, E.; Nikolopoulos, I.; Omerovic, M.; Zizzo, M.; Ugoletti, L.; Costa, G.; Scalzone, R.; Perrone, S.; Occhionorelli, S.; Nardi, M.; Gubbiotti, F.; Muhtaroglu, A.; Scaramuzzo, R.; Corte, H.; Yanez, C.; Zakaria, A. D.; Seretis, C.; Gelmini, R.; Pappalardo, V.; Paratore, F.; Sydorchuk, R.; Mulita, F.; Kara, Y.; Toma, E. A.; Vailas, M.; Sotiropoulou, M.; Elbahnasawy, M.; Sibilla, M. G.; Martines, G.; Goksoy, B.; Hadzhiev, D.; Parini, D.; Zaghi, C.; Podda, M.; Osipov, A.; Brisinda, G.; Gambino, G.; Doklestic, L. A. K.; Loncar, Z.; Micic, D.; Lesevic, I.; D'Agostino, F.; Garzali, I. U.; Caicedo, Y.; Marcela, L.; Marin, P. A. G.; Perivoliotis, K.; Ntentas, I.; Kuptsov, A.; Chowdhury, S.; Patel, T.
abstract

Background: Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods: We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results: Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann’s procedure is mainly performed in grades 1–2 (p < 0.0001). Major complications increased significantly after a Hartmann’s procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). Conclusions: Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann’s procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay.

2023 - Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry [Articolo su rivista]
Baiocchi, G. L.; Giacopuzzi, S.; Vittimberga, G.; De Pascale, S.; Pastorelli, E.; Gelmini, R.; Vigano, J.; Graziosi, L.; Vagliasindi, A.; Rosa, F.; Steccanella, F.; Demartini, P.; Reddavid, R.; Berselli, M.; Elmore, U.; Romario, U. F.; Degiuli, M.; Morgagni, P.; Marrelli, D.; D'Ugo, D.; Rosati, R.; De Manzoni, G.
abstract

Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015–2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien–Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.

2023 - Colorectal Cancer with Peritoneal Metastases: The Impact of the Results of PROPHYLOCHIP, COLOPEC, and PRODIGE 7 Trials on Peritoneal Disease Management [Articolo su rivista]
Sommariva, Antonio; Tonello, Marco; Coccolini, Federico; De Manzoni, Giovanni; Delrio, Paolo; Pizzolato, Elisa; Gelmini, Roberta; Serra, Francesco; Rreka, Erion; Pasqual, Enrico Maria; Marano, Luigi; Biacchi, Daniele; Carboni, Fabio; Kusamura, Shigeki; Sammartino, Paolo
abstract

2023 - Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial) [Articolo su rivista]
Coccolini, Federico; Mazzoni, Alessio; Cremonini, Camilla; Cobuccio, Luigi; Pucciarelli, Marsia; Vetere, Guglielmo; Borelli, Beatrice; Strambi, Silvia; Musetti, Serena; Miccoli, Mario; Cremolini, Chiara; Salvetti, Francesco; Fugattola, Paola; Ceresoli, Marco; Elisa, Nita Gabriela; Litvin, Andrey; Lostoridis, Eftychios; Ahmed, Ali Yasen Yasen Mohamed; Manatakis, Dimitrios; Negoi, Ionut; Ioannidis, Orestis; Uzunoglu, Mustafa Yener; Tochie, Joel Noutakdie; Cillara, Nicola; Tomadze, Gia; Bala, Miklosh; Isik, Arda; Fonseca, Vinicius Cordeiro; Bellanova, Giovanni; Ghannam, Wagih; Yalkin, Omer; Garcia, Fernando Hernandez; Altintoprak, Fatih; Hadzhiev, Dimitar; Chirirca, Mircea; Zese, Monica; Balalis, Dimitros; Cui, Yunfeng; Luppi, Davide; Romeo, Luigi; Muratore, Andrea; Lunghi, Elia Giuseppe; Yovtchev, Yovtcho; Nikolopoulos, Ioannis; Omerovic, Maid; Zizzo, Maurizio; Ugoletti, Lara; Costa, Gianluca; Scalzone, Rocco; Perrone, Stefano; Occhionorelli, Savino; Nardi, Matteo; Gubbiotti, Francesca; Catena, Fausto; Muhtaroglu, Ali; Scaramuzzo, Rosa; Corte, Helene; Yanez, Carlo; Zakaria, Andee Dzulkarnaen; Seretis, Charalampos; Gelmini, Roberta; Pappalardo, Vincenzo; Paratore, Filippo; Sydorchuk, Ruslan; Mulita, Fancesck; Kara, Yasin; Toma, Elena Adelina; Vailas, Michail; Sotiropoulou, Maria; Benedetti, Fabio; Elbahnasawy, Mahamad; Sibilla, Maria Grazia; Martinez, Gennaro; Goksoy, Beslen; Parini, Dario; Zaghi, Claudia; Podda, Mauro; Osipov, Aleksey; Brisinda, Giuseppe; Gambino, Giovanni; Akhmeteli, Lali; Doklestic, Krstina; Loncar, Zlatibor; Micic, Dusan; Lešević, Ivana; D'Agostino, Francesca; Garzali, Ibrahim Umar; Caicedo, Yaset; Marcela, Lina; Marin, Paola Andrea Gasca; Perivoliotis, Konstantinos; Ntentas, Ioannis; Kuptsov, Arthur; Dimitrov, Evgeni; Chowdhury, Sharfuddin; Patel, Tapan; Sartelli, Massimo; Tartaglia, Dario; Chiarugi, Massimo
abstract

Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild-moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild-moderate IC were reported such malignancy (753-100%), diabetes (103-13.7%), malnutrition (26-3.5%) and uremia (1-0.1%), while severe IC causes were steroids treatment (14-16.3%); neutropenia (7-8.1%), malignancy on chemotherapy (71-82.6%). Preoperative risk classification were reported as follow: mild-moderate: ASA 1-14 (1.9%); ASA 2-202 (26.8%); ASA 3-341 (45.3%); ASA 4-84 (11.2%); ASA 5-7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2-16 patients (18.6%); ASA 3-41 patients (47.7%); ASA 4-19 patients (22.1%); ASA 5-3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild-moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild-moderate and severe groups. Long-term survival data: in mild-moderate disease-free survival (median, IQR) is 28 (10-91) and in severe IC, it is 21 (10-94). Overall survival (median, IQR) is 44 (18-99) and 26 (20-90) in mild-moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16-81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild-moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients.

2023 - Enhanced Recovery after Surgery (ERAS) Program for Patients with Peritoneal Surface Malignancies Undergoing Cytoreductive Surgery with or without HIPEC: A Systematic Review and a Meta-Analysis [Articolo su rivista]
Robella, Manuela; Tonello, Marco; Berchialla, Paola; Sciannameo, Veronica; Ilari Civit, Alba Maria; Sommariva, Antonio; Sassaroli, Cinzia; Di Giorgio, Andrea; Gelmini, Roberta; Ghirardi, Valentina; Roviello, Franco; Carboni, Fabio; Lippolis, Piero Vincenzo; Kusamura, Shigeki; Vaira, Marco
abstract

Enhanced recovery after surgery (ERAS) program refers to a multimodal intervention to reduce the length of stay and postoperative complications; it has been effective in different kinds of major surgery including colorectal, gynaecologic and gastric cancer surgery. Its impact in terms of safety and efficacy in the treatment of peritoneal surface malignancies is still unclear. A systematic review and a meta-analysis were conducted to evaluate the effect of ERAS after cytoreductive surgery with or without HIPEC for peritoneal metastases. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane Database were searched from January 2010 and December 2021. Single and double-cohort studies about ERAS application in the treatment of peritoneal cancer were considered. Outcomes included the postoperative length of stay (LOS), postoperative morbidity and mortality rates and the early readmission rate. Twenty-four studies involving 5131 patients were considered, 7 about ERAS in cytoreductive surgery (CRS) + HIPEC and 17 about cytoreductive alone; the case histories of two Italian referral centers in the management of peritoneal cancer were included. ERAS adoption reduced the LOS (−3.17, 95% CrI −4.68 to −1.69 in CRS + HIPEC and −1.65, 95% CrI −2.32 to –1.06 in CRS alone in the meta-analysis including 6 and 17 studies respectively. Non negligible lower postoperative morbidity was also in the meta-analysis including the case histories of two Italian referral centers. Implementation of an ERAS protocol may reduce LOS, postoperative complications after CRS with or without HIPEC compared to conventional recovery.

2023 - External validation of COMPASS and BIOSCOPE prognostic scores in colorectal peritoneal metastases treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) [Articolo su rivista]
Tonello, M.; Baratti, D.; Sammartino, P.; Di Giorgio, A.; Robella, M.; Sassaroli, C.; Framarini, M.; Valle, M.; Macri, A.; Graziosi, L.; Fugazzola, P.; Lippolis, P. V.; Gelmini, R.; Biacchi, D.; Kasamura, S.; Deraco, M.; Cenzi, C.; Del Bianco, P.; Vaira, M.; Sommariva, A.
abstract

Introduction: The selection of patients undergoing cytoreductive- surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. BIOSCOPE and COMPASS are prognostic scores designed to stratify survival into four classes according to clinical and pathological features. The purpose of this study is to analyze the prognostic role of these scores using a large cohort of patients as an external reference. Methods: Overall survival analysis was performed using Log-Rank and Kaplan-Meier curves for each score. The probability of survival at 12, 36, and 60 months was tested using receiver operating characteristic (ROC) curves to determine sensitivity and specificity. Results: From the validation cohort of 437 patients, the analysis included 410 patients in the COMPASS group and 364 patients in the BIOSCOPE group (100% data completeness). We observed a different patient distribution between classes (high-risk for BIOSCOPE compared to COMPASS, p = 0.0001). Nevertheless, both COMPASS and BIOSCOPE effectively stratified overall survival (Log-Rank, p = 0.0001 in both cases), with a lack of discrimination between COMPASS classes II and III (p = n.s.). COMPASS at 12 m and BIOSCOPE at 60 m showed the best performance in terms of survival prediction (AUC of 0.82 and 0.81). The specificity of the two tests is good (median 81.3%), whereas sensibility is quite low (median 64.2%). Conclusion: Following external validation in a large population of patients with CRC-PM who are eligible for surgery, the COMPASS and BIOSCOPE scores exhibit high inter-test variability but effectively stratify cancer-related mortality risk. While the quality of the scores is similar, BIOSCOPE shows better inter-tier differentiation, suggesting that tumor molecular classification could improve test discrimination capability. More powerful stratification scores with the inclusion of novel predictors are needed.

2023 - Is Systemic Chemotherapy Useful in Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Colorectal Peritoneal Metastases? A Propensity-Score Analysis [Articolo su rivista]
Tonello, Marco; Baratti, Dario; Sammartino, Paolo; Di Giorgio, Andrea; Robella, Manuela; Sassaroli, Cinzia; Framarini, Massimo; Valle, Mario; Macrì, Antonio; Graziosi, Luigina; Coccolini, Federico; Lippolis, Piero Vincenzo; Gelmini, Roberta; Deraco, Marcello; Biacchi, Daniele; Santullo, Francesco; Vaira, Marco; Di Lauro, Katia; D'Acapito, Fabrizio; Carboni, Fabio; Milone, Erica; Donini, Annibale; Fugazzola, Paola; Faviana, Pinuccia; Sorrentino, Lorena; Pizzolato, Elisa; Cenzi, Carola; Del Bianco, Paola; Sommariva, Antonio
abstract

Purpose: Multimodal treatment of colorectal (CRC) peritoneal metastases (PM) includes systemic chemotherapy (SC) and surgical cytoreduction (CRS), eventually with hyperthermic intraperitoneal chemotherapy (HIPEC), in select patients. Considering lack of clear guidelines, this study was designed to analyze the role of chemotherapy and its timing in patients treated with CRS-HIPEC. Methods: Data from 13 Italian centers with PM expertise were collected by a collaborative group of the Italian Society of Surgical Oncology (SICO). Clinicopathological variables, SC use, and timing of administration were correlated with overall survival (OS), disease-free survival (DFS), and local (peritoneal) DFS (LDFS) after propensity-score (PS) weighting to reduce confounding factors. Results: A total of 367 patients treated with CRS-HIPEC were included in the propensity-score weighting. Of the total patients, 19.9% did not receive chemotherapy within 6 months of surgery, 32.4% received chemotherapy before surgery (pregroup), 28.9% after (post), and 18.8% received both pre- and post-CRS-HIPEC treatment (peri). SC was preferentially administered to younger (p = 0.02) and node-positive (p = 0.010) patients. Preoperative SC is associated with increased rate of major complications (26.9 vs. 11.3%, p = 0.0009). After PS weighting, there were no differences in OS, DFS, or LDFS (p = 0.56, 0.50, and 0.17) between chemotherapy-treated and untreated patients. Considering SC timing, the post CRS-HIPEC group had a longer DFS and LDFS than the pre-group (median DFS 15.4 vs. 9.8 m, p = 0.003; median LDFS 26.3 vs. 15.8 m, p = 0.026). Conclusions: In patients with CRC-PM treated with CRS-HIPEC, systemic chemotherapy was not associated with overall survival benefit. The adjuvant schedule was related to prolonged disease-free intervals. Additional, randomized studies are required to clarify the role and timing of systemic chemotherapy in this patient subset.

2023 - Laparoscopic Cytoreduction Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Peritoneal Surface Malignancies (PSM): Italian PSM Oncoteam Evidence and Literature Review [Articolo su rivista]
Sommariva, A.; Valle, M.; Gelmini, R.; Tonello, M.; Carboni, F.; De Manzoni, G.; Sorrentino, L.; Pasqual, E. M.; Bacchetti, S.; Sassaroli, C.; Di Giorgio, A.; Framarini, M.; Marrelli, D.; Casella, F.; Federici, O.
abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained increasing acceptance in clinical practice. Performing CRS and HIPEC laparoscopically represents a challenging and intriguing technical evolution. However, the experiences are limited, and the evidence is low. This retrospective analysis was performed on patients treated with laparoscopic CRS-HIPEC within the Italian Peritoneal Surface Malignancies Oncoteam. Clinical, perioperative, and follow-up data were extracted and collected on prospectively maintained databases. We added a systematic review according to the PRISMA method for English-language articles through April 2022 using the keywords laparoscopic, hyperthermic, HIPEC, and chemotherapy. From 2016 to 2022, fourteen patients were treated with Lap-CRS-HIPEC with curative intent within the Italian centers. No conversion to open was observed. The median duration of surgery was 487.5 min. The median Peritoneal Cancer Index (PCI) was 3, and complete cytoreduction was achieved in all patients. Two patients (14.3%) had major postoperative complications, one requiring reintervention. After a median follow-up of 16.9 months, eleven patients were alive without disease (78.6%), two patients developed recurrence (14.3%), and one patient died for unrelated causes (7.1%). The literature review confirmed these results. In conclusion, current evidence shows that Lap-CRS-HIPEC is feasible, safe, and associated with a favorable outcome in selected patients. An accurate patient selection will continue to be paramount in choosing this treatment.

2023 - PEG-Asparaginase Single-Agent Rescue in an Advanced Case of Monomorphic Epitheliotropic Intestinal T Cell Lymphoma [Articolo su rivista]
Barbieri, E.; Pozzi, S.; Gelmini, R.; Roncati, L.; Maccaferri, M.; Potenza, L.; Marasca, R.; Luppi, M.; Leonardi, G.
abstract

Purpose: MEITL is a very rare and highly aggressive peripheral T cell lymphoma with poor prognosis and for which there is no standard treatment. Treatment options for patients patients with relapsed/refractory disease are scarce and the choice of an appropriate rescue still represents an unmet need. Methods: Here, we report the case of a 65-year-old woman affected by MEITL, progressing after initial treatment with an anthracycline-based chemotherapy and surgery, who received single-agent PEG-asparaginase salvage therapy at our institution. Results: PEG-asparaginase single-agent rescue proved to be rapidly effective in controlling the disease and its associated paraneoplastic features. Nevertheless, toxicity was high and the patient died due to a treatment-related complication. Conclusion: The case we described brings new evidences on the effectiveness of PEG-asparaginase therapy in MEITL patients. Whether PEG-asparaginase should be included in the treatment course of MEITL patients could be the subject of future studies.

2022 - A narrative review about difficult laparoscopic cholecystectomy: technical tips [Articolo su rivista]
Missori, G.; Serra, F.; Gelmini, R.
abstract

Background: Laparoscopic cholecystectomy (LC) is the most practiced procedure in general surgery worldwide. It is nowadays the optimum surgical procedure for symptomatic gallbladder lithiasis. Nevertheless, it should not be underestimated since vascular and biliary duct injuries are not uncommon, with devastating consequences. This study aimed to advise the best surgical technical approach for LC according to the intraoperative situation to avoid accidental anatomical structures injuries. Methods: A traditional narrative literature search for articles published up to December 2021 was performed using the most common search engines (PubMed, Web of Science, Google Scholar). The search strategy utilized in all databases included the combination of the keywords: "laparoscopic cholecystectomy", "difficult cholecystectomy", "acute cholecystitis", "prevention bile duct injuries", "safe cholecystectomy". No restrictions were applied to the language of the publication if an English version of the article was available. Key Content and Findings: Difficult laparoscopic cholecystectomy (DLC) is a distressing condition. Its definition is not well established and may vary according to the surgeon's experience. Several techniques have been proposed to minimize the bile duct or hepatic injury risk during the challenging cholecystectomy. Conclusions: Although LC is nowadays the optimum surgical procedure for symptomatic gallbladder lithiasis, it should not be underestimated since vascular and biliary duct injuries are very morbid, significantly increase care costs, and often lead to litigations.

2022 - ASO Visual Abstract: Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy [Articolo su rivista]
Tonello, M.; Baratti, D.; Sammartino, P.; Di Giorgio, A.; Robella, M.; Sassaroli, C.; Framarini, M.; Valle, M.; Macri, A.; Graziosi, L.; Coccolini, F.; Lippolis, P. V.; Gelmini, R.; Deraco, M.; Biacchi, D.; Santullo, F.; Vaira, M.; Di Lauro, K.; D'Acapito, F.; Carboni, F.; Giuffre, G.; Donini, A.; Fugazzola, P.; Faviana, P.; Sorrentino, L.; Scapinello, A.; Del Bianco, P.; Sommariva, A.
abstract

2022 - Beyond Lymph Nodes: Splenectomy, Bursectomy and Omentectomy [Capitolo/Saggio]
Tiberio, Gam; Marano, L; Gelmini, R
abstract

We will discuss here the role of splenectomy, bursectomy and omentectomy in the light of recent literature, taking as a starting point the indications reported by the most important guidelines: those from the Italian Research Group for Gastric Cancer (2015) and from the Japanese Gastric Cancer Association (2018). Splenectomy is indicated in cases of advanced gastric cancer with infiltration of the spleen or the pancreas. Despite the fact that 8–28% of proximal third gastric cancers metastasize to the splenic hilum nodes, the role of splenectomy as a facilitator of station 10 clearance is controversial and should be considered on condition that it can be conducted safely. Bursectomy is no longer supported as a technique increasing surgical cure rates. Still, it may have a role in selected patients candidate to non-standard multimodal management of stage IV gastric cancer. Omentectomy has always been part of curative gastrectomy in order to ensure control of micrometastases. However, the recent literature discusses this role and consensus regarding its real benefit seems lost.

2022 - Correction: Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) (Annals of Surgical Oncology, (2021), 10.1245/s10434-021-11045-3) [Articolo su rivista]
Tonello, M.; Baratti, D.; Sammartino, P.; Di Giorgio, A.; Robella, M.; Sassaroli, C.; Framarini, M.; Valle, M.; Macri, A.; Graziosi, L.; Coccolini, F.; Lippolis, P. V.; Gelmini, R.; Deraco, M.; Biacchi, D.; Santullo, F.; Vaira, M.; Di Lauro, K.; D'Acapito, F.; Carboni, F.; Giuffre, G.; Donini, A.; Fugazzola, P.; Faviana, P.; Sorrentino, L.; Scapinello, A.; Del Bianco, P.; Sommariva, A.
abstract

Roberta Gelmini’s and Lorena Sorrentino’s names are correct as reflected here. Manuela Robella’s and Marco Vaira’s affiliation was corrected. The original article was corrected.

2022 - Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes [Articolo su rivista]
Marrelli, D.; Ansaloni, L.; Federici, O.; Asero, S.; Carbone, L.; Marano, L.; Baiocchi, G.; Vaira, M.; Coccolini, F.; Di Giorgio, A.; Framarini, M.; Gelmini, R.; Palopoli, C.; Accarpio, F.; Fagotti, A.
abstract

Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient’s perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively.

2022 - Development and Multicenter Validation of a Novel Immune-Inflammation-Based Nomogram to Predict Survival in Western Resectable Gastric and Gastroesophageal Junction Adenocarcinoma (GEA): The NOMOGAST [Articolo su rivista]
Salati, Massimiliano; De Ruvo, Nicola; Giglio, Mariano Cesare; Sorrentino, Lorena; Esposito, Giuseppe; Fenocchi, Sara; Cucciarrè, Giovanni; Serra, Francesco; Rossi, Elena Giulia; Vittimberga, Giovanni; Radi, Giorgia; Solaini, Leonardo; Morgagni, Paolo; Grizzi, Giulia; Ratti, Margherita; Gelsomino, Fabio; Spallanzani, Andrea; Ghidini, Michele; Ercolani, Giorgio; Dominici, Massimo; Gelmini, Roberta
abstract

2022 - Ileocecal deep infiltrating endometriosis with intestinal mucinous metaplasia and high-grade dysplasia [Articolo su rivista]
Alboni, C.; Spano Bascio, L.; Camacho Mattos, L.; Gallo, G.; Botticelli, L.; Cabry, F.; Facchinetti, F.; Gelmini, R.
abstract

2022 - Long-term effects of total vs. partial pancreatectomy among patients with pancreatic cancer: a population-based study [Articolo su rivista]
Yang, Zhiwen; Tao, Qiang; Mijiti, Salamu; Luo, Dandong; Tang, Xiang; Liu, Jia; Jiang, Lingmin; Liu, Zonghao; Liang, Chen; Tu, Xinyue; Zhao, Peng; Luu, Andreas Minh; Serra, Francesco; Gelmini, Roberta; Wang, Yong; Zheng, Yun
abstract

Background: Total pancreatectomy (TP) for pancreatic cancer (PC) has been limited historically for fear of elevated perioperative morbidity and mortality. With advances in perioperative care, TP may be an alternative option to partial pancreatectomy (PP). Limited evidence clarified the indication for these two procedures in PC patients, especially in patients with different tumor staging and location. Thus, this study aims to compare the outcomes after TP and PP for PCs of different T stages and locations. Methods: The study identified 14,456 PC patients with potentially curable primary tumor (T1???3) who received TP or PP from the Surveillance, Epidemiology, and End Results (SEER) database during 2000 to 2016. Detailed clinical and tumor covariates were all collected. Overall survival (OS) and cancer-specific survival (CSS) were the primary endpoints of interest in this study. OS and CSS were compared between patients after TP and PP using log-rank analysis. Results: For all patients, except for tumor location, TP group was comparable to the PP group. OS and CSS of the TP group were worse than of the PP group (median OS: 19 vs. 20 months, P=0.0058; median CSS: 24 vs. 26 months, P=0.00098, respectively). In stratifying analyses, TP was significantly related to worse OS and CSS than PP in pancreatic head and neck cancer patients with T2-stage tumors (median OS: 18 vs. 19 months, P=0.0016; median CSS: 22 vs. 24 months, P=0.00055, respectively), whereas for patients with T1-or T3-stage pancreatic head and neck cancer as well as T1-to T3-stage pancreatic body and tail cancer or overlapping location cancer, OS and CSS of the two groups were similar (all P>0.05). Conclusions: Compared with PP, TP offered worse prognosis in pancreatic head and neck cancer patients with T2-stage tumors, furthermore, TP and PP achieved comparable prognosis in patients with T1-or T3-stage pancreatic head and neck cancer as well as T1-to T3-stage pancreatic body and tail cancer or overlapping location cancer.

2022 - Polyphenols, Olive oil and Colonrectal cancer: the effect of Mediterranean Diet in the prevention [Articolo su rivista]
Mattioli, Anna Vittoria; Serra, Francesco; Spatafora, Francesco; Toni, Silvia; Farinetti, Alberto; Gelmini, Roberta
abstract

: In recent years, scientific research has shown that the incidence of various diseases, including some cancers, is relatively low in the Mediterranean Countries compared to that of other European countries or North America. This support the hypothesis that the Mediterranean diet, rich in bioactive food components, including methyl group donors, polyphenols, and fatty acids has efficacy in terms of prevention. Few studies evaluated the efficacy of Med Diet on colon cancer however they all support the beneficial effects of this Diet in preventing cancer.

2022 - Role of poorly differentiated cluster in gastric cancer: is it a new prognosis factor? [Articolo su rivista]
Sorrentino, L; De Ruvo, N; Serra, F; Salati, M; Ricciardolo, A A; Bonetti, L R; Gelmini, R
abstract

Poorly differentiated Clusters (PDCs) of tumor cells composed of more than five elements have been recently described in gastrointestinal cancers and correlate with a worse prognosis. Our study aims to investigate PDC occurrence in a series of patients with gastric cancer and correlate it with lymph node status and clinical outcome.

2022 - Selected Patients With Peritoneal Metastases From Breast Cancer May Benefit From Cytoreductive Surgery: The Results of a Multicenter Survey [Articolo su rivista]
Cardi, Maurizio; Pocard, Marc; Dico, Rea Lo; Fiorentini, Gianmaria; Valle, Mario; Gelmini, Roberta; Vaira, Marco; Pasqual, Enrico Maria; Asero, Salvatore; Baiocchi, Gianluca; Di Giorgio, Andrea; Spagnoli, Alessandra; Di Marzo, Francesco; Sollazzo, Bianca; D'Ermo, Giuseppe; Biacchi, Daniele; Iafrate, Franco; Sammartino, Paolo
abstract

BackgroundEven though breast cancer is the most frequent extra-abdominal tumor causing peritoneal metastases, clear clinical guidelines are lacking. Our aim is to establish whether cytoreductive surgery (CRS) could be considered in selected patients with peritoneal metastases from breast cancer (PMBC) to manage abdominal spread and allow patients to resume or complete other medical treatments. MethodsWe considered patients with PMBC treated in 10 referral centers from January 2002 to May 2019. Clinical data included primary cancer characteristics (age, histology, and TNM) and data on metastatic disease (interval between primary BC and PM, molecular subtype, other metastases, and peritoneal spread). Overall survival (OS) was estimated using the Kaplan-Meier method. Univariate and multivariable data for OS were analyzed using the Cox proportional hazards model. ResultsOf the 49 women with PMBC, 20 were treated with curative aim (CRS with or without HIPEC) and 29 were treated with non-curative procedures. The 10-year OS rate was 27%. Patients treated with curative intent had a better OS than patients treated with non-curative procedures (89.2% vs. 6% at 36 months, p < 0.001). Risk factors significantly influencing survival were age at primary BC, interval between BC and PM diagnosis, extra-peritoneal metastases, and molecular subtype. ConclusionsThe improved outcome in selected cases after a multidisciplinary approach including surgery should lead researchers to regard PMBC patients with greater attention despite their scarce epidemiological impact. Our collective efforts give new information, suggest room for improvement, and point to further research for a hitherto poorly studied aspect of metastatic BC.

2022 - Statins increase pathological response in locally advanced rectal cancer treated with chemoradiation: a multicenter experience. [Articolo su rivista]
Caputo, F; Santini, C; Casadei-Gardini, A; Cerma, K; Bardasi, C; Garajovà, I; Lattanzi, E; Passardi, A; Rapposelli, Ig; Spallanzani, A; Salati, M; Bonetti, Lr; Gelmini, R; Meduri, B; Piccoli, M; Pecchi, A; Benatti, S; Piacentini, F; Dominici, M; Luppi, G; Gelsomino, F.
abstract

Aims: To investigate the influence of various concomitant medications on outcomes in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Materials & methods: The authors retrospectively identified 246 patients from 2003 to 2018, collecting demographic and clinicopathological data of interest. Odds ratio (OR) was used to assess the association between concomitant drugs and outcomes. Results: The authors found an association between statins and a Dworak regression grade of 3-4 (OR = 8.78; p = 0.01). Furthermore, statins were significantly associated with more frequent chemoradiation-related toxicity (OR = 2.39; p = 0.0098) and chemotherapy dose reduction or discontinuation (OR = 2.26; p = 0.03). Conclusion: Despite higher frequency of radiotherapy and chemotherapy interruption or dose reduction, the concomitant use of statins during neoadjuvant chemoradiation proved to be associated with better tumor regression.

2022 - Strong impact of sarcopenia as a risk factor of survival in resected gastric cancer patients: first Italian report of a Bicentric study [Articolo su rivista]
Ricciardolo, A A; De Ruvo, N; Serra, F; Prampolini, F; Solaini, L; Battisti, S; Missori, G; Fenocchi, S; Rossi, E G; Sorrentino, L; Salati, M; Spallanzani, A; Cautero, N; Pecchi, A; Ercolani, G; Gelmini, R
abstract

Gastric cancer (GC) accounts for 4% of all cancers in Europe. Sarcopenia is a complex syndrome characterized by a loss of muscle mass and function associated with age, often present in neoplastic patients. Recently, several studies have shown a significant association between sarcopenia and poor prognosis in various pathological conditions. The current observational retrospective study investigates the association between sarcopenia and overall survival (OS) and recurrence-free survival (RFS) in patients with GC undergoing up-front surgery with curative intent. Resected GC patients' clinical records and CT images were retrospectively assessed. The preoperative CT calculation of the skeletal muscle index (SMI) at L3 level allowed us to categorize patients as sarcopenic or not. Kaplan-Meyer and univariate and multivariate Cox regression analyses were performed to determine the difference in survival and presence of independent prognostic factors. Fifty-five patients, 28 male and 27 female, out of 298 studied for gastric cancer were enrolled in the current study from two cancer referral centers in Italy. The preoperative CT calculation of the SMI at L3 level allowed us to identify 39 patients with and 16 without sarcopenia. A statistically significant difference between the sarcopenic and non-sarcopenic groups was observed in both OS and RFS (p < 0.023; p < 0.006). Moreover, sarcopenia was strongly correlated to a higher risk of recurrence in univariate and multivariate analysis (p < 0.02). Sarcopenia can be considered a critical risk factor for survival in patients with resectable GC treated with up-front surgery. Identifying sarcopenic patients at the time of diagnosis would direct selection of patients who could benefit from early nutritional and/or physical treatments able to increase their muscle mass and possibly improve the prognosis. More extensive multicenter studies are needed to address this issue.

2022 - The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis? [Articolo su rivista]
De Simone, B.; Abu-Zidan, F. M.; Chouillard, E.; Di Saverio, S.; Sartelli, M.; Podda, M.; Gomes, C. A.; Moore, E. E.; Moug, S. J.; Ansaloni, L.; Kluger, Y.; Coccolini, F.; Landaluce-Olavarria, A.; Estraviz-Mateos, B.; Uriguen-Etxeberria, A.; Giordano, A.; Luna, A. P.; Amin, L. A. H.; Hernandez, A. M. P.; Shabana, A.; Dzulkarnaen, Z. A.; Othman, M. A.; Sani, M. I.; Balla, A.; Scaramuzzo, R.; Lepiane, P.; Bottari, A.; Staderini, F.; Cianchi, F.; Cavallaro, A.; Zanghi, A.; Cappellani, A.; Campagnacci, R.; Maurizi, A.; Martinotti, M.; Ruggieri, A.; Jusoh, A. C.; Rahman, K. A.; Zulkifli, A. S. M.; Petronio, B.; Matias-Garcia, B.; Quiroga-Valcarcel, A.; Mendoza-Moreno, F.; Atanasov, B.; Campanile, F. C.; Vecchioni, I.; Cardinali, L.; Travaglini, G.; Sebastiani, E.; Chooklin, S.; Chuklin, S.; Cianci, P.; Restini, E.; Capuzzolo, S.; Curro, G.; Filippo, R.; Rispoli, M.; Aparicio-Sanchez, D.; Munoz-Cruzado, V. D.; Barbeito, S. D.; Delibegovic, S.; Kesetovic, A.; Sasia, D.; Borghi, F.; Giraudo, G.; Visconti, D.; Doria, E.; Santarelli, M.; Luppi, D.; Bonilauri, S.; Grossi, U.; Zanus, G.; Sartori, A.; Piatto, G.; De Luca, M.; Vita, D.; Conti, L.; Capelli, P.; Cattaneo, G. M.; Marinis, A.; Vederaki, S. -A.; Bayrak, M.; Altintas, Y.; Uzunoglu, M. Y.; Demirbas, I. E.; Altinel, Y.; Meric, S.; Aktimur, Y. E.; Uymaz, D. S.; Omarov, N.; Azamat, I.; Lostoridis, E.; Nagorni, E. -A.; Pujante, A.; Anania, G.; Bombardini, C.; Bagolini, F.; Gonullu, E.; Mantoglu, B.; Capoglu, R.; Cappato, S.; Muzio, E.; Colak, E.; Polat, S.; Koylu, Z. A.; Altintoprak, F.; Bayhan, Z.; Akin, E.; Andolfi, E.; Rezart, S.; Kim, J. I.; Jung, S. W.; Shin, Y. C.; Enciu, O.; Toma, E. A.; Medas, F.; Canu, G. L.; Cappellacci, F.; D'Acapito, F.; Ercolani, G.; Solaini, L.; Roscio, F.; Clerici, F.; Gelmini, R.; Serra, F.; Rossi, E. G.; Fleres, F.; Clarizia, G.; Spolini, A.; Ferrara, F.; Nita, G.; Sarnari, J.; Gachabayov, M.; Abdullaev, A.; Poillucci, G.; Palini, G. M.; Veneroni, S.; Garulli, G.; Piccoli, M.; Pattacini, G. C.; Pecchini, F.; Argenio, G.; Armellino, M. F.; Brisinda, G.; Tedesco, S.; Fransvea, P.; Ietto, G.; Franchi, C.; Carcano, G.; Martines, G.; Trigiante, G.; Negro, G.; Vega, G. M.; Gonzalez, A. R.; Ojeda, L.; Piccolo, G.; Bondurri, A.; Maffioli, A.; Guerci, C.; Sin, B. H.; Zuhdi, Z.; Azman, A.; Mousa, H.; al Bahri, S.; Augustin, G.; Romic, I.; Moric, T.; Nikolopoulos, I.; Andreuccetti, J.; Pignata, G.; D'Alessio, R.; Kenig, J.; Skorus, U.; Fraga, G. P.; Hirano, E. S.; de Lima Bertuol, J. V.; Isik, A.; Kurnaz, E.; Asghar, M. S.; Afzal, A.; Akbar, A.; Nikolouzakis, T. K.; Lasithiotakis, K.; Chrysos, E.; Das, K.; Ozer, N.; Seker, A.; Ibrahim, M.; Hamid, H. K. S.; Babiker, A.; Bouliaris, K.; Koukoulis, G.; Kolla, C. -C.; Lucchi, A.; Agostinelli, L.; Taddei, A.; Fortuna, L.; Agostini, C.; Licari, L.; Viola, S.; Callari, C.; Laface, L.; Abate, E.; Casati, M.; Anastasi, A.; Canonico, G.; Gabellini, L.; Tosi, L.; Guariniello, A.; Zanzi, F.; Bains, L.; Sydorchuk, L.; Iftoda, O.; Sydorchuk, A.; Malerba, M.; Costanzo, F.; Galleano, R.; Monteleone, M.; Costanzi, A.; Riva, C.; Waledziak, M.; Kwiatkowski, A.; Czyzykowski, L.; Major, P.; Strzalka, M.; Matyja, M.; Natkaniec, M.; Valenti, M. R.; Di Vita, M. D. P.; Sotiropoulou, M.; Kapiris, S.; Massalou, D.; Veroux, M.; Volpicelli, A.; Gioco, R.; Uccelli, M.; Bonaldi, M.; Olmi, S.; Nardi, M.; Livadoti, G.; Mesina, C.; Dumitrescu, T. V.; Ciorbagiu, M. C.; Ammendola, M.; Ammerata, G.; Romano, R.; Slavchev, M.; Misiakos, E. P.; Pikoulis, E.; Papaconstantinou, D.; Elbahnasawy, M.; Abdel-elsalam, S.; Felsenreich, D. M.; Jedamzik, J.; Michalopoulos, N. V.; Sidiropoulos, T. A.; Papadoliopoulou, M.; Cillara, N.; Deserra, A.; Cannavera, A.; Negoi, I.; Schizas, D.; Syllaios, A.; Vagios, I.; Gourgiotis, S.; Dai, N.; Gurung, R.; Norrey, M.; Pesce, A.; Feo, C. V.; Fabbri, N.; Machairas, N.; Dorovinis, P.; Keramida, M. D.; Mulita, F.; Verras, G. I.; Vailas, M.; Yalkin, O.; Iflazoglu, N.; Yigit, D.; Baraket, O.; Ayed, K.; Ghalloussi, M.; Patias, P
abstract

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract: [Figure not available: see fulltext.]

2022 - Vaginal Evisceration of Small Bowel With Extraperitoneal Ileal Resection of the Herniated Loops: A Case Report [Articolo su rivista]
Missori, Giulia; Marchesini, Nicolò Luigi Arrigo; Mosca, Donatella; Ricciardolo, Andrea Aurelio; Serra, Francesco; Gelmini, Roberta
abstract

Introduction: Vaginal evisceration is an extremely rare surgical emergency that can be described as the extrusion of abdominal viscera through a defect or a rupture of the vaginal wall. We reported the case of an acute abdomen due to small bowel evisceration secondary to vaginal vault dehiscence that required combined vaginal-abdominal approach Case: We discuss the case of a 72-year-old female who presented to the emergency department for a large prolapse with visible extrusion of the small bowel per vagina. The eviscerated bowel was resected by external vaginal approach due to excessive swelling of the loops which made it impossible to reduce them through the vagina defect. A midline laparotomy was undertaken for further assessment, and the vault defect was closed by transabdominal repair Conclusion: From its first description in 1864, just a few cases of vaginal evisceration had been described in the medical literature; the most common organ to eviscerate is the distal ileum, although cases of omentum, colon, fallopian tube, and appendix evisceration have also been reported. We described a rare case of transvaginal evisceration of the small bowel in our emergency department; it is a rare surgical emergency that must be managed to prevent serious consequences, such as bowel ischemia and necrosis, sepsis, and death. We suggest that a multidisciplinary approach to prompt examination and management by gynecologists and general surgeons is recommended to reduce the risk of morbidity and mortality. With this paper the authors would like to share the surgical manage of this rare emergency with other surgeons all around the world.

2021 - Adjunctive Immunotherapy With Polyclonal Ig-M Enriched Immunoglobulins for Septic Shock: From Bench to Bedside. The Rationale for a Personalized Treatment Protocol [Articolo su rivista]
Busani, Stefano; Roat, Erika; Tosi, Martina; Biagioni, Emanuela; Coloretti, Irene; Meschiari, Marianna; Gelmini, Roberta; Brugioni, Lucio; DE BIASI, Sara; Girardis, Massimo
abstract

Septic shock still has a high mortality rate which has not hinted at decreasing in recent years. Unfortunately, randomized trials failed mainly because the septic patient was considered as a homogeneous entity. All this creates a sort of therapeutic impotence in everyday clinical practice in treating patients with septic shock. The need to customize therapy on each patient with sepsis has now become an established necessity. In this scenario, adjuvant therapies can help if interpreted as modulators of the immune system. Indeed, the host’s immune response differs from patient to patient based on the virulence of the pathogen, comorbidity, infection site, and prolonged hospitalization. In this review, we summarize the rationale for using immunoglobulins as an adjunctive treatment. Furthermore, we would like to suggest a possible protocol to personalize treatment in the different clinical scenarios of the host’s response to serious infectious events.

2021 - Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study) [Articolo su rivista]
Sartori, Alberto; Podda, Mauro; Botteri, Emanuele; Passera, Roberto; Agresta, Ferdinando; Arezzo, Alberto; Serra, Francesco; Gelmini, Roberta
abstract

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020.

2021 - Complication of Hirschsprung’s disease immediately after pregnancy: A rare case report [Articolo su rivista]
Sergi, William; Serra, Francesco; Cucciarrè, Giovanni; De Ruvo, Nicola; Gelmini, Roberta
abstract

2021 - Covid-19 and hepatic injury: A systematic review [Articolo su rivista]
Serra, Francesco; Bonaduce, Isabella; De ruvo, Nicola; Cautero, Nicola; Brugioni, Lucio; Gelmini, Roberta
abstract

After observing patients with pneumonia of unknown cause in Wuhan (China), a novel Coronavirus was identified as 2019 novel coronavirus (COVID-19). Gastrointestinal symptoms are common in COVID-19 and can be present in up to 26% of patients in some populations; the most common is diarrhoea, followed by nausea and/or vomiting and abdominal pain. A few studies recently described liver impairment as a common manifestation of the virus; therefore, a correlation between the severity of the disease and liver injury is being sought up.

2021 - Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases [Articolo su rivista]
Brugioni, L.; Bertellini, E.; Ravazzini, M.; Barchetti, M.; Borsatti, A.; Martella, P.; Girardis, M.; Serra, F.; Tricoli, A.; Nicolini, M.; Bianchini, M.; Schepis, F.; Tazzioli, G.; Pinelli, G.; Romagnoli, E.; Gelmini, R.
abstract

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.

2021 - Idiopathic chylous peritonitis mimicking acute appendicitis A case report [Articolo su rivista]
Manco, G.; Caramaschi, S.; Prestigiacomo, G.; Rossi, E. G.; Fenocchi, S.; Gelmini, R.
abstract

We report an uncommon case of idiopathic acute chylous peritonitis mimicking an acute appendicitis in a 30-year-old female patient with a 2-day history of abdominal pain, nausea and vomiting. Chylous ascites is a rare form of ascites characterized by the presence of a milky fluid rich in triglycerides. It occurs as a result of a damage to the lymphatic system due to trauma or other benign and malignant pathologies. Although the most common clinical presentation is progressive painless abdominal distension, less frequently it can cause acute abdomen symptoms. The management is based on identifying and treating the underlying pathology. Aspiration of the fluid and drainage are the only therapy required if a clinically diagnosis cannot be made. Surgical laparoscopic exploration is necessary to make a diagnosis and to treat effectively acute abdomen cases.In the absence of a significant determining pathology, we talk about idiopathic chylous peritonitis. KEY WORDS: Chylous ascites, peritonitis, laparoscopy.

2021 - Methicillin-Resistant Staphylococcus aureus Peritonitis due to Hematogenous Dissemination from Central Venous Catheter in a Maintenance Dialysis Patient [Articolo su rivista]
Alfano, G.; Frisina, M.; Morisi, N.; Ascione, E.; Fontana, F.; Mori, G.; Cerami, C.; Serra, F.; Cabry, F.; Bonucchi, D.; Gelmini, R.; Guaraldi, G.; Magistroni, R.; Cappelli, G.
abstract

Staphylococcus aureus is a Gram-positive bacterium commonly associated with severe infections in hospitalized patients. S. aureus produces many virulence factors leading to local and distant pathological processes. Invasiveness of S. aureus generally induces metastatic infections such as bacteremia, infective endocarditis, osteomyelitis, arthritis, and endophthalmitis. Peritoneal localization from extra-abdominal infection can be a potential consequence of S. aureus infection. Two cases of metastatic peritonitis have been described in patients on peritoneal dialysis with concomitant peripheral vascular catheter-related bloodstream infection. We reported a case of peritoneal metastatic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in a patient on maintenance hemodialysis. A 37-year-old man was admitted with fever and chill due to jugular central vascular catheter (CVC)-related bloodstream infection caused by MRSA. CVC was placed after switching the patient from peritoneal dialysis to hemodialysis for scarce adherence to fluid restriction. Detection of MRSA on the peritoneal effluent combined with a total white blood cell count of 554 cells/mm3 prompted the diagnosis of satellite MRSA peritonitis. Antibiotic treatment with daptomycin and simultaneous CVC and peritoneal catheter removal resolved the infectious process. No further metastatic localizations were detected elsewhere. In conclusion, S. aureus can induce metastatic infections far from the site of primary infection. As reported in this case, peritonitis can be secondary to the hematogenous dissemination of S. aureus especially in hospitalized patients having a central line.

2021 - Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [Articolo su rivista]
Marco, Tonello; Dario, Baratti; Paolo, Sammartino; Andrea, Di Giorgio; Manuela, Robella; Cinzia, Sassaroli; Massimo, Framarini; Mario, Valle; Antonio, Macrì; Luigina, Graziosi; Federico, Coccolini; Piero Vincenzo, Lippolis; Gelmini, Roberta; Marcello, Deraco; Daniele, Biacchi; Francesco, Santullo; Marco, Vaira; Katia, Di Lauro; Fabrizio, D'Acapito; Fabio, Carboni; Giuseppe, Giuffrè; Annibale, Donini; Paola, Fugazzola; Pinuccia, Faviana; Sorrentino, Lorena; Antonio, Scapinello; Paola, Del Bianco; Antonio, Sommariva
abstract

Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) leads to prolonged survival for selected patients with colorectal (CRC) peritoneal metastases (PM). This study aimed to analyze the prognostic role of micro-satellite (MS) status and RAS/RAF mutations for patients treated with CRS. Methods Data were collected from 13 Italian centers with PM expertise within a collaborative group of the Italian Society of Surgical Oncology. Clinical and pathologic variables and KRAS/NRAS/BRAF mutational and MS status were correlated with overall survival (OS) and disease-free survival (DFS). Results The study enrolled 437 patients treated with CRS-HIPEC. The median OS was 42.3 months [95% confidence interval (CI), 33.4-51.2 months], and the median DFS was 13.6 months (95% CI, 12.3-14.9 months). The local (peritoneal) DFS was 20.5 months (95% CI, 16.4-24.6 months). In addition to the known clinical factors, KRAS mutations (p = 0.005), BRAF mutations (p = 0.01), and MS status (p = 0.04) were related to survival. The KRAS- and BRAF-mutated patients had a shorter survival than the wild-type (WT) patients (5-year OS, 29.4% and 26.8% vs 51.5%, respectively). The patients with micro-satellite instability (MSI) had a longer survival than the patients with micro-satellite stability (MSS) (5-year OS, 58.3% vs 36.7%). The MSI/WT patients had the best prognosis. The MSS/WT and MSI/mutated patients had similar survivals, whereas the MSS/mutated patients showed the worst prognosis (5-year OS, 70.6%, 48.1%, 23.4%; p = 0.0001). In the multivariable analysis, OS was related to the Peritoneal Cancer Index [hazard ratio (HR), 1.05 per point], completeness of cytoreduction (CC) score (HR, 2.8), N status (HR, 1.6), signet-ring (HR, 2.4), MSI/WT (HR, 0.5), and MSS/WT-MSI/mutation (HR, 0.4). Similar results were obtained for DFS. Conclusion For patients affected by CRC-PM who are eligible for CRS, clinical and pathologic criteria need to be integrated with molecular features (KRAS/BRAF mutation). Micro-satellite status should be strongly considered because MSI confers a survival advantage over MSS, even for mutated patients.

2021 - Peritoneal carcinomatosis from colorectal cancer in the pediatric population: Cytoreductive surgery and HIPEC. A systematic review [Articolo su rivista]
Sorrentino, Lorena; Serra, Francesco; Cabry, Francesca; Cautero, Nicola; Zmora, Osnat; Gelmini, Roberta
abstract

Colorectal cancer (CRC) is a rare condition in the pediatric population, but it is usually associated with worse prognosis compared to the adult population. Surgical resection is the gold standard and most effective treatment for CRC. Cytoreductive surgery (CRS) and Heated Intra-Peritoneal Chemotherapy (HIPEC) is a feasible option in resectable primary tumour with carcinomatosis and non-evidence of extra-abdominal disease. Although it is very uncommon in children when performed, CRS-HIPEC is based on the description by Sugarbaker et al. and the two most common administrated drugs are Cisplatin and Mitomycin-C. We present a review of the cases found in the literature of peritoneal carcinomatosis from CRC treated with CRS and HIPEC in children. A systematic search was performed in the major databases up to February 2020. We included all the reviews and studies reporting clinical data on pediatric patients with peritoneal colorectal carcinomatosis. Nine cases were extracted from the literature. Patient age was between 11 and 16 years old. All patients underwent neoadjuvant chemotherapy. All patients were treated with HIPEC and the majority of them received a complete cytoreduction (CC-0). At follow-up, three patients were found free from disease with an average time of follow up of 74 weeks (40–100). In 33% of cases, recurrence was described. No postoperative death within 30 days from surgery was observed. CRS and HIPEC can be a feasible option for CRC peritoneal carcinomatosis in children. Because CRC is unusual among the pediatric population, multi-institutional studies should be done to achieve larger cohorts and a more reliable analysis.

2021 - Revisited Hyperoxia Pathophysiology in the Perioperative Setting: A Narrative Review [Articolo su rivista]
Busani, Stefano; Sarti, Marco; Serra, Francesco; Gelmini, Roberta; Venturelli, Sophie; Munari, Elena; Girardis, Massimo
abstract

2021 - Short-term and long term morbidity in robotic pancreatic surgery: a systematic review [Articolo su rivista]
Serra, Francesco; Bonaduce, Isabella; De Ruvo, Nicola; Cautero, Nicola; Gelmini, Roberta
abstract

2021 - Subclinical Atherosclerosis at Peripheral Arteries in Obese Individuals. [Articolo su rivista]
Farinetti, A; Castaniere, I; Clini, E; Migaldi, M; Gelmini, R; Scaringi Raspagliesi, F; Ara, N; Serra, F; Spatafora, F; Genazzani, A; Mattioli, Av.
abstract

Evidence on relationship between obesity and peripheral arterial disease (PAD) are controversial. The aim of the present study is to evaluate the presence of subclinical atherosclerosis at all level of the explorable vascular segments with a systematic method in a selected population of young obese submitted to a comprehensive rehabilitation course. A group of 50 consecutive morbidly obese (BMI>30) was included. All patients underwent Doppler evaluation including intima media thickness (IMT) and presence/absence of plaques. We found that vessels in the upper segment of the body demonstrate the presence of thickening and/or plaques at the level of the carotid segments but not of the subclavian arteries. The IMT of the right Common Carotid Artery (CCA) (1.49 + 1.38 versus 0.62 + 0.23; p=0.037) and of the left CCA (1.66 + 1.89 versus 0.45 + 0.26; p=0.034) was greater in patients. Vessels of the lower segment demonstrate the presence of thickening and/or plaques at the iliac but not at femoral level. The control group did not present vessel thickening at any level. In conclusions asymptomatic vascular damage may be present in different segment of peripheral vessels, thus suggesting an early risk for developing an overt vascular disease over time in obese.

2021 - The using of sealants in pancreatic surgery: A Systematic Review [Articolo su rivista]
Serra, Francesco; Bonaduce, Isabella; Rossi, Elena Giulia; De Ruvo, Nicola; Cautero, Nicola; Gelmini, Roberta
abstract

2020 - A new anterior approach to parastomal hernia repair (PHR) with linear stapler suture: A case report [Articolo su rivista]
Serra, Francesco; Bonaduce, Isabella; Cabry, Francesca; Sorrentino, Lorena; Iaquinta, Tommaso; Fenocchi, Sara; Gelmini, Roberta
abstract

2020 - Adjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study [Articolo su rivista]
Coloretti, I.; Biagioni, E.; Venturelli, S.; Munari, E.; Tosi, M.; Roat, E.; Brugioni, L.; Gelmini, R.; Venturelli, C.; Girardis, M.
abstract

Purpose: Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose hydrocortisone because poorly responsive to vasopressors. Aim of this study is to verify whether triple therapy rather than steroids alone can improve outcome in patients with refractory shock. Materials and methods: In this before-after retrospective analysis, we compared septic shock patients admitted to our intensive care unit (ICU) who received triple therapy from June 2017 to November 2019 to septic shock patients who received only hydrocortisone from January 2015 to June 2017. Patients of the two study periods were matched 1:1 using a propensity score model. Results: A final cohort of 56 patients treated with triple therapy were matched to 56 patients treated only with steroids. Triple therapy reduced the length of mechanical ventilation (p = 0,01) and showed a trend in lowering the 30-day and hospital mortality compared to therapy with only hydrocortisone. Conclusions: Although with significant limitations, our experience indicated that triple therapy seems to provide an improvement of clinical outcomes in patients with refractory septic shock.

2020 - An unusual case of bowel obstruction in emergency surgery: The heterotopic mesenteric ossification [Articolo su rivista]
Ricciardolo, Andrea Aurelio; De Ruvo, Nicola; Caramaschi, Stefania; Serra, Francesco; Farinetti, Alberto; Mattioli, Anna Vittoria; Gelmini, Roberta
abstract

The heterotopic mesenteric ossification, also known as myositis ossificans, is a rare form of heterotopic ossification, a metaplastic phenomenon where new bone is formed in the mesenteric base, generally after abdominal trauma (surgical or other). The pathophysiology of heterotopic mesenteric ossification is unknown; clinical presentation is not specific, with vague abdominal symptoms, uncertain radiological findings, and often regular laboratory exams. No consensus exists on the best possible approach, although it might well be both medical and surgical. We reviewed the clinical history of a 28-year-old man with a recent motor vehicle accident who was admitted to our surgical unit with symptoms consistent with a small bowel obstruction; after surgery, a diagnosis of myositis ossificans was surprisingly made.

2020 - An unusual case of large endometrioma within the rectus abdominis muscle misdiagnosed as desmoid tumour [Articolo su rivista]
Manco, G.; Caramaschi, S.; Serra, F.; Tarantini, A.; Schiavo, G.; Alboni, C.; Gelmini, R.
abstract

We describe an unusual case of giant intramuscular abdominal endometrioma clinically misdiagnosed as desmoid tumour in a 36-year-old female patient with a one-year history of lower abdominal pain. Endometriosis is defined by the presence of endometrial tissue outside the uterine cavity, associated with fibrosis and inflammatory reaction. Although the abdominal wall is one of the most frequent sites of extra pelvic endometriosis, the localization in the anterior rectus abdominis muscle is unusual and associated with previous cesarean section. In most cases, the preoperative diagnosis is erroneous because the different imaging modalities are nonspecific but only useful in determining the extent of disease and in the planning of operative resection. A better acquaintance with the imaging presentation of abdominal wall endometriosis holds the potential of positively impact disease confirmation and may play a crucial role in the face of innovation in treatment. KEY WORDS: Desmoid tumour, Endometrioma, Surgery.

2020 - Case Report: Metastatic breast cancer to the gallbladder [Articolo su rivista]
Missori, Giulia; Serra, Francesco; Prestigiacomo, Giorgia; Ricciardolo, Andrea Aurelio; Brugioni, Lucio; Gelmini, Roberta
abstract

Cholecystitis is one of the leading causes of emergency surgical interventions; the occurrence of metastases to the gallbladder is rare and has only been reported in the literature exceptionally. Metastatic breast cancer to the gallbladder is even less frequent; in fact, breast cancer usually metastasizes to bone, lung, lymph nodes, liver and brain. We report the case of an 83-year-old female patient with a previous history of breast surgery with axillary dissection in 1997, followed by adjuvant chemotherapy due to invasive ductal carcinoma of the left breast. The patient was admitted at the emergency department for sepsis and an episode of acute kidney failure, anuria and fever. Right-upper quadrant abdominal pain triggered by food intake and abdominal tenderness was also present, placing the diagnostic suspicion of biliary sepsis due to acute cholecystitis. The histological examination of the surgical specimen highlighted the presence of metastasis from an infiltrating ductal breast carcinoma with positive hormone receptors. We also report here the results of a review of the literature looking at articles describing cases of gallbladder metastasis from breast cancer.

2020 - Case report of a patient who survived after cardiac arrest and cardiogenic shock by anaphylactic reaction to gadolinium during magnetic resonance imaging [Articolo su rivista]
Biagioni, Emanuela; Coloretti, Irene; Disalvo, Fabrizio; Andreotti, Alberto; Sani, Francesco; Torricelli, Pietro; Gelmini, Roberta; Girardis, Massimo
abstract

We report the case of a young adult which survived to anaphylactic shock caused by gadolinium-based contrast agent (GBCA) contrast agent infusion. The patient had no comorbidities and previous history of allergic reactions to contrast agents and underwent elective magnetic resonance imaging (MRI) for parotid swelling. Seven years before he received intravenous GBCA administration during an MRI, which exact chemical composition is unknown, without any allergic reaction. After intravenous injection of GBCA for MRI the patient developed anaphylactic shock, causing respiratory failure, cardiac arrest, and cardiogenic shock after return of spontaneous circulation. Because of the rarity of the described event, this report has the aim to raise awareness in the healthcare personnel of the possibility of these life-threatening adverse reactions from GBCAs also in a patient without history of allergy to contrast agents and suggest a possible clinical management of these patients.

2020 - Correction to: Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospectivetrial on 1225 cases comparing intra corporeal versus extra corporeal ileo‑colic side‑to‑side anastomosis (Surgical Endoscopy, (2019), 10.1007/s00464-019-07255-2) [Articolo su rivista]
Anania, G.; Agresta, F.; Artioli, E.; Rubino, S.; Resta, G.; Vettoretto, N.; Petz, W. L.; Bergamini, C.; Arezzo, A.; Valpiani, G.; Morotti, C.; Silecchia, G.; Adamo, V.; Agrusa, A.; Alemanno, G.; Allaix, M. E.; Alo, A.; Altamura, A.; Ambrosi, A.; Antoniutti, M.; Apa, D.; Arcuri, G.; Baiocchi, G. L.; Balani, A.; Baldazzi, G.; Basti, M.; Benvenuto, C.; Berti, S.; Boni, L.; Borghi, F.; Botteri, E.; Brachet Contul, R.; Brescia, A.; Budassi, A.; Cafagna, L.; Calgaro, M.; Calo, P. G.; Campagnacci, R.; Canova, G.; Canu, G. L.; Caracino, V.; Carcoforo, P.; Carlini, M.; Casali, L.; Cassetti, D.; Cassinotti, E.; Catarci, M.; Cesari, M.; Checcacci, P.; Ciano, P.; Clementi, M.; Cocorullo, G.; Colombo, F.; Concone, G.; Contine, A.; Coppola, M.; Coratti, A.; Corcione, F.; Corleone, P.; Covotta, L.; Cuccurullo, D.; Cumbo, P.; D'Ambrosio, G.; Deangelis, F.; Deluca, M.; Demanzini, N.; Denisco, C.; Depalma, G. D.; Depaolis, P.; Degiuli, M.; Delogu, D.; Delrio, P.; Deserra, A.; Donini, A.; Elmore, U.; Ercolani, G.; Erdas, E.; Fabris, L.; Ferrari, G.; Feo, C.; Fidanza, F.; Foschi, D.; Galleano, R.; Garulli, G.; Gatti, F.; Gattolin, A.; Gelati, S.; Gelmini, R.; Ghazouani, O.; Gioffre, A.; Gobbi, S.; Grammatico, V.; Guariniello, A.; Giannessi, S.; Guerrieri, M.; Guerriero, L.; Guerriero, G.; Impellizzeri, H.; Izzo, M.; Jovine, E.; Lezoche, G.; Lirusso, C.; Lombardi, R.; Longoni, M.; Lucchi, A.; Luzzi, A. P.; Marini, P.; Marrosu, A. G.; Martino, A.; Mazza, R.; Mazzoccato, S.; Medas, F.; Meloni, A.; Milone, M.; Minciotti, E.; Monari, F.; Moretto, G.; Muttillo, I. A.; Navarra, G.; Neri, S.; Oldani, A.; Olmi, S.; Opocher, E.; Osenda, E.; Ottonello, R.; Panebianco, V.; Pavanello, M.; Pecchini, F.; Pellegrino, L.; Pennisi, D.; Perrotta, N.; Pertile, D.; Petri, R.; Picchetto, A.; Piccoli, M.; Pirrera, B.; Pisani Ceretti, A.; Pisano, M.; Podda, M.; Portolani, N.; Presenti, L.; Puzziello, A.; Razzi, S.; Rega, D.; Restini, E.; Ricci, G.; Rigamonti, M.; Rivolta, U.; Robustelli, V.; Romairone, E.; Rosati, R.; Rosso, E.; Roviello, F.; Sala, S.; Santarelli, M.; Sarro, G.; Sartori, A.; Scabini, S.; Scognamillo, F.; Sechi, R.; Solaini, L.; Soliani, G.; Soliani, P.; Soligo, E.; Sorrentino, M.; Spinoglio, G.; Stratta, E.; Taddei, A.; Talamo, G.; Targa, S.; Tartaglia, N.; Testa, S.; Ubiali, P.; Valeri, A.; Vasta, F.; Verzelli, A.; Vicentini, R.; Viola, G.; Violi, V.; Zago, M.; Zampino, L.
abstract

Due to an error in production the members of SICE CoDIG (Colon Dx Italian Group) listed in the Acknowledgments were not tagged correctly as authors in the XML of this article. This listing is presented again here: SICE CoDIG (ColonDxItalianGroup): V. Adamo (S Lazzaro Alba – CN), A. Agrusa (Palermo), G. Alemanno (Firenze), M.E. Allaix (Torino), A. Alò (Orbassano TO), A. Altamura (Tricase – LE), A. Ambrosi (Foggia), M. Antoniutti (Bassano del Grappa – VI), D. Apa (Roma), G. Arcuri (Gubbio – PG), G.L Baiocchi (Brescia), A. Balani (Gorizia), G. Baldazzi (Milano), M. Basti (Pescara), C. Benvenuto (Protogruaro – VE), S. Berti (La Spezia), L. Boni (Milano), F. Borghi (Cuneo), E. Botteri (Brescia), R. Brachet Contul (Aosta), A. Brescia (Roma), A. Budassi (Frabriano - AN), L. Cafagna (Andria), M. Calgaro (S Lazzaro Alba – CN), P.G. Calò (Cagliari), R. Campagnacci (Jesi – AN), G. Canova (Borgosesia – VC), G.L. Canu (Cagliari), V. Caracino (Pescara), P. Carcoforo (Ferrara), M. Carlini (Roma), L. Casali (Fidenza – PR), D. Cassetti (Siena), E. Cassinotti (Milano), M. Catarci (Ascoli Piceno), M. Cesari (Città di Castello – PG), P. Checcacci (Firenze), P. Ciano (Ascoli Piceno), M. Clementi (L’ Aquila), G. Cocorullo (Palermo), F. Colombo (Milano), G. Concone (Milano), A. Contine (Città di Castello – PG), M. Coppola (Lanusei – NU), A. Coratti (Firenze), F. Corcione (Napoli), P. Corleone (Trieste), L. Covotta (Contrada Pozzillo – AV), D. Cuccurullo (Napoli), P. Cumbo (Chieri – TO), G. D’Ambrosio (Roma), F. De Angelis (Latina), M. De Luca (Montebelluna –TV), N. De Manzini (Trieste), C. De Nisco (Nuoro), G.D. De Palma (Napoli), P. De Paolis (Torino), M. Degiuli (Orbassano – TO), D. Delogu (Lanusei – NU), P. Delrio (Napoli), A. Deserra (Cagliari), A. Donini (Perugia), U. Elmore (Milano), G. Ercolani (Forlì), E. Erdas (Cagliari), L. Fabris (Cles – TN), G. Ferrari (Milano), C. Feo (Valle Oppio – FE), F. Fidanza (Portogruaro – VE), D. Foschi (Milano),R. Galleano (Pietra Ligure – SV), G. Garulli (Rimini), F. Gatti (Milano), A. Gattolin (Mondovì – CN), S. Gelati (Conegliano Veneto – TV), R. Gelmini (Modena), O. Ghazouani (Pietra Ligure – SV), A. Gioffrè (Roma), S. Gobbi (Olbia), V. Grammatico (Chieri – TO), A. Guariniello (Ravenna), S. Giannessi (Pistoia), M. Guerrieri (Ancona), L. Guerriero (Napoli), G. Gullotta (Palermo), H. Impellizzeri (Peschiera del Garda – VR), M. Izzo (Firenze), E. Jovine (Bologna), G. Lezoche (Ancona), C. Lirusso (Udine), R. Lombardi (Bologna), M. Longoni (Milano), A. Lucchi (Riccione – RN), A.P. Luzzi (Genova), P. Marini (Roma), A.G. Marrosu (Sassari), A. Martino (Udine), R. Mazza (Perugia), S. Mazzoccato (Jesi – AN), F. Medas (Cagliari), A. Meloni (San Gavino Monreale – VS), M. Milone (Napoli), E. Minciotti (Gubbio – PG), F. Monari (Riccione – RN), G. Moretto (Peschiera del Garda – VR), I.A. Muttillo (Roma), G. Navarra (Messina), S. Neri (Sassuolo - MO), A. Oldani (Zingonia – BG), S. Olmi (Zingonia – BG), E. Opocher (Milano), E. Osenda (Trieste), R. Ottonello (Muravera – CA), V. Panebianco (Taormina - CT), M. Pavanello (Conegliano Veneto – TV), F. Pecchini (Modena), L. Pellegrino (Cuneo), D. Pennisi (Gorizia), N. Perrotta (Potenza), D. Pertile (Genova), R. Petri (Udine), A. Picchetto (Roma), M. Piccoli (Modena), B. Pirrera (Rimini), A. Pisani Ceretti (Milano), M. Pisano (Muravera – CA), M. Podda (Nuoro), N. Portolani (Brescia), L. Presenti (Olbia), A. Puzziello (Salerno), S. Razzi (Aosta), D. Rega (Napoli), E. Restini (Bari), G. Ricci (Roma), M. Rigamonti (Cles – TN), U. Rivolta (Magenta), V. Robustelli (Pistoia), E. Romairone (Genova), R. Rosati (Milano), E. Rosso (Brescia), F. Roviello (Siena), S. Sala (Sassuolo – MO), M. Santarelli (Torino), G. Sarro (Magenta), A. Sartori (Montebelluna –TV), S. Scabini (Genova), F. Scognamillo (Sassari), R. Sechi (San Gavino Monreale – VS), L. Solaini (Forlì), G. Soliani (Ferrara), P. Solian

2020 - COVID-19-associated vasculitis and thrombotic complications: from pathological findings to multidisciplinary discussion [Articolo su rivista]
Vacchi, Caterina; Meschiari, Marianna; Milic, Jovana; Marietta, Marco; Tonelli, Roberto; Alfano, Gaetano; Volpi, Sara; Faltoni, Matteo; Franceschi, Giacomo; Ciusa, Giacomo; Bacca, Erica; Tutone, Marco; Raimondi, Alessandro; Menozzi, Marianna; Franceschini, Erica; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Di Gaetano, Margherita; Puzzolante, Cinzia; Carli, Federica; Bedini, Andrea; Cossarizza, Andrea; Castaniere, Ivana; Ligabue, Guido; De Ruvo, Nicola; Manco, Gianrocco; Rolando, Giovanni; Gelmini, Roberta; Maiorana, Antonino; Girardis, Massimo; Mascia, Maria Teresa; Mussini, Cristina; Salvarani, Carlo; Guaraldi, Giovanni
abstract

Neutrophilic arterial vasculitis in COVID-19 represents a novel finding and could be responsible for thrombotic complications.

2020 - Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology [Articolo su rivista]
Sommariva, A.; Ansaloni, L.; Baiocchi, G. L.; Cascinu, S.; Cirocchi, R.; Coccolini, F.; Deraco, M.; Fiorentini, G.; Gelmini, R.; Di Giorgio, A.; Lippolis, P. V.; Pasqual, E. M.; Sassaroli, C.; Macri, A.; Sammartino, P.; Scaringi, S.; Valle, M.; Vaira, M.
abstract

Aim: the surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. Method: a panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Onco-team of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. Results: two different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. Conclusion: a shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC.

2020 - Effects of Caffeine on Colon: A Potential Clinical Use of Coffee in Surgical Patients [Articolo su rivista]
Mattioli, Anna Vittoria; Nasi, Milena; Farinetti, Alberto; Gelmini, Roberta
abstract

...

2020 - Handling and processing of blood specimens from patients with Covid-19 for safe studies on cell phenotype and cytokine storm [Articolo su rivista]
Cossarizza, Andrea; Gibellini, Lara; DE BIASI, Sara; LO TARTARO, Domenico; Mattioli, Marco; Paolini, Annamaria; Fidanza, Lucia; Bellinazzi, Caterina; Borella, Rebecca; Castaniere, Ivana; Meschiari, Marianna; Sita, Marco; Manco, Gianrocco; Clini, Enrico; Gelmini, Roberta; Girardis, Massimo; Guaraldi, Giovanni; Mussini, Cristina
abstract

The pandemic caused by SARS-CoV-2 heavily involves all those working in a laboratory. Samples from known infected patients or donors who are considered healthy can arrive, and a colleague might be asymptomatic but able to transmit the virus. Working in a clinical laboratory is posing several safety challenges. Few years ago, ISAC published guidelines to safely analyze and sort human samples that were revised in these days. We describe the procedures that we have been following since the first patient appeared in Italy, which have only slightly modified our standard one, being all human samples associated with risks.

2020 - Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis [Articolo su rivista]
Anania, G.; Agresta, F.; Artioli, E.; Rubino, S.; Resta, G.; Vettoretto, N.; Petz, W. L.; Bergamini, C.; Arezzo, A.; Valpiani, G.; Morotti, C.; Silecchia, G.; Adamo, V.; Agrusa, A.; Alemanno, G.; Allaix, M. E.; Alo, A.; Altamura, A.; Ambrosi, A.; Antoniutti, M.; Apa, D.; Arcuri, G.; Baiocchi, G. L.; Balani, A.; Baldazzi, G.; Basti, M.; Benvenuto, C.; Berti, S.; Boni, L.; Borghi, F.; Botteri, E.; Brachet Contul, R.; Brescia, A.; Budassi, A.; Cafagna, L.; Calgaro, M.; Calo, P. G.; Campagnacci, R.; Canova, G.; Canu, G. L.; Caracino, V.; Carcoforo, P.; Carlini, M.; Casali, L.; Cassetti, D.; Cassinotti, E.; Catarci, M.; Cesari, M.; Checcacci, P.; Ciano, P.; Clementi, M.; Cocorullo, G.; Colombo, F.; Concone, G.; Contine, A.; Coppola, M.; Coratti, A.; Corcione, F.; Corleone, P.; Covotta, L.; Cuccurullo, D.; Cumbo, P.; D'ambrosio, G.; De Angelis, F.; De Luca, M.; De Manzini, N.; De Nisco, C.; De Palma, G. D.; De Paolis, P.; Degiuli, M.; Delogu, D.; Delrio, P.; Deserra, A.; Donini, A.; Elmore, U.; Ercolani, G.; Erdas, E.; Fabris, L.; Ferrari, G.; Feo, G.; Fidanza, F.; Foschi, D.; Galleano, R.; Garulli, G.; Gatti, F.; Gattolin, A.; Gelati, S.; Gelmini, R.; Ghazouani, O.; Gioffre, A.; Gobbi, S.; Grammatico, V.; Guariniello, A.; Giannessi, S.; Guerrieri, M.; Guerriero, L.; Gullotta, G.; Impellizzeri, H.; Izzo, M.; Jovine, E.; Lezoche, G.; Lirusso, C.; Lombardi, R.; Longoni, M.; Lucchi, A.; Luzzi, A. P.; Marini, P.; Marrosu, A. G.; Martino, A.; Mazza, R.; Mazzoccato, S.; Medas, F.; Meloni, A.; Milone, M.; Minciotti, E.; Monari, F.; Moretto, G.; Muttillo, I. A.; Navarra, G.; Neri, S.; Oldani, A.; Olmi, S.; Opocher, E.; Osenda, E.; Ottonello, R.; Panebianco, V.; Pavanello, M.; Pecchini, F.; Pellegrino, L.; Pennisi, D.; Perrotta, N.; Pertile, D.; Petri, R.; Picchetto, A.; Piccoli, M.; Pirrera, B.; Pisani Ceretti, A.; Pisano, M.; Podda, M.; Portolani, N.; Presenti, L.; Puzziello, A.; Razzi, S.; Rega, D.; Restini, E.; Ricci, G.; Rigamonti, M.; Rivolta, U.; Robustelli, V.; Romairone, E.; Rosati, R.; Rosso, E.; Roviello, F.; Sala, S.; Santarelli, M.; Sarro, G.; Sartori, A.; Scabini, S.; Scognamillo, F.; Sechi, R.; Solaini, L.; Soliani, G.; Soliani, P.; Soligo, E.; Sorrentino, M.; Spinoglio, G.; Stratta, E.; Taddei, A.; Talamo, G.; Targa, S.; Tartaglia, N.; Testa, S.; Ubiali, P.; Valeri, A.; Vasta, F.; Verzelli, A.; Vicentini, R.; Viola, G.; Violi, V.; Zago, M.; Zampino, L.
abstract

Background: While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons’ attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods: One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results: ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients’ characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions: In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration: Clinical trial (Identifier: NCT03934151).

2020 - Multicentre validation of an immune-inflammation-based nomogram to predict survival in western resectable gastroesophageal adenocarcinoma: The NOMOGAST [Abstract in Rivista]
Salati, M; Marcheselli, L; De Ruvo, N; Esposito, G; Fenocchi, S; Cucciarre, G; Serra, F; Cautero, N; Cabry, F; Gelmini, R; Vittimberga, G; Radi, G; Solaini, L; Morgagni, P; Ercolani, G; Ghidini, M; Grizzi, G; Ratti, M; Gelsomino, F; Luppi, G; Dominici, M; Spallanzani, A
abstract

2020 - Past, present and future of adjuvant HIPEC in patients at high risk for colorectal peritoneal metastases [Articolo su rivista]
Baratti, D.; Sammartino, P.; Kusamura, S.; Deraco, M.; Ansaloni, L.; Asero, S.; Baiocchi, G.; Bagnoli, P.; Cavaliere, D.; Framarini, M.; Cirocchi, R.; Coccolini, F.; Decian, F.; Delrio, P.; Sassaroli, C.; De Simone, M.; Robella, M.; Vaira, M.; Di Giorgio, A.; Fagotti, A.; Lorusso, D.; Federici, O.; Fiorentini, G.; Fambrini, M.; Scaringi, S.; Garofalo, A.; Valle, M.; Gelmini, R.; Cabry, F.; Cautero, N.; Sorrentino, L.; Graziosi, L.; Guaglio, M.; Montenovo, M.; Bartolini, V.; Lippolis, P. V.; Macri, A.; Pasqual, E. M.; Roviello, F.; Marrelli, D.; Orsenigo, E.; Sommariva, A.
abstract

EDITORIAL

2020 - Relationship between socioeconomic status and asymptomatic peripheral arterial disease: a retrospective study [Articolo su rivista]
Mattioli, Anna V; Nasi, Milena; Coppi, Francesca; Gelmini, Roberta; Farinetti, Alberto
abstract

2020 - Use of strictureplasty technique for surgical treatment of ileal endometriosis: a case series [Articolo su rivista]
Alboni, Carlo; Camacho Mattos, Ludovica; Facchinetti, Fabio; Cabry, Francesca; Serra, Francesco; Ricciardolo, Andrea; Mabrouk, Mohamed; Gelmini, Roberta
abstract

Intestinal deep infiltrating endometriosis is the most frequent extragenital localisation and its traditional surgical treatment is segmental resection of the affected tract. The need for implementing alternative techniques in the treatment of intestinal endometriosis arises from those cases of multiple ileal and recto-sigmoidal localisations, in which removing excessive lengths of intestine could lead to a higher rate of adverse events. Ileal endometriosis represents 4.7% of all intestinal localisations, often associated with multiple lesions and yet, to the best of our knowledge, there are no data on techniques other than intestinal resection for its treatment. Since its capacity to solve fibrostenotic lesions without removing centimeters of intestine, strictureplasty is widely implemented in the management of Crohn’s disease. We propose the use of strictureplasty for the treatment of ileal endometriosis. We performed surgical treatment for symptomatic deep infiltrating endometriosis in two patients with either ileal and sigmoidal localisations. We approached ileal nodules with strictureplasty technique, while sigmoidal nodules were removed by traditional segmental resection. No complications occurred and both patients are now asymptomatic after a 12 months-follow up. Therefore, strictureplasty could provide a tool to eliminate small bowel endometriosis maintaining a regular caliber of the ileal tract without modifying its length.

2019 - A new device for ultrasound-guided peripheral venous access [Articolo su rivista]
Brugioni, Lucio; Marco, Barchetti; Tazzioli, Giovanni; Gelmini, Roberta; Girardis, Massimo; Bianchini, Marcello; Schepis, Filippo; Nicolini, Matteo; Giovanni, Pinelli; Pietro, Martella; Marco, Barozzi; Mori, Francesca; Scarabottini, Serena; Righetti, Andrea; Mirco Ravazzini and Elisabetta Bertellini,
abstract

Background: In patients with difficult peripheral venous access, alternative techniques require expertise and are invasive, expensive, and prone to serious adverse events. This brought us to designing a new venous catheter (JLB® Deltamed, Inc.) for the cannulation of medium and large bore veins; it is echogenic, and available in different lengths (60 / 70 / 80 mm) and Gauges (14 / 16 / 17 / 18). Methods: We led a multi-center observational convenience sampling study to evaluate safety and effectiveness of JLB. Data was collected from June 2015 to February 2018. Inclusion criteria were age ⩾ 18, difficulty in obtaining superficial venous access in the veins of the arm, need for rapid infusion, or patient’s preference. Results: We enrolled 1000 patients, mean age 66.8 years. In total, 951 (95.1%) had the device placed in internal jugular vein, 28 in basilic or cephalic vein, 15 in femoral vein, 5 in axillary vein (infra-clavicular tract), and 1 in the external jugular vein. The procedure was performed by attending physicians or emergency medicine residents under US guidance. Mean procedure time (from disinfection to securing) was approximately 240 s. Mean attempts number was 1.21. Early complications (<24 h) occurred in four patients, consisting in two soft tissue hematoma, one phlebitis, and one atrial tachyarrhythmia. No major complications (such as pneumothorax) were reported. Mean indwelling time was 168 h (7 days); early occlusion/dislocation occurred in four cases. Conclusion: According to preliminary data, the application of JLB appears to be safe, cost-effective, and rapid to place bedside.

2019 - A novel surgical approach with peritonectomy to extranodal multisystemic histiocytic sarcoma: A case report and literature review [Articolo su rivista]
Barbato, Giuseppe; Tarantini, Alessandro; Serra, Francesco; Cabry, Francesca; Farinetti, Alberto; Sorrentino, Lorena; Mattioli, Anna Vittoria; Gelmini, Roberta
abstract

Histiocytic sarcoma (HS) is a very rare malignant histiocytic derivation cancer. The extranodal multisystemic HS has an aggressive clinical course and poor Disease-Free Survival (DFS) and Overall Survival (OS). There are no shared and effective therapeutic protocols; our approach aims to improve the prognosis for advanced diseases.

2019 - A rare case of acute abdomen in the adult: The intestinal duplication cyst. case report and review of the literature [Articolo su rivista]
Ricciardolo, Andrea Aurelio; Iaquinta, Tommaso; Tarantini, Alessandro; Sforza, Nicola; Mosca, Donatella; Serra, Francesco; Cabry, Francesca; Gelmini, Roberta
abstract

Introduction: Duplications of the gastrointestinal tract are rare congenital anomalies that can occur anywhere throughout the gastrointestinal tract. The reported incidence is 1/4500, and more than 80% occurs before the age of two as an acute abdomen or bowel obstruction. The most common site is Ileum (60%), while the colonic localisation is reported between 4 and 18%. Presentation of the case: Herein we report the case of a 35-year-old man, presented at the Emergency Department with fever and localised abdominal pain in the right iliac fossa. Preoperative abdominal ultrasound and CT scan showed a cystic mass of 44 × 43 × 70 mm adjoining the posterior wall of the right colon. He underwent explorative laparoscopy, laparotomy conversion, right hemicolectomy with an intra-operative diagnosis of colonic duplication cyst, confirmed by histology. Discussion: The review of the literature showed as the intestinal duplication cysts are rare congenital anomalies. The clinical presentation is variable and depends on the site and the related complications. A surgical approach based on the resection of the involved bowel tract is the treatment associated with the best long-term outcomes. Conclusion: It is important to include intestinal duplication in the differential diagnosis of acute abdomen, to ensure the best therapeutic strategy.

2019 - A user-friendly nomogram to predict relapse-free survival (RFS) in western patients with resected gastric cancer (GC) [Abstract in Rivista]
Salati, M.; Pipitone, S.; Rimini, M.; Gelsomino, F.; Casadei-Gardini, A.; Andrikou, K.; Schipilliti, F. M.; Cortesi, G.; Cassanelli, L.; Caffari, E.; Serra, F.; Ricciardolo, A.; De Ruvo, N.; Gelmini, R.; Cascinu, S.; Spallanzani, A.
abstract

2019 - Aspirin Use in Patients Undergoing Preoperative Evaluation for Minor Surgery [Articolo su rivista]
Mattioli, A. V.; Farinetti, A.; Gelmini, R.
abstract

We found that 505 patients were treated with aspirin (16.8%), 312 men (61.8%) and 193 women (38.2%) (P < .05). In the group of patients treated with aspirin we found that 379 subjects—254 men (67%) and 125 women (33%)—were treated with aspirin according to guidelines for prevention of cardiovascular disease. In addition, 32 patients (all men) were treated with aspirin outside of guideline indications. Seven hundred ninety-eight patients (26.6%) that needed aspirin or antiplatelet therapy due to their cardiovascular risk were not treated, despite having no contraindication or allergy, and 126 patients discontinued aspirin despite appropriate indication.

2019 - CASE report: Acute hepatic failure secondary to metastatic LIVER’S infiltration by upper tract urothelial carcinoma [Articolo su rivista]
Serra, Francesco; Guidetti, Cristiano; Spatafora, Francesco; Cabry, Francesca; Farinetti, Alberto; Mattioli, Anna Vittoria; Gelmini, Roberta
abstract

Introduction: Acute liver failure (ALF) secondary to malignant infiltration of the liver from urothelial carcinoma is a very rare clinical condition and is often diagnosed only after death. Upper tract urothelial carcinoma (UTUC) is a rare, from 5% to 10% of all urothelial tumours, but possible cause of ALF when there is extensive liver metastatic involvement. We report the case of a patient who died in the intensive care unit (ICU) of our hospital from multiple organ failure (MOF) secondary to ALF, as a result of infiltration of the liver from UTUC diagnosed after surgery.PRESENTATION OF THE CASE: A 69-year-old Caucasian man was referred to our hospital for hematuria, melena, right upper quadrant (RUQ) pain and jaundice developed over the previous two weeks. After multidisciplinary discussion, he underwent emergency exploratory laparotomy to perform cholecystectomy because of suspected acute cholecystitis considered as a septic focus within the left kidney. He developed MOF and died on the 6th postoperative day. Discussion: From the diagnosis of the renal mass and the death of the patient, a few days have passed, and the diagnosis of UTUC has been put only at histological examination.The most common sites of metastases from UTUC are lymph nodes, lungs, liver, bones and peritoneum. Moreover, liver metastases have been identified to have an independent negative impact on overall survival in a patient affected by UTUC. Conclusion: The authors suggest that this condition should be taken into account when dealing with patients with evidence of a renal mass and simultaneous ALF.

2019 - CYTOREDUCTIVE SURGERY AND HIPEC IN A 14 YEARS OLD PATIENT WITH PERITONEAL RECURRENCE OF ADENOCARCINOMA OF THE RIGHT COLON [Articolo su rivista]
Sorrentino, Lorena; Serra, Francesco; Cabry, Francesca; De Julis, Stefano; Barbieri, Elisa; Girardis, Massimo; Ceccarelli, Pier Luca; Gelmini, Roberta
abstract

Introduction Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is nowadays a feasible and effective treatment for peritoneal metastasis. We present a case of a 14 years old child with peritoneal metastasis from recurrent colorectal cancer. Presentation of case Colonoscopy and CT-scan were performed leading to the diagnosis of a stenosing adenocarcinoma of the right colon in 2015. Two pelvic lesions were found at the total body PET scan, suspected for peritoneal metastasis. Neoadjuvant chemotherapy was administered, and restaging CT-scan and magnetic resonance (MRI) highlighted a partial response. The patient underwent right laparoscopic hemicolectomy. The postoperative staging was T4 N1 G3. Seven months after the last cycle of adjuvant chemotherapy, CT-scan revealed two huge abdominal masses. The patient underwent explorative laparotomy and bilateral oophorectomy, positive for metastasis from colorectal cancer and peritoneal washing cytology was positive for neoplastic cells. A CT-scan was performed on December 2017 showed a suspect lesion below the anterior abdominal wall. The case was discussed at the tumour board and the indication for CRS and HIPEC was given. In January 2018 the child underwent complete CRS and HIPEC with no complications. No adjuvant chemotherapy was administered. After 11 months the follow up is negative for the recurrent disease. Discussion and Conclusion Cytoreduction and HIPEC can be performed even in children as a feasible and safe treatment with successful outcomes. As for adults, an appropriate multidisciplinary pre-operative work up and a correct cases selection is needed to have the best results even regarding the quality of life.

2019 - Immune-inflammatory and clinicopathologic prognostic factors in a Western cohort of resected gastric cancers (GCs) [Abstract in Rivista]
Salati, M.; Pipitone, S.; Rimini, M.; Gelsomino, F.; Gardini, A. Casadei; Andrikou, K.; Schipilliti, F.; Cortesi, G.; Cassanelli, L.; Caffari, E.; Serra, F.; Ricciardolo, A.; De Ruvo, N.; Gelmini, R.; Cascinu, S.; Spallanzani, A.
abstract

2019 - Laparoscopic splenectomy in malignancies: is it safe and feasible? [Articolo su rivista]
Serra, F; Roli, Isabella; Campanelli, M; Cabry, F; Baschieri, F; Romano, F; Gelmini, R.
abstract

BACKGROUND: Laparoscopic Splenectomy (LS) is considered the treatment of choice for benign hematologic diseases of the spleen. However, the role of LS in malignancies is still controversial. Technical difficulties, hemorrhagic risk, the need of pathological characterisation of malignant disease, may be considered contraindications to LS in malignancies. This study aims to verify the efficacy and feasibility of LS for hematologic malignancies. METHODS: 145 patients underwent LS for hematologic disease and were retrospectively shared in two groups: Group A (83 patients) patients with preoperative diagnosis of benign hematologic disease and Group B (62 patients) with malignancies. Bipolar spleen diameter, mean operative time, conversion rate and causes, complications and need of transfusion were evaluated. RESULTS: Median splenic diameter was greater in Group B than in Group A with a statistically significant difference (p<0.005), such as higher were the number of accessory mini-laparotomy (p<0.005) and conversion rate (p=0.024) in the group of patients with a diagnosis of malignancy. The mean operative time was 117.6 min. in group A and 148.1 min. in Group B (p<0.005). Besides, there were no significant differences relative to intra-operative and postoperative transfusions and the incidence of postoperative complications. No peri-operative mortality occurred. CONCLUSIONS: The analysis of our data highlights that LS for hematologic malignancies is effective and feasible even if it associated with higher conversion rate due to splenomegaly and difficult hilum dissection. Besides, no differences in the patient outcome were highlighted. LS may be considered a safe procedure in the treatment of haematological malignancies of the spleen.

2019 - Mediterranean Diet and wine intake could improve atrial function in patients with atrial fibrillation [Articolo su rivista]
Mattioli, Anna Vittoria; Farinetti, Alberto; Gelmini, Roberta
abstract

....

2019 - Negative pressure wound therapy (NPWT) after cytoreductive surgery (CRS) and intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies: preliminary report [Articolo su rivista]
Serra, F; Sergi, W; Spatafora, F; De Ruvo, N; Farinetti, A; Mattioli, A V; Brugioni, L; Gelmini, R
abstract

Surgical site (SSI) infection is a common complication that occurs in the post-operative period because it still has a decisive impact on the morbidity and mortality of patients and the costs associated with therapy and prolongation of hospitalization. In recent years, therefore, several authors have published their experience in the use of negative pressure prevention systems (NPWT) for the management of surgical wounds. Few authors in the literature have discussed the use of NPWT in patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies associated with hyperthermic intraperitoneal chemotherapy (HIPEC).

2019 - Pancreaticogastrostomy as reconstruction choice in pancreatic trauma surgery: Case report and review of the literature [Articolo su rivista]
Serra, F.; Barbato, G.; Tazzioli, G.; Gelmini, R.
abstract

Introduction: Due to its retroperitoneal location and its proximity to major vascular structures and other organs, isolated pancreatic injuries are rare. The optimal management for pancreatic injuries of grades III and IV, where a main ductal transection is present, remains controversial. Isolated complete traumatic transection of the pancreatic neck is uncommon, but this condition is associated with some peculiar technical aspects that allow more conservative treatments. Presentation of the case: A closed abdominal blunt trauma in a young patient underwent emergency surgery for suspect hemoperitoneum. Intraoperatively evidence of complete traumatic transection of the pancreatic neck treated with pancreas tissue debridement, suture of the cephalic stump and pancreaticogastrostomy reconstruction. Discussion: Preservation of pancreatic volume and avoidance of adjacent organ resection is associated with lesser mortality and morbidity rate. The advantages of conservative treatments are related to reductions in the postoperative exocrine and endocrine insufficiencies. Conclusion: In selected cases of complete neck transection with preserved pancreatic parenchyma in a stable patient, parenchymal-sparing interventions should be considered. Pancreaticogastrostomy offers an easier to learn and faster technique also suited for less experienced surgeons.

2019 - Peripheral lymphadenopathy: role of excisional biopsy in differential diagnosis based on a five-year experience. [Articolo su rivista]
Campanelli, M; Cabry, F; Marasca, R; Gelmini, R.
abstract

BACKGROUND: Peripheral lymphadenopathy can be caused by benign disease, or it could be a manifestation of underlying haematological disease or metastasis of a yet undiagnosed malignant condition. Fine-needle aspiration cytology (FNAC) and image- guided core biopsy usually make up the first line of investigation. There are several disadvantages to these techniques: FNAC is an acellular aspirate that may provide non- diagnostic specimens, while core biopsy may fail in the presence of composite lymphoma, nodal necrosis, and insufficiency or fragmentation of the specimens. Our aim was to evaluate the safety and effectiveness of excisional biopsy (EB) in a large case series. METHODS: 220 consecutive patients underwent lymph node EB under local anaesthesia. All patients underwent complete and systematic physical examination. Any palpable lymph node was evaluated for its location, size, consistency, fixation, and tenderness. All specimens were sent to the pathologist as fresh tissue. RESULTS: The EB materials demonstrated 89 (40.5%) benign lesions, 130 (59%) malignant diagnoses, and one (0.5%) unclear diagnosis. Mean operative time was 42.9 minutes (range 10-120 minutes). Harvested lymph nodes had a mean diameter of 3.3 x 2.3 cm. All patients were discharged within 8 hours. No major complications were reported, with a mean of 1.16 post-operative outpatient visits. Temporary seroma and/or minor lymph leak at the site of the incision occurred in 14 cases (6.4%), haematoma in 7 (3.2%), and dehiscence of the surgical incision in 4 (1.8%), and in 3 cases (1.4%) pain was reported up to 7 days post-operatively. CONCLUSIONS: Excisional biopsy is a diagnostic method that can be applied safely with minimal morbidity and mortality.

2019 - Polyphenols, Mediterranean diet, and colon cancer [Articolo su rivista]
Mattioli, A. V.; Farinetti, A.; Gelmini, R.
abstract

e have read with great interest the manuscript “Risk factors affecting hospital stay among patients undergoing colon cancer surgery: a prospective cohort study.” by Orive M and coworkers [1] and we found it very important with a view to clinical prevention. The article aimed to identify and validate risk factors that contribute to prolonged length of hospital stay (LOS) in a prospective cohort study that included 1955 patients undergoing resection for colorectal cancer. They found that some of the strongest independent predictors of prolonged LOS, such as surgical infections or open surgery, could be modified to reduce LOS and, in turn, other adverse outcomes.

2019 - Subclinical atherosclerosis at peripheral arteries in obese subjects [Abstract in Rivista]
Farinetti, Alberto; Clini, Enrico; Migaldi, Mario; Gelmini, Roberta; Serra, Francesco; Spatafora, Francesco; Scaringi Raspagliesi, Flavia; Ara, Nicoletta
abstract

2019 - The beneficial effect of Mediterranean Diet on Colon-rectal Cancer [Articolo su rivista]
Mattioli, Anna Vittoria; Farinetti, Alberto; Gelmini, Roberta
abstract

Dear Editor, We have read with great interest the paper “Mediterranean diet adherence and risk of pancreatic cancer: A pooled analysis of two Dutch cohorts.” by Schulpen M and coworkers [1] and we found their conclusion of importance with a view to clinical prevention. They examined the association between Mediterranean Diet (MedD) adherence and pancreatic cancer incidence by pooling data from the Netherlands Cohort Study (NLCS, 120,852 subjects) and the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC‐NL 40,011 subjects). MedD adherence was assessed using alternate and modified Mediterranean diet scores including and excluding alcohol. MedD adherence was not significantly associated with pancreatic cancer risk in pooled and study specific analyses, regardless of sex and MedD score. Authors concluded that MedD adherence was not associated with pancreatic cancer risk in a pooled analysis of two Dutch cohorts. With reference to the findings reported in the paper, we would like to make the following contribution to the discussion. In a recent paper we analysed 3 components of the Mediterranean Diet that seems to be associated with reduction of Colon Cancer [2]. We analysed the effects of olive oil (polyphenols), red grapes (resveratrol), and tomatoes (lycopene). Specifically, the consumption of olive oil exerts a protective effect in reducing risk for CRC many other types of cancer, including prostatic and breast. Olive oil may exert its protective effect, influencing polyamine metabolism in cells leading to a reduction in cancerogenesis progression. [3] Accepted Article This article is protected by copyright. All rights reserved. 3 The Mediterranean Diet is characterized by high intake of antioxidants and polyphenols. [4,5] It is well known that these components exert many positive effects on cardiovascular system and prevent the development of atherosclerosis both in men and women [4,5]. Schulpen M and coworkers observed no association between MedD adherence and pancreatic cancer in both women and men. It is well known that the there is a sex differences in oxidative stress and inflammation. [6,7,8] Oxidative stress and inflammation play a crucial role in the pathogenesis of atherosclerosis vascular inflammation leading to infarction and ischemia. Oxidative stress seems to be higher in male than female rats, being that the levels of SOD, GPx and lipid peroxidation are lower and higher in males versus females, respectively. [6] In humans, the biomarkers of oxidative stress are higher in young men than in women of the same age, although this is not a univocal result. Resveratrol has many pleiotropic pharmacologic properties. It promotes protection against damage from reactive oxygen species and from inflammation, resulting in cardiovascular protective benefits and, certainly, anticancer activities. In our review of the literature we concluded that the beneficial effects of Mediterranean Diet in patients with colon cancer belong to the synergistic effects of several components.

2018 - Effects on Clinical Outcomes of a 5-Year Surgical Safety Checklist Implementation Experience: A Large-scale Population-Based Difference-in-Differences Study [Articolo su rivista]
Rodella, Stefania; Mall, Sabine; Marino, Massimiliano; Turci, Graziella; Gambale, Giorgio; Teresa Montella, Maria; Bonilauri, Stefano; Gelmini, Roberta; Zuin, Piera
abstract

The adoption of a surgical checklist is strongly recommended worldwide as an effective practice to improve patient safety; however, several studies have reported mixed results and a number of issues are still unresolved. The main objective of this study was to explore the impact of the first 5-year period of a surgical checklist-based intervention in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public hospitals between 2006 and 2014. The adherence to the checklist was measured between 2011 and 2013 through a computerized database. The effects of the intervention were explored through multivariable logistic regression and difference-in-differences (DID) approaches, based on current administrative data sources. In-hospital and 30-days mortality, 30-days readmissions and length-of-stay (LOS) ⩾8 days were the observed outcomes. Adherence to the checklist showed marked variations across hospitals (0%-93.3%). A pre/post analysis detected statistically significant differences between surgical interventions performed in hospitals with higher adherence to the checklist (⩾75% of the surgeries) and those performed in other hospitals, as for the 30-days readmissions rate (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98) and LOS ⩾ 8 days rate (OR: 0.88; 95% CI: 0.87-0.89). These findings were confirmed after risk adjustment and DID analysis. No association was observed with mortality outcomes. On the whole, our study attained mixed results. Although a protective effect of the surgical checklist use could not be proved over the first 5 years of this regional implementation experience, our research offers some methodological insights for practical use in the evaluation process of large-scale implementation projects.

2018 - FIRST CASE OF LAPAROSCOPIC PARTIAL SPLENECTOMY IN A CHILD WITH HAMARTOMA: CASE REPORT AND REVIEW OF THE LITERATURE [Articolo su rivista]
Serra, Francesco; Sorrentino, Lorena; Cabry, Francesca; Biondini, Diego; Luca Ceccarelli, Pier; Campanelli, Michela; Gelmini, Roberta
abstract

INTRODUCTION To date, laparoscopic surgery has played a key role in the treatment of not only splenic hematologic pathologies but also solid ones. Hamartoma is a rare disease; only twenty percent of them are of pediatric relevance; it is a benign tumor, but radiological features never allow proper differentiation from malignant neoplasms. In children, hamartoma may be associated with other morbid conditions, such as sickle cell disease or other hematological alterations. PRESENTATION OF THE CASE We report a case of hamartoma in a 7-year-old child treated with partial laparoscopic splenectomy After a multidisciplinary evaluation, the indication of laparoscopic splenectomy was decided; upon evaluating the age of the patient and the affected spleen portion, a partial splenectomy was proposed. The histological examination during surgery was performed to exclude any form of malignancy. The intraoperative frozen section of the specimen was negative for malignancies, and a partial splenectomy was performed. DISCUSSION Surgery remains the first choice in the definitive treatment of solid lesions of the spleen; minimally invasive technique, namely, laparoscopy, has set itself as the technique of choice for surgical treatment. In this case, the possibility of obtaining an intraoperative pathological diagnosis by frozen section of the specimen, confirming the benign nature of the lesion, allowed the surgeon to decide in favor of a laparoscopic partial splenectomy. CONCLUSION Partial laparoscopic splenectomy can be considered a safe, effective and reproducible alternative in patients suffering from benign solid diseases, safeguarding the hematological functions of the organ itself in pediatric age.

2018 - Intestinal perforation due to typhoid fever in Karamoja (Uganda). [Articolo su rivista]
Conventi, Riccardo; Pellis, G; Arzu, G; Nsubuga, Jb; Gelmini, R.
abstract

INTRODUCTION: This is a retrospective analysis of patients operated for typhoid perforation, aiming to analyze epidemiology, clinical-diagnostic and therapeutic aspects, mortality and prognosis. METHODS: 47 patients were operated at Matany Hospital from 2010 to 2016. We examined clinical files to collect data. Microbiological and isthological examinations were unavailable, so etiology was deducted operatively. RESULTS: Median age: 17.85 years, 61.7% of patients were male, 74.47% perforated within two weeks from the onset of symptoms. Every radiological investigation (X-Rays and Ultrasound Scans) resulted positive. 40 patients underwent primary repair, 4 underwent resection. 72.34% experienced postoperative complications, SSI (Surgical Site Infection) occurred in 40.42%. Mortality rate reached 5.56% in patients without organ failure (vs 31.03%) and 11.76% (vs 20.51%) in patients operated within 24 hours from perforation. An MPI (Mannheim Peritonitis Index) score >30 was related with a mortality rate of 36% (vs 3.45%). CONCLUSIONS: Peak of incidence occurs at the end of rainy season. Majority of patients are young men. Main symptoms are fever and signs of intestinal obstruction, with a shorter period before perforation. Primary repair is the technique of choice for single perforations, resection for multiple ones, right colectomy in case of cecal involvement, ileostomy for important peritoneal contamination. SSI are the most frequent complications, enteric fistulas the most severe ones. Mortality rate is around 21.28%. Important prognostic factors are time between perforation and operation and the presence of organ failure. An MPI score >30 is related with a poorer prognosis.

2018 - Response to: A fifth of surgeons in England are female [Articolo su rivista]
Gelmini, R; Farinetti, A; Mattioli, Av
abstract

During the last decade, the percentage of women graduates in medicine has increased considerably, in Italy and Europe, and therefore inevitably also those who specialize in general surgery and specialized branches. The data provided by the Statistical Office of the Ministry of Education of the University and Research (MIUR) for the academic year 2014/2015 show that 45.3% of those enrolled in schools of specialization in general surgery are women.

2018 - Role of sentinel node in differentiated thyroid cancer: a prospective study comparing patent blue injection technique, lymphoscintigraphy and the combined technique [Articolo su rivista]
Gelmini, Roberta; Campanelli, Michela; Cabry, Fancesca; Franceschetto, Antonella; Ceresini, Graziano; Ruffini, Livia; Zaccaroni, Alberto; Del Rio, Paolo
abstract

Purpose The purpose of the present study was to evaluate the feasibility and reproducibility of the sentinel lymphnode (SLNs) biopsy in differentiated thyroid cancer using patent blue injection, lymphoscintigraphy and the combined techniques. Methods Between January 2011 and January 2013, 82 consecutive patients were enrolled in our prospective multicentre study. Inclusion criteria were 18 years of age, preoperative diagnosis of differentiated thyroid carcinoma, no evidence of lymph node enlargement and multifocal neoplasm. To investigate the benefits of each procedure, all patients underwent total thyroidectomy plus central compartment lymphadenectomy, and in all cases, the SLN was identified via one of three techniques using the same protocol. Results Lymphoscintigraphy was used in five patients, patent blue injection was used in 40 patients, and a combined technique was used in 40 patients to identify sentinel lymphnodes (SLN). SLNs were identified in 61 cases. In the patent blue injection technique, the sensitivity, specificity and false negative rates were 88.9, 94.4 and 3.8%, respectively. In the lymphoscintigraphy technique, the percentages of sensitivity and specificity were 100%, and the percentage false negative was 0%. For the combined techniques, the corresponding values were, respectively, 69.2, 90, and 17.4%. Metastases were detected in nine cases of lateral-cervical nodes, ipsilateral tumour metastases were observed in eight cases, and contralateral tumour metastasis was observed in one case. Conclusion Additional well-designed randomized studies are needed to validate and further optimize the SLN biopsy in patients with differentiated thyroid cancer.

2018 - Totally Laparoscopic Partial Splenectomy in a Child with Hamartoma [Articolo su rivista]
Serra, Francesco; Sorrentino, Lorena; Cabry, Francesca; Biondini, Diego; Luca Ceccarelli, Pier; Gelmini, Roberta
abstract

Background: To date laparoscopic surgery plays a key role in the surgical treatment of not only splenic hematologic pathologies but also of solid pathologies such as benign and malignant tumors. Hamartoma is a rare disease, described for the first time by Rokitansky in 1861. Only few cases are described in the literature, and only 20% of these are of pediatric relevance. In children, hamartoma may be associated with other morbid conditions such as sickle cell disease or other hematologic alterations. Material and Methods: In July 2017, a 7-year-old child presented at the pediatric emergency room for lumbar pain and fever. Abdominal ultrasonography showed a single solid lesion of 5.5 × 6.5 cm with rounded morphology, well-defined margins, and occupying the superior two-thirds of the spleen. Magnetic resonance imaging was performed to better investigate the lesion. On evaluation of the age of the patient and the affected spleen portion, we decided to perform a laparoscopic partial splenectomy. Before surgery, the patient underwent chemoembolization of the upper pole of the spleen to minimize intraoperative blood loss. No postoperative complications occurred and the patient was discharged on the fifth postoperative day. Conclusion: The proper integration between radiologists, pediatricians, and surgeons has allowed the correct management of a pediatric patient suffering from a rare disease. Partial laparoscopic splenectomy can be considered a safe, effective, and reproducible treatment in these patients suffering from benign solid disease, safeguarding the hematologic functions of the organ itself.

2017 - A rare case of diaphragmatic hernia after cytoreductive surgery and hypertermic intraperitoneal chemotherapy [Articolo su rivista]
Sorrentino, Lorena; Cabry, Francesca; Serra, Francesco; Gelmini, Roberta
abstract

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective therapeutic approach for selected patients with gastrointestinal and gynecological malignancies with peritoneal spread. The most frequent postoperative surgical complications are anastomotic leakage, digestive perforations, fistulas, intestinal obstruction, abscess and peripancreatitis. This report presents case of a patient with late postoperative diaphragmatic hernia after CRS and HIPEC. A 50- year-old woman previously treated with CRS and HIPEC for a pseudomyxoma peritonei was admitted to our unit with diagnosis of intestinal obstruction. At the CT scan a left diaphragmatic hernia involving the splenocolic flexure was found. Both stripping of the diaphragmatic peritoneum during CRS, sometimes combined with diaphragmatic resection and the heat of HIPEC might be responsible for such complication. The diaphragmatic hernia is rarely diagnosed after CRS and HIPEC. Surgical techniques for repair can be the direct suture of the defect or closure with synthetic or biological tissue, both are possible surgical techniques for repair with a good long term results

2017 - Dome Down Laparoscopic Cholecystectomy: Our Experience and the State of Art [Articolo su rivista]
Sorrentino, L; Serra, F; Cabry, F; Gelmini, R.
abstract

Introduction: Laparoscopic Cholecystectomy is nowadays the gold standard technique for benign gallbladder disease both in elective and emergency surgery. But it is even true that in very acute cholecystitis when the tissues are inflamed and the anatomy can be difficult to recognize, the classic laparoscopic approach can lead to biliary and vascular injuries. Dome down laparoscopic approach can be used to avoid conversion to open surgery and decrease surgical complications. Methods: A retrospective record of all Cholecystectomy carried out in our unit by experienced surgeons from January 2013 to August 2017 was examined. Cases were divided by surgical technique: Classical laparoscopic technique, Open cholecystectomy, Laparoscopic converted to open cholecystectomy, Dome down laparoscopic Cholecystectomy (DDLC). A systematic literature search was performed using PubMedz and Embase databases. The search was limited to studies on humans and to those reported in the English language between January 2009 and December 2016. Results and discussion: 194 cholecystectomy were performed, among these 163 with laparoscopic technique and 3% of all laparoscopic approached cholecystectomy were performed as DDLC. The mean hospital stay was 5 days (2-11). 1 out of 5 patients needed postoperatory ERCP and endobiliary stent was positioned removed in 30 days with no other complications. Other 4 patients were evaluated after 1 week from dismission with no evidence of postoperative complications. Conclusion: Dome down cholecystectomy is a feasible and safe procedure; it avoids biliary and vascular injuries in difficult cholecystectomy. It can still be improved by the combination with ultrasonic devices or with new surgical techniques such as Single-incision Laparoscopic cholecistectomy.

2017 - Fibroadenoma of the perianal region: A case report and review of the literature [Articolo su rivista]
Campanelli, Michela; Cabry, Francesca; Segattini, Silvia; Amorotti, Claudio; Mosca, Donatella; Gelmini, Roberta
abstract

Ectopic breast tissue (EBT) is defined as glands located outside of the breast. EBT has been thought to arise from a remnant of the embryonic mammary ridge along the milk line from the axilla to the groin, including the anal region. Fibroadenomas of the perianal region are very uncommon, in literature has not been reported a complete review yet. We report a case of a 36-year-old woman presented to the surgical outpatient department with complaints of swelling and growing mass in the anal region. The lesion was completely excised as a day surgery case. histological examination showed a rare case of fibroadenoma. Additionally, a comprehensive review of the literature of the last 39 years was performed, collecting 12 cases of fibroadenomas of the perianal region. The population affected was young, the mean age at presentation was 39 years and no male was reported, 6 patients reported a tender painful mass and after a completely excision no recurrence was reported despite 10 of the 12 publications analyzed did not mentioned the follow-up. in conclusion, if a lesion is discovered along the milk line, the possibility of pathological ectopic breast tissue should always be considered, and excision should be the treatment of choice.

2017 - Laparoscopic Treatment of Gastric Duplication in a Child [Articolo su rivista]
Catellani, Barbara; Pecchini, Francesca; Sorrentino, Lorena; Cabry, Francesca; Biondini, Diego; Ceccarelli, Pier Luca; Gelmini, Roberta
abstract

Introduction: Gastric duplication is a rare congenital anomaly with an incidence of 4-8% of all gastrointestinal duplications; enteric duplications are ectopic cystic or tubular structures with a mucous and muscular tunics and they can be in contiguity/continuity with the intestinal lumen.1 Gastric duplication is often an occasional finding, associated to aspecific sintomatology for which pre-operative diagnosis is not univoque; differential diagnosis with other retroperitoneal diseases or mesenteric cysts can be difficult.1 (Run time 8min). Material and Methods: We present a case of a one-year-old child with a pre-natal ultrasound (US) finding of endo-abdominal cystic lesion. After birth, US scans showed an anechogenic-cyst of 33x28mm in the left upper quadrant, between stomach, spleen and kidney. The magnetic resonance confirmed the presence of the lesion (40x34mm), imprinting the posterior gastric wall, the spleen and the anterior side of left kidney. An esophagous-stomach-duodenum contrast study was also performed, showing the imprinting cyst on the great curvature close to the gastric fundus without communication with gastric lumen. On follow-up, the child underwent to periodic US scans and no growth or ultrasonographic changes were described. At 13-months, the diagnosis was still unclear and the patient underwent explorative laparoscopy with esophagous-gastric-duodenoscopy (EGDS). The preliminary EGDS showed a 35mm convexity on the posterior wall of gastric fundus with no evidence of orifice. A 5mm trans-umbilical trocar was placed and 5mm trocar in the epigastric region and 10-12mm trocar in the left side were positioned. At the abdominal exploration the cyst resulted to be in continuity with the posterior gastric wall on the superior third of the great curvature. The lesion was isolated from other tissues, but the postero-medial wall of neoformation appeared to be not dissociable and in continuity with the stomach; a complete resection of the cyst, using 45mm linear stapler, was performed including a small portion of the great gastric curvature. At the following intra-operative endoscopic control no more evidence of irregularity of the gastric wall was seen and the suture was assured. Results: The operative time was 140-minutes. No complications occurred and the blood loss was minimal. The patient started oral intake on 5’ post-operative-day and was discharged on 6’ post-operative-day. The histological examination confirmed the gastric nature of cyst. At 1-year of follow-up no recurrences were diagnosed and the child presents in good health with a regular growth. Conclusion: We can assume that laparoscopic surgery is the correct procedure for gastric duplication cysts, to get both definitive diagnosis and treatment, and the radical surgical excision represents the treatment of choice in order to avoid neoplastic degeneration of internal lining mucosa.2 Furthermore surgical laparoscopy appears to be a feasible and safe technique.

2016 - Chronic and recurrent benign lymphadenopathy without constitutional symptoms associated with human herpesvirus-6B reactivation [Articolo su rivista]
Forghieri, Fabio; Luppi, Mario; Barozzi, Patrizia; Riva, Giovanni; Monica, Morselli; Bigliardi, Sara; Quadrelli, Chiara; Vallerini, Daniela; Maccaferri, Monica; Coluccio, Valeria; Paolini, Ambra; Colaci, Elisabetta; Goretta, Bonacorsi; Maiorana, Antonino; Sara, Tagliazucchi; Fabio, Rumpianesi; Mattioli, Francesco; Presutti, Livio; Gelmini, Roberta; Cermelli, Claudio; Giulio, Rossi; Patrizia, Comoli; Marasca, Roberto; Narni, Franco; Potenza, Leonardo
abstract

Chronic/recurrent behaviour may be encountered in some distinct atypical or malignant lymphoproliferations, while recurrences are not generally observed in reactive/benign lymphadenopathies. We retrospectively anal- ysed a consecutive series of 486 human immunodeficiency virus-negative adults, who underwent lymphadenectomy. Neoplastic and benign/reactive histopathological pictures were documented in 299 (61 5%) and 187 (38 5%) cases, respectively. Of note, seven of the 111 (6 3%) patients with benign lymphadenopathy without well-defined aetiology, showed chronic/ recurrent behaviour, without constitutional symptoms. Enlarged lymph nodes were round in shape and hypoechoic, mimicking lymphoma. Reac- tive follicular hyperplasia and paracortical expansion were observed. Human herpesvirus (HHV)-6B positive staining in follicular dendritic cells (FDCs) was documented in all seven patients. Serological, molecular and immunological examinations suggested HHV-6B reactivation. Among the remaining 104 cases with reactive lymphoid hyperplasia in the absence of well-known aetiology and without recurrences, positivity for HHV-6B on FDCs was found in three cases, whereas in seven further patients, a scanty positivity was documented in rare, scattered cells in inter-follicular regions. Immunohistochemistry for HHV-6A and HHV-6B was invariably negative on 134 lymph nodes, with either benign pictures with known aetiology or malignant lymphoproliferative disorders, tested as further controls. Future studies are warranted to investigate a potential association between HHV- 6B reactivation and chronic/recurrent benign lymphadenopathy.

2016 - Congenital bile duct cyst (BDC) is a more indolent disease in children compared to adults, except for Todani type IV-A BDC: results of the European multicenter study of the French Surgical Association [Articolo su rivista]
Ouaissi, M; Kianmanesh, R; Ragot, E; Belghiti, J; Wildhaber, B; Nuzzo, G; Dubois, R; Revillon, Y; Cherqui, D; Azoulay, D; Letoublon, C; Pruvot, Fr; Roux, A; Mabrut, Jy; Gigot, Jf; De Goyet, Jdv; Hubert, C; Lerut, J; Otte, Jb; Reding, R; Farges, O; Sauvanet, A; Wassila, O; Giulante, F; Ardito, F; De Rose Agostino, M; Gelas, T; Mure, Py; Baulieux, J; Gouillat, C; Ducerf, C; Irtan, S; Sarnacki, S; Laurent, A; Compagnon, P; Salloum, C; Lebeau, R; Risse, O; Truant, S; Boleslawski, E; Corfiotti, F; Rat, P; Doussot, A; Ortega-Deballon, P; Paye, F; Balladur, P; Adham, M; Partensky, C; Alhassane, T; Boudjema, K; Dane, Ct; Le Treut, Yp; Rinaudo, M; Hardwigsen, J; Martelli, H; Gauthier, F; Branchereau, S; Msika, S; Sommacale, D; Palot, Jp; Ayav, A; Laurain, Ca; Falconi, M; Castaing, D; Ciacio, O; Adam, R; Vibert, E; Troisi, R; Vanlander, A; Geiss, S; De Taffin, G; Collet, D; Sa Cunha, A; Duguet, L; Chafik, B; Bentabak, K; Graba, A; Meurisse, N; Pirenne, J; Capussotti, L; Langelle, S; Halkic, N; Demartines, N; Cristaudi, A; Molle, G; Mansvelt, B; Saviano, M; Gelmini, R; Baraket, O; Bouchoucha, S; Sastre, B
abstract

Aim: To compare clinical presentation, operative management and short- and long-term outcomes of congenital bile duct cysts (BDC) in adults with children. Methods: Retrospective multi-institutional Association Francaise de Chirurgie study of Todani types I+IVB and IVA BDC. Results: During the 37-year period to 2011, 33 centers included 314 patients (98 children; 216 adults). The adult population included more high-risk patients, with more active, more frequent prior treatment (47.7% vs 11.2%; p < 0.0001), more complicated presentation (50.5% vs 35.7%; p = 0.015), more synchronous biliary cancer (11.6% vs 0%; p = 0.0118) and more major surgery (23.6% vs 2%; p < 0.0001), but this latter feature was only true for type I+IVB BDC. Compared to children, the postoperative morbidity (48.1% vs20.4%; p < 0.0001), the need for repeat procedures and the status at follow-up were worse in adults (27% vs 8.8%; p = 0.0009). However, severe postoperative morbidity and fair or poor status at follow-up were not statistically different for type IVA BDC, irrespective of patients’ age. Synchronous cancer, priorHBPsurgery and Todani type IVA BDC were independent predictive factors of poor or fair long-term outcome. Conclusion: BDC is a more indolent disease in children compared to adults, except for Todani type IVA BDC.

2015 - Choledochocele: Choledochal Cyst Ora Distinct Entity? [Articolo su rivista]
Pecchini, Francesca; Catellani, Barbara; Acciuffi, Sara; Gelmini, Roberta
abstract

Choledochocele represents a cystic dilatation of the distal common bile duct and it’s included in Todani’s classification as type III choledochal cysts. We report a case of a 66-years-old man who presented a suspected gallbladder lithiasis with colic abdominal pain, vomit, fever, jaundice and abnormal liver function tests. However the endoscopic retrograde cholangio-pancreatography revealed the absence of stones in the common bile duct and the presence of a 15mm-wide choledochocele that was successfully treated with an endoscopic sphincterotomy. Additionally a comprehensive review of the literature of the last 15 years was performed, collecting 105 cases of choledochocele. The available data were classified in 10 variables and subsequently analysed. Summarizing all data, we noticed that choledochocele presents different characteristics if compared with other types of choledochal cysts: The population affected is older, there isn’t a strong female prevalence, the most frequent manifestation is pancreatitis instead of jaundice and cholangitis, the association with anomalous pancreato-biliary duct junction is rare and the risk of malignancy is lower. The standard for the diagnosis is endoscopic retrograde cholangio-pancreatography instead of magnetic resonance cholangio-pancreatography and the most accepted treatment is endoscopic sphincterotomy in order to allow the correct outflow of the biliary juice. In conclusion, even if choledochocele is commonly considered a type of cystic dilatation of the common biliary duct and it is usually included in the choledochal cysts classification, it has to be considered as a distinct entity with its own features.

2014 - Acute obstructive jaundice: a possible clinical manifestation of IPMT. Case report and review of the literature [Articolo su rivista]
Gargaglia, Eleonora; Iotti, Valentina; Ligabue, Guido; Gelmini, Roberta
abstract

I NTRODUCTION : Pancreatic masses causing acute obstructive jaundice still pose diagnostic difficulties and their character- ization can often be complex as there is significant overlap in their imaging features. C ASE R EPORT : We describe a case of Intraductal Papillary Mucinous Tumor (IPMT) presenting with acute obstructive jaundice in a patient with history of recurrent mild pancreatitis. Clinical evaluation, abdominal ultrasonography (US) and CT-scan posed suspicion of adenocarcinoma with cystic degeneration of the pancreatic head or mucinous cystadeno- carcinoma; magnetic resonance (MR) with magnetic resonance cholangiopancreatography (MRCP) demonstrated the com- munication of the mass with the main pancreatic duct, posing differential diagnosis between main-duct-IPMT and muci- nous cystadenocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated the presence of a mucus- secreting lesion inside duodenum and duodenal biopsies showed no evidence of neoplastic cells. R ESULTS : The patient underwent spleen preserving total pancreatectomy that led to histological diagnosis of intraduc- tal papillary mucinous with carcinoma in situ. D ISCUSSION : The international guidelines for management of IPMT, reported in 2006 and revised in 2012, estab- lish that the resectability and the absence of an invasive carcinoma are the most important prognostic factors in IPMT. Therefore an early diagnosis and a radical resection are crucial to improve the patient survival and reduce the recur- rence rate. C ONCLUSION : When an IPMT is suspected, the imaging modalities are essential to pose the diagnosis, maximise the chance to select the right surgical candidate and to perform the best treatment for each patient.

2014 - SENTINEL NODE IN DIFFERENTIATED THYROID CANCER: COMPARISON BETWEEN VITAL-DYE PATENT BLUE, LYMPHOSCINTIGRAPHY AND COMBINED TECHNIQUE [Abstract in Atti di Convegno]
Gelmini, Roberta; Esposito, Sofia; Beghelli, Davide; Gerunda, Giorgio Enrico
abstract

Obiettivo dello studio : aim of the study is to evaluate the role of sentinel node (SN) identification in the treatment of differentiated thyroid cancer (DTC). We also aim to assess feasibility and reproducibility of the SN techniques with vital-dye patent blue, radiotracer and combined technique Materiali e metodi : the study is multicentric, prospective, randomized three arms open. We expect to enroll 120 patients in 2 years. Patients have to be preoperative diagnosis of DTC. Exclusion criteria are previous cervical surgery, medullary cancer, nodes metastasis and multifocal tumor. All patients undergo total thyroidectomy, SN identification and central compartment (CC) dissection: in Arm A SN identification is obtained with vital-dye Patent blue technique, in Arm B with lymphoscintigraphy and in Arm C with combined technique. Specimen histopathology provides information about the characteristics of primary tumor, SN and the remaining nodes with specific immuno-histochemistry protocols Principali risultati : so far we enrolled 42 patients Arm A (26 pts): 18 patients (69.2%) had negative SN and nonSN; 1 (3.8%) with negative SN had micrometastasis in 2 nodes of CC; 2 (7.6%) with macrometastasis in the SN had metastatic nodes in the CC and 1 (3.8%) had macrometastasis in the SN with no other positive nodes. In 4 (15.2%) patients identification of the SN wasn't possible and there was no evidence of metastasis in all nodes removed Arm B: 2 patients (100%) had negative SN and nonSN Arm C (14 pts): 4 patients (28.6%) had negative SN and nonSN; 1 (7.1%) with negative SN had macrometastasis in 2 nodes; 4 (28.6%) with macrometastasis in the SN had metastatic nodes in the CC and 1 (7.1%) had macrometastasis in the SN with no other positive nodes. In 4 (28.6%) patients identification of the SN wasn't possible and in 3 of them there was no evidence of metastasis Conclusioni : so far the data we gathered are too few to make statistic significant conclusions. Once adequate scientific evidence is available, detection of the SN could become a routine procedure in DTC treatment, avoiding central compartment dissection in patients with negative SN. The achievement of a standard protocol of SN detection remains an important issue to solve, although both techniques had shown a good rate of detection of the SN, several studies report that the combined method could reduce false negatives and increase detection rates of SN metastases

2014 - Stump appendicitis: a rare and unusual complication after appendectomy. Case report and review of the literature [Articolo su rivista]
Papi, Simona; Francesca, Pecchini; Gelmini, Roberta
abstract

I NTRODUCTION : Stump appendicitis is a rare but important complication that can occour after an open or laparoscop- ic appendectomy. Although it represents a recognized serious condition that should not be overlooked, it is not often con- sidered by surgeons within the differential diagnoses faced with a patient presenting right iliac fossa abdominal pain, particularly those who present a previous history of appendectomy. M ATERIAL OF S TUDY : A comprehensive review of English literature was performed and 87 cases of stump appendicitis were identified. Each case was charted based on 10 variables and data were analyzed. One original case of stump appen- dicitis after open appendectomy treated at our institution is also described and taken as a model. D ISCUSSION : Several factors may contribute to the etiology of stump appendicitis, mainly related to the length of the residual tissue after appendectomy. A delay in diagnosis, possibly misled by a previous history of appendectomy, represents a risk of complications and possible stump perforation. The imaging studies, especially CT scan, seem to be helpful tools in getting the earliest possible diagnosis. C ONCLUSION : Surgeons should be aware of the occurrence of this rare but dangerous entity, in order to avoid a delay in diagnosis and in the appropriate therapeutic choice. We want to emphasize also the technical recommendations to be respected in course of appendectomy.

2014 - TRANSPERITONEAL LAPAROSCOPIC ADRENALECTOMY IN CHILDREN: INITIAL EXPERIENCE [Articolo su rivista]
B., Catellani; S., Acciuffi; D., Biondini; Pl, Ceccarelli; Cacciari, Alfredo; Gelmini, Roberta
abstract

PURPOSE: The use of mini-invasive approach for adrenalectomy is poorly defined in pediatric patients, although laparoscopic adrenalectomy is considered a standard procedure in adults. The aim of our study is to describe the safety and feasibility of minimally invasive adrenalectomy in children based on surgical skills and results. MATERIALS AND METHODS: This is a retrospective study of four pediatric laparoscopic adrenalectomies performed in our centre between 2009 and 2012. All patients underwent transperitoneal lateral laparoscopic adrenalectomy two of which were right adrenalectomies and two were left. RESULTS: Four laparoscopic adrenalectomies were performed. Indications for surgery were neuroblastoma in two patients, secernent adrenocortical tumor in one patient and adrenocortical nodular hyperplasia in the last one. Patients had a mean age of 87 months (range 17-156) at diagnosis and the average lesion size was 3.23 cm (range 0.7-6.4). All laparoscopic adrenalectomies were successful, no conversions to open surgery were required and no post- operative complications or deaths occurred. The average operating time was 105 minutes (range 80-130), blood loss during surgery was minimal and the mean post-operative hospital stay was 3.75 days (range 3-5). None of the patients showed signs of recurring disease at 15-months follow- up. CONCLUSIONS: Laparoscopic adrenalectomy is a safe, feasible and reproducible technique offering numerous advantages including shortening of operating times and post-operative hospital stays, as well as reduction of blood loss and complications. It also provides good visibility and easy access to other organs.

2013 - An objective comparison of novice trainees learning LESS versus traditional laparoscopy with the use of a pelvic trainer. [Articolo su rivista]
G., Isgrò; Micali, Salvatore; G., Pini; S., De Stefani; Gelmini, Roberta; Franzoni, Chiara; Bianchi, Giampaolo
abstract

OBJECTIVES: To compare the differences between LESS and SL among a population of subjects inexperienced of both techniques. MATERIALS AND METHODS: Participants were randomly assigned to the LESS or SL arm of the course; between the population examined, none had previous laparoscopic experience. The trial consisted in performing three increasingly difficult exercises either with LESS or standard laparoscopy. RESULTS: Time of execution and Objective Structured Assessment of Technical Skills score (OSATS) were recorded. Statistical analysis failed to detect any significant difference between the two arms of the trial. A trend in favor of standard laparoscopy was observed anyway. DISCUSSION: Our study evaluates the technical performance on a surgical simulator in the laboratory setting, with the use of standardized tasks and validated metrics. We believe that a controlled and safe environment aids objective evaluation of LESS compared to SL. Literature on this particular topic is somehow conflicting and heterogeneous. Our trial demonstrated that novices performed LESS tasks without any additional difficulties compared to standard laparoscopy. The aim of such investigation is to support knowledge of this new technology in order to facilitate its use in selected patients and surgical procedures.

2013 - Laparoscopic Adrenalectomy in Children [Abstract in Rivista]
Gelmini, Roberta; Pl, Ceccarelli; Catellani, Barbara; D., Biondini; Cacciari, Alfredo
abstract

Adrenalectomia VL in età pediatrica: indicazioni e tecnica chirurgica

2013 - Progetto SOS.net ‘Sale operatorie sicure’ Adozione della Surgical safety checklist negli ospedali della Regione Emilia-Romagna [Articolo su rivista]
S., Mall; O., Nicastro; C., Basili; C., Castanò; G., Turci; S., Bonilauri; L., Ferri; G., Gambale; Gelmini, Roberta; U., Grandi; Mt, Montella; P., Zuin; S., Rodella
abstract

In 2008 the Who diffused the Guidelines for safe surgery. In 2010, following this milestone publication, the Regional agency for health and social care in Emilia-Romagna, supported by the Mod- ena university hospital, launched the SOS.net project aimed at implementing the Surgical safety checklist in order to improve safety in the operating room and to prevent potentially avoidable adverse events. The regional checklist – divided into two modules – includes a set of check to be carried out during the surgery, and determines possible deviations from the standard. This paper presents the results of the pilot study (2011): more than 60% of the surgical units was for- mally recruited and 52% was able to document the use of the checklist through a dedicated regional database. Overall, the use of the checklist was registered in 62,507 surgeries – 19% of the total num- ber of surgeries delivered at regional level – with a high variation among the different units (min 1.4; max 57.2). Among the 5426 reported deviations from the standard, the unmarked site is the more fre- quent (31.3%). Compliance of involved professionals was assessed through a questionnaire which re- ported an overall positive attitude towards the tool, but clarified the most relevant difficulties (mainly cultural and technical/organisational) for its routine implementation. The paper deals with the report- ed results, compares them with the literature, and identifies some future directions.

2013 - Surrenectomia laparoscopica: la nostra esperienza. [Relazione in Atti di Convegno]
Cacciari, Alfredo; Ceccareli, Pl; Biondini, D; Bianchini, Ma; Repetto, P; Durante, V; Gelmini, Roberta
abstract

La surrenectomia è un intervento molto importanete, in particolare nell'età pediatrica. Usare la laparoscopia è una tecnica sicura e ben riproducibile.

2012 - Chronic/relapsing lymphadenopathy associated with HHV-6B infection: a new benign clinico-pathologic entity occurring in immunocompetent individuals [Abstract in Rivista]
Forghieri, Fabio; Potenza, Leonardo; Barozzi, Patrizia; Vallerini, Daniela; Riva, Giovanni; Zanetti, E; Quadrelli, C; Morselli, M; Leonardi, G; Maccaferri, M; Paolini, Ambra; Coluccio, Valeria; Colaci, Elisabetta; Pedrazzi, Letizia; Fantuzzi, Valeria; Bigliardi, Sara; Soci, Francesco; Bonacorsi, G; Zaldini, P; Rossi, G; Milani, M; Rivasi, Francesco; Gennari, W; Pecorari, M; Grottola, Antonella; Tagliazucchi, S; Rumpianesi, F; Mattioli, F; Presutti, Livio; Franzoni, Chiara; Gelmini, Roberta; Saviano, Massimo; Cermelli, Claudio; Marasca, Roberto; Narni, Franco; Luppi, Mario
abstract

Background. HHV-6 DNA sequences were disclosed in lymph node (LN) tis- sues of several patients with lymphoid malignancies, but a direct major role of HHV-6 in lymphoid malignant transformation has so far not been confirmed. In contrast, active HHV-6 infection has been associated to either infectious mononucleosis-like syndrome or acute lymphadenitis occurring in febrilepatients with systemic symptoms, or to Rosai-Dorfman disease in which viral antigens have been detected by immunohistochimical (IHC) analyses in both histiocytes and follicular dendritic cells (FDCs). Methods. We have retrospec- tively analyzed clinical and pathological data of 365 adult patients, consecutive- ly observed at our Institution over a period of 5 years (2006-2010), because of enlarged superficial lymph nodes and subsequently undergoing lymphadenec- tomy. In the benign/reactive cases in which well-recognized etiologies have been excluded, an involvement of HHV-6 active infection or reactivation was investigated by molecular and immunohistochemical examinations. Results. Malignant disorders, namely malignant lymphoproliferative disorders or solid cancer metastases, were found in 227 cases (62%), whereas in 138 cases (38%) benign/reactive pictures were documented on lymph node examination. Among these latter cases, a well-recognized etiology was demonstrated in 84 patients (61%), while in 54 cases (39%), a well-defined non-malignant reactive/infectious cause could not be documented. Immunohistochemical analyses resulted negative for both HHV-6A and HHV-6B in 38 of these latter lymph nodes (70%). In 7 patients (13%), a scattered, scanty and aspecific pos- itivity for HHV-6B late protein was documented in rare interfollicular plasma cells and histiocytes. Surprisingly, in 9 patients (17%), immunohistochemical analyses showed HHV-6B positive staining of FDCs, together with scattered positivity of interfollicular cells. These 9 HIV-negative adult patients (median age 42 years, range 18-76 years), with either localized or generalized LAP, were observed for a median follow-up of 38 months (range 28-166). Of note, six of them presented with recurrent LAP (one to 3 recurrences), without evolving into lymphoma. A common LN histological pattern at presentation showed florid fol- licular hyperplasia with concurrent mild paracortical expansion. Three cases also showed features consistent with PTGC. Constitutional symptoms were absent in all patients. The IHC reactions for both HHV-6A and HHV-6B, per- formed on further control cases, represented by 131 LN tissues from patients with either benign LAP induced by other known etiologies or lymphoma, were invariably negative. Serology was positive for both IgM and IgG with high avid- ity suggesting viral reactivation/reinfection. However, the molecular analyses failed to detect HHV-6 viremias in cell-free-serum samples of all the 9 patients with positive HHV-6B IHC staining, while positivity for HHV-6B DNA was dis- closed by PCR analyses in 7 out of the 7 LN tissues studied. Conclusions. We show for the first time that local reactivation/infection of HHV-6B should be con- sidered among the possible causes of chronic/relapsing benign LAP in immuno- competent individuals. IHC is the method of choice for investigating the pres- ence of HHV-6 infection in such cases. HHV-6B may indirectly modulate and trigger the proliferation of lymphocytes, by locally affecting FDCs and LN microenvironment. FDCs may indeed be involved in presenting HHV-6B anti- gens to other immune cells, mainly cortical B lymphocytes.

2012 - Day surgery laparoscopic cholecystectomy: initial experience in 43 consecutive patients [Articolo su rivista]
Gelmini, Roberta; Franzoni, Chiara; Saviano, Massimo
abstract

Aim: Analyze the results of an early experience in day-case LC (laparoscopic cholecystectomy) in a single laparoscopic unit, in terms of clinical outcome, unexpected admissions, readmissions, patients satisfaction. Materials and Methods: During three years, 200 consecutive patients underwent LC. Emergency procedures (32pts) and patients scheduled for cholecystectomy plus other surgical procedures (21pts) were excluded. Thus, 147 patients underwent elective LC and 43 were scheduled for DSLC (day-surgery laparoscopic cholecystectomy). Results: 6 patients (13,9%) were considered not eligible for a same day discharge and admitted to the inpatients ward for overnight observation. The re-admission rate was 2,3% and 41 patients (95,3%) were completely satisfied. Discussion: Patients satisfaction was complete in 95,3% of cases, related to a correct preoperative information and the reduction in hospital costs amounted approximately to 41%. Despite the evidence of feasibility and safety of the day-case procedure, the Italian cultural background is nowadays inadequate for a clean acceptance of the DSLC. The provision of adequate staff education and training prior to full DSLC introduction is mandatory to the success of this organizational model. Conclusions: LC can be performed safely in an outpatient setting if there’s a careful education of patients and the surgical and anesthesiologist team is well-trained. Besides, good results can be achieved considering inclusion criteria. For the admission to be kept to a minimum, postoperative pain and nausea management has to be carefully planned such as discharge criteria evaluated. For selected patients, day-case LC is feasible and safe and can provide a reduction in hospital costs.

2012 - Erratum: Four cases of mesenteric cystic neoformations (Minerva Chirurgica (2012) 58:2 (235)) [Articolo su rivista]
Farinetti, A.; Saviano, L.; Tazzioli, G.; Gelmini, R.; Saviano, M.
abstract

2012 - Reproductive status is associated with the severity of fibrosis in women with hepatitis C. [Articolo su rivista]
Villa, Erica; Vukotic, Ranka; Cammà, C; Petta, S; DI LEO, Antonino; Gitto, S; Turola, E; Karampatou, A; Losi, L; Bernabucci, Veronica; Cenci, A; Tagliavini, S; Baraldi, E; De Maria, N; Gelmini, Roberta; Bertolini, Elena; Rendina, M; Francavilla, A.
abstract

INTRODUCTION: Chronic hepatitis C is the main cause of death in patients with end-stage liver disease. Prognosis depends on the increase of fibrosis, whose progression is twice as rapid in men as in women. Aim of the study was to evaluate the effects of reproductive stage on fibrosis severity in women and to compare these findings with age-matched men. MATERIALS AND METHODS: A retrospective study of 710 consecutive patients with biopsy-proven chronic hepatitis C was conducted, using data from a clinical database of two tertiary Italian care centers. Four age-matched groups of men served as controls. Data about demographics, biochemistry, liver biopsy and ultrasonography were analyzed. Contributing factors were assessed by multivariate logistic regression analysis. RESULTS: Liver fibrosis was more advanced in the early menopausal than in the fully reproductive (P&lt;0.0001) or premenopausal (P = 0.042) group. Late menopausal women had higher liver fibrosis compared with the other groups (fully reproductive, P&lt;0.0001; premenopausal, P = &lt;0.0001; early menopausal, P = 0.052). Multivariate analyses showed that male sex was independently associated with more severe fibrosis in the groups corresponding to premenopausal (P = 0.048) and early menopausal (P = 0.004) but not late menopausal pairs. In women, estradiol/testosterone ratio decreased markedly in early (vs. reproductive age: P = 0.002 and vs. premenopausal: P&lt;0.0001) and late menopause (vs. reproductive age: P = 0.001; vs. premenopausal: P&lt;0.0001). In men age-matched with menopausal women, estradiol/testosterone ratio instead increased (reproductive age group vs. early: P = 0.002 and vs. late M: P = 0.001). CONCLUSIONS: The severity of fibrosis in women worsens in parallel with increasing estrogen deprivation and estradiol/testosterone ratio decrease. Our data provide evidence why fibrosis progression is discontinuous in women and more linear and severe in men, in whom aging-associated estradiol/testosterone ratio increase occurs too late to noticeably influence the inflammatory process leading to fibrosis.

2011 - Laparoscopic Ileo-Colic Resection with Radiofrequency Device in Crohn Disease [Abstract in Rivista]
Gelmini, Roberta; Franzoni, Chiara; Saviano, Massimo
abstract

Objective: Since the introduction of laparoscopic colorectal surgery, several studies have demonstrated the advantages of mini-invasive segmental colon resections in the treatment of benign diseases. Laparoscopic ileo-colic resection in complicated Crohn’s disease is often difficult. The presence of fistula, abscess, and inflammation could make the dissection challenging. The use of a radiofrequency vessel-sealing system device both in dissection and vessel ligation, as a unique instrument, seems to make the procedure easier with a low rate of conversion. The aim of this report is to show the feasibility and safety of laparoscopic ileo-colic resection with a radiofrequency device. Materials and Methods: Between January 2009 and December 2010 at our institution, 13 patients underwent to laparoscopic ileo-colic resection with a radiofrequency device for complicated Crohn’s disease. Results: The mean age was 42.3 years, and the preoperative endoscopy showed an ileocecal valve of distal ileum stenosis or fistula. Mean operative time was 166 minutes, and the estimated mean blood loss was 100cc. No conversions occurred. In all cases but one, the margins of resection were disease free. Two postoperative complications occurred: 1 anastomotic dehiscence and 1 intestinal perforation, both surgically treated. No mortalities occurred. The mean hospital stay was 8 days. Conclusions: The analysis of our data highlights that laparoscopic ileo-colic resection with a radiofrequency device is effective and feasible even if this procedure, because of its complexity and for the intrinsic characteristics of the disease, has to be reserved for well-trained laparoscopic surgeons and does not eliminate the risk of postoperative complications.

2011 - Laparoscopic splenectomy: conventional versus robotic approach--a comparative study. [Articolo su rivista]
Gelmini, Roberta; Franzoni, C; Spaziani, A; Patriti, A; Casciola, L; Saviano, M.
abstract

AbstractBACKGROUND:Laparoscopic splenectomy is accepted as a safe approach in the surgical treatment of blood disorders worldwide. Compared with the laparotomic technique, it is associated with a lower risk of intraoperative bleeding, less postoperative pain, and faster discharge times. The advent of robotic surgery (RS) has changed the concept of minimally invasive surgery because, in addition to allowing a three-dimensional view, it permits greater freedom of movement and higher levels of accuracy than laparoscopic surgery (LS). The aim of this study was to comparatively evaluate whether RS presents advantages over LS in spleen surgery.METHODS:In two Surgical Units with experience in laparoscopic splenectomy, over a 7-year period, two groups of 45 patients underwent LS and RS. The two groups were well matched for demographic characteristics, indications, and spleen size.RESULTS:No statistically significant differences were found regarding intraoperative blood loss, conversion rate to laparotomy, food intake, drain removal, postoperative complications, and median time to discharge. On the contrary, statistically increased differences were observed in median operative time and costs. In both groups, the transfusion and mortality rate was 0%. At the 6-month follow-up no surgical complications were observed.CONCLUSIONS:Although RS offers a three-dimensional view, greater freedom of movement, and higher levels of accuracy, it is associated with longer operative times and higher costs. It can consequently be concluded that with the intrinsic limits of the study design used, at the current time, RS does not have any significant advantage over LS in splenectomy.

2010 - Confronto dell’apprendimento dei principi di tecnica laparoscopica standard versus LESS: Analisi dei risultati ottenuti su pelvic trainer. [Poster]
Micali, Salvatore; Gelmini, Roberta; G., Pini; C., Franzoni; G., Isgrò; C., Guarasci; Bianchi, Giampaolo
abstract

Confronto dell’apprendimento dei principi di tecnica laparoscopica standard versus LESS: Analisi dei risultati ottenuti su pelvic trainer

2010 - Dissezione del cavo ascellare in pazienti con micrometastasi nel linfonodo sentinella: nuovi orientamenti. [Abstract in Atti di Convegno]
M., Bolondi; Farinetti, Alberto; Tazzioli, Giovanni; Andreotti, Alessia; Gambini, Anna; Gelmini, Roberta; Saviano, Massimo
abstract

OBIETTIVO: l’indicazione allo svuotamento del cavo ascellare nelle pazienti con tumore della mammella è indicata per la presenza di metastasi (>2 mm di diametro) nel LS o nel caso in cui il LS non venga identificato. Lo scopo del nostro studio è proporre nuovi orientamenti per la dissezione del cavo ascellare in presenza di micrometastasi (con diametro compreso tra 0,2 mm e 2 mm) nel LS in quanto queste potrebbero non dare coinvolgimento metastatico di altri linfonodi del cavo ascellare. METODI: nel nostro studio retrospettivo abbiamo analizzato i dati di 1119 pazienti in un periodo di 7 anni (2002/2009): di queste 72 sono risultate positive per micrometastasi nel LS. Sono stati analizzati anche istologia, dimensioni e grado istologico dei tumori. RISULTATI: delle 72 pazienti positive per micrometastasi nel LS 6 pazienti non sono state sottoposte alla dissezione del cavo ascellare. Abbiamo preso in considerazione 66 pazienti: 13 sono positive per la presenza di metastasi in altri linfonodi del cavo ascellare; i tumori responsabili sono, secondo il TNM, in 9 casi T1c e in 4 casi T2; l’istologia è in 2 casi lobulare infiltrante, in 11 casi duttale infiltrante; il grado istologico è in 7 casi II grado, in 6 casi III grado. CONCLUSIONI: delle 66 pazienti con micrometastasi nel LS il 19,7% (13 casi) presenta positività del cavo ascellare: con tali percentuali, confermando la correttezza delle linee guida attuali, non è ancora possibile rinunciare alla dissezione del cavo ascellare in queste pazienti. Emerge, inoltre, come i tumori responsabili di metastasi in altri linfonodi del cavo ascellare abbiano dimensione >1 cm, istologia di tipo lobulare infiltrante e duttale infiltrante, grading II e III.

2010 - Incidental thyroid carcinoma (ITC): a retrospective study in a series of 737 patients treated for benign disease [Articolo su rivista]
Gelmini, Roberta; Franzoni, Chiara; Pavesi, Erica; Cabry, Francesca; Saviano, Massimo
abstract

Aim: aim of the study is to evaluate correlations between incidental thyroid carcinoma (ITC) and benign thyroid pathologies (BTP), to determine the most represented histotype and to point out the total thyroidectomy’s possible advantages in terms of radicality, follow-up management and incidence of complications.Materials and Methods: during 10 years, 739 patients underwent thyroid surgery for BTP. Fine needle biopsy (FNAB) was negative in all cases; 503 total thyroidectomies(TT), 5 subtotal thyroidectomies(ST) and 231 emithyroidectomies(ET) were performed.Results: the specimens pathological examination revealed the presence of a ITC in 82 patients (11,1%); the prevalent histotype was the papillary one with a less than 1cm diameter in almost the totality of cases but with nodes metastasis in the 3,6% of cases. Complications were detected in 117 patients with a morbidity rate of 15,8%. Discussion: in our study the ITC prevalence was of 11,1% similar to literature with a higher incidence in patients affected by multinodular than uninodular goiter. No statistical significant differences were found between euthyroid and toxic pathologies. In our series hyperthyroidism doesn’t seem to hold a protective role towards the ITC onset. Conclusions: The ITC incidence is relevant; the prevalent histotype is papillary and nodes metastasis are present even if in a low percentage of cases. Besides, the complications of TT are similar to conservative procedures. The recurrence of goiter and ITC require a second surgical procedure, with a higher risk of complications. So we can claim that the standard surgical treatment of bilateral PBT would be represented by TT.

2010 - Laparoscopic cholecystectomy with Harmonic scalpel [Articolo su rivista]
Gelmini, Roberta; Franzoni, Chiara; Zona, Stefano; Andreotti, Alessia; Saviano, Massimo
abstract

BACKGRUOND: Laparoscopic cholecystectomy is considered the “gold standard” in the treatment of symptomatic gallbladder lithiasis. Nevertheless, there are some pitfalls associated with the use of monopolar hook such as risk of thermal injuries and biliary complications. The ultrasonically activated scalpel – Harmonic ® - (Ethicon Endo Surgery INC - Johnson & Johnson Medical SPA) has been used in gallbladder dissection and enables to divide both vessels and cystic duct while reducing the risk of thermal injuries. METHODS:During a period of 2 years, in a personal series involving 95 consecutive patients, the Harmonic was used as the sole instrument for division of both cystic artery and duct and dissection. The mean hospital stay, procedure duration and complications, were compared with a homogenous control group treated with monopolar electrosurgery and clips.RESULTS:Neither major complications nor bile ducts injuries were detected in both groups and no statistically significant difference was found in the incidence of postoperative complications. Instead the mean operative time was significantly shorter in the Harmonic group.CONCLUSIONS:The Harmonic is save and effective and represents an alternative to clips, providing a complete hemo-biliary stasis. Even if no differences were found regarding postoperative complications, Harmonic stands for a better alternative able to guarantee shorter operative time and cost savings which both derive from the use of a unique instrument.

2010 - Laparoscopic splenectomy: conventional versus robotic approach: a comparative study. “19° international congress and endo-expo of SLS [Abstract in Rivista]
Gelmini, Roberta; Franzoni, Chiara; A., Spaziani; A., Patriti; L., Casciola; Saviano, Massimo
abstract

Objectives: Laparoscopic splenectomy (LS) is the gold standard in surgical treatment of splenic hematologic diseases. Robotic surgery (RS) has changed the concept of minimally invasive surgery because of the tridimensional view, degrees of freedom, and accuracy of movements. The aim of this study was to evaluate whether RS has advantages over LS.Methods: In 2 Surgical Units experienced in laparoscopic spleen surgery, 2 groups of patients underwent LS (45 cases G1) and RS (45 cases G2). The 2 groups were well matched for demographic characteristic, indications, and spleen size. The median bipolar spleen diameter was 15cm and 13cm, respectively.Results: Between the 2 groups, there were no statistically significant differences in intraoperative blood loss (<100mL in both groups), conversion rate to laparotomy (5 G1, 4 G2), postoperative food intake, drainage removal, postoperative complications (4 hemoperitoneum and 1 pleural effusion G1, 1 hemoperitoneum and 4 pleural effusion G2) and median postoperative hospital stay. On the contrary, statistically significant differences were observed for median operative time (125 minutes G1, 153 G2) and costs (US$1.600 G1, US$6.930 G2). Transfusion and mortality rate were 0%. The follow-up at 6 months does not highlight late-surgical complications.Conclusion: The analysis of the data does not show advantages of RS over LS. RS even though it offers a tridimensional view of the operative field and the degrees of freedom and accuracy of movement that are superior to that of LS, has longer operative time and higher costs. Therefore, we can conclude that LS is to be considered the gold standard for hematological diseases.

2010 - Phase I study of intraperitoneal MHC unrestricted adoptive cell therapy with TALL-104 cells in patients with peritoneal carcinosis [Abstract in Rivista]
C., Bengala; Rasini, Valeria; Sternieri, Rita; Dominici, Massimo; Andreotti, Alessia; Gelmini, Roberta; Cafarelli, Luca; P., Bevini; A., Berti; Conte, Pierfranco
abstract

Background: TALL-104 is an irradiated human leukemic T cell line (CD3 + , CD4– CD8 + , CD56 + , CD16–) grown in IL-2-containing medium, that has the ability to kill tumor cells in preclinical models in a MHC unrestricted way. A phase I trial in metastatic breast cancer patients, has shown that multiple i.v. infusions (infs) of TALL-104 cells can be given safely. In order to optimise the tumor:effector cell ratio, we have designed a phase I study of intraperitoneal administrations of g-irradiated TALL-104 cells. Methods: Patients (pts) with peritoneal carcinosis from solid tumors resistant to standard treatment were eligible for the study. The treatment included 5 i.p. infs (day 1, 3, 5, 15, 30) and the study was designed to test three cell dose levels: 1 × 108, 5 × 108, 2.5 × 109. End points were: safety, kinetic of TALL-104 cells on ascites (if present) and peripheral blood (PB), levels of cytokines (TGF-b, GM-CSF, IL-2, IL-4, IL-10, IFN-g, TNF-a and -b, HGF, sIL-2R, sICAM-1) on ascites and serum, and immunological monitoring. Results: Fifteen pts have been treated: 8 with ovarian and 7 with GI cancer. Five pts have been treated at each dose level. No treatment-related adverse events were observed. TALL-104 cells were detected in ascites (100% of the pts) and PB (3.3% of the pts) up to 48 hrs after the infs. Cytotoxicity of autologous MNC showed an increase up to 5% at day 3 through 7 and it was still evident at day 30. HLA-DR + /CD14 + cells increased up to 21% and 30% in the serum and ascites respectively at day 7 through 15. GM-CSF, IL-2, IL-4, IL-10, IFN-g, TNF were not detectable neither in serum nor in ascitic fl uid. sIL-2R showed an increase up to 22% and 109% in serum and ascites respectively. IL-10 showed an increase up to 34% at 1st dose level and a decrease down to 20% and 40% in ascites and serum respectively at 2nd dose level. TGF-b1 and -b2 showed an increase both in serum and ascites at 1st and 2nd dose level. sICAM-1 showed an increase up to 22% at 1st dose level and a decrease down to 41% at 2nd dose level. Six patients had a confi rmed stable disease with a median duration of response of 5 months (3–7). Conclusion: These results show that the i.p. infusion of TALL- 104 is safe. Moreover, the increased autologous cell-mediated cytotoxicity and the levels of soluble cytokines after i.p. infs indicate that TALL-104 cells may elicit potential antitumor activity and deserve further evaluation in patients with a less severe stage of disease.

2010 - Putative predictive parameters for the outcome of laparoscopic splenectomy: a multicenter analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen [Articolo su rivista]
Casaccia, M; Torelli, P; Pasa, A; Sormani, Mp; Rossi, E; Valente, U; Spinoglio, G; Prete, F; Logrieco, G; Buccoliero, F; Berta, R; Donini, I; Donini, A; Valeri, A; Prosperi, P; Saviano, Massimo; Gelmini, Roberta; Uggeri, F; Caprotti, R; Romano, F; Colecchia, G; Monteferrante, E; Pedrazzoli, C; Bigi, L; Barbieri, Im; Moraldi, A; Dallatorre, A; Basso, N; Silecchia, G; Rosati, R; Bona, S; Cavaliere, P; Bresadola, F; Terrosu, G; Mosca, F; Pietrabissa, A; Memeo, V; Puglisi, F; Dionigi, R; Benevento, A; Boni, L; Liboni, A; Feo, C; Borghi, F; Geretto, P; Torelli, P; Moroni, R; Sorrentino, M; di Sebastiano, P; Ambrosio, A; Verdecchia, Gm; Cavaliere D., IRLSS Centers
abstract

OBJECTIVE:To identify predictive risk factors for conversion to open splenectomy and postoperative complications in patients undergoing elective laparoscopic splenectomy.BACKGROUND:The laparoscopic approach represents the "gold standard" for splenectomy, but its use in the treatment of splenomegaly and malignant disease is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathologic.METHODS:Univariate and multivariate analyses of data from the Italian Registry of Laparoscopic Surgery of the Spleen, a multicenter database supported by 25 referral centers. Analysis of data (1993-2007) was performed on a series of patients (n = 676) undergoing elective laparoscopic splenectomy. Demographic data, the operative indications, the surgical technique applied, and any intra- and/or postoperative complications with respect to the patients were assessed. Records were analyzed retrospectively using the Student t test, the chi test, and logistic regression.RESULTS:Conversion to open splenectomy was necessary in 39 cases (5.8%). Perioperative deaths occurred in 3 cases (0.4%). There were no complications in 560 patients (82.8%), with a mean hospital stay of 5 days (range, 2-54). Overall, morbidity occurred in 116 patients (17.2%). Multivariate analysis found that the body mass index (P = 0.01) and the presence of hematologic malignancy (P &lt; 0.001) were independent predictors for intraoperative complications and surgical conversion. Spleen longitudinal diameter (P = 0.001) and surgical conversion (P = 0.001) were independent predictors for the occurrence of postoperative complications.CONCLUSIONS:This large multicenter study provides evidence for the significance of predictive risk factors for intra- and postoperative complications in laparoscopic splenic surgery. Besides splenic dimensions, other factors like the patient's habitus and the specific underlying hematologic pathology should be recognized by the surgeon to reduce complications and initiate adequate treatment.

2010 - Surgical treatment of splenic hydatidosis: Report of a case [Articolo su rivista]
Gelmini, Roberta; Cabry, Francesca; Pavesi, Erica; Franzoni, Chiara; Saviano, Massimo
abstract

Hydatid disease is a zoonitic infection caused by Echinococcus granulosus and rarely by multilocularis, that affects predominantly liver, to a lesser extent lung and occasionally other organs. This paper discusses a case study conducted at our Institute to evaluate the surgical management of splenic hydatidosis, and to illustrate the utility of a range of new techniques. Splenic involvement alone is a rare event, even in endemic countries; many patients have no symptoms and its diagnosis can be either made fortuitously during diagnostic procedures such as chest or abdomen X-ray, or based on the appearance of those local symptoms caused by the pressure of growing cyst. The treatment of hydatidosis traditionally consists of surgery, either conservative or radical, along with a perioperative course of antielmintic medications. A number of therapeutic options for splenic localization exist, including conservative treatments such as Percutaneous Aspiration, Injection and Reaspiration (PAIR), cyst enucleation and partial splenectomy; and radical interventions such as total splenectomy. The splenectomy remains today, as it was in the past, the treatment of choice for the radical treatment of the disease under consideration because of its associated rates of low mortality, low relapse and low hemorrhagic complications. The laparoscopic approach has to be reserved for well-selected cases: small cysts without adhesion to others organs.

2009 - Acute appendicitis or gynecological disease? The role of videolaparoscopic approach [Abstract in Rivista]
Gelmini, Roberta; Franzoni, Chiara; Casolari, Veronica; Saviano, Massimo
abstract

Background: The laparoscopic approach for suspected appendicitis is increasingly gaining acceptance even if its remain controversial. Many Authors suggest the usefulness of laparoscopic approach in women of reproductive age because of the high rate of wrong diagnosis for gynecological diseases.Material and Methods: during a period of 2 years at our Institution 130 patients underwent to appendectomy for suspected acute appendicitis. Of those 40 were female in reproductive age and underwent to laparoscopic procedure. In 36 cases a preoperative gynecological examination was carried out and was negative. Results: in all cases the procedure was completed laparoscopically and the postoperative complication rate was 0%. The definitive diagnosis was: acute appendicitis in 15cases (37,5%), complicated appendicitis with abscess or peritonitis in 15 cases (37,5%) and gynecological unknown disease in 10 cases (25%) associated with chronic appendicitis. In the last group of patients both appendicitis and gynecological disease were treated in the same procedure.Conclusions: laparoscopic appendectomy is to be considered as safe as open and if in the male patients it hasn’t got obvious advantages, in women of reproductive age is able to perform a correct differential diagnosis with pelvic diseases and it permit to treat different disorders during a sole procedure and with the same mini-invasive accesses. The high rate of false negative in the diagnosis of pelvic diseases in the preoperative diagnostic tests justified the systematic use of laparoscopic approach in female patients with suspected acute appendicitis.

2009 - LAPAROSCOPIC SPLENECTOMY IN HEMATOLOGIC MALIGNANCIES [Abstract in Atti di Convegno]
Gelmini, Roberta; F., Romano; Franzoni, Chiara; G., Piacentini; Gambini, Anna; C., Penati; Saviano, Massimo; F., Uggieri
abstract

Aims: Although laparoscopic splenectomy (LS) for benign hematologic disease is well accepted, its role in the treatment of haematological malignancies is still controversial. The aim of this study is to compare efficacy and feasibility of LS for hematologic malignancies and patients outcome with benign disease patients wgo underwent thesame procedure.Methods: Between January 2001 and December 2007 in two affiliated university hospital 141 patients underwent to LS for hematologic disease. 104 for benign hematologic disorders (HB) and 37 (26,2%) for malignancies (HM). Results: Median splenic weight was greater in the HM group (mean 787 gr range 205-2500 gr) than in the HB group (mean 350 ge range 150-110 gr) with a statistically significant difference (p<0.005). The conversion rate is significantly greater in the HM group (22,2% versus 2,9% p<0.001) instead the mean operation time (150 minutes in HM group vs 125 in HB) and the mean blood loss are similar in the two groups of patients. Considering the postoperative course, morbidity (13.8% in HM vs 11,5% in HB group) and mean hospital stay (5,5 days in HM vs 4,4 in HB) were not different among the two groups. No mortality occurred.Conclusions: The analysis of our data highlights that LS for hematologic malignancies is effective and feasible even if associated to a higher conversion rate compared with LS for benign disorders. Besides, no differences in the outcome of patients (blood loss, morbidity, mortality and hospital stay) was noted among the two groups

2009 - Laparoscopic total colectomy with ileo-rectal anastomosis for polyposis and ulcerative colitis. Eur Surg Res 2009;43:104 [Abstract in Rivista]
Pavesi, Erica; Gelmini, Roberta; Saviano, Massimo
abstract

Introduction: Since the introduction of laparoscopic colorectal surgery, several studies have demonstrated the advantages of mini-invasive segmental colon resections in the treatment of benign and malignant diseases. On the contrary the use of laparoscopy for total colectomy and proctocolectomy is not worldwide accepted first of all because of the technically challenging nature of these procedures. The aim of this report is to show the feasibility and safety of straight laparoscopic total colectomy (LTC) for polyposis (P) and ulcerative colitis (UC).Material and methods: Between January 2006 and June 2007 in our Institution 5 patients underwent to LTC with ileorectal anastomosis plus temporary loop ileostomy for P ( 2 cases) and UC (3 cases). Results: The mean age was 69.2 yrs (62-77) and in all cases the preoperative endoscopy showed the distal rectum almost without signs of disease. Mean operative time was 320 minutes and the estimated mean blood loss was 250 cc. No transfusions were necessary. No conversions occurred. The mean surgical specimen length was 100 cm. and in all acses the margins of resection were disease free. Considering the postoperative course, no morbidity and mortality occurred. The mean hospital stay was 8 days. The temporary ileostomy was suppressed in all patients within three months since the procedure. Conclusions: The analysis of our data highlights that LTC is effective and feasible even if the use of this procedure, because of its complexity, has to be reserved to well-trained laparoscopic surgeons.

2009 - Surgical safety check list: the italian experience [Abstract in Atti di Convegno]
Cencetti, S; Miselli, M; Basili, C; Marzo, F; Zuin, P; Di Stefano, M; Gelmini, Roberta; Saviano, Massimo
abstract

Introduction: The University Hospital of Modena is one of the largest hospitals in the Emilia Romagna region and each yearabout 15.000 surgery procedures are performed. We have been working on safety surgery, for safety of patients throughoutthe control of the correct function of surgical devices and sterilization of surgical instruments.In particular we have created andapplied a project called "SOS surgery" that included all the 4 objectives of the second Global Patient Safety Challenge "SafeSurgery Save Life" that are: Clean Surgery, Safe Anesthesia, Safe Surgical Teams, and Measurement. In agreement with theW.H.O. program we have decided to use the surgical safety check list to improve communication between all members of thesurgical team.Material and Methods: In October 2008 we started a trial for the application of the surgical check list. We have involved onegeneral surgery unit and we've appropriately trained the whole surgical team involved. We have identified as check listcoordinatora circulating nurse who confirms completion of each step of the check list. At the end of procedures the whole teamagree and sign the check list.Results: During a period of three months we collected 175 check lists. The analysis of the data has highlighted 30 criticalevents (17%) represented by surgical site not market in two cases, laterality not reported on the surgical note in one, change inanaesthesiological technique not reported on the surgical note in three, an inversion in the order of the procedures as plannedin another three, patient without the ID tag in one, the antibiotic prophylaxis not reported on the surgical note in seven, theabsence of the anaesthesiological consent in one, the absence of blood risk evaluation in three, a surgical team different fromwhich on the surgical note in six, procedure not properly indicated on the surgical note in two and lack of preoperative patientpreparation in one case. In any case the critical events reported had clinical negative consequences on patients.Conclusions: The compliance of the whole surgical team in the application of the checklist has been satisfactory and itsapplication has been useful to check and avert critical events. It's our aim to extend its use first of all to the other generalsurgery units and then to the other surgical specialties.

2008 - . Laparoscopic total colectomy with ileo-rectal anastomosis for polyposis and ulcerative colitis. [Abstract in Rivista]
Gelmini, Roberta; Saviano, Massimo
abstract

Objective of the study: Since the introduction of laparoscopic colorectal surgery, several studies have demonstrated the advantages of mini-invasive segmental colon resections in the treatment of benign and malignant diseases. On the contrary the use of laparoscopy for total colectomy and proctocolectomy is not worldwide accepted first of all because of the technically challenging nature of these procedures. The aim of this report is to show the feasibility and safety of straight laparoscopic total colectomy (LTC) for polyposis (P) and ulcerative colitis (UC).Material and methods: Between January 2006 and June 2007 in our Institution 5 patients underwent to LTC with ileorectal anastomosis plus temporary loop ileostomy for P ( 2 cases) and UC (3 cases). Results: The mean age was 69.2 yrs (62-77) and in all cases the preoperative endoscopy showed the distal rectum almost without signs of disease. Mean operative time was 320 minutes and the estimated mean blood loss was 250 cc. No transfusions were necessary. No conversions occurred. The mean surgical specimen length was 100 cm. and in all acses the margins of resection were disease free. Considering the postoperative course, no morbidity and mortality occurred. The mean hospital stay was 8 days. The temporary ileostomy was suppressed in all patients within three months since the procedure. Conclusions: The analysis of our data highlights that LTC is effective and feasible even if the use of this procedure, because of its complexity, has to be reserved to well-trained laparoscopic surgeons.

2007 - A didactic model in laparoscopic surgery: the usefulness of endotrainers. [Abstract in Atti di Convegno]
Gelmini, Roberta; Saviano, Massimo
abstract

Literature data show as operative time and incidence of complication after laparoscopic surgery are strictly related with the training and the experience of surgeons. During a correct formative path for minimal-invasive surgeons, the training using simulators is mandatory because it permits to get practice in new techniques and to familiarize with unusual and developing equipments and instruments from which depends the correct execution of surgical procedures.The Authors present a didactic model of training in laparoscopic surgery using endotrainers. The simulators are shaped to reproduce the abdominal cavity and their top is a membrane useful to carry out pneumoperitoneum and trocars introduction. In the inner, synthetic anatomical models or animal organs can be used to reproduce the main steps of surgical procedures avoiding the use of living animals; it permits to elude the bureaucratic and economic limits related to the use of them. Besides exercises based on the use of ordinary objects as peas and beans, rubber bands or matches are useful to develop the basic gesture, the orientation in a bi-dimensional space and the eye-hand coordination. These exercises are prevalently directed to inexperienced surgeons at the beginning of a training program.In this video is presented a consecutive series of exercises which represents the progression of a training program in laparoscopy beginning from easy “games”, going through procedures of increasing difficulty and finishing with performing the most complex surgical steps. In particular, exercises performed on anatomic models permit to reproduce the main steps of abdominal and pelvic surgery and the use of the same instrumentation utilized in the operating room, allow to obtain the necessary technical competence. The aim of the program is to progressively acquire the right coordination and accuracy in the bimanual gestures and suturing and knotting techniques. The described exercises want to be a incentive for the diffusion of the use of simulators in the training programs for residents and inexperienced surgeons even if the use of endotrainers can be costructive every time. It represent a helpful support to further improve the training in laparoscopic techniques, shortening the learning curve and reducing operative times and complications.

2007 - Clipless laparoscopic cholecystectomy [Abstract in Rivista]
Gelmini, Roberta; Andreotti, Alessia; Franzoni, Chiara; Farinetti, Alberto; Saviano, Massimo
abstract

Background: Laparoscopic cholecystectomy is the gold standard treatment of gallstones. The ultrasonically activated scalpel (Harmonic Scalpel - Ethicon) may be used as sole instrument for both gallbladder dissection and section of cystic artery and duct with no need of further ligatures. Methods: In a series of 40 consecutive patients, laparoscopic cholecystectomy was performed with Harmonic. In 8 patients an additional cystic duct ligature with clips was performed because of the large size of the duct (5 cases of associated common bile duct stones, 1 case of acute cholecystitis and 2 of gallbladder empyema). There were 31 females and 9 males. Indications were: 27 simple gallstones, associated in 5 cases to common bile duct stones, 12 acute cholecystitis and 2 gallbladder empyema. In 11 cases associated procedures were performed. Results: The mean operative time was of 62 minutes, intraoperative cholangiography was performed in 5 cases and common bile duct exploration in 3. A drainage was left in 17 patients. There were no conversions. No patients developed postoperative complications and the mean postoperative hospital stay was of 2,1 days. Conclusions: Laparoscopic cholecystectomy performed with ultrasonically activated scalpel is feasible and effective. The advantages are represented by using a unique instrument both for dissection of the gallbladder and division of artery and duct. Furthermore, because of the minimal thermal dispersion, the use of Harmonic reduces the risk of injuries. The main limit of the procedure is represented by the cystic duct size: if more than 5 mm in diameter an additional ligature is necessary.

2007 - Gravidanza [Capitolo/Saggio]
Saviano, M; Gelmini, Roberta; Cagnacci, Angelo; Volpe, Annibale
abstract

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2007 - Laparoscopic approach of gastric gastrointestinal stromal tumors (GISTs): Is it still a courageous choice? Report of two cases [Articolo su rivista]
Gelmini, Roberta; Bertolini, Federica; Rossi, G; Luppi, G; Saviano, Massimo; Conte, Pierfranco
abstract

Gastrointestinal stromal tumors (GISTs) are a well-defined clinicopathologic and molecular tumor entity, representing the most common gastrointestinal mesenchymal neoplasm. Differential diagnosis between GIST and other mesenchymal malignancies is crucial, given the successful management using targeted therapy in metastatic GIST. The mainstay of treatment remains surgery, complete tumor resection being the most important independent prognostic factor. Videolaparoscopic approach is still controversial for the high risk of tumor rupture or bleeding. Here we report 2 cases of GIST surgically resected using a videolaparoscopic approach and discuss the efficacy of this technique in selected patients.

2007 - Laparoscopic cholecystectomy using harmonic: not only clipless [Abstract in Rivista]
Gelmini, Roberta; Andreotti, Alessia; Franzoni, Chiara; Quaranta, Nicola; Saviano, Massimo
abstract

Background: Laparoscopic cholecystectomy is the gold standard treatment of gallstones. The ultrasonically acti- vated scalpel (Harmonic scalpel, Ethicon) may be used as the sole instrument for both gallbladder dissection and section of the cystic artery and duct with no need of further ligatures. Methods: In a series of 40 consecutive patients, laparo- scopic cholecystectomy was performed with the Harmonic scalpel. In 8 patients, an additional cystic duct ligature with clips was performed because of the large size of the duct (5 cases of associated common bile duct stones, 1 of acute cholecystitis, and 2 of gallbladder empyema). There were 31 females and 9 males. Indications were 27 sim- ple gallstones, associated in 5 cases with common bile duct stones; 12 acute cases of cholecystitis; and 2 cases of gallbladder empyema. Associated procedures were performed in 11 cases. Results: The mean operative time was 62 minutes. Intraop- erative cholangiography was performed in 5 cases and common bile duct exploration in 3. A drain was left in 17 patients. No conversions were necessary. No patients developed postoperative complications, and the mean postoperative hospital stay was 2.1 days. Conclusions: Laparoscopic cholecystectomy performed with an ultrasonically activated scalpel is feasible and effective. The advantages are represented by using a unique instrument both for dissection of the gallbladder and division of the artery and duct. Furthermore, because of the minimal thermal dispersion, the use of the Harmonic scalpel reduces the risk of injuries. The main limit of the procedure is represented by the cystic duct size: if more than 5mm in diameter an additional ligature is necessary.

2007 - Laparoscopic splenectomy: Ligasure versus EndoGIA: A comparative study [Articolo su rivista]
Romano, F; Gelmini, Roberta; Caprotti, R; Andreotti, Alessia; Guaglio, M; Franzoni, Chiara; Uggeri, F; Saviano, Massimo
abstract

Background: Laparoscopic splenectomy (LS) is considered the gold standard for the treatment ofhematologic disease of the spleen. Intraoperative bleeding is the main complication and main causeof conversion during LS. In this paper, we present our experience with 112 LS procedures, com-paring two different techniques and instruments for spleen dissection and hilar vascular control.Methods: We have performed a total of 112 LS procedures in 9 years in two affiliated universityhospitals. There were 48 males and 64 females (median age, 32.8 years). Indications were as follows:idiopathic thrombocytopenic purpura (ITP) in 42 patients, hereditary spherocitosis in 28, 6 with -talassemia, 1 with hemolitic anemia, 27 with lymphoma, 2 with leukemia, 3 with splenic cysts, and3 PPT cases. Associated procedures were present in 25 cases (17 cholecystectomy and 4 liver/lym-phnodal biopsies lysis of adhesions). Patients were divided in two groups according to the methodof dissection and hilar section (group 1, endostapler monopolar coagulation with 38 patients;group 2, the Ligasure™ Vessel Sealing System (Valleylab, Boulder, CO) with 74 patients).Results: Groups were well matched according to age, indications, spleen sizes, and procedures as-sociated. Conversion rates (10 cases, 9%; 5 in each group), postoperative hospital stay (median 4days in each group), and intra- and postoperative complications were similar in the 2 groups with-out any mortality in each group, while intraoperative blood loss (loss of 100 mL in 55 patients ingroup 2, 78%; and in 21 patients in group 1, 52%), transfusion rates (8 patients in group 1 versus4 patients in group 2), and operative mean time (150 minutes in group 1 versus 125 minutes in group2) were minor in the Ligasure Vessel Sealing System group, with a statistical significance.Conclusions: The approach to spleen dissection and hilum section was safe and efficacy in eachcase, otherwise the use of Ligasure results in a gain of time. Furthermore the average intraopera-tive bleeding and average transfusion rates of this series were lower in group 2.

2007 - Laparoscopic treatment of paraesophageal and mixed diaphragmatic hernias report of two cases [Articolo su rivista]
Gelmini, Roberta; Andreotti, Alessia; Saviano, Massimo
abstract

Hiatal hernias are classified into 3 types: sliding hernia (type I), paraesophageal hernia (type II) and mixed hernia (type III), that is a combination of type I and II. The paraesophageal and mixed hernias represent about 5-10% of the surgically treated hiatal hernias. The surgical treatment of the paraesophageal and mixed hernias is unavoidable because of the high risk of severe complications and it has to be considered in a high percentage of cases. The most important technical difficulty in the video-laparoscopic treatment is represented by the hugeness of the hernial defect and by the challenging reduction of the stomach into the abdomen. A cautious dissection of hernial sac and diaphragmatic cruses as well as a careful crural repair make the videolaparoscopic procedure feasible. The operative times are not prolonged and the results are similar to the open technique ones. In literature, the incidence of both intra and postoperative complications doesn't exhibit statistically significant differences between laparoscopic and open techniques. Because of the complexity of the laparoscopic procedure, the minimally invasive access has to be reserved to surgeons who are well trained in those techniques. In this paper we describe 2 cases: one of paraesophageal hernia and the other of mixed hernia which were videolaparoscopicaUy treated with the help, in the second case, of a Gore-Tex mesh. In both cases the technical results were positive. Intra and postoperative complications didn't occur and, one year after the surgical procedure, both patients were in good health and recurrence-free.

2006 - Different methods of dissection during laparoscopic splenectomy [Abstract in Atti di Convegno]
Gelmini, Roberta; Romano, F; Andreotti, Alessia; Caprotti, R; Franzoni, Chiara; Scaini, A; Saviano, Massimo; Uggeri, F.
abstract

Background: Laparoscopic splenectomy (LS) is considered the gold standard for the treatment of hematologic disease of the spleen. Intraoperative bleeding is the main complication and main cause of conversion during laparoscopic splenectomy. Splenic and hilar dissection are sometimes difficult and different technologies have been applied to achieve it. We here present our experience with 110 LS using two different instruments for spleen dissection and hilar vascular control .Methods: We have performed a total of 110 LS in nine years period in two affiliated University Hospitals. There were 50 males and 60 females (median age 34 yrs) and we employed a 4 trocars technique with right semilateral position. Indications were as follows: 41 thrombocytopenic idiopatic purpura (ITP), 30 hereditary spherocytosis, 9  talassemia, 25 Limphoma, 2 leukemia and 3 splenic cysts. Associated procedure were present in 32 cases (28 cholecystectomy and four liver/lymphnodal biopsies). Patients were divided in two group according with method of dissection and hilar section (group 1 Endostapler + electrocoagulation 40 pts; group 2 Ligasure vessel sealing system 70 pts). Results: Groups were well matched according to age, indications, spleen sizes, procedures associated. Conversion rates (10 cases, 9%, five in each group), postoperative hospital stay (median 4 days in each group), intra and postoperative complications were similar in the 2 groups (with no statistically difference) without mortality in each group, while intraoperative blood loss (less of 100 ml in 55 patient of group 2, 78%, and in 21 of group 1, 52%), transfusion rates (8 pts in group 1 versus 4 in group 2) and operative mean time (150 min in group 1 versus 125 min in group 2) were less in the Ligasure vessel sealing device group(with a statistical significance). Conclusions: The approach to spleen dissection and hilum section was safe and efficacy in each case otherwise the use of LigasureTM results in a gain of time. Furthermore the average intraoperative bleeding and average transfusion rates of this series is lower in group 2.

2006 - Different methods of dissection durino laparoscopic splenectomy [Abstract in Atti di Convegno]
Gelmini, Roberta; Romano, F; Andreotti, Alessia; Caprotti, R; Franzoni, Chiara; Scaini, A; Saviano, Massimo; Uggeri, F.
abstract

Background: Laparoscopic splenectomy (LS) is considered the gold standard for the treatment of hematologic disease of the spleen. Intraoperative bleeding is the main complication and main cause of conversion during laparoscopic splenectomy. Splenic and hilar dissection are sometimes difficult and different technologies have been applied to achieve it. We here present our experience with 110 LS using two different instruments for spleen dissection and hilar vascular control . Methods: We have performed a total of 110 LS in nine years period in two affiliated University Hospitals. There were 50 males and 60 females (median age 34 yrs) and we employed a 4 trocars technique with right semilateral position. Indications were as follows: 41 thrombocytopenic idiopatic purpura (ITP), 30 hereditary spherocytosis, 9  talassemia, 25 Limphoma, 2 leukemia and 3 splenic cysts. Associated procedure were present in 32 cases (28 cholecystectomy and four liver/lymphnodal biopsies). Patients were divided in two group according with method of dissection and hilar section (group 1 Endostapler + electrocoagulation 40 pts; group 2 Ligasure vessel sealing system 70 pts). Results: Groups were well matched according to age, indications, spleen sizes, procedures associated. Conversion rates (10 cases, 9%, five in each group), postoperative hospital stay (median 4 days in each group), intra and postoperative complications were similar in the 2 groups (with no statistically difference) without mortality in each group, while intraoperative blood loss (less of 100 ml in 55 patient of group 2, 78%, and in 21 of group 1, 52%), transfusion rates (8 pts in group 1 versus 4 in group 2) and operative mean time (150 min in group 1 versus 125 min in group 2) were less in the Ligasure vessel sealing device group(with a statistical significance). Conclusions: The approach to spleen dissection and hilum section was safe and efficacy in each case otherwise the use of LigasureTM results in a gain of time. Furthermore the average intraoperative bleeding and average transfusion rates of this series is lower in group 2.

2006 - La colecistectomia con Harmonic: non solo clip-less [Relazione in Atti di Convegno]
Gelmini, Roberta
abstract

La colecistectomia con Harmonic: non solo clip-less

2006 - Peritoneal adhesions. A review of the literature [Articolo su rivista]
Gelmini, Roberta; Saviano, Massimo
abstract

Le prime descrizioni di sindromi aderenziali peritoneali nella letteratura medica vengono riportate con dovizia di particolari quali osservazioni autoptiche esiti di peritoniti tubercolari nel XIX secolo in trattati di anatomia patologica.Solo sul finire del XIX secolo, con lo sviluppo della chirurgia addominale legato all’introduzione dell’anestesia e dell’antisepsi, compaiono anche su trattati chirurgici le prime descrizioni di tale patologia quale possibile causa di occlusione intestinale, con precisi riferimenti a diverse ipotesi eziologicheGli Autori, alla luce di una analisi della letteratura, pongono l’accento sull’impatto clinico e socio-economico determinato dalle aderenze peritoneali post-operatorie. In particolare vengono esaminate le sindromi cliniche ed i rischi correlati alla presenza di aderenze peritoneali, le complicanze e le ripercussioni. Numerosi studi sperimentali e clinici hanno portato in questi ultimi anni a comprendere la genesi delle aderenze quale esiti di un processo di riparazione peritoneale nella sede di un traumatismo ove fenomeni locali permettono l’organizzazione di depositi di fibrina tra le superfici peritoneali d’organi e strutture adiacenti, e proprio uno squilibrio tra formazione di fibrina e capacità di fibrinolisi appaiono essere l’elemento patogenetico determinante. La chirurgia video-laparoscopica può risultare oggi utile sia nella diagnosi che nel trattamento di sindromi aderenziali croniche anche se l’approccio mini-invasivo appare ridurre ma non eliminare l’insorgenza di aderenze post-operatorie. Alla luce delle attuali conoscenze patogenetiche in tema di aderenze peritoneali vengono evidenziate le strategie per prevenirne o comunque ridurne lo sviluppo, riconducibili in linea di massima sia a principi di tattica chirurgica sia all’impiego di presidi adiuvanti.

2006 - Phase I study of intraperitoneal MHC un resctrected adoptive cell therapy with TALL-104 cells in patients with peritoneal carcinosis: preliminary results. [Abstract in Atti di Convegno]
Bengala, Carmelo; Rasini, Valeria; Sternieri, Rita; Dominici, Massimo; Gelmini, Roberta; Cafarelli, Luigi; Bevini, Paola; Berti, Andrea; Conte, Pierfranco
abstract

Phase I study of intraperitoneal MHC un resctrected adoptive cell therapy with TALL-104 cells in patients with peritoneal carcinosis: preliminary results.

2006 - Sutureless and stapleless laparoscopic splenectomy using radiofrequency - LigaSure device [Articolo su rivista]
Gelmini, Roberta; F., Romano; Quaranta, Nicola; R., Caprotti; Tazzioli, Giovanni; G., Colombo; Saviano, Massimo; F., Uggeri
abstract

Background: Bleeding is the main complication and cause of conversion during laparoscopic splenectomy (LS). We present the advantages of the LigaSure vessel sealing system added to the lateral approach for achieving safe vascular control. Methods: We performed 63 consecutive LS in a 3-year period using LigaSure in two affiliated university hospitals. We employed a right semilateral position technique with dissection of the spleen and vessel sealing using LigaSure. Forty-two patients had benign hematological disease, 19 had malignant disease, and two had splenic cysts. Results: A total of 58 LS were completed with five conversions due to hilar bleeding (three cases), difficult dissection (one), and massive splenomegaly (one). In all but five patients, blood loss was less than 100 ml. No transfusions were needed. There were five postoperative complications: portal thrombosis (one case), hemoperitoneum (two), surgical wound infection (one), and pleural effusion (one). Conclusions: The use of LigaSure, and the semilateral position, results in a gain of time and safety. Furthermore, average intraoperative bleeding is very low.

2006 - The Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) A retrospective review of 379 patients undergoing laparoscopic splenectomy [Articolo su rivista]
M., Casaccia; P., Torelli; S., Squarcia; Mp, Sormani; A., Savelli; Bm, Troilo; G., Santori; U., Valente; N., Basso; G., Silecchia; F., Bresadola; G., Terrosu; A., Pietrabissa; Fm, Valeri; P., Prosperi; Saviano, Massimo; Gelmini, Roberta; F., Uggeri; R., Caprotti; F., Romano; G., Logrieco; A., Moraldinia; A., Dallatorre; R., Rosati; S., Bona; P., Cavaliere; D., Cavaliere; G., Spinoglio; F., Buccoliero; R., Berta; C., Pedrazzoli; L., Bigi; Im, Barbieri; I., Donini; A., Donini; G., Colecchia; E., Monteferrante; F., Prete; V., Memeo; F., Puglisi
abstract

In December 2000, the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) was formally launched under the auspices of the Italian Society for Endoscopic Surgery and New Technologies (SICE). The aim of this multicentre study was to analyse various aspects of the treatment that are still under discussion, such as the extension of the laparoscopic indications in cases of malignancy, independently of the associated splenomegaly, patient selection and operative techniques. A retrospective review of 379 patients undergoing laparoscopic splenectomy for haematological diseases from February 1, 1993, to September 15, 2005, was conducted. Data were collected from the 18 italian centres participating in the IRLSS. The mean length of surgery was 140 minutes (range: 25-420). Conversion was necessary in 25 cases (6.6%), and at least one accessory spleen was found in 30 patients (8%). The mean spleen weight was 1200 g (range: 85-4500). Perioperative death occurred in two cases (0.5%). There were no complications in 312 patients (82.3%), with a mean hospital stay of 5.5 days (range: 2-30). Morbidity occurred in 67 patients (17.8%), mainly consisting in transient fever (n = 22), pleural effusions (n = 16), and actual or suspected haemorrhage (n = 14), requiring re-intervention in 7 patients. This first study carried out on the IRLSS data shows that laparoscopic splenectomy may constitute the gold standard for haematological diseases with a normal-sized spleen. The low morbidity and mortality rates suggest that laparoscopic splenectomy can be successfully proposed also for splenomegaly in haematological malignancies

2006 - Videolaparoscopic treatment of paraesophageal hernia [Abstract in Rivista]
Gelmini, Roberta; Saviano, Massimo
abstract

6143 General Surgery Videolaparoscopic Treatment of Paraesophageal Hernia Roberta Gelmini, MD, Massimo Saviano, MD Hiatal hernias are classified into 3 types: sliding hernia (type I), paraesophageal hernia (type II), and mixed hernia (type III), which is a combination of type I and II. The paraesophageal and mixed hernias represent about 5% to 10% of surgically treated hiatal hernias. The surgical treat- ment of the paraesophageal and mixed hernias is unavoid- able because of the high risk of severe complications, and it has to be considered in a high percentage of cases. The most important technical difficulty in the videolaparoscopic treatment is represented by the hugeness of the hernial defect and by the challenging reduction of the stomach into the ab- domen. A cautious dissection of the hernial sac and dia- phragmatic cruses and a careful crural repair make the videolaparoscopic procedure feasible. The operative times are not prolonged, and the results are similar to those of the open technique. In the literature, the incidence of complica- tions, both intra- and postoperative, are not statistically sig- nificantly different between the laparoscopic and open technique. Because of the complexity of the laparoscopic procedure, the minimally invasive access has to be reserved for surgeons well trained in these techniques. We describe 2 cases: one paraesophageal and one mixed hernia video- laparoscopically treated with the help, in the second case, of a Gore-Tex mesh. In both cases, the technical results were positive. Intra- and postoperative complications did not occur and, one year after the surgical procedure, both patients were in good health and recurrence free.

2005 - I tumori stromali gastrointestinali: realtà clinica in continua evoluzione. Caso clinico [Articolo su rivista]
Malavasi, Norma; F., Iacchetta; Bertolini, Federica; Rossi, Giulio; G., Luppi; Gelmini, Roberta; Piccinini, Lino; Pf, Conte
abstract

case report di gist metastatico lungosopravvivente

2005 - Laparoscopic splenectomy with radiofrequency [Abstract in Rivista]
Gelmini, Roberta; Romano, F.; Quaranta, Nicola; Uggeri, F.; Saviano, Massimo
abstract

O b j e c t i v e : Intraoperative bleeding is the maincomplication and cause of conversion during laparoscopicsplenectomy (LS). We present the advantages of the useof the Ligasure Vessel Sealing System added to a lateralapproach for achieving safe vascular control.Method: Ligasure applies a precise amount of bipolar en-ergy and pressure to the tissue, achieving a permanentseal. We have performed 55 LS by using a technique with4 trocars, a right semi-lateral position, and dissection ofthe spleen and vessels sealing with 10mm LigaSure Atlas.The indications were thrombocytopenic idiopathic pur-pura (20), spherocytosis (12), b thalassemia (6), lym-phoma (15), hemolytic anemia (1), and splenic cyst (1).Results: LS was completed in 51 patients with 4 (7.2 %)conversions because of hilar bleeding due to accidental injury (1), difficult splenic hilar dissection (1), diffuseperitoneal adhesions (1), and massive splenomegaly (1).The average splenic weight was 485 g, with an averagediameter of 15.2 cm. In all but 4 patients, the intraopera-tive blood loss was less than 100 mL. The average opera-tive time was 121.6 minutes, including 15 patients whounderwent the following combined operations: cholecys-tectomy (9), hepatic biopsy and hilar lymphadenectomy(3), adhesion dissection (3). No mortality and 3 (5.4%)postoperative complications occurred, ie, thrombosis ofthe spleno-portal axis (1); hemoperitoneum due to a pan-creatic tail bleed, laparoscopically treated (1); and pleuraleffusion (1). The average postoperative hospital stay was4.2 days.Conclusion: The use of LigaSure associated with the se-milateral position results in a gain of time and safety.Furthermore, the average intraoperative bleeding is verylow.

2005 - Laparoscopic splenectomy with radiofrequency. SLS annual meeting – 14th international congress and endoexpo, S.Diego (USA) 14-17 settembre 2005 [Abstract in Rivista]
Gelmini, Roberta; Romano, F; Quaranta, Nicola; Uggeri, F; Saviano, Massimo
abstract

O b j e c t i v e : Intraoperative bleeding is the main complication and cause of conversion during laparoscopic splenectomy (LS). We present the advantages of the use of the Ligasure Vessel Sealing System added to a lateral approach for achieving safe vascular control. Method: Ligasure applies a precise amount of bipolar en- ergy and pressure to the tissue, achieving a permanent seal. We have performed 55 LS by using a technique with 4 trocars, a right semi-lateral position, and dissection of the spleen and vessels sealing with 10mm LigaSure Atlas. The indications were thrombocytopenic idiopathic pur- pura (20), spherocytosis (12), b thalassemia (6), lym- phoma (15), hemolytic anemia (1), and splenic cyst (1). Results: LS was completed in 51 patients with 4 (7.2 %) conversions because of hilar bleeding due to accidental injury (1), difficult splenic hilar dissection (1), diffuse peritoneal adhesions (1), and massive splenomegaly (1). The average splenic weight was 485 g, with an average diameter of 15.2 cm. In all but 4 patients, the intraopera- tive blood loss was less than 100 mL. The average opera- tive time was 121.6 minutes, including 15 patients who underwent the following combined operations: cholecys- tectomy (9), hepatic biopsy and hilar lymphadenectomy (3), adhesion dissection (3). No mortality and 3 (5.4%) postoperative complications occurred, ie, thrombosis of the spleno-portal axis (1); hemoperitoneum due to a pan- creatic tail bleed, laparoscopically treated (1); and pleural effusion (1). The average postoperative hospital stay was 4.2 days. Conclusion: The use of LigaSure associated with the se- milateral position results in a gain of time and safety. Furthermore, the average intraoperative bleeding is very low.

2005 - Rupture traumatique totale du pancreas: presentation d'un cas [Poster]
Tazzioli, Giovanni; Gelmini, Roberta; G., Barberini; Farinetti, Alberto; Saviano, Massimo
abstract

descrizione di un caso di rottura traumatica del pancreas senza coinvolgimento vascolare: trattamento chirurigco

2005 - Splenectomie laparoscopique à l’aide du “Ligasure vessel sealing system” - 107° Con gres francais de chirurgie tenutosi a Parigi – Francia – il 28-30 settembre 2005 [Abstract in Rivista]
Gelmini, Roberta; Romano, F; Tazzioli, Giovanni; Farinetti, Alberto; Quaranta, Nicola; Saviano, Massimo
abstract

utilizzo del manipolo a radiofrequenza nella splenectomia VL

2005 - Sutureless and stapleless laparoscopic splenectmy with radiofrequency [Abstract in Atti di Convegno]
Romano, F.; Gelmini, Roberta; Caprotti, R.; Quaranta, Nicola; Uggeri, F.; Saviano, Massimo
abstract

Results of laparoscopic splenectomy usoing radiofrequency device

2005 - Tuberculous peritonitis in no risk patients: Diagnostic approach [Articolo su rivista]
Tazzioli, Giovanni; Farinetti, Alberto; Gelmini, Roberta; G., Longo; Barbolini, Giuseppe; Saviano, Massimo
abstract

Background: Incidence of tubercoulosis is increasing in Western countries particularly in immigrants from endemic areas and in patients with HIV or immunocompromised. The disease is unusual in patients without risk factors. In these conditions the diagnosis of tuberculous peritonitis is often delayed, resulting in high morbidity and mortality. Methods: We describe a case of tuberculous peritonitis in a man suffering from ascites referred for presumed peritoneal carcinosis. The finding of no malignancies in the peritoneal fluid must rise the suspect of tuberculosis that, if misdiagnosed, is fatal. The patient was submitted to diagnostic videolaparoscopy and multiple biopsies were done. The definitive histological diagnosis was chronic granulomatous flogosis with giant cells, focally necrotizing, caused by peritoneal tubercolosis. Results: The patient was submitted to chemotherapy with isoniazide, rifampicine, piazafoline, ethambutol and streptomycine which determined the resolution of the clinical picture. Conclusions: We believe the diagnostic procedure of choice is videolaparoscopy when tubercolous peritonitis is suspected. This technique allows to obtain selective biopsies of peritoneal nodules and to collect samples for specific cultural and cytohistological exams. The operation is safe, reliable with few complications and permits a prompt diagnosis necessary to cure the patient.

2004 - Biopsia del ganglio centinels en el tumor de mama. [Abstract in Atti di Convegno]
Tazzioli, Giovanni; Saviano, Massimo; A., Miselli; Andreotti, Alessia; Farinetti, Alberto; Gelmini, Roberta; Falcone, Simona
abstract

...

2004 - Esplenectomia videolaparoscopica con disector a radiofrecuencia. [Relazione in Atti di Convegno]
Gelmini, Roberta; Quaranta, N; Curcio, A; Tazzioli, Giovanni; Saviano, Massimo
abstract

esperienza di splenectomia laparoscopica con manipolo a radiofrequenza

2004 - Ipertensione portale distrettuale e carcinoma gastrico: case report [Abstract in Rivista]
Beltrami, Stefano; Miselli, A; Manenti, Antonio; Rossi, A; Gelmini, Roberta; Tazzioli, Giovanni; Farinetti, Alberto; Maggiore, Simona; Andreotti, Alessia; Saviano, Massimo
abstract

Ipertensione portale distrettuale e carcinoma gastrico: case report

2004 - La VATS en las enfermedades oncohematologicas. [Abstract in Atti di Convegno]
Saviano, Massimo; Tazzioli, Giovanni; Gelmini, Roberta; Monni, Sebastiano Graziano; Farinetti, Alberto; Maggiore, Simona; T., Diago
abstract

...

2004 - Leishmaniosi viscerale o recidiva di linfoma? Report di un caso. [Abstract in Rivista]
Maggiore, Simona; Andreotti, Alessia; Gelmini, Roberta; Smerieri, Elia; Tosi, Alessandro; Tazzioli, Giovanni; Farinetti, Alberto; Saviano, Massimo
abstract

...

2004 - Leishmaniosi viscerale o recidiva di linfoma? Report di un caso. [Abstract in Atti di Convegno]
Maggiore, Simona; Andreotti, Alessia; Gelmini, Roberta; Smerieri, Elia; Tosi, Alessandro; Tazzioli, Giovanni; Farinetti, Alberto; Saviano, Massimo
abstract

...

2004 - Morbo di Crohn e neoplasia del colon: case report. [Abstract in Rivista]
Beltrami, Stefano; Gelmini, Roberta; Monni, Sebastiano Graziano; Tazzioli, Giovanni; Farinetti, Alberto; Andreotti, Alessia; Smerieri, Elia; Maggiore, Simona; Tosi, Alessandro; Saviano, Massimo
abstract

case report

2004 - Natural history of chronic HBV in northern Italy: Morbidity and morality after 30 years [Articolo su rivista]
M., Manno; C., Camma; Schepis, Filippo; F., Bassi; Gelmini, Roberta; F., Giannini; F., Miselli; Grottola, Antonella; I., Ferretti; C., Vecchi; M., De Palma; Villa, Erica
abstract

Background & Aims: Increased morbidity and mortality from liver disease have been reported in chronic hepatitis B surface antigen (HBsAg) carriers, but data on survival are equivocal. To assess the impact of hepatitis B virus (HBV) infection on survival and liver-related complications, we re-evaluated, after a mean follow-up of 30 years, a cohort of 296 blood donors excluded from donation 30 years ago when HBsAg screening became mandatory. Methods: Clinical and ultrasound examination and biochemical and virologic tests were performed. The cause of death was recorded and survival was compared with a control population of 157 HBV-negative blood donors selected at baseline. Results: Thirty-two (10.8%) cases and 14 controls (8.9%) (P = 0.625) had died; 3 of 32 (9.3%) and 1 of 14 (7.1%) deaths were liver-related. Hepatocellular carcinoma (HCC) caused death in 2 of 296 and 1 of 157 subjects (0.6% in each group). Alcohol-induced cirrhosis occured in the remaining subject. By Cox regression analysis, survival was independently predicted by older age, abnormal gamma-glutamyl transpeptidase (GGT) levels, and presence of medical comorbidities at baseline. Unequivocal liver disease was found in 4 carriers only. No disease decompensation occurred during follow-up. Fifty-nine (32.2%) carriers cleared HBsAg (yearly incidence, 1.0%). Full-length serum HBV DNA was present in 32.2% of persistently HBsAg-positive individuals (average titer always <10(5) copies/mL). Conclusions: Over a 30-year period, chronic HBV carrier blood donors from Northern Italy did not develop clinically significant liver disease, hepatocellular cancer, or other liver-related morbidity or mortality at a higher rate than uninfected controls. The presence of medical comorbidities, older age at diagnosis, and abnormal GGT levels were independent predictors of death among chronic HBV carriers.

2004 - Recidiva de hernia inguinal: revision de nuestra casistica operatoria. [Abstract in Atti di Convegno]
Farinetti, Alberto; Saviano, Massimo; Tazzioli, Giovanni; Gelmini, Roberta; Andreotti, Alessia; Maggiore, Simona
abstract

...

2004 - Sistemas venosos implantables en oncohematologìa: nuestra esperiencia. [Abstract in Atti di Convegno]
Tazzioli, Giovanni; Saviano, Massimo; Gelmini, Roberta; A., Miselli; Andreotti, Alessia; Farinetti, Alberto; Beltrami, Stefano; T., Diago
abstract

...

2004 - Sistemi venosi impiantabili in oncoematologia: 477 casi. [Abstract in Rivista]
Tosi, Alessandro; Tazzioli, Giovanni; Gelmini, Roberta; Farinetti, Alberto; A., Miselli; Andreotti, Alessia; Beltrami, Stefano; Maggiore, Simona; Saviano, Massimo
abstract

...

2004 - Su di un caso di neoformazione cistica del piccolo epiploon: cisti omentale o duplicazione gastrica? [Articolo su rivista]
Gelmini, Roberta; Tazzioli, Giovanni; Farinetti, Alberto; Saviano, Massimo
abstract

Mesenteric and omental cysts, arising between their peritoneal layers, are infrequent lesions but they have to be considered in case of expansive abdominal process because of the difficulty in diagnosis and choice of treatment.Often, they are occasionally founded and characterized by aspecific symptoms and radiological and echografic unclear pictures. The treatment of choice in represented by a radical exeresis and a definitive diagnosis is almost ever surgical and histopathological even if their nosological classification would be difficult for the pathologist too.The Authors report a case of cystic neoformation localized in the sovramesocolic lodge, between left hepatic lobe and less gastric curve, underling the diagnostic problems linked to a clinical and radiological picture with no univocal interpretation. The preoperative differential diagnosis, in fact, was in doubt between a post-traumatic pancreatic pseudocyst and a cyst of different origin.The intraoperative aspect excluded the pancreatic origin and oriented to the hypothesis of a gastric cystic duplication, in the lesser epiploon contest, originated from the lesser gastric curve and the gastro-oesophageal junction. The neoformation wasn’t dissociable from the gastric wall’s muscular tunica.A radical exeresis was preformed associated with a partial resection of the lesser gastric curve and gastro-oesophageal junction.The pathological examination, confirming the difficult nosologic classification of these lesions, gave a different interpretation excluding the hypothesis of a gastric duplication because of the absence of a surface epithelium in the lesion’s lumen.

2004 - VATS IN THE MANAGEMENT OF ONCHOHEMATOLOGICAL DISEASES [Articolo su rivista]
Tazzioli, Giovanni; Gelmini, Roberta; Monni, Sebastiano Graziano; Farinetti, Alberto; S., Beltrami; S., Maggiore; Saviano, Massimo
abstract

Role of VATS in diagnosis and treatment of ocnological and hematological diseases

2004 - Vats in the management of oncohematological. [Abstract in Rivista]
Tazzioli, Giovanni; Gelmini, Roberta; Monni, Sebastiano Graziano; Farinetti, Alberto; Beltrami, Stefano; Maggiore, Simona; Saviano, Massimo
abstract

...

2004 - Wedge resection videolaparoscopica di leiomioma gastrico. [Abstract in Rivista]
Andreotti, Alessia; Gelmini, Roberta; Beltrami, Stefano; Tosi, Alessandro; Smerieri, Elia; Tazzioli, Giovanni; Farinetti, Alberto; Saviano, Massimo
abstract

...

2003 - Bioartificial liver support with human hepatocytes and MARS in fulminant hepatic failure: comparison with standard therapy [Abstract in Atti di Convegno]
R., Balugani; H., Bertani; M., del Buono; R., Iemmolo; Gelmini, Roberta; Girardis, Massimo; Villa, Erica
abstract

x

2003 - Chirurgia videolaparoscopica: tecniche di apprendimento su endotrainer [Monografia/Trattato scientifico]
Saviano, Massimo; Gelmini, Roberta
abstract

Manuale didattico accompagnato da audiovisivo su supporto VSH

2003 - Clinical staging systems for hepatocellular carcinoma: Comparison with estrogen receptor classification [Abstract in Rivista]
Villa, Erica; Colantoni, Alessandra; Camma, C; Grottola, Antonella; Ferretti, Ilva; Gelmini, Roberta; De Maria, N; Manenti, Federico
abstract

Clinical staging systems for hepatocellular carcinoma: Comparison with estrogen receptor classification

2003 - Dispepsia e vomito dopo gastroplastica verticale sec. Mason. [Abstract in Atti di Convegno]
Beltrami, Stefano; Smerieri, Elia; Farinetti, Alberto; Monni, Sebastiano Graziano; Gelmini, Roberta; Tazzioli, Giovanni; Saviano, Laura; Saviano, Massimo
abstract

...

2003 - Dispepsia e vomito dopo gastroplastica verticale secondo Mason. [Relazione in Atti di Convegno]
Beltrami, S; Smerieri, E; Farinetti, A; Gelmini, Roberta; Saviano, L; Tazzioli, G; Saviano, M.
abstract

Dispepsia e vomito dopo gastroplastica verticale secondo Mason.

2003 - Estrogen receptor classification for hepatocellular carcinoma: Comparison with clinical staging systems [Articolo su rivista]
Villa, Erica; A., Colantoni; C., Camma; Grottola, Antonella; Gelmini, Roberta; P., Buttafoco; I., Ferretti; Manenti, Federico
abstract

Purpose: Several scoring systems to evaluate patients with hepatocellular carcinoma (HCC) exist. A good scoring system should provide information on prognosis and guide therapeutic decisions. The presence of variant liver estrogen receptor (ER) transcripts in the tumor has been shown to be the strongest negative predictor of survival in HCC. The aim of this study was to compare the predictive value of the commonly applied clinical scoring systems for survival of patients with HCC with that of the evaluation of ER in patients with HCC (molecular scoring system). Materials and Methods: HCC was staged according to the Okuda classification, Barcelona Clinic Liver Cancer classification, Italian classification system (CLIP), French classification, and ER status in 96 patients. Analysis of survival was performed according to the Kaplan-Maier test and was made for each classification system and ER. A comparison between classifications was made by univariate and multivariate analysis. Results: Among the clinical classification systems, only the CLIP was able to identify patient populations with good, intermediate, and poor prognosis. On multivariate analysis, ER classification was shown to be the best predictive classification for survival of patients with HCC (P < .0001). This difference was the result of a better allocation of patients with ominous prognosis (variant ER) having nevertheless good clinical score. Conclusion: The evaluation of the presence of wild-type or variant ER transcripts in the tumor is the best predictor of survival in patients with HCC. Its accuracy in discriminating patients with good or unfavorable prognosis is significantly greater than that of the commonly used scoring systems for the staging of HCC.

2003 - Il linfonodo sentinella nel carcinoma mammario: esperienza preliminare [Abstract in Rivista]
Andreotti, Alessia; Gelmini, Roberta; Fontana, I.; Tazzioli, Giovanni; Farinetti, Alberto; Beltrami, Stefano; Saviano, Massimo
abstract

esperienza preliminare della tecnica del linfonodo sentinella nella chirurgia della mammella. l'esame istologico del linfonodo sentinella può predire la situazione di linfonodi ascellari, così che la sua biopsia sta sostituendo la dissezione del cavo nella diagnosi e stadiazione dei tumori mammari inferiori a 3 cm.

2003 - La thyroidectomie totale dans le traitement de la pathologie benigne. [Abstract in Atti di Convegno]
Gelmini, Roberta; Andreotti, Alessia; Tazzioli, Giovanni; G., Barberini; Farinetti, Alberto; Beltrami, Stefano; Franzoni, Chiara; Saviano, Massimo
abstract

...

2003 - La thyroidectomie totale dans le tratement de la pathologie benigne. [Relazione in Atti di Convegno]
Gelmini, Roberta; Andreotti, A; Tazzioli, G; Barberini, G; Farinetti, A; Beltrami, S; Franzoni, C; Saviano, M.
abstract

La thyroidectomie totale dans le tratement de la pathologie benigne.

2003 - Laparoscopic wedge resection of a gastric stromal tumor: report of a case. [Abstract in Atti di Convegno]
Gelmini, Roberta; Tazzioli, Giovanni; Farinetti, Alberto; Andreotti, Alessia; Beltrami, Stefano; Saviano, Massimo
abstract

...

2003 - Laparoscopic wedge resection of a gastric stromal tumour: report of a case. [Abstract in Atti di Convegno]
Gelmini, Roberta; Tazzioli, Giovanni; Farinetti, Alberto; Andreotti, Alessia; Beltrami, Stefano; Saviano, Massimo
abstract

CASE REPORT

2003 - Leishmaniosi viscerale o recidiva di linfoma? Report di un caso. [Abstract in Rivista]
Maggiore, Simona; Andreotti, Alessia; Gelmini, Roberta; Smerieri, Elia; Tosi, Alessandro; Tazzioli, Giovanni; Farinetti, Alberto; Saviano, Massimo
abstract

DD tra leishmaniosi e linfoma splenico

2003 - Neoformazioni cistiche mesenteriche: presentazione di 4 casi. [Articolo su rivista]
Farinetti, Alberto; Saviano, Laura; Tazzioli, Giovanni; Gelmini, Roberta; Saviano, Massimo
abstract

...

2003 - Predominance of pre-S1 mutated hepatitis B virus in a patient following treatment with adefovir dipivoxil [Articolo su rivista]
Villa, Erica; V., Boarino; Grottola, Antonella; Gelmini, Roberta; Ng, Lama
abstract

A liver transplant recipient reinfected with a lamivudine-resistant mixed wild-type/pre-S1-deleted hepatitis B virus (HBV) strain and rescued with adefovir dipivoxil was still HBV DNA positive after more than 1 year of therapy. Analysis of serum HBV DNA, amplified by polymerase chain reaction and directly sequenced by dideoxy nucleotide chain-termination method, showed that adefovir inhibited the wild type, but not the pre-S1-deleted HBV. Predominance of the pre-S1-deleted strain over wild type after adefovir treatment suggests that either adefovir inhibited the wild type more effectively or the pre-S1 mutant replicates more efficiently. The normality of liver condition confirms that to exert its pathogenic effect, the pre-S1-deleted strain requires the presence of wild-type virus.

2003 - Ruolo della tiroidectomia totale nel trattamento della patologia benigna della tiroide. [Abstract in Atti di Convegno]
Gelmini, Roberta; Andreotti, Alessia; Tazzioli, Giovanni; Barberini, G; Farinetti, Alberto; Feltrami, S; Franzoni, Chiara; Saviano, Massimo
abstract

indicazioni alla tiroidectomia totale nella patologia benigna della tiroide. Casistica di 916 casi

2003 - Sistemi venosi impiantabili in oncoematologia: la nostra esperienza. [Abstract in Rivista]
Beltrami, Stefano; Smerieri, Elia; Andreotti, Alessia; Barberini, G; Gelmini, Roberta; Farinetti, Alberto; Tazzioli, Giovanni; Saviano, Massimo
abstract

esperienza posizionamento sistemi venosi impiantabili Università di Modena e Reggio Emilia

2003 - Soprappeso ponderale non da obesità patologica. Un caso da non misconoscere: cisti ovarica gigante del peso di 23 kg. [Relazione in Atti di Convegno]
Beltrami, S; Smerieri, E; Farinetti, A; Gelmini, Roberta; Saviano, L; Tazzioli, G; Saviano, M.
abstract

Soprappeso ponderale non da obesità patologica. Un caso da non misconoscere: cisti ovarica gigante del peso di 23 kg.

2003 - TIVA-TCI anesthesiologic technique in videolaparoscopic cholecystectomy. [Relazione in Atti di Convegno]
Reggiani, A; Baroni, S; Gelmini, Roberta; LA COLLA, G.
abstract

TIVA-TCI anesthesiologic technique in videolaparoscopic cholecystectomy.

2003 - Trattamento chirurgico dell'obesità [Abstract in Atti di Convegno]
Smerieri, Elia; Beltrami, Stefano; Falcone, Simona; Farinetti, Alberto; Gelmini, Roberta; Saviano, Laura; Tazzioli, Giovanni; Saviano, Massimo
abstract

...

2003 - Video Assisted thoracic surgery in haematologic malignant disease. [Abstract in Atti di Convegno]
Tazzioli, Giovanni; Gelmini, Roberta; Monni, Sebastiano Graziano; Farinetti, Alberto; Quaranta, Nicola; Beltrami, Stefano; Saviano, Massimo
abstract

...

2003 - Video-assisted thoracic surgery in haematologic malignant diseases. [Relazione in Atti di Convegno]
Tazzioli, G; Gelmini, Roberta; Monni, S; Farinetti, A; Quaranta, N; Beltrami, S; Saviano, M.
abstract

Video-assisted thoracic surgery in haematologic malignant diseases.

2002 - Haemodinamic changes in living-related liver transplant: a colour-doppler ultrasound study. . [Relazione in Atti di Convegno]
Bertani, H; Cremonini, C; DEL BUONO, Mg; Primerano, A; Gelmini, Roberta; Cautero, N; Jovine, Elio; Pinna, Antonio Daniele; Manenti, Federico; Villa, Erica
abstract

Haemodinamic changes in living-related liver transplant: a colour-doppler ultrasound study

2002 - Il trapianto di fegato da donatore vivente: esperienza dell’Universita’ di Modena e Reggio Emilia. [Relazione in Atti di Convegno]
DI BENEDETTO, Fabrizio; Masetti, M; Cautero, N; Gelmini, Roberta; DALLA VALLE, R.; Quintini, C; Sassi, S; Landolfo, G; Diago, T; Jovine, Elio; Pinna, A. . D.
abstract

Il trapianto di fegato da donatore vivente: esperienza dell’Universita’ di Modena e Reggio Emilia.

2002 - Intestinal/multivisceral transplantation: University of Modena experience [Articolo su rivista]
Masetti, Michele; Jovine, Elio; Begliomini, Bruno; Cautero, Nicola; DI BENEDETTO, Fabrizio; Gelmini, Roberta; Villa, Erica; A., Merighi; A., Bagni; L., Bezer; Ad, Pinna
abstract

N/A

2002 - La terapia chirurgica dell’HCC nel paziente anziano. [Relazione in Atti di Convegno]
Gelmini, Roberta; Cautero, N; DI BENEDETTO, Fabrizio; Masetti, M; Quintini, C; Sassi, S; Ferrone, R; Landolfo, G; Jovine, Elio; Pinna, Antonio Daniele
abstract

La terapia chirurgica dell’HCC nel paziente anziano.

2002 - Literature overview on artificial liver support in fulminant hepatic failure: A methodological approach [Articolo su rivista]
H., Bertani; Gelmini, Roberta; MG Del, Buono; N., De Maria; Girardis, Massimo; Villa, Erica; V., Solfrini
abstract

Artificial liver support is a therapeutic option for subjects with fulminant hepatic failure. Results of these studies suggest a possible favourable effect on this condition. The aim of the present review is to evaluate not the results of the different artificial systems available but the methodology used to achieve these results. A computer and manual search of the literature was performed, 832 pertinent references were retrieved. Seventy-seven were full papers reporting the application of artificial liver support in animals or humans (15 RCTs (3 in humans, 12 in animals), 53 uncontrolled phase I trials, 9 case reports)., The results of this review indicate that, although the rationale of artificial liver support as shown by animal studies is acceptable, the widespread use in clinical practice is not justified and a controlled design for the studies on artificial liver support systems is mandatory.

2002 - Modified multivisceral transplantation without a liver graft for Gardner/Desmoid syndrome and chronic intestinal pseudo-obstruction [Articolo su rivista]
Jovine, Elio; Masetti, Michele; Cautero, Nicola; DI BENEDETTO, Fabrizio; Gelmini, Roberta; S., Sassi; C., Quintini; Andreotti, Alessia; Begliomini, Bruno; A., Siniscalchi; Ad, Pinna
abstract

Multivisceral transplant (MVTx) was first performed by Starzi et al in 1988.[1] The results of small bowel transplantation have improved in the past 5 years secondary to the development of new immunosuppressive regimens, to refinements of surgical techniques, as well as to a better candidate selection. [2] The indications for small bowel transplantation are intestinal failure due to congenital or acquired anatomical loss of the intestine, vascular disease, primary disorders of intestinal motility, such as chronic idiopathic pseudo-obstruction syndrome (CIPOS), and intestinal mucosal disease leading to malabsorption. To these typical indications we can add Gardner’s syndrome (familial multiple polyposis) and desmoid tumors. [3] Gardner’s syndrome can affect the whole gastrointestinal tract, often presenting with desmoid lesions at the root of the mesentery. In some patients isolated small bowel transplantation is not crucial to completely treat the disease. Gastric and esophageal manometry is often used to assess whether the patient needs an isolated small bowel transplant or a MVTx. Here we report two cases of modified MVTx without the liver for Gardner/Desmoid syndrome and for CIPOS.

2002 - Orthogonal polarization spectral imaging: A new tool in morphologic surveillance in intestinal transplant recipients [Articolo su rivista]
Cautero, Nicola; Gelmini, Roberta; Villa, Erica; A., Bagni; A., Merighi; Masetti, Michele; DI BENEDETTO, Fabrizio; F., Di Francesco; L., Bezer; Begliomini, Bruno; Jovine, Elio; Ad, Pinna
abstract

Intestinal transplantation (ITx) can be considered a lifesaving procedure in patients with intestinal failure. However, despite improvements in the surgical technique and in patient selection, as well as in immunosuppressive therapy, successful ITx requires an early diagnosis of graft rejection. Acute cellular rejection (ACR) remains the most common and serious complication in clinical ITx. In this scenario frequent endoscopic and histologic surveillance are mandatory to achieve an early diagnosis of rejection and to tailor an effective immunosuppressive regimen. We compared zoom video endoscope (ZVE)[1] and orthogonal polarization spectral (OPS) imaging as techniques to predict qualitative modifications of microscopic architecture and villi microcirculation for the diagnosis of acute cellular rejection in small bowel transplant patients.

2002 - Pretransplantation pre-S2 and S protein heterogeneity predisposes to hepatitis B virus recurrence after liver transplantation [Articolo su rivista]
GROTTOLA, Antonella; BUTTAFOCO, Paola; MG Del, Buono; C., Cremonini; COLANTONI, Alessandra; GELMINI, Roberta; C., Morelli; MASETTI, Michele; JOVINE, Elio; F., Fruet; PINNA, Antonio Daniele; MANENTI, Federico; VILLA, Erica
abstract

Abstract Liver transplantation (LT) in patients with hepatitis B virus (HBV) infection often is complicated by recurrence of infection despite immunoglobulin treatment. To evaluate whether variability in HBV genomic sequences and the target of antibody to hepatitis B surface antigen action in pre-LT samples may be associated with a high recurrence rate, HBV pre-S/S regions of 14 HBV-positive candidates for LT (in 9 of these patients, HBV infection subsequently recurred) were amplified and sequenced. Two hundred ninety-one mutations in 1,167 sequenced nucleotides (24.9%) were found. Of these, 120 mutations (10.2%) led to an amino-acid change. The only significant difference between patients with and without recurrent disease was in the number of mutations in the pre-S2 region (total mutations, P = .042; missense mutations, P = .012) of pre-LT HBV DNA. In addition, a difference in amino-acid level was present in the pre-S2 region (P = .030). The delay in HBV infection recurrence was proportional to the number of pre-LT HBV mutations in the pre-S2 and S genes: the higher the number, the longer the interval between LT and recurrence of infection (pre-S2, P = .0124; S, P = .0060; total number of mutations in S protein, P = .0421). In conclusion, pre-LT determination of pre-S/S gene sequence variability showed that heterogeneity of the pre-S2 and, to a lesser extent, S genes was associated with a greater chance for HBV recurrence. Modification of B-cell epitopes of S, but especially of pre-S2, protein leading to conformational changes and alterations in the viral encapsidation and secretion process may facilitate HBV recurrence and contribute to the failure of immune globulin therapy.

2002 - Procurement technique for isolated small bowel, pancreas, and liver from multiorgan cadaveric donor [Relazione in Atti di Convegno]
Jovine, Elio; DI BENEDETTO, Fabrizio; Quintini, C; Masetti, M; Cautero, N; Gelmini, Roberta; Andreotti, A; Bezer, L; Sassi, S; Boggi, U; Filipponi, F; Pinna, Antonio Daniele
abstract

Intestinal transplants, including either isolated small bowel and multivisceral grafts, have become in the last decade a valuable and safe therapeutic option for patients with intestinal failure. The improvements in intestinal transplants result basically from a better patients selection, refined surgical techniques, and immunosuppressants.[1]The purpose of this article is to define the feasibility of isolated small bowel harvesting simultaneously with pancreas and liver procurement from cadaveric multiorgan donor.

2002 - Retospective analysis of resectability, prognostic factors and outcome of cholangiocellular carcinoma (CCC) [Abstract in Rivista]
Gelmini, Roberta; Bertolini, Federica; Luppi, G; Andreotti, Alessia; Pinna, Ad
abstract

retrospective study to evaluate resecability rate, prognosdtic factors and outcome of both central and peripheal cholangiocarcinoma

2002 - Retrospective analysis of resectability, prognostic factors and outcome of cholangiocarcinoma [Relazione in Atti di Convegno]
Gelmini, Roberta; Bertolini, F; Luppi, G; Andreotti, A.
abstract

Retrospective analysis of resectability, prognostic factors and outcome of cholangiocarcinoma

2002 - Retrospective analysis of resectability, prognostic factors and outcome of cholangiocellular carcinoma (CCC) [Abstract in Rivista]
Gelmini, Roberta; Bertolini, Federica; Luppi, G.; Andreotti, Alessia; Pinna, Antonio Daniele
abstract

Retrospective analysis of resectability, prognostic factors and outcome of cholangiocellular carcinoma (CCC)

2002 - Studio caso-controllo sui fattori di rischio delle infezioni micotiche nei pazienti sottoposti a trapianto ortotopico di fegato (OLT) da donatore cadavere e da donatore vivente. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Bedini, A.; Borghi, R.; Pomelli, I.; Venturelli, C.; Codeluppi, M.; Orlando, G.; Seghetto, B.; Cardini, G.; Girardis, Massimo; Gelmini, Roberta; Masetti, Michele; Pinna, A. D.; Esposito, Roberto
abstract

La sopravvivenza e la qualità della vita dei pazienti sottoposti a trapianto di organo solido è notevolmente migliorata grazie a innovative tecniche chirurgiche, a nuove terapie immunosoppressive e a un miglior controllo delle complicanze infettive. Nonostante ciò l'incidenza delle infezioni micotiche profonde nei pazienti sottoposti a OLT, rimane più alta rispetto ad altri tipi di trapianto di organo solido, e determina una mortalità ad esse correlata tutt'ora rilevante. Non è noto se i pazienti sottoposti a trapianto da donatore vivente abbiano un'incidenza minore di infezioni micotiche rispetto a quelli sottoposti da donatore cadavere.

2002 - Tecnica chirurgica per il prelievo isolato di intestino, pancreas e fegato dallo stesso donatore cadavere multiorgano. [Relazione in Atti di Convegno]
DI BENEDETTO, Fabrizio; Masetti, M.; Cautero, N; Gelmini, Roberta; DALLA VALLE, R.; Quintini, C; Sassi, S; Landolfo, G; DI FRANCESCO, F; Diago, T; Jovine, Elio; Pinna, Ad
abstract

Tecnica chirurgica per il prelievo isolato di intestino, pancreas e fegato dallo stesso donatore cadavere multiorgano.

2002 - Trapianto di intestino: esperienza dell’Università di Modena e Reggio Emilia [Relazione in Atti di Convegno]
Quintini, C; Masetti, M; DI BENEDETTO, Fabrizio; Cautero, N; Gelmini, Roberta; DALLA VALLE, R; Sassi, S; Landolfo, G; DI FRANCESCO, F; Diago, T; Jovine, Elio; Pinna, A. D.
abstract

Trapianto di intestino: esperienza dell’Università di Modena e Reggio Emilia

2002 - Trattamento chirurgico del carcinoma del pancreas nel paziente anziano. [Relazione in Atti di Convegno]
Quintini, C; Gelmini, Roberta; Landolfo, G; DI BENEDETTO, Fabrizio; Masetti, M; Cautero, N; DALLA VALLE, R; Sassi, S; DI FRANCESCO, F; Jovine, Elio; Pinna, A. D.
abstract

Trattamento chirurgico del carcinoma del pancreas nel paziente anziano.

2001 - Haemodinamic changes in living-related liver transplant: a colour-doppler ultrasound study. . [Relazione in Atti di Convegno]
Bertani, H; Cremonini, C; DEL BUONO, Mg; Primerano, A; Gelmini, Roberta; Cautero, N; Jovine, Elio; Pinna, Antonio Daniele; Manenti, Federico; Villa, Erica
abstract

color-doppler ultrasound study: haemodynamic changes in living-ralated liver transplant

2001 - Modified multivisceral transplantation without liver for Gardner desmoid syndrome and cronic intestinal pseudoobstruction [Relazione in Atti di Convegno]
Jovine, Elio; Masetti, M; Cautero, N; DI BENEDETTO, Fabrizio; Gelmini, Roberta; Sassi, S; Quintini, C; Andreotti, A; Begliomini, Bruno; Siniscalchi, A; Pinna, Antonio Daniele
abstract

Modified multivisceral transplantation without liver for Gardner desmoid syndrome and cronic intestinal pseudoobstruction

2001 - Orthogonal Polarization Spectral (OPS) Imaging: A New Tool in Morphologic Surveillance in Intestinal Transplant Recipients [Relazione in Atti di Convegno]
N., Cautero; Gelmini, Roberta; Villa, Erica; A., Bagni; A., Merighi; M., Masetti; DI BENEDETTO, Fabrizio; F., DI FRANCESCO; L., Bezer; Begliomini, Bruno; Jovine, Elio; Pinna, Antonio Daniele
abstract

Orthogonal Polarization Spectral (OPS) Imaging: A New Tool in Morphologic Surveillance in Intestinal Transplant Recipients

2001 - Sirolimus-Tacrolimus combined immunosuppression and early steroidal withdrawal in liver transplantation. [Relazione in Atti di Convegno]
Pinna, Antonio Daniele; Jovine, Elio; Masetti, M; Gelmini, Roberta; Cautero, N; DI BENEDETTO, F; Bezer, L.
abstract

Sirolimus-Tacrolimus combined immunosuppression and early steroidal withdrawal in liver transplantation.

2000 - Cirugia ginecologia por laparoscopia [Capitolo/Saggio]
Saviano, Massimo; Segre, A.; Piccoli, M.; Gelmini, Roberta; Aguzzoli, L.; Heydari, A.
abstract

INDICAZIONI, TECNICHE, COMPLICANZE E COSTI DELLA CHIRURGIA VL GINECOLOGICA

2000 - Valutazione dei materiali biocompatibili nella riparazione di difetti della parete addominale [Articolo su rivista]
F., Ferrara; C., Pezcoller; Barbolini, Giuseppe; R., Ferrone; S., Fundarò; R., Tranò; Gelmini, Roberta; A., Spallanzani; V., Lolli
abstract

valutazione dei materiali biocompatibili per la riparazione dei difetti di parete

1999 - La chirurgia del carcinoma broncogeno non a piccole cellule in stadio IIIA: analisi di 150 casi trattati [Articolo su rivista]
Briccoli, Antonio; Gelmini, Roberta; Spallanzani, A; Guernelli, N.
abstract

BACKGROUND AND AIM:The authors report the findings of a retrospective study made of 150 cases of bronchogenic non-small-cell carcinoma at stage IIIA.METHODS:Of the 150 patients treated 130 were male and 20 female. The mean age of the population examined was 55, with a minimum of 28 and maximum of 76. The techniques of exeresis used were pneumonectomy in 70 cases (33.3%) (simple in 50 cases--33.3% and intrapericardial ligation of pulmonary vessels in 20--13.3%), lobectomy in 61 cases (40.6%), lobectomy with associated atypical resection in 9 cases (6%), atypical resection in 6 patients (4%) and bilobectomy in 4 (2.6%).RESULTS:The 5-year survival rate was 16.9%. It was also found that the 5-year survival rate was 20.7% higher for epidermoid carcinoma compared to other histiotypes. The technique used also influenced survival and subjects undergoing pneumonectomy presented a 5-year survival of 29.7% compared to 26.8% for lobectomies associated with atypical resection.CONCLUSION:Surgery of bronchogenic carcinoma at stage IIIA has not obtained promising results in terms of survival. However, no other alternative treatment permits an average 5-year survival rate of 15% to be achieved.

1999 - Mesenteric cystic neoformations: Report of two cases [Articolo su rivista]
Saviano, Massimo; S., Fundaro; Gelmini, Roberta; G., Begossi; S., Perrone; Farinetti, Alberto; M., Criscuolo
abstract

The authors present two case reports of mesenteric cystic neoformations which they themselves observed and, with the help of the literature regarding this pathology, discuss the problems of both diagnosis and treatment.

1999 - Videolaparoscopic removal of a foreign body housed in the retroperitoneal region [Articolo su rivista]
Saviano, Massimo; M., Piccoli; A., Heydari; Gelmini, Roberta
abstract

description of a case of foreign body retained in the retroperitoneum, removed laparoscopically

1998 - Fundoplicatio secondo Nissen-Rossetti in videolaparoscopia [Abstract in Rivista]
Saviano, Massimo; Monni, Sebastiano Graziano; Farinetti, Alberto; M., Piccoli; Gelmini, Roberta; F., Maurichi; S., Ruocco
abstract

...

1998 - La videolaparoscopia nel paziente con dolore in regione iliaca destra [Articolo su rivista]
Saviano, Massimo; Piccoli, M; Menozzi, M; Gelmini, Roberta; Heydari, A.
abstract

The authors report on their experience of 235 laparotomy operations and 125 laparoscopic operations performed on patients with right lower abdominal pain. Concerning each of these different approaches, the authors analyzed and compared preoperative diagnosis, anatomo-pathological findings, intraoperative and early post operative morbidity and hospital stay. The ratio of negative open-appendectomies was 24.1% (56 cases out of 233). The laparoscopic approach, performed on 88 cases of suspected appendicitis, allowed to document and to treat other pathologies, real causes of the lower right abdominal pain, in 42 cases (47.7%). The rate of conversion from laparoscopic appendectomy to open appendectomy was only 2.19% (2 cases out of 91). The morbidity rate of laparoscopic appendectomy was estimated at 6.5% (4.4% major complications, 2.2% minor complications). The morbidity rate of open appendectomy was estimated at 8.9% (0.4% major complications, 8.5% minor complications). Though the median postoperative stay, after laparotomy approach, was slightly longer (2.6 days versus 2.4 days), the difference was not statistically significant. Based on these results, the authors conclude that the laparoscopic approach should be reserved for fertile female patients, especially when the diagnosis of appendicitis is uncertain.

1998 - Sindromes dolorosos abdomino-pélvicos. Papel de la video-laparoscopia. [Articolo su rivista]
Saviano, Massimo; Piccoli, M.; Heydari, A.; Gelmini, Roberta
abstract

ruolo della laparoscopia nella diagnosi e nel trattamento delle sindromi dolorose addomino-pelviche

1997 - Fenestration of liver and renal cysts in videolaparoscopy [Articolo su rivista]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

technical skills of laparoscopic fenestration of liver cysts

1997 - Incidenti e complicanze della videolaparocolecistectomia. Analisi di 45.187 interventi eseguiti in 147 Ospedali Italiani [Articolo su rivista]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

studio multicentrico su 45.187 casi di colecistectomia laparoscopica. analisi delle complicanze chirurgiche

1997 - La chirurgia delle fistole anali [Articolo su rivista]
Ricchi, Elio; Carriero, A; Spallanzani, A; Fundarò, S; Heydari, A; Piccoli, M; Gelmini, Roberta
abstract

AbstractThe authors report a study on 120 patients with anal fistula (111 males and 9 females). The average age was 44.3 years (median 44, SD +/- 14.807). 64.1% of patients had an intersphincteric fistula, 23.3% hanal transphincteric fistula, 1.6% a suprasphincteric fistula, 7.5% a horseshoe fistula and the 3.3% an extrasphincteric fistula. We treated 14 patients (11.66%) with direct surgical treatment. The other 106 had various types of treatment depending on the localisation and the involvement of the anorectal sphincter. We had 11 cases (9.1%) of complications, such as recurrence in 5 patients (4.1%) transitory incontinence in 2 cases (1.6%) and finally postoperative bleeding in 3 patients (2.5%).

1997 - Laparoscopic managment of varicocele [Articolo su rivista]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

laparoscopic treatment of varicocele

1997 - LONG-TERM RESULTS OF LUNG METASTASECTOMY: PROGNOSTIC ANALYSES BASED ON 5206 CASES [Articolo su rivista]
U., Pastorino; M., Buyse; G., Friedel; R., Ginsberg; P., Girard; P., Goldstraw; M., Johnston; P., Mccormack; H., Pass; J. B. Putnam J., R.; J., Cerrina; A., Chapelier; P., Dartevelle; P., Baldeyrou; D., Grunenwald; H., Bulzebruck; J., Schirren; I., Vogt Moykopf; H., Toomes; van Geel, A. N.; M., Cappello; P., Rocmans; A., Pietraszek; M., Sklodowska; S., Andreani; M., Incarbone; G., Ravasi; L., Tavecchio; V., Ambrogi; C., Ricci; T., Mineo; G., Maggi; A., Briccoli; Gelmini, Roberta; A., Heidari; N., Guernelli; V., Beltrami; Bains, M. S.; Burt, M. E.; N., Martini; Mccormack, P. M.; V. W., Rusch; J., Roth; C., Holmes; H. Pass B., Temeck
abstract

Objectives: The International Registry of Lung Metastases was established in 1991 to assess the long-term results of pulmonary lnetastasectomy. Methods: The Registry has accrued 5206 cases of lung metastasectomy, from 18 departments of thoracic surgery in Europe (n = 13), the United States (n = 4) and Canada (n = 1). Of these patients, 4572 (88%) underwent complete surgical resection. The primary tumor was epithelial in 2260 cases, sarcoma in 2173, germ cell in 363, and melanoma in 328. The disease-free interval was 0 to 11 months in 2199 cases, 12 to 35 months in 1857, and more than 36 months in 1620. Single metastases accounted for 2383 cases and multiple lesions for 2726. Mean follow-up was 46 months. Analysis was performed by Kaplan- Meier estimates of survival, relative risks of death, and multivariate Cox model. Results: The actuarial survival after complete metastasectomy was 36% at 5 years, 26% at 10 years, and 22% at 15 years (median 35 months); the corresponding values for incomplete resection were 113% at 5 years and 7% at 10 years (median 15 months). Among complete resections, the 5-year survival was 33% for patients with a disease-free interval of 0 to 11 months and 45% for those with a disease-free interval of more than 36 months; 43% for single lesions and 27% for four or more lesions. Multivariate analysis showed a better prognosis for patients with germ cell tumors, disease-free intervals of 36 months or more, and single metastases. Conclusions: These results confirm that lung metastasectomy is a safe and potentially curative procedure. Resectability, disease-free interval, and number of metastases enabled us to design a simple system of classification valid for different tumor types.

1997 - Valutazione di materiali biocompatibili nella riparazione di difetti della parete addominale [Abstract in Rivista]
Ferrara, F; Barbolini, G; Fundar, S; Tran, R; Spallanzani, A; Gelmini, Roberta; Ferrone, R.
abstract

VALTUTAZIONE DELL'UTILIZZO DI MATERIALI BIOCOMPATIBILI NELLA CORREZIONE DEI DIFETTI DELLA PARETE ADDOMINALE: STUDIO SPERIMENTALE

1997 - Videolaparoscopic orchiectomy for masculine pseudohermaphroditism (Morris Syndrome) [Articolo su rivista]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

laaparoscopci treatment of Morris Syndrome

1996 - Cholécystectomie coelioscopique en Italie. Rapport sur 45.187 cas [Relazione in Atti di Convegno]
Saviano, Massimo; Piccoli, M.; Heydari, A.; Gelmini, Roberta
abstract

studio retrospettivo multicentrico sui risultati di 45187 colecistectomie vl in italia

1996 - Costi della chirurgia video-laparoscopica nel trattamento delle cisti ovariche [Articolo su rivista]
Saviano, Massimo; Heydari, A; Gelmini, Roberta; Piccoli, M.
abstract

The authors proceeded to point out the hospital stay costs and the operating-room costs of the operations for benign adnexal pathologies, especially concerning the ovarian cysts, after having introduced the laparoscopic technique. The highly costs, due to the laparoscopic surgical equipment, are compensated by the reduced hospital stay. The total unit cost for laparoscopic approach results lower then the total unit cost for laparotomic approach (L. 3.253.923 versus L. 4.662.892). If we consider that, in our local area, in 1993, 1212 operations were performed, with 5454 days of postoperative hospital stay, we could suppose that the laparoscopic approach affords higher savings. This cost estimation is important if we consider the diffusion of the mini-invasive procedures.

1996 - Costi della colecistectomia dopo l’avvento della chirurgia video-laparoscopica [Articolo su rivista]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta; Pezcoller, C; Guarasci, N.
abstract

The authors proceeded to point out the hospital stay costs and the operating-room costs of the cholecystectomy after the introduction of the laparoscopic technique, underlining the higher economic advantages. The total unit cost for laparoscopic cholecystectomy, even if there are higher costs due to the surgical equipment, thanks to the mini-invasive approach and to the reduced hospital stay, results lower (17%) then the total unit cost for laparotomic cholecystectomy (L. 3.982.489 vs. L. 4.825.300). Let us suppose that in the Emilia Romagna Region an 80% of patients underwent to laparoscopic cholecystectomy and only a 20% underwent to laparotomic cholecystectomy: in this case there could be the economic savings of L. 3.777.478.902 and concerning the hospital stay there could be the savings of 17.928 days too. This cost estimation is important if we consider that the rate of cholecystectomy procedures, in our local area, per 1000 inhabitants, increased from 2.29 in 1990 to 3.99 in 1992 (rate of increase: 74%).

1996 - Diritti e doveri del chirurgo nella gestione delle risorse alle soglie del 2000 [Relazione in Atti di Convegno]
Saviano, ; Heydari, A.; Gelmini, Roberta; Piccoli, ; Menozzi, M.; Fundarò, S.
abstract

relazione su diritti e doveri del chirurgo alle soglie del nuovo millenio

1996 - La videolaparocolecistectomia in Italia [Relazione in Atti di Convegno]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta; Menozzi, M; Spallanzani, A.
abstract

5 anni di casistica italiana su 45187 colecistectomie VL

1996 - Painful abdomino-pelvic syndromes. Function of video-laparoscopy [Articolo su rivista]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

the role videolaparoscopy in diagnosis and treatment of right fossa pain syndrome

1996 - Valutazione dei costi nella chirurgia dell’ernia inguinale. Day surgery e one day surgery versus ricovero ordinario [Articolo su rivista]
Saviano, Massimo; Gelmini, Roberta; Piccoli, M; Heydari, A; Guarasci, N; Pezcoller, C.
abstract

The authors have completed an analytic research about costs of hospitalization and treatment for inguinal hernioplasty and costs of anesthesiologic and surgical techniques and hospitalization regimen. The authors consider possible in about 50% of cases the tension-free hernioplasty carried out with local anesthesia and day or one day surgery regimen and they have estimated that it is very less costly then traditional herniorraphy carried out with general anesthesia and hospitalization: L. 1.056.075 versus L. 2.252.650. In Emilia-Romagna we could have a considerable cost-saving, even if only the 50% of patients treated for uncomplicated inguinal hernia every year (7.133 patients with mean hospital stay = 5,8 days and total hospitalization = 41.731 days during 1993) could benefit by treatment in one day surgery regimen. In fact, leaving out of account the advantage of the rapid return the patient to work, the costs of hospital stay, esteemed in L. 25.038.600.000, would be L. 8.558.700.000. A considerable increase of one day surgery hernioplasties should be expected by the hospital administration in budget planning.

1995 - Chirurgia ginecologica in videolaparoscopia. [Abstract in Atti di Convegno]
Heydari, A; Piccoli, M; Gelmini, Roberta; Trano', R; Guarasci, N; Saviano, Massimo
abstract

RUOLO DELLA DAY SUREGRY NEL TRATTAMENTO VL DELLA PATOLOGIA GINECOLOGICA

1995 - Chirurgia plastica e senologica in regime ambulatoriale e di one day surgery. [Abstract in Atti di Convegno]
Fundar, S; Spallanzani, A; Tran, R; Piccoli, M; Gelmini, Roberta; Simonazzi, R; Ferrara, F; Saviano, Massimo
abstract

ruolo della day surgery nella chirurgia mammaria

1995 - Cholécystecomie coelioscopique. Rapport sur 1712 cas - 97° congrès francais de chirurgie [Relazione in Atti di Convegno]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

studio retrospettivo su 1712 casi di colecistectoma VL in Italia

1995 - Cost-effectivness in Ambulatory and One Day Surgery [Abstract in Rivista]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta; Simonazzi, R; Ferrara, F.
abstract

costi e benefici della day surgery: modelli organizzativi e culturali. Esperienza in un Policlinico Univeristario pubblico

1995 - Costi della colecistectomia dopo l’avvento della chirurgia videolaparoscopica [Abstract in Atti di Convegno]
Piccoli, M; Gelmini, Roberta; Heydari, A; Fundar, S; Guarasci, N; Saviano, Massimo
abstract

variazione del costo della cvolecistectomia dopo l'avvento e la diffusione della chirurgia mini-invasiva

1995 - Exeresi di fibromiomi uterini in video-laparoscopia [Abstract in Atti di Convegno]
Heydari, A; Gelmini, Roberta; Piccoli, M; Saviano, Massimo
abstract

tecnica chirurgica di exeresi di fibromi uterini VL

1995 - Rottura di ago-elettrodo per elettrolipolisi e sua ritenzione in retroperitoneo: rimozione videolaparoscopica [Relazione in Atti di Convegno]
Gelmini, Roberta; Heydari, A; Piccoli, M; Saviano, Massimo
abstract

case report

1995 - Ruolo della videolaparoscopia nella diagnosi e trattamento delle sindromi dolorose addomino-pelviche dubbie [Relazione in Atti di Convegno]
Piccoli, M; Gelmini, Roberta; Heydari, A; Saviano, Massimo
abstract

ruolo della VL nel trattamentodelle sdr dolorose addomino-pelviche

1995 - Sindromi dolorose addomino-pelviche: il ruolo della video-laparoscopia [Abstract in Atti di Convegno]
Piccoli, M; Heydari, A; Gelmini, Roberta; Saviano, Massimo
abstract

IL RUOLO DELLA VL NELLA DD E NEL TRATTAMENTO DELLE SINDRTOMI DOLOROSE ADDOMINO-PELVICHE

1995 - Sterilizzazione tubarica in video-laparoscopia [Abstract in Atti di Convegno]
Gelmini, Roberta; Piccoli, M; Heydari, A; Saviano, Massimo
abstract

DESCRIZIONE DELLA TECNICA CHIRURGICA DELLA STERILIZZAZIONE TUBARICA VL

1995 - Stress operatorio ed attivazione dell’asse ipotalamo-ipofisi-surrene in chirurgia videolaparoscopica: addome superiore versus addome inferiore. [Abstract in Atti di Convegno]
Heydari, A; Piccoli, M; Gelmini, Roberta; Fundar, S; Spallanzani, A; Tran, R; Saviano, Massimo; Caregnato, L; Tassi, A.
abstract

STUDIO PROSPETTICO DI CONFRONTO SULLA VALUTAZIONE DELLO STRESS CHIRURGICO ED ATTIVAZIONE DELL'ASSE IPOTALAMO-IPOFISI-SURRENE NEGLI INTERVENTO VL ADDOME SUPERIORE VS ADDOME INFERIORE

1995 - Tecniche di viscero sintesi in videolaparoscopia. Modello didattico di apprendimento su simulatore [Relazione in Atti di Convegno]
Heydari, A; Piccoli, M; Gelmini, Roberta; Saviano, Massimo
abstract

TECNICHE DI APPRENDIMENTO SU SIMULATORE

1995 - Trattamento chirurgico della patologia erniaria: day surgery versus ricovero ordinario. [Abstract in Atti di Convegno]
Gelmini, Roberta; Heydari, A; Piccoli, M; Spallanzani, A; Guarasci, N; Saviano, Massimo
abstract

confronto dei risultati nel trattamento della patologia erniaria inguinale in day surgery vs ricovero ordinario

1995 - Trattamento della gravidanza extrauterina tubarica in video-laparoscopia [Abstract in Atti di Convegno]
Piccoli, M; Heydari, A; Gelmini, Roberta; Saviano, Massimo
abstract

INDICAZIONI E TECNICA CHIRIURGICA DEL RATTAMENTO VL DELLA GRAVIDANZA EXTRA-UTERINA TUBARICA

1995 - Trattamento delle cisti epatiche e renali in video-laparoscopia [Abstract in Atti di Convegno]
Heydari, A; Gelmini, Roberta; Piccoli, M; Saviano, Massimo
abstract

TRATTAMENTO VL DELLE CISTI EPATICHE E RENALI

1995 - Trattamento video-laparoscopico del varicocele [Abstract in Atti di Convegno]
Piccoli, M; Heydari, A; Gelmini, Roberta; Saviano, Massimo
abstract

INDICAZIONI E TECNICA DEL TRATTAMENTO VL DEL VARICOCELE

1995 - Trattamento video-laparoscopico delle cisti ovariche [Abstract in Atti di Convegno]
Gelmini, Roberta; Piccoli, M; Heydari, A; Saviano, Massimo
abstract

TRATTAMENTO VL DELLE CISTI OVARRICHE

1995 - Videolaparoscopic bilateral orchidectomy in Morris Syndrome [Relazione in Atti di Convegno]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

VL bilateral orchiectomy in Morris Sdr

1995 - Videolaparoscopic removal of a foreign body retained in retroperitoneum [Relazione in Atti di Convegno]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

tecnica di asporazione di un ago ritenuto in retroperitoneo in VL

1994 - A multicentric research of 1712 videolaparoscopic cholecystectomy [Abstract in Atti di Convegno]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

Results of 1712 laparoscopic cholecystectomies. A multicentric study

1994 - Appendicectomia in videolaparoscopia: indicazioni e tecniche chirurgiche [Relazione in Atti di Convegno]
Piccoli, M; Heydari, A; Gelmini, Roberta; Guarasci, N; Saviano, Massimo
abstract

indicazioni e tecnica dell'appendicectomia VL

1994 - Chirurgia videolaparoscopica: regole e gestualità di base [Relazione in Atti di Convegno]
Heydari, A; Piccoli, M; Gelmini, Roberta; Farinetti, Alberto; Saviano, Massimo
abstract

regole e gestualità di base in chirurgia mini-invasiva

1994 - Chirurgia videolaparoscopica: regole e gestualità di base. [Abstract in Rivista]
A., Heydari; M., Piccoli; Gelmini, Roberta; Farinetti, Alberto; Saviano, Massimo
abstract

...

1994 - Colecistectomia in videolaparoscopia: particolari e varianti di tecnica chirurgica [Relazione in Atti di Convegno]
PICCOLI M, I. I. I.; Heydari, A; Gelmini, Roberta; Pezcoller, C; Saviano, Massimo
abstract

indicazioni, varanti di tecnica e controindicazioni della colecistectomia VL

1994 - Resezione videolaparoscopica di diverticolo di Meckel [Relazione in Atti di Convegno]
Heydari, A.; Piccoli, M.; Gelmini, Roberta; Farinetti, Alberto; Saviano, Massimo
abstract

Trattamento laparoscopico del diverticolo di Meckel

1994 - Videolaparoscopic orchidectomy in Morris Syndrome [Abstract in Atti di Convegno]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

tecnica di orchiectomia VL nella sdr. di Morris

1994 - Videolaparoscopic removal of a foreign body retained in retroperitoneum (Video session) [Abstract in Atti di Convegno]
Saviano, Massimo; Piccoli, M; Heydari, A; Gelmini, Roberta
abstract

videolaparoscopic removal of a electrolipolysis electrode fragment retained in retroperitoneum

1993 - La diverticolite acuta del colon. Osservazioni clinico-terapeutiche su 100 casi. [Articolo su rivista]
Gelmini, Roberta; Rossi, Aldo
abstract

La diverticolite acuta del colon. Osservazioni clinico-terapeutiche su 100 casi

1993 - Tumour spectrum in hereditary non-polyposis colorectal cancer (HNPCC) and in families with "suspected HNPCC". A population-based study in Northern Italy. Colorectal Cancer Study Group. [Articolo su rivista]
Benatti, Piero; R., Sassatelli; Roncucci, Luca; Pedroni, Monica; R., Fante; C., DI GREGORIO; Losi, Lorena; Gelmini, Roberta; PONZ DE LEON, Maurizio
abstract

Hereditary non-polyposis colorectal cancer (HNPCC or Lynch syndrome) is characterized by the early onset of colorectal neoplasms, frequently localized in the right colon, increased occurrence of multiple primaries, vertical transmission and aggregation of tumours in families in accordance to a Mendelian dominant type of inheritance. The syndrome accounts for approximately 5% of all colorectal cancers. The purpose of the present study was to describe the tumour spectrum and the most relevant clinical features of 28 kindreds with HNPCC, classified according to the guidelines of the international Collaborative Study Group, and of 61 ''suspected'' HNPCC. These families were observed during a 6-year registration of colorectal neoplasms in a health-care district of Northern Italy. Colorectal cancer was by far the most frequent malignancy; gastric cancer was the second. Uterine carcinoma was only slightly more frequent than expected. Lung- and breast-tumour rates were lower than expected. Cancer distribution in the large bowel showed that about two fifths of the tumours developed in the right colon. The occurrence of cancer before the age of SO to 60 was much more frequent in HNPCC. Multiple tumours developed in 25 patients with HNPCC and in 32 with ''suspected'' HNPCC. Pancolonoscopy remains the procedure of choice for surveillance; other examinations, such as gastroscopy, gynaecological investigations, urography and cholangiography, are suggested only to selected families. One of the main features of the study was the inclusion of 61 ''suspected'' HNPCC, a heterogeneous group of families which nonetheless deserves careful follow-up.