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1. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Author: Costa, G, Fransvea, P, Lepre, L, Liotta, G, Mazzoni, G, Biloslavo, A, Bianchi, V, Occhionorelli, S, Costa, A, Sganga, G, Agresta, F, Alemanno, G, Antropoli, M, Apice, N, Argenio, G, Avenia, N, Azzinnaro, A, Barberis, A, Badessi, G, Baldazzi, G, Bergamini, C, Bianco, G, Bombardini, C, Borzellino, G, Brachini, G, Maurizio, B, Canini, T, Capolupo, G, Carannante, F, Caricato, M, Cassini, D, Castriconi, M, Catamero, A, Catarci, M, Ceccarelli, G, Ceresoli, M, Chiarugi, M, Cillara, N, Cirocchi, R, Cobuccio, L, Coccolini, F, Cocorullo, G, Cozza, V, Crucitti, A, Cucinotta, E, D'Alessio, R, de Manzoni Garberini, A, De Manzini, N, De Nisco, C, De Prizio, M, Finotti, E, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Giordano, A, Guerrieri, M, Iacopini, V, Kurihara, H, La Greca, A, Laracca, G, Laterza, E, Mariani, D, Marini, P, Marzaioli, R, Masciana, G, Mercantini, P, Miacci, V, Mingoli, A, Miranda, G, Paderno, N, Palini, G, Paradies, D, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Puccioni, C, Rocca, A, Rondelli, F, Ruscelli, P, Paolo, S, Scattizzi, M, Erao, A, Tartaglia, D, Tebala, G, Trana, C, Zago, M, Costa G., Fransvea P., Lepre L., Liotta G., Mazzoni G., Biloslavo A., Bianchi V., Occhionorelli S., Costa A., Sganga G., Agresta F., Alemanno G., Antropoli M., Apice N., Argenio G., Avenia N., Azzinnaro A., Barberis A., Badessi G., Baldazzi G., Bergamini C., Bianco G., Bombardini C., Borzellino G., Brachini G., Maurizio B. G., Canini T., Capolupo G. T., Carannante F., Caricato M., Cassini D., Castriconi M., Catamero A., Catarci M., Ceccarelli G., Ceresoli M., Chiarugi M., Cillara N., Cirocchi R., Cobuccio L., Coccolini F., Cocorullo G., Cozza V., Crucitti A., Cucinotta E., D'Alessio R., de Manzoni Garberini A., De Manzini N., De Nisco C., De Prizio M., Finotti E., Frezza B., Garbarino G. M., Garulli G., Genna M., Giannessi S., Giordano A., Guerrieri M., Iacopini V., Kurihara H., La Greca A., Laracca G. G., Laterza E., Mariani D., Marini P., Marzaioli R., Masciana G., Mercantini P., Miacci V., Mingoli A., Miranda G., Paderno N., Palini G. M., Paradies D., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Pignata G., Pinotti E., Pisanu A., Puccioni C., Rocca A., Rondelli F., Ruscelli P., Paolo S., Scattizzi M., erao A., Tartaglia D., Tebala G., Trana C., Zago M., Costa, G, Fransvea, P, Lepre, L, Liotta, G, Mazzoni, G, Biloslavo, A, Bianchi, V, Occhionorelli, S, Costa, A, Sganga, G, Agresta, F, Alemanno, G, Antropoli, M, Apice, N, Argenio, G, Avenia, N, Azzinnaro, A, Barberis, A, Badessi, G, Baldazzi, G, Bergamini, C, Bianco, G, Bombardini, C, Borzellino, G, Brachini, G, Maurizio, B, Canini, T, Capolupo, G, Carannante, F, Caricato, M, Cassini, D, Castriconi, M, Catamero, A, Catarci, M, Ceccarelli, G, Ceresoli, M, Chiarugi, M, Cillara, N, Cirocchi, R, Cobuccio, L, Coccolini, F, Cocorullo, G, Cozza, V, Crucitti, A, Cucinotta, E, D'Alessio, R, de Manzoni Garberini, A, De Manzini, N, De Nisco, C, De Prizio, M, Finotti, E, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Giordano, A, Guerrieri, M, Iacopini, V, Kurihara, H, La Greca, A, Laracca, G, Laterza, E, Mariani, D, Marini, P, Marzaioli, R, Masciana, G, Mercantini, P, Miacci, V, Mingoli, A, Miranda, G, Paderno, N, Palini, G, Paradies, D, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Puccioni, C, Rocca, A, Rondelli, F, Ruscelli, P, Paolo, S, Scattizzi, M, Erao, A, Tartaglia, D, Tebala, G, Trana, C, Zago, M, Costa G., Fransvea P., Lepre L., Liotta G., Mazzoni G., Biloslavo A., Bianchi V., Occhionorelli S., Costa A., Sganga G., Agresta F., Alemanno G., Antropoli M., Apice N., Argenio G., Avenia N., Azzinnaro A., Barberis A., Badessi G., Baldazzi G., Bergamini C., Bianco G., Bombardini C., Borzellino G., Brachini G., Maurizio B. G., Canini T., Capolupo G. T., Carannante F., Caricato M., Cassini D., Castriconi M., Catamero A., Catarci M., Ceccarelli G., Ceresoli M., Chiarugi M., Cillara N., Cirocchi R., Cobuccio L., Coccolini F., Cocorullo G., Cozza V., Crucitti A., Cucinotta E., D'Alessio R., de Manzoni Garberini A., De Manzini N., De Nisco C., De Prizio M., Finotti E., Frezza B., Garbarino G. M., Garulli G., Genna M., Giannessi S., Giordano A., Guerrieri M., Iacopini V., Kurihara H., La Greca A., Laracca G. G., Laterza E., Mariani D., Marini P., Marzaioli R., Masciana G., Mercantini P., Miacci V., Mingoli A., Miranda G., Paderno N., Palini G. M., Paradies D., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Pignata G., Pinotti E., Pisanu A., Puccioni C., Rocca A., Rondelli F., Ruscelli P., Paolo S., Scattizzi M., erao A., Tartaglia D., Tebala G., Trana C., and Zago M.
Abstract: Background: Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. Methods: A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. Results: A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien–Dindo classification, the severity of postoperative complications was statistically different only for C–D 1–2. Conclusions: Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide sig
Published: 2023

2. The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly

Author: Fugazzola, P, Ceresoli, M, Coccolini, F, Gabrielli, F, Puzziello, A, Monzani, F, Amato, B, Sganga, G, Sartelli, M, Menichetti, F, Puglisi, G, Tartaglia, D, Carcoforo, P, Avenia, N, Kluger, Y, Paolillo, C, Zago, M, Leppaniemi, A, Tomasoni, M, Cobianchi, L, Dal Mas, F, Improta, M, Moore, E, Peitzman, A, Sugrue, M, Agnoletti, V, Fraga, G, Weber, D, Damaskos, D, Abu-Zidan, F, Wani, I, Kirkpatrick, A, Pikoulis, M, Pararas, N, Tan, E, Broek, R, Maier, R, Davies, R, Kashuk, J, Shelat, V, Mefire, A, Augustin, G, Magnone, S, Poiasina, E, De Simone, B, Chiarugi, M, Biffl, W, Baiocchi, G, Catena, F, Ansaloni, L, Fugazzola P., Ceresoli M., Coccolini F., Gabrielli F., Puzziello A., Monzani F., Amato B., Sganga G., Sartelli M., Menichetti F., Puglisi G. A., Tartaglia D., Carcoforo P., Avenia N., Kluger Y., Paolillo C., Zago M., Leppaniemi A., Tomasoni M., Cobianchi L., Dal Mas F., Improta M., Moore E. E., Peitzman A. B., Sugrue M., Agnoletti V., Fraga G. P., Weber D. G., Damaskos D., Abu-Zidan F. M., Wani I., Kirkpatrick A. W., Pikoulis M., Pararas N., Tan E., Broek R. T., Maier R. V., Davies R. J., Kashuk J., Shelat V. G., Mefire A. C., Augustin G., Magnone S., Poiasina E., De Simone B., Chiarugi M., Biffl W., Baiocchi G. L., Catena F., Ansaloni L., Fugazzola, P, Ceresoli, M, Coccolini, F, Gabrielli, F, Puzziello, A, Monzani, F, Amato, B, Sganga, G, Sartelli, M, Menichetti, F, Puglisi, G, Tartaglia, D, Carcoforo, P, Avenia, N, Kluger, Y, Paolillo, C, Zago, M, Leppaniemi, A, Tomasoni, M, Cobianchi, L, Dal Mas, F, Improta, M, Moore, E, Peitzman, A, Sugrue, M, Agnoletti, V, Fraga, G, Weber, D, Damaskos, D, Abu-Zidan, F, Wani, I, Kirkpatrick, A, Pikoulis, M, Pararas, N, Tan, E, Broek, R, Maier, R, Davies, R, Kashuk, J, Shelat, V, Mefire, A, Augustin, G, Magnone, S, Poiasina, E, De Simone, B, Chiarugi, M, Biffl, W, Baiocchi, G, Catena, F, Ansaloni, L, Fugazzola P., Ceresoli M., Coccolini F., Gabrielli F., Puzziello A., Monzani F., Amato B., Sganga G., Sartelli M., Menichetti F., Puglisi G. A., Tartaglia D., Carcoforo P., Avenia N., Kluger Y., Paolillo C., Zago M., Leppaniemi A., Tomasoni M., Cobianchi L., Dal Mas F., Improta M., Moore E. E., Peitzman A. B., Sugrue M., Agnoletti V., Fraga G. P., Weber D. G., Damaskos D., Abu-Zidan F. M., Wani I., Kirkpatrick A. W., Pikoulis M., Pararas N., Tan E., Broek R. T., Maier R. V., Davies R. J., Kashuk J., Shelat V. G., Mefire A. C., Augustin G., Magnone S., Poiasina E., De Simone B., Chiarugi M., Biffl W., Baiocchi G. L., Catena F., and Ansaloni L.
Abstract: Acute left colonic diverticulitis (ALCD) in the elderly presents with unique epidemiological features when compared with younger patients. The clinical presentation is more nuanced in the elderly population, having higher in-hospital and postoperative mortality. Furthermore, geriatric comorbidities are a risk factor for complicated diverticulitis. Finally, elderly patients have a lower risk of recurrent episodes and, in case of recurrence, a lower probability of requiring urgent surgery than younger patients. The aim of the present work is to study age-related factors that may support a unique approach to the diagnosis and treatment of this problem in the elderly when compared with the WSES guidelines for the management of acute left-sided colonic diverticulitis. During the 1° Pisa Workshop of Acute Care & Trauma Surgery held in Pisa (Italy) in September 2019, with the collaboration of the World Society of Emergency Surgery (WSES), the Italian Society of Geriatric Surgery (SICG), the Italian Hospital Surgeons Association (ACOI), the Italian Emergency Surgery and Trauma Association (SICUT), the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Surgical Pathophysiology (SIFIPAC), three panel members presented a number of statements developed for each of the four themes regarding the diagnosis and management of ALCD in older patients, formulated according to the GRADE approach, at a Consensus Conference where a panel of experts participated. The statements were subsequently debated, revised, and finally approved by the Consensus Conference attendees. The current paper is a summary report of the definitive guidelines statements on each of the following topics: diagnosis, management, surgical technique and antibiotic therapy.
Published: 2022

3. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

Author: Podda, M, Sylla, P, Baiocchi, G, Adamina, M, Agnoletti, V, Agresta, F, Ansaloni, L, Arezzo, A, Avenia, N, Biffl, W, Biondi, A, Bui, S, Campanile, F, Carcoforo, P, Commisso, C, Crucitti, A, De'Angelis, N, De'Angelis, G, De Filippo, M, De Simone, B, Di Saverio, S, Ercolani, G, Fraga, G, Gabrielli, F, Gaiani, F, Guerrieri, M, Guttadauro, A, Kluger, Y, Leppaniemi, A, Loffredo, A, Meschi, T, Moore, E, Ortenzi, M, Pata, F, Parini, D, Pisanu, A, Poggioli, G, Polistena, A, Puzziello, A, Rondelli, F, Sartelli, M, Smart, N, Sugrue, M, Tejedor, P, Vacante, M, Coccolini, F, Davies, J, Catena, F, Podda M., Sylla P., Baiocchi G., Adamina M., Agnoletti V., Agresta F., Ansaloni L., Arezzo A., Avenia N., Biffl W., Biondi A., Bui S., Campanile F. C., Carcoforo P., Commisso C., Crucitti A., De'Angelis N., De'Angelis G. L., De Filippo M., De Simone B., Di Saverio S., Ercolani G., Fraga G. P., Gabrielli F., Gaiani F., Guerrieri M., Guttadauro A., Kluger Y., Leppaniemi A. K., Loffredo A., Meschi T., Moore E. E., Ortenzi M., Pata F., Parini D., Pisanu A., Poggioli G., Polistena A., Puzziello A., Rondelli F., Sartelli M., Smart N., Sugrue M. E., Tejedor P., Vacante M., Coccolini F., Davies J., Catena F., Podda, M, Sylla, P, Baiocchi, G, Adamina, M, Agnoletti, V, Agresta, F, Ansaloni, L, Arezzo, A, Avenia, N, Biffl, W, Biondi, A, Bui, S, Campanile, F, Carcoforo, P, Commisso, C, Crucitti, A, De'Angelis, N, De'Angelis, G, De Filippo, M, De Simone, B, Di Saverio, S, Ercolani, G, Fraga, G, Gabrielli, F, Gaiani, F, Guerrieri, M, Guttadauro, A, Kluger, Y, Leppaniemi, A, Loffredo, A, Meschi, T, Moore, E, Ortenzi, M, Pata, F, Parini, D, Pisanu, A, Poggioli, G, Polistena, A, Puzziello, A, Rondelli, F, Sartelli, M, Smart, N, Sugrue, M, Tejedor, P, Vacante, M, Coccolini, F, Davies, J, Catena, F, Podda M., Sylla P., Baiocchi G., Adamina M., Agnoletti V., Agresta F., Ansaloni L., Arezzo A., Avenia N., Biffl W., Biondi A., Bui S., Campanile F. C., Carcoforo P., Commisso C., Crucitti A., De'Angelis N., De'Angelis G. L., De Filippo M., De Simone B., Di Saverio S., Ercolani G., Fraga G. P., Gabrielli F., Gaiani F., Guerrieri M., Guttadauro A., Kluger Y., Leppaniemi A. K., Loffredo A., Meschi T., Moore E. E., Ortenzi M., Pata F., Parini D., Pisanu A., Poggioli G., Polistena A., Puzziello A., Rondelli F., Sartelli M., Smart N., Sugrue M. E., Tejedor P., Vacante M., Coccolini F., Davies J., and Catena F.
Abstract: Background and aims: Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts’ consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods: The discussion among the steering group of clinical experts and methodologists from the societies’ expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020–January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions: The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary
Published: 2021

4. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

Author: Podda, M, Sylla, P, Baiocchi, G, Adamina, M, Agnoletti, V, Agresta, F, Ansaloni, L, Arezzo, A, Avenia, N, Biffl, W, Biondi, A, Bui, S, Campanile, F, Carcoforo, P, Commisso, C, Crucitti, A, De'Angelis, N, De'Angelis, G, De Filippo, M, De Simone, B, Di Saverio, S, Ercolani, G, Fraga, G, Gabrielli, F, Gaiani, F, Guerrieri, M, Guttadauro, A, Kluger, Y, Leppaniemi, A, Loffredo, A, Meschi, T, Moore, E, Ortenzi, M, Pata, F, Parini, D, Pisanu, A, Poggioli, G, Polistena, A, Puzziello, A, Rondelli, F, Sartelli, M, Smart, N, Sugrue, M, Tejedor, P, Vacante, M, Coccolini, F, Davies, J, Catena, F, Podda M., Sylla P., Baiocchi G., Adamina M., Agnoletti V., Agresta F., Ansaloni L., Arezzo A., Avenia N., Biffl W., Biondi A., Bui S., Campanile F. C., Carcoforo P., Commisso C., Crucitti A., De'Angelis N., De'Angelis G. L., De Filippo M., De Simone B., Di Saverio S., Ercolani G., Fraga G. P., Gabrielli F., Gaiani F., Guerrieri M., Guttadauro A., Kluger Y., Leppaniemi A. K., Loffredo A., Meschi T., Moore E. E., Ortenzi M., Pata F., Parini D., Pisanu A., Poggioli G., Polistena A., Puzziello A., Rondelli F., Sartelli M., Smart N., Sugrue M. E., Tejedor P., Vacante M., Coccolini F., Davies J., Catena F., Podda, M, Sylla, P, Baiocchi, G, Adamina, M, Agnoletti, V, Agresta, F, Ansaloni, L, Arezzo, A, Avenia, N, Biffl, W, Biondi, A, Bui, S, Campanile, F, Carcoforo, P, Commisso, C, Crucitti, A, De'Angelis, N, De'Angelis, G, De Filippo, M, De Simone, B, Di Saverio, S, Ercolani, G, Fraga, G, Gabrielli, F, Gaiani, F, Guerrieri, M, Guttadauro, A, Kluger, Y, Leppaniemi, A, Loffredo, A, Meschi, T, Moore, E, Ortenzi, M, Pata, F, Parini, D, Pisanu, A, Poggioli, G, Polistena, A, Puzziello, A, Rondelli, F, Sartelli, M, Smart, N, Sugrue, M, Tejedor, P, Vacante, M, Coccolini, F, Davies, J, Catena, F, Podda M., Sylla P., Baiocchi G., Adamina M., Agnoletti V., Agresta F., Ansaloni L., Arezzo A., Avenia N., Biffl W., Biondi A., Bui S., Campanile F. C., Carcoforo P., Commisso C., Crucitti A., De'Angelis N., De'Angelis G. L., De Filippo M., De Simone B., Di Saverio S., Ercolani G., Fraga G. P., Gabrielli F., Gaiani F., Guerrieri M., Guttadauro A., Kluger Y., Leppaniemi A. K., Loffredo A., Meschi T., Moore E. E., Ortenzi M., Pata F., Parini D., Pisanu A., Poggioli G., Polistena A., Puzziello A., Rondelli F., Sartelli M., Smart N., Sugrue M. E., Tejedor P., Vacante M., Coccolini F., Davies J., and Catena F.
Abstract: Background and aims: Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts’ consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods: The discussion among the steering group of clinical experts and methodologists from the societies’ expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020–January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions: The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary
Published: 2021

5. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author: Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., De Luca M., De Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Fransvea P., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., De Luca M., De Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Fransvea P., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., and Zanoni E.
Abstract: Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.
Published: 2021

6. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author: Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, P, De Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Fransvea P., Podda M., Pisanu A., Carrano F. M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva P., De Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, P, De Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Fransvea P., Podda M., Pisanu A., Carrano F. M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva P., De Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., and Zanoni E.
Abstract: As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hos
Published: 2020

7. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

Author: Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Chiappetta, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dallacaneva, P, Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Ceresoli M., Carissimi F., Nigro A., Fransvea P., Lepre L., Braga M., Costa G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Chiappetta M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., DallaCaneva P., Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garbarino G., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laracca G., Laterza E., Leonardi A., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mercantini P., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petrucciani N., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Chiappetta, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dallacaneva, P, Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Ceresoli M., Carissimi F., Nigro A., Fransvea P., Lepre L., Braga M., Costa G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Chiappetta M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., DallaCaneva P., Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garbarino G., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laracca G., Laterza E., Leonardi A., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mercantini P., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petrucciani N., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., and Zanoni E.
Abstract: Purpose: The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods: This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results: 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality Conclusion: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation.
Published: 2020

8. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

Author: Podda, Maria Vittoria, Sylla, P., Baiocchi, G., Adamina, M., Agnoletti, V., Agresta, F., Ansaloni, L., Arezzo, A., Avenia, N., Biffl, W., Biondi, Alberto, Bui, S., Campanile, F. C., Carcoforo, P., Commisso, C., Crucitti, Antonio, De'Angelis, N., De'Angelis, G. L., De Filippo, M., De Simone, B., Di Saverio, S., Ercolani, G., Fraga, G. P., Gabrielli, Francesca Augusta, Gaiani, F., Guerrieri, Maria Chiara, Guttadauro, A., Kluger, Y., Leppaniemi, A. K., Loffredo, Andrea, Meschi, T., Moore, E. E., Ortenzi, M., Pata, F., Parini, D., Pisanu, A., Poggioli, G., Polistena, A., Puzziello, A., Rondelli, F., Sartelli, M., Smart, N., Sugrue, M. E., Tejedor, P., Vacante, M., Coccolini, F., Davies, J., Catena, F., Podda M. (ORCID:0000-0002-2779-8417), Biondi A. (ORCID:0000-0002-2470-7858), Crucitti A. (ORCID:0000-0003-3496-4185), Gabrielli F., Guerrieri M. (ORCID:0000-0001-5782-6936), Loffredo A., Podda, Maria Vittoria, Sylla, P., Baiocchi, G., Adamina, M., Agnoletti, V., Agresta, F., Ansaloni, L., Arezzo, A., Avenia, N., Biffl, W., Biondi, Alberto, Bui, S., Campanile, F. C., Carcoforo, P., Commisso, C., Crucitti, Antonio, De'Angelis, N., De'Angelis, G. L., De Filippo, M., De Simone, B., Di Saverio, S., Ercolani, G., Fraga, G. P., Gabrielli, Francesca Augusta, Gaiani, F., Guerrieri, Maria Chiara, Guttadauro, A., Kluger, Y., Leppaniemi, A. K., Loffredo, Andrea, Meschi, T., Moore, E. E., Ortenzi, M., Pata, F., Parini, D., Pisanu, A., Poggioli, G., Polistena, A., Puzziello, A., Rondelli, F., Sartelli, M., Smart, N., Sugrue, M. E., Tejedor, P., Vacante, M., Coccolini, F., Davies, J., Catena, F., Podda M. (ORCID:0000-0002-2779-8417), Biondi A. (ORCID:0000-0002-2470-7858), Crucitti A. (ORCID:0000-0003-3496-4185), Gabrielli F., Guerrieri M. (ORCID:0000-0001-5782-6936), and Loffredo A.
Abstract: Background and aims: Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts’ consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods: The discussion among the steering group of clinical experts and methodologists from the societies’ expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020–January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions: The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary
Published: 2021

9. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author: Costa, G, Massa, G, Agresta, F, Anania, G, Ansaloni, L, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Cardella, S, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Coccolini, F, Cocorullo, G, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Falco, N, Farina, C, Filippone, G, Finotti, E, Fiume, S, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Massa G., Agresta F., Anania G., Ansaloni L., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Balani A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buccoliero F., Buonanno G. M., Buononato M., Campanile F. C., Canini T., Cardella S., Carrara G., Cascini F., Cassini D., Castriconi M., Catalini G., Catena F., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Coccolini F., Cocorullo G., Colangelo E., Crafa F., Crucitti A., Dalla Caneva P., DeLuca M., deManzoni Garberini A., De Nisco C., DeSol A., Falcioni T., Falco N., Farina C., Filippone G., Finotti E., Fiume S., Fontana T., Francioni G., Fransvea P., Frezza B., Gemini S., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iarussi T., Laterza E., Lepre L., Lorenzon L., Lotti R., Luridiana G., Marini P., Marzaioli R., Mingoli A., Mulas S., Nagliati C., Nigri G., Niolu P., Noviello A., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Santella S., Sartelli M., Spagnoli A., Sulis R., Tarasconi A., Trana C., Travaglino A., Valeri A., Vasquez G., Zago M., Zanoni E., Costa, G, Massa, G, Agresta, F, Anania, G, Ansaloni, L, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Cardella, S, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Coccolini, F, Cocorullo, G, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Falco, N, Farina, C, Filippone, G, Finotti, E, Fiume, S, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Massa G., Agresta F., Anania G., Ansaloni L., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Balani A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buccoliero F., Buonanno G. M., Buononato M., Campanile F. C., Canini T., Cardella S., Carrara G., Cascini F., Cassini D., Castriconi M., Catalini G., Catena F., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Coccolini F., Cocorullo G., Colangelo E., Crafa F., Crucitti A., Dalla Caneva P., DeLuca M., deManzoni Garberini A., De Nisco C., DeSol A., Falcioni T., Falco N., Farina C., Filippone G., Finotti E., Fiume S., Fontana T., Francioni G., Fransvea P., Frezza B., Gemini S., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iarussi T., Laterza E., Lepre L., Lorenzon L., Lotti R., Luridiana G., Marini P., Marzaioli R., Mingoli A., Mulas S., Nagliati C., Nigri G., Niolu P., Noviello A., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Santella S., Sartelli M., Spagnoli A., Sulis R., Tarasconi A., Trana C., Travaglino A., Valeri A., Vasquez G., Zago M., and Zanoni E.
Abstract: Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65 years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).
Published: 2018

10. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

Author: Ceresoli, M., Carissimi, F., Nigro, A., Fransvea, Pietro, Lepre, Luca, Braga, M., Costa, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, Giorgio, Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, Giancarlo, Cassini, D., Castriconi, M., Ceccarelli, Giovanni Maria, Celi, D., Chiappetta, M., Chiarugi, M., Cillara, N., Cimino, Filippo Alessandro, Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dallacaneva, P., Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, Gianfranco, Frezza, B., Garbarino, G., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laracca, G., Laterza, E., Leonardi, Marco Antonio, Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mercantini, P., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petrucciani, N., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, Maria Vittoria, Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Fransvea P. (ORCID:0000-0003-4969-3373), Lepre L., Barbera G. (ORCID:0000-0003-1581-0500), Carrara G., Ceccarelli G., Cimino F., Crucitti A. (ORCID:0000-0003-3496-4185), Francioni G., Giordano A. (ORCID:0000-0002-6978-0880), Leonardi A., Lorenzon L. (ORCID:0000-0001-6736-0383), Podda M. (ORCID:0000-0002-2779-8417), Ceresoli, M., Carissimi, F., Nigro, A., Fransvea, Pietro, Lepre, Luca, Braga, M., Costa, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, Giorgio, Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, Giancarlo, Cassini, D., Castriconi, M., Ceccarelli, Giovanni Maria, Celi, D., Chiappetta, M., Chiarugi, M., Cillara, N., Cimino, Filippo Alessandro, Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dallacaneva, P., Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, Gianfranco, Frezza, B., Garbarino, G., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laracca, G., Laterza, E., Leonardi, Marco Antonio, Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mercantini, P., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petrucciani, N., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, Maria Vittoria, Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Fransvea P. (ORCID:0000-0003-4969-3373), Lepre L., Barbera G. (ORCID:0000-0003-1581-0500), Carrara G., Ceccarelli G., Cimino F., Crucitti A. (ORCID:0000-0003-3496-4185), Francioni G., Giordano A. (ORCID:0000-0002-6978-0880), Leonardi A., Lorenzon L. (ORCID:0000-0001-6736-0383), and Podda M. (ORCID:0000-0002-2779-8417)
Abstract: Purpose: The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods: This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results: 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality Conclusion: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation.
Published: 2020

11. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author: Costa, G., Fransvea, P., Podda, M., Pisanu, A., Carrano, F. M., Iossa, A., Balducci, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dalla Caneva, P., De Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Costa, G., Fransvea, P., Podda, M., Pisanu, A., Carrano, F. M., Iossa, A., Balducci, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dalla Caneva, P., De Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., and Crucitti A. (ORCID:0000-0003-3496-4185)
Abstract: As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A d
Published: 2020

12. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author: Poillucci, G., Podda, M., Pisanu, A., Mortola, L., Dalla Caneva, P., Massa, G., Costa, G., Savastano, R., Cillara, N., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, De Luca, M., De Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), Lorenzon L. (ORCID:0000-0001-6736-0383), Poillucci, G., Podda, M., Pisanu, A., Mortola, L., Dalla Caneva, P., Massa, G., Costa, G., Savastano, R., Cillara, N., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, De Luca, M., De Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), and Lorenzon L. (ORCID:0000-0001-6736-0383)
Abstract: Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.
Published: 2019

13. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author: Costa, G., Massa, G., Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Crafa, F., Crucitti, Antonio, Dalla Caneva, P., Deluca, M., deManzoni Garberini, A., De Nisco, C., Desol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, S., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, Laura, Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Mingoli, A., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Trana, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), Lorenzon L. (ORCID:0000-0001-6736-0383), Costa, G., Massa, G., Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Crafa, F., Crucitti, Antonio, Dalla Caneva, P., Deluca, M., deManzoni Garberini, A., De Nisco, C., Desol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, S., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, Laura, Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Mingoli, A., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Trana, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), and Lorenzon L. (ORCID:0000-0001-6736-0383)
Abstract: Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65 years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).
Published: 2018

14. Complications of Neck Dissections in Papillary Thyroid Carcinoma: A Modified Procedure to Reduce Parathyroid Morbidity

Author: Ardito, G, Revelli, Luca, Polistena, A, Lucchini, R, Giustozzi, E, Guidi, Ml, Ardito, Francesco, Avenia, N, Revelli, L (ORCID:0000-0003-1907-773X), Ardito, F (ORCID:0000-0003-1596-2862), Ardito, G, Revelli, Luca, Polistena, A, Lucchini, R, Giustozzi, E, Guidi, Ml, Ardito, Francesco, Avenia, N, Revelli, L (ORCID:0000-0003-1907-773X), and Ardito, F (ORCID:0000-0003-1596-2862)
Abstract: Background/Aim: Hypoparathyroidism is the most significant morbidity after neck dissection for thyroid cancer. Addition of lateral neck dissection (ND) to central ND combined with total thyroidectomy (TT) increases the risk of postoperative hypoparathyroidism compared to TT plus central ND. The aim of this study was to verify if a modified procedure and different access to the neck for lateral ND may improve safety. Patients and Methods: In 62 patients with papillary thyroid cancer (PTC) undergoing TT plus central and lateral ND between 2010 and 2013, lateral ND was performed as first step approaching the neck via extrathyroideal space. Calcium in serum and parathormone (PTH) were determined preoperatively, intraoperatively and during the follow-up. Results: Twenty patients (32%) developed postoperative hypocalcemia. Calcium levels and PTH completely recovered for 58 out of 62 patients from 3 to 6 months after surgery. After a mean of 12 months' follow-up, only four patients (6.5%) had developed permanent hypoparathyroidism. The incidence of parathyroid complication after TT plus central ND and lateral ND did not differ from postoperative hypoparathyroidim after TT plus central ND. Conclusion: The presented surgical procedure may provide a better outcome in terms of parathyroid morbidity.
Published: 2016

15. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB).

Author: Rosato, L, De Crea, Carmela, Bellantone, R, Brandi, Ml, De Toma, Giorgio, Filetti, S, Miccoli, P, Pacini, F, Pelizzo, Mr, Pontecorvi, Alfredo, Avenia, N, De Pasquale, Tiziana Maria Angela, Chiofalo, Mg, Gurrado, A, Innaro, N, Lavalle, Angela, Lombardi, C, Marini, Pl, Mondini, G, Mullineris, B, Pezzullo, Angelo Maria, Raffaelli, Marco, Testini, M, De Palma, M., De Crea C (ORCID:0000-0002-7303-9657), De Toma G, Pontecorvi A (ORCID:0000-0003-0570-6865), De Pasquale L, La Valle G, Pezzullo L (ORCID:0000-0002-8252-4654), Raffaelli M (ORCID:0000-0002-1259-2491), Rosato, L, De Crea, Carmela, Bellantone, R, Brandi, Ml, De Toma, Giorgio, Filetti, S, Miccoli, P, Pacini, F, Pelizzo, Mr, Pontecorvi, Alfredo, Avenia, N, De Pasquale, Tiziana Maria Angela, Chiofalo, Mg, Gurrado, A, Innaro, N, Lavalle, Angela, Lombardi, C, Marini, Pl, Mondini, G, Mullineris, B, Pezzullo, Angelo Maria, Raffaelli, Marco, Testini, M, De Palma, M., De Crea C (ORCID:0000-0002-7303-9657), De Toma G, Pontecorvi A (ORCID:0000-0003-0570-6865), De Pasquale L, La Valle G, Pezzullo L (ORCID:0000-0002-8252-4654), and Raffaelli M (ORCID:0000-0002-1259-2491)
Abstract: PURPOSE: The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale Diagnostico-Terapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. METHODS: This fourth consensus conference involved: a selected group of experts in the preliminary phase; all members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. RESULTS: A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete as possible on who, when, how and why to act. The protocol is meant to help the surgeon to treat the patient in a topical, rational way that can be shared by health-care professionals, but without influencing in any way the physician-patient relationship, which is based on trust and clinical judgment in each individual case. CONCLUSIONS: The PDTA in thyroid surgery approved by the fourth consensus conference (June 2015) is the official PDTA of U.E.C. CLUB.
Published: 2016

16. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

Author: Rosato, Livia, De Crea, Carmela, Bellantone, Rocco Domenico Alfonso, Brandi, M. L., De Toma, Giorgio, Filetti, S., Miccoli, P., Pacini, F., Pelizzo, M. R., Pontecorvi, Alfredo, Avenia, N., De Pasquale, L., Chiofalo, M. G., Gurrado, A., Innaro, N., La Valle, G., Lombardi, Celestino Pio, Marini, P. L., Mondini, G., Mullineris, B., Pezzullo, L., Raffaelli, Marco, Testini, M., De Palma, M., De Crea, Carmela (ORCID:0000-0002-7303-9657), Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469), Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), Lombardi, Celestino Pio (ORCID:0000-0001-8910-6693), Raffaelli, Marco (ORCID:0000-0002-1259-2491), Rosato, Livia, De Crea, Carmela, Bellantone, Rocco Domenico Alfonso, Brandi, M. L., De Toma, Giorgio, Filetti, S., Miccoli, P., Pacini, F., Pelizzo, M. R., Pontecorvi, Alfredo, Avenia, N., De Pasquale, L., Chiofalo, M. G., Gurrado, A., Innaro, N., La Valle, G., Lombardi, Celestino Pio, Marini, P. L., Mondini, G., Mullineris, B., Pezzullo, L., Raffaelli, Marco, Testini, M., De Palma, M., De Crea, Carmela (ORCID:0000-0002-7303-9657), Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469), Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), Lombardi, Celestino Pio (ORCID:0000-0001-8910-6693), and Raffaelli, Marco (ORCID:0000-0002-1259-2491)
Abstract: Purpose: The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale Diagnostico-Terapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. Methods: This fourth consensus conference involved: a selected group of experts in the preliminary phase; all members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. Results: A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete as possible on who, when, how and why to act. The protocol is meant to help the surgeon to treat the patient in a topical, rational way that can be shared by health-care professionals, but without influencing in any way the physician–patient relationship, which is based on trust and clinical judgment in each individual case. Conclusions: The PDTA in thyroid surgery approved by the fourth consensus conference (June 2015) is the official PDTA of U.E.C. CLUB.
Published: 2015

17. Randomized study comparing use of THUNDERBEAT technology vs standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancer

Author: Fagotti, Anna, Vizzielli, Giuseppe, Fanfani, Francesco, Gallotta, Valerio, Rossitto, Cristiano, Costantini, Barbara, Gueli-Alletti, S., Avenia, N., Iodice, R., Scambia, Giovanni, Fagotti A. (ORCID:0000-0001-5579-335X), Vizzielli G., Fanfani F. (ORCID:0000-0003-1991-7284), Gallotta V., Rossitto C., Costantini B., Scambia G. (ORCID:0000-0003-2758-1063), Fagotti, Anna, Vizzielli, Giuseppe, Fanfani, Francesco, Gallotta, Valerio, Rossitto, Cristiano, Costantini, Barbara, Gueli-Alletti, S., Avenia, N., Iodice, R., Scambia, Giovanni, Fagotti A. (ORCID:0000-0001-5579-335X), Vizzielli G., Fanfani F. (ORCID:0000-0003-1991-7284), Gallotta V., Rossitto C., Costantini B., and Scambia G. (ORCID:0000-0003-2758-1063)
Abstract: Study Objective: To compare operative time with use of THUNDERBEAT (TB) vs standard electrosurgery (SES) during laparoscopic radical hysterectomy and pelvic lymphadenectomy to treat gynecologic tumors. Design: Evidence obtained from a properly designed, randomized, controlled trial (Canadian Task Force classification I). Setting: Gynecologic Oncology Unit of the Catholic University of the Sacred Heart in Rome, Italy. Patients: Fifty patients with early cervical cancer (FIGO stages IA2, IB1, IIA <2 cm) or locally advanced cervical cancer (FIGO stages IB2, IIA >2cm, IIB) who received neoadjuvant treatment (chemotherapy or radiochemotherapy) and demonstrated a complete or partial clinical response and early stage endometrioid endometrial cancer (FIGO stages IB, II) were randomly assigned to undergo TB (arm A) or SES (arm B). Intervention: Laparoscopic radical hysterectomy with bilateral pelvic lymphadenectomy, using an easily reproducible technique was performed. Measurements and Main Results: Fifty patients were available for analysis, with 25 women randomly assigned to TB (arm A) and 25 to SES (arm B). The median operative time was 85 minutes for TB vs 115 minutes for SES (p = .001). At multivariate analysis, endometrial cancer (p = .001) and TB (p = .001) were independently associated with shorter operating time. No differences in perioperative outcomes and postoperative complications were observed between the 2 arms. Patients who underwent TB reported less postoperative pain, both at rest (p = .005) and after the Valsalva maneuver (p = .008), with less additional analgesic therapy other than standard therapy required in patients who underwent SES (p = .02). Conclusion: TB is associated with shorter operative time and less postoperative pain than is the standard technique (SES) in patients with uterine cancer. © 2014 AAGL.
Published: 2014

18. Urologic surgery in gynecologic oncology: a large single-institution experience

Author: Costantini, Barbara, Vizzielli, Giuseppe, Fanfani, Francesco, D'Addessi, Alessandro, Ercoli, Alfredo, Avenia, N, Margariti, Pasquale Alessandro, Gallotta, Valerio, Scambia, Giovanni, Fagotti, Anna, Fanfani, Francesco (ORCID:0000-0003-1991-7284), D'Addessi, Alessandro (ORCID:0000-0002-9155-7319), Margariti, Pasquale Alessandro (ORCID:0000-0002-7811-8565), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Fagotti, Anna (ORCID:0000-0001-5579-335X), Costantini, Barbara, Vizzielli, Giuseppe, Fanfani, Francesco, D'Addessi, Alessandro, Ercoli, Alfredo, Avenia, N, Margariti, Pasquale Alessandro, Gallotta, Valerio, Scambia, Giovanni, Fagotti, Anna, Fanfani, Francesco (ORCID:0000-0003-1991-7284), D'Addessi, Alessandro (ORCID:0000-0002-9155-7319), Margariti, Pasquale Alessandro (ORCID:0000-0002-7811-8565), Scambia, Giovanni (ORCID:0000-0003-2758-1063), and Fagotti, Anna (ORCID:0000-0001-5579-335X)
Abstract: The increasing tendency to a tailored treatment in gynecologic oncology has required the extension of the intervention to other non-gynecological structures, as the urinary district. Moreover the role of the urological surgery in gynecologic oncology is still not completely explored. The objective of the study is to evaluate the occurrence of urological procedures in gynecologic oncology surgery.
Published: 2014

19. Urologic surgery in gynecologic oncology: A large single-institution experience

Author: Costantini, B, Vizzielli, G, Fanfani, Francesco, D'Addessi, A, Ercoli, A, Avenia, N, Margariti, P, Gallotta, V, Fagotti, Anna, Scambia, Giovanni, Fanfani, F (ORCID:0000-0003-1991-7284), Fagotti, A (ORCID:0000-0001-5579-335X), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Costantini, B, Vizzielli, G, Fanfani, Francesco, D'Addessi, A, Ercoli, A, Avenia, N, Margariti, P, Gallotta, V, Fagotti, Anna, Scambia, Giovanni, Fanfani, F (ORCID:0000-0003-1991-7284), Fagotti, A (ORCID:0000-0001-5579-335X), and Scambia, Giovanni (ORCID:0000-0003-2758-1063)
Abstract: OBJECTIVE: The increasing tendency to a tailored treatment in gynecologic oncology has required the extension of the intervention to other non-gynecological structures, as the urinary district. Moreover the role of the urological surgery in gynecologic oncology is still not completely explored. The objective of the study is to evaluate the occurrence of urological procedures in gynecologic oncology surgery. METHODS: Patients admitted to the Division of Gynecologic Oncology, Catholic University of Sacred Hearth, Rome, Italy, between January 2009 and December 2012, were retrospectively analyzed. Clinical charts identified the occurrence of urological procedures in major gynecological surgery. RESULTS: A total of 728 patients were analyzed for the study. A total of 204 urologic procedures were carried out in 83 patients. In all patients, preoperative hydronephrosis appears to be the only statistically significant predisposing factor to urological procedures. At multivariate analysis, stratifying data for different neoplasm, recurrence was the only adjunctive significant variable for ovarian cancer, as well as neo-adjuvant treatment and recurrence for cervical cancer. CONCLUSIONS: This study has identified preoperative factors influencing the needing of urological procedures in different gynecologic neoplasms, allowing a proper planning of surgical treatment, tailored on each patient.
Published: 2014

20. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy?A multicenter study of 19662 patients

Author: Testini, M, Gurrado, A, Avenia, N, Bellantone, Rocco Domenico Alfonso, Biondi, A, Brazzarola, P, Calzolari, F, Cavallaro, G, De Toma, G, Guida, P, Lissidini, G, Loizzi, M, Lombardi, Celestino Pio, Piccinni, G, Portincasa, P, Rosato, L, Sartori, N, Zugni, C, Basile, F., Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469), Lombardi, Celestino Pio (ORCID:0000-0001-8910-6693), Testini, M, Gurrado, A, Avenia, N, Bellantone, Rocco Domenico Alfonso, Biondi, A, Brazzarola, P, Calzolari, F, Cavallaro, G, De Toma, G, Guida, P, Lissidini, G, Loizzi, M, Lombardi, Celestino Pio, Piccinni, G, Portincasa, P, Rosato, L, Sartori, N, Zugni, C, Basile, F., Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469), and Lombardi, Celestino Pio (ORCID:0000-0001-8910-6693)
Abstract: PURPOSE: To compare the outcome in patients with cervical goiters and cervicomediastinal goiters (CMGs) undergoing total thyroidectomy using the cervical or extracervical approach. METHODS: This was a retrospective study conducted at six academic departments of general surgery and one endocrine-surgical unit in Italy. The study population consisted of 19,662 patients undergoing total thyroidectomy between 1999 and 2008, of whom 18,607 had cervical goiter (group A) and 1055 had CMG treated using a cervical approach (group B, n = 986) or manubriotomy (group C, n = 69). The main parameters of interest were symptoms, gender, age, operative time, duration of drain, length of hospital stay, malignancy and outcome. RESULTS: A split-sternal approach was required in 6.5% of cases of CMG. Malignancy was significantly more frequent in group B (22.4%) and group C (36.2%) versus group A (10.4%; both P < .001), and in group C versus group B (P = .009). Overall morbidity was significantly higher in groups B + C (35%), B (34.4%) and C (53.5%) versus group A (23.7%; P < .001). Statistically significant increases for group B + C versus group A were observed for transient hypocalcemia, permanent hypocalcemia, transient recurrent laryngeal nerve (RLN) palsies, permanent RLN palsies, phrenic nerve palsy, seroma/hematoma, and complications classified as other. With the exception of transient bilateral RLN palsy, all of these significant differences between group B + C versus group A were also observed for group B versus group A. CONCLUSIONS: Symptoms, malignancy, overall morbidity, hypoparathyroidism, RLN palsy and hematoma are increased in cases of substernal goiter.
Published: 2011

21. Diagnostic, therapeutic and healthcare management protocols in thyroid surgery. 2nd Consensus Conference (U.E.C. CLUB)

Author: Rosato, L, Miccoli, P, Pinchera, A, Lombardi, G, Romano, M, Avenia, N, Bastagli, A, Bellantone, Rocco Domenico Alfonso, De Palma, M, De Toma, G, Gasparri, G, Lampugnani, R, Marini, Pl, Nasi, Pg, Pellizzo, Mr, Pezzullo, L, Piccoli, M, Testini, M., Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469), Rosato, L, Miccoli, P, Pinchera, A, Lombardi, G, Romano, M, Avenia, N, Bastagli, A, Bellantone, Rocco Domenico Alfonso, De Palma, M, De Toma, G, Gasparri, G, Lampugnani, R, Marini, Pl, Nasi, Pg, Pellizzo, Mr, Pezzullo, L, Piccoli, M, Testini, M., and Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469)
Abstract: AIM: To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club). METHOD: The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field. CONCLUSIONS: The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years.
Published: 2009

22. Analysis of human MDM4 variants in papillary thyroid carcinomas reveals new potential markers of cancer properties

Author: Prodosmo, Andrea, Giglio, Simona, Moretti, S, Mancini, F, Barbi, F, Avenia, N, Di Conza, G, Schünemann, Hj, Pistola, L, Ludovini, V, Sacchi, A, Pontecorvi, Alfredo, Puxeddu, E, Moretti, Fabiola, Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), Prodosmo, Andrea, Giglio, Simona, Moretti, S, Mancini, F, Barbi, F, Avenia, N, Di Conza, G, Schünemann, Hj, Pistola, L, Ludovini, V, Sacchi, A, Pontecorvi, Alfredo, Puxeddu, E, Moretti, Fabiola, and Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865)
Abstract: A wild-type (wt) p53 gene characterizes thyroid tumors, except for the rare anaplastic histotype. Because p53 inactivation is a prerequisite for tumor development, alterations of p53 regulators represent an alternative way to impair p53 function. Indeed, murine double minute 2 (MDM2), the main p53 negative regulator, is overexpressed in many tumor histotypes including those of the thyroid. A new p53 regulator, MDM4 (a.k.a. MDMX or HDMX) an analog of MDM2, represents a new oncogene although its impact on tumor properties remains largely unexplored. We estimated levels of MDM2, MDM4, and its variants, MDM4-S (originally HDMX-S) and MDM4-211 (originally HDMX211), in a group of 57 papillary thyroid carcinomas (PTC), characterized by wt tumor protein 53, in comparison to matched contra-lateral lobe normal tissue. Further, we evaluated the association between expression levels of these genes and the histopathological features of tumors. Quantitative real-time polymerase chain reaction revealed a highly significant downregulation of MDM4 mRNA in tumor tissue compared to control tissue (P<0.0001), a finding confirmed by western blot on a subset of 20 tissue pairs. Moreover, the tumor-to-normal ratio of MDM4 levels for each individual was significantly lower in late tumor stages, suggesting a specific downregulation of MDM4 expression with tumor progression. In comparison, MDM2 messenger RNA (mRNA) and protein levels were frequently upregulated with no correlation with MDM4 levels. Lastly, we frequently detected overexpression of MDM4-S mRNA and presence of the aberrant form, MDM4-211 in this tumor group. These findings indicate that MDM4 alterations are a frequent event in PTC. It is worthy to note that the significant downregulation of full-length MDM4 in PTC reveals a novel status of this factor in human cancer that counsels careful evaluation of its role in human tumorigenesis and of its potential as therapeutic target.
Published: 2008

23. [Diagnostic, therapeutic and healtcare management protocols in thyroid surgery. I consensus conference (UEC club)]

Author: Rosato, L, Pinchera, A, Bellastella, A, De Antoni, E, Martino, E, Miccoli, P, Pontecorvi, Alfredo, Torre, G, Vitti, P, Pelizzo, Mr, Avenia, N, Nasi, Pg, Bellantone, Rocco Domenico Alfonso, Lampugnani, R, De Palma, M, Pezzullo, L, Ardito, Guglielmo, De Toma, G., Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469), Rosato, L, Pinchera, A, Bellastella, A, De Antoni, E, Martino, E, Miccoli, P, Pontecorvi, Alfredo, Torre, G, Vitti, P, Pelizzo, Mr, Avenia, N, Nasi, Pg, Bellantone, Rocco Domenico Alfonso, Lampugnani, R, De Palma, M, Pezzullo, L, Ardito, Guglielmo, De Toma, G., Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), and Bellantone, Rocco Domenico Alfonso (ORCID:0000-0002-0844-3469)
Abstract: The aim of the study was to draw up a management protocol in thyroid surgery promoted by the Italian Association of Endocrine Surgery Units (Club delle UEC), shared by the experts and applied by the operators in the sector. The management protocols already presented in February 2002 and drawn up by the first Author of the present publication on the occasion of the current review were examined by the I Consensus Conference called on the topic by the Italian Endocrine Surgery Units. The conference comprised two distinct sessions, the first on 18 June 2005 within the framework of the 4th National Congress of the Club delle UEC in Naples, and the second on 17 September 2005 within the framework of the 8th Multidisciplinary Scanno Prize Meeting. A selected board of endocrinologists and endocrine surgeons, chaired by Aldo Pinchera and comprising the first nine Authors of this paper, examined the individual chapters in close collaboration with the other Authors, comparing their findings with the opinions of the experts cited in the text and submitting the consensus text for the approval of all those present. The diagnostic, therapeutic and healtcare management protocols in thyroid surgery approved by the I Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (Club delle UEC) and are subject to review by October 1, 2007.
Published: 2006

24. BRAF(V599E) mutation is the leading genetic event in adult sporadic papillary thyroid carcinomas.

Author: Puxeddu, E, Moretti, Fabiola, Elisei, R, Romei, C, Pascucci, R, Martinelli, M, Marino, C, Avenia, N, Rossi, Esther, Fadda, Guido, Cavaliere, A, Ribacchi, R, Falorni, A, Pontecorvi, Alfredo, Pacini, Furio, Pinchera, Aldo, Santeusanio, Fausto, Rossi, Esther (ORCID:0000-0003-3819-4229), Fadda, Guido (ORCID:0000-0003-2013-7293), Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), Puxeddu, E, Moretti, Fabiola, Elisei, R, Romei, C, Pascucci, R, Martinelli, M, Marino, C, Avenia, N, Rossi, Esther, Fadda, Guido, Cavaliere, A, Ribacchi, R, Falorni, A, Pontecorvi, Alfredo, Pacini, Furio, Pinchera, Aldo, Santeusanio, Fausto, Rossi, Esther (ORCID:0000-0003-3819-4229), Fadda, Guido (ORCID:0000-0003-2013-7293), and Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865)
Abstract: Activating mutations of BRAF have been identified in a variety of human cancers, most notably melanomas and papillary thyroid carcinomas (PTCs). The aim of the present study was to disclose the role of BRAF mutations in thyroid carcinoma development. Seventy-two thyroid tumors, including 60 PTCs, six follicular adenomas, five follicular carcinomas, and one anaplastic carcinoma, were studied. BRAF mutation screening focused on exon 15 and exon 11 of the gene by single-stranded conformational polymorphism and sequence analysis. Search of RET/PTC expression was conducted with the RT-PCR technique. The molecular genetic study of the BRAF gene showed the presence of a missense thymine to adenine transversion at nucleotide 1796, resulting in the V599E substitution, in 24 of 60 PTCs (40%), none of six follicular adenomas, and none of five follicular carcinomas or one anaplastic carcinoma. Moreover, nine of 60 PTCs (15%) presented RET/PTC expression. A genetico-clinical association analysis showed a statistically significant correlation between BRAF mutation and development of PTCs of the classic papillary histotype (P = 0.038). On the contrary, no link could be detected between expression of BRAF(V599E) and age at diagnosis, gender, dimension, and local invasiveness of the primary cancer, presence of lymph node metastases, tumor stage, and multifocality of the disease. These data clearly confirm that BRAF(V599E) is the more common genetic alteration found to date in adult sporadic PTCs, that it is unique for this thyroid cancer histotype, and that it might drive the development of PTCs of the classic papillary subtype.
Published: 2004

25. Ret/PTC activation does not influence clinical and pathological features of adult papillary thyroid carcinomas

Author: Puxeddu, E, Moretti, S, Giannico, A, Martinelli, M, Marino, C, Avenia, N, Cristofani, R, Farabi, R, Reboldi, G, Ribacchi, R, Pontecorvi, Alfredo, Santeusanio, F., Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), Puxeddu, E, Moretti, S, Giannico, A, Martinelli, M, Marino, C, Avenia, N, Cristofani, R, Farabi, R, Reboldi, G, Ribacchi, R, Pontecorvi, Alfredo, Santeusanio, F., and Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865)
Abstract: OBJECTIVE: RET proto-oncogene rearrangements (ret/PTCs) represent the most common genetic alterations found in papillary thyroid carcinomas (PTCs). Correlation of ret/PTC expression with clinical outcome is controversial. The aim of the present study was to analyze the frequency of RET rearrangements in adult PTCs, and to investigate if ret/PTCs influence biological behavior and clinical features of the cancers. DESIGN: Ret/PTC rearrangements were looked for in tIssue samples of 48 PTCs collected at our institution. Data about clinical and pathological features of the tumors were also reviewed. Three separate association analyses were carried out on the cohort evaluating the effects of, respectively, ret/PTC positivity, preferential RET tyrosine kinase domain (RET-TK) expression, and ret/PTC plus RET-TK positivity, on age, sex, tumor size, staging, number of neoplastic foci, and histological subtype. METHODS: The genetic study was conducted with the RT-PCR-Southern blot technique. Standard Student's t-test and Fisher exact test were applied for the association analyses. RESULTS: The molecular genetic study demonstrated the positivity of ret/PTC1 and ret/PTC3 in 13 of 48 tumors (27.1%), and an exclusive or preferential RET-TK expression in 17 cases (35.4%). None of the three genetico-clinical analyses showed any significant association between ret/PTC expression and the clinical and pathological features of the cancers. CONCLUSIONS: These data indicate that RET rearrangements may not play any distinctive role in driving histotype development and cancer progression in these neoplasms. Moreover, they weaken the possibility of using ret/PTC as a prognostic marker for papillary thyroid carcinomas.
Published: 2003

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1. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

2. The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly

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11. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

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13. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

14. Complications of Neck Dissections in Papillary Thyroid Carcinoma: A Modified Procedure to Reduce Parathyroid Morbidity

15. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB).

16. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

17. Randomized study comparing use of THUNDERBEAT technology vs standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancer

18. Urologic surgery in gynecologic oncology: a large single-institution experience

19. Urologic surgery in gynecologic oncology: A large single-institution experience

20. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy?A multicenter study of 19662 patients

21. Diagnostic, therapeutic and healthcare management protocols in thyroid surgery. 2nd Consensus Conference (U.E.C. CLUB)

22. Analysis of human MDM4 variants in papillary thyroid carcinomas reveals new potential markers of cancer properties

23. [Diagnostic, therapeutic and healtcare management protocols in thyroid surgery. I consensus conference (UEC club)]

24. BRAF(V599E) mutation is the leading genetic event in adult sporadic papillary thyroid carcinomas.

25. Ret/PTC activation does not influence clinical and pathological features of adult papillary thyroid carcinomas

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