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3. Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Author

Coccolini, F, Mazzoni, A, Cremonini, C, Cobuccio, L, Pucciarelli, M, Vetere, G, Borelli, B, Strambi, S, Musetti, S, Miccoli, M, Cremolini, C, Salvetti, F, Fugazzola, P, Ceresoli, M, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Catena, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Benedetti, F, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Akhmeteli, L, Doklestic, K, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Dimitrov, E, Chowdhury, S, Patel, T, Sartelli, M, Tartaglia, D, Chiarugi, M, Coccolini F., Mazzoni A., Cremonini C., Cobuccio L., Pucciarelli M., Vetere G., Borelli B., Strambi S., Musetti S., Miccoli M., Cremolini C., Salvetti F., Fugazzola P., Ceresoli M., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Catena F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Benedetti F., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Akhmeteli L., Doklestic K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Dimitrov E., Chowdhury S., Patel T., Sartelli M., Tartaglia D., Chiarugi M., Coccolini, F, Mazzoni, A, Cremonini, C, Cobuccio, L, Pucciarelli, M, Vetere, G, Borelli, B, Strambi, S, Musetti, S, Miccoli, M, Cremolini, C, Salvetti, F, Fugazzola, P, Ceresoli, M, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Catena, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Benedetti, F, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Akhmeteli, L, Doklestic, K, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Dimitrov, E, Chowdhury, S, Patel, T, Sartelli, M, Tartaglia, D, Chiarugi, M, Coccolini F., Mazzoni A., Cremonini C., Cobuccio L., Pucciarelli M., Vetere G., Borelli B., Strambi S., Musetti S., Miccoli M., Cremolini C., Salvetti F., Fugazzola P., Ceresoli M., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Catena F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Benedetti F., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Akhmeteli L., Doklestic K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Dimitrov E., Chowdhury S., Patel T., Sartelli M., Tartaglia D., and Chiarugi M.

Abstract

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

Published
2023

4. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Author

Tartaglia, D, Cremonini, C, Annunziata, E, Catena, F, Sartelli, M, Kirkpatrick, A, Musetti, S, Strambi, S, Chiarugi, M, Coccolini, F, Salvetti, F, Fugazzola, P, Ceresoli, M, Benedetti, F, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Dimitrov, E, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Doklestic, L, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Chowdhury, S, Patel, T, Tartaglia D., Cremonini C., Annunziata E., Catena F., Sartelli M., Kirkpatrick A. W., Musetti S., Strambi S., Chiarugi M., Coccolini F., Salvetti F., Fugazzola P., Ceresoli M., Benedetti F., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Dimitrov E., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Doklestic L. A. K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Chowdhury S., Patel T., Tartaglia, D, Cremonini, C, Annunziata, E, Catena, F, Sartelli, M, Kirkpatrick, A, Musetti, S, Strambi, S, Chiarugi, M, Coccolini, F, Salvetti, F, Fugazzola, P, Ceresoli, M, Benedetti, F, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Dimitrov, E, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Doklestic, L, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Chowdhury, S, Patel, T, Tartaglia D., Cremonini C., Annunziata E., Catena F., Sartelli M., Kirkpatrick A. W., Musetti S., Strambi S., Chiarugi M., Coccolini F., Salvetti F., Fugazzola P., Ceresoli M., Benedetti F., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Dimitrov E., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Doklestic L. A. K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Chowdhury S., and Patel T.

Abstract

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

Published
2023

5. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Author

Tartaglia, D., Cremonini, C., Annunziata, E., Catena, F., Sartelli, M., Kirkpatrick, A. W., Musetti, S., Strambi, S., Chiarugi, M., Coccolini, F., Salvetti, F., Fugazzola, P., Ceresoli, M., Benedetti, F., Elisa, N. G., Litvin, A., Lostoridis, E., Ahmed, A. Y. Y. M., Manatakis, D., Negoi, I., Ioannidis, O., Uzunoglu, M. Y., Tochie, J. N., Cillara, N., Tomadze, G., Bala, M., Isik, A., Fonseca, V. C., Bellanova, G., Ghannam, W., Yalkin, O., Garcia, F. H., Altintoprak, F., Hadzhiev, D., Chirica, M., Zese, M., Balalis, D., Cui, Y., Luppi, D., Romeo, L., Muratore, A., Lunghi, E. G., Yovtchev, Y., Dimitrov, E., Nikolopoulos, I., Omerovic, M., Zizzo, M., Ugoletti, L., Costa, G., Scalzone, R., Perrone, S., Occhionorelli, S., Nardi, M., Gubbiotti, F., Muhtaroglu, A., Scaramuzzo, R., Corte, H., Yanez, C., Zakaria, A. D., Seretis, C., Gelmini, R., Pappalardo, V., Paratore, F., Sydorchuk, R., Mulita, F., Kara, Y., Toma, E. A., Vailas, M., Sotiropoulou, M., Elbahnasawy, M., Sibilla, M. G., Martines, G., Goksoy, B., Parini, D., Zaghi, C., Podda, M., Osipov, A., Brisinda, G., Gambino, G., Doklestic, L. A. K., Loncar, Z., Micic, D., Lesevic, I., D'Agostino, F., Garzali, I. U., Caicedo, Y., Marcela, L., Marin, P. A. G., Perivoliotis, K., Ntentas, I., Kuptsov, A., Chowdhury, S., Patel, T., Tartaglia, D, Cremonini, C, Annunziata, E, Catena, F, Sartelli, M, Kirkpatrick, A, Musetti, S, Strambi, S, Chiarugi, M, Coccolini, F, Salvetti, F, Fugazzola, P, Ceresoli, M, Benedetti, F, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Dimitrov, E, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Doklestic, L, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Chowdhury, S, and Patel, T

Subjects
Medical therapy, Acute diverticuliti, Gastroenterology, Acute diverticulitis, Surgery, Immunocompromised
Abstract

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

Published
2023

6. Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Author

Coccolini F., Mazzoni A., Cremonini C., Cobuccio L., Pucciarelli M., Vetere G., Borelli B., Strambi S., Musetti S., Miccoli M., Cremolini C., Salvetti F., Fugazzola P., Ceresoli M., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Catena F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Benedetti F., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Akhmeteli L., Doklestic K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Dimitrov E., Chowdhury S., Patel T., Sartelli M., Tartaglia D., Chiarugi M., Coccolini, F, Mazzoni, A, Cremonini, C, Cobuccio, L, Pucciarelli, M, Vetere, G, Borelli, B, Strambi, S, Musetti, S, Miccoli, M, Cremolini, C, Salvetti, F, Fugazzola, P, Ceresoli, M, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Catena, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Benedetti, F, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Akhmeteli, L, Doklestic, K, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Dimitrov, E, Chowdhury, S, Patel, T, Sartelli, M, Tartaglia, D, and Chiarugi, M

Subjects
Survival, Colon, Emergency, Acute care, Surgery, Morbidity, Mortality, Immunosuppression, Cancer
Abstract

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

Published
2023

7. Restructuring surgical training after COVID-19 pandemic: A nationwide survey on the Italian scenario on behalf of the Italian polyspecialistic young surgeons society (SPIGC)

Author

Gaetano, G., Guaitoli, E., Barra, F., Picciariello, A., Pasculli, A., Coppola, A., Pertile, D., Meniconi, R. L., Berton, F., Conti, L., Formisano, G., Iossa, A., Maruccia, M., Mazzari, Mario Attilio, Oragano, L., Ratti, F., Serenari, M., Settembrini, A., Sirignano, P., Soriero, D., Vallicelli, C., Vizzielli, Giuseppe, Dimonte, R., Cianci, Stefano, Giovenzana, M., Palmieri, G., Pasqui, E., Petrillo, Marco, Portigliotti, L., Sambucci, D., Sena, G., Sparavigna, M., Bettini, G., Fanello, G., Mendogni, P., Monteleone, L., Ardo, N. P., Tomaiuolo, P., Tomasicchio, G., Paradiso, N., Dibra, R., Trigiante, G., Dezi, A., Carbone, Luigi, Negrello, S., Di Bartolomeo, M., Patini, Romeo, Marcuzzo, A. V., Campione, A., Comacchio, G., Murana, G., Antonio, M., Manitto, M., Galzerano, G., Di Marco, Carmine, Velluti, F., Berardi, Giulia, Romboli, A., Perelli, F., Weindelmejer, J., Tamburrino, D., Calarco, Alessandro, Losco, L., Nacchiero, E., Elia, R., Torto, F. L., Vicenti, G., Pappalardo, V., Pisani, D., Palmisano, Gerardo, Brascia, D., Troisi, L., Renzi, F., Melandro, F., Pecere, Silvia, Gazia, C., Di Franco, G., Romano, G., Bolletta, A., Botteri, E., Di Meo, G., Chiappetta, S., Sgaramella, I., Pennestri, F., Girardi, A., Mariniello, D., Marcasciano, M., Telegrafo, M., Fracomeni, S., De Paoli, F., Mazzari A. (ORCID:0000-0002-7301-6834), Vizzielli G., Cianci S., Petrillo M., Carbone L., Patini R. (ORCID:0000-0001-7358-8763), Di Marco C., Berardi G., Calarco A., Palmisano G., Pecere S., Gaetano, G., Guaitoli, E., Barra, F., Picciariello, A., Pasculli, A., Coppola, A., Pertile, D., Meniconi, R. L., Berton, F., Conti, L., Formisano, G., Iossa, A., Maruccia, M., Mazzari, Mario Attilio, Oragano, L., Ratti, F., Serenari, M., Settembrini, A., Sirignano, P., Soriero, D., Vallicelli, C., Vizzielli, Giuseppe, Dimonte, R., Cianci, Stefano, Giovenzana, M., Palmieri, G., Pasqui, E., Petrillo, Marco, Portigliotti, L., Sambucci, D., Sena, G., Sparavigna, M., Bettini, G., Fanello, G., Mendogni, P., Monteleone, L., Ardo, N. P., Tomaiuolo, P., Tomasicchio, G., Paradiso, N., Dibra, R., Trigiante, G., Dezi, A., Carbone, Luigi, Negrello, S., Di Bartolomeo, M., Patini, Romeo, Marcuzzo, A. V., Campione, A., Comacchio, G., Murana, G., Antonio, M., Manitto, M., Galzerano, G., Di Marco, Carmine, Velluti, F., Berardi, Giulia, Romboli, A., Perelli, F., Weindelmejer, J., Tamburrino, D., Calarco, Alessandro, Losco, L., Nacchiero, E., Elia, R., Torto, F. L., Vicenti, G., Pappalardo, V., Pisani, D., Palmisano, Gerardo, Brascia, D., Troisi, L., Renzi, F., Melandro, F., Pecere, Silvia, Gazia, C., Di Franco, G., Romano, G., Bolletta, A., Botteri, E., Di Meo, G., Chiappetta, S., Sgaramella, I., Pennestri, F., Girardi, A., Mariniello, D., Marcasciano, M., Telegrafo, M., Fracomeni, S., De Paoli, F., Mazzari A. (ORCID:0000-0002-7301-6834), Vizzielli G., Cianci S., Petrillo M., Carbone L., Patini R. (ORCID:0000-0001-7358-8763), Di Marco C., Berardi G., Calarco A., Palmisano G., and Pecere S.

Abstract

Introduction: The COVID-19 pandemic has led to the disruption of surgical training. Lack of communication, guidelines for managing clinical activity as well as concerns for safety in the workplace appeared to be relevant issues. This study aims to investigate how surgical training has been reorganized in Italy, almost 2 years after the outbreak of COVID-19 pandemic. Materials and methods: A 16-item-electronic anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of different sections concerning demographic characteristics and impacts of the second COVID-19 pandemic wave on surgical and research/didactic activities. Changes applied in the training programme and activities carried out were also investigated. The survey was carried out in the period between June and October 2021. Results: Four hundred and thirty responses were collected, and 399 were considered eligible to be included in the study analysis. Three hundred and thirty-five respondents continued working in Surgical Units, with a significant reduction (less than one surgical session per week) of surgical sessions in 49.6% of them. With concern to didactic and research activities, 140 residents maintained their usual activity, while 116 reported a reduction. A sub-group analysis on resident moved to COVID-19 departments showed a reduction of research activities in 35% of them. During the period considered in this survey, the surgical training program was not substantially modified for most of participants (74.6%). Conclusion: Our survey demonstrated that surgical residency programs haven't improved 2 years after the beginning of the pandemic. Further improvements are needed to guarantee completeness of surgical training, even in emergency conditions.

Published
2023

9. P-099 PERSISTENT POST-SURGICAL PAIN AFTER SURGICAL CORRECTION OF VENTRAL HERNIA REPAIR. PRELIMINARY DATA OF AN OBSERVATIONAL STUDY AT VARESE UNIVERSITY HOSPITAL

Author

Novazzi, C, primary, Guzzetti, L, additional, Selmo, G, additional, D'onofrio, D F, additional, Latham, L, additional, Gianazza, S, additional, Cannavo', M, additional, Cabrini, L, additional, Pappalardo, V, additional, Bacuzzi, A, additional, Inversini, D, additional, Ietto, G, additional, and Carcano, G, additional

Published
2022
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10. [Evaluation of bone health in transgender people. Position of the Argentine Osteoporosis Society].

Author

Nagelberg A, Abdala R, Larroudé MS, Farías V, Garabito M, Balonga MC, Giacoia E, Karlsbrum S, Pavlove MM, Frigeri A, Buttazzoni M, Costanzo P, Suarez S, De Benito A, Pappalardo V, Drnovsek M, San Martin P, Calvar C, and Helien A

Subjects
Humans, Bone Density, Gender Identity, Transgender Persons, Osteoporosis diagnosis
Abstract

The Argentine Osteoporosis Society convened renowned specialists in the care of transgender people to prepare the first local position on the evaluation of bone health in this population. Law 26.743 on "Gender Identity" recognize all identities and guarantees free care throughout the health system. The impact of different gender affirmation treatments on bone mass has been topic of international debate. To date the evidence remains limited and different societies have issued suggestions and recommendations. For this reason, we believe it is relevant to mention our experience, capturing through this document a series of suggestions to be used in medical care.

Published
2024

11. Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD.

Author

Zanchetta M, Inversini D, Pappalardo V, Grappolini N, Morabito M, Gianazza S, Carcano G, and Ietto G

Abstract

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.

Published
2023
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12. Laparoscopic vs Open Treatment for Gastric and Non-Gastric Gastrointestinal Stromal Tumors: a Two-Center Experience.

Author

Pappalardo V, Lianos GD, Morabito M, Gianazza S, Cassinotti E, Frattini F, Pino A, Rausei S, and Carcano G

Subjects
Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Treatment Outcome, Adult, Stomach Neoplasms surgery, Aged, 80 and over, Gastrointestinal Neoplasms surgery, Gastrointestinal Neoplasms mortality, Gastrointestinal Stromal Tumors surgery, Laparoscopy methods
Abstract

We retrospectively reviewed the medical records of 109 patients who underwent curative laparoscopic or open resection for different types of gastrointestinal stromal tumors (GIST). Only primary GIST patients who did not receive preoperative chemotherapy or oral imatinib treatment were included in the analysis. We divided the patients into 2 groups according to the surgical approach:a laparoscopic group (LAP) and a laparotomic group (OPEN). Our aim was to confirm the feasibility and safety of laparoscopic surgery for GISTs that differed in size and location, and to assess its long-term oncologic outcome in terms of overall survival (OS) and disease-free survival (DFS). Furthermore, we performed a surgical short-term outcome analysis. The two groups did not differ with respect to age at operation, gender, BMI or comorbidities. Even the NIH and AFIP risk classifications were not significantly different between the two groups. Furthermore, in our analysis, there was no significant difference in mean tumor size or location between the two groups. Wedge resection was the most frequently performed procedure. The conversion rate was 7.8%. The operative time was 194.75 (60- 350) min for the open group and 181.70 (57-480) min for the laparoscopic group. Our data clearly indicated that the long-term oncologic outcome and DFS of laparoscopic resection were not inferior to those of traditional open operations and laparoscopic resection was still feasible in cases with large tumors: the median size of the tumor was 4.5 cm (3-25) and the tumor was larger than 4.5 cm in 47.7% of the cases in the LAP group. With regard to short-term outcomes, our study demonstrated that the LAP group had fewer complications, faster gastrointestinal recovery, reduced use of analgesic drugs and shorter postoperative hospital stay (each p<0.05). In conclusion, our experience confirms that GISTs are very uncommon cancers for which the prognosis is closely related to size, localization and class of risk. In light of our clinical data, laparoscopic resection for gastric and non-gastric GISTs is a safe, feasible and oncologically correct procedure. The most important advantage of this technique is that it ensures a better postoperative outcome compared with open surgery, without worsening the prognosis.

Published
2023
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13. Microbial Indicators of Dental Health, Dysbiosis, and Early Childhood Caries.

Author

Kahharova D, Pappalardo VY, Buijs MJ, de Menezes RX, Peters M, Jackson R, Hara AT, Eckert G, Katz B, Keels MA, Levy SM, Zaura E, Brandt BW, and Fontana M

Subjects
Child, Humans, Child, Preschool, Dysbiosis, Saliva, RNA, Ribosomal, 16S genetics, Dental Caries, Dental Plaque, Microbiota genetics
Abstract

Dental caries lesions are a clinical manifestation of disease, preceded by microbial dysbiosis, which is poorly characterized and thought to be associated with saccharolytic taxa. Here, we assessed the associations between the oral microbiome of children and various caries risk factors such as demographics and behavioral and clinical data across early childhood and characterized over time the salivary and dental plaque microbiome of children before clinical diagnosis of caries lesions. Children ( N = 266) were examined clinically at ~1, 2.5, 4, and 6.5 y of age. The microbiome samples were collected at 1, 2.5, and 4 y. Caries groups consisted of children who remained caries free (International Caries Detection and Assessment System [ICDAS] = 0) at all time points (CFAT) ( n = 50); children diagnosed with caries (ICDAS ≥ 1) at 6.5 y (C6.5), 4 y (C4), or 2.5 y of age (C2.5); and children with early caries or advanced caries lesions at specific time points. Microbial community analyses were performed on zero-radius operational taxonomic units (zOTUs) obtained from V4 of 16S ribosomal RNA gene amplicon sequences. The oral microbiome of the children was affected by various factors, including antibiotic use, demographics, and dietary habits of the children and their caregivers. At all time points, various risk factors explained more of the variation in the dental plaque microbiome than in saliva. At 1 y, composition of saliva of the C4 group differed from that of the CFAT group, while at 2.5 y, this difference was observed only in plaque. At 4 y, multiple salivary and plaque zOTUs of genera Prevotella and Leptotrichia were significantly higher in samples of the C6.5 group than those of the CFAT group. In conclusion, up to 3 y prior to clinical caries detection, the oral microbial communities were already in a state of dysbiosis that was dominated by proteolytic taxa. Plaque discriminated dysbiotic oral ecosystems from healthy ones better than saliva.

Published
2023
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14. The role of laparoscopic distal gastrectomy in elderly patients.

Author

Pappalardo V, Galli F, and Rausei S

Subjects
Humans, Aged, Treatment Outcome, Gastrectomy adverse effects, Gastrectomy methods, Lymph Node Excision methods, Laparoscopy methods, Stomach Neoplasms
Abstract

Introduction: The aim of this study was to search in the recent literature for scientific evidence about the role of laparoscopic distal gastrectomy (LDG) in the treatment of gastric cancer (GC) in elderly patients., Evidence Acquisition: An analysis of the literature of the last twenty years (from 2001 to 2021) was then carried out., Evidence Synthesis: It showed how the characteristics of the general population, which is aging, and of patients undergoing surgery for GC, also increasingly elderly and, therefore, more fragile, have changed., Conclusions: We have traced the evolution of minimally invasive treatment, with specific regard to LDG, highlighting how this method is not only able to allow an oncologically correct treatment similar to the traditional technique, but, above all, offers short-term advantages especially in elderly patients.

Published
2023
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16. A Green Lipophilization Reaction of a Natural Antioxidant.

Author

Pappalardo V, Ravasio N, Falletta E, De Rosa MC, and Zaccheria F

Abstract

A natural antioxidant, widely spread in plants, chlorogenic acid (CGA), can be lipophilized through a heterogeneous, non-enzymatic, catalytic process. Thus, sulfonic resins under no solvent conditions allow to obtain a series of esters in up to 93% yield through reaction of CGA with fatty alcohols of different chain length. The reaction takes place in one single step under mild conditions with conversions up to 96% and selectivity up to 99%. Product recovery in high purity was very easy and the esters obtained were fully characterized with spectroscopic techniques and through the DPPH test to verify the preservation of antioxidant activity. According to this test, all of them showed increased activity with respect to the parent acid and anyway higher than butylated hydroxyanisole. An in-silico method also suggested their very low toxicity. The increased lipophilicity of the esters allows their formulation in cosmetic and nutraceutic lipid-based products.

Published
2023
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17. Fishery waste valorization: Sulfated ZrO 2 as a heterogeneous catalyst for chitin and chitosan depolymerization.

Author

Pappalardo V, Remadi Y, Cipolla L, Scotti N, Ravasio N, and Zaccheria F

Abstract

Chitin and chitosan are abundant unique sources of biologically-fixed nitrogen mainly derived from residues of the fishery productive chain. Their high potential as nitrogen-based highly added-value platform molecules is still largely unexploited and a catalytic way for their valorization would be strongly desirable within a biorefinery concept. Here we report our results obtained with a series of heterogeneous catalysts in the depolymerization of chitosan and chitin to acetylglucosamine. Copper catalysts supported on SiO 2 , SiO 2 -Al 2 O 3 , SiO 2 -ZrO 2 , ZrO 2 and the corresponding bare oxides/mixed oxides were tested, together with a sulfated zirconia system (ZrO 2 -SO 3 H) that revealed to be extremely selective towards glucosamine, both for chitosan and chitin, thus giving pretty high yields with respect to the values reported so far (44% and 21%, respectively). The use of a heterogeneous catalyst alone, without the need of any additives or the combination with a mineral acid, makes these results remarkable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pappalardo, Remadi, Cipolla, Scotti, Ravasio and Zaccheria.)

Published
2022
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