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1. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author

Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., and De Peppo V.

Abstract

Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods: This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results: 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p<0.001). Conclusion: Curative approaches may guarantee long-term survival in case of recurrence.

Published
2021

2. The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Author

Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, Conticchio, M, Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D. P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., Grazi G. L., Valle R. D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M. G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., Conticchio M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, Conticchio, M, Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D. P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., Grazi G. L., Valle R. D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M. G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., and Conticchio M.

Abstract

Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41–71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921–1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295–0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.

Published
2021

3. The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Author

Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D'Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., Troci, A., Delvecchio, A., Floridi, A., Bernasconi, D. P., Fumagalli, L., Chiarelli, M., Memeo, R., Crespi, M., Zanus, G., Zimmitti, G., Antonucci, A., Zago, M., Frena, A., Griseri, G., Tarchi, P., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Grazi, G. L., Valle, R. D., Giuliante, F., Aldrighetti, L., Romano, F., Torzilli, G., Costa, G., Ciulli, C., Giani, A., Ratti, F., Bellobono, M., Cremaschi, E., Valsecchi, M. G., De Peppo, V., Calabrese, F., Desario, G., Lazzari, G., Cucchetti, A., Cosola, D., Percivale, A., Ciola, M., Montuori, M., Frassani, S., Manzoni, A., Salvador, L., Pennacchi, L., Corleone, P., Conticchio, M., Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D'Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., Troci, A., Delvecchio, A., Floridi, A., Bernasconi, D. P., Fumagalli, L., Chiarelli, M., Memeo, R., Crespi, M., Zanus, G., Zimmitti, G., Antonucci, A., Zago, M., Frena, A., Griseri, G., Tarchi, P., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Grazi, G. L., Valle, R. D., Giuliante, F., Aldrighetti, L., Romano, F., Torzilli, G., Costa, G., Ciulli, C., Giani, A., Ratti, F., Bellobono, M., Cremaschi, E., Valsecchi, M. G., De Peppo, V., Calabrese, F., Desario, G., Lazzari, G., Cucchetti, A., Cosola, D., Percivale, A., Ciola, M., Montuori, M., Frassani, S., Manzoni, A., Salvador, L., Pennacchi, L., Corleone, P., Conticchio, M., Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D.P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G.L., Ruzzenente A., Jovine E., Maestri M., Grazi G.L., Valle R.D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M.G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., Conticchio M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, and Conticchio, M

Subjects
Laparoscopic surgery, medicine.medical_specialty, endocrine system, Carcinoma, Hepatocellular, Disease-free survival, Hepatocellular carcinoma, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, 030230 surgery, NO, Liver surgery, Overall survival, Postoperative ascites, Postoperative complications, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Ascites, Risk of mortality, Medicine, Hepatectomy, Humans, Survival analysis, LS7_4, Retrospective Studies, business.industry, Proportional hazards model, Carcinoma, Liver Neoplasms, Gastroenterology, Hepatocellular, medicine.disease, Surgery, Postoperative complication, Postoperative ascite, Neoplasm Recurrence, Local, 030220 oncology & carcinogenesis, Ascite, medicine.symptom, Neoplasm Recurrence, Local, business, Complication, Varices, Human
Abstract

Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41–71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921–1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295–0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.

Published
2021

4. Recent Innovations & Daily Problems

Author

Tsai, Y., Ross, N., Niebuhr, H., Sailer, M., Köckerling, F., Sun, L., Shen, Y. M., Chen, J., Liu, S. J., Chen, F. Q., Yang, G. Y., Berney, C., Malouf, P., Suarez, D., Tavera, J. L., Ocadiz, J., Chen, T., Wang, J., Mancini, R., Pattaro, G., Ceci, F., Spaziani, E., Bansa, B., Lal, P., Sharma, R., Pradhan, G., Chander, J., Ramteke, V. K., Wijerathne, S., Agarwal, N., Liem, D., Lomanto, D., Warren, J., Cobb, W., Ewing, J., Carbonell, A., Guillaume, O., Holl, E., Park, J., Monforte, X., Redl, H., Petter-Puchner, A., Gruber-Blum, S., Teuschl, A., Yoshihara, E., Pottel, H., D’Hondt, M., Jadhav, P., Nagahama, T., Ando, M., Ami, K., Amagasa, H., Ganno, H., Arai, K., Kitamura, M., El-Hayek, K., Yoo, J., Phillips, M., Pauli, E., Bittner, J., Kroh, M., Garcia, D., Furtado, T., Alberti, L., Neto, C., Hubner, P., Alves, A., Oliveira, C., Vianna, J., Campolina, C., Dumanian, G., Dumanian, Z., Tulaimat, A., Chen, S., Liu, L. J., Guttadauro, A., Frassani, S., Macchini, D., Bertolini, A., Maternini, M., Gabrielli, F., Subramanian, V., Venditti, D., De Majo, A., Sena, G., Lisi, G., De Sanctis, F., Petrella, G., Porwal, A., Jadhav, M., Stein, M., Kaveggia, L., Clift, J., Noda, W., Niebuhr, H., Ross, N., Niebuhr, H., Ross, N., Niebuhr, H., Ross, N., Niebuhr, H., Ross, N., and Niebuhr, H.

Published
2015
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5. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

Author

Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Carissimi, F, Perri, P, Iaria, M, Dominioni, T, Zanello, M, Conci, S, Molfino, S, Labarba, G, Ferrari, C, Germani, P, Patauner, S, Pinotti, E, Lodo, E, Garatti, M, Sciannamea, I, Troci, A, Conticchio, M, Floridi, A, Chiarelli, M, Fumagalli, L, Memeo, R, Crespi, M, Antonucci, A, Zimmitti, G, Zanus, G, Zago, M, Frena, A, Tarchi, P, Griseri, G, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, Ciulli, C, Giani, A, Costa, G, Ratti, F, Bellobono, M, Calabrese, F, Cremaschi, E, De Peppo, V, Cucchetti, A, Lazzari, G, Percivale, A, Ciola, M, Sega, V, Frassani, S, Del Vecchio, A, Pennacchi, L, Corleone, P, Cosola, D, Salvador, L, Montuori, M, Famularo S., Donadon M., Cipriani F., Ardito F., Carissimi F., Perri P., Iaria M., Dominioni T., Zanello M., Conci S., Molfino S., LaBarba G., Ferrari C., Germani P., Patauner S., Pinotti E., Lodo E., Garatti M., Sciannamea I., Troci A., Conticchio M., Floridi A., Chiarelli M., Fumagalli L., Memeo R., Crespi M., Antonucci A., Zimmitti G., Zanus G., Zago M., Frena A., Tarchi P., Griseri G., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., DallaValle R., Grazi G. L., Giuliante F., Aldrighetti L., Torzilli G., Romano F., Bernasconi D. P., Ciulli C., Giani A., Costa G., Ratti F., Bellobono M., Calabrese F., Cremaschi E., De Peppo V., Cucchetti A., Lazzari G., Percivale A., Ciola M., Sega V., Frassani S., Del Vecchio A., Pennacchi L., Corleone P., Cosola D., Salvador L., Montuori M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Carissimi, F, Perri, P, Iaria, M, Dominioni, T, Zanello, M, Conci, S, Molfino, S, Labarba, G, Ferrari, C, Germani, P, Patauner, S, Pinotti, E, Lodo, E, Garatti, M, Sciannamea, I, Troci, A, Conticchio, M, Floridi, A, Chiarelli, M, Fumagalli, L, Memeo, R, Crespi, M, Antonucci, A, Zimmitti, G, Zanus, G, Zago, M, Frena, A, Tarchi, P, Griseri, G, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, Ciulli, C, Giani, A, Costa, G, Ratti, F, Bellobono, M, Calabrese, F, Cremaschi, E, De Peppo, V, Cucchetti, A, Lazzari, G, Percivale, A, Ciola, M, Sega, V, Frassani, S, Del Vecchio, A, Pennacchi, L, Corleone, P, Cosola, D, Salvador, L, Montuori, M, Famularo S., Donadon M., Cipriani F., Ardito F., Carissimi F., Perri P., Iaria M., Dominioni T., Zanello M., Conci S., Molfino S., LaBarba G., Ferrari C., Germani P., Patauner S., Pinotti E., Lodo E., Garatti M., Sciannamea I., Troci A., Conticchio M., Floridi A., Chiarelli M., Fumagalli L., Memeo R., Crespi M., Antonucci A., Zimmitti G., Zanus G., Zago M., Frena A., Tarchi P., Griseri G., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., DallaValle R., Grazi G. L., Giuliante F., Aldrighetti L., Torzilli G., Romano F., Bernasconi D. P., Ciulli C., Giani A., Costa G., Ratti F., Bellobono M., Calabrese F., Cremaschi E., De Peppo V., Cucchetti A., Lazzari G., Percivale A., Ciola M., Sega V., Frassani S., Del Vecchio A., Pennacchi L., Corleone P., Cosola D., Salvador L., and Montuori M.

Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020

6. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

Author

Famularo, S., Donadon, M., Cipriani, Fabrizio, Ardito, Francesco, Carissimi, F., Perri, Pierluigi, Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, Anna Maria, Zimmitti, Giuseppe, Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, Marta, Dallavalle, R., Grazi, G. L., Giuliante, Felice, Aldrighetti, L., Torzilli, Guido, Romano, Federica, Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, Giovanni, Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, Arianna, Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., Montuori, M., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Ardito, Francesco, Carissimi, Francesca, Perri, Pasquale, Iaria, Maurizio, Dominioni, Tommaso, Zanello, Matteo, Conci, Simone, Molfino, Sarah, LaBarba, Giuliano, Ferrari, Cecilia, Germani, Paola, Patauner, Stefan, Pinotti, Enrico, Lodo, Enrico, Garatti, Marco, Sciannamea, Ivano, Troci, Albert, Conticchio, Maria, Floridi, Antonio, Chiarelli, Marco, Fumagalli, Luca, Memeo, Riccardo, Crespi, Michele, Antonucci, Adelmo, Zimmitti, Giuseppe, Zanus, Giacomo, Zago, Mauro, Frena, Antonio, Tarchi, Paola, Griseri, Guido, Ercolani, Giorgio, Baiocchi, Gian Luca, Ruzzenente, Andrea, Jovine, Elio, Maestri, Marcello, DallaValle, Raffaele, Grazi, Gian Luca, Giuliante, Felice, Aldrighetti, Luca, Torzilli, Guido, Romano, Fabrizio, Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Carissimi, F., Perri, P., Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, A., Zimmitti, G., Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Dallavalle, R., Grazi, G. L., Giuliante, F., Aldrighetti, L., Torzilli, G., Romano, F., Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, G., Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, A., Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., and Montuori, M.

Subjects
Male, Cirrhosis, Outcome Assessment, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Datasets as Topic, HERCOLES, Hepatocarcinoma recurrence, Liver surgery, Redo surgery, Outcome Assessment, Health Care, Ascites, Registries, Laparoscopy, education.field_of_study, medicine.diagnostic_test, Liver Neoplasms, Middle Aged, Italy, Local, Radiological weapon, Female, medicine.symptom, Reoperation, medicine.medical_specialty, Carcinoma, Hepatocellular, Population, NO, Internal medicine, medicine, Hepatectomy, Humans, education, LS7_4, Aged, business.industry, Carcinoma, Hepatocellular, Perioperative, Hepatology, medicine.disease, Surgery, Health Care, Neoplasm Recurrence, Neoplasm Recurrence, Local, business
Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power. Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020

7. Desmoid tumor of the abdominal wall A case report and literature review

Author

Guttadauro, A, Maternini, M, Frassani, S, Guanziroli, E, Lo Bianco, G, Gabrielli, F, Guttadauro, A, Maternini, M, Frassani, S, Guanziroli, E, Lo Bianco, G, and Gabrielli, F

Subjects
Adult, Fibromatosis, Aggressive, Estrogen Receptor Modulators, Abdominal Neoplasms, Aggressive fibromatos Desmoid tumor, Soft tissue neoplasia, Abdominal Wall, Anti-Inflammatory Agents, Non-Steroidal, Disease Management, Humans, Antineoplastic Agents, Female, Radiotherapy, Adjuvant
Abstract

INTRODUZIONE: Il tumore desmoide è una rara neoplasia dei tessuti molli caratterizzata da tendenza all’invasività locale, da un elevato rischio di recidiva locale dopo asportazione. Colpisce maggiormente il sesso femminile, soprattutto in età fertile.CASE REPORT: Donna caucasica di 31 anni, unipara, con una tumefazione al terzo medio del muscolo retto sinistro dell’addome non dolente, insorta da circa un mese. Un’ecografia e una RMN dell’addome pongono il sospetto di un tumore desmoide della parete addominale. Si pone indicazione al trattamento chirurgico di enucleazione della lesione e ricostruzione dei piani muscolari senza ausilio di reti protesiche. Il follow-up eseguito a 1 anno non ha evidenziato alcuna recidiva.CONCLUSIONI: La mancata raccolta dei dati e la mancanza di un registro che differenzi tumori desmoidi localizzati in sedi diverse e l’accorpamento di lesioni primitive e secondarie presente in letteratura non hanno standardizzato un corretto iter terapeutico. Sicuramente di fronte a desmoidi della parete addominale il trattamento chirurgico può essere ritenuto il trattamento di scelta. Il prossimo futuro sviluppo di terapie geniche potrà contribuire a migliorare il trattamento e la prognosi dei pazienti. BACKGROUND: Desmoid tumor is a rare soft tissues neoplasia characterized by local invasiveness and by a tendency towards local recurrence although not towards metastasization.DISCUSSION: Etiology is not clear. Desmoid tumors originate from the monoclonal proliferation of one mesenchymal cell and develop in the context of fascial, muscular and aponeurotic tissue. They are free of capsule and do not usually metastatize, although they do present a high risk of local recurrence CONCLUSION: In the absence of a systematic data collection and of a clear distinction, in the existing databases, between primitive and recurrent lesions and between lesions of different sites, there are no standard guidelines for a correct management of desmoids.KEY WORDS: Aggressive fibromatos Desmoid tumor, Soft tissue neoplasia.

Published
2018

8. “All-in-one mesh” hernioplasty: A new procedure for primary inguinal hernia open repair

Author

Guttadauro, A, Maternini, M, Frassani, S, De Simone, M, Chiarelli, M, Macchini, D, Pecora, N, Bertolini, A, Cioffi, U, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, MACCHINI, DANIELE, PECORA, NICOLETTA, GABRIELLI, FRANCESCO, Guttadauro, A, Maternini, M, Frassani, S, De Simone, M, Chiarelli, M, Macchini, D, Pecora, N, Bertolini, A, Cioffi, U, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, MACCHINI, DANIELE, PECORA, NICOLETTA, and GABRIELLI, FRANCESCO

Abstract

Background: We propose a new open mesh hernia repair procedure for the treatment of inguinal hernias in adults aiming to improve patients’ comfort and to reduce the incidence of chronic neuralgia. Methods: From September 2012 to August 2015, 250 consecutive patients were treated with “all in-one” mesh hernioplasty procedure in our Institution. According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasteric sheath avoiding contact with neural structures. Follow-up was carried out at 3, 6, 12, 18 and 24 months for evaluation of postoperative pain using Visual Analogue Scale score, need of medication, patients’ comfort and short or long-term complications. Results: All patients were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and 47.6% of them did not require pain medication at home. After the 1st postoperative week 96.8% reported no pain and no other symptoms. No relevant limitation of normal activities was reported. There has been no postoperative neuralgia. One recurrence was observed. Conclusions: This new hernioplasty technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgia with maximum comfort for the patients.

Published
2018

10. Recent Innovations & Daily Problems. A new prosthesis in inguinal hernia repair:preliminary results of a pilot study

Author

Tsai, Y, Ross, N, Niebuhr, H, Sailer, M, Köckerling, F, Sun, L, Shen, Y, Chen, J, Liu, S, Chen, F, Yang, G, Berney, C, Malouf, P, Suarez, D, Tavera, J, Ocadiz, J, Chen, T, Wang, J, Mancini, R, Pattaro, G, Ceci, F, Spaziani, E, Bansa, B, Lal, P, Sharma, R, Pradhan, G, Chander, J, Ramteke, V, Wijerathne, S, Agarwal, N, Liem, D, Lomanto, D, Warren, J, Cobb, W, Ewing, J, Carbonell, A, Guillaume, O, Holl, E, Park, J, Monforte, X, Redl, H, Petter Puchner, A, Gruber Blum, S, Teuschl, A, Yoshihara, E, Pottel, H, D'Hondt, M, Jadhav, P, Nagahama, T, Ando, M, Ami, K, Amagasa, H, Ganno, H, Arai, K, Kitamura, M, El Hayek, K, Yoo, J, Phillips, M, Pauli, E, Bittner, J, Kroh, M, Garcia, D, Furtado, T, Alberti, L, Neto, C, Hubner, P, Alves, A, Oliveira, C, Vianna, J, Campolina, C, Dumanian, G, Dumanian, Z, Tulaimat, A, Chen, S, Liu, L, Guttadauro, A, Frassani, S, Macchini, D, Bertolini, A, Maternini, M, Gabrielli, F, Subramanian, V, Venditti, D, De Majo, A, Sena, G, Lisi, G, De Sanctis, F, Petrella, G, Porwal, A, Jadhav, M, Stein, M, Kaveggia, L, Clift, J, and Noda, W

Subjects
Settore MED/18 - Chirurgia Generale
Published
2015

11. What is this very big skin lesion?

Author

Guttadauro, A, Frassani, S, Maternini, M, Rubino, B, Guanziroli, E, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, GABRIELLI, FRANCESCO, Guttadauro, A, Frassani, S, Maternini, M, Rubino, B, Guanziroli, E, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, and GABRIELLI, FRANCESCO

Abstract

This clinical image shows the importance of the early diagnosis and treatment of any suspicious skin lesion

Published
2017

12. Desmoid tumor of the abdominal wall A case report and literature review

Author

Guttadauro, A, Maternini, M, Frassani, S, Guanziroli, E, Lo Bianco, G, Gabrielli, F, Guttadauro, A, Maternini, M, Frassani, S, Guanziroli, E, Lo Bianco, G, and Gabrielli, F

Abstract

INTRODUZIONE: Il tumore desmoide è una rara neoplasia dei tessuti molli caratterizzata da tendenza all’invasività locale, da un elevato rischio di recidiva locale dopo asportazione. Colpisce maggiormente il sesso femminile, soprattutto in età fertile.CASE REPORT: Donna caucasica di 31 anni, unipara, con una tumefazione al terzo medio del muscolo retto sinistro dell’addome non dolente, insorta da circa un mese. Un’ecografia e una RMN dell’addome pongono il sospetto di un tumore desmoide della parete addominale. Si pone indicazione al trattamento chirurgico di enucleazione della lesione e ricostruzione dei piani muscolari senza ausilio di reti protesiche. Il follow-up eseguito a 1 anno non ha evidenziato alcuna recidiva.CONCLUSIONI: La mancata raccolta dei dati e la mancanza di un registro che differenzi tumori desmoidi localizzati in sedi diverse e l’accorpamento di lesioni primitive e secondarie presente in letteratura non hanno standardizzato un corretto iter terapeutico. Sicuramente di fronte a desmoidi della parete addominale il trattamento chirurgico può essere ritenuto il trattamento di scelta. Il prossimo futuro sviluppo di terapie geniche potrà contribuire a migliorare il trattamento e la prognosi dei pazienti., BACKGROUND: Desmoid tumor is a rare soft tissues neoplasia characterized by local invasiveness and by a tendency towards local recurrence although not towards metastasization.DISCUSSION: Etiology is not clear. Desmoid tumors originate from the monoclonal proliferation of one mesenchymal cell and develop in the context of fascial, muscular and aponeurotic tissue. They are free of capsule and do not usually metastatize, although they do present a high risk of local recurrence CONCLUSION: In the absence of a systematic data collection and of a clear distinction, in the existing databases, between primitive and recurrent lesions and between lesions of different sites, there are no standard guidelines for a correct management of desmoids.KEY WORDS: Aggressive fibromatos Desmoid tumor, Soft tissue neoplasia.

Published
2017

13. Pneumoretroperitoneum and pneumomediastinum after stapled anopexy Is conservative treatment possible?

Author

Macchini, D, Guttadauro, A, Frassani, S, Maternini, M, Gabrielli, F, MACCHINI, DANIELE, GUTTADAURO, ANGELO, FRASSANI, SILVIA, GABRIELLI, FRANCESCO, Macchini, D, Guttadauro, A, Frassani, S, Maternini, M, Gabrielli, F, MACCHINI, DANIELE, GUTTADAURO, ANGELO, FRASSANI, SILVIA, and GABRIELLI, FRANCESCO

Abstract

INTRODUCTION: Stapled anopexy is considered the gold standard in treating haemorroidal disease associated to mucosal prolapse, but severe complications have been described. Among these, a minimal anastomotic leakage may lead to gas spreading into surrounding soft tissues. CASE REPORT: We report the case of a 61 year old male who developed pneumoretroperitoneum and pneumomediastinun two days after a Stapled Anopexy. CT scans showed a minimal leakage with no abscess. The patient was successfully treated by bowel rest, antibiotics and total parenteral nutrition, avoiding surgical approach. CONCLUSION: A minimal anastomotic leakage following Stapled Anopexy, when leading to air diffusion into soft tissues and not associated to abscess or peritonitis may be treated conservatively avoiding ileostomy or colostomy.

Published
2016

14. Big anal skin tags? What is this?

Author

Guttadauro, A, Frassani, S, Maternini, M, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, GABRIELLI, FRANCESCO, Guttadauro, A, Frassani, S, Maternini, M, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, and GABRIELLI, FRANCESCO

Abstract

A hard and bleeding anal and perianal mass stenotized the anus and required left-sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass.

Published
2015

15. Recent Innovations & Daily Problems

Author

Tsai, Y, Ross, N, Niebuhr, H, Sailer, M, Köckerling, F, Sun, L, Shen, Y, Chen, J, Liu, S, Chen, F, Yang, G, Berney, C, Malouf, P, Suarez, D, Tavera, J, Ocadiz, J, Chen, T, Wang, J, Mancini, R, Pattaro, G, Ceci, F, Spaziani, E, Bansa, B, Lal, P, Sharma, R, Pradhan, G, Chander, J, Ramteke, V, Wijerathne, S, Agarwal, N, Liem, D, Lomanto, D, Warren, J, Cobb, W, Ewing, J, Carbonell, A, Guillaume, O, Holl, E, Park, J, Monforte, X, Redl, H, Petter Puchner, A, Gruber Blum, S, Teuschl, A, Yoshihara, E, Pottel, H, D'Hondt, M, Jadhav, P, Nagahama, T, Ando, M, Ami, K, Amagasa, H, Ganno, H, Arai, K, Kitamura, M, El Hayek, K, Yoo, J, Phillips, M, Pauli, E, Bittner, J, Kroh, M, Garcia, D, Furtado, T, Alberti, L, Neto, C, Hubner, P, Alves, A, Oliveira, C, Vianna, J, Campolina, C, Dumanian, G, Dumanian, Z, Tulaimat, A, Chen, S, Liu, L, Guttadauro, A, Frassani, S, Macchini, D, Bertolini, A, Maternini, M, Gabrielli, F, Subramanian, V, Venditti, D, De Majo, A, Sena, G, Lisi, G, De Sanctis, F, Petrella, G, Porwal, A, Jadhav, M, Stein, M, Kaveggia, L, Clift, J, Noda, W, Niebuhr, H., GUTTADAURO, ANGELO, FRASSANI, SILVIA, MACCHINI, DANIELE, GABRIELLI, FRANCESCO, Tsai, Y, Ross, N, Niebuhr, H, Sailer, M, Köckerling, F, Sun, L, Shen, Y, Chen, J, Liu, S, Chen, F, Yang, G, Berney, C, Malouf, P, Suarez, D, Tavera, J, Ocadiz, J, Chen, T, Wang, J, Mancini, R, Pattaro, G, Ceci, F, Spaziani, E, Bansa, B, Lal, P, Sharma, R, Pradhan, G, Chander, J, Ramteke, V, Wijerathne, S, Agarwal, N, Liem, D, Lomanto, D, Warren, J, Cobb, W, Ewing, J, Carbonell, A, Guillaume, O, Holl, E, Park, J, Monforte, X, Redl, H, Petter Puchner, A, Gruber Blum, S, Teuschl, A, Yoshihara, E, Pottel, H, D'Hondt, M, Jadhav, P, Nagahama, T, Ando, M, Ami, K, Amagasa, H, Ganno, H, Arai, K, Kitamura, M, El Hayek, K, Yoo, J, Phillips, M, Pauli, E, Bittner, J, Kroh, M, Garcia, D, Furtado, T, Alberti, L, Neto, C, Hubner, P, Alves, A, Oliveira, C, Vianna, J, Campolina, C, Dumanian, G, Dumanian, Z, Tulaimat, A, Chen, S, Liu, L, Guttadauro, A, Frassani, S, Macchini, D, Bertolini, A, Maternini, M, Gabrielli, F, Subramanian, V, Venditti, D, De Majo, A, Sena, G, Lisi, G, De Sanctis, F, Petrella, G, Porwal, A, Jadhav, M, Stein, M, Kaveggia, L, Clift, J, Noda, W, Niebuhr, H., GUTTADAURO, ANGELO, FRASSANI, SILVIA, MACCHINI, DANIELE, and GABRIELLI, FRANCESCO

Published
2015

16. 'All in one mesh hernioplasty' : una nuova tecnica per la cura dell'ernia inguinale

Author

Guttadauro, A, Frassani, S, Macchini, D, Maternini, M, Bertolini, A, Pecora, N, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, MACCHINI, DANIELE, PECORA, NICOLETTA, GABRIELLI, FRANCESCO, Guttadauro, A, Frassani, S, Macchini, D, Maternini, M, Bertolini, A, Pecora, N, Gabrielli, F, GUTTADAURO, ANGELO, FRASSANI, SILVIA, MACCHINI, DANIELE, PECORA, NICOLETTA, and GABRIELLI, FRANCESCO

Published
2015

18. Circumferential Anal Giant Condyloma Acuminatum: A New Surgical Approach

Author

Guttadauro, A, Chiarelli, M, Macchini, D, Frassani, S, Maternini, M, Bertolini, A, Gabrielli, F, GUTTADAURO, ANGELO, MACCHINI, DANIELE, FRASSANI, SILVIA, GABRIELLI, FRANCESCO, Guttadauro, A, Chiarelli, M, Macchini, D, Frassani, S, Maternini, M, Bertolini, A, Gabrielli, F, GUTTADAURO, ANGELO, MACCHINI, DANIELE, FRASSANI, SILVIA, and GABRIELLI, FRANCESCO

Abstract

INTRODUCTION: Perianal giant condyloma acuminatum is a rare clinical condition related to human papillomavirus infection and characterized by a circumferential, exophytic, cauliflower-like mass with an irregular warty surface localized in the anal region. TECHNIQUE: A circular incision with a diathermocoagulator was performed on macroscopically healthy skin, 1 cm from the margin of the lesion. The dermis was divided from the subcutaneous tissue. This way, a mucocutaneous cylinder including the whole lesion was obtained. A median radial incision was carried out to open the cylinder at its front. A progressive circumferential section on healthy mucosa (≈1 cm above the margin of the lesion) by means of a radiofrequency dissector allowed for the complete removal of the mass. The healthy mucosa of the anal canal was pulled out by Allis forceps and was sutured to the external margin of the internal sphincter with single layer of Vicryl (polyglactin 910) 2-0 sutures. RESULTS: Two months after surgery, no findings of anal stenosis or mucosal ectropion were reported. At the 1-year follow-up there was no recurrence of condylomatosis in any of the 3 cases. CONCLUSIONS: Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.

Published
2015

21. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author

Simone Famularo, Matteo Donadon, Federica Cipriani, Davide P. Bernasconi, Giuliano LaBarba, Tommaso Dominioni, Maurizio Iaria, Sarah Molfino, Simone Conci, Cecilia Ferrari, Marco Garatti, Antonella Delvecchio, Albert Troci, Stefan Patauner, Silvia Frassani, Maurizio Cosimelli, Giacomo Zanus, Felice Giuliante, Elio Jovine, Maria G. Valsecchi, GianLuca Grazi, Adelmo Antonucci, Antonio Frena, Michele Crespi, Riccardo Memeo, Giuseppe Zimmitti, Guido Griseri, Andrea Ruzzenente, Gianluca Baiocchi, Raffaele DallaValle, Marcello Maestri, Giorgio Ercolani, Luca Aldrighetti, Guido Torzilli, Fabrizio Romano, Cristina Ciulli, Alessandro Giani, Francesca Carissimi, Guido Costa, Francesca Ratti, Alessandro Cucchetti, Francesco Calabrese, Elena Cremaschi, Giovanni Lazzari, Angelo Franceschi, Valentina Sega, Maria Conticchio, Luca Pennacchi, Michele Ciola, Ivano Sciannamea, Valerio De Peppo, Famularo S., Donadon M., Cipriani F., Bernasconi D.P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M.G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Bernasconi, Davide P, Labarba, Giuliano, Dominioni, Tommaso, Iaria, Maurizio, Molfino, Sarah, Conci, Simone, Ferrari, Cecilia, Garatti, Marco, Delvecchio, Antonella, Troci, Albert, Patauner, Stefan, Frassani, Silvia, Cosimelli, Maurizio, Zanus, Giacomo, Giuliante, Felice, Jovine, Elio, Valsecchi, Maria G, Grazi, Gianluca, Antonucci, Adelmo, Frena, Antonio, Crespi, Michele, Memeo, Riccardo, Zimmitti, Giuseppe, Griseri, Guido, Ruzzenente, Andrea, Baiocchi, Gianluca, Dallavalle, Raffaele, Maestri, Marcello, Ercolani, Giorgio, Aldrighetti, Luca, Torzilli, Guido, and Romano, Fabrizio

Subjects
Sorafenib, medicine.medical_specialty, recurrence, Carcinoma, Hepatocellular, Tumor burden, 030230 surgery, liver, Gastroenterology, NO, 03 medical and health sciences, 0302 clinical medicine, hepatectomy, Retrospective Studie, Internal medicine, Humans, Medicine, Chemoembolization, Therapeutic, Liver surgery, Retrospective Studies, LS7_4, Hepatology, business.industry, Palliative Care, Liver Neoplasms, hepatocellular carcinoma, medicine.disease, Recurrent Hepatocellular Carcinoma, multicentric, Treatment Outcome, Time to recurrence, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Liver function, Neoplasm Recurrence, Local, business, medicine.drug, Human
Abstract

Background Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p Conclusion Curative approaches may guarantee long-term survival in case of recurrence.

Published
2021

22. 'All-in-one mesh' hernioplasty: A new procedure for primary inguinal hernia open repair

Author

Francesco Gabrielli, Nicoletta Pecora, Silvia Frassani, Aimone Bertolini, Ugo Cioffi, Matilde De Simone, Angelo Guttadauro, Daniele Macchini, Matteo Maternini, Marco Chiarelli, Guttadauro, A, Maternini, M, Frassani, S, De Simone, M, Chiarelli, M, Macchini, D, Pecora, N, Bertolini, A, Cioffi, U, and Gabrielli, F

Subjects
Adult, Male, medicine.medical_specialty, Weakness, Time Factors, Inguinal hernioplasty, medicine.medical_treatment, lcsh:Surgery, Hernia, Inguinal, 030230 surgery, Neuralgia post-hernioplasty, Prosthesis, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Postoperative Complications, medicine, Humans, Hernia, Herniorrhaphy, Hernioplasty technique, Aged, Tension free hernia repair, Aged, 80 and over, business.industry, General surgery, lcsh:RD1-811, Middle Aged, Surgical Mesh, medicine.disease, Inguinal canal, Surgery, Inguinal hernia, Surgical mesh, medicine.anatomical_structure, Treatment Outcome, 030220 oncology & carcinogenesis, Chronic Disease, Neuralgia, Open repair, Mesh for groin hernia, Female, medicine.symptom, business, Follow-Up Studies
Abstract

Summary: Background: We propose a new open mesh hernia repair procedure for the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia. Methods: From September 2012 to August 2015, 250 consecutive patients were treated with “all in-one” mesh hernioplasty procedure in our Institution. According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasteric sheath avoiding contact with neural structures. Follow-up was carried out at 3, 6, 12, 18 and 24 months for evaluation of postoperative pain using Visual Analogue Scale score, need of medication, patients' comfort and short or long-term complications. Results: All patients were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and 47.6% of them did not require pain medication at home. After the 1st postoperative week 96.8% reported no pain and no other symptoms. No relevant limitation of normal activities was reported. There has been no postoperative neuralgia. One recurrence was observed. Conclusions: This new hernioplasty technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgia with maximum comfort for the patients. Keywords: Inguinal hernioplasty, Tension free hernia repair, Hernioplasty technique, Mesh for groin hernia, Neuralgia post-hernioplasty

Published
2018

23. What is this very big skin lesion?

Author

Silvia Frassani, Angelo Guttadauro, Barbara Rubino, Francesco Gabrielli, Elena Guanziroli, Matteo Maternini, Guttadauro, A, Frassani, S, Maternini, M, Rubino, B, Guanziroli, E, and Gabrielli, F

Subjects
Pathology, medicine.medical_specialty, integumentary system, business.industry, medicine.medical_treatment, skin lesion, Distant metastasis, General Medicine, medicine.disease, radiation therapy, Radiation therapy, distant metastasis, Clinical Images, Clinical Image, Basal cell carcinoma, Medicine, Radiology, business, Skin lesion, distant metastasi
Abstract

Key Clinical Message This clinical image shows the importance of the early diagnosis and treatment of any suspicious skin lesion.

Published
2017

24. Circumferential anal giant condyloma acuminatum: a new surgical approach

Author

Aimone Bertolini, Matteo Maternini, Silvia Frassani, Angelo Guttadauro, Daniele Macchini, Marco Chiarelli, Francesco Gabrielli, Guttadauro, A, Chiarelli, M, Macchini, D, Frassani, S, Maternini, M, Bertolini, A, and Gabrielli, F

Subjects
medicine.medical_specialty, Forceps, Anal Canal, Condilomi acuminati anali, HPV, condiloma gigante, Buschke-Lowenstein Tumor, Lesion, Anal stenosis, medicine, Humans, Vicryl, Giant condyloma acuminatum, business.industry, Rectal Neoplasms, Gastroenterology, Ectropion, Anal Region, General Medicine, Anal canal, medicine.disease, Surgery, Buschke-Löwenstein tumor, medicine.anatomical_structure, Female, medicine.symptom, business, Circular incision
Abstract

Introduction Perianal giant condyloma acuminatum is a rare clinical condition related to human papillomavirus infection and characterized by a circumferential, exophytic, cauliflower-like mass with an irregular warty surface localized in the anal region. Technique A circular incision with a diathermocoagulator was performed on macroscopically healthy skin, 1 cm from the margin of the lesion. The dermis was divided from the subcutaneous tissue. This way, a mucocutaneous cylinder including the whole lesion was obtained. A median radial incision was carried out to open the cylinder at its front. A progressive circumferential section on healthy mucosa (≈1 cm above the margin of the lesion) by means of a radiofrequency dissector allowed for the complete removal of the mass. The healthy mucosa of the anal canal was pulled out by Allis forceps and was sutured to the external margin of the internal sphincter with single layer of Vicryl (polyglactin 910) 2-0 sutures. Results Two months after surgery, no findings of anal stenosis or mucosal ectropion were reported. At the 1-year follow-up there was no recurrence of condylomatosis in any of the 3 cases. Conclusions Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.

Published
2015

25. 'All in one mesh hernioplasty' : una nuova tecnica per la cura dell'ernia inguinale

Author

GUTTADAURO, ANGELO, FRASSANI, SILVIA, MACCHINI, DANIELE, Maternini, M, Bertolini, A, PECORA, NICOLETTA, GABRIELLI, FRANCESCO, Guttadauro, A, Frassani, S, Macchini, D, Maternini, M, Bertolini, A, Pecora, N, and Gabrielli, F

Subjects
Ernioplastica inguinale, Nevralgia cronica postoperatoria, protesi per ernioplastica
Published
2015

26. Recent Innovations & Daily Problems

Author

Y. Tsai, N. Ross, H. Niebuhr, M. Sailer, F. Köckerling, L. Sun, Y. M. Shen, J. Chen, S. J. Liu, F. Q. Chen, G. Y. Yang, C. Berney, P. Malouf, D. Suarez, J. L. Tavera, J. Ocadiz, T. Chen, J. Wang, R. Mancini, G. Pattaro, F. Ceci, E. Spaziani, B. Bansa, P. Lal, R. Sharma, G. Pradhan, J. Chander, V. K. Ramteke, S. Wijerathne, N. Agarwal, D. Liem, D. Lomanto, J. Warren, W. Cobb, J. Ewing, A. Carbonell, O. Guillaume, E. Holl, J. Park, X. Monforte, H. Redl, A. Petter-Puchner, S. Gruber-Blum, A. Teuschl, E. Yoshihara, H. Pottel, M. D’Hondt, P. Jadhav, T. Nagahama, M. Ando, K. Ami, H. Amagasa, H. Ganno, K. Arai, M. Kitamura, K. El-Hayek, J. Yoo, M. Phillips, E. Pauli, J. Bittner, M. Kroh, D. Garcia, T. Furtado, L. Alberti, C. Neto, P. Hubner, A. Alves, C. Oliveira, J. Vianna, C. Campolina, G. Dumanian, Z. Dumanian, A. Tulaimat, S. Chen, L. J. Liu, A. Guttadauro, S. Frassani, D. Macchini, A. Bertolini, M. Maternini, F. Gabrielli, V. Subramanian, D. Venditti, A. De Majo, G. Sena, G. Lisi, F. De Sanctis, G. Petrella, A. Porwal, M. Jadhav, M. Stein, L. Kaveggia, J. Clift, W. Noda, Tsai, Y, Ross, N, Niebuhr, H, Sailer, M, Köckerling, F, Sun, L, Shen, Y, Chen, J, Liu, S, Chen, F, Yang, G, Berney, C, Malouf, P, Suarez, D, Tavera, J, Ocadiz, J, Chen, T, Wang, J, Mancini, R, Pattaro, G, Ceci, F, Spaziani, E, Bansa, B, Lal, P, Sharma, R, Pradhan, G, Chander, J, Ramteke, V, Wijerathne, S, Agarwal, N, Liem, D, Lomanto, D, Warren, J, Cobb, W, Ewing, J, Carbonell, A, Guillaume, O, Holl, E, Park, J, Monforte, X, Redl, H, Petter Puchner, A, Gruber Blum, S, Teuschl, A, Yoshihara, E, Pottel, H, D'Hondt, M, Jadhav, P, Nagahama, T, Ando, M, Ami, K, Amagasa, H, Ganno, H, Arai, K, Kitamura, M, El Hayek, K, Yoo, J, Phillips, M, Pauli, E, Bittner, J, Kroh, M, Garcia, D, Furtado, T, Alberti, L, Neto, C, Hubner, P, Alves, A, Oliveira, C, Vianna, J, Campolina, C, Dumanian, G, Dumanian, Z, Tulaimat, A, Chen, S, Liu, L, Guttadauro, A, Frassani, S, Macchini, D, Bertolini, A, Maternini, M, Gabrielli, F, Subramanian, V, Venditti, D, De Majo, A, Sena, G, Lisi, G, De Sanctis, F, Petrella, G, Porwal, A, Jadhav, M, Stein, M, Kaveggia, L, Clift, J, and Noda, W

Subjects
Local anaesthesia, medicine.medical_specialty, business.industry, General surgery, Alternative medicine, Incarcerated inguinal hernia, Surgery, medicine, Incarcerated Inguinal Hernia, Safety, business, Abdominal surgery
Published
2015

28. Persistent perianal dermatitis associated with mucosal hemorrhoidal prolapse

Author

Angelo Guttadauro, Silvia Frassani, G. Rizzitelli, Elena Guanziroli, Stefano Veraldi, Guanziroli, E, Veraldi, S, Guttadauro, A, Rizzitelli, G, and Frassani, S

Subjects
Adult, Male, medicine.medical_specialty, Perianal dermatitis, Mucous Membrane, business.industry, Dermatitis, Dermatology, Middle Aged, Hemorrhoids, Surgery, Young Adult, Treatment Outcome, Potassium Permanganate, Chronic Disease, medicine, Humans, Immunology and Allergy, perianal dermatitis, mucosal hemorrhoidal prolapse, Female, Staphylococcal Skin Infections, business, Aged
Published
2011

29. Big anal skin tags? What is this?

Author

Matteo Maternini, Angelo Guttadauro, Silvia Frassani, Francesco Gabrielli, Guttadauro, A, Frassani, S, Maternini, M, and Gabrielli, F

Subjects
Anal mass, medicine.medical_specialty, Incisional biopsy, Skin tags, business.industry, medicine.medical_treatment, Colostomy, General Medicine, Skin tags, spinalioma, Anus, medicine.disease, spinocellular carcinoma, Surgery, medicine.anatomical_structure, Clinical Images, Carcinoma, Medicine, Perianal mass, radiochemotherapy, Spinocellular carcinoma, business, rectal bleeding, Chemoradiotherapy
Abstract

Key Clinical Message A hard and bleeding anal and perianal mass stenotized the anus and required left-sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass.

Published
2015
Full Text
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30. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison.

Author

Famularo S, Donadon M, Cipriani F, Bernasconi DP, LaBarba G, Dominioni T, Iaria M, Molfino S, Conci S, Ferrari C, Garatti M, Delvecchio A, Troci A, Patauner S, Frassani S, Cosimelli M, Zanus G, Giuliante F, Jovine E, Valsecchi MG, Grazi G, Antonucci A, Frena A, Crespi M, Memeo R, Zimmitti G, Griseri G, Ruzzenente A, Baiocchi G, DallaValle R, Maestri M, Ercolani G, Aldrighetti L, Torzilli G, and Romano F

Subjects
Humans, Neoplasm Recurrence, Local therapy, Palliative Care, Retrospective Studies, Treatment Outcome, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic, Liver Neoplasms therapy
Abstract

Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC., Methods: This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups., Results: 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14-2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22-2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54-0.69; p<0.001)., Conclusion: Curative approaches may guarantee long-term survival in case of recurrence., (Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Published
2021
Full Text
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31. "All-in-one mesh" hernioplasty: A new procedure for primary inguinal hernia open repair.

Author

Guttadauro A, Maternini M, Frassani S, De Simone M, Chiarelli M, Macchini D, Pecora N, Bertolini A, Cioffi U, and Gabrielli F

Subjects
Adult, Aged, Aged, 80 and over, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neuralgia prevention & control, Postoperative Complications prevention & control, Surgical Mesh, Time Factors, Treatment Outcome, Young Adult, Hernia, Inguinal surgery, Herniorrhaphy methods
Abstract

Background: We propose a new open mesh hernia repair procedure for the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia., Methods: From September 2012 to August 2015, 250 consecutive patients were treated with "all in-one" mesh hernioplasty procedure in our Institution. According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasteric sheath avoiding contact with neural structures. Follow-up was carried out at 3, 6, 12, 18 and 24 months for evaluation of postoperative pain using Visual Analogue Scale score, need of medication, patients' comfort and short or long-term complications., Results: All patients were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and 47.6% of them did not require pain medication at home. After the 1st postoperative week 96.8% reported no pain and no other symptoms. No relevant limitation of normal activities was reported. There has been no postoperative neuralgia. One recurrence was observed., Conclusions: This new hernioplasty technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgia with maximum comfort for the patients., (Copyright © 2017. Published by Elsevier Taiwan LLC.)

Published
2018
Full Text
View/download PDF

32. Desmoid tumor of the abdominal wall A case report and literature review.

Author

Guttadauro A, Maternini M, Frassani S, Guanziroli E, Lo Bianco G, and Gabrielli F

Subjects
Abdominal Neoplasms pathology, Abdominal Neoplasms surgery, Abdominal Wall surgery, Adult, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Antineoplastic Agents therapeutic use, Disease Management, Estrogen Receptor Modulators therapeutic use, Female, Fibromatosis, Aggressive pathology, Fibromatosis, Aggressive surgery, Fibromatosis, Aggressive therapy, Humans, Radiotherapy, Adjuvant, Abdominal Neoplasms diagnosis, Abdominal Wall pathology, Fibromatosis, Aggressive diagnosis
Abstract

Background: Desmoid tumor is a rare soft tissues neoplasia characterized by local invasiveness and by a tendency towards local recurrence although not towards metastasization., Discussion: Etiology is not clear. Desmoid tumors originate from the monoclonal proliferation of one mesenchymal cell and develop in the context of fascial, muscular and aponeurotic tissue. They are free of capsule and do not usually metastatize, although they do present a high risk of local recurrence CONCLUSION: In the absence of a systematic data collection and of a clear distinction, in the existing databases, between primitive and recurrent lesions and between lesions of different sites, there are no standard guidelines for a correct management of desmoids., Key Words: Aggressive fibromatos Desmoid tumor, Soft tissue neoplasia.

Published
2017

33. What is this very big skin lesion?

Author

Guttadauro A, Frassani S, Maternini M, Rubino B, Guanziroli E, and Gabrielli F

Abstract

This clinical image shows the importance of the early diagnosis and treatment of any suspicious skin lesion.

Published
2017
Full Text
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34. Psyllium fiber vs. placebo in early treatment after STARR for obstructed defecation: a randomized double-blind clinical trial.

Author

Gabrielli F, Macchini D, Guttadauro A, Frassani S, Bertolini A, Giussani C, DE Simone M, and Cioffi U

Subjects
Adult, Aged, Body Mass Index, Constipation diagnostic imaging, Constipation etiology, Constipation surgery, Defecography methods, Double-Blind Method, Female, Humans, Middle Aged, Severity of Illness Index, Treatment Outcome, Cathartics administration & dosage, Constipation drug therapy, Psyllium administration & dosage, Quality of Life
Abstract

Background: Previous Literature has never evaluated the effectiveness of fiber intake after surgery for obstructed defecation in improving residual constipation and defecation urgency., Methods: From May 2010 to June 2011, 65 patients were randomly assigned to either the active group (N.=32) or placebo group (N.=33) receiving 3.5 g/day of pure Psyllium fiber or inert compound respectively. During the 6-month follow-up score systems were evaluated: Longo's Obstructed Defecation Syndrome Score, Cleveland Constipation Score; Wexner incontinence Score and Visual Analogic Scale. We also recorded the incidence of postoperative defecation urgency., Results: Active group reported less constipation at 1 week (ODS: 6.25±3.55 vs. 11.94±4.99, P<0.01-CCS: 6.59±2.65 vs. 15.10±3.33, P<0.01) and 6 months (ODS: 3.40±5.26 vs. 4.97±4.21, P<0.05-CCS: 5.00±3.82 vs. 6.63±3.68; P<0.01). Wexner Score was better at t-test in the treatment group (difference from baseline: 0.5 vs. 2.70, P<0.01 after 1 week and -0.17 vs. 1.33, P<0.01 after 6 months). Defecation urgency was less frequent in the treatment group (15.62% vs. 42.42%, P<0.05 at the χ2 Test)., Conclusions: Early treatment with Psyllium fiber improves early and 6 month results after stapled transanal rectal resection, both in terms of residual constipation and fecal incontinence. It also reduces postoperative defecation urgency.

Published
2016

35. Pneumoretroperitoneum and pneumomediastinum after Stapled Anopexy Is conservative treatment possible?

Author

Macchini D, Guttadauro A, Frassani S, Maternini M, and Gabrielli F

Subjects
Anastomotic Leak etiology, Anti-Bacterial Agents therapeutic use, Combined Modality Therapy, Humans, Male, Mediastinal Emphysema etiology, Metronidazole therapeutic use, Middle Aged, Parenteral Nutrition, Total, Penicillanic Acid analogs & derivatives, Penicillanic Acid therapeutic use, Piperacillin therapeutic use, Piperacillin, Tazobactam Drug Combination, Postoperative Complications etiology, Retropneumoperitoneum etiology, Tomography, X-Ray Computed, Anastomotic Leak therapy, Conservative Treatment, Hemorrhoids surgery, Mediastinal Emphysema therapy, Postoperative Complications therapy, Retropneumoperitoneum therapy, Surgical Stapling adverse effects
Abstract

Introduction: Stapled anopexy is considered the gold standard in treating haemorroidal disease associated to mucosal prolapse, but severe complications have been described. Among these, a minimal anastomotic leakage may lead to gas spreading into surrounding soft tissues., Case Report: We report the case of a 61 year old male who developed pneumoretroperitoneum and pneumomediastinun two days after a Stapled Anopexy. CT scans showed a minimal leakage with no abscess. The patient was successfully treated by bowel rest, antibiotics and total parenteral nutrition, avoiding surgical approach., Conclusion: A minimal anastomotic leakage following Stapled Anopexy, when leading to air diffusion into soft tissues and not associated to abscess or peritonitis may be treated conservatively avoiding ileostomy or colostomy., Key Words: Anastomotic leakage, Pneumoretroperitoneum, Stapled Anopexy.

Published
2016

36. Big anal skin tags? What is this?

Author

Guttadauro A, Frassani S, Maternini M, and Gabrielli F

Abstract

A hard and bleeding anal and perianal mass stenotized the anus and required left-sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass.

Published
2015
Full Text
View/download PDF

37. Circumferential anal giant condyloma acuminatum: a new surgical approach.

Author

Guttadauro A, Chiarelli M, Macchini D, Frassani S, Maternini M, Bertolini A, and Gabrielli F

Subjects
Buschke-Lowenstein Tumor pathology, Female, Humans, Rectal Neoplasms pathology, Anal Canal surgery, Buschke-Lowenstein Tumor surgery, Rectal Neoplasms surgery
Abstract

Introduction: Perianal giant condyloma acuminatum is a rare clinical condition related to human papillomavirus infection and characterized by a circumferential, exophytic, cauliflower-like mass with an irregular warty surface localized in the anal region., Technique: A circular incision with a diathermocoagulator was performed on macroscopically healthy skin, 1 cm from the margin of the lesion. The dermis was divided from the subcutaneous tissue. This way, a mucocutaneous cylinder including the whole lesion was obtained. A median radial incision was carried out to open the cylinder at its front. A progressive circumferential section on healthy mucosa (≈1 cm above the margin of the lesion) by means of a radiofrequency dissector allowed for the complete removal of the mass. The healthy mucosa of the anal canal was pulled out by Allis forceps and was sutured to the external margin of the internal sphincter with single layer of Vicryl (polyglactin 910) 2-0 sutures., Results: Two months after surgery, no findings of anal stenosis or mucosal ectropion were reported. At the 1-year follow-up there was no recurrence of condylomatosis in any of the 3 cases., Conclusions: Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.

Published
2015
Full Text
View/download PDF

38. Persistent perianal dermatitis associated with mucosal hemorrhoidal prolapse.

Author

Guanziroli E, Veraldi S, Guttadauro A, Rizzitelli G, and Frassani S

Subjects
Adult, Aged, Chronic Disease, Dermatitis drug therapy, Dermatitis microbiology, Female, Humans, Male, Middle Aged, Mucous Membrane drug effects, Potassium Permanganate therapeutic use, Staphylococcal Skin Infections complications, Staphylococcal Skin Infections drug therapy, Treatment Outcome, Young Adult, Dermatitis etiology, Hemorrhoids complications
Published
2011

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