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1. 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

2. The unrestricted global effort to complete the COOL trial

Author

Kirkpatrick, A, Coccolini, F, Tolonen, M, Minor, S, Catena, F, Gois, E, Doig, C, Hill, M, Ansaloni, L, Chiarugi, M, Tartaglia, D, Ioannidis, O, Sugrue, M, Colak, E, Hameed, S, Lampela, H, Agnoletti, V, Mckee, J, Garraway, N, Sartelli, M, Ball, C, Parry, N, Voght, K, Julien, L, Kroeker, J, Roberts, D, Faris, P, Tiruta, C, Moore, E, Ammons, L, Anestiadou, E, Bendinelli, C, Bouliaris, K, Carroll, R, Ceresoli, M, Favi, F, Gurrado, A, Rezende-Neto, J, Isik, A, Cremonini, C, Strambi, S, Koukoulis, G, Testini, M, Trpcic, S, Pasculli, A, Picariello, E, Abu-Zidan, F, Adeyeye, A, Augustin, G, Alconchel, F, Altinel, Y, Hernandez Amin, L, Aranda-Narvaez, J, Baraket, O, Biffl, W, Baiocchi, G, Bonavina, L, Brisinda, G, Cardinali, L, Celotti, A, Chaouch, M, Chiarello, M, Costa, G, De'Angelis, N, De Manzini, N, Delibegovic, S, Di Saverio, S, De Simone, B, Dubuisson, V, Fransvea, P, Garulli, G, Giordano, A, Gomes, C, Hayati, F, Huang, J, Ibrahim, A, Huei, T, Jailani, R, Khan, M, Luna, A, Malbrain, M, Marwah, S, Mcbeth, P, Mihailescu, A, Morello, A, Mulita, F, Murzi, V, Mohammad, A, Parmar, S, Pak, A, Wong, M, Pantalone, D, Podda, M, Puccioni, C, Rasa, K, Ren, J, Roscio, F, Gonzalez-Sanchez, A, Sganga, G, Scheiterle, M, Slavchev, M, Smirnov, D, Tosi, L, Trivedi, A, Vega, J, Waledziak, M, Xenaki, S, Winter, D, Wu, X, Zakaria, A, Zakaria, Z, Kirkpatrick A. W., Coccolini F., Tolonen M., Minor S., Catena F., Gois E., Doig C. J., Hill M. D., Ansaloni L., Chiarugi M., Tartaglia D., Ioannidis O., Sugrue M., Colak E., Hameed S. M., Lampela H., Agnoletti V., McKee J. L., Garraway N., Sartelli M., Ball C. G., Parry N. G., Voght K., Julien L., Kroeker J., Roberts D. J., Faris P., Tiruta C., Moore E. E., Ammons L. A., Anestiadou E., Bendinelli C., Bouliaris K., Carroll R., Ceresoli M., Favi F., Gurrado A., Rezende-Neto J., Isik A., Cremonini C., Strambi S., Koukoulis G., Testini M., Trpcic S., Pasculli A., Picariello E., Abu-Zidan F., Adeyeye A., Augustin G., Alconchel F., Altinel Y., Hernandez Amin L. A., Aranda-Narvaez J. M., Baraket O., Biffl W. L., Baiocchi G. L., Bonavina L., Brisinda G., Cardinali L., Celotti A., Chaouch M., Chiarello M., Costa G., de'Angelis N., De Manzini N., Delibegovic S., Di Saverio S., De Simone B., Dubuisson V., Fransvea P., Garulli G., Giordano A., Gomes C., Hayati F., Huang J., Ibrahim A. F., Huei T. J., Jailani R. F., Khan M., Luna A. P., Malbrain M. L. N. G., Marwah S., McBeth P., Mihailescu A., Morello A., Mulita F., Murzi V., Mohammad A. T., Parmar S., Pak A., Wong M. P. -K., Pantalone D., Podda M., Puccioni C., Rasa K., Ren J., Roscio F., Gonzalez-Sanchez A., Sganga G., Scheiterle M., Slavchev M., Smirnov D., Tosi L., Trivedi A., Vega J. A. G., Waledziak M., Xenaki S., Winter D., Wu X., Zakaria A. D., Zakaria Z., Kirkpatrick, A, Coccolini, F, Tolonen, M, Minor, S, Catena, F, Gois, E, Doig, C, Hill, M, Ansaloni, L, Chiarugi, M, Tartaglia, D, Ioannidis, O, Sugrue, M, Colak, E, Hameed, S, Lampela, H, Agnoletti, V, Mckee, J, Garraway, N, Sartelli, M, Ball, C, Parry, N, Voght, K, Julien, L, Kroeker, J, Roberts, D, Faris, P, Tiruta, C, Moore, E, Ammons, L, Anestiadou, E, Bendinelli, C, Bouliaris, K, Carroll, R, Ceresoli, M, Favi, F, Gurrado, A, Rezende-Neto, J, Isik, A, Cremonini, C, Strambi, S, Koukoulis, G, Testini, M, Trpcic, S, Pasculli, A, Picariello, E, Abu-Zidan, F, Adeyeye, A, Augustin, G, Alconchel, F, Altinel, Y, Hernandez Amin, L, Aranda-Narvaez, J, Baraket, O, Biffl, W, Baiocchi, G, Bonavina, L, Brisinda, G, Cardinali, L, Celotti, A, Chaouch, M, Chiarello, M, Costa, G, De'Angelis, N, De Manzini, N, Delibegovic, S, Di Saverio, S, De Simone, B, Dubuisson, V, Fransvea, P, Garulli, G, Giordano, A, Gomes, C, Hayati, F, Huang, J, Ibrahim, A, Huei, T, Jailani, R, Khan, M, Luna, A, Malbrain, M, Marwah, S, Mcbeth, P, Mihailescu, A, Morello, A, Mulita, F, Murzi, V, Mohammad, A, Parmar, S, Pak, A, Wong, M, Pantalone, D, Podda, M, Puccioni, C, Rasa, K, Ren, J, Roscio, F, Gonzalez-Sanchez, A, Sganga, G, Scheiterle, M, Slavchev, M, Smirnov, D, Tosi, L, Trivedi, A, Vega, J, Waledziak, M, Xenaki, S, Winter, D, Wu, X, Zakaria, A, Zakaria, Z, Kirkpatrick A. W., Coccolini F., Tolonen M., Minor S., Catena F., Gois E., Doig C. J., Hill M. D., Ansaloni L., Chiarugi M., Tartaglia D., Ioannidis O., Sugrue M., Colak E., Hameed S. M., Lampela H., Agnoletti V., McKee J. L., Garraway N., Sartelli M., Ball C. G., Parry N. G., Voght K., Julien L., Kroeker J., Roberts D. J., Faris P., Tiruta C., Moore E. E., Ammons L. A., Anestiadou E., Bendinelli C., Bouliaris K., Carroll R., Ceresoli M., Favi F., Gurrado A., Rezende-Neto J., Isik A., Cremonini C., Strambi S., Koukoulis G., Testini M., Trpcic S., Pasculli A., Picariello E., Abu-Zidan F., Adeyeye A., Augustin G., Alconchel F., Altinel Y., Hernandez Amin L. A., Aranda-Narvaez J. M., Baraket O., Biffl W. L., Baiocchi G. L., Bonavina L., Brisinda G., Cardinali L., Celotti A., Chaouch M., Chiarello M., Costa G., de'Angelis N., De Manzini N., Delibegovic S., Di Saverio S., De Simone B., Dubuisson V., Fransvea P., Garulli G., Giordano A., Gomes C., Hayati F., Huang J., Ibrahim A. F., Huei T. J., Jailani R. F., Khan M., Luna A. P., Malbrain M. L. N. G., Marwah S., McBeth P., Mihailescu A., Morello A., Mulita F., Murzi V., Mohammad A. T., Parmar S., Pak A., Wong M. P. -K., Pantalone D., Podda M., Puccioni C., Rasa K., Ren J., Roscio F., Gonzalez-Sanchez A., Sganga G., Scheiterle M., Slavchev M., Smirnov D., Tosi L., Trivedi A., Vega J. A. G., Waledziak M., Xenaki S., Winter D., Wu X., Zakaria A. D., and Zakaria Z.

Abstract

Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) (https://clinicaltrials.gov/ct2/show/NCT03163095). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. Methods: The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by co

Published
2023

3. 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

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. 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

8. The unrestricted global effort to complete the COOL trial

Author

Andrew W. Kirkpatrick, Federico Coccolini, Matti Tolonen, Samuel Minor, Fausto Catena, Emanuel Gois, Christopher J. Doig, Michael D. Hill, Luca Ansaloni, Massimo Chiarugi, Dario Tartaglia, Orestis Ioannidis, Michael Sugrue, Elif Colak, S. Morad Hameed, Hanna Lampela, Vanni Agnoletti, Jessica L. McKee, Naisan Garraway, Massimo Sartelli, Chad G. Ball, Neil G. Parry, Kelly Voght, Lisa Julien, Jenna Kroeker, Derek J. Roberts, Peter Faris, Corina Tiruta, Ernest E. Moore, Lee Anne Ammons, Elissavet Anestiadou, Cino Bendinelli, Konstantinos Bouliaris, Rosemarry Carroll, Marco Ceresoli, Francesco Favi, Angela Gurrado, Joao Rezende-Neto, Arda Isik, Camilla Cremonini, Silivia Strambi, Georgios Koukoulis, Mario Testini, Sandy Trpcic, Alessandro Pasculli, Erika Picariello, Fikri Abu-Zidan, Ademola Adeyeye, Goran Augustin, Felipe Alconchel, Yuksel Altinel, Luz Adriana Hernandez Amin, José Manuel Aranda-Narváez, Oussama Baraket, Walter L. Biffl, Gian Luca Baiocchi, Luigi Bonavina, Giuseppe Brisinda, Luca Cardinali, Andrea Celotti, Mohamed Chaouch, Maria Chiarello, Gianluca Costa, Nicola de’Angelis, Nicolo De Manzini, Samir Delibegovic, Salomone Di Saverio, Belinda De Simone, Vincent Dubuisson, Pietro Fransvea, Gianluca Garulli, Alessio Giordano, Carlos Gomes, Firdaus Hayati, Jinjian Huang, Aini Fahriza Ibrahim, Tan Jih Huei, Ruhi Fadzlyana Jailani, Mansoor Khan, Alfonso Palmieri Luna, Manu L. N. G. Malbrain, Sanjay Marwah, Paul McBeth, Andrei Mihailescu, Alessia Morello, Francesk Mulita, Valentina Murzi, Ahmad Tarmizi Mohammad, Simran Parmar, Ajay Pak, Michael Pak-Kai Wong, Desire Pantalone, Mauro Podda, Caterina Puccioni, Kemal Rasa, Jianan Ren, Francesco Roscio, Antonio Gonzalez-Sanchez, Gabriele Sganga, Maximilian Scheiterle, Mihail Slavchev, Dmitry Smirnov, Lorenzo Tosi, Anand Trivedi, Jaime Andres Gonzalez Vega, Maciej Waledziak, Sofia Xenaki, Desmond Winter, Xiuwen Wu, Andee Dzulkarnean Zakaria, Zaidi Zakaria, Kirkpatrick, A, Coccolini, F, Tolonen, M, Minor, S, Catena, F, Gois, E, Doig, C, Hill, M, Ansaloni, L, Chiarugi, M, Tartaglia, D, Ioannidis, O, Sugrue, M, Colak, E, Hameed, S, Lampela, H, Agnoletti, V, Mckee, J, Garraway, N, Sartelli, M, Ball, C, Parry, N, Voght, K, Julien, L, Kroeker, J, Roberts, D, Faris, P, Tiruta, C, Moore, E, Ammons, L, Anestiadou, E, Bendinelli, C, Bouliaris, K, Carroll, R, Ceresoli, M, Favi, F, Gurrado, A, Rezende-Neto, J, Isik, A, Cremonini, C, Strambi, S, Koukoulis, G, Testini, M, Trpcic, S, Pasculli, A, Picariello, E, Abu-Zidan, F, Adeyeye, A, Augustin, G, Alconchel, F, Altinel, Y, Hernandez Amin, L, Aranda-Narvaez, J, Baraket, O, Biffl, W, Baiocchi, G, Bonavina, L, Brisinda, G, Cardinali, L, Celotti, A, Chaouch, M, Chiarello, M, Costa, G, De'Angelis, N, De Manzini, N, Delibegovic, S, Di Saverio, S, De Simone, B, Dubuisson, V, Fransvea, P, Garulli, G, Giordano, A, Gomes, C, Hayati, F, Huang, J, Ibrahim, A, Huei, T, Jailani, R, Khan, M, Luna, A, Malbrain, M, Marwah, S, Mcbeth, P, Mihailescu, A, Morello, A, Mulita, F, Murzi, V, Mohammad, A, Parmar, S, Pak, A, Wong, M, Pantalone, D, Podda, M, Puccioni, C, Rasa, K, Ren, J, Roscio, F, Gonzalez-Sanchez, A, Sganga, G, Scheiterle, M, Slavchev, M, Smirnov, D, Tosi, L, Trivedi, A, Vega, J, Waledziak, M, Xenaki, S, Winter, D, Wu, X, Zakaria, A, and Zakaria, Z

Subjects
Intraperitoneal sepsi, Laparotomy, Peritoniti, Randomized controlled trial, Septic shock, Emergency Medicine, Global health, Surgery, Open abdomen, Multiple organ dysfunction
Abstract

Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) (https://clinicaltrials.gov/ct2/show/NCT03163095). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. Methods The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. Discussion OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of “damage control”; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. Trial registration: National Institutes of Health (https://clinicaltrials.gov/ct2/show/NCT03163095).

Published
2023

9. The Challenge of Melanocytic Lesions in Pediatric Patients: Clinical-Pathological Findings and the Diagnostic Value of PRAME

Author

Letizia Trotta, Giuseppe D’Abbronzo, Claudio Spinelli, Giuseppina Rosaria Umano, Vittoria Donofrio, Maria Elena Errico, Renato Franco, Silvia Strambi, Andrea Ronchi, Giulia Delehaye, Alfonso Papparella, Umano, G. R., Errico, M. E., D'Onofrio, V., Delehaye, G., Trotta, L., Spinelli, C., Strambi, S., Franco, R., D'Abbronzo, G., Ronchi, A., and Papparella, A.

Subjects
Cancer Research, medicine.medical_specialty, Malignancy, atypical spitzoid tumor, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, children, PRAME, melanoma, Medicine, immunohistochemistry, Pathological, neoplasms, RC254-282, Original Research, business.industry, Melanoma, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Dermatology, Oncology, 030220 oncology & carcinogenesis, Cohort, Immunohistochemistry, Differential diagnosis, business, Rare disease
Abstract

Pediatric melanoma is a rare disease especially in children aged younger than 10 years old. Recent estimates report a rise of disease incidence in both adults and children. Diagnostic work-up is challenging in pediatric melanoma, as it displays a wide range of clinical presentations. Immunohistochemical biomarkers have been reported as predictors of malignancy in melanoma, however data specific to pediatric melanoma are poor. Our study aims to contribute to provide evidence of pediatric melanoma clinical features and differential diagnosis in this patient population. We describe our experience with a retrospective case series of pigmented skin lesions including malignant melanoma, atypical spitzoid tumor, and benign nevi in children and adolescents aged less than 16 years. We described the clinical and demographic characteristics of the cohort and evaluated the immunohistochemical expression of the PReferentially expressed Antigen in MElanoma (PRAME) for differential diagnosis of melanoma in children. The series displayed a similar distribution of melanoma between males and females, and the most common site of melanoma onset were the upper and lower limbs. In our cohort, PRAME was negative in most cases. Focal and slight positivity (from 1 to 5% of the neoplastic cells) was observed in four cases (two Spitz nevi and two atypical Spitz tumors). A moderate positivity in 25% of the neoplastic cells was observed in one case of atypical Spitz tumor. Immunohistochemical expression of PRAME might be useful in the differential diagnosis of malignant melanoma.

Published
2021

10. 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 AW, Musetti S, Strambi S, Chiarugi M, and Coccolini F

Subjects
Humans, Middle Aged, Aged, Treatment Outcome, Colostomy adverse effects, Anastomosis, Surgical adverse effects, Immunocompromised Host, Internet, Diverticulitis, Colonic surgery, Diverticulitis, Colonic complications, Diverticulitis complications, Intestinal Perforation etiology, Intestinal Perforation surgery, Peritonitis etiology
Abstract

Background: Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis., Methods: We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2)., Results: Data from 482 patients were analyzed-229 patients (47.5%) [M:F = 1:1; median age: 60 (24-95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26-94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann's procedure is mainly performed in grades 1-2 (p < 0.0001). Major complications increased significantly after a Hartmann's procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002)., Conclusions: Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann's procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay., (© 2023. The Author(s).)

Published
2023
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11. Ovarian torsion in the pediatric population: predictive factors for ovarian-sparing surgery-an international retrospective multicenter study and a systematic review.

Author

Spinelli C, Tröbs RB, Nissen M, Strambi S, Ghionzoli M, Bertocchini A, Cagnetta Domass V, Sanna B, Morganti R, Molinaro F, Messina M, Tursini S, Briganti V, Gennari F, Lisi G, and Lelli Chiesa P

Subjects
Female, Child, Humans, Retrospective Studies, Ovarian Torsion, Torsion Abnormality diagnosis, Torsion Abnormality surgery, Abdominal Pain etiology, Multicenter Studies as Topic, Ovarian Diseases diagnosis, Ovarian Diseases surgery, Cysts
Abstract

Study Objective: Ovarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making., Design: We conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010-2020)., Participants: Patients aged 0-18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions., Results: Ninety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary., Conclusions: Our results showed that a post-menarchal age (p = .001), a pre-operative US ovarian size < 5 cm, (p = .001), the presence of severe abdominal pain (p = .002), a laparoscopic approach (p < .001), and the presence of a functional cyst (p = .002) were significantly associated with conservative surgery., (© 2022. The Author(s).)

Published
2023
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12. The unrestricted global effort to complete the COOL trial.

Author

Kirkpatrick AW, Coccolini F, Tolonen M, Minor S, Catena F, Gois E Jr, Doig CJ, Hill MD, Ansaloni L, Chiarugi M, Tartaglia D, Ioannidis O, Sugrue M, Colak E, Hameed SM, Lampela H, Agnoletti V, McKee JL, Garraway N, Sartelli M, Ball CG, Parry NG, Voght K, Julien L, Kroeker J, Roberts DJ, Faris P, Tiruta C, Moore EE, Ammons LA, Anestiadou E, Bendinelli C, Bouliaris K, Carroll R, Ceresoli M, Favi F, Gurrado A, Rezende-Neto J, Isik A, Cremonini C, Strambi S, Koukoulis G, Testini M, Trpcic S, Pasculli A, Picariello E, Abu-Zidan F, Adeyeye A, Augustin G, Alconchel F, Altinel Y, Hernandez Amin LA, Aranda-Narváez JM, Baraket O, Biffl WL, Baiocchi GL, Bonavina L, Brisinda G, Cardinali L, Celotti A, Chaouch M, Chiarello M, Costa G, de'Angelis N, De Manzini N, Delibegovic S, Di Saverio S, De Simone B, Dubuisson V, Fransvea P, Garulli G, Giordano A, Gomes C, Hayati F, Huang J, Ibrahim AF, Huei TJ, Jailani RF, Khan M, Luna AP, Malbrain MLNG, Marwah S, McBeth P, Mihailescu A, Morello A, Mulita F, Murzi V, Mohammad AT, Parmar S, Pak A, Wong MP, Pantalone D, Podda M, Puccioni C, Rasa K, Ren J, Roscio F, Gonzalez-Sanchez A, Sganga G, Scheiterle M, Slavchev M, Smirnov D, Tosi L, Trivedi A, Vega JAG, Waledziak M, Xenaki S, Winter D, Wu X, Zakaria AD, and Zakaria Z

Subjects
Humans, Inflammation, Multiple Organ Failure etiology, Prospective Studies, United States, Abdomen, Laparotomy adverse effects
Abstract

Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study., Methods: The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer., Discussion: OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of "damage control"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention., Trial Registration: National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 )., (© 2023. The Author(s).)

Published
2023
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13. Thyroid cancer in children: A multicenter international study highlighting clinical features and surgical outcomes of primary and secondary tumors.

Author

Martucci C, Crocoli A, De Pasquale MD, Spinelli C, Strambi S, Brazzarola P, Morelli E, Cassiani J, Mancera J, Luengas JP, Lobos P, Liberto D, Astori E, Sarnacki S, Couloigner V, Simon F, Lambert C, Abib SCV, Cervantes O, Caran E, Delgado Lindman D, Jones MO, Shukla R, Losty PD, and Inserra A

Abstract

Background: Thyroid gland malignancies are rare in pediatric patients (0.7% of tumors); only 1.8% are observed in patients aged <20 years, with a higher prevalence recorded in women and adolescents. Risk factors include genetic syndromes, MEN disorders, autoimmune diseases, and exposure to ionizing radiation. Radiotherapy is also associated with an increased risk of secondary thyroid cancer. This study describes the clinical features and surgical outcomes of primary and secondary thyroid tumors in pediatric patients., Methods: Institutional data were collected from eight international surgical oncology centers for pediatric patients with thyroid cancer between 2000 and 2020. Statistical analyses were performed using the GraphPad Prism software., Results: Among 255 total cases of thyroid cancer, only 13 (5.1%) were secondary tumors. Primary thyroid malignancies were more likely to be multifocal in origin (odds ratio [OR] 1.993, 95% confidence interval [CI].7466-5.132, p = 0.2323), have bilateral glandular location (OR 2.847, 95% CI.6835-12.68, p = 0.2648), and be metastatic at first diagnosis (OR 1.259, 95% CI.3267-5.696, p > 0.999). Secondary tumors showed a higher incidence of disease relapse (OR 1.556, 95% CI.4579-5.57, p = 0.4525) and surgical complications (OR 2.042, 95% CI 0.7917-5.221, p = 0.1614), including hypoparathyroidism and recurrent laryngeal nerve injury. The overall survival (OS) was 99% at 1 year and 97% after 10 years. No EFS differences were evident between the primary and secondary tumors (chi-square 0.7307, p = 0.39026)., Conclusions: This multicenter study demonstrated excellent survival in pediatric thyroid malignancies. Secondary tumors exhibited greater disease relapse (15.8 vs. 10.5%) and a higher incidence of surgical complications (36.8 vs. 22.2%)., (Copyright © 2022 Martucci, Crocoli, De Pasquale, Spinelli, Strambi, Brazzarola, Morelli, Cassiani, Mancera, Luengas, Lobos, Liberto, Astori, Sarnacki, Couloigner, Simon, Lambert, Abib, Cervantes, Caran, Delgado Lindman, Jones, Shukla, Losty and Inserra.)

Published
2022
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14. Intestinal Ischemia: Unusual but Fearsome Complication of COVID-19 Infection.

Author

Strambi S, Proietti A, Galatioto C, Coccolini F, Cremonini C, Musetti S, Basolo F, Chiarugi M, and Tartaglia D

Abstract

The pathophysiology of gastrointestinal damage in coronavirus disease (COVID-19) is probably multifactorial. It is not clear whether the etiology of intestinal ischemia may be directly related to viral replication or may result from hyper-coagulability following SARS-CoV-2 infection.To confirm a pathogenic role of COVID-19, we retrospectively investigated the presence of SARS-CoV-2 virus in the ischemic bowel of five COVID-19 patients undergoing emergency surgery for intestinal ischemia in the period of March 2020-May 2021. Immunohistochemical positivity with weak intensity was observed in four out of five cases, but only one case was strongly positive both at immunohistochemistry and at molecular analysis. The histological alterations in the intestinal tissue samples showed similarity with the well-known alterations described in typical targetorgans of the virus (e.g., the lung). This observation suggests a similar mechanism of action of the virus. Further larger studies are, thus, required to confirm this preliminary finding. Clinicians should carefully monitor all COVID-19 patients for the possible presence of a SARS-CoV-2 intestinal infection, a potential cause of ischemia and bowel perforation.

Published
2022
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15. Sarcina Ventriculi infection: a rare but fearsome event. A Systematic Review of the Literature.

Author

Tartaglia D, Coccolini F, Mazzoni A, Strambi S, Cicuttin E, Cremonini C, Taddei G, Puglisi AG, Ugolini C, Di Stefano I, Basolo F, and Chiarugi M

Subjects
Anti-Bacterial Agents therapeutic use, Clostridium, Female, Humans, Middle Aged, Sarcina, Stomach Diseases
Abstract

Objectives: This study is aimed to report a case of SV-related gastritis and the results of a systematic literature review of SV infections., Methods: Following a case presentation, we systematically searched different databases (MEDLINE, PubMed, Scopus, Web of Science, EMBASE, google scholar) for the items "sarcina," "ventriculi," "clostridium" with AND/OR., Results: A total of 55 articles reporting 65 cases of Sarcina Ventriculi were found. Thus, 66 patients, including our case, were reviewed. The median age was 51 years (IQR: 0-87 years). Females accounted for 51% of cases. 68% of patients had one or more comorbidities. SV was isolated in the gastrointestinal tract (88%), respiratory (5%), urine (4%), and bloodstream (3%) systems. Upper endoscopy was performed in 52 patients (79%). Biopsies were obtained in all 52 cases and were normal in 23%. Surgery was warranted in 15 patients (23%), and specific antimicrobial therapy was delivered in 34 (52%) patients. Mortality was 14%. At follow-up, 88% of patients showed complete eradication of the SV infection., Conclusions: Upper gastrointestinal biopsy positive for SV should prompt an evaluation of the clinical conditions, considering the risk of gastric perforation is not negligible. Antibiotic therapy may eradicate the infection and prevent complications. Emergency surgery is required in case of source control., Competing Interests: Declaration of Competing Interest No conflict of interest to declare., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2022
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16. Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence.

Author

Cicuttin E, Sartelli M, Scozzafava E, Tartaglia D, Cremonini C, Brevi B, Ramacciotti N, Musetti S, Strambi S, Podda M, Catena F, Chiarugi M, and Coccolini F

Abstract

Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.

Published
2022
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17. Laparoscopic cholecystectomy for acute calculous cholecystitis in elderly. More complex but equally safe and effective.

Author

Tartaglia D, Coccolini F, Cremonini C, Strambi S, Musetti S, Cicuttin E, Di Dato A, Cobuccio L, Cengeli I, Pucciarelli M, and Chiarugi M

Subjects
Aged, Aged, 80 and over, Humans, Male, Cholecystectomy, Common Bile Duct, Length of Stay, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Retrospective Studies, Treatment Outcome, Female, Cholecystectomy, Laparoscopic adverse effects, Cholecystitis, Acute surgery, Gallstones complications, Gallstones surgery
Abstract

Aim: Acute calculous cholecystitis (ACC) is one of the most common pathologies in the elderly. Laparoscopy is the gold standard for ACC treatment, regardless of age. This study aimed to compare different classes of elderly patients affected by ACC and assess whether laparoscopy has the same safety and effectiveness as younger patients., Materials and Methods: Patients aging ≠ 70 y-o presenting with ACC treated with laparoscopic cholecystectomy were prospectively enrolled from 2010 to 2020. Three groups were identified: age 70-75 (Group 1); age 76-80 (Group 2); Age > 80 (Group 3). Major postoperative complications were considered as more than grade II according to the Clavien and Dindo classification. Demographic, intra-, and postoperative outcomes were compared. A multivariate analysis was also performed to identify predictive factors of morbidity., Results: We reviewed 832 patients: 302 (36.3%) were ≠ 70 y-o. Group 1 accounted for 124 patients (41.1%), group 2 for 74 (24.5%) and group 3 for 104 (34.3%). Male gender was significantly less represented with increasing ages (p<0.001). ASA score >2 (p=0.010), CACI score (p<0.001), and ERD score (p<0.001) were more frequent in group 3. No significant differences were found about AAST distribution and comorbidities. Conversion to open rate was significantly higher in group 1 (6.5%) and group 3 (8.7%) (p=0.019). Common bile duct stones rate was higher in group 3 (14.5% vs 13.5% vs 31.7%; p<0.001). Median postoperative hospital length of stay was increasingly longer (p<0.001). AAST grade ≠ 3 (OR 3.187; 95% CI 1.356-7.489; p=0.008), age ≠ 70 y-o (OR 3.358; p<0.001), and CBD stones (OR 2.912; 95% CI 1.456-5.824; p=0.003) were identified as predictive factors of morbidity between < and ≠ 70 ys. Among the three groups of elderly, age > 80 ys was associated with an increase of OR of postoperative complication by 2.94 (95% CI 1.099-7.912; p = 0.032)., Conclusions: Laparoscopy can be safely offered in elderly patients, although longer postoperative hospital stay. The presence of associated CBD stones may increase the risk of morbidity., Key Words: Acute calculous cholecystitis, Cholecystectomy, Common bile duct lithiasis, Elderly, Frailty, Laparoscopy.

Published
2022

18. Testicular germ cells tumors in adolescents and young adults: Management and outcomes from a single-center experience.

Author

Spinelli C, Cito G, Morelli G, Ghionzoli M, Bertocchini A, Sanna B, Galli L, Antonuzzo A, Morganti R, and Strambi S

Subjects
Adolescent, Adult, Follow-Up Studies, Humans, Male, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Orchiectomy, Retrospective Studies, Young Adult, Neoplasms, Germ Cell and Embryonal epidemiology, Neoplasms, Germ Cell and Embryonal surgery, Testicular Neoplasms epidemiology, Testicular Neoplasms surgery
Abstract

Objective: To investigate and compare the effectiveness of active surveillance versus post-surgical active treatment, in patients with testicular germ cells tumor (TGCT)., Materials and Methods: We retrospectively analyzed 52 patients who underwent surgery for TGCT from January 2009 to December 2014. All the patients were divided into two age groups: the Group A included children-adolescents from 18 months to 21 years old, while the Group B comprised young adults from 22 to 39 years old. Clinical, histopathological, therapeutic and follow-up data were collected., Results: Overall, 22 patients (42,3%) were enrolled in the Group A and 30 patients (57.7%) were categorized in the Group B. Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed in 4 patients (7.7%). Post-surgical management differed based on clinical stage, resulting in active surveillance or adjuvant therapy. After an average 7 years follow-up period (range: 3.5-9.0 years), the overall survival rate is 100%. The relapse risk is significantly higher for the patients in the Group B, displaying a recurrence free-survival rate of 72% versus 95% (Group A); 11 relapses (21.1%) were recorded 2 years after surgery. Of these, 3 recurrences (12.0%) occurred in patients undergoing an active surveillance approach, while 8 (29.6%) in patients subjected to an active treatment., Conclusions: The excellent prognosis in both age groups confirms the high curability of this neoplasia. The active surveillance could represent an optimal option for low recurrence risk tumors. However, post-surgical treatments should be taken into consideration for TGCT with high risk factors, including tumor size, lymphovascular and rete testis invasion.

Published
2021
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19. The Challenge of Melanocytic Lesions in Pediatric Patients: Clinical-Pathological Findings and the Diagnostic Value of PRAME.

Author

Umano GR, Errico ME, D'Onofrio V, Delehaye G, Trotta L, Spinelli C, Strambi S, Franco R, D'Abbronzo G, Ronchi A, and Papparella A

Abstract

Pediatric melanoma is a rare disease especially in children aged younger than 10 years old. Recent estimates report a rise of disease incidence in both adults and children. Diagnostic work-up is challenging in pediatric melanoma, as it displays a wide range of clinical presentations. Immunohistochemical biomarkers have been reported as predictors of malignancy in melanoma, however data specific to pediatric melanoma are poor. Our study aims to contribute to provide evidence of pediatric melanoma clinical features and differential diagnosis in this patient population. We describe our experience with a retrospective case series of pigmented skin lesions including malignant melanoma, atypical spitzoid tumor, and benign nevi in children and adolescents aged less than 16 years. We described the clinical and demographic characteristics of the cohort and evaluated the immunohistochemical expression of the PReferentially expressed Antigen in MElanoma (PRAME) for differential diagnosis of melanoma in children. The series displayed a similar distribution of melanoma between males and females, and the most common site of melanoma onset were the upper and lower limbs. In our cohort, PRAME was negative in most cases. Focal and slight positivity (from 1 to 5% of the neoplastic cells) was observed in four cases (two Spitz nevi and two atypical Spitz tumors). A moderate positivity in 25% of the neoplastic cells was observed in one case of atypical Spitz tumor. Immunohistochemical expression of PRAME might be useful in the differential diagnosis of malignant melanoma., 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 © 2021 Umano, Errico, D’Onofrio, Delehaye, Trotta, Spinelli, Strambi, Franco, D’Abbronzo, Ronchi and Papparella.)

Published
2021
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20. An Unusual Evolution of Krukenberg Tumour: A Case Report.

Author

Spinelli C, Liloia C, Piscioneri J, Ugolini C, and Strambi S

Abstract

Krukenberg tumours are rare metastatic tumours of the ovaries characterized by the presence of mucin-producing neoplastic Signet Ring Cell Carcinoma (SRCC). At first glance, this tumour may be confused with a primary ovarian tumour. Surgery and chemotherapy combination have led to improvement in prognosis, but it still remains severe. We report the case of a 60-year-old woman with a Krukenberg tumour rising from a low differentiated gastric adenocarcinoma. The patient was clinically stable for 26 months after surgery until she experienced a prompt decline and died of cerebral haemorrhage within two weeks. The aim of this article was to give an overview of the Krukenberg tumour starting from our case report and comparing it with clinicopathological characteristics of this pathology derived from a review of recent literature.

Published
2016
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21. Spigelian hernia in a 14-year-old girl: a case report and review of the literature.

Author

Spinelli C, Strambi S, Pucci V, Liserre J, Spinelli G, and Palombo C

Abstract

Spigelian hernia (SH) is a surgical rarity in children, which occurs through slit-like defects in the anterior abdominal wall adjacent to the semilunar line, the convexity lateral line which joins the nine ribs to the pubic tubercle and signs the limit between the muscular and aponeurotic portion of transversus abdominis muscle. As there are no specific symptoms and signs, the diagnosis is difficult, especially in children. We report a case of SH that comes to our observation: a 14-year-old girl presented recurrent abdominal pain associated to intermittent palpable mass in the paraumbilical region. Starting from our case report, we review the literature of pediatric SH from 2000 to 2013 and we describe the anatomy, etiology, clinical presentation, instrumental diagnosis, and surgical technique of pediatric SH.

Published
2014
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