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Inconel 718 is a widely used superalloy, due to its unique corrosion resistance and mechanical strength properties at very high temperatures. Hot metal extrusion is the most widely used forming technique, if the manufacturing of slender components is required. As the current scientific literature does not comprehensively cover the fundamental aspects related to the process–structure relationships, in the present work, a combined numerical and experimental approach is employed. A finite element (FE) model was established to answer three key questions: (1) predicting the required extrusion force at different extrusion speeds; (2) evaluating the influence of the main processing parameters on the formation of surface cracks using the normalized Cockcroft Latham's (nCL) damage criterion; and (3) quantitatively assessing the amount of recrystallized microstructure through Avrami's equation. For the sake of modeling validation, several experimental investigations were carried out under different processing conditions. Particularly, it was found that the higher the initial temperature of the billet, the lower the extrusion force, although a trade-off must be sought to avoid the formation of surface cracks occurring at excessive temperatures, while limiting the required extrusion payload. The extrusion speed also plays a relevant role. Similarly to the role of the temperature, an optimal extrusion speed value must be identified to minimize the possibility of surface crack formation (high speeds) and to minimize the melting of intergranular niobium carbides (low speeds). [ABSTRACT FROM AUTHOR]

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

Peritoneal carcinomatosis (PC) is typically identified in advanced stage gastric cancer and is frequently considered to be an incurable disease. Along with macroscopic PC, microscopic PC may be diagnosed through pathological examination of tissue specimens and is not detectable during surgical intervention. The present study aimed to analyse the prevalence, prognostic value and predictive factors for microscopic PC. In the present retrospective study, data from patients with epithelial gastric cancer that were treated with curative intent surgery were examined. Patients with macroscopic PC were excluded. Additionally, the study population was divided into two groups based on the presence or absence of microscopic PC. The prevalence of microscopic PC was 5.5%. Microscopic PC exhibited a significant negative effect on overall survival. In addition, multivariate analyses revealed that the significant predictive factors for the presence of microscopic PC were adenocarcinoma of a diffuse type, lymphatic and vascular invasion, cancer location at the site of previous gastric surgery and a tumour extent >T2. In particular, the presence of lymphatic and vascular invasion was the most significant predictive factor. These results indicate that ≥5.5% of patients with gastric cancer who undergo surgery with a curative intent may benefit from more aggressive loco-regional treatment against microscopic PC at the time of surgery. [ABSTRACT FROM AUTHOR]

Background: In deceased donor kidney transplantation (KT), the use of hypothermic machine perfusion (HMP) has been acquiring the status of best practice in the pre-transplant management of kidney grafts. Two types of HMP are currently available, oxygenated HMP and non-oxygenated HMP. However, data on the real clinical impact of oxygenation on KT outcome are still heterogeneous., Methods: Retrospective study on a cohort of 103 patients transplanted with a single kidney graft that was managed either with end-ischemic oxygenated (O 2 group, Waves Machine, n  = 51, 49.5%) or non-oxygenated HMP (no-O 2 group, Life Port Kidney Transporter Machine, n  = 52, 50.5%), during the period January 2016-December 2020. Oxygenation was performed at pO 2 21%., Results: The median cold ischemia time was 29 h:40 min [IQR 26 h:55 min-31 h:10 min] and the prevalence of grafts from extended criteria donors (ECD) was 46.7%, with a median kidney donor profile index (KDPI) of 72 [41-94]. The study groups were homogeneous in terms of recipient characteristics, ischemia times and donor characteristics. O 2 and no-O 2 groups showed comparable outcomes in terms of delayed graft function (O 2 vs no-O 2 , 21.5% vs 25%, p  = 0.58), vascular (0.2% vs 0.2%, p  > 0.99) and urologic (13.7% vs 11.5%, p  = 0.77) complications, and episodes of graft rejection (11.7% vs 7.7%, p  = 0.52). At 1 year follow up, even creatinine serum levels were comparable between the groups (1.27 mg/dL [1.09 and 1.67] vs 1.4 mg/dL [1.9-1.78], p  = 0.319), with similar post-transplant trend ( p  = 0.870). No significant benefit was either observed in ECD or KDPI > 60 subgroups, respectively., Conclusions: Oxygenation at pO 2 21% during HMP seems not to significantly enhance the KT outcomes in terms of postoperative complications or graft function.

Background: The role of surgical therapy in patients with liver metastases from neuroendocrine tumors (NETs) is unclear. In this study, the results obtained with curative or palliative resection, by reviewing recent literature and performing a meta-analysis, were examined., Materials and Methods: A systematic review and meta-analysis of observational studies published between January 1990 and October 2013 were performed. Studies that evaluated the different survival between patients treated by curative or palliative surgical resection of hepatic metastases from NETs were considered. The collected studies were evaluated for heterogeneity, publication bias, and quality. To calculate the pooled hazard ratio (HR) estimate and the 95% confidence interval (95% CI), a fixed-effects model was applied., Results: After the literature search, 2,546 studies were found and, among 38 potentially eligible studies, 3 were considered. We did not find a significant longer survival in patients treated with curative surgical resection of hepatic metastases when compared to palliative hepatic resection HR 0.40 (95% CI: 0.14-1.11). In one study, palliative resection of hepatic metastases significantly increased survival when compared to embolization., Conclusions: Curative and also palliative surgery of NETs liver metastases may improve survival outcome. However, further randomized clinical trials are needed to elucidate this argument.

Background: Peritoneal recovery after uncomplicated serum manipulation usually lasts 7 days and high values of serical CA 125 are measured following abdominal surgery. The aim of this study was to assess a possible correlation between peritoneal manipulation and serical CA 125 levels following abdominal surgery for benign diseases., Patients and Methods: Twenty-eight patients with abdominal benign disease were operated on. They were pooled into three groups of low, intermediate and high peritoneal manipulation, according to the extent of laparotomy and length of surgical peritoneal manipulation. Venous blood samples (5 ml) were taken from each patient 24-48 hours before surgery, 12-24 hours after surgery and on the 4th and 7th postoperative day. CA 125 levels were quantified by microparticle enzyme immunoassay., Results: After surgery, patients having high peritoneal manipulation showed significantly higher levels of CA 125 compared to the preoperative levels. In particular, the length of peritoneal manipulation was correlated with increasing levels of the marker (p<0.0001)., Conclusion: Peritoneal manipulation was significantly correlated to serum CA 125 levels; therefore its role as marker of peritoneal surgical injury should be considered.

Background: Hepatic artery infusion (HAI) is indicated to treat unresectable colorectal hepatic metastases, with recent applications as a neoadjuvant or adjuvant treatment. Traditionally performed with the infusion of fluoropyrimidine-based chemotherapy, it has been now tested with oxaliplatin or irinotecan and associated with systemic chemotherapy., Methods: To evaluate the impact of medical devices complications we carried out a search of the published studies on HAI in unresectable colorectal liver metastases. Complications were pooled according to the applied medical system: 1) surgical catheter, 2) radiological catheter, and 3) fully implantable pump. The surgical catheter is inserted into the hepatic artery from the gastro-duodenal artery. The radiological catheter is inserted into the hepatic artery through a percutaneous transfemoral or transaxillar access. The fully implantable pump is a totally internal medical device connected to the arterial hepatic catheter during laparotomy., Results: The selection criteria were met in 47/319 studies. The complications of surgical and radiological medical devices connected to a port were found in 16 and 14 studies respectively. Meanwhile, complications with a fully implantable pump were reported in 17 studies. The total number of complications reported in studies evaluating patients with surgical or radiological catheter were 322 (322/948, 34%) and 261 (261/722, 36.1%) respectively. In studies evaluating patients with a fully implantable pump, the total number of complications was 237 (237/1502, 15.8%). In 18/319 studies the number of cycles was reported. The median number of cycles with surgically and radiologically implanted catheters was 8 and 6 respectively. The fully implantable pump allows a median number of 12 cycles., Conclusions: The fully implantable pump, maintaining a continuous infusion through the system, allows the lowest risk for thrombosis and infection and the best median number of cycles of loco-regional chemotherapy in HAI.

Diffuse hepatic haemangiomatosis is rare in adults. Association with high output intrahepatic arteriovenous fistulas has been described. To avoid heart failure complications, treatment is essential. The second case in the literature, treated with repeated transcatheter arterial embolizations (TAE) but complicated by infection of multiple haemangiomas and by Kasabach-Merritt syndrome, is presented. Complications were due to the persistent presence of haemangiomas within the liver, where an impressive collection of platelets and a superinfection were observed. Therefore, to treat arteriovenous fistula-related problems and to prevent possible complications due to persistence of the haemangiomas, surgical removal should be preferred over embolisation.

Arterial infusion or perfusion are currently used to treat hepatic tumours, head and neck malignancy, melanomas and sarcomas of the limbs. An experimental study with epirubicin and cis-platinum infused into the hepatic artery was performed. Epirubicin was injected via the systemic vein or the hepatic artery in 27 rats. Cis-platinum was injected via a systemic route or the hepatic artery in 29 rats. Drug concentrations were evaluated in liver and tumour tissues. In the rats the tumour tissue drug concentration after hepatic artery infusion was 6- and 4-fold higher than with systemic infusion for epirubicin and cis-platinum, respectively. Arterial administration appeared to be better than systemic in terms of drug concentration within the tumours and systemic toxicity.

Adrenalectomy represents the gold standard treatment for hyperfunctioning adrenal incidentaloma. In cases of silent adrenal masses, on the other hand, the surgical removal of an adrenocortical cancer entails the sacrifice of a large number of safe benign masses, and in most cases surgery is therefore unjustified. The aim of this paper was to clarify the surgical indications for adrenal incidentaloma by reviewing our experience in comparison with the main reference literature. Over the period from 1995 to 2001 we managed 40 cases of incidentaloma. US and CT abdominal scans, adrenal scintigraphy and biochemical tests were performed on an outpatient basis. Seven pre-Cushing syndromes were removed. Ten incidentalomas measured 4 cm or more in diameter: 5 of these were operated on and in 5 cases surgery was not feasible or was refused. Only one malignant mass was detected (an angiosarcoma). Four postoperative minimal complications (18.7%) were observed. The follow-up (median: 48 months) was uneventful. The surgical approach was traditional in 11 cases and laparoscopic in 1 case. Surgery should be considered mandatory in cases of hyperfunctioning adrenal masses in the presence of suspect radiological evidence, in cases of discordant CT and scintigraphy findings and when the maximum diameter is 4 cm or more.