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2. Intraperitoneal drain placement and outcomes after elective colorectal surgery: International matched, prospective, cohort study
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Sgro A., Blanco-Colino R., Ahmed W. U. R., Brindl N., Gujjuri R. R., Lapolla P., Mills E. C., Perez-Ajates S., Soares A. S., Varghese C., Xu W., McLean K. A., Chapman S. J., Espin-Basany E., Glasbey J. C., Mihaljevic A., Nepogodiev D., Pata F., Pellino G., Pockney P., Dudi-Venkata N. N., Egoroff N., Ludbrook I., Raubenheimer K., Richards T., Delibegovic S., Salibasic M., Amjad T., Dorr-Harim C., Gedeon N., Gsenger J., Tachezy M., Bini S., Gallo G., Gori A., Picciariello A., Podda M., Riboni C., Machatschek M. J., Nguyen A., Jakubauskas M., Kryzauskas M., Poskus T., Kuiper S. Z., Wang J., Wells C. I., Bissett I. P., Augestad K. M., Steinholt I., Vieira B. N., Juloski J., Anabitarte Bautista O., El Kasmy El Kasmy Y., Martin-Borregon P., Ossola Revilla M., Van Straten S., Aktas M. K., Baki B. E., Akhbari M., Baker D., Bhatia S., Brown S., Cambridge W., Kamarajah S. K., Khaw R. A., Kouli O., Murray V., Trout I., Yasin I., Wong J. Y., Reyhani H., Wong K. H. F., Pancharatnam R., Chia W. L., Walmsley A., Hassane A., Saeed D., Wang B., Walters B., Nowinka Z., Alsaif A., Mirza M., Foster K., Luu J., Kakodkar P., Hughes J. T., Yogarajah T., Antypas A., Rahman A., Bradbury M., McLarnon M., Nagi S., Riad A. M., Erotocritou M., Kyriacou H., Kaminskaite V., Alfadhel S., Fatimah Hussain Q., Handa A., Massy-Westropp C., Custovic S., Dimov R., Mughal H., Slavchev M., Ivanov T., Gouvas N., Hegazi A., Kocian P., Kjaer M. D., Mark-Christensen A., Papakonstantinou D., Machairas N., Triantafyllou T., Garoufalia Z., Korkolis D., Castaldi A., Giaccari S., Spolverato G., Pagano G., Milone M., Turri G., Colombo F., Cucinotta E., Poillucci G., Perra T., Tutino R., Belia F., Coletta D., Belli A., Rega D., Cianci P., Pirozzolo G., Di Lena M., Perrone F., Giani A., Lovisetto F., Grassia M., Pipitone Federico N. S., Ferrara F., Biancafarina A., Tamini N., Sinibaldi G., Tuminello F., Galleano R., Sasia D., Bragaglia L., de Manzoni Garberini A., Pesce A., Cassaro F., Venturelli P., Canu G. L., Esposito G., Campanelli M., Cardia R., Ricciardiello M., Sagnotta A., Canonico G., De Marco G., Cappiello A., Pinotti E., Carlei F., Lisi G., Bagaglini G., Farrugia M., Meima-Van Praag E. M., Monteiro C., Pereira M., Botelho P., Quigley A., O'Neill A., Gaule L., Crone L., Arnold A., Grama F., Beuca A., Tulina I., Litvin A., Panyko A., Ossola M. E., Trujillo Diaz J., Marin Santos J. M., Alonso Batanero E., Gortazar de las Casas S., Soldevila Verdeguer C., Colas-Ruiz E., Talal El-Abur I., Garcia Dominguez M., Delorme M., Sauvain M., Ozmen B. B., Ozkan B. B., Calikoglu F., Kural S., Zafer F., Kaya Y., Yalcinkaya A., Kargici K., Tepe M. D., Tatar O. C., Kabadayi E., Yildirim A., Hurmuzlu D., Korkmaz K., Sharma P., Troller R., Hagan N., Mooney J., Light A., Tansey M., Bhojwani D., McGing R. M., Mallon A., Fadel M., Spilsbury C., James R., O'Brien S., Isaac A., Balasubramanya S., Sadik H., Gala T., Chen J. Y., Turner B., Goh E., Hassan K., Karam M., Mason P., Tzoumas N., Noton T., Seehra J. K., Ahmed N., Motiwale R., Tanna V., Argyriou A., Bylapudi S. K., Grace N., Latif S., Hounat A., Kiam J. S., Zaidi M., Elsamani K., Hughes C., Suresh A., Sinan L. O. H., El-Dalil D., Khoo E. J. M., Salim E. E., Stark D., Minhas N., Fowler G., Rees E., Giudiceandrea I., Bardon A., Jayawardena P., Dieseru N., Murphy A., Yates C., Ziolkowska K., Rafie A., Khoda F., Okocha M., Ashdown T., Vitish-Sharma P., Gilliland J., Toh S., Jones K., Devine A., Berry A., McDonnell S., Olivier J., Richardson G., Lim H. J., Slim N., Elsayeh K., Sammour T., Sarpanov A., Belev N., Dimitrov D., Dusek T., Ntomi V., Sotiropoulos G. C., Theodorou D., Nikiteas N., Balalis D., Antropoli C., Altomare D. F., Luglio G., De Palma G. D., Pedrazzani C., Simonelli L., Brozzetti S., Porcu A., Massani M., Grazi G. L., Izzo F., Delrio P., Restini E., Chetta G., Lantone G., Ferrari G., Lucchi A., De Prizio M., Caristo G., Borghi F., Petrucciani N., Huscher C., Cocorullo G., Tonini V., Medas F., Sica G., Cillara N., Anastasi A., Bianco F., Giuliani A., Carlini M., Selvaggi F., Sammarco G., Ozolins A., Malasonoks A., Andrejevic P., Tanis P., van de Ven A., Gerhards M., Ribeiro da Silva B., Silva A., Lima M. J., Kavanagh D., McCawley N., Bintintan V., Karamarkovic A., Sanz Ortega G., De Andres-Asenjo B., Nevado Garcia C., Garcia Florez L. J., Segura-Sampedro J. J., Blas Laina J. L., Ponchietti L., Buchwald P., Gialamas E., Ozben V., Rencuzogullari A., Gecim I. E., Altinel Y., Isik O., Yoldas T., Isik A., Leventoglu S., Erturk M. S., Guner A., Guler S. A., Attaallah W., Ugur M., Ozbalci G. S., Marzook H., Eardley N., Smolarek S., Morgan R., Roxburgh C., Lala A. K., Salama Y., Singh B., Khanna A., Evans M., Shaikh I., Maradi Thippeswamy K., Appleton B., Moug S., Smith I., Smart N., Shah P., Williams G., Khera G., Goede A., Varcada M., Parmar C., Duff S., Hargest R., Marriott P., Speake D., Ben Sassi A., Furfaro B., Daudu D., Golijanin N., Yek W. Y., Capasso G., Mansour L. T., Niu N., Seow W., Hamidovic A., Kulovic E., Letic E., Aljic A., Helez M., Banji-Kelan A., Dimitrova N., Kavradjieva P., Ivanov V., Jukaku A., Hadzhiev D., Gabarski A., Karamanliev M., Vladova P., Iliev S., Yotsov T., Vetsa K., Stavrinidou O., Papatheodorou P., Liassides T., Georgiou T., Al Nassrallah M., Altaf R., Negametzyanov M., Zagibova D., Foltys F., Stefanova H., Paspala A., Bompetsi G., Sidiropoulos T., Stamopoulos P., Triantafyllou A., Theodoropoulos C., Kimpizi A., Palyvou T., Charalabopoulos A., Syllaios A., Schizas D., Liatsou E., Baili E., Vagios I., Tomara N., Davakis S., Palumbo A., Foroni F., Dibra R., Papagni V., Urbani A., Rossin E., Nezi G., Romano P., Amendola A., Esposito E., Manigrasso M., Anoldo P., Vertaldi S., Gecchele G., Sabrina Z. S., Guerci C., Cammarata F., Lamperti G. M. B., Zaffaroni G., Benuzzi L., Ferrario L., Cigognini M., Mazzeo C., Badessi G., Pintabona G., Fassari A., Mingoli A., Cirillo B., D'Alterio C., Brachini G., Tancredi M., Zambon M., Aulicino M., Sapienza P., Liberatore P., Scanu A. M., Feo C. F., Iacomino A., Pelizzo P., Rossi S., Vigna S. A., Grossi U., Grillo V., Agnes A., Schena C. A., Marincola G., Oddi A., Perotti B., Mario V., Perri P., Zazza S., Aversano A., Scala D., Di Lauro K., Leongito M., Piccirillo M., Patrone R., Capuzzolo S., Vignotto C., Bao Q. R., Giuseppe C., Angarano E., Marino F., Pezzolla F., Gigante G., Magistro C., Crippa J., Maspero M., Carnevali P., Trapani R., Zonta S., Agostinelli L., Vittori L., Romeo L., Doria E., Farnesi F., Danna R., Andolfi E., Pellicano' G. A., Angelini M., Scricciolo M., Zanframundo C., Ciulli C., Ripamonti L., Cigagna L., Oldani M., Larcinese A., Rossi D., Picone E., Crescentini G., Marano A., Migliore M., Giuffrida M. 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S., Top C., Detering R., Matos C., Silva C., Pinto D., Mendes J., Couto J., Leite M., Velez C., Damasio Cotovio M., Cinza A. M., Pedroso de Lima R., Boyle E., Yang H. W., Banerjee I., Rahmat S., Afzal Z., Reid C., Dumitrascu F., Croyle J. A., Gressmann K., Cullen N., Graham A., Nasehi A., Montano King C., Martin B., Stokell C., Sanderson N., Farnan R., Jassim S., Chan B., Chua Vi Long K., Kaka N., Pandey S., Neo W. X., Chitul A., Bezede C., Cincilei D., David A., Blaga M., Blaga S. N., Fagarasan V., Khetagurova M., Rodimov S., Kapustina A., Mekhralyzade A., Zabiyaka M., Jankovic U., Cuk V., Hajska M., Dubovsky M., Hrosova M., Ferancikova N., Camarero Rodriguez E., Laguna Alcantara F., Adarraga J., Jezieniecki C., Ruiz Soriano M., Gomez Sanz T., Suarez A., Sanchez Garcia C., Cifrian Canales I., Llosa Perez J., Merayo M., Urbieta A., Gegundez Simon A., Tone J. 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H., Chohan N., Thaker A., Thompson B., Ahari D., Burdekin E., Okwu U., Akintunde A., Lhaf F., Douthwaite J., Govindan R., Leelamanthep S., Gull E., Wright F., Dundas L., Mackdermott N., Burchi-Khairy T., Campbell I., Walsh J., Yeo J. Y., Meehan S., Banerjee D., Fu M., Kawka M., Ali T., Hussain Z., Thomas C., Ahmad H., Moroney J., Yick C., Risquet R., Ntuiabane D., Shimato M., Khan M., Ilangovan S., Vaselli N. M., Smithers R., Uhanowita Marage R., Valnarov-Boulter A., Kayran J., Banerjee M., Parekh-Hill N., Hooper A., Bowen J., Jagdish R., McQuoid C., Khan N., O'Hare R., Jeffery S., Zahid A., Elsworth C., Walter L., Dhillon S., Rao S., Anthony A., Ashaye A., Phillips N., Faderani R., Pengelly S., Choi S., Kwak S. Y., Lau Y. H. L., Bagheri K., Ong D. Y. C., Kerr E., Falconer K., Clancy N., Douglas S., Zhang Y., Greenfield F., Mutanga I., McAlinden J., Willis L., Adefolaju A., Agarwal H., Barter R., Harris G., Spencer G., Lee M. W., Vadiveloo V. T., Herbert G., Patel R., Shah M., El Falaha S., Wong C., Soare C., Akram J., Bozhkova L., Ma Y., Vo U. G., Tan H. W. N., Leto L., Kamal M. A., Hadzhieva E., Krastev P., Tonchev P., Kokkinos G., Pozotou I., Sabbagh D., Votava J., St F., Koliakos N., Tsaparas P., Zografos G., Mantas D., Tsourouflis G., Fradelos E., Trigiante G., Labellarte G., Resta G., Capelli G., D'Amore A., Verlingieri V., Campagnaro T., Maffioli A., Viscosi F., De Lucia C., Meneghini S., Fancellu A., Colella M., Biondi A., De Peppo V., Pace U., Albino V., Gattulli D., Piangerelli A., Kalivaci D., Sisto G., Mazzola M., Caneparo A., Lunghi E. G., Nespoli L. C., Angrisani M., Langone A., Gelarda E., Virgilio E., Angelini E., Fornasier C., Asero S., Filippone E., Frongia F., Calo P. G., Panaccio P., Ipponi P., Gili S., Braccio B., Tiesi V., Stolcers K., Kokaine L., Novikovs V., Capel L., Bastiaenen V., Heijmans H., Henriques S., Gan S. Z., Ramanayake H., Nolan M., Temperley H., Ciofic E., Pop B. A., Kurtenkov M., Jovanovic M., Vician M., Egea Arias P., Beltran de Heredia J., Labalde Martinez M., De Santiago Alvarez I., Alvarez-Gallego M., Rodriguez Artigas J. M., Dwidar O., Korkmaz H. K., Eray I. C., Meric S., Aydin R., Cetin B., Karaca B. E., Kuyumcu O. F., Yuksel E., Uprak T. K., Karabulut K., Kavukcu E., Mansor A., Hackett R., Zammit-Maempel M., Sabaratnam R., Maan A., Ferarrio I., Dixon L., Halai H., Sethi S., Nelson L., Grassam-Rowe A., Krishnan E., Deeny D., McKeever M., George Pandeth A., Dhavala P., Sreenivasan S., Sundaram Venkatesan G., Zhu L., Atiyah Z., Gregory J., Morey T., Seymour Z., Holdsworth L., Abdelmahmoud S., Bourhill J., Bisheet G., Shaw J., Kulkarni K., Kumarakulasingam P., Pillay S., Al-Habsi R., Kungwengwe G., Richards J., Davoudi K., Ibrahim B., Tailor B., Zayed M., Chen F., Bailey S., Sheefat S., Nawaz G., Pawar R., Marsh S., Sam Z. H., Roy Bentley S., Simpson C., Hughes J., Lim Y., Ooi R., Toh W. H., Mannion P., Lovett A., Kincius A., Hussein S., Kirby E., Beckett R. G., Salmon J., Glynn T., Choo S. Y., Lyons S., Browne D., Ravindran W., Ahmad S., Zhu X., McNulty J., McCarthy L., Ng J., Karmally Z., McTeir K., Hanna M., Tan E., Namdeo S., Schembri R., Pusey E., Sgro A., Blanco-Colino R., Ahmed W.U.R., Brindl N., Gujjuri R.R., Lapolla P., Mills E.C., Perez-Ajates S., Soares A.S., Varghese C., Xu W., McLean K.A., Chapman S.J., Espin-Basany E., Glasbey J.C., Mihaljevic A., Nepogodiev D., Pata F., Pellino G., Pockney P., Dudi-Venkata N.N., Egoroff N., Ludbrook I., Raubenheimer K., Richards T., Delibegovic S., Salibasic M., Amjad T., Dorr-Harim C., Gedeon N., Gsenger J., Tachezy M., Bini S., Gallo G., Gori A., Picciariello A., Podda M., Riboni C., Machatschek M.J., Nguyen A., Jakubauskas M., Kryzauskas M., Poskus T., Kuiper S.Z., Wang J., Wells C.I., Bissett I.P., Augestad K.M., Steinholt I., Vieira B.N., Juloski J., Anabitarte Bautista O., El Kasmy El Kasmy Y., Martin-Borregon P., Ossola Revilla M., Van Straten S., Aktas M.K., Baki B.E., Akhbari M., Baker D., Bhatia S., Brown S., Cambridge W., Kamarajah S.K., Khaw R.A., Kouli O., Murray V., Trout I., Yasin I., Wong J.Y., Reyhani H., Wong K.H.F., Pancharatnam R., Chia W.L., Walmsley A., Hassane A., Saeed D., Wang B., Walters B., Nowinka Z., Alsaif A., Mirza M., Foster K., Luu J., Kakodkar P., Hughes J.T., Yogarajah T., Antypas A., Rahman A., Bradbury M., McLarnon M., Nagi S., Riad A.M., Erotocritou M., Kyriacou H., Kaminskaite V., Alfadhel S., Fatimah Hussain Q., Handa A., Massy-Westropp C., Custovic S., Dimov R., Mughal H., Slavchev M., Ivanov T., Gouvas N., Hegazi A., Kocian P., Kjaer M.D., Mark-Christensen A., Papakonstantinou D., Machairas N., Triantafyllou T., Garoufalia Z., Korkolis D., Castaldi A., Giaccari S., Spolverato G., Pagano G., Milone M., Turri G., Colombo F., Cucinotta E., Poillucci G., Perra T., Tutino R., Belia F., Coletta D., Belli A., Rega D., Cianci P., Pirozzolo G., Di Lena M., Perrone F., Giani A., Lovisetto F., Grassia M., Pipitone Federico N.S., Ferrara F., Biancafarina A., Tamini N., Sinibaldi G., Tuminello F., Galleano R., Sasia D., Bragaglia L., de Manzoni Garberini A., Pesce A., Cassaro F., Venturelli P., Canu G.L., Esposito G., Campanelli M., Cardia R., Ricciardiello M., Sagnotta A., Canonico G., De Marco G., Cappiello A., Pinotti E., Carlei F., Lisi G., Bagaglini G., Farrugia M., Meima-Van Praag E.M., Monteiro C., Pereira M., Botelho P., Quigley A., O'Neill A., Gaule L., Crone L., Arnold A., Grama F., Beuca A., Tulina I., Litvin A., Panyko A., Ossola M.E., Trujillo Diaz J., Marin Santos J.M., Alonso Batanero E., Gortazar de las Casas S., Soldevila Verdeguer C., Colas-Ruiz E., Talal El-Abur I., Garcia Dominguez M., Delorme M., Sauvain M., Ozmen B.B., Ozkan B.B., Calikoglu F., Kural S., Zafer F., Kaya Y., Yalcinkaya A., Kargici K., Tepe M.D., Tatar O.C., Kabadayi E., Yildirim A., Hurmuzlu D., Korkmaz K., Sharma P., Troller R., Hagan N., Mooney J., Light A., Tansey M., Bhojwani D., McGing R.M., Mallon A., Fadel M., Spilsbury C., James R., O'Brien S., Isaac A., Balasubramanya S., Sadik H., Gala T., Chen J.Y., Turner B., Goh E., Hassan K., Karam M., Mason P., Tzoumas N., Noton T., Seehra J.K., Ahmed N., Motiwale R., Tanna V., Argyriou A., Bylapudi S.K., Grace N., Latif S., Hounat A., Kiam J.S., Zaidi M., Elsamani K., Hughes C., Suresh A., Sinan L.O.H., El-Dalil D., Khoo E.J.M., Salim E.E., Stark D., Minhas N., Fowler G., Rees E., Giudiceandrea I., Bardon A., Jayawardena P., Dieseru N., Murphy A., Yates C., Ziolkowska K., Rafie A., Khoda F., Okocha M., Ashdown T., Vitish-Sharma P., Gilliland J., Toh S., Jones K., Devine A., Berry A., McDonnell S., Olivier J., Richardson G., Lim H.J., Slim N., Elsayeh K., Sammour T., Sarpanov A., Belev N., Dimitrov D., Dusek T., Ntomi V., Sotiropoulos G.C., Theodorou D., Nikiteas N., Balalis D., Antropoli C., Altomare D.F., Luglio G., De Palma G.D., Pedrazzani C., Simonelli L., Brozzetti S., Porcu A., Massani M., Grazi G.L., Izzo F., Delrio P., Restini E., Chetta G., Lantone G., Ferrari G., Lucchi A., De Prizio M., Caristo G., Borghi F., Petrucciani N., Huscher C., Cocorullo G., Tonini V., Medas F., Sica G., Cillara N., Anastasi A., Bianco F., Giuliani A., Carlini M., Selvaggi F., Sammarco G., Ozolins A., Malasonoks A., Andrejevic P., Tanis P., van de Ven A., Gerhards M., Ribeiro da Silva B., Silva A., Lima M.J., Kavanagh D., McCawley N., Bintintan V., Karamarkovic A., Sanz Ortega G., De Andres-Asenjo B., Nevado Garcia C., Garcia Florez L.J., Segura-Sampedro J.J., Blas Laina J.L., Ponchietti L., Buchwald P., Gialamas E., Ozben V., Rencuzogullari A., Gecim I.E., Altinel Y., Isik O., Yoldas T., Isik A., Leventoglu S., Erturk M.S., Guner A., Guler S.A., Attaallah W., Ugur M., Ozbalci G.S., Marzook H., Eardley N., Smolarek S., Morgan R., Roxburgh C., Lala A.K., Salama Y., Singh B., Khanna A., Evans M., Shaikh I., Maradi Thippeswamy K., Appleton B., Moug S., Smith I., Smart N., Shah P., Williams G., Khera G., Goede A., Varcada M., Parmar C., Duff S., Hargest R., Marriott P., Speake D., Ben Sassi 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S., Ferrara, F., Biancafarina, A., Tamini, N., Sinibaldi, G., Tuminello, F., Galleano, R., Sasia, D., Bragaglia, L., de Manzoni Garberini, A., Pesce, A., Cassaro, F., Venturelli, P., Canu, G. L., Esposito, G., Campanelli, M., Cardia, R., Ricciardiello, M., Sagnotta, A., Canonico, G., De Marco, G., Cappiello, A., Pinotti, E., Carlei, F., Lisi, G., Bagaglini, G., Farrugia, M., Meima-Van Praag, E. M., Monteiro, C., Pereira, M., Botelho, P., Quigley, A., O'Neill, A., Gaule, L., Crone, L., Arnold, A., Grama, F., Beuca, A., Tulina, I., Litvin, A., Panyko, A., Ossola, M. E., Trujillo Diaz, J., Marin Santos, J. M., Alonso Batanero, E., Gortazar de las Casas, S., Soldevila Verdeguer, C., Colas-Ruiz, E., Talal El-Abur, I., Garcia Dominguez, M., Delorme, M., Sauvain, M., Ozmen, B. B., Ozkan, B. B., Calikoglu, F., Kural, S., Zafer, F., Kaya, Y., Yalcinkaya, A., Kargici, K., Tepe, M. D., Tatar, O. C., Kabadayi, E., Yildirim, A., Hurmuzlu, D., Korkmaz, K., Sharma, P., Troller, R., Hagan, N., Mooney, J., Light, A., Tansey, M., Bhojwani, D., Mcging, R. M., Mallon, A., Fadel, M., Spilsbury, C., James, R., O'Brien, S., Isaac, A., Balasubramanya, S., Sadik, H., Gala, T., Chen, J. Y., Turner, B., Goh, E., Hassan, K., Karam, M., Mason, P., Tzoumas, N., Noton, T., Seehra, J. K., Ahmed, N., Motiwale, R., Tanna, V., Argyriou, A., Bylapudi, S. K., Grace, N., Latif, S., Hounat, A., Kiam, J. S., Zaidi, M., Elsamani, K., Hughes, C., Suresh, A., Sinan, L. O. H., El-Dalil, D., Khoo, E. J. M., Salim, E. E., Stark, D., Minhas, N., Fowler, G., Rees, E., Giudiceandrea, I., Bardon, A., Jayawardena, P., Dieseru, N., Murphy, A., Yates, C., Ziolkowska, K., Rafie, A., Khoda, F., Okocha, M., Ashdown, T., Vitish-Sharma, P., Gilliland, J., Toh, S., Jones, K., Devine, A., Berry, A., Mcdonnell, S., Olivier, J., Richardson, G., Lim, H. J., Slim, N., Elsayeh, K., Sammour, T., Sarpanov, A., Belev, N., Dimitrov, D., Dusek, T., Ntomi, V., Sotiropoulos, G. C., Theodorou, D., Nikiteas, N., Balalis, D., Antropoli, C., Altomare, D. F., Luglio, G., De Palma, G. D., Pedrazzani, C., Simonelli, L., Brozzetti, S., Porcu, A., Massani, M., Grazi, G. L., Izzo, F., Delrio, P., Restini, E., Chetta, G., Lantone, G., Ferrari, G., Lucchi, A., De Prizio, M., Caristo, G., Borghi, F., Petrucciani, N., Huscher, C., Cocorullo, G., Tonini, V., Medas, F., Sica, G., Cillara, N., Anastasi, A., Bianco, F., Giuliani, A., Carlini, M., Selvaggi, F., Sammarco, G., Ozolins, A., Malasonoks, A., Andrejevic, P., Tanis, P., van de Ven, A., Gerhards, M., Ribeiro da Silva, B., Silva, A., Lima, M. J., Kavanagh, D., Mccawley, N., Bintintan, V., Karamarkovic, A., Sanz Ortega, G., De Andres-Asenjo, B., Nevado Garcia, C., Garcia Florez, L. J., Segura-Sampedro, J. J., Blas Laina, J. L., Ponchietti, L., Buchwald, P., Gialamas, E., Ozben, V., Rencuzogullari, A., Gecim, I. E., Altinel, Y., Isik, O., Yoldas, T., Isik, A., Leventoglu, S., Erturk, M. S., Guner, A., Guler, S. A., Attaallah, W., Ugur, M., Ozbalci, G. S., Marzook, H., Eardley, N., Smolarek, S., Morgan, R., Roxburgh, C., Lala, A. K., Salama, Y., Singh, B., Khanna, A., Evans, M., Shaikh, I., Maradi Thippeswamy, K., Appleton, B., Moug, S., Smith, I., Smart, N., Shah, P., Williams, G., Khera, G., Goede, A., Varcada, M., Parmar, C., Duff, S., Hargest, R., Marriott, P., Speake, D., Ben Sassi, A., Furfaro, B., Daudu, D., Golijanin, N., Yek, W. Y., Capasso, G., Mansour, L. T., Niu, N., Seow, W., Hamidovic, A., Kulovic, E., Letic, E., Aljic, A., Helez, M., Banji-Kelan, A., Dimitrova, N., Kavradjieva, P., Ivanov, V., Jukaku, A., Hadzhiev, D., Gabarski, A., Karamanliev, M., Vladova, P., Iliev, S., Yotsov, T., Vetsa, K., Stavrinidou, O., Papatheodorou, P., Liassides, T., Georgiou, T., Al Nassrallah, M., Altaf, R., Negametzyanov, M., Zagibova, D., Foltys, F., Stefanova, H., Paspala, A., Bompetsi, G., Sidiropoulos, T., Stamopoulos, P., Triantafyllou, A., Theodoropoulos, C., Kimpizi, A., Palyvou, T., Charalabopoulos, A., Syllaios, A., Schizas, D., Liatsou, E., Baili, E., Vagios, I., Tomara, N., Davakis, S., Palumbo, A., Foroni, F., Dibra, R., Papagni, V., Urbani, A., Rossin, E., Nezi, G., Romano, P., Amendola, A., Esposito, E., Manigrasso, M., Anoldo, P., Vertaldi, S., Gecchele, G., Sabrina, Z. S., Guerci, C., Cammarata, F., Lamperti, G. M. B., Zaffaroni, G., Benuzzi, L., Ferrario, L., Cigognini, M., Mazzeo, C., Badessi, G., Pintabona, G., Fassari, A., Mingoli, A., Cirillo, B., D'Alterio, C., Brachini, G., Tancredi, M., Zambon, M., Aulicino, M., Sapienza, P., Liberatore, P., Scanu, A. M., Feo, C. F., Iacomino, A., Pelizzo, P., Rossi, S., Vigna, S. A., Grossi, U., Grillo, V., Agnes, A., Schena, C. A., Marincola, G., Oddi, A., Perotti, B., Mario, V., Perri, P., Zazza, S., Aversano, A., Scala, D., Di Lauro, K., Leongito, M., Piccirillo, M., Patrone, R., Capuzzolo, S., Vignotto, C., Bao, Q. R., Giuseppe, C., Angarano, E., Marino, F., Pezzolla, F., Gigante, G., Magistro, C., Crippa, J., Maspero, M., Carnevali, P., Trapani, R., Zonta, S., Agostinelli, L., Vittori, L., Romeo, L., Doria, E., Farnesi, F., Danna, R., Andolfi, E., Pellicano', G. A., Angelini, M., Scricciolo, M., Zanframundo, C., Ciulli, C., Ripamonti, L., Cigagna, L., Oldani, M., Larcinese, A., Rossi, D., Picone, E., Crescentini, G., Marano, A., Migliore, M., Giuffrida, M. C., Palagi, S., Testa, V., Borrello, A., Lucarini, A., Garofalo, E., Canali, G., Orlandi, P., Nervegna, F., Marchegiani, F., Damoli, I., Licata, A., Trovato, C., Alicata, F., Sardo, F., Milazzo, M., Randisi, B., Dominici, D. M., Sartarelli, L., Zanni, M., Pisanu, A., Soddu, C., Delogu, D., Erdas, E., Campus, F., Cappellacci, F., Casti, F., Marcialis, J., Atzeni, J., Podda, M. G., Sensi, B., Franceschilli, M., Bellato, V., Cannavera, A., Putzu, G., di Mola, F. F., Picardi, B., Solinas, L., Loponte, M., Rossi del Monte, S., Di Martino, C., Linari, C., Spagni, G., Capezzuoli, L., Tirloni, L., Nelli, T., Caridi, A., Elter, C., Camassa, M., D'Amico, S., Bargellini, T., Incollingo, P., Montuori, M., Maffione, F., Romano, L., Valiyeva, S., Spoletini, D., Menegon Tasselli, F., Sciaudone, G., Selvaggi, L., Menna, M. P., De Paola, G., Fulginiti, S., Truskovs, A., Weiss, C., Saknitis, G., Rauscher, J. T. R., Larnovskis, J., Jeyarajan-Davidsson, M., Nitisa, D., Gille, N., Reiser, S. C., Roshan, M. H. K., Leseman, C., Chen, J., van Dalen, A. S., Top, C., Detering, R., Matos, C., Silva, C., Pinto, D., Mendes, J., Couto, J., Leite, M., Velez, C., Damasio Cotovio, M., Cinza, A. M., Pedroso de Lima, R., Boyle, E., Yang, H. W., Banerjee, I., Rahmat, S., Afzal, Z., Reid, C., Dumitrascu, F., Croyle, J. A., Gressmann, K., Cullen, N., Graham, A., Nasehi, A., Montano King, C., Martin, B., Stokell, C., Sanderson, N., Farnan, R., Jassim, S., Chan, B., Chua Vi Long, K., Kaka, N., Pandey, S., Neo, W. X., Chitul, A., Bezede, C., Cincilei, D., David, A., Blaga, M., Blaga, S. N., Fagarasan, V., Khetagurova, M., Rodimov, S., Kapustina, A., Mekhralyzade, A., Zabiyaka, M., Jankovic, U., Cuk, V., Hajska, M., Dubovsky, M., Hrosova, M., Ferancikova, N., Camarero Rodriguez, E., Laguna Alcantara, F., Adarraga, J., Jezieniecki, C., Ruiz Soriano, M., Gomez Sanz, T., Suarez, A., Sanchez Garcia, C., Cifrian Canales, I., Llosa Perez, J., Merayo, M., Urbieta, A., Gegundez Simon, A., Tone, J. F., Gazo Martinez, J., Vicario Bravo, M., Chavarrias, N., Gil Catalan, A., Oseira, A., Villalonga, B., Jeri, S., Perez Calvo, J., Nogues, A., Cros, B., Yanez, C., Utrilla Fornals, A., Roldon Golet, M., Colsa, P., Gimenez Maurel, T., Axmarker, T., Chevallay, M., Pham, T. V., Sel, E. K., Atar, C., Aba, M., Sarkin, M., Akkaya, Y. M., Durmaz, A. G., Gullu, H. F., Boga, A., Aktas, A., Bakar, B., Demirel, M. T., Hysejni, X., Taser, M., Guzel, O. R., Bozbiyik, O., Ozen, D., Olmez, M., Uyar, B., Gulcek, E., Kayacan, G. S., Atici, N., Gul, O. F., Altiner, S., Ibis, B., Altunsu, S., Banaz, T., Diler, C., Demirbas, I., Usta, M. A., Erkul, O., Orman, R., Salih, S., Utkan, N. Z., Acil, C., Ozgur, E., Maddahali, M., Turhan, A. B., Eskici, A. B., Ular, B., Dogru, M., Ozturk, O. U., Arslan, E. R., Panahi Sharif, A., Dikmen, E., Ates, J., Bircan, R., Cavus, T., Sever, A. E., Balak, B., Duman, E., Altay, L., Emanet, O., Cullen, F., Tan, J. Y., Nathan, A., Rottenberg, A., Williams, C. Y., Mitrofan, C. G., Xu, D., Bawa, J. H., Morris, P., Gordon, D., Richmond, G., Hui, J. C., Ighomereho, O., Rocks, R., Mccabe, S., Fitzpatrick, A., Nicoletti, J., Auterson, L., Darrah, N., Soh, V. W. Y., Ong, C. S., Utukuri, M., Gallagher, C., Stuart, L. M., Hipolito, M., Douglas, N., Ghazal, R., Parris, G., Catchpole, J., Bryden, M., Jamal, S., Karim, Z., Lyon-Dean, C., Rowley, G., Lee, K. S., Whitehurst, O., Mirza, A., Sheikh, F., Yousaf, H., Bilbao, J., Sinclair, R., Takar, S., Kressel, H., Chan, V., Schack, K., Osborne, R., Baldemor, S., Smyth, S., Gilmour, S., Ting, A., Bozonelou, I., Saunders, P., Qhaireel Anwar, Q. A., Tirimanna, R., Jauhari, S., Gardener, A., Walker, B., Wenban, C., Reddy, H., Conway-Jones, R., Loganathan, S., Clynch, A., James, C., Matey, E., Cameron, F., Roberts, W., Gicquel, A., Milliken, C., Forbes, J., Rubinchik, P., Azmi, A., Hawkes, C., Cornett, L., Adarkwah, P., Mcconville, R., O'Hara, S., Tijare, C., Parkes, J., Yao, L., Ahmad, R., Shafiq, U., Mhaisalkar, A., Gurung, A., de Stadler, K., Elias, S., Thomas, T., Madras, A., Jani, A., Daler, H. K., Tong, K. S., Sundaralingam, S. S., Szal, A., Khan, A., O'Sullivan, C., Baker, E., Joseph-Gubral, J., Hadley, E., Trivedi, R., Igwelaezoh, E., Barton, H., Allison, W., Hurst, W., Alam, F., Parkes, I., Jamshaid, M., Azizan, N., Burgher, T., Afzal, A., Eltilib, I., Zahid, M., Sadiq, O., Lloyd, A., Ho, R., Brazukas, A., Li, C. H., Kamdar, M., Mohamed Nazeer, M. N., Mighiu, A., Kim, D., Wilkins, L., Kuo, L., Rafe, T., Maduka, D., Cheema, H., Farag, K., Abdellatif, M., Nzewi, R., Kruczynska, A., Grasselli, H., Yousuff, M., Bassi, R., Mann, A. K., Chopra, J., Shaikh, M., Sa, D. S., Tsimplis, V., Ghanchi, A., Skene, E., Asim, K., Zaheer, M., Chan, S., Dalton, H., Gibbons, K., Adderley, O., Chukwujindu, I., Jayasuriya, I., Sivanu, K., Borumand, M., Chick, G., Bridges, I., Tomlin, J., Mckenna, J., Nandra, N., Grieco, C., Quek, F. F., Mercer, R., Brankin-Frisby, T., Sattar, A., Aslam, A., Edelsten, E., Shafi, S., Kouli, T., Ford, V., Gurung, F., Fernandes, M., Deader, N., Ponniah, R., Jamieson, S., Davies, A., Taubwurcel, J., Aung, M. T., Desai, R., Begum, S., Jamadar, T., Kangatharan, A., Rzeszowski, B., Ho, C., Yap, S. H. K., Prendergast, M., Sethi, R., Duku, A., Lowe, C., Bray, J., Ghobrial, M., Nichita, V., Wagstaff, A., Rengasamy, E., Abu Hassan, F., Mahmood, H., Savill, N., Shah, S., Almeida, T., Edwards, A., Catchpole, B., Halford, Z., Carmichael, A., Alsusa, H., Boyd, M., Williams, J., Feyi-Waboso, J., Patel, M., Zeidan, Z., Bailey, E., Bapty, J., Brazkiewicz, M., Tremlett, A., Pringle, H., Mankal, S., Chung, W., Parry-Jones, E., Anderson, K., Mcforrester, A., Stanley, A., Hoather, A., Wise, H., Laid, I., Scriven, J., Braniste, A., Wilson, A., Le Blevec, L., Pakunwanich, N., Evans, N., Chong, H. L., White, C., Hunter, J., Haque, M., Vanalia, P., Murdoch, S., Choudhary, T., Mccann, A., Harun, A., Shah, H., Hunt, S., Shafiq, Y., Bickley-Morris, E., Emms, L., Dare, M., Akula, Y., Deliyannis, E., Mayes, F., Ellacott, M., Zagorac, Z., Farren, A., Manning, C., Hughed, C., Stewart, E. G., Lim, K. H., Chohan, N., Thaker, A., Thompson, B., Ahari, D., Burdekin, E., Okwu, U., Akintunde, A., Lhaf, F., Douthwaite, J., Govindan, R., Leelamanthep, S., Gull, E., Wright, F., Dundas, L., Mackdermott, N., Burchi-Khairy, T., Campbell, I., Walsh, J., Yeo, J. Y., Meehan, S., Banerjee, D., Fu, M., Kawka, M., Ali, T., Hussain, Z., Thomas, C., Ahmad, H., Moroney, J., Yick, C., Risquet, R., Ntuiabane, D., Shimato, M., Khan, M., Ilangovan, S., Vaselli, N. M., Smithers, R., Uhanowita Marage, R., Valnarov-Boulter, A., Kayran, J., Banerjee, M., Parekh-Hill, N., Hooper, A., Bowen, J., Jagdish, R., Mcquoid, C., Khan, N., O'Hare, R., Jeffery, S., Zahid, A., Elsworth, C., Walter, L., Dhillon, S., Rao, S., Anthony, A., Ashaye, A., Phillips, N., Faderani, R., Pengelly, S., Choi, S., Kwak, S. Y., Lau, Y. H. L., Bagheri, K., Ong, D. Y. C., Kerr, E., Falconer, K., Clancy, N., Douglas, S., Zhang, Y., Greenfield, F., Mutanga, I., Mcalinden, J., Willis, L., Adefolaju, A., Agarwal, H., Barter, R., Harris, G., Spencer, G., Lee, M. W., Vadiveloo, V. T., Herbert, G., Patel, R., Shah, M., El Falaha, S., Wong, C., Soare, C., Akram, J., Bozhkova, L., Ma, Y., Vo, U. G., Tan, H. W. N., Leto, L., Kamal, M. A., Hadzhieva, E., Krastev, P., Tonchev, P., Kokkinos, G., Pozotou, I., Sabbagh, D., Votava, J., St, F., Koliakos, N., Tsaparas, P., Zografos, G., Mantas, D., Tsourouflis, G., Fradelos, E., Trigiante, G., Labellarte, G., Resta, G., Capelli, G., D'Amore, A., Verlingieri, V., Campagnaro, T., Maffioli, A., Viscosi, F., De Lucia, C., Meneghini, S., Fancellu, A., Colella, M., Biondi, A., De Peppo, V., Pace, U., Albino, V., Gattulli, D., Piangerelli, A., Kalivaci, D., Sisto, G., Mazzola, M., Caneparo, A., Lunghi, E. G., Nespoli, L. C., Angrisani, M., Langone, A., Gelarda, E., Virgilio, E., Angelini, E., Fornasier, C., Asero, S., Filippone, E., Frongia, F., Calo, P. G., Panaccio, P., Ipponi, P., Gili, S., Braccio, B., Tiesi, V., Stolcers, K., Kokaine, L., Novikovs, V., Capel, L., Bastiaenen, V., Heijmans, H., Henriques, S., Gan, S. Z., Ramanayake, H., Nolan, M., Temperley, H., Ciofic, E., Pop, B. A., Kurtenkov, M., Jovanovic, M., Vician, M., Egea Arias, P., Beltran de Heredia, J., Labalde Martinez, M., De Santiago Alvarez, I., Alvarez-Gallego, M., Rodriguez Artigas, J. M., Dwidar, O., Korkmaz, H. K., Eray, I. C., Meric, S., Aydin, R., Cetin, B., Karaca, B. E., Kuyumcu, O. F., Yuksel, E., Uprak, T. K., Karabulut, K., Kavukcu, E., Mansor, A., Hackett, R., Zammit-Maempel, M., Sabaratnam, R., Maan, A., Ferarrio, I., Dixon, L., Halai, H., Sethi, S., Nelson, L., Grassam-Rowe, A., Krishnan, E., Deeny, D., Mckeever, M., George Pandeth, A., Dhavala, P., Sreenivasan, S., Sundaram Venkatesan, G., Zhu, L., Atiyah, Z., Gregory, J., Morey, T., Seymour, Z., Holdsworth, L., Abdelmahmoud, S., Bourhill, J., Bisheet, G., Shaw, J., Kulkarni, K., Kumarakulasingam, P., Pillay, S., Al-Habsi, R., Kungwengwe, G., Richards, J., Davoudi, K., Ibrahim, B., Tailor, B., Zayed, M., Chen, F., Bailey, S., Sheefat, S., Nawaz, G., Pawar, R., Marsh, S., Sam, Z. H., Roy Bentley, S., Simpson, C., Hughes, J., Lim, Y., Ooi, R., Toh, W. H., Mannion, P., Lovett, A., Kincius, A., Hussein, S., Kirby, E., Beckett, R. G., Salmon, J., Glynn, T., Choo, S. Y., Lyons, S., Browne, D., Ravindran, W., Ahmad, S., Zhu, X., Mcnulty, J., Mccarthy, L., Ng, J., Karmally, Z., Mcteir, K., Hanna, M., Tan, E., Namdeo, S., Schembri, R., and Pusey, E.
- Subjects
Adult ,Elective Surgical Procedure ,Aged ,Cohort Studies ,Drainage ,Elective Surgical Procedures ,Female ,Humans ,Postoperative Complications ,Prospective Studies ,Surgical Wound Infection ,Colorectal Surgery ,drain ,intrabdominal ,Adult, Aged, Cohort Studies, Colorectal Surgery, Drainage, Elective Surgical Procedures, Female, Humans, Postoperative Complications, Prospective Studies, Surgical Wound Infection ,Settore MED/18 ,Settore MED/18 - Chirurgia Generale ,Prospective Studie ,Surgery ,Postoperative Complication ,Cohort Studie ,drain, intrabdominal ,Human - Abstract
Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.
- Published
- 2022
3. Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis
- Author
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Anania G., Agresta F., Artioli E., Rubino S., Resta G., Vettoretto N., Petz W. L., Bergamini C., Arezzo A., Valpiani G., Morotti C., Silecchia G., Adamo V., Agrusa A., Alemanno G., Allaix M. E., Alo A., Altamura A., Ambrosi A., Antoniutti M., Apa D., Arcuri G., Baiocchi G. L., Balani A., Baldazzi G., Basti M., Benvenuto C., Berti S., Boni L., Borghi F., Botteri E., Brachet Contul R., Brescia A., Budassi A., Cafagna L., Calgaro M., Calo P. G., Campagnacci R., Canova G., Canu G. L., Caracino V., Carcoforo P., Carlini M., Casali L., Cassetti D., Cassinotti E., Catarci M., Cesari M., Checcacci P., Ciano P., Clementi M., Cocorullo G., Colombo F., Concone G., Contine A., Coppola M., Coratti A., Corcione F., Corleone P., Covotta L., Cuccurullo D., Cumbo P., D'ambrosio G., De Angelis F., De Luca M., De Manzini N., De Nisco C., De Palma G. D., De Paolis P., Degiuli M., Delogu D., Delrio P., Deserra A., Donini A., Elmore U., Ercolani G., Erdas E., Fabris L., Ferrari G., Feo G., Fidanza F., Foschi D., Galleano R., Garulli G., Gatti F., Gattolin A., Gelati S., Gelmini R., Ghazouani O., Gioffre A., Gobbi S., Grammatico V., Guariniello A., Giannessi S., Guerrieri M., Guerriero L., Gullotta G., Impellizzeri H., Izzo M., Jovine E., Lezoche G., Lirusso C., Lombardi R., Longoni M., Lucchi A., Luzzi A. P., Marini P., Marrosu A. G., Martino A., Mazza R., Mazzoccato S., Medas F., Meloni A., Milone M., Minciotti E., Monari F., Moretto G., Muttillo I. A., Navarra G., Neri S., Oldani A., Olmi S., Opocher E., Osenda E., Ottonello R., Panebianco V., Pavanello M., Pecchini F., Pellegrino L., Pennisi D., Perrotta N., Pertile D., Petri R., Picchetto A., Piccoli M., Pirrera B., Pisani Ceretti A., Pisano M., Podda M., Portolani N., Presenti L., Puzziello A., Razzi S., Rega D., Restini E., Ricci G., Rigamonti M., Rivolta U., Robustelli V., Romairone E., Rosati R., Rosso E., Roviello F., Sala S., Santarelli M., Sarro G., Sartori A., Scabini S., Scognamillo F., Sechi R., Solaini L., Soliani G., Soliani P., Soligo E., Sorrentino M., Spinoglio G., Stratta E., Taddei A., Talamo G., Targa S., Tartaglia N., Testa S., Ubiali P., Valeri A., Vasta F., Verzelli A., Vicentini R., Viola G., Violi V., Zago M., Zampino L., Anania, G., Agresta, F., Artioli, E., Rubino, S., Resta, G., Vettoretto, N., Petz, W. L., Bergamini, C., Arezzo, A., Valpiani, G., Morotti, C., Silecchia, G., Adamo, V., Agrusa, A., Alemanno, G., Allaix, M. E., Alo, A., Altamura, A., Ambrosi, A., Antoniutti, M., Apa, D., Arcuri, G., Baiocchi, G. L., Balani, A., Baldazzi, G., Basti, M., Benvenuto, C., Berti, S., Boni, L., Borghi, F., Botteri, E., Brachet Contul, R., Brescia, A., Budassi, A., Cafagna, L., Calgaro, M., Calo, P. G., Campagnacci, R., Canova, G., Canu, G. L., Caracino, V., Carcoforo, P., Carlini, M., Casali, L., Cassetti, D., Cassinotti, E., Catarci, M., Cesari, M., Checcacci, P., Ciano, P., Clementi, M., Cocorullo, G., Colombo, F., Concone, G., Contine, A., Coppola, M., Coratti, A., Corcione, F., Corleone, P., Covotta, L., Cuccurullo, D., Cumbo, P., D'Ambrosio, G., De Angelis, F., De Luca, M., De Manzini, N., De Nisco, C., De Palma, G. D., De Paolis, P., Degiuli, M., Delogu, D., Delrio, P., Deserra, A., Donini, A., Elmore, U., Ercolani, G., Erdas, E., Fabris, L., Ferrari, G., Feo, G., Fidanza, F., Foschi, D., Galleano, R., Garulli, G., Gatti, F., Gattolin, A., Gelati, S., Gelmini, R., Ghazouani, O., Gioffre, A., Gobbi, S., Grammatico, V., Guariniello, A., Giannessi, S., Guerrieri, M., Guerriero, L., Gullotta, G., Impellizzeri, H., Izzo, M., Jovine, E., Lezoche, G., Lirusso, C., Lombardi, R., Longoni, M., Lucchi, A., Luzzi, A. P., Marini, P., Marrosu, A. G., Martino, A., Mazza, R., Mazzoccato, S., Medas, F., Meloni, A., Milone, M., Minciotti, E., Monari, F., Moretto, G., Muttillo, I. A., Navarra, G., Neri, S., Oldani, A., Olmi, S., Opocher, E., Osenda, E., Ottonello, R., Panebianco, V., Pavanello, M., Pecchini, F., Pellegrino, L., Pennisi, D., Perrotta, N., Pertile, D., Petri, R., Picchetto, A., Piccoli, M., Pirrera, B., Pisani Ceretti, A., Pisano, M., Podda, M., Portolani, N., Presenti, L., Puzziello, A., Razzi, S., Rega, D., Restini, E., Ricci, G., Rigamonti, M., Rivolta, U., Robustelli, V., Romairone, E., Rosati, R., Rosso, E., Roviello, F., Sala, S., Santarelli, M., Sarro, G., Sartori, A., Scabini, S., Scognamillo, F., Sechi, R., Solaini, L., Soliani, G., Soliani, P., Soligo, E., Sorrentino, M., Spinoglio, G., Stratta, E., Taddei, A., Talamo, G., Targa, S., Tartaglia, N., Testa, S., Ubiali, P., Valeri, A., Vasta, F., Verzelli, A., Vicentini, R., Viola, G., Violi, V., Zago, M., Zampino, L., Anania G., Agresta F., Artioli E., Rubino S., Resta G., Vettoretto N., Petz W.L., Bergamini C., Arezzo A., Valpiani G., Morotti C., Silecchia G, and Adamo V, Agrusa A, Alemanno G, Allaix ME, Alò A, Altamura A, Ambrosi A, Antoniutti M, Apa D, Arcuri G, Baiocchi GL, Balani A, Baldazzi G, Basti M, Benvenuto C, Berti S, Boni L, Borghi F, Botteri E, Brachet Contul R, Brescia A, Budassi A, Cafagna L, Calgaro M, Calò PG, Campagnacci R, Canova G, Canu GL, Caracino V, Carcoforo P, Carlini M, Casali L, Cassetti D, Cassinotti E, Catarci M, Cesari M, Checcacci P, Ciano P, Clementi M, Cocorullo G, Colombo F, Concone G, Contine A, Coppola M, Coratti A, Corcione F, Corleone P, Covotta L, Cuccurullo D, Cumbo P, D'Ambrosio G, De Angelis F, De Luca M, De Manzini N, De Nisco C, De Palma GD, De Paolis P, Degiuli M, Delogu D, Delrio P, Deserra A, Donini A, Elmore U, Ercolani G, Erdas E, Fabris L, Ferrari G, Feo C, Fidanza F, Foschi D, Galleano R, Garulli G, Gatti F, Gattolin A, Gelati S, Gelmini R, Ghazouani O, Gioffrè A, Gobbi S, Grammatico V, Guariniello A, Giannessi S, Guerrieri M, Guerriero L, Guerriero G, Impellizzeri H, Izzo M, Jovine E, Lezoche G, Lirusso C, Lombardi R, Longoni M, Lucchi A, Luzzi AP, Marini P, Marrosu AG, Martino A, Mazza R, Mazzoccato S, Medas F, Meloni A, Milone M, Minciotti E, Monari F, Moretto G, Muttillo IA, Navarra G, Neri S, Oldani A, Olmi S, Opocher E, Osenda E, Ottonello R, Panebianco V, Pavanello M, Pecchini F, Pellegrino L, Pennisi D, Perrotta N, Pertile D, Petri R, Picchetto A, Piccoli M, Pirrera B, Pisani Ceretti A, Pisano M, Podda M, Portolani N, Presenti L, Puzziello A, Razzi S, Rega D, Restini E, Ricci G, Rigamonti M, Rivolta U, Robustelli V, Romairone E, Rosati R, Rosso E, Roviello F, Sala S, Santarelli M, Sarro G, Sartori A, Scabini S, Scognamillo F, Sechi R, Solaini L, Soliani G, Soliani P, Soligo E, Sorrentino M, Spinoglio G, Stratta E, Taddei A, Talamo G, Targa S, Tartaglia N, Testa S, Ubiali P, Valeri A, Vasta F, Verzelli A, Vicentini R, Viola G, Violi V, Zago M, Zampino L.
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Male ,medicine.medical_specialty ,Anastomosis ,Colon ,Intracorporeal anastomosis ,Outcomes ,Laparoscopic colectomy ,Article ,Intracorporeal anastomosi ,Ileo-colic anastomosis ,Laparoscopy ,Postoperative complications ,Right hemicolectomy ,Aged ,Anastomosis, Surgical ,Colectomy ,Colonic Neoplasms ,Female ,Humans ,Prospective Studies ,Treatment Outcome ,Economica ,Surgical ,medicine ,LS7_1 ,LS7_4 ,Right hemicolectomy, Ileo-colic anastomosis, Laparoscopy, Postoperative complications, Intracorporeal anastomosis, Outcomes ,Outcome ,LS7_9 ,medicine.diagnostic_test ,business.industry ,General surgery ,Right hemicolectomy · Ileo-colic anastomosis · Laparoscopy · Postoperative complications · Intracorporeal anastomosis · Outcomes ,Correction ,Postoperative complication ,Ileo-colic anastomosi ,Prospective trial ,Surgery ,Side to side anastomosis ,business ,Laparoscopic right hemicolectomy - Abstract
Background While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons’ attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients’ characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration Clinical trial (Identifier: NCT03934151).
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- 2020
4. Changes in Clinical Practice in Adherence to the 2014 American Thyroid Association Guidelines on Thyroid Cancer: A Retrospective Study from a Tertiary Referral Center.
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Cappellacci F, Canu GL, Noli E, Argiolas A, Peis G, Lai ML, Calò PG, and Medas F
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Thyroidectomy, a pivotal treatment for various thyroid disorders, has seen its indications evolve, particularly with the 2014 American Thyroid Association (ATA) Guidelines advocating for conservative surgical approaches like lobectomy. This retrospective study analyzes thyroidectomy practices at a high-volume center from January 2014 to December 2023, focusing on patients potentially eligible for lobectomy per ATA guidelines. The inclusion criteria were tumors < 4 cm, indeterminate thyroid nodules, or differentiated thyroid carcinoma with clinically uninvolved lymph nodes (cN0). This study analyzed the proportion of patients undergoing lobectomy versus total thyroidectomy (TT) and the oncological outcomes. Of 357 patients, 243 underwent TT and 114 underwent lobectomy. The prevalence of lobectomies rose markedly, comprising 73.9% of surgeries in 2023. TT patients were predominantly female (83.5%) and had higher rates of autoimmune thyroiditis (67.5%) and malignancy (89.7%). Lobectomy patients had larger nodules and more indeterminate cytology. Among 301 malignant cases, TT was associated with higher lymph node metastasis, but similar recurrence rates, compared to lobectomy. This study underscores a shift towards lobectomy, reflecting adherence to ATA guidelines and suggesting conservative surgery is feasible without compromising outcomes. Further research on long-term outcomes and refined patient selection criteria is needed to optimize surgical approaches.
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- 2024
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5. Exploring the Link between BMI and Aggressive Histopathological Subtypes in Differentiated Thyroid Carcinoma-Insights from a Multicentre Retrospective Study.
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Di Filippo G, Canu GL, Lazzari G, Serbusca D, Morelli E, Brazzarola P, Rossi L, Gjeloshi B, Caradonna M, Kotsovolis G, Pliakos I, Poulios E, Papavramidis T, Cappellacci F, Nocini PF, Calò PG, Materazzi G, and Medas F
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Obesity's role in thyroid cancer development is still debated, as well as its association with aggressive histopathological subtypes (AHSs). To clarify the link between Body Mass Index (BMI) and AHS of differentiated thyroid carcinoma (DTC), we evaluated patients who underwent thyroidectomy for DTC from 2020 to 2022 at four European referral centres for endocrine surgery. Based on BMI, patients were classified as normal-underweight, overweight, or obese. AHSs were defined according to 2022 WHO guidelines. Among 3868 patients included, 34.5% were overweight and 19.6% obese. Histological diagnoses were: 93.6% papillary (PTC), 4.8% follicular (FTC), and 1.6% Hürthle cell (HCC) thyroid carcinoma. Obese and overweight patients with PTC had a higher rate of AHSs ( p = 0.03), bilateral, multifocal tumours ( p = 0.014, 0.049), and larger nodal metastases ( p = 0.017). In a multivariate analysis, BMI was an independent predictor of AHS of PTC, irrespective of gender ( p = 0.028). In younger patients (<55 years old) with PTC > 1 cm, BMI predicted a higher ATA risk class ( p = 0.036). Overweight and obese patients with FTC had larger tumours ( p = 0.036). No difference was found in terms of AHS of FTC and HCC based on BMI category. Overweight and obese patients with PTC appear to be at an increased risk for AHS and aggressive clinico-pathological characteristics.
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- 2024
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6. Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation.
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Cappellacci F, Canu GL, Rossi L, De Palma A, Mavromati M, Kuczma P, Di Filippo G, Morelli E, Demarchi MS, Brazzarola P, Materazzi G, Calò PG, and Medas F
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Introduction: Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy., Methods: In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B)., Results: We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015)., Discussion: Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable., 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. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Cappellacci, Canu, Rossi, De Palma, Mavromati, Kuczma, Di Filippo, Morelli, Demarchi, Brazzarola, Materazzi, Calò, Medas and our Mediastinal Goiter Study Collaborative Group.)
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- 2024
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7. Diffuse C-Cells Hyperplasia Is the Source of False Positive Calcitonin Measurement in FNA Washout Fluids of Thyroid Nodules: A Rational Clinical Approach to Avoiding Unnecessary Surgery.
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Mura C, Rodia R, Corrias S, Cappai A, Lai ML, Canu GL, Medas F, Calò PG, Mariotti S, and Boi F
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Purpose: The FNA-CT is useful for the diagnosis of MTC. The aim of this study was to evaluate the performance of FNA-CT in TNs coexisting with CCH., Methods: This study retrospectively reviewed the records of 11 patients with TNs submitted to thyroidectomy on the basis of elevated basal and/or stimulated serum CT values, which at histology were not confirmed to be MTC. The results obtained in this group were compared with those of a previously reported group of histologically proven MTC patients submitted to an identical presurgical evaluation. All patients, negative for known mutations in the RET proto-oncogene, were preoperatively submitted to neck ultrasound, FNA-cytology, and FNA-CT., Results: Approximately 6 of 11 patients showed increased (>36 ng/mL, as established in previous studies not involving patients with CCH) FNA-CT. All these patients showed diffuse CCH at histology in the thyroid lobe submitted to FNA; 5 of them were benign at histology, while only one was malignant (papillary thyroid carcinoma, PTC). The remaining 5 of 11 patients had low FNA-CT (<36 ng/mL), and all of them showed only focal CCH in the lobe submitted to FNA; three of them were malignant (2 PTC, 1 follicular carcinoma), while two were benign., Conclusions: Employing the currently proposed cut-off values, false-positive FNA-CT results may be observed in benign/malignant TNs with coexisting diffuse CCH. FNA-CT must therefore be cautiously used in the diagnostic approach for patients with TNs and a slightly increased basal or stimulated serum CT concentration in order to avoid unnecessary surgery.
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- 2024
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8. Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study).
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Canu GL, Medas F, Cappellacci F, Rossi L, Gjeloshi B, Sessa L, Pennestrì F, Djafarrian R, Mavromati M, Kotsovolis G, Pliakos I, Di Filippo G, Lazzari G, Vaccaro C, Izzo M, Boi F, Brazzarola P, Feroci F, Demarchi MS, Papavramidis T, Materazzi G, Raffaelli M, and Calò PG
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Background: Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence., Methods: Patients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed., Results: Eight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex ( P < 0.001), older age ( P < 0.001), higher BMI ( P = 0.021), unilateral lateral neck dissection ( P < 0.001), drain placement ( P = 0.007), and shorter operative times ( P < 0.001) were found to be independent risk factors for cervical haematoma., Conclusions: Based on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery., 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. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2023 Canu, Medas, Cappellacci, Rossi, Gjeloshi, Sessa, Pennestrì, Djafarrian, Mavromati, Kotsovolis, Pliakos, Di Filippo, Lazzari, Vaccaro, Izzo, Boi, Brazzarola, Feroci, Demarchi, Papavramidis, Materazzi, Raffaelli, Calò and REDHOT Study Collaborative Group.)
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- 2023
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9. Surgical Management of Indeterminate Thyroid Nodules across Different World Regions: Results from a Retrospective Multicentric (the MAIN-NODE) Study.
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Canu GL, Cappellacci F, Abdallah A, Elzahaby I, Figueroa-Bohorquez D, Lori E, Miller JA, Pavia SZ, Pinillos P, Pongtippan A, Saleh SS, Sorrenti S, Sriphrapradang C, Calò PG, and Medas F
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Indeterminate thyroid nodules (ITNs) are characterized by an expected malignancy ranging from 5% to 30%, with most patients undergoing a diagnostic, rather than therapeutic, operation. The aim of our study was to compare the approach to ITNs across different regions of the world. In this retrospective, multicentric, international study, according to the WHO classification, we identified the South East Asian Region (SEAR), the Americas Region (AMR), the Eastern Mediterranean Region (EMR), the Europe Region (EUR), and the Western Pacific Region (WPR). One high-volume thyroid centre was included for each region. Demographic, preoperative, and pathologic data were compared among the different regions. Overall, 5737 patients from five high-volume thyroid centres were included in this study. We found that the proportion of ITNs over the global activity for thyroid disease was higher in the EUR (37.6%) than in the other regions (21.1-23.6%). In the EMR, the patients were significantly younger (with a mean of 43.1 years) than in the other regions (range, 48.8-57.4 years). The proportion of lobectomy was significantly higher in the WPR, where 83.2% (114/137) of patients received this treatment, than in the other regions, where lobectomies were performed in 44.1-58.1% of patients. The pathological diagnosis of malignancy was significantly higher in the SEAR centre, being over 60%, than in centres of the other regions, where it ranged from 26.3% to 41.3%. The occurrence of lymph node metastases was higher in the WPR (27.8%), AMR (26.9%), and EMR (20%) centres than in the EUR and SEAR centres, where it was lower than 10%. In summary, we found in our study different approaches and outcomes in the diagnosis and treatment of ITNs among countries. Overall, almost 60% of patients with ITNs who underwent surgery actually presented a benign disease, potentially undergoing an unnecessary operation.
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- 2023
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10. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.
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Medas F, Dobrinja C, Al-Suhaimi EA, Altmeier J, Anajar S, Arikan AE, Azaryan I, Bains L, Basili G, Bolukbasi H, Bononi M, Borumandi F, Bozan MB, Brenta G, Brunaud L, Brunner M, Buemi A, Canu GL, Cappellacci F, Cartwright SB, Castells Fusté I, Cavalheiro B, Cavallaro G, Chala A, Chan SYB, Chaplin J, Cheema MS, Chiapponi C, Chiofalo MG, Chrysos E, D'Amore A, de Cillia M, De Crea C, de Manzini N, de Matos LL, De Pasquale L, Del Rio P, Demarchi MS, Dhiwakar M, Donatini G, Dora JM, D'Orazi V, Doulatram Gamgaram VK, Eismontas V, Kabiri EH, El Malki HO, Elzahaby I, Enciu O, Eskander A, Feroci F, Figueroa-Bohorquez D, Filis D, François G, Frías-Fernández P, Gamboa-Dominguez A, Genc V, Giordano D, Gómez-Pedraza A, Graceffa G, Griffin J, Guerreiro SC, Gupta K, Gupta KK, Gurrado A, Hajiioannou J, Hakala T, Harahap WA, Hargitai L, Hartl D, Hellmann A, Hlozek J, Hoang VT, Iacobone M, Innaro N, Ioannidis O, Jang JHI, Xavier-Junior JC, Jovanovic M, Kaderli RM, Kakamad F, Kaliszewski K, Karamanliev M, Katoh H, Košec A, Kovacevic B, Kowalski LP, Králik R, Yadav SK, Kumorová A, Lampridis S, Lasithiotakis K, Leclere JC, Leong EKF, Leow MK, Lim JY, Lino-Silva LS, Liu SYW, Llorach NP, Lombardi CP, López-Gómez J, Lori E, Quintanilla-Dieck L, Lucchini R, Madani A, Manatakis D, Markovic I, Materazzi G, Mazeh H, Mercante G, Meyer-Rochow GY, Mihaljevic O, Miller JA, Minuto M, Monacelli M, Mulita F, Mullineris B, Muñoz-de-Nova JL, Muradás Girardi F, Nader S, Napadon T, Nastos C, Offi C, Ronen O, Oragano L, Orois A, Pan Y, Panagiotidis E, Panchangam RB, Papavramidis T, Parida PK, Paspala A, Pérez ÒV, Petrovic S, Raffaelli M, Ramacciotti CF, Ratia Gimenez T, Rivo Vázquez Á, Roh JL, Rossi L, Sanabria A, Santeerapharp A, Semenov A, Seneviratne S, Serdar A, Sheahan P, Sheppard SC, Slotcavage RL, Smaxwil C, Kim SY, Sorrenti S, Spartalis E, Sriphrapradang C, Testini M, Turk Y, Tzikos G, Vabalayte K, Vargas-Osorio K, Vázquez Rentería RS, Velázquez-Fernández D, Vithana SMP, Yücel L, Yulian ED, Zahradnikova P, Zarogoulidis P, Ziablitskaia E, Zolotoukho A, and Calò PG
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- Humans, Male, Female, Cross-Sectional Studies, Pandemics, Retrospective Studies, Lymphatic Metastasis, Thyroid Nodule epidemiology, Thyroid Nodule surgery, Thyroid Nodule diagnosis, COVID-19 epidemiology, Thyroid Neoplasms epidemiology, Thyroid Neoplasms surgery, Thyroid Neoplasms pathology
- Abstract
Background: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours., Methods: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186., Findings: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039)., Interpretation: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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11. US Evaluation of Topical Hemostatic Agents in Post-Thyroidectomy.
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Dolcetti V, Lori E, Fresilli D, Del Gaudio G, Di Bella C, Pacini P, D'Andrea V, Frattaroli FM, Vallone GG, Liberatore P, Pironi D, Canu GL, Calò PG, Cantisani V, and Sorrenti S
- Abstract
Background: the aim of this study was to describe the ultrasound appearance of topical hemostatics after thyroidectomy., Methods: we enrolled 84 patients who were undergoing thyroid surgery and were treated with two types of topical hemostats, 49 with an absorbable hemostat of oxidized regenerated cellulose (Oxitamp
® ) and 35 with a fibrin glue-based hemostat (Tisseel® ). All patients were examined using B-mode ultrasound., Results: In 39 patients of the first group (approximately 80%), a hemostatic residue was detected and in some cases confused with a native gland residue, or with cancer recurrence in oncological patients. No residue was detected in patients in the second group. The main ultrasound characteristics of the tampon were analyzed and arranged according to predefined patterns, and suggestions to recognize it and avoid wrong diagnoses were provided. A part of the group of patients with tampon residue was re-evaluated after 6-12 months, ensuring that the swab remained for months after the maximum resorption time declared by the manufacturer., Conclusions: with equal hemostatic effectiveness, the fibrin glue pad is more favorable in the ultrasound follow-up because it creates reduced surgical outcomes. It is also important to know and recognize the ultrasound characteristics of oxidized cellulose-based hemostats in order to reduce the number of diagnostic errors and inappropriate diagnostic investigations.- Published
- 2023
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12. The paradox of Zeno in bariatric surgery weight loss: Superobese patients run faster than morbidly obese patients, but can't overtake them.
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Medas F, Moroni E, Deidda S, Zorcolo L, Restivo A, Canu GL, Cappellacci F, Calò PG, Pintus S, and Fantola G
- Abstract
Introduction: Superobesity (SO) is defined as a BMI > 50 Kg/m
2 , and represents the extreme severity of the disease, resulting in a challenge for the surgeons., Methods: In this retrospective study we aimed to compare the outcomes of SO patients compared to morbidly obese (MO) patients., Results: We included in this study 154 MO patients, with a median preoperative BMI of 40.8 kg/m2 , and 19 SO patients with median preoperative BMI of 54.9 kg/m2 . The MO patients underwent sleeve gastrectomy (SG) in 62 (40.3%) cases, laparoscopic Roux-and-Y gastric bypass (LRYGBP) in 85 (55.2%) cases and One-Anastomosis Gastric Bypass (OAGB) in 7 (4.5%) cases. underwent OAGB. The patients in the SO group were submitted to SG in 11 (57.9%) cases, LRYGBP in 5 (26.3%) cases, and OAGB in 3 (15.8%). At 24-month follow-up, an excess weight loss (EWL) >50% was achieved in 129 (83.8%) patients in the MO group and in 15 (78.9%) in the SO group ( p = 0.53). A BMI < 35 kg/m2 was achieved in 137 (89%) patients in the MO group and from 8 (42.2%) patients in the SO group ( p < 0.001). The total weight loss was significantly directly related to the initial BMI. Superobesity was identified as independent risk factor for surgical failure when considering the outcome of BMI < 35 kg/m2 ., Discussion: Our study confirms that, although SO patients tend to gain a greater weight loss than MO patients, they less frequently achieve the desired BMI target. In this setting, it should be necessary to re-consider malabsorptive procedures as first choice., 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., (© 2023 Medas, Moroni, Deidda, Zorcolo, Restivo, Canu, Cappellacci, Calò, Pintus and Fantola.)- Published
- 2023
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13. Axillary Treatment Management in Breast Cancer during COVID-19 Pandemic (Association between ACOSOG Z0011 Criteria and OSNA Test).
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Anedda G, Cappellacci F, Canu GL, Farris S, Calò PG, Dessena M, and Medas F
- Abstract
The outbreak of the SARS-COVID-2 pandemic (COVID-19) had a significant effect on the organisation of healthcare systems. Surgical units saw a significant reduction in the volume of surgical procedures performed, with lengthening waiting lists as a consequence. We assessed the surgical activity in relation to breast cancer that took place at the University Hospital of Cagliari, Italy, from February 2018 to March 2022. Two phases were identified based on the epidemiological circumstances: Phase 1-February 2018 to February 2020; Phase 2-March 2020 to March 2022. The surgery performed in the two phases was then compared. All the patients in our sample underwent a breast surgical procedure involving a lymph node biopsy using OSNA associated with the ACOSOG Z0011 criteria. In the study period overall at our facility, there were 4214 procedures, 417 of which involved breast surgery. In Phase 2, 91 procedures were performed using the OSNA method and ACOSOG Z0011 criteria, enabling the intraoperative staging of axillary nodes. Axillary treatment in breast cancer using this approach resulted in a significant reduction in the number of reoperations for the radicalisation of metastatic sentinel lymph nodes.
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- 2023
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14. The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?
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De Simone B, Abu-Zidan FM, Chouillard E, Di Saverio S, Sartelli M, Podda M, Gomes CA, Moore EE, Moug SJ, Ansaloni L, Kluger Y, Coccolini F, Landaluce-Olavarria A, Estraviz-Mateos B, Uriguen-Etxeberria A, Giordano A, Luna AP, Amín LAH, Hernández AMP, Shabana A, Dzulkarnaen ZA, Othman MA, Sani MI, Balla A, Scaramuzzo R, Lepiane P, Bottari A, Staderini F, Cianchi F, Cavallaro A, Zanghì A, Cappellani A, Campagnacci R, Maurizi A, Martinotti M, Ruggieri A, Jusoh AC, Rahman KA, Zulkifli ASM, Petronio B, Matías-García B, Quiroga-Valcárcel A, Mendoza-Moreno F, Atanasov B, Campanile FC, Vecchioni I, Cardinali L, Travaglini G, Sebastiani E, Chooklin S, Chuklin S, Cianci P, Restini E, Capuzzolo S, Currò G, Filippo R, Rispoli M, Aparicio-Sánchez D, Muñóz-Cruzado VD, Barbeito SD, Delibegovic S, Kesetovic A, Sasia D, Borghi F, Giraudo G, Visconti D, Doria E, Santarelli M, Luppi D, Bonilauri S, Grossi U, Zanus G, Sartori A, Piatto G, De Luca M, Vita D, Conti L, Capelli P, Cattaneo GM, Marinis A, Vederaki SA, Bayrak M, Altıntas Y, Uzunoglu MY, Demirbas IE, Altinel Y, Meric S, Aktimur YE, Uymaz DS, Omarov N, Azamat I, Lostoridis E, Nagorni EA, Pujante A, Anania G, Bombardini C, Bagolini F, Gonullu E, Mantoglu B, Capoglu R, Cappato S, Muzio E, Colak E, Polat S, Koylu ZA, Altintoprak F, Bayhan Z, Akin E, Andolfi E, Rezart S, Kim JI, Jung SW, Shin YC, Enciu O, Toma EA, Medas F, Canu GL, Cappellacci F, D'Acapito F, Ercolani G, Solaini L, Roscio F, Clerici F, Gelmini R, Serra F, Rossi EG, Fleres F, Clarizia G, Spolini A, Ferrara F, Nita G, Sarnari J, Gachabayov M, Abdullaev A, Poillucci G, Palini GM, Veneroni S, Garulli G, Piccoli M, Pattacini GC, Pecchini F, Argenio G, Armellino MF, Brisinda G, Tedesco S, Fransvea P, Ietto G, Franchi C, Carcano G, Martines G, Trigiante G, Negro G, Vega GM, González AR, Ojeda L, Piccolo G, Bondurri A, Maffioli A, Guerci C, Sin BH, Zuhdi Z, Azman A, Mousa H, Al Bahri S, Augustin G, Romic I, Moric T, Nikolopoulos I, Andreuccetti J, Pignata G, D'Alessio R, Kenig J, Skorus U, Fraga GP, Hirano ES, de Lima Bertuol JV, Isik A, Kurnaz E, Asghar MS, Afzal A, Akbar A, Nikolouzakis TK, Lasithiotakis K, Chrysos E, Das K, Özer N, Seker A, Ibrahim M, Hamid HKS, Babiker A, Bouliaris K, Koukoulis G, Kolla CC, Lucchi A, Agostinelli L, Taddei A, Fortuna L, Agostini C, Licari L, Viola S, Callari C, Laface L, Abate E, Casati M, Anastasi A, Canonico G, Gabellini L, Tosi L, Guariniello A, Zanzi F, Bains L, Sydorchuk L, Iftoda O, Sydorchuk A, Malerba M, Costanzo F, Galleano R, Monteleone M, Costanzi A, Riva C, Walędziak M, Kwiatkowski A, Czyżykowski Ł, Major P, Strzałka M, Matyja M, Natkaniec M, Valenti MR, Di Vita MDP, Sotiropoulou M, Kapiris S, Massalou D, Veroux M, Volpicelli A, Gioco R, Uccelli M, Bonaldi M, Olmi S, Nardi M, Livadoti G, Mesina C, Dumitrescu TV, Ciorbagiu MC, Ammendola M, Ammerata G, Romano R, Slavchev M, Misiakos EP, Pikoulis E, Papaconstantinou D, Elbahnasawy M, Abdel-Elsalam S, Felsenreich DM, Jedamzik J, Michalopoulos NV, Sidiropoulos TA, Papadoliopoulou M, Cillara N, Deserra A, Cannavera A, Negoi I, Schizas D, Syllaios A, Vagios I, Gourgiotis S, Dai N, Gurung R, Norrey M, Pesce A, Feo CV, Fabbri N, Machairas N, Dorovinis P, Keramida MD, Mulita F, Verras GI, Vailas M, Yalkin O, Iflazoglu N, Yigit D, Baraket O, Ayed K, Ghalloussi MH, Patias P, Ntokos G, Rahim R, Bala M, Kedar A, Sawyer RG, Trinh A, Miller K, Sydorchuk R, Knut R, Plehutsa O, Liman RK, Ozkan Z, Kader SA, Gupta S, Gureh M, Saeidi S, Aliakbarian M, Dalili A, Shoko T, Kojima M, Nakamoto R, Atici SD, Tuncer GK, Kaya T, Delis SG, Rossi S, Picardi B, Del Monte SR, Triantafyllou T, Theodorou D, Pintar T, Salobir J, Manatakis DK, Tasis N, Acheimastos V, Ioannidis O, Loutzidou L, Symeonidis S, de Sá TC, Rocha M, Guagni T, Pantalone D, Maltinti G, Khokha V, Abdel-Elsalam W, Ghoneim B, López-Ruiz JA, Kara Y, Zainudin S, Hayati F, Azizan N, Khei VTP, Yi RCX, Sellappan H, Demetrashvili Z, Lekiashvili N, Tvaladze A, Froiio C, Bernardi D, Bonavina L, Gil-Olarte A, Grassia S, Romero-Vargas E, Bianco F, Gumbs AA, Dogjani A, Agresta F, Litvin A, Balogh ZJ, Gendrikson G, Martino C, Damaskos D, Pararas N, Kirkpatrick A, Kurtenkov M, Gomes FC, Pisanu A, Nardello O, Gambarini F, Aref H, Angelis ND, Agnoletti V, Biondi A, Vacante M, Griggio G, Tutino R, Massani M, Bisetto G, Occhionorelli S, Andreotti D, Lacavalla D, Biffl WL, and Catena F
- Subjects
- Male, Humans, Middle Aged, Female, Pandemics, SARS-CoV-2, Postoperative Complications epidemiology, COVID-19 epidemiology, Cholecystitis epidemiology, Cholecystitis surgery, Cholecystitis, Acute epidemiology, Cholecystitis, Acute surgery, Sepsis
- Abstract
Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not., Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not., Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]., Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands., (© 2022. The Author(s).)
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- 2022
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15. Does the continuation of low-dose acetylsalicylic acid during the perioperative period of thyroidectomy increase the risk of cervical haematoma? A 1-year experience of two Italian centers.
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Canu GL, Medas F, Cappellacci F, Giordano ABF, Casti F, Grifoni L, Feroci F, and Calò PG
- Abstract
Background: A growing number of patients taking antiplatelet drugs, mainly low-dose acetylsalicylic acid (ASA) (75-150 mg/day), for primary or secondary prevention of thrombotic events, are encountered in every field of surgery. While the bleeding risk due to the continuation of these medications during the perioperative period has been adequately investigated in several surgical specialties, in thyroid surgery it still needs to be clarified. The main aim of this study was to assess the occurrence of cervical haematoma in patients receiving low-dose acetylsalicylic acid, specifically ASA 100 mg/day, during the perioperative period of thyroidectomy., Methods: Patients undergoing thyroidectomy in two high-volume thyroid surgery centers in Italy, between January 2021 and December 2021, were retrospectively analysed. Enrolled patients were divided into two groups: those not taking ASA were included in Group A, while those receiving this drug in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analysis was employed to evaluate the use of low-dose ASA as independent risk factor for cervical haematoma., Results: A total of 412 patients underwent thyroidectomy during the study period. Among them, 29 (7.04%) were taking ASA. Based on the inclusion criteria, 351 patients were enrolled: 322 were included in Group A and 29 in Group B. In Group A, there were 4 (1.24%) cervical haematomas not requiring surgical revision of haemostasis and 4 (1.24%) cervical haematomas requiring surgical revision of haemostasis. In Group B, there was 1 (3.45%) cervical haematoma requiring surgical revision of haemostasis. At univariate analysis, no statistically significant difference was found between the two groups in terms of occurrence of cervical haematoma, nor of the other early complications of thyroidectomy. At multivariate analysis, the use of low-dose ASA did not prove to be an independent risk factor for cervical haematoma., Conclusions: Based on our findings, we believe that in patients receiving this drug, either for primary or secondary prevention of thrombotic events, its discontinuation during the perioperative period of thyroidectomy is not necessary., 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., (© 2022 Canu, Medas, Cappellacci, Giordano, Casti, Grifoni, Feroci and Calò.)
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- 2022
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16. Association between hashimoto thyroiditis and differentiated thyroid cancer: A single-center experience.
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Cappellacci F, Canu GL, Lai ML, Lori E, Biancu M, Boi F, and Medas F
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Hashimoto's thyroiditis is the most common cause of hypothyroidism in the iodine-sufficient areas of the world. Differentiated thyroid cancer is the most common thyroid cancer subtype, accounting for more than 95% of cases, and it is considered a tumor with a good prognosis, although a certain number of patients experience a poor clinical outcome. Hashimoto's thyroiditis has been found to coexist with differentiated thyroid cancer in surgical specimens, but the relationship between these two entities has not yet been clarified. Our study aims to analyze the relationship between these two diseases, highlighting the incidence of histological diagnosis of Hashimoto thyroiditis in differentiated thyroid cancer patients, and assess how this autoimmune disorder influences the risk of structural disease recurrence and recurrence rate., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cappellacci, Canu, Lai, Lori, Biancu, Boi and Medas.)
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- 2022
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17. The Use of Harmonic Focus and Thunderbeat Open Fine Jaw in Thyroid Surgery: Experience of a High-Volume Center.
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Canu GL, Medas F, Cappellacci F, Casti F, Bura R, Erdas E, and Calò PG
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Background: In thyroid surgery, achieving accurate haemostasis is fundamental in order to avoid the occurrence of complications. Energy-based devices are currently extensively utilized in this field of surgery. This study aims to compare Harmonic Focus and Thunderbeat Open Fine Jaw with regard to surgical outcomes and complications. Methods: Patients submitted to total thyroidectomy in our center, between January 2017 and June 2020, were retrospectively analysed. Based on the energy-based device utilized, two groups were identified: Group A (Harmonic Focus) and Group B (Thunderbeat Open Fine Jaw). Results: A total of 527 patients were included: 409 in Group A and 118 in Group B. About surgical outcomes, the mean operative time was significantly shorter in Group B than in Group A (p < 0.001), while as regards complications, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in Group B than in Group A (p = 0.019). Conclusions. Both Harmonic Focus and Thunderbeat Open Fine Jaw have proven to be effective devices. Operative times were significantly shorter in thyroidectomies performed with Thunderbeat Open Fine Jaw; however, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in patients operated on with this device.
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- 2022
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18. Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study.
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Canu GL, Medas F, Cappellacci F, Giordano ABF, Gurrado A, Gambardella C, Docimo G, Feroci F, Conzo G, Testini M, and Calò PG
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There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim of this study was to investigate this topic. Patients undergoing a thyroidectomy for thyroid nodular disease with an indeterminate cytology in four high-volume thyroid surgery centres in Italy, between January 2017 and December 2020, were retrospectively analysed. Based on the surgical procedure performed, four groups were identified: the TT Group (total thyroidectomy), HT Group (hemithyroidectomy), CT Group (completion thyroidectomy) and HT + CT Group (hemithyroidectomy with subsequent completion thyroidectomy). A total of 751 patients were included. As for the initial surgery, 506 (67.38%) patients underwent a total thyroidectomy and 245 (32.62%) a hemithyroidectomy. Among all patients submitted to a hemithyroidectomy, 66 (26.94%) were subsequently submitted to a completion thyroidectomy. No statistically significant difference was found in terms of complications comparing both the TT Group with the HT + CT Group and the HT Group with the CT Group. The risk of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology was comparable to that of patients submitted to primary thyroid surgery (both a total thyroidectomy and hemithyroidectomy).
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- 2022
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19. A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies.
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Canu GL, Cappellacci F, Noordzij JP, Piras S, Erdas E, Calò PG, and Medas F
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- Humans, Minimally Invasive Surgical Procedures methods, Parathyroidectomy methods, Radiopharmaceuticals, Retrospective Studies, Technetium Tc 99m Sestamibi, Ultrasonography, Hyperparathyroidism, Primary diagnostic imaging, Hyperparathyroidism, Primary surgery
- Abstract
Preoperative localisation of pathological glands in patients with primary hyperparathyroidism (PHP) is the mainstay for mini-invasive parathyroidectomy. Nevertheless, a not negligible number of patients presents discordant or negative neck ultrasound (US) and
99m Tc-Sestamibi (MIBI) scan. The aim of this study was to assess if a mini-invasive approach is feasible in this kind of patients. In this retrospective study were included patients that underwent parathyroidectomy for PHP. Patients were divided into two groups according to concordance of US and MIBI scan results. 242 patients were included: 183 had concordant preoperative studies, and 59 had discordant or negative studies. A mini-invasive approach was possible in 42 (72.9%) patients with unclear preoperative studies, whereas 12 (20.3%) additional patients required conversion to BNE. The incidence of persistent PHP was higher in patients with unclear preoperative studies (8.5% vs 2.7%), but this difference did not reach a statistical significance (p = 0.121). In patients with unclear preoperative studies, a negative result of intraoperative PTH allowed to avoid a persistent disease in 12 patients, while in 3 cases led to an unnecessary additional exploration. In patients with discordant preoperative studies a mini-invasive approach is feasible; in this setting, the use of intraoperative PTH is mandatory to reduce the incidence of persistent PHP., (© 2021. Italian Society of Surgery (SIC).)- Published
- 2022
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20. Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients.
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Canu GL, Medas F, Cappellacci F, Soddu C, Romano G, Erdas E, and Calò PG
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- Calcium, Humans, Parathyroid Hormone, Postoperative Complications diagnosis, Postoperative Complications etiology, Retrospective Studies, Thyroidectomy adverse effects, Hypocalcemia etiology, Hypoparathyroidism diagnosis, Hypoparathyroidism etiology
- Abstract
Introduction: Hypoparathyroidism represents a common complication following total thyroidectomy. To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical hypoparathyroidism will develop permanent hypoparathyroidism. The main purpose of the present study was to assess whether the intact parathyroid hormone (iPTH) value on the first postoperative day is a good predictor of permanent hypoparathyroidism., Material and Methods: Patients undergoing thyroidectomy in our unit between March 2018 and January 2020 were analysed. According to the iPTH value on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into two groups: Group A (iPTH ≥ 4.6 pg/mL) and Group B (iPTH < 4.6 pg/mL, undetectable)., Results: In total 426 patients were included: 364 in Group A and 62 in Group B. Permanent hypoparathyroidism occurred in 3 (0.82%) patients from Group A and in 26 (41.94%) from Group B (p < 0.001). When iPTH levels were < 4.6 pg/mL on the first postoperative day the sensitivity for the prediction of permanent hypoparathyroidism was 89.66%, the specificity was 90.93%, the positive predictive value (PPV) was 41.94%, the negative predicitive value (NPV) was 99.18% and the accuracy was 90.85%., Conclusions: An iPTH value < 4.6 pg/mL on the first postoperative day following total thyroidectomy has proven to be a good parameter for early identification of patients at high risk for permanent hypoparathyroidism. Moreover, we want to underline that in our experience no patient with an iPTH level > 6.5 pg/mL developed this complication.
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- 2022
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21. The role of Rapid Intraoperative Parathyroid Hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: A systematic review and meta-analysis.
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Medas F, Cappellacci F, Canu GL, Noordzij JP, Erdas E, and Calò PG
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- Humans, Intraoperative Period, Secondary Prevention, Treatment Outcome, Hyperparathyroidism, Primary prevention & control, Hyperparathyroidism, Primary surgery, Parathyroid Hormone blood, Parathyroidectomy
- Abstract
Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. In the last few decades, the introduction of Rapid Intraoperative Parathyroid Hormone (ioPTH) monitoring has allowed to ensurance of the excision of all hyperfunctioning parathyroid tissues, reducing the risks of persistent and recurrent PHPT. However, the use of ioPTH is still debated among endocrine surgeons., Material and Methods: The objective of this systematic review and meta-analysis was to assess if ioPTH monitoring is able to reduce the incidence of persistent or recurrent PHPT. A systematic literature search was performed using PubMed, Scopus, ISI-Web of Science and Cochrane Library Database. Prospective and retrospective studies addressing the efficacy of ioPTH monitoring were included in the systematic review and meta-analysis. The random-effects model was assumed to account for different sources of variation among studies. The overall effect size was computed through the inverse variance method. Heterogeneity across studies, possible outlier studies, and publication bias were evaluated., Results: A total of 28 studies with 13,323 patients were included in the quantitative analysis. The incidence of operative failure was 3.2% in the case group and 5.8% in the control group. After excluding three outlier studies, the quantitative analysis revealed that ioPTH reduced significantly the incidence of postoperative persistent or recurrent PHPT. (Risk Difference = -0.02; CI = -0.03, -0.01; p < 0.001). There was no evidence of heterogeneity among the studies (Q = 19.92, p = 0.70; I
2 = 0%). The analysis of several continuous moderators revealed that the effectiveness of ioPTH was larger in studies with lower preoperative serum calcium values and higher incidences of multiple gland disease., Conclusion: ioPTH monitoring is effective in reducing the incidence of persistent and recurrent PHPT. Its routine use should be suggested in the next guidelines regarding management of PHPT., (Copyright © 2021 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)- Published
- 2021
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22. Seroprevalence of SARS-CoV-2 in unselected surgical patients: An update from an unicentric regional study.
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Cappellacci F, Anedda G, Del Giacco S, Coghe F, Cappai R, Canu GL, Erdas E, Calò PG, Medas F, and Firinu D
- Abstract
Competing Interests: The authors declare no conflicts of interest.
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- 2021
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23. What is the Real Incidence of Trocar Site Hernias?
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Erdas E, Canu GL, Cappellacci F, Medas F, and Calò PG
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- Humans, Incidence, Surgical Instruments adverse effects, Hernia, Ventral epidemiology, Hernia, Ventral etiology, Hernia, Ventral surgery, Laparoscopy adverse effects
- Abstract
Competing Interests: The authors declare no conflicts of interest.
- Published
- 2021
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24. Antibiotic Prophylaxis for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis.
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Medas F, Canu GL, Cappellacci F, Romano G, Amato G, Erdas E, and Calò PG
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- Humans, Antibiotic Prophylaxis, Parathyroidectomy, Surgical Wound Infection prevention & control, Thyroidectomy
- Abstract
Objective: Although thyroid and parathyroid surgery is considered a clean procedure with a low incidence of surgical site infections (SSIs), a great number of endocrine surgeons use antibiotic prophylaxis (AP). The aim of this study was to assess whether AP is significantly effective in reducing the incidence of SSIs in this kind of surgery., Data Sources: A systematic literature search was performed with PubMed, Scopus, and ISI-Web of Science. Studies addressing the efficacy of AP in reducing the incidence of SSIs in thyroid and parathyroid surgery were included in the systematic review and meta-analysis., Review Methods: The random effects model was assumed to account for different sources of variation among studies. The overall effect size was computed through the inverse variance method. Heterogeneity across studies, possible outlier studies, and publication bias were evaluated., Results: A total of 6 studies with 4428 patients were included in the quantitative analysis. The incidence of SSI was 0.6% in the case group and 0.4% in the control group (odds ratio, 1.07; 95% CI, 0.3-3.81; P = .915). There was no evidence of heterogeneity among the studies ( Q = 8.36, P = .138; I
2 = 40.17). The analysis of several continuous moderators, including age, use of drain, and duration of surgery, did not generate any significant result., Conclusion: AP is not effective in reducing the incidence of SSI in thyroid and parathyroid surgery and should be avoided, notwithstanding the negative impact on social costs and the risk of development of antibiotic resistance.- Published
- 2021
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25. Risk factors of permanent hypoparathyroidism after total thyroidectomy Retrospective analysis of 285 consecutive patients.
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Canu GL, Medas F, Cappellacci F, Noordzij JP, Marcialis J, Erdas E, and Calò PG
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- Humans, Parathyroid Glands, Parathyroid Hormone, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Hypoparathyroidism epidemiology, Hypoparathyroidism etiology, Thyroidectomy adverse effects
- Abstract
Aim: Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy. The aim of the present study was to investigate the risk factors of this complication., Material and Methods: Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 were retrospectively analysed. They were divided into 2 groups: those with normal parathyroid function in the long term were included in Group A, those who developed permanent hypoparathyroidism in Group B., Results: Two hundred and eighty-five patients were included in this study: 271 in Group A and 14 in Group B. No statistically significant difference was found in terms of sex, age, extent of surgery, rate of retrosternal goiter, postoperative stay and histopathological findings between the 2 groups. On the contrary, mean operative time, rate of patients with PTH values < 6.3 pg/mL on postoperative day 1 and mean thyroid weight were significantly greater in Group B than in Group A (P = 0.049, P < 0.001, P = 0.014; respectively)., Conclusions: Long operative times, PTH levels < 6.3 pg/mL on postoperative day 1 and high thyroid weight have proved to be strong risk factors of permanent hypoparathyroidism after total thyroidectomy. Thus, in these cases a careful follow-up is highly recommended., Key Words: Permanent hypoparathyroidism, Risk factors, Total thyroidectomy.
- Published
- 2021
26. Is extensive surgery really necessary in patients with parathyroid carcinoma? Single-centre experience and a brief review of the literature.
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Canu GL, Medas F, Cappellacci F, Piras S, Sorrenti S, Erdas E, and Calò PG
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- Calcium blood, Humans, Neoplasm Recurrence, Local prevention & control, Parathyroid Diseases blood, Parathyroid Diseases complications, Parathyroid Diseases surgery, Parathyroid Hormone blood, Reoperation, Retrospective Studies, Hyperparathyroidism, Primary blood, Hyperparathyroidism, Primary etiology, Hyperparathyroidism, Primary surgery, Parathyroid Neoplasms blood, Parathyroid Neoplasms complications, Parathyroid Neoplasms surgery, Parathyroidectomy methods
- Abstract
Aim: Parathyroid carcinoma (PC) represents a rare cause of primary hyperparathyroidism (PHPT). In this paper, among patients who underwent surgery for PHPT, we compared those with benign parathyroid disease with those affected by PC in terms of demographic and preoperative biochemical features. Moreover, we singularly described all 10 cases of PC treated at our Institution (including a case that occurred in a patient with tertiary hyperparathyroidism) and a brief review of the literature., Material and Methods: Patients undergoing surgery for PHPT in our Unit between 2003 and 2018 were retrospectively analysed. They were divided into two groups: Group A (benign parathyroid disease), Group B (PC). The case of PC that occurred in the patient with tertiary hyperparathyroidism was not included into the two groups., Results: Three hundred and eight patients were included: 299 in Group A and 9 in Group B. The mean preoperative serum PTH value and mean preoperative serum calcium level were significantly higher in Group B than in Group A (P = 0.018, P = 0.027; respectively). Including the case of PC that occurred in the patient with tertiary hyperparathyroidism, 10 patients with PC were treated at our Institution. Among these, 3 underwent a re-exploration. Disease recurrence occurred in 1 (10%) patient, who developed a local recurrence and distant metastases., Conclusions: In the presence of PHPT characterized by particularly high preoperative levels of serum PTH and calcium this malignancy should be suspected. On the basis of our experience, we believe that extensive surgery is not always necessary., Key Words: Hyperparathyroidism, Parathyroid carcinoma, Parathyroid surgery.
- Published
- 2021
27. Tall Cell Variant versus Conventional Papillary Thyroid Carcinoma: A Retrospective Analysis in 351 Consecutive Patients.
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Longheu A, Canu GL, Cappellacci F, Erdas E, Medas F, and Calò PG
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Background: The aim of this retrospective study was to investigate clinical and pathological characteristics of the tall cell variant of papillary thyroid carcinoma compared to conventional variants., Methods: The clinical records of patients who underwent surgical treatment between 2009 and 2015 were analyzed. The patients were divided into two groups: those with a histopathological diagnosis of tall cell papillary carcinoma were included in Group A, and those with a diagnosis of conventional variants in Group B., Results: A total of 35 patients were included in Group A and 316 in Group B. All patients underwent total thyroidectomy. Central compartment and lateral cervical lymph node dissection were performed more frequently in Group A (42.8% vs. 18%, p = 0.001, and 17.1% vs. 6.9%, p = 0.04). Angiolymphatic invasion, parenchymal invasion, extrathyroidal extension, and lymph node metastases were more frequent in Group A, and the data reached statistical significance. Local recurrence was more frequent in Group A (17.1% vs. 6.3%, p = 0.02), with two patients (5.7%) in Group A showing visceral metastases, whereas no patient in Group B developed metastatic cancer ( p = 0.009)., Conclusions: Tall cell papillary carcinoma is the most frequent aggressive variant of papillary thyroid cancer. Tall cell histology represents an independent poor prognostic factor compared to conventional variants.
- Published
- 2020
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28. Parathyroid Carcinoma in the Setting of Tertiary Hyperparathyroidism: Case Report and Review of the Literature.
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Cappellacci F, Medas F, Canu GL, Lai ML, Conzo G, Erdas E, and Calò PG
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Introduction: Parathyroid carcinoma is one of the rarest cancers in normal population, and it is extremely uncommon in the setting of tertiary hyperparathyroidism. Indeed, only 24 cases have been reported in the literature. Presentation of the Case . We report the case of parathyroid carcinoma in a 51-year-old man, with a history of end-stage renal disease due to a horseshoe kidney treated with haemodialysis since 2013. He came to our attention due to an increase in calcium and parathyroid hormone serum levels. Neck ultrasound (US) showed a solid hypodense mass, probably the right inferior parathyroid gland, with an estimated size of 25 × 15 × 13 mm; the 99mTc-sestamibi SPECT/CT scan revealed a large radiotracer activity area in the right cervical region, compatible with a hyperfunctioning right inferior parathyroid gland. So, a tertiary hyperparathyroidism diagnosis was made. In April 2018, resection of three parathyroid glands was performed. Histopathological examination demonstrated the right inferior parathyroid gland specimen to be a parathyroid carcinoma, due to the presence of multiple, full-thickness, capsular infiltration foci, and a venous vascular invasion focus. Discussion . Diagnosis of parathyroid carcinoma in tertiary hyperparathyroidism is remarkably complex because of the lack of clinical diagnostic criteria and, in many cases, is made postoperatively at histopathological examination., Conclusion: To date, radical surgery represents the mainstay of treatment, with a five- and ten-year survival rates overall acceptable., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2020 Federico Cappellacci et al.)
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- 2020
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29. Seroprevalence of SARS-Cov-2 in the setting of a non-dedicated COVID-19 hospital in a low CoV-2 incidence area: Implications for surgery.
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Medas F, Cappellacci F, Anedda G, Canu GL, Del Giacco S, Calò PG, and Firinu D
- Abstract
The aim of this study was to assess the seroprevalence of SARS-Cov-2 in the setting of a non-dedicated COVID-19 hospital in a low CoV-2 incidence area. We analysed the data of the patients admitted at our surgical department during the period 31st March - June 30, 2020. Among 86 patients included in the study, we found 2 (2.3%) patients positive for both SARS-CoV-2 specific IgM and IgG, 2 (2.3%) for only SARS-CoV-2 specific IgM, and 1 for only SARS-CoV-2 specific IgG. Thus, seroprevalence for SARS-CoV-2 was 5.8%; nasopharyngeal swab was negative in all the cases. Considering the current limitations in sensitivity of nasopharyngeal swab, the uncertainty in the natural history of SARS-CoV2, and the reported prevalence of CoV-2, we think that careful preadmission triage and tests, the use of personal protective equipment and safe management of surgical smoke are mandatory also in our context of low CoV-2 incidence area., Competing Interests: The authors declare no conflicts of interest., (© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)
- Published
- 2020
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30. Can thyroidectomy be considered safe in obese patients? A retrospective cohort study.
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Canu GL, Medas F, Cappellacci F, Podda MG, Romano G, Erdas E, and Calò PG
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- Adult, Aged, Body Mass Index, Female, Humans, Male, Middle Aged, Overweight complications, Retrospective Studies, Thinness complications, Thyroid Diseases complications, Treatment Outcome, Obesity complications, Thyroid Diseases surgery, Thyroidectomy adverse effects, Thyroidectomy methods
- Abstract
Background: Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients., Methods: Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI < 30 kg/m
2 were included in Group A, while those with BMI ≥ 30 kg/m2 in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analyses were performed to evaluate whether the BMI value (considered in this case as a continuous variable) had a significant role in the development of each individual postoperative complication., Results: A total of 813 patients were included in this study: 31 (3.81%) were underweight, 361 (44.40%) normal-weight, 286 (35.18%) overweight, 94 (11.57%) obese and 41 (5.04%) morbidly obese. Six hundred and seventy-eight patients were included in Group A and 135 in Group B. At univariate analysis, the comparison between the two groups, in terms of operative time and thyroid weight resulted in statistically significant results (P = 0.001, P = 0.008; respectively). These features were significantly higher in Group B than in Group A. About postoperative stay and complications, no statistically significant difference was found between the two groups. At multivariate analyses, only the development of cervical haematoma was statistically significantly correlated to the BMI value. Patients with high BMI had a lower risk of cervical haematoma (P = 0.045, OR 0.797, 95% CI 0.638-0.995)., Conclusions: This study showed that obesity, in the field of thyroid surgery, is not associated with any increase of postoperative complications. Thus, it is possible to conclude that thyroidectomy can be performed safely in obese patients. Our result about operative times had no clinical significance.- Published
- 2020
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31. Intraoperative cholangiography during laparoscopic cholecystectomy. Should we follow the recommendations of the current guidelines?
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Erdas E, Canu GL, and Medas F
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- Cholangiography, Humans, Intraoperative Care, Intraoperative Complications, Cholecystectomy, Laparoscopic adverse effects, Gallstones surgery
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- 2020
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32. Predictive Factors of Lymph Node Metastasis in Patients With Papillary Microcarcinoma of the Thyroid: Retrospective Analysis on 293 Cases.
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Medas F, Canu GL, Cappellacci F, Boi F, Lai ML, Erdas E, and Calò PG
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- Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma, Papillary epidemiology, Carcinoma, Papillary surgery, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Lymph Nodes surgery, Lymphatic Metastasis, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Thyroid Neoplasms epidemiology, Thyroid Neoplasms surgery, Young Adult, Carcinoma, Papillary pathology, Lymph Nodes pathology, Thyroid Neoplasms pathology, Thyroidectomy methods
- Abstract
Introduction: Papillary thyroid microcarcinoma (PTMC) is defined as a tumor with a larger diameter ≤ 1 cm and is considered having an indolent course and an excellent prognosis. Nevertheless, the incidence of lymph node metastasis in PTMC is not negligible, reaching up to 65% in some series. The aim of this study was to assess the incidence of lymph node metastasis in patients with PTMC and to evaluate predictive factors for lymph node metastasis. Methods: We included in this retrospective observational study patients who underwent thyroidectomy with pathological diagnosis of PTMC at our department from January 2003 to June 2019. Results: Two hundred ninety-three patients were included in the study. The incidence of lymph node metastasis was 13.7%. Multivariate analysis revealed as independent risk factors for lymph node metastasis age <45 years, nodule size ≥6 mm, tall cell variant of PTC, extrathyroidal extension, and angioinvasion. Conversely, autoimmune thyroiditis was found as a protective factor for lymph node metastasis. A subgroup of patients, with nodule size ≤ 5 mm, presented non-aggressive features. Conclusion: The incidence of lymph node metastasis in PTMC is considerable; the size of the tumor appears to be the most significant predictive factor for lymph node metastasis. The traditional cut-off value used for definition of microcarcinoma could be reconsidered to identify patients with an indolent course of the tumor, where active surveillance could be the appropriate treatment, and on the other hand, patients with potentially aggressive tumors requiring an adequate surgical intervention. Clinical Trial Registration: The trial was registered at ClinicalTrials.gov (ID: NCT04274829)., (Copyright © 2020 Medas, Canu, Cappellacci, Boi, Lai, Erdas and Calò.)
- Published
- 2020
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33. Prophylactic Central Lymph Node Dissection Improves Disease-Free Survival in Patients with Intermediate and High Risk Differentiated Thyroid Carcinoma: A Retrospective Analysis on 399 Patients.
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Medas F, Canu GL, Cappellacci F, Anedda G, Conzo G, Erdas E, and Calò PG
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The role of prophylactic central lymph node dissection (pCLND) in the treatment of differentiated thyroid cancer (DTC) is controversial and still a matter of debate. The primary outcome of our study was to assess whether pCLND is effective in reducing the incidence of recurrent disease, and the secondary goal was to estimate the incidence of postoperative complications in patients who underwent pCLND and to evaluate the prognostic value of occult node metastases. In this retrospective study, we included patients with preoperative diagnosis of DTC and clinically uninvolved lymph nodes (cN0). The patients were divided into two groups, depending on the surgical approach: total thyroidectomy alone (TT group) or total thyroidectomy and pCLND (pCLND group). Three hundred and ninety-nine patients were included in this study, 320 (80.2%) in the TT group and 79 (19.8%) in the pCLND group. There were no significant differences in morbidity among the two groups. Histopathological evaluation demonstrated a similar distribution of aggressive features, especially regarding multicentricity, extrathyroidal extension, and angioinvasivity between the two groups. Occult lymph node metastases were found in 20 (25.3%) patients in the pCLND group. Prophylactic CLND was effective in improving disease-free survival in patients with intermediate and high risk of disease recurrence ( p = 0.0392); occult lymph node metastases resulted as a significant negative prognostic factor ( p < 0.001).
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- 2020
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34. Thyroidectomy with energy-based devices: surgical outcomes and complications-comparison between Harmonic Focus, LigaSure Small Jaw and Thunderbeat Open Fine Jaw.
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Canu GL, Medas F, Podda F, Tatti A, Pisano G, Erdas E, and Calò PG
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Background: Being the thyroid gland a highly vascularized organ, achieving a meticulous hemostasis is essential to avoid serious complications. Currently, energy-based devices are widely used in thyroid surgery. The aim of this study was to compare Harmonic Focus (HF), LigaSure Small Jaw (LSJ) and Thunderbeat Open Fine Jaw (TB) in terms of surgical outcomes and complications., Methods: Patients undergoing thyroidectomy in our Unit between January 2012 and June 2018 were retrospectively analyzed. According to the type of energy-device used, patients were divided into three groups: Group A (HF), Group B (LSJ) and Group C (TB)., Results: A total of 1,165 patients were included in this study: 1,012 in Group A, 96 in Group B and 57 in Group C. Demographic data and histopathological findings were comparable between the three groups. About the postoperative stay and complications, no statistically significant difference was found. The mean operative time was 89.41±20.60 minutes in Group A, 85.57±15.91 minutes in Group B and 78.07±17.67 minutes in Group C (P<0.01). However, the post-hoc test for all pairwise comparisons showed a statistically significant difference only between Group A and Group C., Conclusions: HF, LSJ and TB have proved to be safe and effective. The postoperative stay and complications were comparable between the three groups. Considering the limits of our investigation, further studies are needed to investigate the effect of TB on operative times., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs.2020.03.31). PGC serves as an unpaid editorial board member of Gland Surgery from June 2019 to May 2021. The other authors have no conflicts of interest to declare., (2020 Gland Surgery. All rights reserved.)
- Published
- 2020
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35. Is prophylactic central neck dissection justified in patients with cN0 differentiated thyroid carcinoma? An overview of the most recent literature and latest guidelines.
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Canu GL, Medas F, Conzo G, Boi F, Amato G, Erdas E, and Calò PG
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- Humans, Lymph Nodes, Lymphatic Metastasis, Neoplasm Recurrence, Local, Practice Guidelines as Topic, Thyroidectomy, Neck Dissection, Thyroid Neoplasms surgery
- Abstract
To date, in patients with differentiated thyroid cancer, central neck dissection is recommended in the presence of central compartment lymph node metastases. Differently, the efficacy of prophylactic central neck dissection in case of clinically node-negative differentiated thyroid carcinoma remains still uncertain. There are many arguments in favor and many against the execution of this surgical procedure. The most recent literature and latest guidelines have been reviewed and illustrated, paying particular attention to currently hottest and most discussed points. Prophylactic central neck dissection is associated with higher rates of postoperative complications, such as recurrent laryngeal nerve injury and hypoparathyroidism, with unclear oncological benefits. Thus, in the absence of lymph node involvement, this procedure should be avoided, reserving it for high-risk patients with advanced primary tumors. Moreover, to avoid serious complications, prophylactic central neck dissection should be performed by high-volume surgeons. KEY WORDS: Clinically node-negative differentiated thyroid cancer, Differentiated thyroid carcinoma, Prophylactic central neck dissection.
- Published
- 2020
36. Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases.
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Medas F, Tuveri M, Canu GL, Erdas E, and Calò PG
- Subjects
- Adult, Anatomic Landmarks, Cicatrix etiology, Edema etiology, Female, Humans, Hypoparathyroidism etiology, Male, Middle Aged, Postoperative Complications, Postoperative Hemorrhage, Recurrent Laryngeal Nerve Injuries etiology, Reoperation, Retrospective Studies, Risk Factors, Goiter, Nodular surgery, Thyroid Nodule surgery, Thyroidectomy adverse effects
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Reoperative thyroid surgery is an uncommon procedure that is indicated in recurrent benign or malignant disease. It is associated with a high complication rate, especially of hypoparathyroidism and recurrent nerve palsy. We retrospectively reviewed our series of patients on whom reoperative thyroid surgery was performed and we compared this group with patients who underwent primary thyroidectomies. From 2002 to 2015, 4572 thyroidectomies were performed at our institution; among these, 152 (3.3%) were for benign or malignant recurrent disease. We observed a higher rate of transient hypoparathyroidism in secondary vs primary surgery (56.6% vs 25.9%; p < 0.0001), of permanent hypoparathyroidism (10% vs 2.0%; p < 0.0001) and of transient recurrent nerve injury (4.6% vs 1.4%; p < 0.05). Reoperative thyroid surgery is a technical challenge with a high incidence of complications. Scarring, edema, and friability of the tissues together with distortion of the landmarks make reoperative surgery hazardous. Careful assessment of patient's risk factors, physical examination, and if necessary fine needle aspiration cytology are crucial for selecting the patients who should undergo reoperation. Research registry n. 2617 registered 5 June 2017 (retrospectively registered).
- Published
- 2019
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37. Predictive Factors of Recurrence in Patients with Differentiated Thyroid Carcinoma: A Retrospective Analysis on 579 Patients.
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Medas F, Canu GL, Boi F, Lai ML, Erdas E, and Calò PG
- Abstract
Differentiated thyroid carcinoma (DTC) is usually associated with a favorable prognosis. Nevertheless, up to 30% of patients present a local or distant recurrence. The aim of this study was to assess the incidence of recurrence after surgery for DTC and to identify predictive factors of recurrence. We included in this retrospective study 579 consecutive patients who underwent thyroidectomy for DTC from 2011 to 2016 at our institution. We observed biochemical or structural recurrent disease in 36 (6.2%) patients; five-year disease-free survival was 94.1%. On univariate analysis, male sex, histotype, lymph node yield, lymph node metastasis, extrathyroidal invasion and multicentricity were associated with significantly higher risk of recurrence, while microcarcinoma was correlated with significantly lower risk of recurrence. On multivariate analysis, only lymph node metastases (OR 4.724, p = 0.012) and microcarcinoma (OR 0.328, p = 0.034) were detected as independent predictive factors of recurrence. Postoperative management should be individualized and commensurate with the risk of recurrence: Patients with high-risk carcinoma should undergo strict follow-up and aggressive treatment. Furthermore, assessment of the risk should be repeated over time, considering individual response to therapy., Competing Interests: The authors declare no conflict of interest.
- Published
- 2019
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38. Monitored transoral endoscopic thyroidectomy.
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Calò PG, Medas F, Canu GL, and Erdas E
- Abstract
Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
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- 2019
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39. Tentacle-shaped mesh for fixation-free repair of umbilical hernias.
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Amato G, Romano G, Agrusa A, Canu GL, Gulotta E, Erdas E, and Calò PG
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- Abdominal Wall surgery, Adult, Aged, Female, Humans, Male, Middle Aged, Prosthesis Implantation methods, Recurrence, Suture Techniques, Umbilicus surgery, Hernia, Umbilical surgery, Herniorrhaphy methods, Prostheses and Implants, Surgical Mesh
- Abstract
Purpose: Mesh fixation and broad overlap represent an open issue in umbilical hernia repair. A proprietary-designed implant with tentacle straps at its boundary has been developed to ensure a suture-free repair and a broader coverage of the abdominal wall. The study describes the results of umbilical hernia procedures carried out with the tentacle-shaped implant and the related surgical technique., Methods: A proprietary tentacle-shaped flat mesh having a central body with integrated radiating arms at its edge was used to repair large umbilical hernias in 62 patients. The implant was placed in preperitoneal sublay. The friction of the straps, crossing the abdominal wall thanks to a special needle passer, was intended to assure adequate grip to hold the implant in place assuring a fixation-free procedure and broad overlap of the hernia defect., Results: In a mean follow-up of 48 months (range 10-62 months), 4 seromas and 2 ischemia of the navel skin occurred. No infections, hematomas, chronic pain, mesh dislocation, or recurrence has been reported., Conclusions: The tentacle strap system of the prosthesis effectively ensured an easier implant placement avoiding the need for suturing the mesh. The arms of the implant ensured a proper orientation and stabilization of the mesh in association with a broad defect overlap. The specifically developed surgical procedure showed a quick postoperative recovery, a very low complication rate, and no recurrences even in the long term.
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- 2019
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40. Correlation between iPTH Levels on the First Postoperative Day After Total Thyroidectomy and Permanent Hypoparathyroidism: Our Experience.
- Author
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Canu GL, Medas F, Longheu A, Boi F, Docimo G, Erdas E, and Calò PG
- Abstract
Permanent hypoparathyroidism is the most common long-term complication after thyroidectomy. We evaluated whether iPTH concentrations on the first postoperative day may be a good predictor of this complication. Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 who developed postsurgical hypoparathyroidism were analysed. According to iPTH values on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into 2 groups: Group A (iPTH < 6.3 pg/mL, undetectable), Group B (iPTH ≥ 6.3 pg/mL). Seventy-five patients were included in this study: 64 in Group A and 11 in Group B. Permanent hypoparathyroidism occurred in 14 (21.88%) patients in Group A, while none developed this complication in Group B. When iPTH was < 6.3 pg/mL, the sensitivity for the prediction of permanent hypoparathyroidism was 100%, the specificity was 18.03%, the positive predictive value was 21.88% and the negative predictive value was 100%. No patient with iPTH ≥ 6.3 pg/mL on the first postoperative day developed permanent hypoparathyroidism. On the other hand, iPTH concentrations < 6.3 pg/mL have not proved to be a strong predictor of this condition. However, this cut-off value can be useful to identify patients at risk of developing this complication., Competing Interests: Conflict of interest: Authors state no conflict of interest.
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- 2019
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41. Tracheostomy after total thyroidectomy: indications and results in a series of 3214 operations.
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Pisano G, Canu GL, Erdas E, Medas F, and Calò PG
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Treatment Outcome, Young Adult, Thyroidectomy methods, Tracheostomy statistics & numerical data
- Published
- 2019
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42. Does antithrombotic prophylaxis worsen early outcomes of total thyroidectomy? - a retrospective cohort study.
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Erdas E, Medas F, Sanna S, Gordini L, Pisano G, Canu GL, and Calò PG
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- Aged, Cohort Studies, Female, Hemorrhage epidemiology, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, Fibrinolytic Agents administration & dosage, Heparin, Low-Molecular-Weight administration & dosage, Thyroid Gland surgery, Thyroidectomy methods
- Abstract
Background: Currently, there is no strong evidence on the effectiveness and safety of pharmacological antithrombotic prophylaxis in thyroid surgery. The aim of this study was to establish whether the prophylactic use of low-molecular-weight heparin (LMWH) could negatively affect the early outcomes of patients undergoing total thyroidectomy., Methods: Data from patients submitted to total thyroidectomy between February 2013 and October 2017 were retrospectively collected and analysed. Only patients with indication to antithrombotic prophylaxis according to current guidelines were included in the study. Eligible cases were divided into two groups, which corresponded to two distinct periods of our surgical practice: Group A, which included 178 consecutive patients who were submitted to antithrombotic prophylaxis with LMWH, and Group B, which included 348 consecutive patients who did not receive prophylaxis. Primary endpoints were the incidence of post-operative cervical haematomas (POCH) and thromboembolic events. Secondary endpoint was the length of postoperative hospital stay. Statistical analysis was performed by using Student's t test for continuous variables and Chi-square test for categorical variables. A P value of less than 0.05 was considered statistically significant., Results: The two groups of patients were comparable in terms of age, gender, thyroid disease, duration of surgery, and weight of the thyroid gland. Overall, no thromboembolic events were registered. The comparative analysis of the other outcome measures, showed no significant differences between the two groups (POCH: 2 cases (1.12%) in Group A vs 8 cases (2.30%) in Group B - p 0.349; Postoperative hospital stay: 2.90 ± 0.86 days in Group A vs 2.89 ± 0.99 days in Group B - p 0.908)., Conclusions: Data from this study do not support or contraindicate the use of antithrombotic prophylaxis in thyroid surgery. However, since thyroidectomy is a closed-space procedure, and even modest bleeding may quickly result in airway compression and death by asphyxia, mechanical prophylaxis should be preferred to LMWH whenever possible., Trial Registration: ISRCTN ISRCTN12029395. Registered 05/02/2018 retrospectively registered.
- Published
- 2019
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43. Gallstone ileus in elderly patients.
- Author
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Erdas E, Medas F, Salaris C, Canu GL, Sanna S, Gordini L, Pisano G, and Calò PG
- Subjects
- Aged, Aged, 80 and over, Comorbidity, Female, Humans, Ileus diagnostic imaging, Ileus surgery, Jejunal Diseases diagnostic imaging, Jejunal Diseases surgery, Male, Recurrence, Tomography, X-Ray Computed, Ultrasonography, Cholelithiasis complications, Gallstones, Ileus etiology, Jejunal Diseases etiology
- Published
- 2018
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44. Pseudoangiomatous stromal hyperplasia (PASH) presenting as axillary lump: case report and review of the literature.
- Author
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Canu GL, Medas F, Ravarino A, Furcas S, Loi G, Cerrone G, Rossi C, Erdas E, and Calò P G
- Subjects
- Angiomatosis etiology, Angiomatosis pathology, Angiomatosis surgery, Breast, Breast Diseases etiology, Breast Diseases pathology, Breast Diseases surgery, Choristoma complications, Contraceptives, Oral, Hormonal adverse effects, Contraceptives, Oral, Hormonal pharmacology, Diagnosis, Differential, Female, Gonadal Steroid Hormones adverse effects, Hormone Replacement Therapy adverse effects, Humans, Hyperplasia etiology, Hyperplasia pathology, Hyperplasia surgery, Myofibroblasts drug effects, Young Adult, Angiomatosis diagnosis, Axilla pathology, Breast Diseases diagnosis, Hyperplasia diagnosis
- Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign mesenchymal breast lesion. There are extremely rare reports of PASH arising in accessory breast tissue. To date, in literature, fewer than 10 cases of PASH occurring in axillary region have been described. We report a case presenting as axillary lump in a young woman. A 20-year-old female presented to our surgical unit for a progressively growing and painful palpable mass of the right axilla for about a year. Before surgery an ultrasound was performed. The patient underwent local excision of the lesion under local anaesthesia. Through histological and immunohistochemical examination a pseudoangiomatous stromal hyperplasia (PASH) was diagnosed. At 6 months of followup the patient is free of disease. It is important to include PASH also in the differential diagnosis of axillary lumps. Histological examination of the surgical specimen and surgery represent, respectively, the mainstay for diagnosis and therapy.
- Published
- 2018
45. Emergency Laparoscopic Repair of Giant Left Diaphragmatic Hernia following Minimally Invasive Esophagectomy: Description of a Case and Review of the Literature.
- Author
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Erdas E, Canu GL, Gordini L, Mura P, Laconi G, Pisano G, Medas F, and Calò PG
- Abstract
Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. PDH occurs more frequently when minimally invasive techniques are employed, but very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 71-year-old man underwent minimally invasive esophagectomy for esophageal cancer. Three months later, he developed a giant PDH, which was repaired by direct suture via laparoscopic approach. A hypertensive pneumothorax occurred during surgery. This complication was managed by the anaesthesiologist through a high fraction of inspired O
2 and several recruitment manoeuvres. The patient remained free of hernia recurrence until he died of neoplastic cachexia 5 months later. Laparoscopic repair of PDH may be safe and effective even in the acute setting and in the case of massive herniation. However, surgeons and anaesthesiologists should be aware of the risk of intraoperative pneumothorax and be prepared to treat it promptly.- Published
- 2018
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46. Benign Multicystic Peritoneal Mesothelioma in a Male Patient with Previous Wilms' Tumor: A Case Report and Review of the Literature.
- Author
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Canu GL, Medas F, Columbano G, Gordini L, Saba L, Erdas E, and Calò PG
- Abstract
Benign multicystic peritoneal mesothelioma (BMPM) is a rare condition, more common in females of reproductive age, which arises from the peritoneal mesothelium. A 33-year-old male presented to our unit with abdominal pain and constipation. His past medical history included a previous unilateral nephrectomy for Wilms' tumor and the previous incidental finding of some intra-abdominal cystic formations at the level of the mesentery. After performing a CT scan, an exploratory laparotomy was done and a voluminous cystic mesenteric mass, composed of 3 confluent formations, was observed. Some other similar but significantly smaller lesions were found. An en bloc resection of the mesenteric mass together with the corresponding intestinal loops, an appendicectomy, and some peritoneal biopsies were performed. The postoperative period was complicated by a peritonitis due to dehiscence of the intestinal anastomosis, which required another operation, and a delayed return of normal bowel function, which was resolved through prokinetic therapy. Through histological examination, a BMPM was diagnosed. At 8 months of follow-up, the patient is free of symptoms. BMPM exact etiopathogenesis still remains uncertain. Given his high recurrence rate, a long-term follow-up is recommended.
- Published
- 2018
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47. Does hyperthyroidism worsen prognosis of thyroid carcinoma? A retrospective analysis on 2820 consecutive thyroidectomies.
- Author
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Medas F, Erdas E, Canu GL, Longheu A, Pisano G, Tuveri M, and Calò PG
- Subjects
- Adult, Age Distribution, Aged, Case-Control Studies, Comorbidity, Disease Progression, Female, Humans, Hyperthyroidism pathology, Incidence, Male, Middle Aged, Monitoring, Physiologic methods, Positron-Emission Tomography methods, Prognosis, Reference Values, Retrospective Studies, Risk Assessment, Thyroid Function Tests, Thyroid Neoplasms pathology, Ultrasonography, Doppler methods, Hyperthyroidism epidemiology, Hyperthyroidism surgery, Thyroid Neoplasms epidemiology, Thyroid Neoplasms surgery, Thyroidectomy methods
- Abstract
Background: Hyperthyroidism is associated with high incidence of thyroid carcinoma; furthermore, tumors arisen in hyperthyroid tissue show an aggressive behavior. Thyroid Stimulating Hormone (TSH) and Thyroid-stimulating antibodies, present in Graves's disease, seem to play a key role in carcinogenesis and tumoral growth., Methods: We retrospectively reviewed our series of patients who underwent thyroidectomy for thyroid carcinoma. We compared pathological features and surgical outcomes of hyperthyroid versus euthyroid patients., Results: From 2007 to 2015, 909 thyroidectomies were performed at our institution for thyroid cancer: 87 patients were hyperthyroid and 822 euthyroid. We observed, in hyperthyroid patients, a higher rate of transient hypoparathyroidism (28.1% vs 13.2%; p < 0.01) and of node metastases (12.6% vs 6.1%; p = 0.03); also local recurrence rate was higher (5.7% vs 2.5%) even if not statistically significant (p = 0.17). Five-year disease free survival rate was significant lower in the same group (89.1% vs 96.6%; p = 0.03)., Conclusion: Thyroid cancers in hyperthyroid patients have an aggressive behavior, with high incidence of local invasion and a worse prognosis than euthyroid patients. All hyperthyroid patients should undergo a careful evaluation with ultrasound and scintigraphy; in case of suspicious nodules, an aggressive approach, including thyroidectomy and lymphectomy, is justified. In patients with toxic adenoma, thyroid cancer is uncommon, thus a loboisthmectomy can be safely performed., Trial Registration Number: Research registry n. 2670 registered 19 June 2017 (retrospectively registered).
- Published
- 2018
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48. Primary thyroid leiomyosarcoma: a case report and review of the literature.
- Author
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Canu GL, Bulla JS, Lai ML, Medas F, Baghino G, Erdas E, Mariotti S, and Calò PG
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Doxorubicin administration & dosage, Esophagectomy methods, Esophagus pathology, Esophagus surgery, Humans, Ifosfamide administration & dosage, Leiomyosarcoma diagnosis, Leiomyosarcoma drug therapy, Leiomyosarcoma pathology, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local drug therapy, Thyroid Neoplasms diagnosis, Thyroid Neoplasms drug therapy, Thyroid Neoplasms pathology, Thyroidectomy, Leiomyosarcoma surgery, Thyroid Neoplasms surgery
- Abstract
Primary thyroid leiomyosarcoma (LMS) is an extremely rare tumor. We report a case of a 47-year-old male with a rapidly growing neck mass and disfagia. Preoperative investigations were diagnostic of anaplastic carcinoma. Total thyroidectomy with partial esophagectomy and dissection of right infrahyoid muscles was performed. Through histolological and immunohistochemical evaluations a primary thyroid high-grade LMS was diagnosed. At 2 months of follow-up a local recurrence was detected and consequently the patient was submitted to chemotherapy with partial response. He is still alive 9 months after surgery. Diagnosis of primary thyroid LMS is difficult due to its similarity to other more common thyroid tumors. To date, there is no standard therapy and prognosis is poor.
- Published
- 2018
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49. Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified?
- Author
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Calò PG, Medas F, Conzo G, Podda F, Canu GL, Gambardella C, Pisano G, Erdas E, and Nicolosi A
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Postoperative Complications etiology, Postoperative Complications prevention & control, Predictive Value of Tests, Recurrent Laryngeal Nerve Injuries etiology, Recurrent Laryngeal Nerve Injuries prevention & control, Sensitivity and Specificity, Thyroid Gland innervation, Thyroid Gland surgery, Thyroidectomy adverse effects, Tracheostomy, Vocal Cord Paralysis etiology, Vocal Cord Paralysis prevention & control, Young Adult, Clinical Decision-Making methods, Intraoperative Neurophysiological Monitoring methods, Signal Processing, Computer-Assisted, Thyroidectomy methods
- Abstract
Background: The aim of this study was to evaluate the diagnostic accuracy of intraoperative neuromonitoring (IONM) in predicting postoperative nerve function during thyroid surgery and its consequent ability to assist the surgeon in intraoperative decision making., Materials and Methods: A total of 2365 consecutive patients were submitted to thyroidectomy by the same surgical team. Group A included 1356 patients (2712 nerves at risk) in whom IONM was utilized, and Group B included 1009 patients (2018 nerves at risk) in whom IONM was not utilized., Results: In Group A, loss of signal (LOS) was observed in 37 patients; there were 29 true positive, 1317 true negative, 8 false positive, and 2 false negative cases. Accuracy was 99.3%, positive predictive value was 78.4%, negative predictive value was 99.8%, sensitivity was 93.6%, and specificity was 99.4%. A total of 29 (2.1%) cases of unilateral paralysis were observed, 23 (1.7%) of which were transient and 6 (0.4%) of which were permanent. Bilateral palsy was observed in two (0.1%) cases requiring a tracheostomy. In Group A, 31 (2.3%) injuries were observed, 25 (1.8%) of which were transient and 6 (0.4%) of which were permanent. In Group B, 26 (2.6%) unilateral paralysis cases were observed, 20 (2%) of which were transient and 6 (0.6%) of which were permanent; bilateral palsy was observed in 2 (0.2%) cases. In Group B, 28 (2.8%) injuries were observed, 21 (2.1%) of which were transient and 7 (0.7%) of which were permanent. Differences between the two groups were not statistically significant., Conclusions: Our results show that IONM has a very high sensitivity and negative predictive value, but also good specificity and positive predictive value. For these reasons, in selected patients with LOS, the surgical strategy should be reconsidered. However, patients need to be informed preoperatively about potential strategy changes during the planned bilateral surgery. Future larger and multicenter studies are needed to confirm the benefits of this therapeutic strategy., (Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2017
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50. Risk of malignancy in thyroid nodules classified as TIR-3A: What therapy?
- Author
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Medas F, Erdas E, Gordini L, Conzo G, Gambardella C, Canu GL, Pisano G, Nicolosi A, and Calò PG
- Subjects
- Adenocarcinoma, Follicular epidemiology, Adenocarcinoma, Follicular etiology, Adult, Aged, Axilla, Biopsy, Fine-Needle, Carcinoma, Papillary epidemiology, Carcinoma, Papillary etiology, Female, Humans, Lymph Nodes pathology, Male, Middle Aged, Retrospective Studies, Risk Factors, Thyroid Cancer, Papillary, Thyroid Neoplasms epidemiology, Thyroid Neoplasms etiology, Thyroid Nodule classification, Thyroid Nodule pathology, Ultrasonography, Adenocarcinoma, Follicular pathology, Carcinoma, Papillary pathology, Thyroid Neoplasms pathology, Thyroid Nodule complications
- Abstract
Background: The aim of the present study was to assess the clinical applicability of the TIR3A category in managing thyroid nodules, to examine the malignancy rates of TIR 3A and TIR 3B nodules, and to suggest management guidelines for these nodules., Materials and Methods: Thyroid cytologies performed in patients referred to our Department between January 2014 and August 2016 were classified according to the guidelines published by the SIAPEC. 102 cases were included in this retrospective study and were divided into two groups: 19 TIR3A were included in group A and 83 TIR3B in group B., Results: In group A, malignancy was diagnosed in 4 (21.1%) cases, papillary thyroid cancer was found in 3 patients and follicular thyroid cancer in 1; one case was classified as microcarcinoma, in two cancer was multicentric and bilateral and in one central node metastases were observed. In Group B malignancy was diagnosed in 48 (57.8%) patients, papillary thyroid cancer was found in 36 patients and follicular cancer in 12; microcarcinoma was observed in 25 cases, 12 were unilateral multicentric and 7 bilateral multicentric; in 3 cases central node metastases were present., Conclusion: Thyroid nodules with TIR3A cytology have a lower risk of malignancy than TIR3B cases, for which the new SIAPEC classification has proved accurate and effective. Malignancy rates in nodules with TIR3A cytology are higher than expected, although the real and accurate definition of the risk is extremely difficult. The recommendation to perform an accurate follow-up and repeat the fine-needle aspiration still appears the best option. For better management of patients with TIR3A cytology a careful assessment of risk factors and ultrasound characteristics is always needed. Further multicenter studies with longer follow-up are needed to better define the efficacy of this classification, the actual cancer risk, and the best management of these lesions., (Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
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