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1. Prospective minimally invasive pancreatic resections from the IGOMIPS registry: a snapshot of daily practice in Italy on 1191 between 2019 and 2022

Author

Boggi, U., Donisi, G., Napoli, N., Partelli, S., Esposito, A., Ferrari, G., Butturini, G., Morelli, L., Abu Hilal, M., Viola, M., Di Benedetto, F., Troisi, R., Vivarelli, M., Jovine, E., Ferrero, A., Bracale, U., Alfieri, Sergio, Casadei, R., Ercolani, G., Moraldi, L., Molino, C., Dalla Valle, R., Ettorre, G., Memeo, R., Zanus, G., Belli, A., Gruttadauria, S., Brolese, A., Coratti, A., Garulli, G., Romagnoli, R., Massani, M., Borghi, F., Belli, G., Coppola, R., Falconi, M., Salvia, R., Zerbi, A., Kauffmann, E. F., Capretti, G., Genova, L., Matteo, P., Mazzola, M., Giardino, A., Palmieri, M., Manzoni, A., Barbieri, V., Ballarin, R., Rompianesi, G., Rossi, R., Mastrangelo, L., Langella, S., Ilardi, M., Menghi, Roberta, Ricci, C., Gardini, A., Campra, D., Crolla, E., Cecconi, S., Meniconi, R. L., Ferraro, V., Brizzolari, M., Izzo, F., Cintorino, D., Marcucci, S., Giuliani, G., Veneroni, L., Moro, F., Nistri, C., Caputo, D., Gianluca, B., Mazzaferro, V., Alfieri S. (ORCID:0000-0002-0404-724X), Menghi R., Boggi, U., Donisi, G., Napoli, N., Partelli, S., Esposito, A., Ferrari, G., Butturini, G., Morelli, L., Abu Hilal, M., Viola, M., Di Benedetto, F., Troisi, R., Vivarelli, M., Jovine, E., Ferrero, A., Bracale, U., Alfieri, Sergio, Casadei, R., Ercolani, G., Moraldi, L., Molino, C., Dalla Valle, R., Ettorre, G., Memeo, R., Zanus, G., Belli, A., Gruttadauria, S., Brolese, A., Coratti, A., Garulli, G., Romagnoli, R., Massani, M., Borghi, F., Belli, G., Coppola, R., Falconi, M., Salvia, R., Zerbi, A., Kauffmann, E. F., Capretti, G., Genova, L., Matteo, P., Mazzola, M., Giardino, A., Palmieri, M., Manzoni, A., Barbieri, V., Ballarin, R., Rompianesi, G., Rossi, R., Mastrangelo, L., Langella, S., Ilardi, M., Menghi, Roberta, Ricci, C., Gardini, A., Campra, D., Crolla, E., Cecconi, S., Meniconi, R. L., Ferraro, V., Brizzolari, M., Izzo, F., Cintorino, D., Marcucci, S., Giuliani, G., Veneroni, L., Moro, F., Nistri, C., Caputo, D., Gianluca, B., Mazzaferro, V., Alfieri S. (ORCID:0000-0002-0404-724X), and Menghi R.

Abstract

This retrospective analysis of the prospective IGOMIPS registry reports on 1191 minimally invasive pancreatic resections (MIPR) performed in Italy between 2019 and 2022, including 668 distal pancreatectomies (DP) (55.7%), 435 pancreatoduodenectomies (PD) (36.3%), 44 total pancreatectomies (3.7%), 36 tumor enucleations (3.0%), and 8 central pancreatectomies (0.7%). Spleen-preserving DP was performed in 109 patients (16.3%). Overall incidence of severe complications (Clavien-Dindo & GE; 3) was 17.6% with a 90-day mortality of 1.9%. This registry analysis provided some important information. First, robotic assistance was preferred for all MIPR but DP with splenectomy. Second, robotic assistance reduced conversion to open surgery and blood loss in comparison to laparoscopy. Robotic PD was also associated with lower incidence of severe postoperative complications and a trend toward lower mortality. Fourth, the annual cut-off of & GE; 20 MIPR and & GE; 20 MIPD improved selected outcome measures. Fifth, most MIPR were performed by a single surgeon. Sixth, only two-thirds of the centers performed spleen-preserving DP. Seventh, DP with splenectomy was associated with higher conversion rate when compared to spleen-preserving DP. Eighth, the use of pancreatojejunostomy was the prevalent reconstruction in PD. Ninth, final histology was similar for MIPR performed at high- and low-volume centers, but neoadjuvant chemotherapy was used more frequently at high-volume centers. Finally, this registry analysis raises important concerns about the reliability of R1 assessment underscoring the importance of standardized pathology of pancreatic specimens. In conclusion, MIPR can be safely implemented on a national scale. Further analyses are required to understand nuances of implementation of MIPR in Italy.

Published
2023

2. Regret affects the choice between neoadjuvant therapy and upfront surgery for potentially resectable pancreatic cancer

Author

Cucchetti, A., Djulbegovic, B., Crippa, S., Hozo, I., Sbrancia, M., Tsalatsanis, A., Binda, C., Fabbri, C., Salvia, R., Falconi, M., Ercolani, G., Alfieri, Sergio, Amato, A., Amisano, M., Anderloni, A., Maestri, A., Coluccio, C., Brandi, G., Casadei-Gardini, A., Cennamo, V., Crino, S. F., Valle, R. D., De Angelis, C., Di Battista, M., Di Maio, M., Di Marco, M., Di Matteo, F., Di Mitri, R., Ettorre, G. M., Facciorusso, A., Farina, G., Ferrari, G., Fornaro, L., Frigerio, I., Frisone, D., Fuccio, L., Gardini, A., Garufi, C., Giampieri, R., Grazi, G. L., Jovine, E., Kauffmann, E., Langella, S., Larghi, Alberto Leonardo, Manno, M., Marciano, E., Marzioni, M., Merighi, A., Mutignani, M., Nardo, B., Niger, M., Palmisano, V., Partelli, S., Pinto, C., Piras, E., Rapposelli, I. G., Reni, M., Ricci, C., Rimassa, L., Siena, S., Spada, Cristiano, Sperti, E., Spezzaferro, M., Sposito, C., Tamberi, S., Troisi, R., Veneroni, L., Vivarelli, M., Zerbi, A., Alfieri S. (ORCID:0000-0002-0404-724X), Larghi A., Spada C. (ORCID:0000-0002-5692-0960), Cucchetti, A., Djulbegovic, B., Crippa, S., Hozo, I., Sbrancia, M., Tsalatsanis, A., Binda, C., Fabbri, C., Salvia, R., Falconi, M., Ercolani, G., Alfieri, Sergio, Amato, A., Amisano, M., Anderloni, A., Maestri, A., Coluccio, C., Brandi, G., Casadei-Gardini, A., Cennamo, V., Crino, S. F., Valle, R. D., De Angelis, C., Di Battista, M., Di Maio, M., Di Marco, M., Di Matteo, F., Di Mitri, R., Ettorre, G. M., Facciorusso, A., Farina, G., Ferrari, G., Fornaro, L., Frigerio, I., Frisone, D., Fuccio, L., Gardini, A., Garufi, C., Giampieri, R., Grazi, G. L., Jovine, E., Kauffmann, E., Langella, S., Larghi, Alberto Leonardo, Manno, M., Marciano, E., Marzioni, M., Merighi, A., Mutignani, M., Nardo, B., Niger, M., Palmisano, V., Partelli, S., Pinto, C., Piras, E., Rapposelli, I. G., Reni, M., Ricci, C., Rimassa, L., Siena, S., Spada, Cristiano, Sperti, E., Spezzaferro, M., Sposito, C., Tamberi, S., Troisi, R., Veneroni, L., Vivarelli, M., Zerbi, A., Alfieri S. (ORCID:0000-0002-0404-724X), Larghi A., and Spada C. (ORCID:0000-0002-5692-0960)

Abstract

Background: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes to-ward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma.Methods: Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons). Respondents were asked to report their regret of omission and commission regarding neo-adjuvant chemotherapy on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied to analyze respondents' attitudes toward neo-adjuvant therapy.Results: The lowest regret of omission was elicited in the low-risk scenario, and the highest regret in the high-risk scenario (P < .001). The regret of the commission was diametrically opposite to the regret of omission (P < .001). The disease-specific threshold mortality at which upfront surgery is favored over the neoadjuvant therapy progressively decreased from the low-risk to the high-risk scenarios (P <=.001). The nonsurgeons working in or with lower surgical volume centers (P = .010) and surgeons (P = .018) accepted higher disease-specific mortality after upfront surgery, which resulted in the lower likelihood of adopting neoadjuvant therapy.Conclusion: Regret drives decision making in the management of pancreatic adenocarcinoma. Being a surgeon or a specialist working in surgical centers with lower patient volumes reduces the likelihood of recommending neoadjuvant therapy.(c) 2023 Elsevier Inc. All rights reserved.

Published
2023

8. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Author

De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., Sommacale D., De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., and Sommacale D.

Abstract

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Published
2021

9. Preoperative risk score for prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma: Report of a collaborative, international-based, external validation study

Author

Brustia, R, Langella, S, Kawai, T, Fonseca, G, Schielke, A, Colli, F, Resende, V, Fleres, F, Roulin, D, Leyman, P, Giacomoni, A, Granger, B, Fartoux, L, De Carlis, L, Demartines, N, Sommacale, D, Sanches, M, Patrono, D, Detry, O, Herman, P, Okumura, S, Ferrero, A, Scatton, O, Uemoto, S, Perdigao, F, Nolasco, F, Laroche, S, Romagnoli, R, Famularo, S, Brustia R., Langella S., Kawai T., Fonseca G. M., Schielke A., Colli F., Resende V., Fleres F., Roulin D., Leyman P., Giacomoni A., Granger B., Fartoux L., De Carlis L., Demartines N., Sommacale D., Sanches M. D., Patrono D., Detry O., Herman P., Okumura S., Ferrero A., Scatton O., Uemoto S., Perdigao F., Nolasco F., Laroche S., Romagnoli R., Famularo S., Brustia, R, Langella, S, Kawai, T, Fonseca, G, Schielke, A, Colli, F, Resende, V, Fleres, F, Roulin, D, Leyman, P, Giacomoni, A, Granger, B, Fartoux, L, De Carlis, L, Demartines, N, Sommacale, D, Sanches, M, Patrono, D, Detry, O, Herman, P, Okumura, S, Ferrero, A, Scatton, O, Uemoto, S, Perdigao, F, Nolasco, F, Laroche, S, Romagnoli, R, Famularo, S, Brustia R., Langella S., Kawai T., Fonseca G. M., Schielke A., Colli F., Resende V., Fleres F., Roulin D., Leyman P., Giacomoni A., Granger B., Fartoux L., De Carlis L., Demartines N., Sommacale D., Sanches M. D., Patrono D., Detry O., Herman P., Okumura S., Ferrero A., Scatton O., Uemoto S., Perdigao F., Nolasco F., Laroche S., Romagnoli R., and Famularo S.

Abstract

Purpose: A preoperative risk score (PRS) to predict outcome of patients with intrahepatic cholangiocarcinoma treated by liver surgery could be clinically relevant.To assess accuracy for broadly adoption, external validation of predictive models on independent datasets is crucial. The objective of this study was to externally validate the score for prediction of long-term outcomes after liver surgery for intrahepatic cholangiocarcinoma proposed by Sasaki et al. and based on preoperative albumin, neutrophil-to-lymphocytes-ratio, CA19-9 and tumor size. Methods: Patients treated by liver surgery for intrahepatic cholangiocarcinoma at 11 international HPB centers from 2001 to 2018 were included in the external validation cohort. Harrell's c-index and Hosmer-Lemeshow analyses were used to test PRS discrimination and calibration. Kaplan–Meier curve for risk groups as described in the original study were displayed. Results: A total of 355 patients with 174 deaths during the follow-up period (median = 41.7 months, IQR 32.8–50.6) were included. The median PRS value was 14.7 (IQR 10.7–20.6), with normal distribution across the cohort. A Cox regression on PRS covariates found coefficients similar to those of the derivation cohort, except for tumor size. Measures of discrimination estimated by Harrell's c-index was 0.61(95%CI:0.56–0.67) and Hosmer-Lemeshow p = 0.175. The Kaplan-Meyer estimation showed reasonable discrimination across risk groups, with 5years survival rate ranging from 20.1% to 0%. Conclusion: In this external validation cohort, the PRS had mild discrimination and poor calibration performance, similarly to the original publication. Nevertheless, its ability to identify different classes of risk is clinically useful, for a better tailoring of a therapeutic strategy.

Published
2020

10. Un'esperienza molteplice del bene: fra percezione e pratica del valore morale

Author

Langella, S, Vaccarezza, MS, Croce, M, Monti, P, Langella, S, Vaccarezza, MS, Croce, M, and Monti, P

Abstract

Nel saggio si considera analiticamente la categoria di "esperienza integrale" a partire dalla sua espressione nell'opera di Angelo Campodonico e se ne propone un'analisi critica nel confronto con alcune voci del dibattito internazionale (R. Audi, A. MacIntyre, J. Raz, M. Nussbaum). A tale scopo, la categoria viene discussa a partire da tre aree problematiche: il rapporto fra esperienza assiologica e percezione morale, la presenza della ricerca di senso nelle pratiche sociali, la tensione fra esperienza religiosa ed etica pubblica., The essay analytically considers the category of "integral experience" starting from its expression in the work of Angelo Campodonico and proposes a critical analysis in comparison with some voices of the international debate (R. Audi, A. MacIntyre, J. Raz, M. Nussbaum). To this end, the category is discussed starting from three problematic areas: the relationship between axiological experience and moral perception, the presence of the search for meaning in social practices, the tension between religious experience and public ethics.

Published
2022

13. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Author

De'Angelis, N., Catena, F., Memeo, R., Coccolini, F., Martínez-Pérez, A., Romeo, O.M., Simone, B. De, Saverio, S. Di, Brustia, R., Rhaiem, R., Piardi, T., Conticchio, M., Marchegiani, F., Beghdadi, N., Abu-Zidan, F.M., Alikhanov, R., Allard, M.A., Allievi, N., Amaddeo, G., Ansaloni, L., Andersson, R., Andolfi, E., Azfar, M., Bala, M., Benkabbou, A., Ben-Ishay, O., Bianchi, G., Biffl, W.L., Brunetti, F., Carra, M.C., Casanova, D., Celentano, V., Ceresoli, M., Chiara, O., Cimbanassi, S., Bini, R., Coimbra, R., de'Angelis, G. Luigi, Decembrino, F., Palma, A., Reuver, P.R. de, Domingo, C., Cotsoglou, C., Ferrero, A., Fraga, G.P., Gaiani, F., Gheza, F., Gurrado, A., Harrison, E., Henriquez, A., Hofmeyr, S., Iadarola, R., Kashuk, J.L., Kianmanesh, R., Kirkpatrick, A.W., Kluger, Y., Landi, F., Langella, S., Lapointe, R., Roy, B., Luciani, A., Machado, F., Maggi, U., Maier, R.V., Mefire, A.C., Hiramatsu, K., Ordoñez, C., Patrizi, F., Planells, M., Peitzman, A.B., Pekolj, J., Perdigao, F., Pereira, B.M., Pessaux, P., Pisano, M., Puyana, J.C., Rizoli, S., Portigliotti, L., Romito, R., Sakakushev, B., Sanei, B., Scatton, O., Serradilla-Martin, M., Schneck, A.S., Sissoko, M.L., Sobhani, I., Broek, R.P. Ten, Testini, M., Valinas, R., Veloudis, G., Vitali, G.C., Weber, D., Zorcolo, L., Giuliante, F., Gavriilidis, P., Fuks, D., Sommacale, D., De'Angelis, N., Catena, F., Memeo, R., Coccolini, F., Martínez-Pérez, A., Romeo, O.M., Simone, B. De, Saverio, S. Di, Brustia, R., Rhaiem, R., Piardi, T., Conticchio, M., Marchegiani, F., Beghdadi, N., Abu-Zidan, F.M., Alikhanov, R., Allard, M.A., Allievi, N., Amaddeo, G., Ansaloni, L., Andersson, R., Andolfi, E., Azfar, M., Bala, M., Benkabbou, A., Ben-Ishay, O., Bianchi, G., Biffl, W.L., Brunetti, F., Carra, M.C., Casanova, D., Celentano, V., Ceresoli, M., Chiara, O., Cimbanassi, S., Bini, R., Coimbra, R., de'Angelis, G. Luigi, Decembrino, F., Palma, A., Reuver, P.R. de, Domingo, C., Cotsoglou, C., Ferrero, A., Fraga, G.P., Gaiani, F., Gheza, F., Gurrado, A., Harrison, E., Henriquez, A., Hofmeyr, S., Iadarola, R., Kashuk, J.L., Kianmanesh, R., Kirkpatrick, A.W., Kluger, Y., Landi, F., Langella, S., Lapointe, R., Roy, B., Luciani, A., Machado, F., Maggi, U., Maier, R.V., Mefire, A.C., Hiramatsu, K., Ordoñez, C., Patrizi, F., Planells, M., Peitzman, A.B., Pekolj, J., Perdigao, F., Pereira, B.M., Pessaux, P., Pisano, M., Puyana, J.C., Rizoli, S., Portigliotti, L., Romito, R., Sakakushev, B., Sanei, B., Scatton, O., Serradilla-Martin, M., Schneck, A.S., Sissoko, M.L., Sobhani, I., Broek, R.P. Ten, Testini, M., Valinas, R., Veloudis, G., Vitali, G.C., Weber, D., Zorcolo, L., Giuliante, F., Gavriilidis, P., Fuks, D., and Sommacale, D.

Abstract

Contains fulltext : 238974.pdf (Publisher’s version ) (Open Access), Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Published
2021

17. Un caso di storiografia filosofica. L'Aristotele 'metafisico' di Giovanni Reale

Author

Malusa, L., De Giorgi, F., Krienke, M., Di Giovanni, P., Zoppi, M., Celada Ballanti, R., Meo, O., Langella, S., Cacciatore, G., Pasini, M., Cunico, G., Cavaciuti, S., Marcolungo, F.L., Marangon, P., Zanardi, S., Camera, F., Tessitore, F., Tadini, S.F., Rolando, D., Mauro, L., Cattanei, E., Damonte, M., Marsonet, M., Campodonico, A., Rossi Cassottana, O., De Lucia, P., Longo, M., Cattanei, Elisabetta, Elisabetta Cattanei (ORCID:0000-0003-0417-8474), Malusa, L., De Giorgi, F., Krienke, M., Di Giovanni, P., Zoppi, M., Celada Ballanti, R., Meo, O., Langella, S., Cacciatore, G., Pasini, M., Cunico, G., Cavaciuti, S., Marcolungo, F.L., Marangon, P., Zanardi, S., Camera, F., Tessitore, F., Tadini, S.F., Rolando, D., Mauro, L., Cattanei, E., Damonte, M., Marsonet, M., Campodonico, A., Rossi Cassottana, O., De Lucia, P., Longo, M., Cattanei, Elisabetta, and Elisabetta Cattanei (ORCID:0000-0003-0417-8474)

Abstract

Si ricostruisce il "background", legato alla polemica di Werner Jaeger con Paul Natorp, dell'intepretazione della "Metafisica" di Aristotele, maturata da Giovanni Reale a Marburg a partire dal 1955. Si mette in luce la centralità, all'interno di questa interpretazione, di una concezione verticale di "taxis" che si ispira al "Simposio" di Platone.

Published
2020

27. L’abord cœlioscopique n’est plus une contre-indication pour la résection des cholangiocarcinomes intrahépatiques (CCAi) : étude de cohorte internationale

Author

Brustia, R., primary, Laurent, A., additional, Goumard, C., additional, Langella, S., additional, Soubrane, O., additional, Kaway, T., additional, Sommacale, D., additional, Patrono, D., additional, Salamé, E., additional, Fuks, D., additional, Boleslawski, E., additional, Regimbeau, J.M., additional, Vibert, E., additional, and Scatton, O., additional

Published
2020
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28. Preoperative risk score for prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma: Report of a collaborative, international-based, external validation study

Author

Brustia, R., primary, Langella, S., additional, Kawai, T., additional, Fonseca, G Marques, additional, Schielke, A., additional, Fartoux, L., additional, Colli, F., additional, Fleres, F., additional, Famularo, S., additional, Giacomoni, A., additional, Sommacale, D., additional, Patrono, D., additional, Detry, O., additional, Hermann, P., additional, Okumura, S., additional, and Scatton, O., additional

Published
2020
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31. Intraoperative Ultrasound Staging for Colorectal Liver Metastases in the Era of Liver-Specific Magnetic Resonance Imaging: Is It Still Worthwhile?

Author

Langella, S, Ardito, Francesco, Russolillo, N, Panettieri, Elena, Perotti, S, Mele, Caterina, Giuliante, Felice, Ferrero, A., Ardito F (ORCID:0000-0003-1596-2862), Panettieri E, Mele C, Giuliante F (ORCID:0000-0001-9517-8220), Langella, S, Ardito, Francesco, Russolillo, N, Panettieri, Elena, Perotti, S, Mele, Caterina, Giuliante, Felice, Ferrero, A., Ardito F (ORCID:0000-0003-1596-2862), Panettieri E, Mele C, and Giuliante F (ORCID:0000-0001-9517-8220)

Abstract

Background: To assess the efficacy of intraoperative ultrasound (IOUS) compared with liver-specific magnetic resonance imaging (MRI) in patients with colorectal liver metastases (CRLMs). Methods: From January 2010 to December 2017, 721 patients underwent MRI as a part of preoperative workup within 1 month before hepatectomy and were considered for the study. Early intrahepatic recurrence (relapse at cut surface excluded) was assessed 6 months after the resection and was considered as residual disease undetected by IOUS and/or MRI. IOUS and MRI performance was compared on a patient-by-patient basis. Long-term results were also studied. Results: A total of 2845 CRLMs were detected by MRI, and the median number of CRLMs per patient was 2 (1-31). Preoperative chemotherapy was administered in 489 patients (67.8%). In 177 patients, 379 new nodules were intraoperatively found and resected. Among 379 newly identified nodules, 317 were histologically proven CRLMs (11.1% of entire series). The median size of new CRLMs was 6 ± 2.5 mm. Relationships between intrahepatic vessels and tumors differed between IOUS and MRI in 128 patients (17.7%). The preoperative surgical plan was intraoperatively changed for 171 patients (23.7%). Overall, early intrahepatic recurrence occurred in 8.7% of cases. To assess the diagnostic performance, 24 (3.3%) recurrences at the cut surface were excluded; thus, 5.4% of early relapses were considered for analysis. The sensitivity of IOUS was superior to MRI (94.5% vs 75.1%), while the specificity was similar (95.7% vs 95.9%). Multivariate analysis at the hepatic dome or subglissonian and mucinous histology revealed predictive factors of metastases missing at MRI. The 5-year OS (52.1% vs 37.8%, p=0.006) and DF survival (45.1% vs 33%, p=0.002) were significantly worse among patients with new CRLMs than without. Conclusions: IOUS improves staging in patients undergoing resection for CRLMs even in the era of liver-specific MRI. Intraoperative de

Published
2019

35. A Novel Clinical Score Including Future Liver Remnant Volume and Indocyanine Green Retention Test to Predict Post-hepatectomy Liver Failure

Author

Bagante, F., primary, Ruzzenente, A., additional, Russolillo, N., additional, Dorna, A., additional, Valcanover, S., additional, Langella, S., additional, Campagnaro, T., additional, Conci, S., additional, Bertuzzo, F., additional, Iacono, C., additional, Ferrero, A., additional, and Guglielmi, A., additional

Published
2019
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41. An unusual cause of cardiogenic shock: tricuspid regurgitation and right ventricular perforation due to vena cava filter migration

Author

Mocavero, P E, Staglianò, A, Coppola, M, Langella, S, Conte, A, Pappalardo, F, Martiniello, A R, Pieri, M, Mattei, A, Mocavero, P E, Staglianò, A, Coppola, M, Langella, S, Conte, A, Pappalardo, F, Martiniello, A R, Pieri, M, and Mattei, A

Subjects
vena cava filter, cardiogenic shock, cardiovascular system, echocardiography, cardiovascular diseases, Case-Report, intensive care unit
Abstract

Dislocation and migration of the inferior vena cava filter to the right heart is an uncommon but serious complication, requiring prompt diagnosis and appropriate therapy. We report the case of a seventy-year old man, who had previously undergone vena cava filter implantation and who was admitted to the Intensive Care Unit due to acute respiratory distress with the suspect of pneumonia-related sepsis. Due to the worsening of hemodynamics and the development of cardiogenic shock, the patient underwent bedside echocardiography, which on the contrary revealed dislocation of the filter and the entrapment of the device within the tricuspid valve and chordae tendineae. This evidence was confirmed also by the chest-abdominal X-ray. The patient underwent tricuspid valve surgical replacement and successfully recovered. The transthoracic and transesophageal echocardiographies performed in the intensive care unit were able to first orient the diagnostic efforts toward the correct cause.

Published
2012

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