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1. NAD+ repletion with niacin counteracts cancer cachexia

Author: Marc Beltrà, Noora Pöllänen, Claudia Fornelli, Kialiina Tonttila, Myriam Y. Hsu, Sandra Zampieri, Lucia Moletta, Samantha Corrà, Paolo E. Porporato, Riikka Kivelä, Carlo Viscomi, Marco Sandri, Juha J. Hulmi, Roberta Sartori, Eija Pirinen, and Fabio Penna
Subjects: Science
Abstract: The loss of nicotinamide adenine dinucleotide is reported to be associated with muscle mitochondrial dysfunction in murine cancer models. Here the authors show that niacin supplementation improves mitochondrial metabolism and reduces muscle wasting in mouse models of cachexia.
Published: 2023
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2. Editorial: Surgical oncology in the elderly: the state of the art and future challenges

Author: Cosimo Sperti, Lucia Moletta, and Felix Berlth
Subjects: surgical oncology, elderly, esophageal cancer, gastric cancer, pancreatic cancer, colorectal cancer, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Published: 2023
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3. Minimally invasive Ivor Lewis esophagectomy in the elderly patient: a multicenter retrospective matched-cohort study

Author: Giovanni Capovilla, Eren Uzun, Alessia Scarton, Lucia Moletta, Edin Hadzijusufovic, Luca Provenzano, Renato Salvador, Elisa Sefora Pierobon, Gianpietro Zanchettin, Evangelos Tagkalos, Felix Berlth, Hauke Lang, Michele Valmasoni, and Peter P. Grimminger
Subjects: MIE, RAMIE, laparoscopy, thoracoscopy, esophagectomy, esophageal cancer, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: IntroductionSeveral studies reported the advantages of minimally invasive esophagectomy over the conventional open approach, particularly in terms of postoperative morbidity and mortality. The literature regarding the elderly population is however scarce and it is still not clear whether elderly patients may benefit from a minimally invasive approach as the general population. We sought to evaluate whether thoracoscopic/ laparoscopic (MIE) or fully robotic (RAMIE) Ivor-Lewis esophagectomy significantly reduces postoperative morbidity in the elderly population.MethodsWe analyzed data of patients who underwent open esophagectomy or MIE/RAMIE at Mainz University Hospital and at Padova University Hospital between 2016 and 2021. Elderly patients were defined as those ≥ 75 years old. Clinical characteristics and the postoperative outcomes were compared between elderly patients who underwent open esophagectomy or MIE/RAMIE. A 1-to-1 matched comparison was also performed. Patients < 75 years old were evaluated as a control group.ResultsAmong elderly patients MIE/RAMIE were associated with a lower overall morbidity (39.7% vs. 62.7%, p=0.005), less pulmonary complications (32.8 vs. 56.9%, p=0.003) and a shorter hospital stay (13 vs. 18 days, p=0.03). Comparable findings were obtained after matching. Similarly, among < 75 years-old patients, a reduced morbidity (31.2% vs. 43.5%, p=0.01) and less pulmonary complications (22% vs. 36%, p=0.001) were detected in the minimally invasive group.DiscussionMinimally invasive esophagectomy improves the postoperative course of elderly patients reducing the overall incidence of postoperative complications, particularly of pulmonary complications.
Published: 2023
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4. PET/CT incidental detection of second tumor in patients investigated for pancreatic neoplasms

Author: Lucia Moletta, Sergio Bissoli, Alberto Fantin, Nicola Passuello, Michele Valmasoni, and Cosimo Sperti
Subjects: Incidentaloma, Pancreas, Pancreatic neoplasms, Positron emission tomography, Surveillance, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background Positron Emission Tomography/computed tomography (PET/CT) is an imaging technique which has a role in the detection and staging malignancies (both in first diagnosis and follow-up). The finding of an unexpected region of FDG (Fluorodeoxyglucose) uptake can occur when performing whole-body FDG-PET, raising the possibility of a second primary tumor. The aim of this study was to evaluate our experience of second primary cancer incidentally discovered during PET/CT examination performed for pancreatic diseases, during the initial work-up or follow-up after surgical resection. Methods In this study, a retrospective evaluation of a prospectively collected data base was performed. Three hundred ninety- nine patients with pancreatic pathology were evaluated by whole body PET/CT imaging from January 2004 to December 2014. Among them, 348 patients were scanned before surgical resection and 51 during the course of their follow-up (pancreatic cancer). Median follow-up time was 29 months (range 14-124). Results Fifty-six patients (14%) had incidental uptake of FDG in their organs: 31 patients had focal uptake and 25 showed diffuse with or without focal uptake. All patients with focal uptake were investigated, and invasive malignancy was diagnosed in 22 patients: 14 colon, 4 lung, 1 larynx, 1 urothelial, 1 breast cancer, and 1 colon metastasis from pancreatic cancer. Twenty patients underwent resection, and 6 endoscopic removal of colonic polyps. Three patients were not operated for advanced disease, and two patients did not show any pathology (PET/CT false positive). Of the 10 patients investigated for diffuse uptake, no malignancy was found; none of these patients developed a second cancer during the follow-up. Conclusions As in other malignancies, unexpected FDG uptake can occur in patients having PET/CT investigation for pancreatic diseases. Focal uptake is likely to be a malignancy and deserves further investigations, although the stage and the poor prognosis of primary pancreatic cancer should be kept in mind. Some selected patients may benefit from the aggressive treatment of incidental lesions and show survival benefit.
Published: 2018
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5. Endoscopic Tumor Length Should Be Reincluded in the Esophageal Cancer Staging System: Analyses of 662 Consecutive Patients.

Author: Michele Valmasoni, Elisa Sefora Pierobon, Alberto Ruol, Carlo Alberto De Pasqual, Gianpietro Zanchettin, Lucia Moletta, Renato Salvador, Mario Costantini, and Stefano Merigliano
Subjects: Medicine, Science
Abstract: Esophageal cancer represents the 6th cause of cancer mortality in the World. New treatments led to outcome improvements, but patient selection and prognostic stratification is a critical aspect to gain maximum benefit from therapies. Today, patients are stratified into 9 prognostic groups, according to a staging system developed by the American Joint Committee on Cancer. Recently, trying to better select patients with curing possibilities several authors are reconsidering tumor length as a valuable prognostic parameter. Specifically, endoscopic tumor length can be easily measured with an esophageal endoscopy and, if its utility in esophageal cancer staging is demonstrated, it may represent a simple method to identify high risk patients and an easy-to-obtain variable in prognostic stratification. In this study we retrospectively analyzed 662 patients treated for esophageal cancer, stratified according to cancer histology and current staging system, to assess the possible role of endoscopic tumor length. We found a significant correlation between endoscopic tumor length, current staging parameters and 5-year survival, proving that endoscopic tumor length may be used as a simple risk stratification tool. Our results suggest a possible indication for preoperative therapy in early stage squamocellular carcinoma patients without lymph nodes involvement, who are currently treated with surgery alone.
Published: 2016
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6. Could the Pittsburgh Severity Score guide the treatment of esophageal perforation? Experience of a single referral center

Author: Lucia, Moletta, Sefora, Pierobon Elisa, Giovanni, Capovilla, Giovanni, Valotto, Laura, Gavagna, Luca, Provenzano, Gianpietro, Zanchettin, Renato, Salvador, Mario, Costantini, Stefano, Merigliano, and Michele, Valmasoni
Published: 2021
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7. Laparoscopic Revisional Surgery After Failed Heller Myotomy for Esophageal Achalasia: Long-Term Outcome at a Single Tertiary Center

Author: Lucia Moletta, Luca Provenzano, Mario Costantini, Michele Valmasoni, Elisa Sefora Pierobon, Giovanni Capovilla, Renato Salvador, and Stefano Merigliano
Subjects: Myotomy, medicine.medical_specialty, medicine.medical_treatment, Revisional surgery, Achalasia, Heller Myotomy, Esophageal Sphincter, Lower, medicine, Humans, Stage (cooking), Laparoscopy, Heller myotomy, medicine.diagnostic_test, business.industry, Esophagectomy, Gastroenterology, Reflux, medicine.disease, Surgery, Esophageal Achalasia, Treatment Outcome, GERD, Original Article, business
Abstract: Background Laparoscopic Heller myotomy (HM) has gained acceptance as the gold standard of treatment for achalasia. However, 10–20% of the patients will experience symptom recurrence, thus requiring further treatment including pneumodilations (PD) or revisional surgery. The aim of our study was to assess the long-term outcome of laparoscopic redo HM. Methods Patients who underwent redo HM at our center between 2000 and 2019 were enrolled. Postoperative outcomes of redo HM patients (redo group) were compared with that of patients who underwent primary laparoscopic HM in the same time span (control group). For the control group, we randomly selected patients matched for age, sex, FU time, Eckardt score (ES), previous PD, and radiological stage. Failure was defined as an Eckardt score > 3 or the need for re-treatment. Results Forty-nine patients underwent laparoscopic redo HM after failed primary HM. A new myotomy on the right lateral wall of the EGJ was the procedure of choice in the majority of patients (83.7%). In 36 patients (73.5%) an anti-reflux procedure was deemed necessary. Postoperative outcomes were somewhat less satisfactory, albeit comparable to the control group; the incidence of postoperative GERD was higher in the redo group (p < 0.01). At a median 5-year FU time, a good outcome was obtained in 71.4% of patients in the redo group; further 5 patients (10.2%) obtained a long-term symptom control after complementary PD, thus bringing the overall success rate to 81.6%. Stage IV disease at presentation was independently associated with a poor outcome of revisional LHD (p = 0.003). Conclusions This study reports the largest case series of laparoscopic redo HM to date. The procedure, albeit difficult, is safe and effective in relieving symptoms in this group of patients with a highly refractory disease. The failure rate, albeit not significantly, and the post-operative reflux are higher than after primary HM. Patients with stage IV disease are at high risk of esophagectomy.
Published: 2021

8. Laparoscopic Heller-Dor Is an Effective Treatment for Esophageal-Gastric Junction Outflow Obstruction

Author: Giulia Nezi, Stefano Merigliano, Loredana Nicoletti, Lucia Moletta, Michele Valmasoni, Giovanni Capovilla, Mario Costantini, Elisa Sefora Pierobon, Renato Salvador, and Luca Provenzano
Subjects: medicine.medical_specialty, Manometry, EGJOO, Prospective data, Achalasia, Treatment failure, 03 medical and health sciences, 0302 clinical medicine, Heller-Dor, medicine, Humans, Effective treatment, High-resolution manometry, In patient, Esophagogastric junction, High resolution manometry, business.industry, Gastroenterology, medicine.disease, Surgery, Esophageal Achalasia, Treatment Outcome, 030220 oncology & carcinogenesis, Laparoscopy, 030211 gastroenterology & hepatology, Esophagogastric Junction, business
Abstract: Background The treatment of esophagogastric junction outflow obstruction (EGJOO) currently mirrors that of achalasia, but this is based on only a few studies on small case series. The aim of this prospective, controlled study was to assess the outcome of laparoscopic Heller-Dor (LHD) in patients with EGJOO, as compared with patients with esophageal achalasia. Materials and Methods Between 2016 and 2019, patients with manometric diagnosis of idiopathic EGJOO and patients with radiological stage I achalasia, both treated with LHD, were compared. The achalasia group was further analyzed by subgrouping the patients based on the manometric pattern. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3 or the need for retreatment. Results During the study period, 150 patients were enrolled: 25 patients had EGJOO and 125 had radiological stage I achalasia (25 pattern I, 74 pattern II, and 26 pattern III). The median follow-up was 24 months (IQR: 34–16). Treatment was successful in 96% of patients in the EGJOO group and in 96% of achalasia patients with pattern I, 98.7% in those with pattern II, and 96.2% of those with pattern III (p=0.50). High-resolution manometry showed a reduction in the LES resting pressure and integrated relaxation pressure for all patients in all 4 groups (p Conclusion This is the first comparative study based on prospective data collection to assess the outcome of LHD in patients with EGJOO. LHD emerged as an effective treatment for EGJOO, with an excellent success rate, comparable with the procedure’s efficacy in treating early-stage achalasia.
Published: 2021

9. The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: a systematic literature review

Author: Gianluca Cassarino, Simone Serafini, Laura Evangelista, Lucia Moletta, Nicola Pegoraro, Cosimo Sperti, Francesca Bergamo, Diego Cecchin, and Pietro Zucchetta
Subjects: Adult, Male, medicine.medical_specialty, FDG, PET/CT, medicine.medical_treatment, Standardized uptake value, Review Article, 03 medical and health sciences, 0302 clinical medicine, Fluorodeoxyglucose F18, Pancreatic cancer, Positron Emission Tomography Computed Tomography, medicine, Humans, Radiology, Nuclear Medicine and imaging, Neoadjuvant therapy, Fluorodeoxyglucose, PET-CT, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, General Medicine, Middle Aged, medicine.disease, PET/MRI, Neoadjuvant Therapy, Pancreatic Neoplasms, Positron emission tomography, 030220 oncology & carcinogenesis, Radiology, business, Chemoradiotherapy, 030215 immunology, medicine.drug
Abstract: The aim of the present systematic review is to examine the role of fluorodeoxyglucose (FDG) positron emission tomography (PET) associated with computed tomography (CT) or magnetic resonance imaging (MRI) in assessing response to preoperative chemotherapy or chemoradiotherapy (CRT) for patients with borderline and resectable pancreatic ductal adenocarcinoma (PDAC). Three researchers ran a database query in PubMed, Web of Science and EMBASE. The total number of patients considered was 488. The most often used parameters of response to therapy were the reductions in the maximum standardized uptake value (SUVmax) or the peak standardized uptake lean mass (SULpeak). Patients whose SUVs were higher at the baseline (before CRT) were associated with a better response to therapy and a better overall survival. SUVs remaining high after neoadjuvant therapy correlated with a poor prognosis. Available data indicate that FDG PET/CT or PET/MRI can be useful for predicting and assessing response to CRT in patients with resectable or borderline PDAC.
Published: 2021

10. NAD+ repletion with niacin counteracts cancer cachexia

Author: Marc Beltrà, Noora Pöllänen, Claudia Fornelli, Kialiina Tonttila, Myriam Y. Hsu, Sandra Zampieri, Lucia Moletta, Paolo E. Porporato, Riikka Kivelä, Marco Sandri, Juha J. Hulmi, Roberta Sartori, Eija Pirinen, and Fabio Penna
Abstract: SUMMARYCachexia is a debilitating wasting syndrome and highly prevalent comorbidity in cancer patients. It manifests especially with energy and mitochondrial metabolism aberrations that promote tissue wasting. We recently identified nicotinamide adenine dinucleotide (NAD+) loss to associate with muscle mitochondrial dysfunction in cancer hosts. In this study we confirmed that depletion of NAD+ and downregulation of Nrk2, an NAD+ biosynthetic enzyme, are common features of different mouse models and cachectic cancer patients. Testing NAD+ repletion therapy in cachectic mice revealed that NAD+ precursor, vitamin B3 niacin, efficiently corrected tissue NAD+ levels, improved mitochondrial metabolism and ameliorated cancer- and chemotherapy-induced cachexia. To examine NAD+ metabolism in a clinical setting, we showed that the low expression of NRK2 in cancer patients correlated with metabolic abnormalities underscoring the significance of NAD+ in the pathophysiology of human cancer cachexia. Overall, our results propose a novel therapy target, NAD+ metabolism, for cachectic cancer patients.
Published: 2022

11. Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature

Author: Lucia Moletta, Francesco Volpin, Giovanni Capovilla, Alfredo Piangerelli, Eleonora Ciccioli, Mario Costantini, Renato Salvador, Gianpietro Zanchettin, Francesco Massimiliano Finocchiaro, Stefano Merigliano, Michele Valmasoni, and Elisa Sefora Pierobon
Subjects: Cervical spine surgery, anterior cervical spine, cervical spine, esophageal injury, esophageal perforation, fusion, surgical flap, medicine.medical_specialty, business.industry, Perforation (oil well), Single Center, Cervical spine, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine, Orthopedics and Sports Medicine, 030212 general & internal medicine, Neurology (clinical), Esophageal injury, Complication, business, 030217 neurology & neurosurgery
Abstract: Study Design: Case series and systematic review of the Literature. Objectives: Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients. Methods: Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines. Results: Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation. Conclusions: PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients
Published: 2021

12. Safety and Efficacy of Surgery for Metastatic Tumor to the Pancreas: A Single-Center Experience

Author: Lucia Moletta, Alberto Friziero, Simone Serafini, Valeria Grillo, Elisa Sefora Pierobon, Giovanni Capovilla, Michele Valmasoni, and Cosimo Sperti
Subjects: pancreatic metastases, renal cell carcinoma, pancreatic secondary tumors, metastasis, General Medicine, pancreatectomy
Abstract: Pancreatic metastases from other neoplasms are rare. The role of surgery for this clinical entity is unclear. The aim of this study was to investigate the role of resection in patients with pancreatic secondary lesions. We observed 44 patients with pancreatic metastases from other tumors. Renal cell carcinoma was the most common primary tumor (n = 19, 43.2%). Thirty-seven patients underwent surgery, and pancreatic resection with curative intent was feasible in 35 cases. Fifteen patients (43.2%) experienced major postoperative complications (Clavien-Dindo > 2), and postoperative mortality rate was 5.4%. The median overall survival and disease-free survival were 38 (range 0–186) and 11 (range 0–186) months, respectively. Overall survival and disease-free survival were significantly longer for pancreatic metastases from renal cell carcinoma when compared to other primary tumors. Multivariate analysis confirmed a pathological diagnosis of metastasis from RCC as an independent prognostic factor for overall survival (OR 2.48; 95% CI, 1.00–6.14; p = 0.05). In conclusion, radical resection of metastases to the pancreas is feasible and safe, and may confer a survival benefit for selected patients. There is a clear benefit of metastasectomy in terms of patient survival for metastases from renal cell carcinoma, while for those with other primary tumors, surgery seems to be mainly palliative.
Published: 2023

13. Extending Myotomy Both Downward and Upward Improves the Final Outcome in Manometric Pattern III Achalasia Patients

Author: Michele Valmasoni, Dario Briscolini, Mario Costantini, Giovanni Capovilla, Stefano Merigliano, Lucia Moletta, Renato Salvador, Loredana Nicoletti, and Luca Provenzano
Subjects: Adult, Male, Myotomy, medicine.medical_specialty, Manometry, medicine.medical_treatment, Achalasia, Outcome (game theory), 03 medical and health sciences, 0302 clinical medicine, otorhinolaryngologic diseases, medicine, Humans, Postoperative Period, Aged, Retrospective Studies, achalasia, laparoscopic Heller-Dor, manometric pattern, myotomy, pattern III, business.industry, Middle Aged, medicine.disease, Surgery, Esophageal Achalasia, Treatment Outcome, 030220 oncology & carcinogenesis, Gastroesophageal Reflux, Female, Laparoscopy, 030211 gastroenterology & hepatology, business
Abstract: Background: Achalasia is currently classified in three manometric patterns. Pattern III is the least common pattern, and reportedly correlated with the worst outcome after all available treatments....
Published: 2020

14. Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

Author: Pata, Francesco, Di Martino, Marcello, Podda, Mauro, Di Saverio, Salomone, Ielpo, Benedetto, Pellino, ACIE Appy Study Collaborative Abba Julio, Gianluca., Abdullah, Alshamrani, Abdullah, Alturkistani, Abdulrahman, Alghamdi, Abdulrahman, Almalki, Adam, Orengia, Adnan, Kuvvetli, Adolfo, Pisanu, Adrian, Smith, Adriana Michelle Treviño Figueroa, Aeris Jane Nacion, Ahmad, Alhazmi, Ahmad, Bouhuwaish, Ahmad, Khalid, Ahmed, Alsufyani, Ainhoa Valle Rubio, Akshay, Bavikatte, Kumar, Akshay, Al-Radjid, Jamiri, Alberto de San Ildefonso Pereira, Alberto, Porcu, Alberto, Sartori, Aldo, Rocca, Aleksandar, Sretenovic, Anselmo, Alessandro, Alessandro De Luca, Alexandros, Charalabopoulos, Alexios, Tzivanakis, Alfonso, Bandin, Alfonso, Nájar, Alice, Frontali, Alsulaimani, Faisal, Amaia Martínez Roldan, Amal, Hamid, Ana, André, Ana, Minaya-Bravo, Andre, Das, Andrea, Bondurri, Andrea, Costanzi, Lucchi, Andrea, Andrei, Mihailescu, Police, Andrea, Andres Mendoza Zuchini, Angela, Romano, Iossa, Angelo, Antonella, Chessa, Antonella, Tromba, Antonio, Castaldi, Antonio, Brillantino, Antonio, Ferronetti, Giuliani, Antonio, Antonio Ramos-De la Medina, Antonio, Tarasconi, Arcangelo, Picciariello, Argyrios, Ioannidis, Ari, Leppäniemi, Arshad, Rashid, Ashrarur Rahman Mitul, Asif, Mehraj, Asim, Laharwal, Atif, Iqbal, Athanasios, Liarakos, Athanasios, Marinis, Beatriz de Andrés-Asenjo, Belén, Matías-García, DE SIMONE, Belinda, Ben, Creavin, Ben, Stubbs, Brian, Goh, Branislav, Jovanovic, Bruno, Sensi, Carlo, Gazia, Carlos, Cerdán, Carlos Javier Gómez Díaz, Carlos Petrola Chacón, Carlos, Yánez, Carmelo Lo Faro, Caroline, Reinke, Casandra, Dominguez, Charudutt, Paranjape, Charlotte, Thomas, Chia Chi Fung, DE LUCIA, Chiara, Chiu Hiu Fung Jennifer, Christian, Ovalle-Chao, Claudio, Guerci, Cleo, Kenington, Corina, Gica, Cristina, Folliero, Cristopher, Varela, Daniel, Popowich, Daniele, Delogu, Daniele, Zigiotto, Danilo, Vinci, Dario, D'Antonio, David Alessio Merlini, David, Merlini, David, Moro-Valdezate, Deborah, Keller, Diana Cristiana Nicolaescu, Diego, Sasia, Edgar, Rodas, Dimitrios, Linardoutsos, Domenico, Russello, Pedro Alfonso Nájar-Castañeda, Habil Gregor Stavrou, Edoardo, Rosso, Edoardo, Saladino, Edoardo, Ricciardi, Eduardo, Smith-Singares, Efstratia, Baili, Eleftheria, Douka, Guaitoli, Eleonora, Elisa, Francone, Elisa Maria Vaterlini, Elisa Sefora Pierobon, Emilio, Morales, Emilio Peña Ros, Enrico, Benzoni, Enrico, Erdas, Enrico, Pinotti, Enrique, Colás-Ruiz, Ernesto, Laterza, Esteban, Foianini, Eugenia, Cardamone, Eugenio, Licardie, Fabio, Marino, Fahad, Alsofyani, Fahad, Qahtani, Farhan, Khan, Fatlum, Maraska, Fatmir, Saliu, Fausto, Madrid, Fausto, Rosa, Federico, Luvisetto, Felipe, Alconchel, Felipe, Pareja-Ciuro, Fernanda, Neves, Ferdinando, Agresta, Fernando, Cordera, Fernando, Pardo, Fernando, Mendoza-Moreno, Fernando, Munoz-Flores, Francesca Maria Silvestri, Francesca Paola Tropeano, Francesca, Pecchini, Francesca, Serio, Francesco, Colombo, Francesco Di Marzo, Francesco, Ferrara, Francesco, Lancellotti, Francesco, Litta, Francesco, Martini, Francesco, Roscio, Francisco, Blanco-Antona, Francisco Javier Quezada Barcenas, Francisco, Schlottmann, Gabriel, Herrera-Almario, Gabrielle van Ramshorst, Gallo, Gaetano, Gaetano, Luglio, Georgios, Kampouroglou, Georgios, Papadopoulos, Gerardo, Arredondo, Giacomo, Calini, Giampaolo, Formisano, Galiffa, Giampaolo, Gian Marco Palini, Gianluca, Colucci, Gianluca, Pagano, Gianluca, Vanni, Gianmaria Casoni Pattacini, Gianpiero, Gravante, Giorgio, Lisi, Giovanni, Bellanova, Giovanni De Nobili, Giovanni Sammy Necchi, Sinibaldi, Giovanni, Giulia, Bacchiocchi, Giulia, Bagaglini, Maggi, Giulia, Giuliano, Izzo, Giulio, Argenio, Giuseppe, Brisinda, Giuseppe, Esposito, Giuseppe, Frazzetta, Giuseppe Massimiliano De Luca, Nigri, Giuseppe, Giuseppe, Sica, MARTIN DE MERCADO, Gonzalo, Gustavo Armand Ugon, Gustavo, Martinez-Mier, Gustavo Miguel Machain Vega, Gustavo, Nari, Herald, Nikaj, Ignacio, Neri, Igor Alberdi San Roman, Iliya, Fidoshev, Iñaki, Martínez, Ionut, Negoi, Irene, Ortega, Irune Vicente Rodríguez, Isabel, Cornejo, Ismael, Mora-Guzmán, Issam, Al-Najami, Ivan, Romic, Izaskun, Balciscueta, James, Olivier, Jan, Lammel-Lindemann, Jana, Dziakova, Javier, Salinas, Jelena Pejanovic Jovanovic, Jeryl Anne Silvia Reyes, Joanne, Salas, Jose Antonio Diaz-Elizondo, Jose Gustavo Parreira, Juan, Bellido, Juan, Salamea, Juan Carlos Martín Del Olmo, Juliana María Ordoñez, Sofi, Junaid, Justin, Davies, Kapil, Sahnan, Kebebe, Bekele, Kelvin, Voon, Leandro, Siragusa, Lorenzo, Petagna, Ferrario, Luca, Luca, Giordano, Luca, Nespoli, Luca, Pio, Lucia, Moletta, Luciano, Curella, Lucio, Taglietti, Luigi, Bonavina, Luigi, Conti, Luis Eduardo Pérez-Sánchez, Luis Felipe Cabrera Vargas, Luis, Sánchez-Guillén, Luis, Tallon-Aguilar, Mansoor, Khan, Marcello Giuseppe Spampinato, Marcelo, Viola, Marcelo Viola Malet, Angrisani, Marco, Marco, Calussi, Marco, Catarci, Marco, Giordano, Marco, Materazzo, Marco, Milone, Marco, Pellicciaro, Marco Vito Marino, María Daniela Moreno Villamizar, Lolli, MARIA GIULIA, Bellini, MARIA IRENE, Maria, Lemma, Maria Michela Chiarello, Mario, Montes-Manrique, Mario, Rodriguez-Lopez, Mario, Serradilla-Martín, Mark, Peter, Marta, Paniagua-García-Señoráns, Martin, Rutegård, Martin, Salö, Massimiliano, Silveri, Massimiliano, Veroux, Matteo, Nardi, Matteo, Rottoli, Matti, Tolonen, Mauricio Pedraza Ciro, Mauricio, Zuluaga, Maurizio, Iacobone, Mauro, Montuori, Mazin, Ali, Melody García Domínguez, Menna Maria Paola, Micaela, Piccoli, Michela, Campanelli, Michele De Rosa, Manigrasso, Michele, Maruccia, Michele, Michele, Torre, Michele, Zuolo, Miguel, Pera, Mihiri, Weerasekera, Mikel, Prieto, Min Myat Thway, Mohamed, Shaat, Mohammad, Azfar, Mostafa, Shalaby, Muhammad Asif Raza, Muhammad Umar Younis, Muhammed, Elhadi, Mujahid, Ali, Musab, Althomali, Nadiah Al Amri, Nagendra, Dudi-Venkata, Nahar, Alselaim, Neil, Smart, Nelson, Trelles, Nicolò, Falco, Petrucciani, Niccolo', Nicola, Antonacci, Nicola, Cillara, Nicolae, Gica, Nicolò, Pecorelli, Nicolò, Tamini, Nikolaos, Machairas, Nura, Feituri, Nuria Ortega Torrecilla, Octavio Avila Mercado, Ohood, Alaamer, Oktay, Irkorucu, Omar, Alsherif, Oreste Claudio Buonomo, Orestes, Valles-Guerra, Orestis, Ioannidis, Oscar Isaac Hernández Palmas, Oscar Sanz Guadarrama, Osman, Bozbiyik, Pablo, Rodrigues, Pamela, Milito, Paolo, Panaccio, Panagiotis, Dorovinis, Paola, Prieto, Paolo, Baroffio, Patrizia, Marsanic, Pawel, Ajawin, Peng Soon Koh, Pietro, Anoldo, Piotr, Major, Qasem, Alharthi, Rashid, Lui, Riccardo, Caruso, Richard, Brady, Rishi, Rattan, Rishi, Singhal, Roberta, Angelico, Roberta Maria Isernia, Roberta, Tutino, Roberto, Peltrini, Rodrigo, Tejos, Roosevelt, Fajardo, Rossella, Elia, Salvador, Morales-Conde, Sami, Benli, Sara, Fuentes, Sara Gortázar de Las Casas, Sara Ortiz de Guzmán Aragón, Sara, Vertaldi, Selmy, Awad, Sergio, Gentilli, Sergio Alberto Weckmann Lujan, Serkan, Tayar, Shabab, Althobaiti, DI GIOVANNI, Silvia, Soliman, Ghedan, Sonia, Pérez-Bertólez, Sonja, Chiappetta, Spiros, Delis, Stefano, Scaringi, Süleyman, Çetinkünar, Stylianos, Kykalos, Syed Muhammad Ali, Sylvia, Krivan, Tak Lit Derek Fung, Tarik, Delko, Tatiana Nicolás López, Tercio De Campos, Teresa Calderón Duque, Teresa, Perra, Theodore, Liakakos, Theodoros, Daskalakis, Tijmen, Koëter, Tiku, Zalla, Tomás Elosua González, Tommaso, Campagnaro, Toure Alpha Oumar, Ugo, Grossi, Valentina, Sosa, Valentina, Testa, Valentina, Tomajer, Valeria, Andriola, Valeria, Tonini, Valerio, Celentano, Voglino, Valerio, Venkateswara Rao Katta, Víctor Hugo García Orozco, Victor, Turrado-Rodriguez, Victor, Visag-Castillo, Victoria, Graham, Viktor, Rachkov, Vincenzo, Papagni, Vincenzo, Vigorita, Virginia Jiménez Carneros, Bellato, Vittoria, Wolf, Bechstein, Yuksel, Altinel, and Zutoia, Balciscueta
Subjects: appendicitis, COVID19
Published: 2022

15. Transoral septotomy with septum traction is an effective treatment for recurrent Zenker diverticulum

Author: Renato Salvador, Luca Provenzano, Giulia Bonventre, Cesare Cutrone, Lucia Moletta, Marianna Sari, Andrea Costantini, Francesca Forattini, Arianna Vittori, Michele Valmasoni, Mario Costantini, and Giovanni Capovilla
Subjects: Zenker’s diverticulum, swallowing/dysphagia, upper esophageal sphincter, Gastroenterology, General Medicine
Abstract: Symptoms of Zenker diverticulum can recur whatever the type of primary treatment administered. A modified transoral stapler-assisted septotomy (TS) was introduced in clinical practice a few years ago to improve the results of this mini-invasive technique. The aim of this prospective, controlled study was to assess the outcome of TS in patients with recurrent Zenker diverticulum (RZD), as compared with patients with treatment-naïve Zenker diverticulum (NZD). Patients diagnosed with NZD or RZD, and treated with TS between 2015 and 2021 were compared. Symptoms were recorded and scored using a detailed questionnaire. Barium swallow and endoscopy were performed before and after the TS procedure. In sum, 89 patients were enrolled during the study period: 68 had NZD and 21 had RZD. The patients’ demographic and clinical data were similar in the two groups. Three mucosal lesions were detected intra-operatively, and one came to light at post-operative radiological assessment in the NZD group. No mucosal lesions were detected in the RZD group. The median follow-up was 36 months (interquartile range 23–60). The treatment was successful in 97% NZD patients and 95% of RZD patients (P = 0.56). This is the first comparative study based on prospectively collected data to assess the outcome of TS in patients with RZD. Traction on the septum during the procedure proved effective in the treatment of RZD, achieving a success rate that was excellent, and comparable with the outcome in treating NZD.
Published: 2022

16. Recent Advances in Pancreatic Neoplasms

Author: Lucia Moletta, Cosimo Sperti, and Simone Serafini
Subjects: genetic structures, business.industry, General Medicine, Bioinformatics, Editorial, n/a, Treatment modality, otorhinolaryngologic diseases, Medicine, business, Pathological, psychological phenomena and processes
Abstract: Pancreatic neoplasms, both primary and secondary, include different pathological entities with variable biological behavior and, consequently, different treatment modalities [...]
Published: 2021

17. The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis

Author: Giovanni Capovilla, Lucia Moletta, Roberta Sartori, Alessandra Rosalba Brazzale, Stefano Merigliano, Sandra Zampieri, Elisa Sefora Pierobon, Simone Serafini, Gianpietro Zanchettin, Michele Valmasoni, and Cosimo Sperti
Subjects: medicine.medical_specialty, pancreatic cancer, low muscle mass, sarcopenia, pancreatic adenocarcinoma, pancreatic cancer, pancreatic surgery, body composition, Review, 030230 surgery, Gastroenterology, sarcopenia, 03 medical and health sciences, Low muscle mass, 0302 clinical medicine, Internal medicine, Pancreatic cancer, medicine, pancreatic adenocarcinoma, In patient, pancreatic surgery, body composition, business.industry, Cancer, General Medicine, medicine.disease, Systematic review, 030220 oncology & carcinogenesis, Meta-analysis, Sarcopenia, low muscle mass, Adenocarcinoma, Medicine, business
Abstract: Low muscle mass is associated with reduced survival in patients with different cancer types. The interest in preoperative sarcopenia and pancreatic cancer has risen in the last decade as muscle mass loss seems to be associated with poorer survival, higher postoperative morbidity, and mortality. The aim of the present study was to review the literature to compare the impact of low muscle mass on the outcomes of patients undergoing surgery for pancreatic adenocarcinoma. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 10 articles were analyzed in detail and included in the meta-analysis. Data were retrieved on 2811 patients undergoing surgery for pancreatic cancer. Meta-analysis identified that patients with low muscle mass demonstrated a significantly reduced OS when compared to patients without alterations of the muscle mass (ROM 0.86; 95% CI: 0.81–0.91, p < 0.001), resulting in a 14% loss for the former. Meta-analysis failed to identify an increase in the postoperative complications and length of stay of patients with low muscle mass. Our analysis confirms the role of low muscle mass in influencing oncologic outcomes in pancreatic cancer. Its role on surgical outcomes remains to be established.
Published: 2021

18. Impact of Sarcopenia and Myosteatosis on the Surgical Outcomes of Patients with Esophagogastric Cancer

Author: Giovanni Capovilla, Sandra Zampieri, Paolo Enrico Meneghesso, Michele Valmasoni, Stefano Merigliano, Elisa Sefora Pierobon, Lucia Moletta, Marco Sandri, Alberto Ponzoni, and Roberta Sartori
Subjects: Oncology, medicine.medical_specialty, Esophagogastric cancer, business.industry, Internal medicine, Sarcopenia, medicine, Surgery, medicine.disease, business
Published: 2021

19. Optimal Treatment of cT2N0 Esophageal Carcinoma: Is Upfront Surgery Really the Way?

Author: Renato Salvador, Giovanni Capovilla, Gianpietro Zanchettin, Lucia Moletta, Mario Costantini, Stefano Merigliano, Elisa Sefora Pierobon, Michele Valmasoni, and Luca Provenzano
Subjects: medicine.medical_specialty, Esophageal Neoplasms, Lymphovascular invasion, medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, medicine, Carcinoma, Humans, Neoadjuvant therapy, Neoplasm Staging, Retrospective Studies, business.industry, Mortality rate, Cancer, Esophageal cancer, medicine.disease, Neoadjuvant Therapy, Surgery, Esophagectomy, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Carcinoma, Squamous Cell, Adenocarcinoma, 030211 gastroenterology & hepatology, business, Chemoradiotherapy
Abstract: Staging is inaccurate for cT2N0 esophageal cancer, and patients often are clinically mis-staged. This study aimed to evaluate the outcome after upfront surgery or neoadjuvant therapy, considering the impact of clinical "mis-staging."This study reviewed patients with squamous cell carcinoma (SCC) or adenocarcinoma (ADK) of the esophagus who underwent upfront surgery (S group) or neoadjuvant treatment (chemoradiotherapy [CRT] group) for cT2N0 cancer. Overall survival (OS), disease-free survival (DFS), morbidity, and mortality were evaluated. Correctly staged (cTNM = pTNM), understaged (cTNMpTNM), and overstaged (cTNMpTNM) patients in the S group and the CRT group were analyzed. Risk factors for unexpected lymph-node involvement were identified in the S group and for cancer-related death in the whole study cohort.The study enrolled 229 patients with cT2N0 esophageal cancer. The 5-year OS rate was 34.2% in the S group versus 55.7% in the CRT group (p = 0.0088). The DFS also was significantly higher (p = 0.01). The morbidity and mortality rates were similar. In the S group, the cTNM was correctly staged for 21.4% and understaged for 63.4% of the patients, with 48.7% of the patients showing unexpected nodal involvement. A tumor length of 3 cm or more was an independent predictor of nodal metastases in SCC (p = 0.03), as was lymphovascular invasion (LVI) in ADK (p0.01). Cancer-related mortality was independently associated with lymph-node metastases (p = 0.03) and treatment by upfront surgery (p = 0.01).Given the high rate of understaged patients in this study (63.4%), the authors advocate for combining the induction therapy with surgery in cT2N0, achieving better survival with similar morbidity and mortality.
Published: 2021

20. Systematic Review and Meta-Analysis of Surgical Treatment for Isolated Local Recurrence of Pancreatic Cancer

Author: Alessandra Rosalba Brazzale, Alberto Ponzoni, Lucia Moletta, Simone Serafini, Alessia Buratin, Alberto Friziero, and Cosimo Sperti
Subjects: Cancer Research, medicine.medical_specialty, recurrence, medicine.medical_treatment, isolated local recurrence, pancreatectomy, pancreatic cancer, pancreatic remnant, redo surgery, lcsh:RC254-282, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Pancreatic cancer, medicine, Surgical treatment, business.industry, Recurrent pancreatic cancer, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Confidence interval, Systematic review, Oncology, 030220 oncology & carcinogenesis, Redo surgery, Meta-analysis, Pancreatectomy, 030211 gastroenterology & hepatology, Systematic Review, business
Abstract: Simple Summary Recurrences after primary resection of pancreatic cancer are generally treated with chemotherapy or best supportive care. Despite some reports of encouraging results after the re-resection of recurrences, the real role of surgery in this setting remains unclear. The aim of our systematic review and meta-analysis was to define the benefit of surgery in the case of isolated local recurrence. The data collected on 431 patients suggest an overall survival benefit of 29 months for patients re-operated compared to patients given medical therapies. In selected patients with recurrent pancreatic cancer, resection is safe and feasible, and may offer a survival advantage. Abstract Purpose: To perform a systematic review and meta-analysis on the outcome of surgical treatment for isolated local recurrence of pancreatic cancer. Methods: A systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted in PubMed, Scopus, and Web of Science. Results: Six studies concerning 431 patients with recurrent pancreatic cancer met the inclusion criteria and were included in the analysis: 176 underwent redo surgery, and 255 received non-surgical treatments. Overall survival and post-recurrence survival were significantly longer in the re-resected group (ratio of means (ROM) 1.99; 95% confidence interval (CI), 1.54–2.56, I2 = 75.89%, p = 0.006, and ROM = 2.05; 95% CI, 1.48–2.83, I2 = 76.39%, p = 0.002, respectively) with a median overall survival benefit of 28.7 months (mean difference (MD) 28.7; 95% CI, 10.3–47.0, I2 = 89.27%, p < 0.001) and median survival benefit of 15.2 months after re-resection (MD 15.2; 95% CI, 8.6–21.8, I2 = 58.22%, p = 0.048). Conclusion: Resection of isolated pancreatic cancer recurrences is safe and feasible and may offer a survival benefit. Selection of patients and assessment of time and site of recurrence are mandatory.
Published: 2021

21. Perturbed BMP signaling and denervation promote muscle wasting in cancer cachexia

Author: Sandra Zampieri, Monika Kustermann, Lars Larsson, Elisa Sefora Pierobon, Bradley J. Turner, Paola Costelli, Roberta Sartori, Laís R. Viana, Alberto Ponzoni, Catherine E. Winbanks, Aram Megighian, Mouna Haidar, Adam Hagg, Stefano Merigliano, Michele Valmasoni, Gianpietro Zanchettin, Cosimo Sperti, Fabio Penna, Lucia Moletta, Andrea Armani, Marco Sandri, Pardis Zanganeh, Paul Gregorevic, Hongwei Qian, Kevin I. Watt, Camilla Pezzini, Shady Attar, Rachel E. Thomson, Gianfranco Da Dalt, Anna Larsson, and Kate L Loveland
Subjects: animal structures, Cachexia, Bone morphogenetic protein, Neuromuscular junction, 03 medical and health sciences, Mice, 0302 clinical medicine, Atrophy, Neoplasms, medicine, Animals, Humans, Noggin, Muscle, Skeletal, Wasting, 030304 developmental biology, Denervation, 0303 health sciences, business.industry, Skeletal muscle, General Medicine, Skeletal, medicine.disease, 3. Good health, Muscular Atrophy, medicine.anatomical_structure, Cancer research, Muscle, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Most patients with advanced solid cancers exhibit features of cachexia, a debilitating syndrome characterized by progressive loss of skeletal muscle mass and strength. Because the underlying mechanisms of this multifactorial syndrome are incompletely defined, effective therapeutics have yet to be developed. Here, we show that diminished bone morphogenetic protein (BMP) signaling is observed early in the onset of skeletal muscle wasting associated with cancer cachexia in mouse models and in patients with cancer. Cancer-mediated factors including Activin A and IL-6 trigger the expression of the BMP inhibitor Noggin in muscle, which blocks the actions of BMPs on muscle fibers and motor nerves, subsequently causing disruption of the neuromuscular junction (NMJ), denervation, and muscle wasting. Increasing BMP signaling in the muscles of tumor-bearing mice by gene delivery or pharmacological means can prevent muscle wasting and preserve measures of NMJ function. The data identify perturbed BMP signaling and denervation of muscle fibers as important pathogenic mechanisms of muscle wasting associated with tumor growth. Collectively, these findings present interventions that promote BMP-mediated signaling as an attractive strategy to counteract the loss of functional musculature in patients with cancer.
Published: 2021

22. Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Author: Simone Serafini, Alberto Friziero, Amanda Belluzzi, Andrea Grego, Cosimo Sperti, Lucia Moletta, and Luca Maria Saadeh
Subjects: Cancer Research, medicine.medical_specialty, medicine.medical_treatment, overall survival, pancreatic cancer, MEDLINE, POPF, Cochrane Library, Gastroenterology, survival, pancreatectomy, pancreatic adenocarcinoma, postoperative pancreatic fistula, Pancreatic cancer, Internal medicine, medicine, RC254-282, Neoadjuvant therapy, business.industry, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Retrospective cohort study, medicine.disease, Oncology, Pancreatic fistula, Meta-analysis, Pancreatectomy, Systematic Review, business
Abstract: Simple Summary The real influence of postoperative pancreatic fistula (POPF) on long-term survival after pancreatic cancer resection is unclear. The purpose of the present study was therefore to conduct a systematic review and meta-analysis of the impact of POPF on the disease-free and overall survival of patients with pancreatic cancer. Our results highlighted that clinically relevant POPF after surgery for PDAC seems to be significantly associated with shorter DFS and OS. Confirmation, with future studies, of a negative impact of POPF on survival may encourage the widespread use of risk-stratification tools for assessing fistula, centralization of patients, and probably a closer oncological follow-up. Abstract Background: The impact of postoperative pancreatic fistula (POPF) on survival after resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: The MEDLINE, Scopus, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting on survival in patients with and without POPF. A meta-analysis was performed to investigate the impact of POPF on disease-free survival (DFS) and overall survival (OS). Results: Sixteen retrospective cohort studies concerning a total of 5019 patients with an overall clinically relevant POPF (CR-POPF) rate of 12.63% (n = 634 patients) were considered. Five of eleven studies including DFS data reported higher recurrence rates in patients with POPF, and one study showed a higher recurrence rate in the peritoneal cavity. Six of sixteen studies reported worse OS rates in patients with POPF. Sufficient data for a meta-analysis were available in 11 studies for DFS, and in 16 studies for OS. The meta-analysis identified a shorter DFS in patients with CR-POPF (HR 1.59, p = 0.0025), and a worse OS in patients with POPF, CR-POPF (HR 1.15, p = 0.0043), grade-C POPF (HR 2.21, p = 0.0007), or CR-POPF after neoadjuvant therapy. Conclusions: CR-POPF after resection for PDAC is significantly associated with worse overall and disease-free survival.
Published: 2021

23. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Author: Benedetto, Ielpo, Mauro, Podda, Gianluca, Pellino, Pata, Francesco, Gianpiero, Gravante, Salomone Di Saverio, Gallo, Gaetano, Rashid, Lui, Adam, Orengia, Aditya, Chowdary, Aditya, Kulkarni, Adnan, Kuvvetli, Adolfo, Navarro, Adolfo, Pisanu, Adrian, Smith, Adriana Cavero Ibiricu, Aeris Jane, D Nacion, Ahmad, Alsaleh, Ahmad, Alhazmi, Ahmad, Elmabri, Ajaz, Wani, Ahmet, Rencuzogullari, Aingeru Sarriugarte Lasarte, Ainhoa Valle Rubio, Akshay, Bavikatte, Akshay, Kumar, Al-Radjid, Jamiri, Alain Michel Alvarado Padilla, Alban, Cacurri, Alberto de San Ildefonso, Alberto, Porcu, Alberto, Sartori, Aldo, Rocca, Alejandro Paz Yáñez, Alejandro, Becaria, Alejandro, Solís-Peña, Aleksandar, Sretenović, Alex, Urbistondo, Alfonso, Bandin, Alfonso, Najar, Alessandro De Luca, Alex, Boddy, Alexandros, Charalabopoulos, Alexios, Tzivanakis, Alfonso, Amendola, Alfredo Ramirez-Gutierrez de Velasco, Ali Cihat Yildirim, Alice, Frontali, Alpha Oumar Toure, Alvaro, García-Granero, Amaia Martínez Roldan, Amaia Sanz Larrainzar, Amila Sanjiva Ratnayake, Ana María Gonzalez-Ganso, Ana, M Minaya-Bravo, Andre, Das, Andrea, Bondurri, Andrea, Costanzi, Andrea, Lucchi, Andrea, Mazzari, Andrea, Musig, Andrea, Peloso, Andrea, Piano, Andrea, Police, Andrei, Mihailescu, Andrés, Pouy, Angela, Romano, Iossa, Angelo, Anna Carmen Leonetti, Anna, Guariniello, Anna, Isaac, Anna Pia Delli Bovi, Antonella, Chessa, Antonella, Tromba, Antonio Álvarez Martínez, Antonio, Brillantino, Antonio, Caira, Antonio, Castaldi, Antonio, Ferronetti, Antonio, Giuliani, Antonio, Prestera, Antonio Ramos-De la Medina, Antonio, Tarasconi, Antonino, Tornambè, Arcangelo, Picciariello, Argyrios, Ioannidis, Ari, Leppäniemi, Arshad, Khan, Arshad, Rashid, Arteaga Luis Eduardo Pérez-Sánchez, Ashok, Mittal, Ashrarur Rahman Mitul, Asif, Mehraj, Asim, Laharwal, Asnel, Dorismé, Athanasios, Marinis, Atif, Iqbal, Augusto, Moncada, Bartolomeo, Braccio, Basim, Alkhafaji, Beatriz de Andrés Asenjo, Beatriz, Martin-Perez, Belinda Sánchez Pérez, Ben, Creavin, Benedetto, Calì, Beniamino, Pascotto, Benjamin, Stubbs, Benjamin Zavala Retes, Branislav, Jovanovic, Brian Kp Goh, Bruno, Sensi, Carlo, Biddau, Carlo, Gazia, Carlo, Vallicelli, Carlos Alberto Fagundes, Carlos Cerdán Santacruz, Carlos, Chirico, Carlos Javier Gómez, Carlos, Petrola, Carlos Sánchez Rodriguez, Carlos Yánez Benítez, Carmelisa, Dammaro, Carmelo Lo Faro, Caroline, Reinke, Casandra Dominguez Paez, Catalina, Oliva, Charudutt, Paranjape, Charlotte, Thomas, Chi Fung Chia, Chi Kwan Kong, Chiara De Lucia, Christian Ovalle Chao, Claudio, Arcudi, Claudio, Guerci, Clement, Chia, Cristiano, Parise, Cristina, Folliero, Cristopher, Varela, Dalya, M Ferguson, Daniel, Camacho, Daniel, Popowich, Daniel Souza Lima, Daniela, Rega, Daniele, Delogu, Daniele, Zigiotto, Danilo, Vinci, Dario, D'Antonio, Dario, Parini, David Alessio Merlini, David DE Zimmerman, David, Moro-Valdezate, Davide, Pertile, Deborah Maria Giusti, Deborah, S Keller, Delko, Tarik, Denis, Kalivaçi, Dennis, Mazingi, Diana Gabriela Maldonado-Pintado, Diego, Sasia, Dimitrios, Linardoutsos, Dixon, Osilli, Domenico, Murrone, Domenico, Russello, Edgar, Rodas, Edisson Alberto Acuña Roa, Edoardo, Ricciardi, Edoardo, Rosso, Edoardo, Saladino, Eduardo, Flores-Villalba, Eduardo Ruiz Ajs, Eduardo, Smith-Singares, Efstratia, Baili, Efstratios, Kouroumpas, Eirini, Bourmpouteli, Eleftheria, Douka, Elena, Martin-Perez, Eleonora, Guaitoli, Elgun, Samadov, Elisa, Francone, Elisa, Vaterlini, Emilio, Morales, Emilio, Peña, Enhao, Zhao, Eneko Del Pozo Andres, Enrico, Benzoni, Enrico, Erdas, Enrico, Pinotti, Enrique, Colás-Ruiz, Erman, Aytac, Ernesto, Laterza, Ervis, Agastra, Esteban, Foianini, Esteban, Moscoso, Estefania, Laviano, Ester, Marra, Eugenia, Cardamone, Eugenio, Licardie, Eustratia, Mpaili, Eva, Pinna, Evaristo, Varo, Fabian Martín Navarro, Fabio, Marino, Fabio, Medas, Fabio, Romano, Fatlum, Maraska, Fatmir, Saliu, Fausto, Madrid, Fausto, Rosa, Federica, Mastella, Federico, Gheza, Federico, Luvisetto, Felipe, Alconchel, Felipe Monge Vieira, Felipe, Pareja, Ferdinando, Agresta, Fernanda, Luna, Fernando, Bonilla, Fernando, Cordera, Fernando, Burdió, Fernando, Mendoza-Moreno, Fernando Muñoz Flores, Fernando Pardo Aranda, Fiona, Taylor, Flavia, L Ramos, Flavio, Fernandes, Francesca Paola Tropeano, Francesco, Balestra, Francesco, Bianco, Francesco, Ceci, Francesco, Colombo, Francesco Di Marzo, Francesco, Ferrara, Francesco, Lancellotti, Francesco, Lazzarin, Francesco, Litta, Francesco, Martini, Francesco, Pizza, Francesco, Roscio, Francesco, Virdis, Francisco Blanco Antona, Francisco Cervantes Ramírez, Francisco Miguel Fernandez, Francisco Oliver Llinares, Francisco, Quezada, Francisco, Schlottmann, Gabriel, Herrera-Almario, Gabriel, Massaferro, Gabriele, Bislenghi, Gabrielle van Ramshorst, Gaetano, Gallo, Gaetano, Luglio, Georgios, Bointas, Georgios, Kampouroglou, Georgios, Papadopoulos, Gerardo Arredondo Manrique, Giacomo, Calini, Giacomo, Nastri, Giampaolo, Formisano, Giampaolo, Galiffa, Gian Marco Palini, Gianluca, Colucci, Gianluca, Pagano, Gianluca, Vanni, Gianmaria Casoni Pattacini, Gilda De Paola, Giorgio, Lisi, Giovanna, Partida, Giovanni, Bellanova, Giovanni De Nobili, Giovanni Sammy Necchi, Giovanni, Sinibaldi, Giovanni, Tebala, Giulia, Bagaglini, Giuliano, Izzo, Giulio, Argenio, Giuseppe, Brisinda, Giuseppe, Candilio, Giuseppe Di Grezia, Giuseppe, Esposito, Giuseppe, Faillace, Giuseppe, Frazzetta, Giuseppe La Gumina, Giuseppe, Nigri, Giuseppe, Romeo, Gloria Chocarro Amatriaín, Gloria, Ortega, Gonzalo, Martin-Martin, Gregor, A Stavrou, Gunadi, Gustavo Armand Ugon, Gustavo, Machain, Gustavo, Marcucci, Gustavo, Martínez-Mier, Gustavo Miguel Machain, Gustavo, Nari, Haydée, Calvo, Hamada, Fathy, Hamilto, Hazem, Ahmed, Hazem, Faraj, Hector, Nava, Hector Ordas Macias, Herald, Nikaj, Heriberto, Solano, Huma Ahmed Khan, Humberto Sánchez Alarcón, Husam, Ebied, Iacopo, Giani, Ibabe Villalabeitia Ateca, Ignacio, Neri, Igor Alberdi San Roman, Iliya, Fidoshev, Iñaki Martinez Rodriguez, Ionut, Negoi, Irene, Ortega, Irina, Bernescu, Iris Shari Russo, Irune Vincente Rodríguez, Irving, Palomares, Isaac, Baltazar, Isabel Jaén Torrejimeno, Isabel María Cornejo Jurado, Isabella, Reccia, Ishtiyaq, Hussain, Ismael Brito Toledo, Ismael, Mora-Guzmán, Iulia, Dogaru, Ivan, Romic, Izaskun, Balciscueta, J Cleo Kenington, Jackison, Sagolsem, Jae, Y Jang, James, Olivier, Jan, Lammel-Lindemann, Jana, Dziakova, Javier Ismael Roldán Villavicencio, Javier, Salinas, Jelena, Pejanovic, Jose Gustavo Parreira, Jovanovic, Jeny Rincón Pérez, Jeryl, Asreyes, Jesus Antonio Medina Luque, Joanna, Mak, Joanne Salas Rodriguez, Johnn Henry Herrera Kok, Jon, Krook, Jose Antonio Diaz-Elizondo, Jose, Castell, José Eduardo García-Flores, José María Jover Navalón, Jose Mauro Silva Rodrigues, José, Pereira, José Tomas Castell Gómez, Juan Bellido Luque, Juan Carlos Martín Del Olmo, Juan Carlos Salamea, Juan Francisco Coronel Olivier, Juan Luis Blas Laina, Juliana Maria Ordoñez, Julieta, Gutierrez, Julio, Abba, Junaid Ahmad Sofi, Kashaf, Sherafgan, Kapil, Sahnan, Katsuhiko, Yanaga, Kevin, Beatson, Laharwal, Asim, Laura, Alvarez, Leandro, Siragusa, Lee, Farber, Lester, Ong, Liarakos, Athanasios, Lorena, García-Bruña, Luca De Martino, Luca, Ferrario, Luca, Giordano, Luca, Gordini, Luca, Pio, Luca, Ponchietti, Lucia, Moletta, Luciano, Curella, Luciano, Poggi, Lucio, Taglietti, Luigi, Bonavina, Luigi, Conti, Luigi, Goffredi, Luis Angel Garcia Ruiz, Luis, Barrionuevo, Luis Enrique Fregoso, Luis, F Cabrera, Luis, G Rodriguez, Luis, Grande, Luis Gregorio Osoria, Luis Javier Kantun Gonzalez, Luis, Sánchez-Guillén, Luis, Tallon-Aguilar, Luis, Tresierra, Luisa, Giavarini, Mahmoud, Hasabelnabi, Maja, Odovic, Mamoru, Uemura, Mansoor, Khan, Manuel, Artiles-Armas, Mara, David, Marcello Di Martino, Marcello Giuseppe Spampinato, Marcelo A, F Ribeiro, Marcelo, Viola, Marco, Angrisani, Marco, Calussi, Marco, Cannistrà, Marco, Catarci, Marco, Cereda, Marco, Conte, Marco, Giordano, Marco, Pellicciaro, Marco Vito Marino, Maria, E Vaterlini, María, F Jiménez, María Giulia Lolli, Bellini, MARIA IRENE, Maria, Lemma, Maria Michela Chiarello, Maria, Nicola, Mario, Arrigo, Mario Caneda Mejia, Mario Montes Manrique, Mario, Rodriguez-Lopez, Mario, Serradilla-Martín, Mario Zambrano Lara, Marisa, Martínez, Mark, Bagnall, Mark, Peter, Marta Cañón Lara, Marta Jimenez Gomez, Marta, Paniagua-Garcia-Señorans, Marta Perez Gonzalez, Martin, Rutegård, Martin, Salö, Marzia, Franceschilli, Massimiliano, Silveri, Massimiliano, Veroux, Massimo, Pezzulo, Matteo, Nardi, Matteo, Rottoli, Matti, Tolonen, Mauricio Pedraza Ciro, Mauricio, Zuluagua, Maurizio, Cannavò, Maurizio, Cervellera, Maurizio, Iacobone, Mauro, Montuori, Melody García Domínguez, Meltem, Bingol-Kologlu, Mian, Tahir, Michael, Lim, Michael Sj Wilson, Michael, Wilson, Michela, Campanelli, Michele, Bisaccia, Michele De Rosa, Michele, Maruccia, Michele, Paterno, Michele, Pisano, Michele, Torre, Michele, Treviño, Michele, Zuolo, Miguel, A Hernandez Bartolome, Miguel, Farina, Miguel, Pera, Miguel Prieto Calvo, Milagros, Sotelo, Min Myat Thway, Mohamed, Hassan, Mohamed Salah Eldin Hassan, Mohammad, Azfar, Mohammad, Bouhuwaish, Mohammad, Taha, Mohammad, Zaieem, Mohammed, Korkoman, Montserrat, Guraieb, Mostafa, Shalaby, Muhammad Asif Raza, Muhammad Umar Younis, Muhammed, Elhadi, Mujahid Zulfiqar Ali, Nadeem, Quazi, Nagendra, N Dudi-Venkata, Nahar, Alselaim, Natasha, Loria, Nathalie Villan Ramírez, Nay Win Than, Neil, Smart, Nelson, Trelles, Nicanor, Pinto, Niccolò, Allievi, Niccolo, Petrucciani, Nicola, Antonacci, Nicola, Cillara, Nicolae, Gica, Nicolaescu Diana Cristiana, Nicolás, Nicolás, Nicolò, Falco, Nicolò, Pecorelli, Nicolò, Tamini, Nikolaos Andreas Dallas, Nikolaos, Machairas, Noelia, Brito, Nura Ahmed Fieturi, Nuria, Ortega, Octavio, Avilamercado, Oktay, Irkorucu, Omar, Alsherif, Orestes, Valles, Orestis, Ioannidis, Oscar Hernández Palmas, Oscar Isaac Hernandez Palmas, Oscar Sanz Guadarrama, Osman, Bozbiyik, Pablo, Omelanczuk, Pablo, Ottolino, Pablo, Rodrigues, Pablo, Ruiz, Paola, Campenni, Paola, Chiarade, Paola Prieto Olivares, Paolo, Baroffio, Pascal, Wintringer, Pasquale Di Fronzo, Pasquale, Talento, Pasqualino, Favoriti, Patricia, Sendino, Patrizia, Marsanic, Patricia, Mifsut, Paúl, Andrade, Pawel, Ajawin, Valentina, Ferri, Giuseppe Massimiliano de Luca, Sara, Ingallinella, Eva, Pueyo, Francesco, Palmieri, Jesus, Silva, Ken Min Chin, Nicholas, Syn, Brian K, P Goh, Ye Xin Koh, Valeria, Tonini, Ana, Gonzales-Ganso, Vicente, Simó, Maria Victoria Diago, Pedro, Abadía-Barnó, Pedro Alfonso Najar Castañeda, Pedro Omar Sillas Arevalos, Pedro Palazón Bellver, Peng Soon Koh, Petry, Souza, Piotr, Major, Rajandeep Singh Bali, Rakesh Mohan Khattar, Renato Bessa Melo, Reza, Ebrahiminia, Ricardo, Azar, Ricardo López Murga, Riccardo, Caruso, Riccardo, Pirolo, Richard, Brady, Richard Justin Davies, Rishi, Dholakia, Rishi, Rattan, Rishi, Singhal, Robert, Lim, Roberta, Angelico, Roberta Maria Isernia, Roberta, Tutino, Roberto, Faccincani, Roberto, Peltrini, Rocío, Carrera-Ceron, Rodrigo, Tejos, Rohit, Kashyap, Roosevelt, Fajardo, Rosa, Lozito, Royer Madariaga Pareja, Sabrina, Garbarino, Salvador, Morales-Conde, Sami, Benli, Sami, Mansour, Samir, Flores, Samuel Limon Suarez, Santiago Lopez Ben, Sara, Fuentes, Sara, Napetti, Sara Ortiz de Guzmán, Selmy, Awad, Sergio, A Weckmann Luján, Sergio, Gentilli, Sergio, Grimaldi, Sergio Olivares Pizarro, Serkan, Tayar, Shakeeb, Nabi, Shannon, M Chan, Sheikh, Junaid, Sidney, Rojas, Silvana, Monetti, Silvia, García, Silvia, Salvans, Silvia, Tenconi, Simon, Shaw, Simone, Santoni, Sofia Andrea Parra, Sofía, Cárdenas, Sonia, Pérez-Bertólez, Sonja, Chiappetta, Sophie, Dessureault, Spiros, Delis, Stefano Amore Bonapasta, Stefano, Rausei, Stefano, Scaringi, Sundeep, Keswani, Syed Muhammad Ali, Süleyman, Cetinkunar, Tak Lit Derek Fung, Tariq, Rawashdeh, Tatiana Nicolás López, Tercio De Campos, Teresa Calderon Duque, Teresa, Perra, Theodore, Liakakos, Theodoros, Daskalakis, Theodoros, Liakakos, Thomas, Barnes, Tijmen, Koëter, Tiku, Zalla, Tomás, E González, Tomás, Elosua, Tommaso, Campagnaro, Tommy, Brown, Topi, Luoto, Touré Alpha Oumar, Ugo, Giustizieri, Ugo, Grossi, Umberto, Bracale, Uriel, Rivas, Valentina, Sosa, Valentina, Testa, Valeria, Andriola, Valerio, Balassone, Valerio, Celentano, Valerio, Progno, Varun, Raju, Vanessa, Carroni, Venera, Cavallaro, Venkateswara Rao Katta, Veronica De Simone, Vicent Primo Romaguera, Victor Hugo García Orozco, Victor, Luraschi, Victor, Rachkov, Victor, Turrado-L, Victor, Visag-Castillo, Victoria, Dowling, Victoria, Graham, Vincenzo, Papagni, Vincenzo, Vigorita, Vinicius Cordeiro Fonseca, Virginia Jimenez Carneros, Vittoria, Bellato, Walyson, Gonçalves, William, F Powers, William, Grigg, Wolf, O Bechstein, Yu Bing Lim, Yuksel, Altinel, Zoran, Golubović, Zutoia, Balciscueta, Ielpo B., Podda M., Pellino G., Pata F., Caruso R., Gravante G., Di Saverio S., Gallo G., Lui R., Orengia A., Chowdary A., Kulkarni A., Kuvvetli A., Navarro A., Pisanu A., Smith A., Ibiricu A.C., Nacion A.J.D., Alsaleh A., Alhazmi A., Elmabri A., Wani A., Rencuzogullari A., Lasarte A.S., Rubio A.V., Bavikatte A., Kumar A., Jamiri A.-R., Padilla A.M.A., Cacurri A., de San Ildefonso A., Porcu A., Sartori A., Rocca A., Yanez A.P., Becaria A., Solis-Pena A., Sretenovic A., Urbistondo A., Bandin A., Najar A., De Luca A., Boddy A., Charalabopoulos A., Tzivanakis A., Amendola A., de Velasco A.R.-G., Yildirim A.C., Frontali A., Toure A.O., Garcia-Granero A., Roldan A.M., Larrainzar A.S., Ratnayake A.S., Gonzalez-Ganso A.M., Minaya-Bravo A.M., Das A., Bondurri A., Costanzi A., Lucchi A., Mazzari A., Musig A., Peloso A., Piano A., Police A., Mihailescu A., Pouy A., Romano A., Iossa A., Leonetti A.C., Guariniello A., Isaac A., Bovi A.P.D., Chessa A., Tromba A., Martinez A.A., Brillantino A., Caira A., Castaldi A., Ferronetti A., Giuliani A., Prestera A., la Medina A.R.-D., Tarasconi A., Tornambe A., Picciariello A., Ioannidis A., Leppaniemi A., Khan A., Rashid A., Perez-Sanchez A.L.E., Mittal A., Mitul A.R., Mehraj A., Laharwal A., Dorisme A., Marinis A., Iqbal A., Moncada A., Braccio B., Alkhafaji B., de Andres Asenjo B., Martin-Perez B., Perez B.S., Creavin B., Cali B., Pascotto B., Stubbs B., Retes B.Z., Jovanovic B., Goh B.K.P., Sensi B., Biddau C., Gazia C., Vallicelli C., Fagundes C.A., Santacruz C.C., Chirico C., Diaz C.J.G., Petrola C., Rodriguez C.S., Benitez C.Y., Dammaro C., Faro C.L., Reinke C., Paez C.D., Oliva C., Paranjape C., Thomas C., Chia C.F., Kong C.K., De Lucia C., Chao C.O., Arcudi C., Guerci C., Chia C., Parise C., Folliero C., Varela C., Ferguson D.M., Camacho D., Popowich D., Lima D.S., Rega D., Delogu D., Zigiotto D., Vinci D., D'Antonio D., Parini D., Merlini D.A., Zimmerman D.D.E., Moro-Valdezate D., Pertile D., Giusti D.M., Keller D.S., Tarik D., Kalivaci D., Mazingi D., Maldonado-Pintado D.G., Sasia D., Linardoutsos D., Osilli D., Murrone D., Russello D., Rodas E., Roa E.A.A., Ricciardi E., Rosso E., Saladino E., Flores-Villalba E., Ajs E.R., Smith-Singares E., Baili E., Kouroumpas E., Bourmpouteli E., Douka E., Martin-Perez E., Guaitoli E., Samadov E., Francone E., Vaterlini E., Morales E., Pena E., Zhao E., Andres E.D.P., Benzoni E., Erdas E., Pinotti E., Colas-Ruiz E., Aytac E., Laterza E., Agastra E., Foianini E., Moscoso E., Laviano E., Marra E., Cardamone E., Licardie E., Mpaili E., Pinna E., Varo E., Navarro F.M., Marino F., Medas F., Romano F., Maraska F., Saliu F., Madrid F., Rosa F., Mastella F., Gheza F., Luvisetto F., Alconchel F., Vieira F.M., Pareja F., Agresta F., Luna F., Bonilla F., Cordera F., Burdio F., Mendoza-Moreno F., Flores F.M., Aranda F.P., Taylor F., Ramos F.L., Fernandes F., Tropeano F.P., Balestra F., Bianco F., Ceci F., Colombo F., Di Marzo F., Ferrara F., Lancellotti F., Lazzarin F., Litta F., Martini F., Pizza F., Roscio F., Virdis F., Antona F.B., Ramirez F.C., Fernandez F.M., Llinares F.O., Quezada F., Schlottmann F., Herrera-Almario G., Massaferro G., Bislenghi G., van Ramshorst G., Luglio G., Bointas G., Kampouroglou G., Papadopoulos G., Manrique G.A., Calini G., Nastri G., Formisano G., Galiffa G., Palini G.M., Colucci G., Pagano G., Vanni G., Pattacini G.C., De Paola G., Lisi G., Partida G., Bellanova G., De Nobili G., Necchi G.S., Sinibaldi G., Tebala G., Bagaglini G., Izzo G., Argenio G., Brisinda G., Candilio G., Di Grezia G., Esposito G., Faillace G., Frazzetta G., La Gumina G., Nigri G., Romeo G., Amatriain G.C., Ortega G., Martin-Martin G., Stavrou G.A., Gunadi, Ugon G.A., Machain G., Marcucci G., Martinez-Mier G., Machain G.M., Nari G., Calvo H., Fathy H., Hamilto, Ahmed H., Faraj H., Nava H., Macias H.O., Nikaj H., Solano H., Khan H.A., Alarcon H.S., Ebied H., Giani I., Ateca I.V., Neri I., Roman I.A.S., Fidoshev I., Rodriguez I.M., Negoi I., Ortega I., Bernescu I., Russo I.S., Rodriguez I.V., Palomares I., Baltazar I., Torrejimeno I.J., Jurado I.M.C., Reccia I., Hussain I., Toledo I.B., Mora-Guzman I., Dogaru I., Romic I., Balciscueta I., Kenington J.C., Sagolsem J., Jang J.Y., Olivier J., Lammel-Lindemann J., Dziakova J., Villavicencio J.I.R., Salinas J., Parreira J.P.J.G., Jovanovic, Perez J.R., Reyes J.A.S., Luque J.A.M., Mak J., Rodriguez J.S., Kok J.H.H., Krook J., Diaz-Elizondo J.A., Castell J., Garcia-Flores J.E., Navalon J.M.J., Rodrigues J.M.S., Pereira J., Gomez J.T.C., Luque J.B., del Olmo J.C.M., Salamea J.C., Olivier J.F.C., Laina J.L.B., Ordonez J.M., Gutierrez J., Abba J., Sofi J.A., Sherafgan K., Sahnan K., Yanaga K., Beatson K., Asim L., Alvarez L., Siragusa L., Farber L., Ong L., Athanasios L., Garcia-Bruna L., De Martino L., Ferrario L., Giordano L., Gordini L., Pio L., Ponchietti L., Moletta L., Curella L., Poggi L., Taglietti L., Bonavina L., Conti L., Goffredi L., Ruiz L.A.G., Barrionuevo L., Fregoso L.E., Cabrera L.F., Rodriguez L.G., Grande L., Osoria L.G., Gonzalez L.J.K., Sanchez-Guillen L., Tallon-Aguilar L., Tresierra L., Giavarini L., Hasabelnabi M., Odovic M., Uemura M., Khan M., Artiles-Armas M., David M., Di Martino M., Spampinato M.G., Ribeiro M.A.F., Viola M., Angrisani M., Calussi M., Cannistra M., Catarci M., Cereda M., Conte M., Giordano M., Pellicciaro M., Marino M.V., Vaterlini M.E., Jimenez M.F., Lolli M.G., Bellini M.I., Lemma M., Chiarello M.M., Nicola M., Arrigo M., Mejia M.C., Manrique M.M., Rodriguez-Lopez M., Serradilla-Martin M., Lara M.Z., Martinez M., Bagnall M., Peter M., Lara M.C., Gomez M.J., Paniagua-Garcia-Senorans M., Gonzalez M.P., Rutegard M., Salo M., Franceschilli M., Silveri M., Veroux M., Pezzulo M., Nardi M., Rottoli M., Tolonen M., Ciro M.P., Zuluagua M., Cannavo M., Cervellera M., Iacobone M., Montuori M., Dominguez M.G., Bingol-Kologlu M., Tahir M., Lim M., Wilson M.S., Wilson M., Campanelli M., Bisaccia M., De Rosa M., Maruccia M., Paterno M., Pisano M., Torre M., Trevino M., Zuolo M., Hernandez Bartolome M.A., Farina M., Pera M., Calvo M.P., Sotelo M., Thway M.M., Hassan M., Hassan M.S.E., Azfar M., Bouhuwaish M., Taha M., Zaieem M., Korkoman M., Guraieb M., Shalaby M., Raza M.A., Younis M.U., Elhadi M., Ali M.Z., Quazi N., Dudi-Venkata N.N., Alselaim N., Loria N., Ramirez N.V., Than N.W., Smart N., Trelles N., Pinto N., Allievi N., Petrucciani N., Antonacci N., Cillara N., Gica N., Cristiana N.D., Krystek N., Falco N., Pecorelli N., Tamini N., Dallas N.A., Machairas N., Brito N., Fieturi N.A., Ortega N., Mercado O.A., Irkorucu O., Alsherif O., Valles O., Ioannidis O., Palmas O.H., Palmas O.I.H., Guadarrama O.S., Bozbiyik O., Omelanczuk P., Ottolino P., Rodrigues P., Ruiz P., Campenni P., Chiarade P., Olivares P.P., Baroffio P., Panaccio P., Wintringer P., Di Fronzo P., Talento P., Favoriti P., Sendino P., Marsanic P., Mifsut P., Andrade P., Ajawin P., Abadia-Barno P., Castaneda P.A.N., Arevalos P.O.S., Bellver P.P., Koh P.S., Souza P., Major P., Bali R.S., Khattar R.M., Melo R.B., Ebrahiminia R., Azar R., Murga R.L., Pirolo R., Brady R., Davies R.J., Dholakia R., Rattan R., Singhal R., Lim R., Angelico R., Isernia R.M., Tutino R., Faccincani R., Peltrini R., Carrera-Ceron R., Tejos R., Kashyap R., Fajardo R., Lozito R., Pareja R.M., Garbarino S., Morales-Conde S., Benli S., Mansour S., Flores S., Suarez S.L., Ben S.L., Fuentes S., Napetti S., de Guzman S.O., Awad S., Weckmann Lujan S.A., Gentilli S., Grimaldi S., Pizarro S.O., Tayar S., Nabi S., Chan S.M., Junaid S., Rojas S., Monetti S., Garcia S., Salvans S., Tenconi S., Shaw S., Santoni S., Parra S.A., Cardenas S., Perez-Bertolez S., Chiappetta S., Dessureault S., Delis S., Bonapasta S.A., Rausei S., Scaringi S., Keswani S., Ali S.M., Cetinkunar S., Fung T.L.D., Rawashdeh T., Lopez T.N., De Campos T., Duque T.C., Perra T., Liakakos T., Daskalakis T., Barnes T., Koeter T., Zalla T., Gonzalez T.E., Elosua T., Campagnaro T., Brown T., Luoto T., Oumar T.A., Giustizieri U., Grossi U., Bracale U., Rivas U., Sosa V., Testa V., Andriola V., Tonini V., Balassone V., Celentano V., Progno V., Raju V., Carroni V., Cavallaro V., Katta V.R., De Simone V., Romaguera V.P., Orozco V.H.G., Luraschi V., Rachkov V., Turrado-L V., Visag-Castillo V., Dowling V., Graham V., Papagni V., Vigorita V., Fonseca V.C., Carneros V.J., Bellato V., Goncalves W., Powers W.F., Grigg W., Bechstein W.O., Lim Y.B., Altinel Y., Golubovic Z., Balciscueta Z., Ielpo, B., Podda, M., Pellino, G., Pata, F., Caruso, R., Gravante, G., Di Saverio, S., Gallo, G., Lui, R., Orengia, A., Chowdary, A., Kulkarni, A., Kuvvetli, A., Navarro, A., Pisanu, A., Smith, A., Ibiricu, A. C., Nacion, A. J. D., Alsaleh, A., Alhazmi, A., Elmabri, A., Wani, A., Rencuzogullari, A., Lasarte, A. S., Rubio, A. V., Bavikatte, A., Kumar, A., Jamiri, A. -R., Padilla, A. M. A., Cacurri, A., de San Ildefonso, A., Porcu, A., Sartori, A., Rocca, A., Yanez, A. P., Becaria, A., Solis-Pena, A., Sretenovic, A., Urbistondo, A., Bandin, A., Najar, A., De Luca, A., Boddy, A., Charalabopoulos, A., Tzivanakis, A., Amendola, A., de Velasco, A. R. -G., Yildirim, A. C., Frontali, A., Toure, A. O., Garcia-Granero, A., Roldan, A. M., Larrainzar, A. S., Ratnayake, A. S., Gonzalez-Ganso, A. M., Minaya-Bravo, A. M., Das, A., Bondurri, A., Costanzi, A., Lucchi, A., Mazzari, A., Musig, A., Peloso, A., Piano, A., Police, A., Mihailescu, A., Pouy, A., Romano, A., Iossa, A., Leonetti, A. C., Guariniello, A., Isaac, A., Bovi, A. P. D., Chessa, A., Tromba, A., Martinez, A. A., Brillantino, A., Caira, A., Castaldi, A., Ferronetti, A., Giuliani, A., Prestera, A., la Medina, A. R. -D., Tarasconi, A., Tornambe, A., Picciariello, A., Ioannidis, A., Leppaniemi, A., Khan, A., Rashid, A., Perez-Sanchez, A. L. E., Mittal, A., Mitul, A. R., Mehraj, A., Laharwal, A., Dorisme, A., Marinis, A., Iqbal, A., Moncada, A., Braccio, B., Alkhafaji, B., de Andres Asenjo, B., Martin-Perez, B., Perez, B. S., Creavin, B., Cali, B., Pascotto, B., Stubbs, B., Retes, B. Z., Jovanovic, B., Goh, B. K. P., Sensi, B., Biddau, C., Gazia, C., Vallicelli, C., Fagundes, C. A., Santacruz, C. C., Chirico, C., Diaz, C. J. G., Petrola, C., Rodriguez, C. S., Benitez, C. Y., Dammaro, C., Faro, C. L., Reinke, C., Paez, C. D., Oliva, C., Paranjape, C., Thomas, C., Chia, C. F., Kong, C. K., De Lucia, C., Chao, C. O., Arcudi, C., Guerci, C., Chia, C., Parise, C., Folliero, C., Varela, C., Ferguson, D. M., Camacho, D., Popowich, D., Lima, D. S., Rega, D., Delogu, D., Zigiotto, D., Vinci, D., D'Antonio, D., Parini, D., Merlini, D. A., Zimmerman, D. D. E., Moro-Valdezate, D., Pertile, D., Giusti, D. M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Andres, E. D. P., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, F., Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, G., Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., Roman, I. A. S., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Parreira, J. P. J. G., Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pereira, J., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Hernandez Bartolome, M. A., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Ali, M. Z., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Than, N. W., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., Gica, N., Cristiana, N. D., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Ben, S. L., Fuentes, S., Napetti, S., de Guzman, S. O., Awad, S., Weckmann Lujan, S. A., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Katta, V. R., De Simone, V., Romaguera, V. P., Orozco, V. H. G., Luraschi, V., Rachkov, V., Turrado-L, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Ielpo, B, Podda, M, Pellino, G, Pata, F, Caruso, R, Gravante, G, Di Saverio, S, and Luglio, G
Subjects: medicine.medical_specialty, Anti-Bacterial Agents, Appendectomy, Appendicitis, COVID-19 Testing, Hospital Administration, Humans, Pandemics, Personal Protective Equipment, Practice Patterns, Physicians', Surveys and Questionnaires, Attitude of Health Personnel, COVID-19, Surgeons, Coronavirus disease 2019 (COVID-19), Settore MED/18 - CHIRURGIA GENERALE, COVID-19 pandemic. Acute appendicitis, MEDLINE, Practice Patterns, 030230 surgery, Health administration, 03 medical and health sciences, 0302 clinical medicine, Anti-Bacterial Agent, Pandemic, medicine, Surveys and Questionnaire, Appendiciti, General, Laparoscopy, Personal protective equipment, Physicians', medicine.diagnostic_test, business.industry, General surgery, Original Articles, medicine.disease, Anti-bacterial agents, appendectomy, appendicitis, COVID-19 testing, hospital administration, humans, pandemics, personal protective equipment, practice patterns physicians', surveys and questionnaires, attitude of health personnel, surgeons, appendicitis - COVI-19 - ACIE study - management, Acute appendicitis, Original Article, Surgery, Covid-19, business, Human
Abstract: Background Surgical strategies are being adapted to face the COVID‐19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X‐ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P, The COVID‐19 pandemic required reorganization of surgical services, affecting patients with common surgical diseases including acute appendicitis. No evidence is available on the topic. This study found global variation in screening policies, use of personal protective equipment and intraoperative directives. There has been increased adoption of non‐operative management and open appendicectomy. Hands off
Published: 2021

24. Multimodal treatment of radiation-induced esophageal cancer: Results of a case-matched comparative study from a single center

Author: Elisa Sefora, Pierobon, Giovanni, Capovilla, Lucia, Moletta, Anna Laura, De Pasqual, Caterina, Fornasier, Renato, Salvador, Gianpietro, Zanchettin, Sara, Lonardi, Sara, Galuppo, Edin, Hadzijusufovic, Peter P, Grimminger, Matteo, Stocchero, Mario, Costantini, Stefano, Merigliano, and Michele, Valmasoni
Subjects: Neoadjuvant treatment, Radiotherapy, Esophageal Neoplasms, Esophageal cancer, Esophagectomy, Chemoradiotherapy, Combined Modality Therapy, Female, Humans, Neoadjuvant Therapy, Neoplasm Staging, Retrospective Studies, Survival Rate, General Medicine, Surgery
Abstract: Radiation-induced esophageal cancer (RIEC) is a rare but severe late consequence of radiotherapy. The literature regarding this topic is predominately limited in describing the risk of this disease. Tumor behavior, treatment strategies, and prognosis of this cancer remain poorly defined.We collected data of patients who were referred to our unit between 2000 and 2020 for RIEC. After tumor board discussion, upfront surgery or neoadjuvant therapy and surgery were indicated as the main treatment. Preoperative characteristics, long-term and short-term postoperative outcomes of RIEC patients were compared with a 1:1 clustering-matched cohort of patients affected by primary esophageal cancer (PEC).At pre-matching, 54 RIEC and 936 PEC patients were enrolled. The median time between primary irradiation and diagnosis of RIEC was 13.5 years, and the median primary radiation dose was 60 Gy. Compared to the unmatched cohort of PECs, RIEC patients were more frequently female (p = 0.0007), had earlier detection of disease (p = 0.03) and presented more frequently with upper esophageal cancers (p 0.0001). Neoadjuvant treatment was used less frequently in RIEC patients (p 0.0001). After matching, the 51 RIEC and 50 PEC patients showed comparable results in terms of exposure to neoadjuvant treatment, surgical radicality and survival outcomes. RIEC patients had more severe postoperative complications (p = 0.04) and a higher proportion of pulmonary complications (p = 0.04).Curative treatments are feasible for RIEC. Neoadjuvant chemotherapy or chemoradiation can be used in this subgroup, treatment response and long-term outcomes are comparable to those of PEC. The risk of postoperative complications is probably related to the detrimental effect of primary irradiation on lung function.
Published: 2022

25. 75 LONG-TERM OUTCOME OF LAPAROSCOPIC HELLER–DOR OPERATION: RESULTS AT A MEDIAN 20-YEAR FOLLOW UP

Author: Luca Provenzano, Renato Salvador, Lucia Moletta, Stefano Merigliano, Elisa Sefora Pierobon, Andrea Costantini, Mario Costantini, Loredana Nicoletti, Michele Valmasoni, and Giovanni Capovilla
Subjects: medicine.medical_specialty, business.industry, General surgery, Gastroenterology, Medicine, General Medicine, business, Outcome (game theory), Term (time)
Abstract: Since its introduction in 1993, Laparoscopic Heller-Dor (LHD) operation has been the gold standard treatment for esophageal achalasia. Little is known, however, of the natural story of the operated patients in the long run. The aim of this study was to assess the long-term outcome of patients who underwent LHD more than 20 years ago, in order to provide benchmark data to which new techniques should compare. Methods All the patients who underwent LHD from 1992 to 1999 at our Institution were evaluated. Patients with previous endoscopic treatment with pneumatic dilations (PD) or Botox were included, whereas patients with previous myotomy were ruled out. Symptoms were prospectively collected and scored using a detailed questionnaire. Barium swallow, endoscopy and manometry were performed before and 6–12 months after the operation, when also pH-metry was performed. Endoscopy was then suggested every 2 years. Treatment failure was defined as a postoperative symptom score > 10th percentile of the preoperative score (i.e. > 8) or the need for further treatment. Results Eighty-seven patients with a minimum 10-year follow-up were evaluated (median f/u 20 years). One patient died for esophageal cancer 11.5 years after LHD; 8 patients died 11–24 years after LHD for unrelated causes. All were highly satisfied with the results of the operation. Symptoms recurred in 23 patients (26.4%) 1 month to 13.5 years after LHD: all received 1 to 6 PD, effective in 16: 3 required revisional myotomy and 3 need periodic PD. Good long-term outcome was recorded in 73.6% of patients, and in 92% with combined treatment. Post-operative reflux (pH and/or endoscopy-proven) developed in 10 patients only (11.5%). Conclusion LHD can durably relieve symptoms in the majority of patients, though some of them may require complementary PD to maintain effective symptom control. LHD confirms to be an excellent long-term treatment for achalasia and these results represent the reference point for all other treatments.
Published: 2020

26. Histology of the spleen in immune thrombocytopenia: clinical-pathological characterization and prognostic implications

Author: Marta Sbaraglia, Elena Sabattini, Fabrizio Fabris, Alberto Friziero, Fabio D'Amore, Cosimo Sperti, Matteo Fassan, Lucia Moletta, Andrea Grego, Fabrizio Vianello, Angelo Paolo Dei Tos, Marco Pizzi, Simone Zoletto, Irene Bertozzi, Gianni Binotto, Elisa Carraro, Gianfranco Da Dalt, Giovanni Capovilla, Simona Righi, Stefano Merigliano, Elisa Sefora Pierobon, and Nicola Baldan
Subjects: White pulp, Adult, Male, Pathology, medicine.medical_specialty, Adolescent, medicine.medical_treatment, T cell, Biopsy, Splenectomy, Spleen, Autoimmunity, histology, Young Adult, T-Lymphocyte Subsets, hemic and lymphatic diseases, medicine, Cytotoxic T cell, Humans, clinical-pathological correlations, Immune thrombocytopenia, spleen, Aged, Retrospective Studies, Purpura, Thrombocytopenic, Idiopathic, business.industry, Germinal center, Histology, Hematology, General Medicine, Middle Aged, Prognosis, Combined Modality Therapy, Immunohistochemistry, medicine.anatomical_structure, Treatment Outcome, Red pulp, Female, business
Abstract: Objective Immune thrombocytopenia (ITP) is an acquired disorder, characterized by immune-mediated platelet destruction. The spleen plays a key pathogenic role in ITP and splenectomy is a valuable second-line therapy for this disease. Little is known on ITP spleen histology and response to splenectomy is unpredictable. This study aims to characterize ITP spleen histology and assess possible predictors of splenectomy outcome. Methods A series of 23 ITP spleens were retrospectively assessed for the following histological parameters: density of lymphoid follicles (LFs), marginal zones (MZs), T helper and cytotoxic T cells; presence of reactive germinal centers (GCs); width of perivascular T cell sheaths; and red pulp features. Clinical and histological data were matched with postsplenectomy platelet counts to assess their prognostic relevance. Results Three histological patterns were documented: a hyperplastic white pulp pattern, a non-activated white pulp pattern (lacking GCs), and a white pulp-depleted pattern. Poor surgical responses were associated with presplenectomy high-dose steroid administration, autoimmune comorbidities and low T follicular helper cell density. The combination of such parameters stratified patients into different splenectomy response groups. The removal of accessory spleens was also associated with better outcome. Conclusion ITP spleens are histologically heterogeneous and clinical-pathological parameters may help predict the splenectomy outcome.
Published: 2020

27. Providing surgery for cancer during the COVID-19 pandemic: experience of a northern Italian referral centre

Author: Lucia Moletta, Stefano Merigliano, Elisa Sefora Pierobon, Alfredo Piangerelli, Giovanni Capovilla, Renato Salvador, Mario Costantini, and Michele Valmasoni
Subjects: Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Neoplasms, Pandemic, Correspondence, medicine, 80 and over, Humans, Viral, General, Pandemics, Referral and Consultation, Aged, Aged, 80 and over, Cross Infection, business.industry, Cancer, COVID-19, Pneumonia, Neoplasms surgery, Middle Aged, medicine.disease, Coronavirus Infections, Female, Italy, Surgical Oncology, Family medicine, Referral centre, Surgery, business
Published: 2020
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28. Prognostic Implications of 18-FDG Positron Emission Tomography/Computed Tomography in Resectable Pancreatic Cancer

Author: Alberto Ponzoni, Simone Serafini, Sergio Bissoli, Lucia Moletta, Andrea Grego, Cosimo Sperti, Alberto Friziero, and Emanuele Grego
Subjects: medicine.medical_specialty, positron emission tomography, medicine.medical_treatment, pancreatic cancer, lcsh:Medicine, Standardized uptake value, FDG-Positron Emission Tomography, Article, fluorodeoxyglucose, 03 medical and health sciences, 0302 clinical medicine, Pancreatic cancer, medicine, Lymph node, Fluorodeoxyglucose, medicine.diagnostic_test, business.industry, lcsh:R, Cancer, General Medicine, medicine.disease, medicine.anatomical_structure, Positron emission tomography, 030220 oncology & carcinogenesis, Pancreatectomy, standardized uptake value, 030211 gastroenterology & hepatology, Radiology, prognosis, pancreatectomy, business, medicine.drug
Abstract: There are currently no known preoperative factors for determining the prognosis in pancreatic cancer. The aim of this study was to examine the role of 18-fluorodeoxyglucose (18-FDG) positron emission tomography/computed tomography (18-FDG-PET/CT) as a prognostic factor for patients with resectable pancreatic cancer. Data were obtained from a retrospective analysis of patients who had a preoperative PET scan and then underwent pancreatic resection from January 2007 to December 2015. The maximum standardized uptake value (SUVmax) of 18-FDG-PET/CT was calculated. Patients were divided into high (&gt, 3.65) and low (&le, 3.65) SUVmax groups, and compared in terms of their TNM classification (Union for International Cancer Contro classification), pathological grade, surgical treatment, state of resection margins, lymph node involvement, age, sex, diabetes and serum Carbohydrate Antigen 19-9 (CA 19-9) levels. The study involved 144 patients, 82 with high SUVmax pancreatic cancer and 62 with low SUVmax disease. The two groups&rsquo, disease-free and overall survival rates were significantly influenced by tumor stage, lymph node involvement, pathological grade, resection margins and SUVmax. Patients with an SUVmax &le, 3.65 had a significantly better survival than those with SUVmax &gt, 3.65 (p &lt, 0.001). The same variables were independent predictors of survival on multivariate analysis. The SUVmax calculated with 18-FDG-PET/CT is an important prognostic factor for patients with pancreatic cancer, and may be useful in decisions concerning patients&rsquo, therapeutic management.
Published: 2020
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29. International Guidelines And Recommendations For Surgery During Covid-19 Pandemic: A Systematic Review

Author: Mario Costantini, Michele Valmasoni, Lucia Moletta, Renato Salvador, Stefano Merigliano, Elisa Sefora Pierobon, and Giovanni Capovilla
Subjects: Laparoscopic surgery, medicine.medical_specialty, Infectious Disease Transmission, Patient-to-Professional, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, COVID-19, aerosol generating procedures, emergency, operatory room, pandemic, surgery, Pneumonia, Viral, Article, Task (project management), 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Pandemic, medicine, Infection control, Humans, Personal protective equipment, Pandemics, Personal Protective Equipment, Infection Control, business.industry, SARS-CoV-2, General Medicine, Triage, Surgery, Systematic review, 030220 oncology & carcinogenesis, Surgical Procedures, Operative, 030211 gastroenterology & hepatology, Laparoscopy, business, Coronavirus Infections, Emergency Service, Hospital, Surgery Department, Hospital
Abstract: Background During the COVID-19 pandemic, surgical departments were forced to re-schedule their activity giving priority to urgent procedures and non-deferrable oncological cases. There is a lack of evidence-based literature providing clinical and organizational guidelines for the management of a general surgery department. Aim of our study was to review the available recommendations published by general Surgery Societies and Health Institutions and evaluate the underlying Literature. Materials and Methods A review of the English Literature was conducted according to the AMSTAR and to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results After eligibility assessment, a total of 22 papers and statements were analyzed. Surgical societies have established criteria for triage and prioritization in order to identify procedures that can be postponed after the pandemic and those that should not. Prioritization among oncologic cases represents a difficult task: clinicians have to balance a possible delay in cancer diagnosis or treatment against the risk for a potential COVID-19 exposure. There is broad agreement among guidelines that indication to proceed with surgery should be discussed in virtual Tumor Boards taking into consideration alternative therapeutic approaches. Several guidelines deal with the role of laparoscopic surgery during the pandemic: a tailored approach is currently suggested, with a case-by-case evaluation provided that appropriate personal protective equipment is available in order to minimize the potential risk of transmission. Finally, there is a considerable agreement in the published Literature concerning the management of the personnel during the peri- and intraoperative phase and on the technical advices regarding the induction, operative and recover maneuvers in COVID-19 cases. Conclusions During COVID-19 pandemic, it is of paramount importance to face the emergency in the most effective and efficient manner, retrieving resources from non-essential settings and, at the same time, providing care to high priority non-COVID-19 related diseases., Highlights • The COVID-19 pandemic has forced surgical departments to reschedule their activity. • The development of a surgical plan with criteria for elective cases prioritization is necessary. • It is essential to ensure emergency surgery care, preferring non operative management if feasible and safe. • All patients (acute and elective) should be considered COVID-19 suspected cases until proven otherwise: appropriate use of personal protective equipment and organization of the surgical spaces are fundamental.
Published: 2020

30. The Role of Positron Emission Tomography in Clinical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Author: Elisa Sefora Pierobon, Lucia Moletta, Alessandra Rosalba Brazzale, Cosimo Sperti, Alberto Ponzoni, Michele Valmasoni, Simone Serafini, Pietro Zucchetta, and Diego Cecchin
Subjects: Cancer Research, medicine.medical_specialty, positron emission tomography, Review, lcsh:RC254-282, 03 medical and health sciences, Therapeutic approach, 0302 clinical medicine, Medicine, International Consensus Guidelines, Heterogeneous group, medicine.diagnostic_test, business.industry, cystic tumor, intraductal papillary mucinous neoplasms, pancreatic neoplasms, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Patient management, Clinical Practice, medicine.anatomical_structure, Systematic review, Oncology, Positron emission tomography, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Radiology, Differential diagnosis, business, Pancreas
Abstract: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a heterogeneous group of tumors, increasingly diagnosed in clinical practice. An early differential diagnosis between malignant and benign lesions is crucial to patient management and the choice of surgery or observation. The therapeutic approach is currently based on a patient’s clinical, biochemical, and morphological characteristics. The latest published International Consensus Guidelines (ICG) make no mention of the role of metabolic assessments of IPMNs. The aim of this study was to review the current literature, examining the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in IPMN management. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 10 articles were analyzed in detail, focusing on the value of PET as opposed to other standard imaging criteria. Data were retrieved on 419 patients. The 18-FDG-PET proved more sensitive, specific, and accurate than the ICG criteria in detecting malignant IPMNs (reaching 80%, 95%, and 87% vs. 67%, 58%, and 63%, respectively). Metabolic assessments may be used as an additional tool for the appropriate management of patients with doubtful imaging findings.
Published: 2020

31. Genome-wide association study identifies an early onset pancreatic cancer risk locus

Author: Verena Katzke, Jakob R. Izbicki, Francesca Tavano, Rita T. Lawlor, Thilo Hackert, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Federico Canzian, Frederike Dijk, Martin Oliverius, George Theodoropoulos, Pavel Soucek, Manuel Gentiluomo, Rudolf Kaaks, Erika Darvasi, Yogesh K. Vashist, Bill Greenhalf, Juozas Kupcinskas, Maurizio Lucchesi, Borislav Rusev, Andrea Szentesi, Gabriele Capurso, Ewa Małecka-Panas, Lucia Moletta, Beatrice Mohelnikova-Duchonova, Franco Bambi, Ugo Boggi, Alba Ballerini, Krzysztof Jamroziak, Ben Schöttker, Simona Bursi, Raffaele Pezzilli, Gyula Farkas, Dania Bozzato, Áron Vincze, Stefano Landi, Anna Caterina Milanetto, Péter Hegyi, Michael F. Nentwich, Laura Ginocchi, Pavel Vodicka, Stefania Moz, Ludmila Vodickova, Hermann Brenner, Olivier R. Busch, Viktor Hlavac, Audrius Ivanauskas, John P. Neoptolemos, Domenica Gioffreda, Ofure Obazee, Livia Archibugi, Nathalia A. Giese, Giuseppe Vanella, Xin Gao, Renata Talar-Wojnarowska, Angelo Andriulli, Oliver Strobel, Daniele Campa, Maria Gazouli, Pathology, CCA - Cancer biology and immunology, Surgery, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Campa, D., Gentiluomo, M., Obazee, O., Ballerini, A., Vodickova, L., Hegyi, P., Soucek, P., Brenner, H., Milanetto, A. C., Landi, S., Gao, X., Bozzato, D., Capurso, G., Tavano, F., Vashist, Y., Hackert, T., Bambi, F., Bursi, S., Oliverius, M., Gioffreda, D., Schottker, B., Ivanauskas, A., Mohelnikova-Duchonova, B., Darvasi, E., Pezzilli, R., Malecka-Panas, E., Strobel, O., Gazouli, M., Katzke, V., Szentesi, A., Cavestro, G. M., Farkas, G., Izbicki, J. R., Moz, S., Archibugi, L., Hlavac, V., Vincze, A., Talar-Wojnarowska, R., Rusev, B., Kupcinskas, J., Greenhalf, B., Dijk, F., Giese, N., Boggi, U., Andriulli, A., Busch, O. R., Vanella, G., Vodicka, P., Nentwich, M., Lawlor, R. T., Theodoropoulos, G. E., Jamroziak, K., Zuppardo, R. A., Moletta, L., Ginocchi, L., Kaaks, R., Neoptolemos, J. P., Lucchesi, M., and Canzian, F.
Subjects: Oncology, Male, Cancer Research, medicine.medical_specialty, Pancreatic disease, pancreatic cancer, early onset, Single-nucleotide polymorphism, Genome-wide association study, very early onset pancreatic cancer, Polymorphism, Single Nucleotide, 03 medical and health sciences, single nucleotide polymorphisms, 0302 clinical medicine, Risk Factors, Pancreatic cancer, Internal medicine, Genetic predisposition, Medicine, Humans, Genetic Predisposition to Disease, Genetic variability, Pancreas, Genetic association, genome-wide association study, business.industry, Middle Aged, medicine.disease, Pancreatic Neoplasms, 030220 oncology & carcinogenesis, Case-Control Studies, Female, Age of onset, business, Carcinoma, Pancreatic Ductal
Abstract: Early onset pancreatic cancer (EOPC) is a rare disease with a very high mortality rate. Almost nothing is known on the genetic susceptibility of EOPC, therefore we performed a genome-wide association study (GWAS) to identify novel genetic variants specific for patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) at younger ages. In the first phase, conducted on 821 cases with age of onset ≤60 years, of whom 198 with age of onset ≤50, and 3227 controls from PanScan I-II, we observed four SNPs (rs7155613, rs2328991, rs4891017 and rs12610094) showing an association with EOPC risk (P < 1x10-4 ). We replicated these SNPs in the PANcreatic Disease ReseArch (PANDoRA) consortium and used additional in silico data from PanScan III and PanC4. Among these four variants rs2328991 was significant in an independent set of 855 cases with age of onset ≤60 years, of whom 265 with age of onset≤50, and 4142 controls from the PANDoRA consortium while in the in silico data we observed no statistically significant association. However, the resulting meta-analysis supported the association (P = 1.15x10-4 ). In conclusion we propose a novel variant rs2328991 to be involved in EOPC risk. Even though it was not possible to find a mechanistic link between the variant and the function, the association is supported by a solid statistical significance obtained in the largest study on EOPC genetics present so far in the literature. This article is protected by copyright. All rights reserved.
Published: 2020

32. Primary mesenteric vein thrombosis: a case series

Author: Roberto Marconato, Giovanni Capovilla, Giulia Nezi, Lucia Moletta, Silvio Alen Canton, Renato Salvador, Nicola Baldan, S Spirch, and Stefano Merigliano
Subjects: Abdominal pain, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Peritonitis, Low molecular weight heparin, Case Report, intestinal infarction, 030204 cardiovascular system & hematology, Thrombophilia, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Medicine, thrombophilia, business.industry, Gold standard, abdominal pain, Bowel resection, medicine.disease, Thrombosis, mesenteric venous thrombosis, Radiological weapon, Surgery, Radiology, medicine.symptom, business
Abstract: Mesenteric vein thrombosis (MVT) is a rare condition, often misdiagnosed due to its vague and misleading clinical presentation. It can cause intestinal infarction, peritonitis, and consequently necessitate bowel resection. CT scanning with intravenous contrast enhancement is the gold standard for its diagnosis. Radiologists have an important role in defining the extent of thrombosis and identifying any signs of intestinal infarction influencing the decision whether or not to operate. In patients with no clinical signs of peritonitis or radiological evidence of intestinal infarction, the treatment can be exclusively medical, based on full anticoagulation (initially with low molecular weight heparin, followed by vitamin K antagonists or direct acting oral-anticoagulants). The duration of medical treatment depends on radiological evidence of resolution of thrombosis and the identification of pro-coagulant risk factors.
Published: 2020

33. Epidemiology, clinical features and diagnostic work-up of cystic neoplasms of the pancreas: Interim analysis of the prospective PANCY survey

Author: Silvia Giovanelli, Matteo Tacelli, Romano Sassatelli, Renato Cannizzaro, Luigi Veneroni, Bastianello Germanà, E.D. Mandelli, Cosimo Sperti, Andrea Galli, Fabio Monica, Carlo Fabbri, Luca Frulloni, Saverio Alicante, Riccardo Casadei, C. Vattiato, Massimo Falconi, Luca Barresi, Germana de Nucci, Domenico Stillittano, Mauro Frego, Giovanna Del Vecchio Blanco, Claudio Ricci, Filippo Antonini, A. Pezzullo, Gabriele Capurso, Silvia Carrara, Vincenzo Giorgio Mirante, Giulia De Marchi, Lucia Moletta, Paolo Cecinato, Mariano Quartini, Rita Conigliaro, Massimo Graffeo, Milena Di Leo, Elisabetta Buscarini, Gioia Pozza, Deborah Bonamini, Giampiero Macarri, Tommaso Pollini, Giovanni Marchegiani, Raffaele Pezzilli, Giulio Belfiori, Alberto Fantin, Giampiero Manes, and Stefano Crippa
Subjects: Endoscopic ultrasound, Male, Epidemiology, Endosonography, Settore MED/12, 0302 clinical medicine, Surveys and Questionnaires, Prospective Studies, Prospective cohort study, Aged, 80 and over, medicine.diagnostic_test, Cystadenoma, Serous, Gastroenterology, Middle Aged, Magnetic Resonance Imaging, Neuroendocrine Tumors, medicine.anatomical_structure, Italy, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, 030211 gastroenterology & hepatology, Female, Radiology, Pancreas, Adult, medicine.medical_specialty, Adolescent, Cystic neoplasm, Adenocarcinoma, Multidetector computed tomography, 03 medical and health sciences, Young Adult, Cystadenoma, Mucinous, medicine, Humans, Mucinous cystadenoma, Aged, Hepatology, Intraductal papillary mucinous neoplasm, business.industry, Pancreatic cyst, Serous Cystadenoma, medicine.disease, Cystic Neoplasm, Pancreatic Neoplasms, Biomarkers, Cytology, Magnetic resonance imaging, Cystadenoma, business
Abstract: Introduction A prospective survey to evaluate the diagnostic workup of cystic pancreatic neoplasms (CPNs) according to the Italian guidelines. Methods An online data sheet was built. Results Fifteen of the 1385 patients (1.1%) had non cystic neoplastic lesions. Forty percent (518/1295) had at least one 1st degree relative affected by a solid tumor of the digestive and extra-digestive organs. Symptoms/signs associated with the cystic lesion were present in 24.5% of the patients. The cysts were localized in the head of the pancreas in 38.5% of patients. Of the 2370 examinations (1.7 examinations per patient) which were carried out for the diagnosis, magnetic resonance imaging was performed as a single test in 48.4% of patients and in combination with endoscopic ultrasound in 27% of the cases. Of the 1370 patients having CPNs, 89.9% had an intraductal papillary mucinous neoplasm (IPMN) (70.1% a branch duct IPMN, 6.2% a mixed type IPMN and 4.6% a main duct IPMN), 12.7% had a serous cystadenoma, 2.8% a mucinous cystadenoma, 1.5% a non-functioning cystic neuroendocrine neoplasm, 0.7% a solid-pseudopapillary cystic neoplasm, 0.3% a cystic adenocarcinoma, and 1.2% an undetermined cystic neoplasm. Seventy-eight (5.7%) patients were operated upon after the initial work-up. Conclusions This prospective study offers a reliable real-life picture of the diagnostic work-up CPN.
Published: 2019

34. P90 TRACTION ON THE SEPTUM DURING TRANSORAL SEPTOTOMY FOR ZENKER DIVERTICULUM IMPROVES THE FINAL OUTCOME

Author: Giovanni Capovilla, Stefano Merigliano, Luca Provenzano, Elisa Sefora Pierobon, Cesare Cutrone, Michele Valmasoni, Loredana Nicoletti, Lucia Moletta, Renato Salvador, and Mario Costantini
Subjects: Zenker Diverticulum, medicine.medical_specialty, business.industry, medicine.medical_treatment, Gastroenterology, medicine, General Medicine, Traction (orthopedics), business, Surgery
Abstract: Background Transoral Diverticulostomy/Septotomy has become a popular treatment for patients with Zenker Diverticulum (ZD) because of the low complication rates, reduced procedure time, and shorter hospital stay. However, the outcome of this procedure is not, so far, as positive as the open techniques. In order to improve the results of transoral septotomy (TS), a modification of the technique by tractioning the septum with stiches, has been introduced. In this study we aimed to compare the final outcome of a Modify Transoral Septotomy (MTS) with those of the Traditional Transoral Septotomy (TTS) in patients with ZD. Methods Seventy-seven consecutive patients with ZD underwent Transoral Septotomy between 2010-2019. Patients who had already been treated with surgical or endoscopic procedures were excluded. TTS was performed with the classic technique. Since 2015, we adopted a MTS, by positioning 2 sutures at the lateral edges of the septum, for traction. Symptoms were collected and scored using a detailed questionnaire; barium-swallow (to assess the size of the pouch), endoscopy and manometry were performed before and after surgical treatment. Failures were defined when a patient needed an additional procedure for recurrent symptoms. Results Of the 52 patients representing the study population (M:F=49:28), 25 had TTS and 52 had MTS. The patients’ demographic and clinical parameters (sex, age, symptom-score, duration of symptoms, diverticulum size) were similar in both groups. Only two intraoperative mucosal lesions were detected and mortality was nil. The median time of the procedure was 25 min (IQR:22-35) in the TTS and 30 min (IQR:25-36) in the MTS (p At the univariate and multivariate analyses, the surgical procedure was the only factor predictive of a positive final result. Conclusions Transoral Septotomy improves the final outcome of this treatment in patients with ZD.
Published: 2019

35. Metastatic tumors to the pancreas: the role of surgical treatment in a single istitution

Author: A. Friziero, A. Ponzoni, Cosimo Sperti, S. Serafini, Elisa Sefora Pierobon, Lucia Moletta, and Michele Valmasoni
Subjects: medicine.medical_specialty, medicine.anatomical_structure, Hepatology, business.industry, Endocrinology, Diabetes and Metabolism, Gastroenterology, Medicine, Radiology, business, Pancreas, Surgical treatment
Published: 2020

36. P91 PHARYNGO-OESOPHAGEAL PERFORATION FOLLOWING CERVICAL SPINE SURGERY: A SINGLE CENTRE EXPERIENCE

Author: Lucia, Moletta, primary, Giovanni, Capovilla, additional, Laura, Gavagna, additional, Giorgia, Cornaviera, additional, Marco, Taufer, additional, Elisa, Sefora Pierobon, additional, Renato, Salvador, additional, Mario, Costantini, additional, Stefano, Merigliano, additional, and Michele, Valmasoni, additional
Published: 2019
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37. P146 AN IMPROVEMENT TO THE CIRCULAR STAPLING ANASTOMOSIS TECHNIQUE DURING MINIMALLY

Author: Giovanni, Capovilla, primary, Elisa, Sefora Pierobon, additional, Lucia, Moletta, additional, Luca, Provenzano, additional, Mario, Costantini, additional, Renato, Salvador, additional, Stefano, Merigliano, additional, and Michele, Valmasoni, additional
Published: 2019
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38. ASO Visual Abstract: Optimal Treatment of cT2N0 Esophageal Carcinoma—Is Upfront Surgery Really the Way?

Author: Michele Valmasoni, Lucia Moletta, Giovanni Capovilla, Gianpietro Zanchettin, Renato Salvador, Mario Costantini, Stefano Merigliano, Elisa Sefora Pierobon, and Luca Provenzano
Subjects: medicine.medical_specialty, Oncology, business.industry, Surgical oncology, Optimal treatment, Carcinoma, medicine, MEDLINE, Surgery, medicine.disease, business
Published: 2021

39. The Ratio of C-Reactive Protein to Albumin Is an Independent Predictor of Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas

Author: Alberto Friziero, Lorenzo Vallese, Cosimo Sperti, Simone Serafini, Alfredo Piangerelli, Lucia Moletta, Amanda Belluzzi, and Andrea Grego
Subjects: medicine.medical_specialty, pancreatic cancer, Malignancy, Gastroenterology, Article, 03 medical and health sciences, 0302 clinical medicine, neutrophyl lymphocite ratio, Internal medicine, Pancreatic cancer, Medicine, Prospective cohort study, modified Glasgow prognostic score, Univariate analysis, Intraductal papillary mucinous neoplasm, business.industry, C-reactive protein to albumin ratio, intraductal papillary mucinous neoplasm, Cancer, General Medicine, medicine.disease, platelet-to-lymphocyte ratio, medicine.anatomical_structure, inflammation, Dysplasia, 030220 oncology & carcinogenesis, biomarker, 030211 gastroenterology & hepatology, business, Pancreas
Abstract: There is growing evidence to indicate that inflammatory reactions are involved in cancer progression. The aim of this study is to assess the significance of systemic inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the ratio of C-reactive protein to albumin ratio (CAR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score (mGps) in the diagnosis and prognosis of malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Data were obtained from a retrospective analysis of patients who underwent pancreatic resection for IPMNs from January 2005 to December 2015. Univariate and multivariate analyses were performed, considering preoperative inflammatory biomarkers, clinicopathological variables, and imaging features. Eighty-three patients with histologically proven IPMNs of the pancreas were included in the study, 37 cases of low-grade or intermediate dysplasia and 46 cases of high-grade dysplasia (HGD) or invasive carcinoma. Univariate analysis showed that obstructive jaundice (p = 0.02) and a CAR of &gt, 0.083 (p = 0.001) were predictors of malignancy. On multivariate analysis, only the CAR was a statistically significant independent predictor of HGD or invasive carcinoma in pancreatic IPMNs, identifying a subgroup of patients with a poor prognosis. Combining the CAR with patients’ imaging findings, clinical features and tumor markers can be useful in the clinical management of IPMNs. Their value should be tested in prospective studies.
Published: 2021

40. 911 OPTIMAL TREATMENT OF CT2N0 SQUAMOUS-CELLS ESOPHAGEAL CARCINOMA (SCC): IS UPFRONT SURGERY REALLY THE WAY?

Author: Elisa Sefora Pierobon, Stefano Merigliano, Giovanni Capovilla, Michele Valmasoni, Renato Salvador, Mario Costantini, Lucia Moletta, and Gianpietro Zanchettin
Subjects: medicine.medical_specialty, Hepatology, business.industry, Optimal treatment, Gastroenterology, medicine, Carcinoma, business, medicine.disease, Surgery
Published: 2021

41. 915 THE LAPAROSCOPIC HELLER-DOR IS AN EFFECTIVE LONG-TERM TREATMENT FOR END-STAGE ACHALASIA

Author: Renato Salvador, Francesca Forattini, Arianna Vittori, Mario Costantini, Giulia Nezi, Loredana Nicoletti, Luca Provenzano, Stefano Merigliano, Federica Riccio, Gianpietro Zanchettin, Lucia Moletta, Michele Valmasoni, Giovanni Capovilla, and Elisa Sefora Pierobon
Subjects: medicine.medical_specialty, Long term treatment, Hepatology, business.industry, Gastroenterology, Medicine, Achalasia, Stage (cooking), business, medicine.disease, Surgery
Published: 2021

42. 917 SURGICAL TREATMENT OF RADIOINDUCED ESOPHAGEAL CANCER: RESULTS OF A SINGLE CENTER CASE-CONTROL STUDY WITH PROPENSITY SCORE MATCHING

Author: Elisa Sefora Pierobon, Lucia Moletta, Stefano Merigliano, Giovanni Capovilla, Mario Costantini, Gianpietro Zanchettin, Luca Provenzano, Michele Valmasoni, Anna Laura De Pasqual, and Renato Salvador
Subjects: medicine.medical_specialty, Hepatology, business.industry, Propensity score matching, Gastroenterology, Case-control study, medicine, Esophageal cancer, Single Center, Surgical treatment, business, medicine.disease, Surgery
Published: 2021

43. 492 VALIDATION OF THE PITTSBURGH SEVERITY SCORE IN DETERMINING THE CLINICAL OUTCOME AFTER ESOPHAGEAL PERFORATION: A SINGLE CENTER EXPERIENCE

Author: Lucia Moletta, Elisa Sefora Pierobon, Mario Costantini, Michele Valmasoni, Laura Gavagna, Giovanni Valotto, Stefano Merigliano, Gianpietro Zanchettin, Renato Salvador, and Giovanni Capovilla
Subjects: medicine.medical_specialty, Hepatology, business.industry, Perforation (oil well), Gastroenterology, Medicine, business, Single Center, Outcome (game theory), Surgery
Published: 2021

44. Staging chronic pancreatitis with exocrine function tests: Are we better?

Author: Cosimo Sperti and Lucia Moletta
Subjects: medicine.medical_specialty, Exocrine pancreatic insufficiency, Disease, Gastroenterology, Pancreatic function tests, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Endocrine system, Stage (cooking), Pancreatitis, chronic, Steathorrea, Chronic pancreatitis, Exocrine pancreatic insufficiency, Fecal elastase-1, Pancreatic function tests, Steathorrea, Fecal elastase-1, business.industry, General Medicine, medicine.disease, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Etiology, Pancreatitis, 030211 gastroenterology & hepatology, business, Pancreas, Chronic pancreatitis
Abstract: Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al. (2017) demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease.
Published: 2017

45. Pancreatic resection in very elderly patients: A critical analysis of existing evidence

Author: Lucia Moletta, Cosimo Sperti, and Gioia Pozza
Subjects: medicine.medical_specialty, Pancreatic neoplasms, Survival, medicine.medical_treatment, Population, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Elderly, Pancreatectomy, Octogenarian, medicine, Periampullary cancer, Adjuvant therapy, Prospective cohort study, education, Pancreatic resection, education.field_of_study, Rehabilitation, business.industry, General surgery, Mortality rate, Gastroenterology, Minireviews, people.cause_of_death, Surgery, Oncology, 030220 oncology & carcinogenesis, business, people
Abstract: The aging of the population results in a rise of number of elderly patients (aged 80 years and older) with pancreatic or periampullary cancer, and more pancreatectomies could eventually be performed in such complex patients. However, early and long-term results after pancreatic resection in octogenarians are still controversial, and may trouble the surgeon when approaching this type of population. Evaluation of reported experiences shows that for almost all Authors, pancreatectomy can be performed safely in elderly population, although overall morbidity and mortality rates were 34.9% and 13.2% respectively, with a mean length of hospital stay of 18 d. These features appear higher in older patients compared to the younger counterpart. Less than 50% of patients underwent adjuvant therapy after operation. Long-term survival is reported not significantly different in aged 80 years and older patients, with a median overall survival time of 17.6 mo. The quality of life after pancreatic resection is only sporadically evaluated but, when considered, it highlights the need of health facility service after operation for these "frail" patients. Prospective studies on the quality of life of pancreatectomized octogenarians are welcome. Proper selection of patients, geriatric assessment with multidisciplinary approach, centralization of pancreatic surgery in high-volume centres and rehabilitation programs after surgery appear to be crucial points in order to improve surgical treatments of pancreatic tumors in very elderly patients.
Published: 2017

46. Could the Pittsburgh Severity Score guide the treatment of esophageal perforation? Experience of a single referral center.

Author: Lucia, Moletta, Sefora, Pierobon Elisa, Capovilla, Giovanni, Giovanni, Valotto, Laura, Gavagna, Luca, Provenzano, Gianpietro, Zanchettin, Renato, Salvador, Mario, Costantini, Stefano, Merigliano, Michele, Valmasoni, Moletta, Lucia, Pierobon, Elisa Sefora, Valotto, Giovanni, Gavagna, Laura, Provenzano, Luca, Zanchettin, Gianpietro, Salvador, Renato, Costantini, Mario, and Merigliano, Stefano
Published: 2022
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47. A Technical Modification to the Circular Stapling Anastomosis Technique During Minimally Invasive Ivor Lewis Procedure

Author: Elisa Sefora Pierobon, Mario Costantini, Stefano Merigliano, Lucia Moletta, Luca Provenzano, Michele Valmasoni, Renato Salvador, and Giovanni Capovilla
Subjects: Male, medicine.medical_specialty, Leak, Esophageal Neoplasms, Anastomotic Leak, Anastomosis, Complete resection, Resection, 03 medical and health sciences, 0302 clinical medicine, Invasive esophagectomy, Surgical Stapling, medicine, Ivor lewis, Humans, Minimally Invasive Surgical Procedures, esophageal cancer, Prospective Studies, Ivor Lewis, Intraoperative Complications, Aged, staple lines intersection, business.industry, minimally invasive esophagectomy, Anastomosis, Surgical, circular stapled anastomosis, Esophageal cancer, Middle Aged, medicine.disease, Surgery, Esophagectomy, 030220 oncology & carcinogenesis, Staple line, Feasibility Studies, 030211 gastroenterology & hepatology, Female, business
Abstract: Background: The circular stapled (CS) technique with transoral placement of the anvil is commonly used to perform the esophagogastric anastomosis during minimally invasive esophagectomy (MIE). The procedure is safe, efficient, and highly reproducible; however, the intersection between the circular plane of the stapler and the linear staple line of the esophageal stump can expose the anastomosis to the formation of dog-ears and, therefore, increase the risk of anastomotic leak (AL). We describe a simple modification of the CS technique that consists of folding the linear esophageal transection line with a stitch around the anvil shaft, to include the staple line in the resection during the EEA™ firing. Methods: We prospectively collected data on a small group of patients who underwent MIE for cancer using our modified CS technique. Feasibility has been evaluated as the percentage of cases in which the modified anastomosis technique has been carried out successfully with the formation of a complete anastomotic ring. Safety has been defined as the absence of procedure-related complications. Results: MIE was performed in 10 patients using our modified CS technique. All the procedures were successfully completed with complete resection of the linear esophageal staple line and no intraoperative complications. Only one patient developed a postoperative AL that was only detected by barium swallow and did not cause any symptom or clinical sign. Conclusion: Our modified CS technique is feasible and did successfully prevent the occurrence of clinically relevant ALs in this small case series of patients.
Published: 2019

48. Traction on the septum during transoral septotomy for Zenker diverticulum improves the final outcome

Author: Luca Provenzano, Renato Salvador, Michele Valmasoni, Lucia Moletta, Giovanni Capovilla, Mario Costantini, Stefano Merigliano, Loredana Nicoletti, and Cesare Cutrone
Subjects: Zenker Diverticulum, Male, Natural Orifice Endoscopic Surgery, medicine.medical_specialty, transoral diverticulostomy, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Time windows, Traction, medicine, Humans, In patient, Zenker diverticulum, Aged, Nasal Septum, Retrospective Studies, Aged, 80 and over, Transoral septotomy, Mouth, medicine.diagnostic_test, business.industry, Mucosal lesions, Surgery, Endoscopy, Treatment Outcome, Otorhinolaryngology, Median time, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, business, Symptom score
Abstract: OBJECTIVE Transoral diverticulostomy/septotomy has become a popular treatment for patients with Zenker diverticulum (ZD). To improve the results of transoral stapler-assisted septotomy, a modification of the technique has been introduced. In this study, we aimed to compare the final outcome of such a modified transoral septotomy (MTS) with the results of traditional transoral septotomy (TTS) in patients with ZD. METHODS Fifty-two consecutive patients with ZD underwent transoral stapler-assisted septotomy between 2010 and 2018. Symptoms were recorded and scored using a detailed questionnaire. Barium swallow, endoscopy, and manometry were performed before and after the procedure. RESULTS Of the 52 patients forming the study population (male:female = 35:17), 25 had TTS and 27 had MTS. The patients' demographic and clinical parameters were similar in the two groups. No intraoperative mucosal lesions were detected, and the mortality was nil. The median time taken to complete the procedure was 25 minutes (interquartile range [IQR]: 22-35) for TTS, and 30 minutes (IQR: 25-36) for MTS (P < 0.07). The median follow-up was 69 months (IQR: 46-95) in the TTS group and 30 months (IQR: 25-35) in the MTS group. All patients in both groups had an improvement in their symptom score after the procedure, but the failure rates were 32% (8 of 25) after TTS and 3.7% (1 of 27) after MTS (P < 0.02). At univariate and multivariate analyses, the procedure was the only predictor of a positive final outcome. CONCLUSION Albeit with the intrinsic limitations of the study (retrospective, different time window, and different follow-up), traction on the septum during transoral septotomy improves the final outcome of this treatment in patients with ZD. LEVEL OF EVIDENCE 4 Laryngoscope, 130:637-640, 2020.
Published: 2019

49. Neutrophil to lymphocyte ratio and intraductal papillary mucinous neoplasms of the pancreas: what are we missing?

Author: S. Serafini, A. Ponzoni, L. Vallese, Lucia Moletta, and Cosimo Sperti
Subjects: Pathology, medicine.medical_specialty, medicine.anatomical_structure, Hepatology, business.industry, Endocrinology, Diabetes and Metabolism, Gastroenterology, medicine, Neutrophil to lymphocyte ratio, Pancreas, business
Published: 2020

50. Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study

Author: Alberto Ruol, Lucia Moletta, Gianpietro Zanchettin, Stefano Merigliano, Carlo Alberto De Pasqual, Mario Costantini, Elisa Sefora Pierobon, Michele Valmasoni, and Renato Salvador
Subjects: Liver Cirrhosis, Lung Diseases, Male, medicine.medical_specialty, Cirrhosis, Esophageal Neoplasms, medicine.medical_treatment, Operative Time, Blood Loss, Surgical, Anastomotic Leak, Kaplan-Meier Estimate, Risk Assessment, Severity of Illness Index, Gastroenterology, End Stage Liver Disease, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, medicine, Humans, Risk factor, Contraindication, Survival rate, Aged, business.industry, Carcinoma, Length of Stay, Middle Aged, Esophageal cancer, medicine.disease, Surgery, Esophagectomy, Survival Rate, body regions, Oncology, Case-Control Studies, 030220 oncology & carcinogenesis, Concomitant, Female, 030211 gastroenterology & hepatology, business
Abstract: Cirrhosis is a risk factor with nonhepatic surgery, but only three series regarding esophagectomy are reported. The Model for End-Stage Liver Disease (MELD) score has shown benefit in risk evaluation, but there is no experience regarding esophagectomy. This study aimed to compare the outcomes of surgery for esophageal cancer between cirrhotic and noncirrhotic patients and to evaluate whether the MELD score has a prognostic value for risk stratification. From the authors’ esophageal cancer database, they selected all the patients with concomitant cirrhosis who underwent surgery with curative intent and a matched cohort of patients without cirrhosis. The preoperative data included demographics, medical history, blood work, American Society of Anesthesiologists (ASA) score, Child-Turcotte-Pugh (CTP) score, and MELD score. The operative data included type of surgery, radicality, operative time, and blood loss. The postoperative data included hemoderivatives, 90-day morbidity and mortality rates, lab works, and hospital length of stay. The cirrhotic patients were further divided and analyzed according to a MELD score cutoff of 9. Of 3445 esophageal cancer patients, 73 cirrhotic patients underwent surgery. Their 90-day morbidity and mortality rates were higher than those for 146 noncirrhotic patients. The cirrhotic patients also had more respiratory events (p = 0.013) and infections (p = 0.005). The anastomotic complications among the cirrhotic patients were significantly more severe (p = 0.046). No difference in 5-year survival rates was registered. Stratification according to the MELD score showed that patients with a MELD score higher than 9 had a significantly worse postoperative course (5-year survival: p = 0.004). The patients with a MELD score of 9 or lower showed an outcome similar to that of the noncirrhotic patients. Liver cirrhosis is not an absolute contraindication to esophagectomy. The MELD score can be applicable for esophagectomy risk assessment for cirrhotic patients.
Published: 2016

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