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2. Augmentation of the Anterior Cruciate Ligament Using the Peroneus Longus: Description of the Surgical Technique

Author

Diego Escudeiro de Oliveira MSc, Melanie Mayumi Horita MD, Marcos Vaz de Lima PhD, Juliano Mangini Dias Malpaga MD, and Pedro Baches Jorge PhD

Subjects
Sports medicine, RC1200-1245, Orthopedic surgery, RD701-811
Abstract

Background: The quadruple graft from the hamstring tendons has become a widely used option in the reconstruction of the anterior cruciate ligament (ACL), however, this graft may not have the desirable diameter for the reconstruction, increasing the risk of re-rupture. In this context, the peroneus longus tendon graft appears as an option to complement other grafts, transforming a thin quadruple graft into a sextuple graft. Indications: The sextuple graft technique for ACL reconstruction is used in patients who have a quadruple graft with a diameter of less than 8 mm, and due to its length, it is not possible to make a quintuple graft, for example. Technique Description: Initially, the hamstring tendons are removed with the aid of a tenotome. After that, the anterior half of the peroneus longus tendon is identified and removed. On the back table, the definitive graft is prepared so that we have a sextuple graft with a diameter greater than 8 mm. Finally, the ACL reconstruction is performed anatomically using an adjustable loop device in the femur and an interference screw in the tibia. Results: In our experience with patients who have a hamstring graft diameter of less than 8 mm, we obtained an average increase of 1.8 mm in graft diameter when augmentation was performed with the anterior half of the peroneus longus. Discussion: Grafts less than 8 mm in diameter are at increased risk of rupturing and failure of surgical treatment of the ACL injury. The surgeon must be prepared to make a quintuple or sextuple graft, but in some patients, the tendons are short or there is no availability of a tissue bank, making this practice impossible. The use of the anterior half of the peroneus longus to perform graft augmentation is safe, causing almost no morbidity to the donor area and is easily accessible during the procedure, making it an excellent option for increasing the diameter of thin grafts. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Published
2023
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3. A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study

Author

Cillara, Nicola, Podda, Mauro, Cicalò, Enrico, Sotgiu, Giovanni, Provenzano, Maria, Fransvea, Pietro, Poillucci, Gaetano, Sechi, Raffaele, Deserra, Antonello, DʼAgostino, Francesca, Margiani, Carla, Scabini, Stefano, Pertile, Davide, Rosa, Raffaele De, Prosperi, Paolo, Bruscino, Alessandro, Bella, Annamaria Di, Casati, Massimiliano, Laface, Letizia, Abate, Emmanuele, Frontali, Alice, Bonomi, Alessandro Michele, Ferrario, Luca, Mucilli, Felice, Barone, Mirko, Borghi, Felice, Sasia, Diego, Giraudo, Giorgio, Puzziello, Alessandro, Loffredo, Andrea, Steccanella, Francesca, Donnarumma, Elio, Galleano, Raffaele, Malerba, Michele, Runfola, Matteo, Agus, Marcello, Fortunato, Federica, Calò, Pietro Giorgio, Medas, Fabio, Canu, Gian Luigi, Stella, Marco, Ferrara, Francesco, Baldi, Caterina, Benuzzi, Laura, Pisanu, Adolfo, Saba, Alessandra, Gessa, Emanuela, Muratore, Andrea, Calabrò, Marcello, Cuzzola, Bruno, Garino, Mauro, Marafante, Chiara, Farfaglia, Roberto, Pandolfo, Gianpiero, Pata, Giacomo, Lantone, Giulio, Marino, Fabio, Perrone, Fabrizio, Scognamillo, Fabrizio, Delogu, Daniele, Tilocca, Pier Luigi, Frena, Antonio, Malpaga, Anna, Bertelli, Giacomo, Memeo, Riccardo, Ferraro, Valentina, Libia, Annarita, Sarro, Giuliano, Marconi, Matteo, Nava, Samuele, Pierpaolo, Bordoni, Fleres, Francesco, Clarizia, Guglielmo, Alfieri, Sergio, Rosa, Fausto, Longo, Fabio, Restini, Enrico, Cianci, Pasquale, Capuzzolo, Sabino, Anania, Gabriele, Bombardini, Cristina, Urbani, Alessia, Bona, Davide, Aiolfi, Alberto, Lastraioli, Caterina, Paola, Massimiliano Di, DallʼOglio, Anna, D’Eletto, Marco, Capelli, Patrizio, Conti, Luigi, Luzietti, Enrico, Banchini, Filippo, Manca, Giuseppe, Calo, Gabriele’, Centomze, Antonella, Andreano, Mauro, Sullo, Pasquale, Giuseppina, Oliva, Anastasi, Alessandro, Canonico, Giuseppe, Nelli, Tommaso, Trompetto, Mario, Gallo, Gaetano, Clerico, Giuseppe, Arganini, Marco, Palmeri, Matteo, Bonuso, Claudio, Mirabella, Antonello, Marino, Marco V., Vaccarella, Gianpaolo, Salzano, Francesco, Meccariello, Renato, Mastrorilli, Maurizio, Campanile, Fabio Cesare, Foti, Nicola, Angelis, Monica De, Palma, Giovanni Domenico De, Aprea, Giovanni, Palomba, Giuseppe, Milone, Marco, Capano, Mariana, Manigrasso, Michele, Baldazzi, Gianandrea, Cassini, Diletta, Epifani, Angelo Gabriele, Bottino, Vincenzo, Canfora, Alfonso, Ferronetti, Antonio, de Manzini, Nicolò, Biloslavo, Alan, Fracon, Stefano, Filauro, Marco, Barberis, Andrea, Azzinnaro, Antonio, Oliva, Alba, Razzore, Andrea, Maira, Lorenzo Di, Bima, Carlo, Gibin, Enrico, Peluso, Chiara, Perrotta, Nicola, Celiento, Marta, Scorzelli, Marco, Tuveri, Antonio, Madeddu, Francesco, Fois, Claudia, Russello, Domenico, Latteri, Saverio, Sofia, Maria, Rio, Paolo Del, Cozzani, Federico, Giuffrida, Mario, Mariani, Pierpaolo, Giussani, Martina, Ansaloni, Luca, Maestri, Marcello, Tartaglia, Giuseppe, Caricato, Marco, Capolupo, Gabriella Teresa, Carannante, Filippo, Gambino, Giovanni, Bertino, Vanessa, Bonilauri, Stefano, Frazzetta, Giuseppe, Amodio, Pietro Maria, Siena, Teresa De, Zanzi, Federico, Guariniello, Anna, Rocco, Giuseppe, Mancini, Stefano, Sagnotta, Andrea, Solinas, Luigi, Porta, Andrea, Sambucci, Daniele, Monti, Eleonora, Quaglino, Francesco, Mantova, Serena, Fiore, Alessia, Costi, Renato, Virgilio, Edoardo, Montali, Filippo, Catarci, Marco, Apa, Daniela, Bertoldi, Innocenzo, Camandona, Michele, Bossotti, Maurizio, Palagi, Silvia, Doria, Emaunele, Caltagirone, Alice, Balani, Alessandro, Petronio, Barbara, Terranova, Susanna, Martuzzi, Federica, Romeo, Carlo, Carluccio, Raffaele, Neri, Silvia, Auriemma, Pasquale Pio, Prestigiacomo, Giorgia, Sala, Stefano, Colli, Francesco, Marini, Pierluigi, Cosimo, Carla Di, Gattolin, Andrea, Rimonda, Roberto, Travaglio, Elisabetta, Cotsoglou, Christian, Granieri, Stefano, Chierici, Andrea Piero, Tamini, Nicolò, Pitoni, Ludovica, Vico, Eleonora, Altomare, Donato Francesco, Martines, Gennaro, Tomasicchio, Giovanni, Coppola, Massimiliano, Aprile, Giovanna, Sau, Paolo, Papa, Mauro Del, Manzi, Fulvio, DʼAmata, Gabriele, Cocorullo, Gianfranco, Venturelli, Paolina, Carollo, Giuseppe, Tondolo, Vincenzo, Dore, Andrea, Giorgio, Danilo Di, Gusai, Giovanni Pietro Paolo, Salaris, Claudia, Sanna, Silvia, Pignata, Giusto, Andreuccetti, Jacopo, DʼAlessio, Rossella, Massani, Marco, Tutino, Roberta, Viola, Vincenzo, Stella, Luigi Persico, Diana, Massimo, Sampietro, Gianluca Matteo, Merlini, David Alessio, Sica, Giuseppe, Bagaglini, Giulia, Manzia, Tommaso Maria, Siracusa, Leandro, Tisone, Giuseppe, Ercolani, Giorgio, DʼAcapito, Fabrizio, Pietrantonio, Daniela Di, Fiscon, Valentino, Portale, Giuseppe, Cipollari, Chiara, Sorrentino, Mario, Piccolo, Roberta, Cojutti, Alessandro, Canova, Gualtiero, Nicotera, Antonella, Zago, Marcello, Montis, Giorgio De, Castaldi, Fabio, Morelli, Maria Morena, Parma, Emilio, Paolini, Claudia, Marco, Giovanni De, Elter, Chiara, Feo, Carlo V., Fabbri, Nicolò, Severi, Silvia, Nasto, Aurelio, Patrone, Renato, Conti, Lorenzo, Rizzi, Andrea, Broggi, Luca, Danelli, Piergiorgio, Cammarata, Francesco, Fiore, Luigi, Grande, Michele, Campanelli, Michela, and Grande, Simona

Published
2023
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4. Spastic Hips in Cerebral Palsy - Retrospective Study of Salvage with the McHale Procedure

Author

Helder Henzo Yamada, Dante Galvanese Amato Neto, Juliano Mangini Dias Malpaga, and Patricia Maria de Moraes Barros Fucs

Subjects
cerebral palsy, hip/deformities, hip/surgery, Medicine, Orthopedic surgery, RD701-811
Abstract

Abstract Objective To perform a retrospective and cross-sectional assessment to determine the pain and positional improvement of all patients with spastic cerebral palsy (CP) and severe hip deformity who underwent a McHale procedure in our center. A second objective was to analyze the potential complications from the procedure. Methods All consecutive patients treated between 1995 and 2017 were analyzed. Clinically, the patients should present pain on hip mobilization, difficulty in positioning for sitting and hygiene care, and medical records with complete data; functionally was assessed through the Gross Motor Function Classification System (GMFCS). In the preoperative radiographs, we analyzed the migration percentage (MP), the type of deformity according to the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS), and the type of deformity of the femoral head. After the surgery, we assessed the proximal migration of the proximal femoral fragment, implant changes and/or failure, and potential heterotopic ossification. The outcomes were reported as successful (D1) in patients presenting remission of pain, painless mobility, and improved positioning, or unsuccessful (D2) in those presenting procedural failure that required a new surgery. Results In total, 47 patients (53 hips) were treated. Functionally, 43 patients were classified as GMFCS V (91%), 3 as GMFCS IV patients (6%), and 1 as GMFCS III (2%). The mean age was 13 years and 2 months. The follow-up ranged from 1 year to 15 years and 4 months, with an average of 4 years and 8 months. A total of 36 patients (41 hips) presented successful (D1) outcomes after the McHale procedure, corresponding to 77% of our cases, whereas 11 (23%) cases had unsuccessful (D2) outcomes. Conclusion The McHale procedure is a treatment option for GMFCS IV and V, but we must be aware of the potential complications.

Published
2021
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9. The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs): Time-trend and Outcome Analysis From 587 Consecutive Resections at a High-volume Institution

Author

Landoni, Luca, Marchegiani, Giovanni, Pollini, Tommaso, Cingarlini, Sara, D’Onofrio, Mirko, Capelli, Paola, De Robertis, Riccardo, Davì, Maria V., Amodio, Antonio, Impellizzeri, Harmony, Malpaga, Anna, Miotto, Marco, Boninsegna, Letizia, Crepaz, Lorenzo, Nessi, Chiara, Zingaretti, Caterina C., Paiella, Salvatore, Esposito, Alessandro, Casetti, Luca, Malleo, Giuseppe, Tuveri, Massimiliano, Butturini, Giovanni, Salvia, Roberto, Scarpa, Aldo, Falconi, Massimo, and Bassi, Claudio

Published
2019
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11. Estresse oxidativo e a riboflavina: uma abordagem fisiopatológica da síndrome metabólica / Oxidative stress and riboflavina: a pathophysiological approach to the metabolic syndrome

Author

Rodrigo Suiter Dias Malpaga, Ricardo Braga Varella, Leonardo Bartolomeu Coradini Impaléa, and Eitor Morais Alves De Toledo

Subjects
medicine.medical_specialty, antioxidante, business.industry, farmacologia, General Medicine, medicine.disease_cause, medicine.disease, Pathophysiology, estresse oxidativo, biossíntese, Endocrinology, Riboflavina, Internal medicine, Medicine, epidemiologia, Metabolic syndrome, Riboflavina, estresse oxidativo, antioxidante, síndrome metabólica, epidemiologia, biossíntese, farmacologia, business, síndrome metabólica, Oxidative stress
Abstract

Introdução: A riboflavina é uma das vitaminas do complexo B (B2) que possui importante papel antioxidante. Esta tem como funções a oxidação de ácidos graxos, metabolização de lipídeos, aminoácidos e carboidratos. Por conta disso tem-se estudado a sua importância terapêutica em processos de estresse oxidativo, mediante a formação de ROS (Espécies Reativas de Oxigênio). Objetivos: Explicar os possíveis efeitos e a importância da suplementação da vitamina B2, no que diz respeito aos processos antioxidantes na fisiopatologia da síndrome metabólica. Metodologia: Foi feito um levantamento bibliográfico através de artigos indexados nas bases de dados como LILACS, SciELO, Google acadêmico e PubMed pelos quais se estabeleceram como critérios de inclusão estudos realizados entre 2001 a 2018, nos idiomas inglês e português por conta da quantidade de artigos publicados sobre o assunto ser pequena e a maioria dos artigos serem de mais de 10 anos atrás. Usou-se os descritores: riboflavina, farmacocinética, biossíntese, farmacologia, uso terapêutico, epidemiologia. Resultados/Discussão: Averiguou-se que a suplementação com riboflavina na síndrome metabólica traz diversos benefícios ao paciente, visto que auxilia na diminuição da circunferência abdominal, melhora quadros de hipertensão arterial, auxilia nos quadros hiperlipidêmicos, diminuindo LDL-colesterol e aumentando o HDL-colesterol, e traz um quadro antioxidante orgânico importante para o organismo. Conclusão

Published
2021
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12. Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Author

Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, Oldani, A, Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, Oldani, A, Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., and Oldani A.

Abstract

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registrat

Published
2021

14. Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Author

Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, A., Podda, M., Botteri, E., Passera, R., Agresta, F., Arezzo, A., Guerrieri, M., Ortenzi, M., Cavallo, F., Zese, M., Prando, D., Restini, E., Cianci, P., Millo, P., Brachet Contul, R., Serrao, A., Abatini, F., Altomare, D. F., Picciariello, A., Chetta, G., Lattanzio, F., Tonini, V., Gori, A., Jovine, E., Mastrangelo, L., Sartarelli, L., Frena, A., Malpaga, A., Bertelli, F., Pignata, G., Andreuccetti, J., Sanna, S., Lares, B., Sechi, R., Cillara, N., Pisanu, A., Delogu, D., Ciaccio, G., Farulla, M., Casati, M., Laface, L., De Luca, M., Russello, D., Latteri, S., Longoni, M., Masci, E., Vigna, S., Campanile, F. C., Foti, N., Lepiane, P., Balla, A., Cantore, F., Raveglia, V., Borghi, F., Giraudo, G., Verzelli, A., Budassi, A., Patriti, A., Foghetti, D., Montin, U., Amadio, L., Anania, G., Bombardini, C., Fabbri, N., Feo, C., Cianchi, F., Manetti, A., Lucchese, M., Soricelli, E., Ceccarelli, G., Patiti, M., Frascio, M., Stabilini, C., Filauro, M., Barberis, A., Troian, M., Nagliati, C., Campagnacci, R., Maurizi, A., Berti, S., Gennai, A., Marvaso, A., D'Antonio, D., Feo, C. V., Mazzola, L., Selvaggi, F., Carini, S., Costanzo, F., Boccia, L., Pascariello, A., Perrotta, N., Celiento, M., Opocher, E., Giovenzana, M., Stella, M., Ferrara, F., Boni, L., Abate, E., Da Lio, C., Valli, V., Gelmini, R., Serra, F., Piccoli, M., Gozzo, D., Gattolin, A., Sasia, D., Balani, A., Petronio, B., Calo, P. G., Canu, G. L., Contarini, E., Piatto, G., Vettoretto, N., Caprioli, M., Braga, M., Chiappetta, M. F., Maida, P., Tammaro, P., De Palma, G., Milone, M., Bottino, V., Canfora, A., Bagaglini, G., Agrusa, A., Barone, M., Mirabella, A., Marino, M. V., Gulotta, G., Romano, G., Sorrentino, M., Ferfoglia, S., Papagni, V., Eramo, S., Boselli, C., Basti, M., Caracino, V., Moretto, G., Inama, M., Capelli, P., Conti, L., Muratore, A., Cuoghi, M. M., Zerbinati, A., Corso, S., Vasino, M. C., Montuori, M., Fidanza, F., Lucchetta, A., Giuliani, A., Dinatale, G., Zanzi, F., Guariniello, A., Bonilauri, S., Frazzetta, G., Garino, M., Marafante, C., Gioffre, A., Del Monte, S. R., Sganga, G., Fransvea, P., Grande, M., Siragusa, L., Sica, G., Paola, M., Passantino, D. G., Catani, M., Ricci, F., Lauro, E., Facci, E., Parini, D., Armellino, M. F., Argenio, G., Porcu, A., Perra, T., Bordoni, P., Fleres, F., Parisi, A., Rossi, S., Saracco, R., Bono, D., Viora, T., Orlando, F., Ferrero, A., Fontana, A. P., De Paolis, P., Visconti, D., Quaglino, F., Festa, F., Palagi, S., Lo Secco, G., Morino, M., Allaix, M. E., Salzano, A., Tirone, G., Motter, M., Zanus, G., Passuello, N., Massani, M., Tutino, R., Manzini, N., Terranova, S., Merenda, R., Nordio, S., Zonta, S., Lovisetto, F., Guglielmi, A., Campagnaro, T., Amedeo, E., Scollica, M., Amodio, P., Giannotti, D., Olmi, S., Oldani, A., Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D.F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F.C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C.V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P.G., Canu G.L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M.F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M.V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M.M., Zerbinati A., Corso S., Vasino M.C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S.R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D.G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M.F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A.P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M.E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, Alberto, Podda, Mauro, Botteri, Emanuele, Passera, Roberto, Agresta, Ferdinando, Arezzo, Alberto, M Guerrieri, M Ortenzi, F Cavallo, M Zese, D Prando, E Restini, P Cianci, P Millo, R Brachet Contul, A Serrao, F Abatini, D F Altomare, A Picciariello, G Chetta, F Lattanzio, V Tonini, A Gori, E Jovine, L Mastrangelo, L Sartarelli, A Frena, A Malpaga, F Bertelli, G Pignata, J Andreuccetti, S Sanna, B Lares, R Sechi, N Cillara, A Pisanu, D Delogu, G Ciaccio, M Farulla, M Casati, L Laface, M De Luca, D Russello, S Latteri, M Longoni, E Masci, S Vigna, F C Campanile, N Foti, P Lepiane, A Balla, F Cantore, V Raveglia, F Borghi, G Giraudo, A Verzelli, A Budassi, A Patriti, D Foghetti, U Montin, L Amadio, G Anania, C Bombardini, Niccolò Fabbri, Carlo Feo, F Cianchi, A Manetti, M Lucchese, E Soricelli, G Ceccarelli, M Patiti, M Frascio, C Stabilini, M Filauro, A Barberis, M Troian, C Nagliati, R Campagnacci, A Maurizi, S Berti, A Gennai, A Marvaso, D D'Antonio, C V Feo, N Fabbri, L Mazzola, F Selvaggi, S Carini, F Costanzo, L Boccia, A Pascariello, N Perrotta, M Celiento, E Opocher, M Giovenzana, M Stella, F Ferrara, L Boni, E Abate, C Da Lio, V Valli, R Gelmini, F Serra, M Piccoli, D Gozzo, A Gattolin, D Sasia, A Balani, B Petronio, P G Calò, G L Canu, E Contarini, G Piatto, N Vettoretto, M Caprioli, M Braga, M F Chiappetta, P Maida, P Tammaro, G De Palma, M Milone, V Bottino, A Canfora, F Selvaggi, G Bagaglini, A Agrusa, M Barone, A Mirabella, M V Marino, G Gulotta, G Romano, M Sorrentino, S Ferfoglia, V Papagni, S Eramo, C Boselli, M Basti, V Caracino, G Moretto, M Inama, P Capelli, L Conti, A Muratore, M M Cuoghi, A Zerbinati, S Corso, M C Vasino, M Montuori, F Fidanza, A Lucchetta, A Giuliani, G Dinatale, F Zanzi, A Guariniello, S Bonilauri, G Frazzetta, M Garino, C Marafante, A Gioffrè, S R Del Monte, G Sganga, P Fransvea, M Grande, L Siragusa, G Sica, M Paola, D G Passantino, Marco Catani, F Ricci, E Lauro, E Facci, D Parini, M F Armellino, G Argenio, A Porcu, T Perra, P Bordoni, F Fleres, A Parisi, S Rossi, R Saracco, D Bono, T Viora, F Orlando, A Ferrero, A P Fontana, P De Paolis, D Visconti, F Quaglino, F Festa, S Palagi, G Lo Secco, M Morino, M E Allaix, A Salzano, G Tirone, M Motter, G Zanus, N Passuello, M Massani, R Tutino, N Manzini, S Terranova, R Merenda, S Nordio, S Zonta, F Lovisetto, A Guglielmi, T Campagnaro, E Amedeo, M Scollica, P Amodio, D Giannotti, S Olmi, A Oldani, Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, and Oldani, A

Subjects
medicine.medical_specialty, COVID-19 Pandemic, Coronavirus disease 2019 (COVID-19), Endoscopic surgery, NO, Appendectomy, Appendicitis, Machine learning, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Retrospective Studie, Pandemic, medicine, Humans, Appendiciti, Laparoscopy, Pandemics, Retrospective Studies, medicine.diagnostic_test, business.industry, COVID-19 Pandemic, Appendicitis, Appendicectomy, Machine learning, SARS-CoV-2, COVID-19, Length of Stay, medicine.disease, Settore MED/18, Surgery, Italy, 030220 oncology & carcinogenesis, appendicitis, COVID-19 pandemic, machine learning, appendectomy, cohort studies, humans, length of stay, pandemics, postoperative complications, retrospective studies, laparoscopy, 030211 gastroenterology & hepatology, Observational study, Original Article, Postoperative Complication, Appendicectomy, Cohort Studie, business, Complication, Cohort study, Human
Abstract

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020

Published
2021

15. Corrigendum: Whole-genome landscape of pancreatic neuroendocrine tumours

Author

Scarpa, Aldo, Chang, David K., Nones, Katia, Corbo, Vincenzo, Patch, Ann-Marie, Bailey, Peter, Lawlor, Rita T., Johns, Amber L., Miller, David K., Mafficini, Andrea, Rusev, Borislav, Scardoni, Maria, Antonello, Davide, Barbi, Stefano, Sikora, Katarzyna O., Cingarlini, Sara, Vicentini, Caterina, McKay, Skye, Quinn, Michael C. J., Bruxner, Timothy J. C., Christ, Angelika N., Harliwong, Ivon, Idrisoglu, Senel, McLean, Suzanne, Nourse, Craig, Nourbakhsh, Ehsan, Wilson, Peter J., Anderson, Matthew J., Fink, Lynn J., Newell, Felicity, Waddell, Nick, Holmes, Oliver, Kazakoff, Stephen H., Leonard, Conrad, Wood, Scott, Xu, Qinying, Nagaraj, Shivashankar Hiriyur, Amato, Eliana, Dalai, Irene, Bersani, Samantha, Cataldo, Ivana, Dei Tos, Angelo P., Capelli, Paola, Davì, Maria Vittoria, Landoni, Luca, Malpaga, Anna, Miotto, Marco, Whitehall, Vicki L. J., Leggett, Barbara A., Harris, Janelle L., Harris, Jonathan, Jones, Marc D., Humphris, Jeremy, Chantrill, Lorraine A., Chin, Venessa, Nagrial, Adnan M., Pajic, Marina, Scarlett, Christopher J., Pinho, Andreia, Rooman, Ilse, Toon, Christopher, Wu, Jianmin, Pinese, Mark, Cowley, Mark, Barbour, Andrew, Mawson, Amanda, Humphrey, Emily S., Colvin, Emily K., Chou, Angela, Lovell, Jessica A., Jamieson, Nigel B., Duthie, Fraser, Gingras, Marie-Claude, Fisher, William E., Dagg, Rebecca A., Lau, Loretta M. S., Lee, Michael, Pickett, Hilda A., Reddel, Roger R., Samra, Jaswinder S., Kench, James G., Merrett, Neil D., Epari, Krishna, Nguyen, Nam Q., Zeps, Nikolajs, Falconi, Massimo, Simbolo, Michele, Butturini, Giovanni, Van Buren, George, Partelli, Stefano, Fassan, Matteo, Khanna, Kum Kum, Gill, Anthony J., Wheeler, David A., Gibbs, Richard A., Musgrove, Elizabeth A., Bassi, Claudio, Tortora, Giampaolo, Pederzoli, Paolo, Pearson, John V., Waddell, Nicola, Biankin, Andrew V., and Grimmond, Sean M.

Published
2017
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16. Whole-genome landscape of pancreatic neuroendocrine tumours

Author

Scarpa, Aldo, Chang, David K., Nones, Katia, Corbo, Vincenzo, Patch, Ann-Marie, Bailey, Peter, Lawlor, Rita T., Johns, Amber L., Miller, David K., Mafficini, Andrea, Rusev, Borislav, Scardoni, Maria, Antonello, Davide, Barbi, Stefano, Sikora, Katarzyna O., Cingarlini, Sara, Vicentini, Caterina, McKay, Skye, Quinn, Michael C. J., Bruxner, Timothy J. C., Christ, Angelika N., Harliwong, Ivon, Idrisoglu, Senel, McLean, Suzanne, Nourse, Craig, Nourbakhsh, Ehsan, Wilson, Peter J., Anderson, Matthew J., Fink, Lynn J., Newell, Felicity, Waddell, Nick, Holmes, Oliver, Kazakoff, Stephen H., Leonard, Conrad, Wood, Scott, Xu, Qinying, Nagaraj, Shivashankar Hiriyur, Amato, Eliana, Dalai, Irene, Bersani, Samantha, Cataldo, Ivana, Dei Tos, Angelo P., Capelli, Paola, Davì, Maria Vittoria, Landoni, Luca, Malpaga, Anna, Miotto, Marco, Whitehall, Vicki L. J., Leggett, Barbara A., Harris, Janelle L., Harris, Jonathan, Jones, Marc D., Humphris, Jeremy, Chantrill, Lorraine A., Chin, Venessa, Nagrial, Adnan M., Pajic, Marina, Scarlett, Christopher J., Pinho, Andreia, Rooman, Ilse, Toon, Christopher, Wu, Jianmin, Pinese, Mark, Cowley, Mark, Barbour, Andrew, Mawson, Amanda, Humphrey, Emily S., Colvin, Emily K., Chou, Angela, Lovell, Jessica A., Jamieson, Nigel B., Duthie, Fraser, Gingras, Marie-Claude, Fisher, William E., Dagg, Rebecca A., Lau, Loretta M. S., Lee, Michael, Pickett, Hilda A., Reddel, Roger R., Samra, Jaswinder S., Kench, James G., Merrett, Neil D., Epari, Krishna, Nguyen, Nam Q., Zeps, Nikolajs, Falconi, Massimo, Simbolo, Michele, Butturini, Giovanni, Van Buren, George, Partelli, Stefano, Fassan, Matteo, Khanna, Kum Kum, Gill, Anthony J., Wheeler, David A., Gibbs, Richard A., Musgrove, Elizabeth A., Bassi, Claudio, Tortora, Giampaolo, Pederzoli, Paolo, Pearson, John V., Waddell, Nicola, Biankin, Andrew V., and Grimmond, Sean M.

Published
2017
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18. Role of Combined 68Ga-DOTATOC and 18F-FDG Positron Emission Tomography/Computed Tomography in the Diagnostic Workup of Pancreas Neuroendocrine Tumors: Implications for Managing Surgical Decisions

Author

Cingarlini, Sara, Ortolani, Silvia, Salgarello, Matteo, Butturini, Giovanni, Malpaga, Anna, Malfatti, Veronica, DʼOnofrio, Mirko, Davì, Maria Vittoria, Vallerio, Paola, Ruzzenente, Andrea, Capelli, Paola, Citton, Elia, Grego, Elisabetta, Trentin, Chiara, De Robertis, Riccardo, Scarpa, Aldo, Bassi, Claudio, and Tortora, Giampaolo

Published
2017
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19. A influência da alimentação no desenvolvimento e prognostico da nefropatia diabética / The influence of food on the development and prognosis of diabetic nephropathy

Author

Leonardo Takito Passarinho, Rodrigo Suiter Dias Malpaga, Eitor Morais Alves De Toledo, Leonardo Bartolomeu Coradini Impaléa, and Ricardo Braga Varella

Subjects
Diabetic nephropathy, Nefropatia diabetica, medicine.medical_specialty, business.industry, Internal medicine, Medicine, Transtorno Autista, General Medicine, Exercício, Transtorno Autista, Exercício, business, medicine.disease, Gastroenterology
Abstract

Introdução: A nefropatia diabética é uma das complicações mais graves decorrente da Diabetes mellitus, a qual possui grande probabilidade de tornar o paciente dependente da hemodiálise, de modo a diminuir de modo expressivo a sua qualidade de vida. Porém, a alimentação surge como uma forma de tratamento suplementar aos medicamentos tradicionais com o objetivo de impedir a progressão ou o desencadear da nefropatia diabética. Objetivo: Investigar as possíveis influências da dieta no prognóstico do paciente diabético portador de nefropatia. Métodos: Revisão bibliográfica de artigos científicos na base de dados Scielo, Lilacs e Pubmed no intervalo de tempo de 2001 a 2017 usando os descritores nefropatias diabéticas e glomerulosclerose diabética. Resultados: A alimentação orientada para o paciente diabético se mostrou relevante no que diz respeito à progressão da nefropatia, assim como o seu desencadear. Discussão: A nefropatia exprime grande gravidade entre as complicações, pois diminui expressivamente a qualidade de vida do acometido, entre outros motivos, pelo fato de submeter ao processo de hemodiálise no estágio final da doença e potencialmente ao óbito. Portanto, além do tratamento farmacológico e hemodialítico, a dieta direcionado surge como tratamento complementar para retardar danos ocasionados ao glomérulo renal. Conclusão: A redução da ingesta proteica e a correção da dislipidemia refletem na diminuição da excreção urinária de albumina, de maneira a confirmar as suas influências no quadro. É um problema de cunho fisiopatológico que pode ser retardado por uma restrição dietética específica, e também, de saúde pública, visto que é uma doença de elevada prevalência.

Published
2021

20. Augmentation of the Anterior Cruciate Ligament Using the Peroneus Longus: Description of the Surgical Technique.

Author

Escudeiro de Oliveira, Diego, Horita, Melanie Mayumi, Lima, Marcos Vaz de, Malpaga, Juliano Mangini Dias, and Jorge, Pedro Baches

Subjects
ANTERIOR cruciate ligament, OPERATIVE surgery, TENDONS, KNEE injuries, SURGEONS
Abstract

Background: The quadruple graft from the hamstring tendons has become a widely used option in the reconstruction of the anterior cruciate ligament (ACL), however, this graft may not have the desirable diameter for the reconstruction, increasing the risk of re-rupture. In this context, the peroneus longus tendon graft appears as an option to complement other grafts, transforming a thin quadruple graft into a sextuple graft. Indications: The sextuple graft technique for ACL reconstruction is used in patients who have a quadruple graft with a diameter of less than 8 mm, and due to its length, it is not possible to make a quintuple graft, for example. Technique Description: Initially, the hamstring tendons are removed with the aid of a tenotome. After that, the anterior half of the peroneus longus tendon is identified and removed. On the back table, the definitive graft is prepared so that we have a sextuple graft with a diameter greater than 8 mm. Finally, the ACL reconstruction is performed anatomically using an adjustable loop device in the femur and an interference screw in the tibia. Results: In our experience with patients who have a hamstring graft diameter of less than 8 mm, we obtained an average increase of 1.8 mm in graft diameter when augmentation was performed with the anterior half of the peroneus longus. Discussion: Grafts less than 8 mm in diameter are at increased risk of rupturing and failure of surgical treatment of the ACL injury. The surgeon must be prepared to make a quintuple or sextuple graft, but in some patients, the tendons are short or there is no availability of a tissue bank, making this practice impossible. The use of the anterior half of the peroneus longus to perform graft augmentation is safe, causing almost no morbidity to the donor area and is easily accessible during the procedure, making it an excellent option for increasing the diameter of thin grafts. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form. Graphical Abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]

Published
2023
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23. Genome-wide DNA methylation patterns in pancreatic ductal adenocarcinoma reveal epigenetic deregulation of SLIT-ROBO, ITGA2 and MET signaling

Author

Nones, Katia, Waddell, Nic, Song, Sarah, Patch, Ann-Marie, Miller, David, Johns, Amber, Wu, Jianmin, Kassahn, Karin S., Wood, David, Bailey, Peter, Fink, Lynn, Manning, Suzanne, Christ, Angelika N., Nourse, Craig, Kazakoff, Stephen, Taylor, Darrin, Leonard, Conrad, Chang, David K., Jones, Marc D., Thomas, Michelle, Watson, Clare, Pinese, Mark, Cowley, Mark, Rooman, Ilse, Pajic, Marina, Butturini, Giovanni, Malpaga, Anna, Corbo, Vincenzo, Crippa, Stefano, Falconi, Massimo, Zamboni, Giuseppe, Castelli, Paola, Lawlor, Rita T., Gill, Anthony J., Scarpa, Aldo, Pearson, John V., Biankin, Andrew V., and Grimmond, Sean M.

Published
2014
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26. The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs): Time-trend and Outcome Analysis From 587 Consecutive Resections at a High-volume Institution

Author

Harmony Impellizzeri, Maria Vittoria Davì, Alessandro Esposito, Giuseppe Malleo, Massimo Falconi, Antonio Amodio, Massimiliano Tuveri, Sara Cingarlini, Giovanni Butturini, Luca Casetti, Lorenzo Crepaz, Giovanni Marchegiani, Claudio Bassi, Mirko D'Onofrio, Chiara Nessi, Marco Miotto, Tommaso Pollini, Anna Malpaga, Roberto Salvia, Aldo Scarpa, Riccardo De Robertis, Caterina Costanza Zingaretti, Luca Landoni, Letizia Boninsegna, Salvatore Paiella, Paola Capelli, Landoni, L., Marchegiani, G., Pollini, T., Cingarlini, S., D'Onofrio, M., Capelli, P., De Robertis, R., Davi, M. V., Amodio, A., Impellizzeri, H., Malpaga, A., Miotto, M., Boninsegna, L., Crepaz, L., Nessi, C., Zingaretti, C. C., Paiella, S., Esposito, A., Casetti, L., Malleo, G., Tuveri, M., Butturini, G., Salvia, R., Scarpa, A., Falconi, M., and Bassi, C.

Subjects
Male, medicine.medical_specialty, Time Factors, Outcome analysis, 030230 surgery, Neuroendocrine tumors, Pan-NEN, surgery, 03 medical and health sciences, Pancreatectomy, 0302 clinical medicine, Text mining, Nodal status, medicine, Humans, cancer, neuroendocrine, pancreas, Surgical approach, Tumor size, business.industry, Cancer, Middle Aged, medicine.disease, Pancreatic Neoplasms, Neuroendocrine Tumors, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, cancer, neuroendocrine, pancreas, Pan-NEN, surgery, Female, Radiology, Pancreas, business, Hospitals, High-Volume
Abstract

Objective The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome. Background Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection. Methods From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses. Results Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years. Conclusions Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.

Published
2019

27. Are Cystic Pancreatic Neuroendocrine Tumors an Indolent Entity Results from a Single-Center Surgical Series

Author

Riccardo De Robertis, Giovanni Marchegiani, Harmony Impellizzeri, Luca Landoni, Claudio Bassi, Anna Malpaga, Sara Cingarlini, G. Montagnini, Paola Capelli, Tommaso Pollini, Marco Miotto, Chiara Nessi, Mirko D'Onofrio, Letizia Boninsegna, Salvatore Paiella, Aldo Scarpa, Roberto Salvia, Giovanni Butturini, and Ilaria Posenato

Subjects
Adult, Male, medicine.medical_specialty, Cystic pancreatic neuroendocrine tumors, Endocrinology, Diabetes and Metabolism, Population, Neuroendocrine tumors, Single Center, Postoperative outcome, Young Adult, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Endocrinology, Internal medicine, Solid pancreatic neuroendocrine tumors, Single-center surgical series, Clinical features, medicine, Humans, Lack of knowledge, Diagnostic Errors, education, Pathological, Aged, Aged, 80 and over, education.field_of_study, Endocrine and Autonomic Systems, business.industry, Middle Aged, medicine.disease, Tumor Burden, Well differentiated, Pancreatic Neoplasms, Neuroendocrine Tumors, 030220 oncology & carcinogenesis, Cohort, Female, 030211 gastroenterology & hepatology, Radiology, Neoplasm Recurrence, Local, Pancreatic Cyst, business, Follow-Up Studies
Abstract

Introduction: Cystic pancreatic neuroendocrine tumors (CPanNETs) represent an uncommon variant of pancreatic neuroendocrine tumors (PanNETs). Due to their rarity, there is a lack of knowledge with regard to clinical features and postoperative outcome. Methods: The prospectively maintained surgical database of a high-volume institution was queried, and 46 resected CPanNETs were detected from 1988 to 2015. Clinical, demographic, and pathological features and survival outcomes of CPanNETs were described and matched with a population of 92 solid PanNETs (SPanNETs) for comparison. Results: CPanNETs accounted for 7.8% of the overall number of resected PanNETs (46/587). CPanNETs were mostly sporadic (n = 42, 91%) and nonfunctioning (39%). Two functioning CPanNETs were detected (4.3%), and they were 2 gastrinomas. The median tumor diameter was 30 mm (range 10-120). All tumors were well differentiated, with 38 (82.6%) G1 and 8 (17.4%) G2 tumors. Overall, no CPanNET showed a Ki-67 >5%. A correct preoperative diagnosis of a CPanNET was made in half of the cases. After a median follow-up of >70 months, the 5- and 10-year overall survival of resected CPanNETs was 93.8 and 62.5%, respectively, compared to 92.7 and 84.6% for SPanNETs (p > 0.05). The 5- and 10-year disease-free survival rates were 94.5 and 88.2% for CPanNETs and 81.8 and 78.9% for SPanNETs, respectively (p > 0.05). Conclusion: In the setting of a surgical cohort, CPanNETs are rare, nonfunctional, and well-differentiated neoplasms. After surgical resection, they share the excellent outcome of their well-differentiated solid counterparts for both survival and recurrence.

Published
2017
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28. Corrigendum: Whole-genome landscape of pancreatic neuroendocrine tumours (Nature (2017) 543 (65-71) DOI: 10.1038/nature21063)

Author

Scarpa, Aldo, Chang, David K, Nones, Katia, Corbo, Vincenzo, Patch, Ann-Marie, Bailey, Peter, Lawlor, Rita T, Johns, Amber L, Miller, David K, Mafficini, Andrea, Rusev, Borislav, Scardoni, Maria, Antonello, Davide, Barbi, Stefano, Sikora, Katarzyna O, Cingarlini, Sara, Vicentini, Caterina, McKay, Skye, Quinn, Michael C J, Bruxner, Timothy J C, Christ, Angelika N, Harliwong, Ivon, Idrisoglu, Senel, McLean, Suzanne, Nourse, Craig, Nourbakhsh, Ehsan, Wilson, Peter J, Anderson, Matthew J, Fink, J Lynn, Newell, Felicity, Waddell, Nick, Holmes, Oliver, Kazakoff, Stephen H, Leonard, Conrad, Wood, Scott, Xu, Qinying, Hiriyur Nagaraj, Shivashankar, Amato, Eliana, Dalai, Irene, Bersani, Samantha, Cataldo, Ivana, Dei Tos, Angelo P, Capelli, Paola, Vittoria Davì, Maria, Landoni, Luca, Malpaga, Anna, Miotto, Marco, Whitehall, Vicki L J, Leggett, Barbara A, Harris, Janelle L, Harris, Jonathan, Jones, Marc D, Humphris, Jeremy, Chantrill, Lorraine A, Chin, Venessa, Nagrial, Adnan M, Pajic, Marina, Scarlett, Christopher J, Pinho, Andreia, Rooman, Ilse, Toon, Christopher, Wu, Jianmin, Pinese, Mark, Cowley, Mark, Barbour, Andrew, Mawson, Amanda, Humphrey, Emily S, Colvin, Emily K, Chou, Angela, Lovell, Jessica A, Jamieson, Nigel B, Duthie, Fraser, Gingras, Marie-Claude, Fisher, William E, Dagg, Rebecca A, Lau, Loretta M S, Lee, Michael, Pickett, Hilda A, Reddel, Roger R, Samra, Jaswinder S, Kench, James G, Merrett, Neil D, Epari, Krishna, Nguyen, Nam Q, Zeps, Nikolajs, Falconi, Massimo, Simbolo, Michele, Butturini, Giovanni, Van Buren, George, Partelli, Stefano, Fassan, Matteo, Khanna, Kum Kum, Gill, Anthony J, Wheeler, David A, Gibbs, Richard A, Musgrove, Elizabeth A, Bassi, Claudio, Tortora, Giampaolo, Pederzoli, Paolo, Pearson, John V, Waddell, Nicola, Biankin, Andrew V, Grimmond, Sean M, Scarpa, Aldo, Chang, David K, Nones, Katia, Corbo, Vincenzo, Patch, Ann-Marie, Bailey, Peter, Lawlor, Rita T, Johns, Amber L, Miller, David K, Mafficini, Andrea, Rusev, Borislav, Scardoni, Maria, Antonello, Davide, Barbi, Stefano, Sikora, Katarzyna O, Cingarlini, Sara, Vicentini, Caterina, Mckay, Skye, Quinn, Michael C J, Bruxner, Timothy J C, Christ, Angelika N, Harliwong, Ivon, Idrisoglu, Senel, Mclean, Suzanne, Nourse, Craig, Nourbakhsh, Ehsan, Wilson, Peter J, Anderson, Matthew J, Fink, J Lynn, Newell, Felicity, Waddell, Nick, Holmes, Oliver, Kazakoff, Stephen H, Leonard, Conrad, Wood, Scott, Xu, Qinying, Hiriyur Nagaraj, Shivashankar, Amato, Eliana, Dalai, Irene, Bersani, Samantha, Cataldo, Ivana, Dei Tos, Angelo P, Capelli, Paola, Vittoria Davì, Maria, Landoni, Luca, Malpaga, Anna, Miotto, Marco, Whitehall, Vicki L J, Leggett, Barbara A, Harris, Janelle L, Harris, Jonathan, Jones, Marc D, Humphris, Jeremy, Chantrill, Lorraine A, Chin, Venessa, Nagrial, Adnan M, Pajic, Marina, Scarlett, Christopher J, Pinho, Andreia, Rooman, Ilse, Toon, Christopher, Wu, Jianmin, Pinese, Mark, Cowley, Mark, Barbour, Andrew, Mawson, Amanda, Humphrey, Emily S, Colvin, Emily K, Chou, Angela, Lovell, Jessica A, Jamieson, Nigel B, Duthie, Fraser, Gingras, Marie-Claude, Fisher, William E, Dagg, Rebecca A, Lau, Loretta M S, Lee, Michael, Pickett, Hilda A, Reddel, Roger R, Samra, Jaswinder S, Kench, James G, Merrett, Neil D, Epari, Krishna, Nguyen, Nam Q, Zeps, Nikolaj, Falconi, Massimo, Simbolo, Michele, Butturini, Giovanni, Van Buren, George, Partelli, Stefano, Fassan, Matteo, Khanna, Kum Kum, Gill, Anthony J, Wheeler, David A, Gibbs, Richard A, Musgrove, Elizabeth A, Bassi, Claudio, Tortora, Giampaolo, Pederzoli, Paolo, Pearson, John V, Waddell, Nicola, Biankin, Andrew V, and Grimmond, Sean M

Abstract

It has been brought to our attention that in Fig. 2d of this Article, an incorrect Sanger trace was used to represent the breakpoint of the EWSR1 and FLI1 type 2 fusion. This was due to an error during manuscript preparation, when we inadvertently inserted the electrophoretic trace referring to EWSR1 splicing variants. Figure 2d has been corrected in the online versions of the Article. We apologize for the confusion. In addition, in the first sentence of the 'Somatic driver mutation' section on page 67, the sentence: 'A total of 15,751 somatic coding mutations (7,703 non-silent) were detected in 2,787 genes (Supplementary Tables 4, 5)", should have stated "A total of 3,097 somatic coding mutations (2,498 non-silent) were detected in 2,567 genes (Supplementary Tables 4, 5)". Note that the numbers in the Supplementary Tables are correct. This sentence has been corrected in the online versions of the Article.

Published
2017

30. Genome-wide DNA methylation patterns in pancreatic ductal adenocarcinoma reveal epigenetic deregulation of SLIT-ROBO, ITGA2 and MET signaling

Author

Lynn Fink, Sean M. Grimmond, Ann-Marie Patch, Sarah Song, Jianmin Wu, Amber L. Johns, Giovanni Butturini, Karin S. Kassahn, Conrad Leonard, Michelle Thomas, Marina Pajic, Rita T. Lawlor, Clare Watson, Suzanne Manning, Vincenzo Corbo, Giuseppe Zamboni, Anna Malpaga, Mark J. Cowley, Stephen H. Kazakoff, David Miller, Craig Nourse, Ilse Rooman, David L. A. Wood, Stefano Crippa, Nic Waddell, Anthony J. Gill, Peter Bailey, Paola Castelli, Katia Nones, Andrew V. Biankin, Massimo Falconi, Angelika N. Christ, Aldo Scarpa, Mark Pinese, John V. Pearson, Marc D. Jones, Darrin Taylor, and David K. Chang

Subjects
Regulation of gene expression, Cancer Research, Wnt signaling pathway, Methylation, Biology, medicine.disease_cause, Oncology, CpG site, ROBO1, DNA methylation, Cancer research, medicine, Epigenetics, Carcinogenesis
Abstract

The importance of epigenetic modifications such as DNA methylation in tumorigenesis is increasingly being appreciated. To define the genome-wide pattern of DNA methylation in pancreatic ductal adenocarcinomas (PDAC), we captured the methylation profiles of 167 untreated resected PDACs and compared them to a panel of 29 adjacent nontransformed pancreata using high-density arrays. A total of 11,634 CpG sites associated with 3,522 genes were significantly differentially methylated (DM) in PDAC and were capable of segregating PDAC from non-malignant pancreas, regardless of tumor cellularity. As expected, PDAC hypermethylation was most prevalent in the 5' region of genes (including the proximal promoter, 5'UTR and CpG islands). Approximately 33% DM genes showed significant inverse correlation with mRNA expression levels. Pathway analysis revealed an enrichment of aberrantly methylated genes involved in key molecular mechanisms important to PDAC: TGF-β, WNT, integrin signaling, cell adhesion, stellate cell activation and axon guidance. Given the recent discovery that SLIT-ROBO mutations play a clinically important role in PDAC, the role of epigenetic perturbation of axon guidance was pursued in more detail. Bisulfite amplicon deep sequencing and qRT-PCR expression analyses confirmed recurrent perturbation of axon guidance pathway genes SLIT2, SLIT3, ROBO1, ROBO3, ITGA2 and MET and suggests epigenetic suppression of SLIT-ROBO signaling and up-regulation of MET and ITGA2 expression. Hypomethylation of MET and ITGA2 correlated with high gene expression, which was associated with poor survival. These data suggest that aberrant methylation plays an important role in pancreatic carcinogenesis affecting core signaling pathways with potential implications for the disease pathophysiology and therapy.

Published
2014
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32. Distal pancreatectomy associated with multivisceral resection: results from a single centre experience

Author

Tiziana Marchese, Giovanni Butturini, Laura Maggino, Anna Malpaga, Roberto Salvia, Francesca Panzeri, Giuseppe Malleo, Giovanni Marchegiani, and Claudio Bassi

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Operative Time, Distal pancreatectomy, 030230 surgery, Neuroendocrine tumors, 03 medical and health sciences, Pancreatectomy, Postoperative Complications, 0302 clinical medicine, Median follow-up, Pancreatic cancer, medicine, Carcinoma, Humans, Aged, Retrospective Studies, business.industry, Incidence, Middle Aged, medicine.disease, Surgery, Pancreatic Neoplasms, Neuroendocrine Tumors, Viscera, Treatment Outcome, Pancreatic fistula, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Multivisceral resection, Female, business, Abdominal surgery
Abstract

Tumors arising in the body/tail of the pancreas tend to be diagnosed at a more advanced stage, with a lower rate of resectability compared to disease of the head. Distal pancreatectomy (DP) associated to multivisceral resections (MVR) can represent a surgical option for selected patients with advanced tumors. We retrospectively analyzed data of patients who underwent DP associated with MVR at our Institution over a 9-year period, and compared them to standard DP. MVR was defined as resection of at least one additional organ or vascular structure because of neoplastic involvement. Out of 508 DP, in 59 cases MVR was performed. The absolute incidence of complications was comparable between the two groups (69.5 % in MVR arm vs. 57.2 % in control arm, p = 0.072) but more patients in the study group had a Clavien-Dindo class ≥3 (18.6 vs. 9.8 %, p = 0.04). A longer operative time (291 ± 91 vs. 227 ± 67, p

Published
2017

33. Role of Combined Ga-68-DOTATOC and F-18-FDG Positron Emission Tomography/Computed Tomography in the Diagnostic Workup of Pancreas Neuroendocrine Tumors Implications for Managing Surgical Decisions

Author

Giovanni Butturini, Matteo Salgarello, Paola Vallerio, Claudio Bassi, Anna Malpaga, Elisabetta Grego, Silvia Ortolani, Maria Vittoria Davì, Andrea Ruzzenente, Sara Cingarlini, Elia Citton, Giampaolo Tortora, Riccardo De Robertis, Aldo Scarpa, Mirko DʼOnofrio, Veronica Malfatti, Chiara Trentin, and Paola Capelli

Subjects
Adult, Male, medicine.medical_specialty, 18f fdg positron emission tomography, Endocrinology, Diabetes and Metabolism, Decision Making, Computed tomography, Neuroendocrine tumors, Octreotide, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, 68ga dotatoc, 03 medical and health sciences, pancreas neuroendocrine tumors (PanNETs), 0302 clinical medicine, Endocrinology, Fluorodeoxyglucose F18, Positron Emission Tomography Computed Tomography, Organometallic Compounds, Internal Medicine, medicine, Humans, Pancreas, Grading (tumors), Aged, Retrospective Studies, Aged, 80 and over, Hepatology, medicine.diagnostic_test, business.industry, Reproducibility of Results, Retrospective cohort study, Middle Aged, medicine.disease, Pancreatic Neoplasms, Ga-DOTATOC (Ga) positron emission tomography (PET)/computed tomography (CT), Neuroendocrine Tumors, medicine.anatomical_structure, Positron emission tomography, 030220 oncology & carcinogenesis, Preoperative Period, pancreas neuroendocrine tumors (PanNETs), Ga-DOTATOC (Ga) positron emission tomography (PET)/computed tomography (CT), Female, Radiology, business, Nuclear medicine
Abstract

Objectives Ga-DOTATOC (Ga) positron emission tomography (PET)/computed tomography (CT) is recommended in the workup of pancreas neuroendocrine tumors (PanNETs); evidence suggests that F-FDG (F) PET/CT can also provide prognostic information. Aims of this study were to assess the role of combined Ga- and F-PET/CT in the evaluation of grade (G) 1-2 PanNETs and to test the correlation between F-PET/CT positivity and tumor grade. Methods Preoperative Ga- and F-PET/CT of 35 patients with surgically resected G1-2 PanNETs were evaluated. For grading, the 2010 World Health Organization Classification was used; an ancillary analysis with Ki67 cutoffs at 5% to 20% was conducted. Correlation between F-PET/CT positivity (SUVmax > 3.5) and grade was assessed. Results Of 35 PanNETs, 28.6% and 71.4% were G1 and G2 as per World Health Organization. Ga-PET/CT showed high sensitivity (94.3%) in detecting G1-2 PanNETs. F-PET/CT was positive in 20% and 76% G1 and G2 tumors (P = 0.002). F-PET/CT identified G2 PanNETs with high positive predictive value (PPV, 90.5%). F-PET/CT correlated with tumor grade also in the ancillary analysis (P = 0.009). Conclusions The high sensitivity of Ga-PET/CT in NET detection is known. The high PPV of F-PET/CT in the identification of G2 forms suggests its potential role in PanNETs prognostication and risk stratification.

Published
2017

34. Perioperative management of patients undergoing pancreatic resection: Implementation of a care plan in a tertiary-care center

Author

Beatrice Personi, Martina Fontana, Giovanni Butturini, Salvatore Paiella, Roberto Salvia, Giuseppe Malleo, Marco Dal Molin, Alessandro Esposito, Anna Malpaga, Claudio Bassi, and Giovanni Marchegiani

Subjects
medicine.medical_specialty, Perioperative management, business.industry, General Medicine, Tertiary care, Pancreatic surgery, Abdominal drains, Oncology, Pain control, Device removal, Care plan, Medicine, Surgery, Pancreatic resection, business, Intensive care medicine
Abstract

Evidence-based perioperative management is important for a successful outcome after pancreatic surgery. Use of protocolized pathways of care based on fast-track concepts has been shown to reduce hospital stay and contain costs. These regimens include pain control, early device removal (nasogastric tube, abdominal drains), enforced early mobilization, and early oral feeding. In this article, current evidence on perioperative management of pancreatic resections was analyzed in the attempt to implement our institutional care plan. J. Surg. Oncol. 2013;107:51–57. © 2012 Wiley Periodicals, Inc.

Published
2012
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38. Are Cystic Pancreatic Neuroendocrine Tumors an Indolent Entity Results from a Single-Center Surgical Series

Author

Paiella, Salvatore, primary, Marchegiani, Giovanni, additional, Miotto, Marco, additional, Malpaga, Anna, additional, Impellizzeri, Harmony, additional, Montagnini, Greta, additional, Pollini, Tommaso, additional, Nessi, Chiara, additional, Butturini, Giovanni, additional, Capelli, Paola, additional, Posenato, Ilaria, additional, Scarpa, Aldo, additional, D'Onofrio, Mirko, additional, De Robertis, Riccardo, additional, Cingarlini, Sara, additional, Boninsegna, Letizia, additional, Bassi, Claudio, additional, Salvia, Roberto, additional, and Landoni, Luca, additional

Published
2017
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39. A Single Institution's 27-Year Surgical Experience with Pancreatic Neuroendocrine Tumors: Time Trends, Comparison of Current Staging Systems and Outcome Analysis

Author

Marchegiani, Giovanni, primary, Pollini, Tommaso, additional, Paiella, Salvatore, additional, Miotto, Marco, additional, Malpaga, Anna, additional, Impellizzeri, Harmony, additional, Damoli, Isacco, additional, Bianchi, Beatrice, additional, Baroni, Tommaso, additional, Zingaretti, Caterina Costanza, additional, Nessi, Chiara, additional, Crepaz, Lorenzo, additional, Salvia, Roberto, additional, and Landoni, Luca, additional

Published
2017
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40. Whole-genome landscape of pancreatic neuroendocrine tumours

Author

Scarpa, A., Chang, D. K., Nones, K., Corbo, V., Patch, A. -M., Bailey, P., Lawlor, R. T., Johns, A. L., Miller, D. K., Mafficini, A., Rusev, B., Scardoni, M., Antonello, D., Barbi, S., Sikora, K. O., Cingarlini, S., Vicentini, C., Mckay, S., Quinn, M. C. J., Bruxner, T. J. C., Christ, A. N., Harliwong, I., Idrisoglu, S., Mclean, S., Nourse, C., Nourbakhsh, E., Wilson, P. J., Anderson, M. J., Fink, J. L., Newell, F., Waddell, N., Holmes, O., Kazakoff, S. H., Leonard, C., Wood, S., Xu, Q., Nagaraj, S. H., Amato, E., Dalai, I., Bersani, S., Cataldo, I., Dei Tos, A. P., Capelli, P., Davi, M. V., Landoni, L., Malpaga, A., Miotto, M., Whitehall, V. L. J., Leggett, B. A., Harris, J. L., Harris, J., Jones, M. D., Humphris, J., Chantrill, L. A., Chin, V., Nagrial, A. M., Pajic, M., Scarlett, C. J., Pinho, A., Rooman, I., Toon, C., Wu, J., Pinese, M., Cowley, M., Barbour, A., Mawson, A., Humphrey, E. S., Colvin, E. K., Chou, A., Lovell, J. A., Jamieson, N. B., Duthie, F., Gingras, M. -C., Fisher, W. E., Dagg, R. A., Lau, L. M. S., Lee, M., Pickett, H. A., Reddel, R. R., Samra, J. S., Kench, J. G., Merrett, N. D., Epari, K., Nguyen, N. Q., Zeps, N., Falconi, M., Simbolo, M., Butturini, G., Van Buren, G., Partelli, S., Fassan, M., Khanna, K. K., Gill, A. J., Wheeler, D. A., Gibbs, R. A., Musgrove, E. A., Bassi, C., Tortora, G., Pederzoli, P., Pearson, J. V., Biankin, A. V., Grimmond, S. M., Amato E., Tortora G. (ORCID:0000-0002-1378-4962), Pederzoli P., Scarpa, A., Chang, D. K., Nones, K., Corbo, V., Patch, A. -M., Bailey, P., Lawlor, R. T., Johns, A. L., Miller, D. K., Mafficini, A., Rusev, B., Scardoni, M., Antonello, D., Barbi, S., Sikora, K. O., Cingarlini, S., Vicentini, C., Mckay, S., Quinn, M. C. J., Bruxner, T. J. C., Christ, A. N., Harliwong, I., Idrisoglu, S., Mclean, S., Nourse, C., Nourbakhsh, E., Wilson, P. J., Anderson, M. J., Fink, J. L., Newell, F., Waddell, N., Holmes, O., Kazakoff, S. H., Leonard, C., Wood, S., Xu, Q., Nagaraj, S. H., Amato, E., Dalai, I., Bersani, S., Cataldo, I., Dei Tos, A. P., Capelli, P., Davi, M. V., Landoni, L., Malpaga, A., Miotto, M., Whitehall, V. L. J., Leggett, B. A., Harris, J. L., Harris, J., Jones, M. D., Humphris, J., Chantrill, L. A., Chin, V., Nagrial, A. M., Pajic, M., Scarlett, C. J., Pinho, A., Rooman, I., Toon, C., Wu, J., Pinese, M., Cowley, M., Barbour, A., Mawson, A., Humphrey, E. S., Colvin, E. K., Chou, A., Lovell, J. A., Jamieson, N. B., Duthie, F., Gingras, M. -C., Fisher, W. E., Dagg, R. A., Lau, L. M. S., Lee, M., Pickett, H. A., Reddel, R. R., Samra, J. S., Kench, J. G., Merrett, N. D., Epari, K., Nguyen, N. Q., Zeps, N., Falconi, M., Simbolo, M., Butturini, G., Van Buren, G., Partelli, S., Fassan, M., Khanna, K. K., Gill, A. J., Wheeler, D. A., Gibbs, R. A., Musgrove, E. A., Bassi, C., Tortora, G., Pederzoli, P., Pearson, J. V., Biankin, A. V., Grimmond, S. M., Amato E., Tortora G. (ORCID:0000-0002-1378-4962), and Pederzoli P.

Abstract

The diagnosis of pancreatic neuroendocrine tumours (PanNETs) is increasing owing to more sensitive detection methods, and this increase is creating challenges for clinical management. We performed whole-genome sequencing of 102 primary PanNETs and defined the genomic events that characterize their pathogenesis. Here we describe the mutational signatures they harbour, including a deficiency in G:C > T:A base excision repair due to inactivation of MUTYH, which encodes a DNA glycosylase. Clinically sporadic PanNETs contain a larger-than-expected proportion of germline mutations, including previously unreported mutations in the DNA repair genes MUTYH, CHEK2 and BRCA2. Together with mutations in MEN1 and VHL, these mutations occur in 17% of patients. Somatic mutations, including point mutations and gene fusions, were commonly found in genes involved in four main pathways: chromatin remodelling, DNA damage repair, activation of mTOR signalling (including previously undescribed EWSR1 gene fusions), and telomere maintenance. In addition, our gene expression analyses identified a subgroup of tumours associated with hypoxia and HIF signalling.

Published
2017

42. Pancreatic Metastases from Renal Neoplasms and Neuroendocrine Pancreatic Tumors: Differential Diagnosis at CT

Author

Zamboni, Giulia, Ambrosetti, Maria Chiara, Lombardo, F, Sava, T, Malpaga, A, Butturini, G, and POZZI MUCELLI, Roberto

Subjects
Pancreatic metastases from renal-cell carcinoma (PRCC), differential diagnosis, Pancreatic metastases from renal-cell carcinoma (PRCC), neuroendocrine pancreatic tumors (PNET), differential diagnosis, neuroendocrine pancreatic tumors (PNET)
Published
2015

46. A Single Institution's 27-Year Surgical Experience with Pancreatic Neuroendocrine Tumors: Time Trends, Comparison of Current Staging Systems and Outcome Analysis

Author

Isacco Damoli, Salvatore Paiella, Beatrice Bianchi, Chiara Nessi, Luca Landoni, Tommaso Baroni, Tommaso Pollini, Harmony Impellizzeri, Roberto Salvia, Marco Miotto, Caterina Costanza Zingaretti, Lorenzo Crepaz, Anna Malpaga, and Giovanni Marchegiani

Subjects
medicine.medical_specialty, Hepatology, Time trends, business.industry, General surgery, Gastroenterology, Outcome analysis, Neuroendocrine tumors, medicine.disease, Surgery, not available, medicine, Single institution, business
Published
2017
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47. Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors

Author

Paiella, Salvatore, primary, Impellizzeri, Harmony, additional, Zanolin, Elisabetta, additional, Marchegiani, Giovanni, additional, Miotto, Marco, additional, Malpaga, Anna, additional, De Robertis, Riccardo, additional, D'Onofrio, Mirko, additional, Rusev, Borislav, additional, Capelli, Paola, additional, Cingarlini, Sara, additional, Butturini, Giovanni, additional, Davì, Maria Vittoria, additional, Amodio, Antonio, additional, Bassi, Claudio, additional, Scarpa, Aldo, additional, Salvia, Roberto, additional, and Landoni, Luca, additional

Published
2017
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50. Is Routine Imaging Necessary After Pancreatic Resection? An appraisal of postoperative ultrasonography for the detection of pancreatic fistula

Author

Enrico Martone, Mirko D'Onofrio, Giuseppe Malleo, Roberto Salvia, Giovanni Marchegiani, Giovanni Butturini, Anna Malpaga, Claudio Bassi, and Enrico Molinari

Subjects
Adult, Male, pancreatic fistula, pancreaticoduodenectomy, distal pancreatectomy, ultrasonography, medicine.medical_specialty, Time Factors, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Early detection, Sensitivity and Specificity, Pancreatectomy, Postoperative Complications, Endocrinology, Predictive Value of Tests, Internal Medicine, medicine, Humans, Postoperative Period, Prospective Studies, Pancreatic resection, Prospective cohort study, Pancreas, Aged, Hepatology, business.industry, Incidence (epidemiology), Reproducibility of Results, Middle Aged, Pancreaticoduodenectomy, medicine.disease, Partial Pancreatectomy, Pancreatic fistula, Amylases, Drainage, Female, Radiology, Ultrasonography, business
Abstract

OBJECTIVES This study aimed to assess whether routine transabdominal ultrasonography (US) is clinically helpful for the early detection of postoperative pancreatic fistula (PF). METHODS In a prospective cohort of patients undergoing partial pancreatectomy, US was performed on postoperative day (POD) 3. Potential predictors of PF, including amylase value in drains (AVD) on POD 1, were investigated. A tree-based classification model of the independent predictors of PF was also performed. RESULTS One hundred seventy-three patients were analyzed. A peripancreatic collection on US and an AVD 5000 U/L or greater on POD 1 were predictors of PF. In the tree-based classification model, patients were stratified by AVD on POD 1. For values less than 5000 U/L (incidence of PF, 11.3%), US had a sensitivity of 23.1% and a specificity of 97.5%. For AVD 5000 U/L or greater (incidence of PF, 70.7%), sensitivity was 46.3% and specificity was 100%. CONCLUSIONS Despite the presence of a peripancreatic collection as a predictor of PF, US-as a diagnostic test-resulted to be highly specific but poorly sensitive even in the tree-based classification model. Therefore, its role does not seem to be clinically relevant and does not add value to AVD on POD 1, which remains the most powerful and relevant early predictor of PF.

Published
2014

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