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2. Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

Author

Sirignano, P, Piffaretti, G, Ceruti, S, Orso, M, Picozzi, M, Ricci, G, Sirignano, A, Taurino, M, Giancarlo Accarino, M, Accrocca, F, Alba, G, Alberti, A, Alberti, V, Allevi, S, Aloisi, F, Amato, B, Amico, A, Andreoli, F, Angiletta, D, Antico, A, Antico, L, Antonello, M, Baccellieri, D, Badalamenti, G, Bafile, G, Baldi, C, Barillà, C, Barillà, D, Bartoli, S, Basile, G, Battaglia, G, Battocchio, C, Belloni, A, Bellosta, R, Benevento, D, Bernardini, G, Bertagna, G, Bertoglio, L, Bianchini Massoni, C, Bisacco, D, Bischetti, M, Boccalon, L, Bonanno, P, Bonardelli, S, Borioni, R, P Borrelli, M, Bozzani, A, M Bracale, U, Camparini, S, Canciglia, A, Canova, F, Capoccia, L, Cappelli, A, Cappiello, P, Carluccio, C, Casalino, A, Casella, F, Casilli, G, Castagno, C, Castelli, P, Castrucci, T, Cavallo, M, Cavazzini, C, Ceccanei, G, Cefalì, P, Celoria, G, Cevolani, M, Chiappa, R, Chisci, E, Comande, C, Compagna, R, Cumino, A, Cuozzo, S, Dalla Caneva, P, D'Alessio, I, D'Arrigo, G, DE Caridi, G, DE Donato, G, DE Donno, G, Desantis, C, DE Santis, F, DE Troia, A, Dezi, T, A Diaco, D, DI Domenico, R, DI Filippo, M, DI Girolamo, A, P Dionisi, C, Dinoto, E, DI Stefano, F, DI STEFANO, L, D'Oria, M, Esposito, A, Esposito, D, Ettore, L, F Fadda, G, Faggioli, G, T Fargion, A, Fazzini, S, Fermani, N, Ferrante, G, Ferrari, M, Ferraro, S, Ferrer, C, Ferretto, L, Ficarelli, I, Filippi, F, Fino, G, Forliti, E, Formiconi, M, Flora, L, Fresilli, M, Frigatti, P, Frigerio, D, Froio, A, Freyrie, A, Furgiuele, S, Gabrielli, R, Gaggiano, A, Galassi, L, Gallelli, G, Gallitto, E, Gallo, F, Galzerano, G, Gargiulo, M, Garriboli, L, G Genadiev, G, Gentile, L, Giaquinta, A, Gibello, L, Grande, R, Grassi, V, Ippoliti, A, Irsara, S, Kahlberg, A, Konstantinos, N, LA Corte, F, Lanza, G, Lauricella, A, Lazzeri, E, Lenti, M, Leopardi, M, Lepidi, S, Li Destri, A, Locatelli, F, Lomazzi, C, Lombardi, F, Lorido, A, Maggiore, C, Mansour, W, Marcucci, V, Mascia, D, Massara, M, Mastrangelo, G, Margheritini, C, Maritati, G, Martelli, E, Martinelli, O, Marzano, A, Mauri, F, Mazzacaro, D, Melloni, A, Mezzetti, R, Michelagnoli, S, Migliara, B, Migliari, M, Millarelli, M, Misuraca, M, Modugno, P, Moniaci, D, Montelione, N, Monti, A, Monzio-Compagnoni, N, Moro, M, Mortola, L, Mozzetta, G, Musilli, A, Nano, G, Occhiuto, M, M Oddi, F, Orellana, B, Orlando, P, Orrico, M, A Pacilè, M, Pagliariccio, G, Pallini, C, Palmieri, A, Palughi, M, Panagrasso, M, Panzano, C, Panzera, C, Pascucci, F, Pasqua, R, Pasquetti, L, Pasqui, E, Pecchio, A, Pecoraro, F, Peluttiero, I, F Pennetta, F, Perini, P, Piazza, M, Pini, R, Pipito, N, Pranteda, C, Praquin, B, Pratesi, C, F Porreca, C, Pulli, R, Reina, N, F Rinaldi, L, Rizzo, L, Romano, E, Ronchey, S, Ruggiero, F, Ruggiero, M, Sallustro, M, Saviane, G, Sbarigia, E, Scovazzi, P, M Segramor, V, Sena, G, Setacci, C, Setacci, F, E Setteducati, C, M Settembrini, A, Siani, A, Sica, S, Speziale, F, Squizzato, F, Stella, N, Stilo, F, Sufali, G, Tanda, E, Tinelli, G, Tomei, F, Tosti, F, Trimarchi, S, Troisi, N, Tshomba, Y, Turchino, D, Turriziani, V, Ucci, A, Veneto, V, Veraldi, G, Wiesel, P, Xodo, A, Zacà, S, Zaraca, F, Zenunaj, G, SIRIGNANO, Pasqualino, PIFFARETTI, Gabriele, CERUTI, Silvia, ORSO, Massimiliano, PICOZZI, Mario, RICCI, Giovanna, SIRIGNANO, Ascanio, TAURINO, Maurizio, Giancarlo Accarino, Maurizio, Accrocca, Federico, Alba, Giuseppe, Alberti, Antonino, Alberti, Vittorio, Allevi, Sara, Aloisi, Francesco, Amato, Bruno, Amico, Alessio, Andreoli, Francesco, Angiletta, Domenico, Antico, Antonio, Antico, Lorenzo, Antonello, Michele, Baccellieri, Domenico, Badalamenti, Giovanni, Bafile, Gennaro, Baldi, Claudio, Barillà, Chiara, Barillà, David, Bartoli, Stefano, Basile, Giusi, Battaglia, Giuseppe, Battocchio, Cesare, Belloni, Ailin, Bellosta, Raffello, Benevento, Domenico, Bernardini, Giulia, Bertagna, Giulia, Bertoglio, Luca, Bianchini Massoni, Claudio, Bisacco, Daniel, Bischetti, Michelangelo, Boccalon, Luca, Bonanno, Paolo, Bonardelli, Stefano, Borioni, Raul, P Borrelli, Maria, Bozzani, Antonio, M Bracale, Umberto, Camparini, Stefano, Canciglia, Aldo, Canova, Francesco, Capoccia, Laura, Cappelli, Alessandro, Cappiello, Pierlugi, Carluccio, Chiara, Casalino, Alfonso, Casella, Francesco, Casilli, Giulia, Castagno, Claudio, Castelli, Patrizio, Castrucci, Tommaso, Cavallo, Matteo, Cavazzini, Carlo, Ceccanei, Gianluca, Cefalì, Pietro, Celoria, Gianni, Cevolani, Mauro, Chiappa, Roberto, Chisci, Emiliano, Comande, Carlo, Compagna, Rita, Cumino, Andrea, Cuozzo, Simone, Dalla Caneva, Patrizia, D'Alessio, Ilaria, D'Arrigo, Giuseppe, DE Caridi, Giovanni, DE Donato, Gianmarco, DE Donno, Gabriele, Desantis, Claudio, DE Santis, Francesco, DE Troia, Alessandro, Dezi, Tommaso, A Diaco, Domenico, DI Domenico, Rossella, DI Filippo, Michele, DI Girolamo, Alessia, P Dionisi, Carlo, Dinoto, Ettore, DI Stefano, Francesco, DI STEFANO, Lucia, D'Oria, Mario, Esposito, Andrea, Esposito, Davide, Ettore, Ludovica, F Fadda, Gian, Faggioli, Gianluca, T Fargion, Aaron, Fazzini, Stefano, Fermani, Nicoletta, Ferrante, Giulia, Ferrari, Mauro, Ferraro, Stafanio, Ferrer, Ciro, Ferretto, Luca, Ficarelli, Ilaria, Filippi, Federico, Fino, Gianluigi, Forliti, Enzo, Formiconi, Martina, Flora, Loris, Fresilli, Mauro, Frigatti, Paolo, Frigerio, Dalmazio, Froio, Alberto, Freyrie, Antonio, Furgiuele, Sergio, Gabrielli, Roberto, Gaggiano, Andrea, Galassi, Luca, Gallelli, Giuseppe, Gallitto, Enrico, Gallo, Francesco, Galzerano, Giuseppe, Gargiulo, Mauro, Garriboli, Luca, G Genadiev, Genadi, Gentile, Lucia, Giaquinta, Alessia, Gibello, Lorenzo, Grande, Raffaele, Grassi, Viviana, Ippoliti, Arnaldo, Irsara, Sandro, Kahlberg, Andrea, Konstantinos, Nikolakopoulos, LA Corte, Francesco, Lanza, Gaetano, Lauricella, Antonio, Lazzeri, Elisa, Lenti, Massimo, Leopardi, Marco, Lepidi, Sandro, Li Destri, Andrea, Locatelli, Federica, Lomazzi, Chiara, Lombardi, Francesco, Lorido, Antonio, Maggiore, Claudia, Mansour, Wassim, Marcucci, Vittorio, Mascia, Daniele, Massara, Mafalda, Mastrangelo, Giovanni, Margheritini, Costanza, Maritati, Gabriele, Martelli, Eugenio, Martinelli, Ombretta, Marzano, Antonio, Mauri, Francesca, Mazzacaro, Daniela, Melloni, Andrea, Mezzetti, Roberto, Michelagnoli, Stefano, Migliara, Bruno, Migliari, Mattia, Millarelli, Massimiliano, Misuraca, Maria, Modugno, Pietro, Moniaci, Diego, Montelione, Nunzio, Monti, Andrea, Monzio-Compagnoni, Nicola, Moro, Mario, Mortola, Lorenzo, Mozzetta, Gaddiel, Musilli, Aldo, Nano, Giovanni, Occhiuto, Mariateresa, M Oddi, Fabio, Orellana, Bernardo, Orlando, Paola, Orrico, Matteo, A Pacilè, Maria, Pagliariccio, Gabriele, Pallini, Cristina, Palmieri, Armando, Palughi, Martina, Panagrasso, Marco, Panzano, Claudia, Panzera, Chiara, Pascucci, Francesco, Pasqua, Rocco, Pasquetti, Leonardo, Pasqui, Eduardo, Pecchio, Alberto, Pecoraro, Felice, Peluttiero, Ilaria, F Pennetta, Federico, Perini, Paolo, Piazza, Michele, Pini, Rodolfo, Pipito, Narayana, Pranteda, Chiara, Praquin, Barbara, Pratesi, Carlo, F Porreca, Carlo, Pulli, Raffaele, Reina, Nicola, F Rinaldi, Luigi, Rizzo, Luigi, Romano, Elisa, Ronchey, Sonia, Ruggiero, Federica, Ruggiero, Massimo, Sallustro, Marianna, Saviane, Gianna, Sbarigia, Enrico, Scovazzi, Paolo, M Segramor, Vittorio, Sena, Giuseppe, Setacci, Carlo, Setacci, Francesco, E Setteducati, Carmen, M Settembrini, Alberto, Siani, Andrea, Sica, Simona, Speziale, Francesco, Squizzato, Francesco, Stella, Nazzareno, Stilo, Francesco, Sufali, Gemmi, Tanda, Elisabetta, Tinelli, Giovanni, Tomei, Francesca, Tosti, Filomena, Trimarchi, Santi, Troisi, Nicola, Tshomba, Yamume, Turchino, Davide, Turriziani, Valerio, Ucci, Alessandro, Veneto, Vincenzo, Veraldi, Gianfranco, Wiesel, Paola, Xodo, Andrea, Zacà, Sergio, Zaraca, Francesco, Zenunaj, Glaudiol, Sirignano, P, Piffaretti, G, Ceruti, S, Orso, M, Picozzi, M, Ricci, G, Sirignano, A, Taurino, M, Giancarlo Accarino, M, Accrocca, F, Alba, G, Alberti, A, Alberti, V, Allevi, S, Aloisi, F, Amato, B, Amico, A, Andreoli, F, Angiletta, D, Antico, A, Antico, L, Antonello, M, Baccellieri, D, Badalamenti, G, Bafile, G, Baldi, C, Barillà, C, Barillà, D, Bartoli, S, Basile, G, Battaglia, G, Battocchio, C, Belloni, A, Bellosta, R, Benevento, D, Bernardini, G, Bertagna, G, Bertoglio, L, Bianchini Massoni, C, Bisacco, D, Bischetti, M, Boccalon, L, Bonanno, P, Bonardelli, S, Borioni, R, P Borrelli, M, Bozzani, A, M Bracale, U, Camparini, S, Canciglia, A, Canova, F, Capoccia, L, Cappelli, A, Cappiello, P, Carluccio, C, Casalino, A, Casella, F, Casilli, G, Castagno, C, Castelli, P, Castrucci, T, Cavallo, M, Cavazzini, C, Ceccanei, G, Cefalì, P, Celoria, G, Cevolani, M, Chiappa, R, Chisci, E, Comande, C, Compagna, R, Cumino, A, Cuozzo, S, Dalla Caneva, P, D'Alessio, I, D'Arrigo, G, DE Caridi, G, DE Donato, G, DE Donno, G, Desantis, C, DE Santis, F, DE Troia, A, Dezi, T, A Diaco, D, DI Domenico, R, DI Filippo, M, DI Girolamo, A, P Dionisi, C, Dinoto, E, DI Stefano, F, DI STEFANO, L, D'Oria, M, Esposito, A, Esposito, D, Ettore, L, F Fadda, G, Faggioli, G, T Fargion, A, Fazzini, S, Fermani, N, Ferrante, G, Ferrari, M, Ferraro, S, Ferrer, C, Ferretto, L, Ficarelli, I, Filippi, F, Fino, G, Forliti, E, Formiconi, M, Flora, L, Fresilli, M, Frigatti, P, Frigerio, D, Froio, A, Freyrie, A, Furgiuele, S, Gabrielli, R, Gaggiano, A, Galassi, L, Gallelli, G, Gallitto, E, Gallo, F, Galzerano, G, Gargiulo, M, Garriboli, L, G Genadiev, G, Gentile, L, Giaquinta, A, Gibello, L, Grande, R, Grassi, V, Ippoliti, A, Irsara, S, Kahlberg, A, Konstantinos, N, LA Corte, F, Lanza, G, Lauricella, A, Lazzeri, E, Lenti, M, Leopardi, M, Lepidi, S, Li Destri, A, Locatelli, F, Lomazzi, C, Lombardi, F, Lorido, A, Maggiore, C, Mansour, W, Marcucci, V, Mascia, D, Massara, M, Mastrangelo, G, Margheritini, C, Maritati, G, Martelli, E, Martinelli, O, Marzano, A, Mauri, F, Mazzacaro, D, Melloni, A, Mezzetti, R, Michelagnoli, S, Migliara, B, Migliari, M, Millarelli, M, Misuraca, M, Modugno, P, Moniaci, D, Montelione, N, Monti, A, Monzio-Compagnoni, N, Moro, M, Mortola, L, Mozzetta, G, Musilli, A, Nano, G, Occhiuto, M, M Oddi, F, Orellana, B, Orlando, P, Orrico, M, A Pacilè, M, Pagliariccio, G, Pallini, C, Palmieri, A, Palughi, M, Panagrasso, M, Panzano, C, Panzera, C, Pascucci, F, Pasqua, R, Pasquetti, L, Pasqui, E, Pecchio, A, Pecoraro, F, Peluttiero, I, F Pennetta, F, Perini, P, Piazza, M, Pini, R, Pipito, N, Pranteda, C, Praquin, B, Pratesi, C, F Porreca, C, Pulli, R, Reina, N, F Rinaldi, L, Rizzo, L, Romano, E, Ronchey, S, Ruggiero, F, Ruggiero, M, Sallustro, M, Saviane, G, Sbarigia, E, Scovazzi, P, M Segramor, V, Sena, G, Setacci, C, Setacci, F, E Setteducati, C, M Settembrini, A, Siani, A, Sica, S, Speziale, F, Squizzato, F, Stella, N, Stilo, F, Sufali, G, Tanda, E, Tinelli, G, Tomei, F, Tosti, F, Trimarchi, S, Troisi, N, Tshomba, Y, Turchino, D, Turriziani, V, Ucci, A, Veneto, V, Veraldi, G, Wiesel, P, Xodo, A, Zacà, S, Zaraca, F, Zenunaj, G, SIRIGNANO, Pasqualino, PIFFARETTI, Gabriele, CERUTI, Silvia, ORSO, Massimiliano, PICOZZI, Mario, RICCI, Giovanna, SIRIGNANO, Ascanio, TAURINO, Maurizio, Giancarlo Accarino, Maurizio, Accrocca, Federico, Alba, Giuseppe, Alberti, Antonino, Alberti, Vittorio, Allevi, Sara, Aloisi, Francesco, Amato, Bruno, Amico, Alessio, Andreoli, Francesco, Angiletta, Domenico, Antico, Antonio, Antico, Lorenzo, Antonello, Michele, Baccellieri, Domenico, Badalamenti, Giovanni, Bafile, Gennaro, Baldi, Claudio, Barillà, Chiara, Barillà, David, Bartoli, Stefano, Basile, Giusi, Battaglia, Giuseppe, Battocchio, Cesare, Belloni, Ailin, Bellosta, Raffello, Benevento, Domenico, Bernardini, Giulia, Bertagna, Giulia, Bertoglio, Luca, Bianchini Massoni, Claudio, Bisacco, Daniel, Bischetti, Michelangelo, Boccalon, Luca, Bonanno, Paolo, Bonardelli, Stefano, Borioni, Raul, P Borrelli, Maria, Bozzani, Antonio, M Bracale, Umberto, Camparini, Stefano, Canciglia, Aldo, Canova, Francesco, Capoccia, Laura, Cappelli, Alessandro, Cappiello, Pierlugi, Carluccio, Chiara, Casalino, Alfonso, Casella, Francesco, Casilli, Giulia, Castagno, Claudio, Castelli, Patrizio, Castrucci, Tommaso, Cavallo, Matteo, Cavazzini, Carlo, Ceccanei, Gianluca, Cefalì, Pietro, Celoria, Gianni, Cevolani, Mauro, Chiappa, Roberto, Chisci, Emiliano, Comande, Carlo, Compagna, Rita, Cumino, Andrea, Cuozzo, Simone, Dalla Caneva, Patrizia, D'Alessio, Ilaria, D'Arrigo, Giuseppe, DE Caridi, Giovanni, DE Donato, Gianmarco, DE Donno, Gabriele, Desantis, Claudio, DE Santis, Francesco, DE Troia, Alessandro, Dezi, Tommaso, A Diaco, Domenico, DI Domenico, Rossella, DI Filippo, Michele, DI Girolamo, Alessia, P Dionisi, Carlo, Dinoto, Ettore, DI Stefano, Francesco, DI STEFANO, Lucia, D'Oria, Mario, Esposito, Andrea, Esposito, Davide, Ettore, Ludovica, F Fadda, Gian, Faggioli, Gianluca, T Fargion, Aaron, Fazzini, Stefano, Fermani, Nicoletta, Ferrante, Giulia, Ferrari, Mauro, Ferraro, Stafanio, Ferrer, Ciro, Ferretto, Luca, Ficarelli, Ilaria, Filippi, Federico, Fino, Gianluigi, Forliti, Enzo, Formiconi, Martina, Flora, Loris, Fresilli, Mauro, Frigatti, Paolo, Frigerio, Dalmazio, Froio, Alberto, Freyrie, Antonio, Furgiuele, Sergio, Gabrielli, Roberto, Gaggiano, Andrea, Galassi, Luca, Gallelli, Giuseppe, Gallitto, Enrico, Gallo, Francesco, Galzerano, Giuseppe, Gargiulo, Mauro, Garriboli, Luca, G Genadiev, Genadi, Gentile, Lucia, Giaquinta, Alessia, Gibello, Lorenzo, Grande, Raffaele, Grassi, Viviana, Ippoliti, Arnaldo, Irsara, Sandro, Kahlberg, Andrea, Konstantinos, Nikolakopoulos, LA Corte, Francesco, Lanza, Gaetano, Lauricella, Antonio, Lazzeri, Elisa, Lenti, Massimo, Leopardi, Marco, Lepidi, Sandro, Li Destri, Andrea, Locatelli, Federica, Lomazzi, Chiara, Lombardi, Francesco, Lorido, Antonio, Maggiore, Claudia, Mansour, Wassim, Marcucci, Vittorio, Mascia, Daniele, Massara, Mafalda, Mastrangelo, Giovanni, Margheritini, Costanza, Maritati, Gabriele, Martelli, Eugenio, Martinelli, Ombretta, Marzano, Antonio, Mauri, Francesca, Mazzacaro, Daniela, Melloni, Andrea, Mezzetti, Roberto, Michelagnoli, Stefano, Migliara, Bruno, Migliari, Mattia, Millarelli, Massimiliano, Misuraca, Maria, Modugno, Pietro, Moniaci, Diego, Montelione, Nunzio, Monti, Andrea, Monzio-Compagnoni, Nicola, Moro, Mario, Mortola, Lorenzo, Mozzetta, Gaddiel, Musilli, Aldo, Nano, Giovanni, Occhiuto, Mariateresa, M Oddi, Fabio, Orellana, Bernardo, Orlando, Paola, Orrico, Matteo, A Pacilè, Maria, Pagliariccio, Gabriele, Pallini, Cristina, Palmieri, Armando, Palughi, Martina, Panagrasso, Marco, Panzano, Claudia, Panzera, Chiara, Pascucci, Francesco, Pasqua, Rocco, Pasquetti, Leonardo, Pasqui, Eduardo, Pecchio, Alberto, Pecoraro, Felice, Peluttiero, Ilaria, F Pennetta, Federico, Perini, Paolo, Piazza, Michele, Pini, Rodolfo, Pipito, Narayana, Pranteda, Chiara, Praquin, Barbara, Pratesi, Carlo, F Porreca, Carlo, Pulli, Raffaele, Reina, Nicola, F Rinaldi, Luigi, Rizzo, Luigi, Romano, Elisa, Ronchey, Sonia, Ruggiero, Federica, Ruggiero, Massimo, Sallustro, Marianna, Saviane, Gianna, Sbarigia, Enrico, Scovazzi, Paolo, M Segramor, Vittorio, Sena, Giuseppe, Setacci, Carlo, Setacci, Francesco, E Setteducati, Carmen, M Settembrini, Alberto, Siani, Andrea, Sica, Simona, Speziale, Francesco, Squizzato, Francesco, Stella, Nazzareno, Stilo, Francesco, Sufali, Gemmi, Tanda, Elisabetta, Tinelli, Giovanni, Tomei, Francesca, Tosti, Filomena, Trimarchi, Santi, Troisi, Nicola, Tshomba, Yamume, Turchino, Davide, Turriziani, Valerio, Ucci, Alessandro, Veneto, Vincenzo, Veraldi, Gianfranco, Wiesel, Paola, Xodo, Andrea, Zacà, Sergio, Zaraca, Francesco, and Zenunaj, Glaudiol

Abstract

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Società Italiana di Chirurgia Vascolare ed Endovascolare - SI CVE). METHODS : A questionnaire consisting of 26 statements was developed, validated by an 18-member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when ≥70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two-hundred-forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first-round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline

Published
2024

3. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

Author

Siragusa, L, Angelico, R, Angrisani, M, Zampogna, B, Materazzo, M, Sorge, R, Giordano, L, Meniconi, R, Coppola, A, Marino, A, Giraudo, G, Esposito, S, Urbani, A, De Pastena, M, Mastrapasqua, R, Garancini, M, Frontal, A, Pascal, G, Martellucc, J, Falb, F, Boscarelli, A, Bertoglio, P, Trecca, E, Galassi, L, Vento, V, Chiappini, A, Antonelli, A, Bennardo, F, Familiari, F, Giannaccare, G, Zappia, A, Giuliani, G, Falcone, F, Sebastiani, S, Montuori, M, Rossi, S, Sagnotta, A, Giuliani, B, Imbriani, G, Restaino, S, Andreani, L, Di Maria, F, Lagana, A, Vitiello, L, Berton, F, Virgilio, E, Palisi, M, Portigliotti, L, Calussi, M, Conti, L, Mauriello, C, Barone, M, Saladino, E, Giaquinta, A, Zerb, D, Frazzetta, G, Merola, G, Chierici, A, Bini, R, Centonze, L, De Carlis, R, Ferrario, L, Giani, A, Lauterio, A, Tamini, N, Corti, S, Botteri, E, Andreuccetti, J, D'Alessio, R, Cestaro, G, Clarizia, G, Spolini, A, Carboni, A, Benzoni, E, Galiffa, G, Perotti, B, Veroux, M, Randazzo, V, Topa, D, Pranteda, C, Contini, G, Iacusso, C, Voglino, V, Vita, P, Carrano, F, Ambrosio, L, Cammarata, R, Capolupo, G, Caputo, D, Carannante, F, Cascone, C, Esperto, F, Farolfi, T, Frasca, L, Gallo, I, Gibin, G, Giurazza, G, Improta, L, La Vaccara, V, Luffarelli, P, Luvero, D, Marangi, G, Masciana, G, Mazzola, A, Mazzotta, E, Miligi, C, Montelione, N, Nenna, A, Orsaria, P, Papalia, R, Papalia, G, Parisi, F, Prata, F, Salzillo, R, Santini, S, Sofo, F, Zampoli, A, Tanda, C, Altieri, G, Ardito, F, Belia, F, Bianchi, V, Biondi, A, Brisinda, G, Chiappetta, M, Ciolli, G, Ciolli, A, Ferracci, F, Ferri, L, Fico, V, Fiorillo, C, Fransvea, P, Galiandro, F, Giovinazzo, F, La Greca, A, Litta, F, Mele, C, Pafundi, D, Panettieri, E, Papa, V, Patini, R, Perrotta, G, Puccioni, C, Santocchi, P, Armatura, G, Olmi, S, Casoni Pattacini, G, Salgarello, S, Trompetto, M, Bombardini, C, La Rocca, R, Celentano, G, Micalef, A, Mazzella, A, Settembrini, A, Zoia, C, Degrate, L, Musumeci, G, Palopoli, C, Montori, G, Bonati, E, Dinuzzi, V, Velluti, F, Balla, A, Bonasia, D, Coletta, D, Berardi, G, Colasanti, M, Ferretti, S, Gasparoli, C, Mariano, G, Avenia, S, Cianci, P, Cestino, L, Festa, F, Fazio, F, Ascari, F, Desio, M, Arroyo Murillo, G, Cereda, M, Galleano, R, David, G, Pansini, A, Gazia, C, Atzori, G, Desideri, L, Famularo, S, Galvanin, J, Giudici, V, Mangiameli, G, Mei, S, Milana, F, Pansa, A, Sacchi, M, Testori, A, Di Carlo, G, Paratore, M, Perrone, U, Vagge, A, Vigano, J, Torre, B, Scotti, M, Carbone, G, Cerchione, R, De Nardi, P, Gozzini, L, Ottaviani, L, Senni, C, Piccin, O, Pio, L, Colombo, F, Avantifiori, R, Baldassarri, V, Caronna, R, Cicerchia, P, Corallino, D, Crocetti, D, Gallo, G, Giovanardi, F, Giovannetti, F, Hassan, R, Iossa, A, Lai, Q, Lancellotti, F, Lucarini, A, Lucchese, S, Mazzarella, G, Melandro, F, Minervini, A, Muttillo, E, Palmieri, L, Pasqua, R, Rosiello, F, Salina, G, Sibio, S, Sirignano, P, Tarallo, M, Usai, S, Vanni, C, Viglietta, E, Zambon, M, Conversano, N, Epifani, A, Milano, V, Sacco, L, Nava, M, Maffioli, A, Giuratrabocchetta, S, Baracchi, F, Zuolo, M, Ceresoli, M, Verdi, D, Belli, A, Pata, F, Piovano, E, Pastore, G, Bernabei, F, Deiana, S, Arceri, A, D'Agostino, C, Marafante, C, Moggia, E, Parini, S, Moretti, M, Uggeri, F, Pontarolo, N, Fontana, T, Palmisano, G, Giuffrida, M, Guaitoli, E, Ferretti, C, Iacopino, G, Gioco, R, Roscitano, G, Montanelli, P, Pinotti, E, Monati, E, Fazio, G, Di Pietro, F, Damarco, F, Barberis, A, Razzore, A, Pascale, A, Loi, S, Ferrara, F, Rossi, M, Lisi, G, Viel, G, Sasia, D, Bono, D, Cordaro, E, Giacomelli, E, Giani, I, Seriau, L, Pellino, G, Sparavigna, M, Trigiante, G, D'Ambrogio, R, Cardella, F, Guzzetti, S, Luzzi, A, Carganico, G, Drago, B, Micheletto, G, Orlandi, R, Cutolo, C, Gibello, U, Mistrangelo, M, Forcignano, E, D'Ugo, S, Losurdo, P, Manitto, M, Caroli, G, Franco, M, Tilocca, P, Mendogni, P, Sena, G, Sambucci, D, Luciani, C, Atelli, P, Guida, A, Marino, F, Morini, A, Sibilla, M, Longo, F, Giaccari, S, Vigorita, V, Balduzzi, A, Barra, F, Delogu, D, Milone, E, Bencini, L, Aprile, V, Papini, P, Montemurro, N, Cavallo, M, Picciariello, A, Tomasicchio, G, Fittipaldi, A, Maruccia, M, Gerardi, S, Cillara, N, Deidda, S, Demarinis, G, Peiretti, E, Tatti, F, Iovino, C, Isola, G, Progno, V, Migliore, M, Badessi, G, Barilla, C, Calleri, G, Cianci, S, Fama, F, Fleres, F, Mazzeo, C, Visaloco, M, Marchetto, C, Bolognesi, F, Benuzzi, L, Bracchetti, G, Brucchi, F, Manzo, C, Scaravilli, L, Ferrari, C, Rocca, A, Napolitano, P, Anoldo, P, Caricato, C, Manigrasso, M, Milone, M, Napolitano, L, Palomba, G, Schiavone, V, Vetrella, M, Grossi, U, Moletta, L, Annicchiarico, A, Vella, I, Talesa, G, Boggi, U, Aiello, F, Anselmo, A, Bacchiocchi, G, Beati, F, Bellato, V, Billeci, F, Blasi, F, Buonomo, O, Campanelli, M, Coco, G, Contadini, A, Conte, L, D'Ippolito, G, Di Marcantonio, A, Spicchiale, C, Afflitto, G, Gismondi, A, Gorgolini, G, Granai, A, Grande, S, Gravina, A, Ingallinella, S, Keci, L, Latini, E, Marino, D, Oddi, F, Orecchia, L, Don, C, Pellicciaro, M, Petagna, L, Pirozzi, B, Quaranta, C, Rho, M, Rosina, A, Santicchia, M, Saraceno, F, Schiavone, A, Sensi, B, Spina, A, Sullo, L, Tacconi, F, Taje, R, Vanni, G, Vinci, D, Vita, G, Alba, G, Badalucco, S, Carbone, L, Samorani, O, Chisci, G, Cuomo, R, Francia, A, Fusario, D, Gargiulo, B, Pasqui, E, Pasquetti, L, Puoti, P, Resca, L, Cumbo, J, Ganio, S, Vizzielli, G, Anastasi, M, Guerra, D, Romanzi, A, Vannelli, A, Baia, M, Siragusa L., Angelico R., Angrisani M., Zampogna B., Materazzo M., Sorge R., Giordano L., Meniconi R., Coppola A., Marino A., Giraudo G., Esposito S., Urbani A., De Pastena M., Mastrapasqua R., Garancini M., Frontal A., Pascal G., Martellucc J., Falb F., Boscarelli A., Bertoglio P., Trecca E., Galassi L., Vento V., Chiappini A., Antonelli A., Bennardo F., Familiari F., Giannaccare G., Zappia A. S., Giuliani G., Falcone F., Sebastiani S., Montuori M., Rossi S., Sagnotta A., Giuliani B., Imbriani G. C., Restaino S., Andreani L., Di Maria F., Lagana A. S., Vitiello L., Berton F., Virgilio E., Palisi M., Portigliotti L., Calussi M., Conti L., Mauriello C., Barone M., Saladino E., Giaquinta A., Zerb D., Frazzetta G., Merola G., Chierici A., Bini R., Centonze L., De Carlis R., Ferrario L., Giani A., Lauterio A., Tamini N., Corti S., Botteri E., Andreuccetti J., D'Alessio R., Cestaro G., Clarizia G., Spolini A., Carboni A. S., Benzoni E., Galiffa G., Perotti B., Veroux M., Randazzo V., Topa D., Pranteda C., Contini G., Iacusso C., Voglino V., Vita P., Carrano F. M., Ambrosio L., Cammarata R., Capolupo G. T., Caputo D., Carannante F., Cascone C., Esperto F., Farolfi T., Frasca L., Gallo I. F., Gibin G., Giurazza G., Improta L., La Vaccara V., Luffarelli P., Luvero D., Marangi G., Masciana G., Mazzola A., Mazzotta E., Miligi C. I., Montelione N., Nenna A., Orsaria P., Papalia R., Papalia G. F., Parisi F. R., Prata F., Salzillo R., Santini S., Sofo F., Zampoli A., Tanda C., Altieri G., Ardito F., Belia F., Bianchi V., Biondi A., Brisinda G., Chiappetta M., Ciolli G., Ciolli A., Ferracci F., Ferri L., Fico V., Fiorillo C., Fransvea P., Galiandro F., Giovinazzo F., La Greca A., Litta F., Mele C., Pafundi D. P., Panettieri E., Papa V., Patini R., Perrotta G., Puccioni C., Santocchi P., Armatura G., Olmi S., Casoni Pattacini G., Salgarello S., Trompetto M., Bombardini C., La Rocca R., Celentano G., Micalef A., Mazzella A., Settembrini A., Zoia C., Degrate L., Musumeci G., Palopoli C. A. M., Montori G., Bonati E., Dinuzzi V. P., Velluti F., Balla A., Bonasia D. E., Coletta D., Berardi G., Colasanti M., Ferretti S., Gasparoli C., Mariano G., Avenia S., Cianci P., Cestino L., Festa F., Fazio F., Ascari F., Desio M., Arroyo Murillo G. A., Cereda M., Galleano R., David G., Pansini A., Gazia C., Atzori G., Desideri L. F., Famularo S., Galvanin J., Giudici V. M., Mangiameli G., Mei S., Milana F., Pansa A., Sacchi M., Testori A., Di Carlo G., Paratore M., Perrone U., Vagge A., Vigano J., Torre B., Scotti M. A., Carbone G., Cerchione R., De Nardi P., Gozzini L., Ottaviani L., Senni C., Piccin O., Pio L., Colombo F., Avantifiori R., Baldassarri V., Caronna R., Cicerchia P. M., Corallino D., Crocetti D., Gallo G., Giovanardi F., Giovannetti F., Hassan R., Iossa A., Lai Q., Lancellotti F., Lucarini A., Lucchese S., Mazzarella G., Melandro F., Minervini A., Muttillo E. M., Palmieri L., Pasqua R., Rosiello F., Salina G., Sibio S., Sirignano P., Tarallo M., Usai S., Vanni C., Viglietta E., Zambon M., Conversano N. I., Epifani A. G., Milano V., Sacco L., Nava M., Maffioli A., Giuratrabocchetta S., Baracchi F., Zuolo M., Ceresoli M., Verdi D., Belli A., Pata F., Piovano E., Pastore G., Bernabei F., Deiana S., Arceri A., D'Agostino C., Marafante C., Moggia E., Parini S., Moretti M., Uggeri F., Pontarolo N., Fontana T., Palmisano G., Giuffrida M., Guaitoli E., Ferretti C., Iacopino G., Gioco R., Roscitano G., Montanelli P., Chiappetta M. F., Pinotti E., Monati E., Fazio G., Di Pietro F., Damarco F., Barberis A., Razzore A., Pascale A., Loi S., Ferrara F., Rossi M., Lisi G., Viel G., Sasia D., Bono D., Cordaro E. R., Giacomelli E., Giani I., Seriau L., Pellino G., Sparavigna M., Trigiante G., D'Ambrogio R. G., Cardella F., Guzzetti S., Luzzi A. -P., Carganico G., Drago B., Micheletto G., Orlandi R., Cutolo C., Gibello U., Mistrangelo M., Forcignano E., D'Ugo S., Losurdo P., Manitto M., Caroli G., Franco M., Tilocca P. L., Mendogni P., Sena G., Sambucci D., Luciani C., Atelli P., Guida A., Marino F., Morini A., Sibilla M. G., Longo F., Giaccari S., Vigorita V., Balduzzi A., Barra F., Delogu D., Milone E., Bencini L., Aprile V., Papini P., Montemurro N., Cavallo M., Picciariello A., Tomasicchio G., Fittipaldi A., Maruccia M., Gerardi S., Cillara N., Deidda S., Demarinis G., Peiretti E., Tatti F., Iovino C., Isola G., Progno V. C., Migliore M., Badessi G., Barilla C., Calleri G. S., Cianci S., Fama F., Fleres F., Mazzeo C., Visaloco M. G., Marchetto C., Bolognesi F., Benuzzi L., Bracchetti G., Brucchi F., Manzo C. A., Scaravilli L., Ferrari C., Rocca A., Napolitano P., Anoldo P., Caricato C., Manigrasso M., Milone M., Napolitano L., Palomba G., Schiavone V., Vetrella M., Grossi U., Moletta L., Annicchiarico A., Vella I., Talesa G., Boggi U., Aiello F., Anselmo A., Bacchiocchi G., Beati F., Bellato V., Billeci F., Blasi F., Buonomo O. C., Campanelli M., Coco G., Contadini A., Conte L. E., D'Ippolito G., Di Marcantonio A., Spicchiale C. F., Afflitto G. G., Gismondi A., Gorgolini G., Granai A. V., Grande S., Gravina A., Guida A. M., Ingallinella S., Keci L., Latini E., Marino D., Oddi F. M., Orecchia L., Don C. B. P., Pellicciaro M., Petagna L., Pirozzi B. M., Quaranta C., Rho M., Rosina A., Santicchia M. S., Saraceno F., Schiavone A., Sensi B., Spina A., Sullo L., Tacconi F., Taje R., Vanni G., Vinci D., Vita G., Alba G., Badalucco S., Carbone L., Samorani O. C., Chisci G., Cuomo R., Francia A., Fusario D., Gargiulo B., Pasqui E., Pasquetti L., Puoti P., Resca L., Cumbo J., Ganio S., Vizzielli G., Anastasi M., Guerra D., Romanzi A., Vannelli A., Baia M., Siragusa, L, Angelico, R, Angrisani, M, Zampogna, B, Materazzo, M, Sorge, R, Giordano, L, Meniconi, R, Coppola, A, Marino, A, Giraudo, G, Esposito, S, Urbani, A, De Pastena, M, Mastrapasqua, R, Garancini, M, Frontal, A, Pascal, G, Martellucc, J, Falb, F, Boscarelli, A, Bertoglio, P, Trecca, E, Galassi, L, Vento, V, Chiappini, A, Antonelli, A, Bennardo, F, Familiari, F, Giannaccare, G, Zappia, A, Giuliani, G, Falcone, F, Sebastiani, S, Montuori, M, Rossi, S, Sagnotta, A, Giuliani, B, Imbriani, G, Restaino, S, Andreani, L, Di Maria, F, Lagana, A, Vitiello, L, Berton, F, Virgilio, E, Palisi, M, Portigliotti, L, Calussi, M, Conti, L, Mauriello, C, Barone, M, Saladino, E, Giaquinta, A, Zerb, D, Frazzetta, G, Merola, G, Chierici, A, Bini, R, Centonze, L, De Carlis, R, Ferrario, L, Giani, A, Lauterio, A, Tamini, N, Corti, S, Botteri, E, Andreuccetti, J, D'Alessio, R, Cestaro, G, Clarizia, G, Spolini, A, Carboni, A, Benzoni, E, Galiffa, G, Perotti, B, Veroux, M, Randazzo, V, Topa, D, Pranteda, C, Contini, G, Iacusso, C, Voglino, V, Vita, P, Carrano, F, Ambrosio, L, Cammarata, R, Capolupo, G, Caputo, D, Carannante, F, Cascone, C, Esperto, F, Farolfi, T, Frasca, L, Gallo, I, Gibin, G, Giurazza, G, Improta, L, La Vaccara, V, Luffarelli, P, Luvero, D, Marangi, G, Masciana, G, Mazzola, A, Mazzotta, E, Miligi, C, Montelione, N, Nenna, A, Orsaria, P, Papalia, R, Papalia, G, Parisi, F, Prata, F, Salzillo, R, Santini, S, Sofo, F, Zampoli, A, Tanda, C, Altieri, G, Ardito, F, Belia, F, Bianchi, V, Biondi, A, Brisinda, G, Chiappetta, M, Ciolli, G, Ciolli, A, Ferracci, F, Ferri, L, Fico, V, Fiorillo, C, Fransvea, P, Galiandro, F, Giovinazzo, F, La Greca, A, Litta, F, Mele, C, Pafundi, D, Panettieri, E, Papa, V, Patini, R, Perrotta, G, Puccioni, C, Santocchi, P, Armatura, G, Olmi, S, Casoni Pattacini, G, Salgarello, S, Trompetto, M, Bombardini, C, La Rocca, R, Celentano, G, Micalef, A, Mazzella, A, Settembrini, A, Zoia, C, Degrate, L, Musumeci, G, Palopoli, C, Montori, G, Bonati, E, Dinuzzi, V, Velluti, F, Balla, A, Bonasia, D, Coletta, D, Berardi, G, Colasanti, M, Ferretti, S, Gasparoli, C, Mariano, G, Avenia, S, Cianci, P, Cestino, L, Festa, F, Fazio, F, Ascari, F, Desio, M, Arroyo Murillo, G, Cereda, M, Galleano, R, David, G, Pansini, A, Gazia, C, Atzori, G, Desideri, L, Famularo, S, Galvanin, J, Giudici, V, Mangiameli, G, Mei, S, Milana, F, Pansa, A, Sacchi, M, Testori, A, Di Carlo, G, Paratore, M, Perrone, U, Vagge, A, Vigano, J, Torre, B, Scotti, M, Carbone, G, Cerchione, R, De Nardi, P, Gozzini, L, Ottaviani, L, Senni, C, Piccin, O, Pio, L, Colombo, F, Avantifiori, R, Baldassarri, V, Caronna, R, Cicerchia, P, Corallino, D, Crocetti, D, Gallo, G, Giovanardi, F, Giovannetti, F, Hassan, R, Iossa, A, Lai, Q, Lancellotti, F, Lucarini, A, Lucchese, S, Mazzarella, G, Melandro, F, Minervini, A, Muttillo, E, Palmieri, L, Pasqua, R, Rosiello, F, Salina, G, Sibio, S, Sirignano, P, Tarallo, M, Usai, S, Vanni, C, Viglietta, E, Zambon, M, Conversano, N, Epifani, A, Milano, V, Sacco, L, Nava, M, Maffioli, A, Giuratrabocchetta, S, Baracchi, F, Zuolo, M, Ceresoli, M, Verdi, D, Belli, A, Pata, F, Piovano, E, Pastore, G, Bernabei, F, Deiana, S, Arceri, A, D'Agostino, C, Marafante, C, Moggia, E, Parini, S, Moretti, M, Uggeri, F, Pontarolo, N, Fontana, T, Palmisano, G, Giuffrida, M, Guaitoli, E, Ferretti, C, Iacopino, G, Gioco, R, Roscitano, G, Montanelli, P, Pinotti, E, Monati, E, Fazio, G, Di Pietro, F, Damarco, F, Barberis, A, Razzore, A, Pascale, A, Loi, S, Ferrara, F, Rossi, M, Lisi, G, Viel, G, Sasia, D, Bono, D, Cordaro, E, Giacomelli, E, Giani, I, Seriau, L, Pellino, G, Sparavigna, M, Trigiante, G, D'Ambrogio, R, Cardella, F, Guzzetti, S, Luzzi, A, Carganico, G, Drago, B, Micheletto, G, Orlandi, R, Cutolo, C, Gibello, U, Mistrangelo, M, Forcignano, E, D'Ugo, S, Losurdo, P, Manitto, M, Caroli, G, Franco, M, Tilocca, P, Mendogni, P, Sena, G, Sambucci, D, Luciani, C, Atelli, P, Guida, A, Marino, F, Morini, A, Sibilla, M, Longo, F, Giaccari, S, Vigorita, V, Balduzzi, A, Barra, F, Delogu, D, Milone, E, Bencini, L, Aprile, V, Papini, P, Montemurro, N, Cavallo, M, Picciariello, A, Tomasicchio, G, Fittipaldi, A, Maruccia, M, Gerardi, S, Cillara, N, Deidda, S, Demarinis, G, Peiretti, E, Tatti, F, Iovino, C, Isola, G, Progno, V, Migliore, M, Badessi, G, Barilla, C, Calleri, G, Cianci, S, Fama, F, Fleres, F, Mazzeo, C, Visaloco, M, Marchetto, C, Bolognesi, F, Benuzzi, L, Bracchetti, G, Brucchi, F, Manzo, C, Scaravilli, L, Ferrari, C, Rocca, A, Napolitano, P, Anoldo, P, Caricato, C, Manigrasso, M, Milone, M, Napolitano, L, Palomba, G, Schiavone, V, Vetrella, M, Grossi, U, Moletta, L, Annicchiarico, A, Vella, I, Talesa, G, Boggi, U, Aiello, F, Anselmo, A, Bacchiocchi, G, Beati, F, Bellato, V, Billeci, F, Blasi, F, Buonomo, O, Campanelli, M, Coco, G, Contadini, A, Conte, L, D'Ippolito, G, Di Marcantonio, A, Spicchiale, C, Afflitto, G, Gismondi, A, Gorgolini, G, Granai, A, Grande, S, Gravina, A, Ingallinella, S, Keci, L, Latini, E, Marino, D, Oddi, F, Orecchia, L, Don, C, Pellicciaro, M, Petagna, L, Pirozzi, B, Quaranta, C, Rho, M, Rosina, A, Santicchia, M, Saraceno, F, Schiavone, A, Sensi, B, Spina, A, Sullo, L, Tacconi, F, Taje, R, Vanni, G, Vinci, D, Vita, G, Alba, G, Badalucco, S, Carbone, L, Samorani, O, Chisci, G, Cuomo, R, Francia, A, Fusario, D, Gargiulo, B, Pasqui, E, Pasquetti, L, Puoti, P, Resca, L, Cumbo, J, Ganio, S, Vizzielli, G, Anastasi, M, Guerra, D, Romanzi, A, Vannelli, A, Baia, M, Siragusa L., Angelico R., Angrisani M., Zampogna B., Materazzo M., Sorge R., Giordano L., Meniconi R., Coppola A., Marino A., Giraudo G., Esposito S., Urbani A., De Pastena M., Mastrapasqua R., Garancini M., Frontal A., Pascal G., Martellucc J., Falb F., Boscarelli A., Bertoglio P., Trecca E., Galassi L., Vento V., Chiappini A., Antonelli A., Bennardo F., Familiari F., Giannaccare G., Zappia A. S., Giuliani G., Falcone F., Sebastiani S., Montuori M., Rossi S., Sagnotta A., Giuliani B., Imbriani G. C., Restaino S., Andreani L., Di Maria F., Lagana A. S., Vitiello L., Berton F., Virgilio E., Palisi M., Portigliotti L., Calussi M., Conti L., Mauriello C., Barone M., Saladino E., Giaquinta A., Zerb D., Frazzetta G., Merola G., Chierici A., Bini R., Centonze L., De Carlis R., Ferrario L., Giani A., Lauterio A., Tamini N., Corti S., Botteri E., Andreuccetti J., D'Alessio R., Cestaro G., Clarizia G., Spolini A., Carboni A. S., Benzoni E., Galiffa G., Perotti B., Veroux M., Randazzo V., Topa D., Pranteda C., Contini G., Iacusso C., Voglino V., Vita P., Carrano F. M., Ambrosio L., Cammarata R., Capolupo G. T., Caputo D., Carannante F., Cascone C., Esperto F., Farolfi T., Frasca L., Gallo I. F., Gibin G., Giurazza G., Improta L., La Vaccara V., Luffarelli P., Luvero D., Marangi G., Masciana G., Mazzola A., Mazzotta E., Miligi C. I., Montelione N., Nenna A., Orsaria P., Papalia R., Papalia G. F., Parisi F. R., Prata F., Salzillo R., Santini S., Sofo F., Zampoli A., Tanda C., Altieri G., Ardito F., Belia F., Bianchi V., Biondi A., Brisinda G., Chiappetta M., Ciolli G., Ciolli A., Ferracci F., Ferri L., Fico V., Fiorillo C., Fransvea P., Galiandro F., Giovinazzo F., La Greca A., Litta F., Mele C., Pafundi D. P., Panettieri E., Papa V., Patini R., Perrotta G., Puccioni C., Santocchi P., Armatura G., Olmi S., Casoni Pattacini G., Salgarello S., Trompetto M., Bombardini C., La Rocca R., Celentano G., Micalef A., Mazzella A., Settembrini A., Zoia C., Degrate L., Musumeci G., Palopoli C. A. M., Montori G., Bonati E., Dinuzzi V. P., Velluti F., Balla A., Bonasia D. E., Coletta D., Berardi G., Colasanti M., Ferretti S., Gasparoli C., Mariano G., Avenia S., Cianci P., Cestino L., Festa F., Fazio F., Ascari F., Desio M., Arroyo Murillo G. A., Cereda M., Galleano R., David G., Pansini A., Gazia C., Atzori G., Desideri L. F., Famularo S., Galvanin J., Giudici V. M., Mangiameli G., Mei S., Milana F., Pansa A., Sacchi M., Testori A., Di Carlo G., Paratore M., Perrone U., Vagge A., Vigano J., Torre B., Scotti M. A., Carbone G., Cerchione R., De Nardi P., Gozzini L., Ottaviani L., Senni C., Piccin O., Pio L., Colombo F., Avantifiori R., Baldassarri V., Caronna R., Cicerchia P. M., Corallino D., Crocetti D., Gallo G., Giovanardi F., Giovannetti F., Hassan R., Iossa A., Lai Q., Lancellotti F., Lucarini A., Lucchese S., Mazzarella G., Melandro F., Minervini A., Muttillo E. M., Palmieri L., Pasqua R., Rosiello F., Salina G., Sibio S., Sirignano P., Tarallo M., Usai S., Vanni C., Viglietta E., Zambon M., Conversano N. I., Epifani A. G., Milano V., Sacco L., Nava M., Maffioli A., Giuratrabocchetta S., Baracchi F., Zuolo M., Ceresoli M., Verdi D., Belli A., Pata F., Piovano E., Pastore G., Bernabei F., Deiana S., Arceri A., D'Agostino C., Marafante C., Moggia E., Parini S., Moretti M., Uggeri F., Pontarolo N., Fontana T., Palmisano G., Giuffrida M., Guaitoli E., Ferretti C., Iacopino G., Gioco R., Roscitano G., Montanelli P., Chiappetta M. F., Pinotti E., Monati E., Fazio G., Di Pietro F., Damarco F., Barberis A., Razzore A., Pascale A., Loi S., Ferrara F., Rossi M., Lisi G., Viel G., Sasia D., Bono D., Cordaro E. R., Giacomelli E., Giani I., Seriau L., Pellino G., Sparavigna M., Trigiante G., D'Ambrogio R. G., Cardella F., Guzzetti S., Luzzi A. -P., Carganico G., Drago B., Micheletto G., Orlandi R., Cutolo C., Gibello U., Mistrangelo M., Forcignano E., D'Ugo S., Losurdo P., Manitto M., Caroli G., Franco M., Tilocca P. L., Mendogni P., Sena G., Sambucci D., Luciani C., Atelli P., Guida A., Marino F., Morini A., Sibilla M. G., Longo F., Giaccari S., Vigorita V., Balduzzi A., Barra F., Delogu D., Milone E., Bencini L., Aprile V., Papini P., Montemurro N., Cavallo M., Picciariello A., Tomasicchio G., Fittipaldi A., Maruccia M., Gerardi S., Cillara N., Deidda S., Demarinis G., Peiretti E., Tatti F., Iovino C., Isola G., Progno V. C., Migliore M., Badessi G., Barilla C., Calleri G. S., Cianci S., Fama F., Fleres F., Mazzeo C., Visaloco M. G., Marchetto C., Bolognesi F., Benuzzi L., Bracchetti G., Brucchi F., Manzo C. A., Scaravilli L., Ferrari C., Rocca A., Napolitano P., Anoldo P., Caricato C., Manigrasso M., Milone M., Napolitano L., Palomba G., Schiavone V., Vetrella M., Grossi U., Moletta L., Annicchiarico A., Vella I., Talesa G., Boggi U., Aiello F., Anselmo A., Bacchiocchi G., Beati F., Bellato V., Billeci F., Blasi F., Buonomo O. C., Campanelli M., Coco G., Contadini A., Conte L. E., D'Ippolito G., Di Marcantonio A., Spicchiale C. F., Afflitto G. G., Gismondi A., Gorgolini G., Granai A. V., Grande S., Gravina A., Guida A. M., Ingallinella S., Keci L., Latini E., Marino D., Oddi F. M., Orecchia L., Don C. B. P., Pellicciaro M., Petagna L., Pirozzi B. M., Quaranta C., Rho M., Rosina A., Santicchia M. S., Saraceno F., Schiavone A., Sensi B., Spina A., Sullo L., Tacconi F., Taje R., Vanni G., Vinci D., Vita G., Alba G., Badalucco S., Carbone L., Samorani O. C., Chisci G., Cuomo R., Francia A., Fusario D., Gargiulo B., Pasqui E., Pasquetti L., Puoti P., Resca L., Cumbo J., Ganio S., Vizzielli G., Anastasi M., Guerra D., Romanzi A., Vannelli A., and Baia M.

Abstract

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March–April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients’ management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons’ personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon–patient/family communication. From the Italian surgeons’ perspective, COVID-related measures will continue to influence

Published
2023

4. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

Author

Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., Vizzielli G., Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., and Vizzielli G.

Abstract

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March–April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients’ management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons’ personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon–patient/family communication. From the Italian surgeons’ perspective, COVID-related measures will continue to influence

Published
2023

7. Laparoscopic modified double stapling technique with transanal resection for low anterior resection of rectal cancer

Author

Illuminati G, Dimitri Krizzuk, Pizzardi G, Perotti B, Pasqua R, and Urciuoli P

Subjects
Adult, Aged, 80 and over, Male, Rectal Neoplasms, Anal Canal, laparoscopic anterior resection, Middle Aged, Colorectal cancer, Treatment Outcome, Low colorectal anastomosis, Surgical Stapling, double stapling technique, Humans, Female, Laparoscopy, Colorectal cancer, laparoscopic anterior resection, Low colorectal anastomosis, double stapling technique, Digestive System Surgical Procedures, Aged, Retrospective Studies
Abstract

Anterior resection of the rectum with a total mesorectal excision is the standard surgical technique for the treatment of rectal cancer. Laparoscopic low anterior resection (LALAR) is an alternative to open surgical approach and was validated in diverse randomized control trials to be as safe and oncologically effective. That said, confronting a low rectal tumor in an obese patient with a narrow pelvis can be technically challenging even for the most expert surgeon.We propose a modified double stapling technique with transanal eversion and staple resection of the rectal stump.We applied the above technique in 3 patients with a dubious distal resection margin due to patient/tumor characteristics. The mean length of operation was 272 minutes and a R0 resection with a mean number of 16 nodes could be obtained in all the patients. No recurrence occurred during a follow-up of 28 months.We conclude that this technique is a feasible, safe and valid adjunct to the double staple technique whenever intraabdominal application of the linear staple is difficult or unsafe.Colorectal cancer, Laparoscopic anterior resection, Double, Low colorectal anastomosis, Stapling technique.La resezione anteriore del retto con l’escissione totale del mesoretto è la tecnica standard per il trattamento del cancro del retto. La resezione anteriore per via laparoscopica costituisce un’alternativa all’accesso laparotomico convenzionale e la sua validità oncologica è stata confermata da numerosi studi randomizzati. In pazienti obesi o dalla pelvi molto stretta l’applicazione dellatecnica del doppio “stapler” può essere tecnicamente difficoltosa. In queste circostanze tale tecnica può essere modificata con la resezione del tumore ela chiusura del moncone rettale previa eversione del moncone stesso. Questa modifica tecnica è stata applicate in 3 pazienti. La durata media dell’intervento è stata di 272 minuti ed una resezione R0 con un numero medio di 16 linfonodi è stata ottenuta in tutti i pazienti. Nessuna recidiva di malattia è stata riscontrata durante un follow-up medio di 28 mesi. In conclusione, questa modifica tecnica può essere considerata un valido apporto tecnico aggiuntivo in ogni condizione che renda difficoltosa l’applicazione della suturatrice lineare per via addominale.

Published
2019

18. Laparoscopic lavage/drainage as a bridge treatment for perforated diverticulitis with purulent peritonitis associated with an abdominal aortic aneurysm A retrospective case-control study

Author

Illuminati G, Dimitri Krizzuk, Fg, Calio, Urciuoli P, Pizzardi G, and Pasqua R

Subjects
Aged, 80 and over, Male, Suppuration, Peritonitis, Laparoscopic lavage drainage, Intestinal Perforation, Case-Control Studies, Abdominal aortic aneurysm, Drainage, Humans, Female, Laparoscopy, Therapeutic Irrigation, Diverticulitis, Aged, Aortic Aneurysm, Abdominal, Retrospective Studies
Abstract

Laparoscopic lavage /drainage (LALA) or surgical resection are both methods of treatment for perforated diverticulitis with purulent peritonitis (Hinchey Stage III). In case of associated abdominal aortic aneurysm (AAA), laparoscopic lavage/drainage could be an interesting bridge option to treat sepsis before endovascular exclusion of the aneurysm and resection of the sigmoid. We performed LALA as a bridge treatment of peritonitis before elective, staged endovascular exclusion of the aneurysm (EE) and elective resection of the colon.Seven patients presenting a perforated diverticulitis with purulent peritonitis (Hinchey III), associated with an uncomplicated AAA of a mean diameter of 6 cm, underwent LALA followed by staged EE and resection. They were retrospectively reviewed for a case-control study. The mean length of follow-up after completing all the procedures was 28 months. Primary endpoints were mortality and morbidity of each procedure, complications related to each procedure and to the untreated disease in the interval between each one of them, late outcome and complications related to each treatment method. As secondary endpoints, the mean length of surgery for resection, of stay in the hospital, of the interval between each procedure, and of time required for the treatment of both the diseases were considered.Postoperative mortality was absent. Morbidity consisted of a sigmoido-vescical fistula 18 days after resolution of peritonitis and sepsis, not hindering EE,and a delayed healing of the surgical wound for access to the common femoral artery (28.6%). No complications of untreated disease in the interval between each procedure were observed. No late complications of both diseases occurred. The mean interval between LALA and EE,and between EE and resection was, respectively, 19 days and 18 days. Both the diseases were treated within a mean delay of 37 days after LALA (range, 24-61 days).LALA, as a bridge treatment, before EE and resection, in patients presenting a perforated diverticulitis with purulent peritonitis, associated with an uncomplicated AAA, may be an effective treatment option.Perforated diverticulitis, Purulent peritonitis, Abdominal aortic aneurysm.Il lavaggio/drenaggio laparoscopico e la resezione chirurgica sono, entrambi, riconosciuti metodi di trattamento della diverticolite perforata del colon con una peritonite purulenta (Stadio III di Hinchey). Nel caso in cui questa sia associata ad un aneurisma dell’aorta addominale, il lavaggio/drenaggio laparoscopico potrebbe essere un interessante trattamento “ponte” dello stato settico, prima di procedere all’esclusione endovascolare dell’aneurisma e alla resezione del colon-sigma. Vengono qui riportati i risultati del lavaggio/ drenaggio, prima del trattamento in elezione dell’aneurisma mediante esclusione endovascolare, seguito dalla resezione del colon.Sette pazienti con una diverticolite perforata associata ad una peritonite purulenta (Hinchey III) e ad un aneurisma dell’aorta addominale non complicato, del diametro medio di 6 cm, sono stati trattati mediante lavaggio/drenaggio laparoscopico, seguito dal trattamento stadiato dell’aneurisma mediante esclusione endovascolare seguito, a sua volta, dalla resezione del colon. La durata media del follow-up, dopo il completamento di tutte le procedure chirurgiche, è stata di 28 mesi. I criteri di valutazione principali sono stati la mortalità e morbidità di ciascuna procedura, le complicanze correlate con ciascuna procedura e con la patologia non trattata nell’intervallo tra un trattamento e l’altro, i risultati a distanza e le complicanze tardive di ciascun trattamento. I criteri di valutazione secondari sono stati la durata dell’intervento di resezione del colon, la lunghezza della degenza ospedaliera, dell’intervallo tra ciascuna procedura e del tempo complessivo richiesto per il trattamento di entrambe le patologie.La mortalità post-operatoria è stata assente. La morbidità è consistita in una fistola sigmoido-vescicale 18 giorni dopo la risoluzione della peritonite e della sepsi, che non ha impedito l’esclusione endovascolare dell’aneurisma ed una ritardata cicatrizzazione di un accesso femorale per il trattamento endovascolare dell’aneurisma (28%). Nessuna complicanza relativa alla patologia non trattata è stata osservata nell’intervallo tra un trattamento e l’altro. Non si è verificata alcuna complicanza tardiva di ciascuna delle due patologie trattate. In media, l’intervallo tra il lavaggio/drenaggio e l’esclusione dell’aneurisma e tra quest’ultima e la resezione del colon è stato, rispettivamente di 19 e 18 giorni. Complessivamente, entrambe le patologie sono state trattate, mediamente, dopo 37 giorni dal lavaggio drenaggio (estremi 24-61 giorni).Il lavaggio/drenaggio laparoscopico potrebbe essere un efficace trattamento “ponte” della peritonite e dello stato settico, prima della esclusione endovascolare e della resezione, nei pazienti con una diverticolite perforata e peritonite purulenta associata ad un aneurisma non complicato dell’aorta addominale.

19. In vitro antimicrobial activity of essential oils from Mediterranean Apiaceae, Verbenaceae and Lamiaceae against foodborne pathogens and spoilage bacteria

Author

Di Pasqua, R., Feo, V., Francesco Villani, Mauriello, G., R., Di Pasqua, V., De Feo, Villani, Francesco, and Mauriello, Gianluigi

Subjects
foodborne pathogen, essential oil, natural antimicrobial, spoilage bacteria
Abstract

The aim of this work was to investigate the antimicrobial activity of twelve essential oils, against Gram-positive and Gram-negative bacteria, for a potential use in food industry. The antimicrobial activity of essential oils was determined by an agar diffusion method against foodborne pathogens and spoilage bacteria. Further, bacteriostatic and bactericidal concentrations were determined for each strain that evidenced sensitivity to the oils. All the oils showed bacteriostatic and bactericidal activity against E. coli O157:H7 and Salmonella Typhimurium, while B. thermosphacta was inhibited by eight of 12 tested oils. Finally, the pathogenic microorganism L. monocytogenes and lactic acid bacteria strains were affected only by thyme, oregano and vervain oils. The essential oils considered in this research showed a satisfactory antimicrobial activity. The essential oils could be used for the development of novel systems for food preservation.

21. Teatri ed anfiteatri dell’Africa proconsolare: l’architettura al servizio del potere. Immagine della città e romanizzazione

Author

Montali, Gilberto, Livadiotti, M, Belli Pasqua, R, Caliò, LM, Martines, G, and Gilberto Montali

Subjects
teatri, anfiteatri, architettura romana, Africa proconsolare, teatri, anfiteatri, architettura romana, Africa proconsolare
Abstract

A partire dall’età augustea si assiste ad una straordinaria proliferazione di teatri ed anfiteatri nei centri urbani dell’Africa proconsolare. Questi edifici, che comportavano un notevole impegno economico da parte delle comunità locali, rappresentavano un vero e proprio status symbol e connotavano in modo scenografico le città, diventando una sorta di cerniera architettonica ed al contempo ideologica tra la campagna e i centri abitati. Teatri e anfiteatri assurgono ad emblema stesso della romanizzazione di queste terre e la loro costruzione sottolinea spesso il passaggio delle città a municipium o a colonia. Contribuire alla edificazione di questi monumenti, alla loro decorazione o offrire spettacoli rappresenta per i notabili locali un’imperdibile occasione per mettersi in mostra, sottolineando al contempo l’adesione dell’intera comunità alla politica imperiale. Costituiscono inoltre il banco di prova di una grande varietà di soluzioni tecniche ed architettoniche: negli edifici di minori dimensioni si manifesta sovente un tenace attaccamento alla tradizione costruttiva locale mentre negli edifici più grandi è evidente il riferimento a modelli squisitamente romani ed urbani. Il contributo, partendo dai dati raccolti in recenti ricerche e da un nuovo censimento degli edifici della provincia, si prefigge di mostrare come il forte impatto visivo di questi complessi monumentali condizioni significativamente l’immagine delle antiche città dell’Africa proconsolare.

Published
2018

22. Expression of DnaK, HtpG, GroEL and Tf chaperones and the corresponding encoding genes during growth of Salmonella Thompson in presence of thymol alone or in combination with salt and cold stress

Author

Danilo Ercolini, Gianluigi Mauriello, Gianfranco Mamone, Rosangela Di Pasqua, Di Pasqua, R, Mauriello, Gianluigi, Mamone, G, and Ercolini, Danilo

Subjects
Salmonella, Sodium, chemistry.chemical_element, stress response, Biology, medicine.disease_cause, biology.organism_classification, GroEL, essential oil, chemistry.chemical_compound, chemistry, Biochemistry, Salmonella enterica, thymol, Chaperone (protein), Gene expression, biology.protein, medicine, chaperones, Thymol, Gene, Food Science
Abstract

The expression of four different proteins (DnaK, HtpG, GroEL and Trigger factor Tf) commonly involved in stress response, and the corresponding encoding genes, was studied in Salmonella enterica serovar Thompson. The growth of S. Thompson MCV1 was monitored in the presence of sublethal concentrations of thymol (0.1%) alone or in combination with salt stress (NaCl 0.7%) or cold stress (15 °C). Salmonella growth was also monitored in the presence of salt stress (NaCl 0.7%) and also in the presence of cold stress (15 °C) alone. During the different growth phases (lag, exponential and early stationary) the expression of dnaK , htpG , groEL and tig genes was studied by quantitative reverse transcription-PCR (qRT-PCR), while the regulation of the corresponding proteins was monitored by 2D-PAGE analysis. Thymol increased the expression of chaperone proteins in all cases except when salt stress was also present. The cold stress increased the levels of expression of the chaperones and this was further enhanced by the presence of thymol. Each stress alone induced a variation in the chaperone regulation and the combination of different stresses together did not always lead to a cumulative response. Our evidence suggests that the response to thymol, salt and cold involves the regulation of all the studied chaperones. This process starts in the lag phase but the chaperones keep working in the further growth phases in order to help Salmonella cells to face the adverse conditions. Our study suggests that adaptation to stress conditions related to food storage takes place through a global response where DnaK, HtpG, GroEL and TF are only part of the protein network that gives support to the adaptation.

Published
2013
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23. Il piano di Tirana

Author

RESTA, GIUSEPPE, Belli Pasqua R., Caliò L. M., Menghini A. B., and Resta, Giuseppe

Published
2016

24. I paesaggi dell'Albania

Author

RESTA, GIUSEPPE, Belli Pasqua R., Caliò L. M., Menghini A. B., and Resta, Giuseppe

Published
2016

25. Bonifiche e infrastrutture

Author

RESTA, GIUSEPPE, Belli Pasqua R., Caliò L. M., Menghini A. B., and Resta, Giuseppe

Published
2016

26. Restituzione virtuale del quartiere Alessandrino a Roma

Author

CALISI, DANIELE, CIANCI, MARIA GRAZIA, GEREMIA, FRANCESCA, Caliò L M, Liviadotti M, Martines G, Belli Pasqua R ( comitato organizzatore ), Calisi, Daniele, Cianci, MARIA GRAZIA, and Geremia, Francesca

Subjects
storia urbana, Roma, tessuto edilizio storico, restituzione virtuale, modellazione 3D
Abstract

Le mutate condizioni politiche, sociali e culturali, unitamente alle concrete rinnovate esigenze che seguirono l’istituzione di Roma a capitale d’Italia hanno condotto nel giro di pochi decenni alla trasformazione della sua consistenza urbana sino ad allora sviluppatasi gradualmente e lentamente attraverso i secoli. Il quartiere Alessandrino che, a partire dal medioevo, era sorto sulle rovine dei Fori Imperiali ed aveva assunto nel corso del tempo, anche in virtù della sua posizione geomorfologicamente centrale, il ruolo di sistema connettivo fra i rioni circostanti, fu sacrificato per la realizzazione della monumentale via dell’Impero. Pur essendo fuori questione l’importanza complessiva dell’operazione che ha riportato alla luce i resti archeologici, si pone tuttavia l’attenzione sul tessuto urbano demolito in quella occasione. L’obiettivo della ricerca che si intende presentare è di documentare un momento della storia urbana di Roma e ricomporre virtualmente una particolare immagine della città. Il lavoro è stato portato avanti mettendo a punto un metodo condiviso che ha consentito l’integrazione multidisciplinare, tale da mantenere scientificamente coerente et attendibile l’esito finale. L’iniziale ricerca e acquisizione delle fonti, ha costituito la base dello studio. Le fonti sono state poi organizzate in un database che verrà inserito in un web GIS condiviso on line. La seconda fase, analitica, ha portato al riconoscimento della consistenza architettonica ed urbana del tessuto edilizio oggetto di studio. La terza fase, di ricomposizione progettuale e visualizzazione virtuale attraverso la modellazione 3D delle preesistenze, rappresenta la sintesi del lavoro svolto. I risultati ottenuti attraverso questa metodologia di indagine consentono di visualizzare il tessuto urbano scomparso e testimoniarne il significato storico architettonico.

Published
2016

27. Decarboxylase gene expression and cadaverine and putrescine production by Serratia proteamaculans in vitro and in beef

Author

Francesca De Filippis, Alberto Fiore, Vincenzo Fogliano, Francesco Villani, Carmela Pennacchia, Danilo Ercolini, Rosangela Di Pasqua, DE FILIPPIS, Francesca, Pennacchia, C, Di Pasqua, R, Fiore, A, Fogliano, Vincenzo, Villani, Francesco, and Ercolini, Danilo

Subjects
Meat, Serratia, Carboxy-Lyases, Meat spoilage, biogenic amines, Ornithine Decarboxylase, Microbiology, Serratia proteamaculans, Ornithine decarboxylase, chemistry.chemical_compound, Decarboxylase genes, Tandem Mass Spectrometry, Cadaverine, Gene expression, Putrescine, Animals, Food microbiology, putrescine, Growth medium, biology, Temperature, Gene Expression Regulation, Bacterial, General Medicine, Biogenic amines production, biology.organism_classification, chemistry, Biochemistry, Food Microbiology, Cattle, Food Science
Abstract

Studies of the molecular basis of microbial metabolic activities that are important for the changes in food quality are valuable in order to help in understanding the behavior of spoiling bacteria in food. The growth of a psychrotrophic Serratia proteamaculans strain was monitored in vitro and in artificially inoculated raw beef. Two growth temperatures (25 °C and 4 °C) were tested in vitro , while growth at 15 °C and 4 °C was monitored in beef. During growth, the expression of inducible lysine and ornithine-decarboxylase genes was evaluated by quantitative reverse transcription-PCR (qRT-PCR), while the presence of cadaverine and putrescine was quantified by LC-ESI–MS/MS. The expression of the decarboxylase genes, and the consequent production of cadaverine and putrescine were shown to be influenced by the temperature, as well as by the complexity of the growth medium. Generally, the maximum gene expression and amine production took place during the exponential and early stationary phase, respectively. In addition, lower temperatures caused slower growth and gene downregulation. Higher amounts of cadaverine compared to putrescine were found during growth in beef with the highest concentrations corresponding to microbial loads of ca. 9 CFU/g. The differences found in gene expression evaluated in vitro and in beef suggested that such activities are more reliably investigated in situ in specific food matrices.

Published
2013

28. Collective responses of flocking sheep (Ovis aries) to a herding dog (border collie).

Author

Jadhav V, Pasqua R, Zanon C, Roy M, Tredan G, Bon R, Guttal V, and Theraulaz G

Subjects
Animals, Dogs, Sheep, Social Behavior, Behavior, Animal
Abstract

Group-living organisms commonly exhibit collective escape responses, yet how information flows among group members in these events remains an open question. Here, we study the collective responses of a sheep flock (Ovis aries) to a shepherd dog (border collie) in a driving task between two well-defined target points. We collected high-resolution spatiotemporal data from 14 sheep and the dog, using Ultra-Wide-Band tags attached to each individual. We find that the spatial positions of sheep along the front-back axis of the group's velocity strongly correlate with their impact on the collective movement. Our analyses reveal that, even though the dog chases the sheep flock from behind, directional information on shorter time scales propagates from the front of the group towards the rear; further, the dog adjusts its movement in response to the flock's dynamics. We introduce an agent-based model that captures key data features. Specifically, in response to chasing, the sheep change their spatial relative positions less frequently and exhibit a transfer of directional information flow from front to back; this pattern disappears in the absence of chasing. Our study reveals some general insights into how directional information propagates in escaping animal groups., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Published
2024
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29. Simultaneous Percutaneous Coronary Intervention (PCI) and Endovascular Aneurysm Repair (EVAR): A Preliminary Report.

Author

Nardi P, Rinaldi V, Costanzo ML, Pasqua R, Loiacono F, Palumbo P, Miraldi F, Tanzilli G, D'Andrea V, and Illuminati G

Abstract

Background : Performing percutaneous coronary intervention (PCI) and endovascular aneurysm repair (EVAR) at the same time represents a groundbreaking development in the multidisciplinary treatment of cardiovascular disease. This combined PCI-EVAR approach bridges a critical gap by offering treatment for patients who have both coronary artery disease and aortic aneurysms. This innovative strategy exemplifies the evolving landscape of cardiovascular care, providing a new solution for complex clinical situations that previously required separate procedures. Methods : Six patients with critical coronary artery lesions and asymptomatic infrarenal aortic aneurysms (AAAs) ≥ 6 cm diameter, as well as one patient with critical coronary artery lesions and endoleak type 1A with aneurysms ≥ 6 cm, underwent simultaneous coronary artery revascularization through percutaneous intervention (PCI) and endovascular aneurysm repair (EVAR). The occurrence of any intraoperative or postoperative complication was considered to be the primary endpoint of the study, including the abortion or failure of either PCI or EVAR, bleeding requiring a conversion to open surgical procedures, the failure of local anesthesia, postoperative myocardial or lower limb ischemia, and a postoperative serum creatinine level of >125 mmol/L or of >180 mmol/L in patients affected by chronic renal failure. The overall length of the procedure, X-ray exposure, the quantity of iodine contrast medium administered, and the length of recovery were considered to be secondary endpoints. Results : Postoperative complications included two episodes of acute renal failure in the two patients already affected by chronic renal failure, which were easily resolved with adequate daily hydration and the elimination of nephrotoxic drugs. In no cases did cardiac ischemia or lower limb ischemia occur. The average procedure duration was 198 min (range: 180-240 min), the average fluoroscopy duration was 41.7 min (range: 35-50 min), the average amount of iodinated contrast medium was 34.8 mL (range: 30-40 mL), and the mean length of hospitalization was 2.7 days (range: 2-5 days). Conclusions : In selected patients, this surgical approach has demonstrated safety, reduced hospitalization times, minimized risks associated with complications from the untreated condition if procedures were performed at different times, and facilitated the effective management of intraoperative complications due to the presence of a multidisciplinary team. However, the limited number of patients necessitates further research.

Published
2024
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30. Percutaneous Retrograde Trans-Gluteal Embolization of Type 2 Endoleak Causing Iliac Aneurysm Enlargement after Endovascular Repair: Case Report and Literature Review.

Author

Esposito A, Pasqua R, Menna D, Giordano AN, Illuminati G, and D'Andrea V

Abstract

Late type II endoleaks (T2ELs) arising from the internal iliac artery (IIA) may present during follow-up after endovascular aortic repair (EVAR) of aortoiliac aneurysm and may warrant embolization if enlargement of the aneurysmal sac is demonstrated. When coverage of the IIA ostium has been made due to extensive iliac disease, access options can be challenging. Different treatment options have been reported over recent years, and a careful selection of the best one must be made based on the characteristics of each case. The present study reports a simple and reproducible sheathless percutaneous superior gluteal artery (SGA) access and provides a discussion based on a review of the existing literature on this topic.

Published
2024
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31. Editor's Choice - Infra-inguinal Endovascular Revascularisation and Bypass Surgery for Chronic Limb Threatening Ischaemia: a Retrospective European Multicentre Cohort Study with Propensity Score Matching.

Author

Ricco JB, Roiger RJ, Schneider F, Guetarni F, Thaveau F, Illuminati G, Pasqua R, Chaufour X, Porterie J, and Hostalrich A

Abstract

Objective: The aim of this study was to compare the long term efficacy of lower limb bypass with that of endovascular treatment (EVT) in patients with chronic limb threatening ischaemia (CLTI)., Methods: This retrospective, multicentre study evaluated the outcomes of patients with CLTI who underwent first time infra-inguinal bypass or EVT. The primary outcome was to compare amputation free survival (AFS) rates between the two propensity score matched groups. The secondary outcome was to compare wound healing within the first six months. Major adverse events were compared according to the type of revascularisation., Results: Overall, 793 patients fulfilled the eligibility criteria, from whom 236 propensity score matched pairs were analysed. The mean follow up was 52 months. The 236 bypass procedures included 190 autogenous bypass grafts (80.5%), 151 (64.0%) of which were infrapopliteal. Among the 236 EVT procedures, the target lesion was the femoropopliteal segment in 81 patients (34.3%), the femoropopliteal and infrapopliteal segments in 101 patients (42.8%), and the infrapopliteal segment in 54 patients (22.9%). AFS was significantly better in the bypass group at five years (60.5 ± 3.6%) compared with the EVT group (35.3 ± 3.6%) (p < .001). Major amputation occurred in 61 patients (25.8%) in the bypass group and 85 patients (36.0%) in the EVT group (HR 0.66, 95% CI 0.47 - 0.92; p = .014). The probability of healing was significantly better in the bypass group at six months compared with the EVT group (p = .003). The median length of stay was shorter for the EVT group (4 days) than for the bypass group (8 days) (p = .001). Urgent re-intervention and re-admission rates were high and did not differ significantly between the groups., Conclusion: This study has shown that lower limb bypass surgery offered a significantly higher probability of AFS and wound healing compared with EVT in patients with CLTI., (Copyright © 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2023
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32. Laparoscopy-assisted vs open total gastrectomy with D2 lymphadenectomy for advanced gastric cancer: results of a retrospective, multicenter study.

Author

Illuminati G, D'Urso A, Fiori E, Cerasari S, Nardi P, Lapergola A, Pasqua R, Sorrenti S, Pironi D, Lauro A, and D'Andrea V

Subjects
Humans, Retrospective Studies, Treatment Outcome, Lymph Node Excision methods, Gastrectomy methods, Postoperative Complications epidemiology, Postoperative Complications surgery, Stomach Neoplasms pathology, Laparoscopy methods
Abstract

The aim of this study was to retrospectively compare the results of laparoscopy-assisted total gastrectomy (LATG) with those of open total gastrectomy (OTG) for advanced gastric cancer. Patients undergoing total gastrectomy for a T4a, N0-3a-b, M0 gastric adenocarcinoma were divided into two groups. Patients in group A (n = 122) underwent LAG, whereas patients in group B (n = 109) underwent OTG. Mean length of follow-up was 39 months. Primary study's endpoints were postoperative mortality and morbidity, overall late survival (OS) and disease-free survival (DFS). Secondary endpoints were the number of retrieved lymph nodes, operating time, intraoperative blood loss, postoperative length of stay (LOS) and the incidence of local recurrence. Twenty-four patients in group A (19.6%) required conversion into OTG. Postoperative mortality was absent in both groups. Postoperative morbidity was 19% in group A and 11% in group B [p = 0.19]. OS was 34% in group A and 42% in group B [p = 0.21]. DFS was 29% in group A and 33% in group B [p = 0.49]. Mean number of retrieved lymph nodes was 29 in group A and 34 in group B [p < 0.01]. Mean intraoperative blood loss was 230 ml in group A and 180 ml in group B [p = 0.02]. Mean postoperative LOS was 9 days in group A and 11 days in group B [p = 0.09]. Local recurrence was 19% in group A and 13% in group B [p = 0.20]. For advanced gastric cancer, OTG favorably compares with LATG., (© 2023. Italian Society of Surgery (SIC).)

Published
2023
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34. Surgeon-Pathologist Team Approach Dramatically Affects Lymph Nodes Detection and Improves Patients' Short-Term Outcome.

Author

Ambrosio MR, Perotti B, Battini A, Fattorini C, Cavazzana A, Pasqua R, Palumbo P, Gia L, and Arganini M

Abstract

The downstaging of gastric cancer has recently gained particular attention in the field of gastric cancer surgery. The phenomenon is mainly due to an inappropriate sampling of lymph nodes during standard lymphadenectomy. Hence, collection of the maximum number of lymph nodes is a critical factor affecting the outcome of patients. None of the techniques proposed so far have demonstrated a real efficiency in increasing the number of identified lymph nodes. To harvest the maximum number of lymph nodes, we designed a protocol for on-site macroscopic evaluation and sampling of lymph nodes according to the Japanese Gastric Cancer Association protocol. The procedure was carried out by a surgeon/pathologist team in the operating room. We enrolled one hundred patients, 50 of whom belonged to the study group and 50 to a control group. The study group included patients who underwent lymph node dissection following the proposed protocol; the control group encompassed patients undergoing standard procedures for sampling. We compared the number and maximum diameter of lymph nodes collected in both groups, as well as some postoperative variables, the 30-day mortality and the overall survival. In the study group, the mean number of lymph nodes harvested was higher than the control one ( p = 0.001). Moreover, by applying the proposed technique, we sampled lymph nodes with a very small diameter, some of which were metastatic. Noticeably, no difference in terms of postoperative course was identified between the two groups, again supporting the feasibility of an extended lymphadenectomy. By comparing the prognosis of patients, a better overall survival ( p = 0.03) was detected in the study group; however, to date, no long-term follow-up is available. Interestingly, patients with metastasis in node stations number 8, 9, 11 or with skip metastasis, experienced a worse outcome and died. Based on our preliminary results, the pathologist/surgeon team approach seems to be a reliable option, despite of a slight increase in sfaff workload and technical cost. It allows for the harvesting of a larger number of lymph nodes and improves the outcome of the patients thanks to more precise staging and therapy. Nevertheless, since a higher number of patients are necessary to confirm our findings and assess the impact of this technique on oncological outcome, our study could serve as a proof-of-concept for a larger, multicentric collaboration.

Published
2022
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35. Simultaneous Laparoscopic Cholecystectomy and Endovascular Infrarenal Aortic Aneurysm Repair.

Author

Illuminati G, Calio' FG, Pasqua R, Nardi P, Fratini C, and Urciuoli P

Abstract

Background/Aim: With the increasing use of endovascular aneurysm repair (EVAR) and the availability of laparoscopic cholecystectomy (LC) for treating abdominal aortic aneurysms (AAA) and cholelithiasis, respectively, the association between these elective treatments is not yet well-defined. Thus, this study aimed to evaluate the results of elective and simultaneous EVAR and LC. Methods: Thirteen patients (mean age, 72 years) with concomitant large and asymptomatic AAA and asymptomatic cholelithiasis underwent simultaneous EVAR and LC. Results: Post-operative mortality was absent, and the morbidity rate was 7%. The mean total duration of the procedure was 142 min. The mean duration of fluoroscopy was 19 min, and the mean radiation dose was 65 mGy. The mean amount of iodinated contrast injected was 49 mL. The timing of oral fluid intake was 28 h (range, 24-48 h) and that of the oral low-fat diet was 53 h (range, 48-72 h). No patient presented with an aortic graft infection during the entire follow-up period (mean duration, 41 months). The mean length of post-operative hospital stay was 6 days (range, 5-8 days). Late survival was 85%, and the exclusion of AAA was 100%. Conclusion: Simultaneous EVAR and LC can be performed safely, allowing effective and durable treatment under both AAA and cholelithiasis conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Illuminati, Calio', Pasqua, Nardi, Fratini and Urciuoli.)

Published
2021
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36. Results of Adrenalectomy for Isolated, Metachronous Metastasis of Breast Cancer: A Retrospective Cohort Study.

Author

Illuminati G, Pasqua R, D'Ermo G, Girolami M, Cerbelli B, D'Amati G, Carboni F, and Fiori E

Abstract

Background and Aim: Metachronous, isolated adrenal metastases from breast cancer are extremely rare. The aim of this study was to evaluate the results of adrenalectomy as a treatment of this uncommon condition. Methods: Twelve female patients (median age: 68 years) underwent 13 adrenalectomies for isolated, metachronous metastases of breast cancer. Ten resections were performed thorugh open surgery and two were preformed through a laparoscopic approach. As main study endpoints, postoperative mortality, postoperative morbidity and disease-free survival were considered. Median length of follow-up was 40 months. Results: Postoperative mortality was absent. Postoperative morbidity was 17%: one patient presented a postoperative pneumothorax requiring drainage and one patient required re-hospitalization 8 days after contralateral adrenalectomy for electrolyte imbalance. Two patients died of recurrent metastatic disease, 28 and 33 months respectively after adrenalectomy. One patient remained alive with hepatic metastases at 32 months from resection of adrenal recurrence. All in all, disease-free survival at 48 months was 75%. Conclusions: Adrenalectomy for metachronous, isolated metastases of breast cancer can be performed with no postoperative mortality and minimal postoperative morbidity, enabling good long-term disease-free survival., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Illuminati, Pasqua, D'Ermo, Girolami, Cerbelli, D'Amati, Carboni and Fiori.)

Published
2021
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37. Outcomes After Open and Endovascular Repair of Non-Ruptured True Pancreaticoduodenal and Gastroduodenal Artery Aneurysms Associated with Coeliac Artery Compression: A Multicentre Retrospective Study.

Author

Illuminati G, Hostalrich A, Pasqua R, Nardi P, Chaufour X, and Ricco JB

Subjects
Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation methods, Celiac Artery pathology, Computed Tomography Angiography methods, Duodenum blood supply, Endovascular Procedures adverse effects, Endovascular Procedures methods, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Pancreas blood supply, Stents, Stomach blood supply, Aneurysm diagnostic imaging, Aneurysm surgery, Compartment Syndromes diagnosis, Compartment Syndromes etiology, Compartment Syndromes surgery, Hepatic Artery diagnostic imaging, Hepatic Artery pathology, Hepatic Artery surgery, Postoperative Complications etiology, Postoperative Complications surgery, Reoperation methods, Reoperation statistics & numerical data
Abstract

Objective: True aneurysms of the peri-pancreatic arcade (PDAA) have been attributed to increased collateral flow related to coeliac axis (CA) occlusion by a median arcuate ligament (MAL). Although PDAA exclusion is currently recommended, simultaneous CA release and the technique to be used are debated. The aim of this retrospective multicentre study was to compare the results of open surgical repair of true non-ruptured PDAA with release or CA bypass (group A) vs. coil embolisation of PDAA and CA stenting or laparoscopic release (group B)., Methods: From January 1994 to February 2019, 57 consecutive patients (group A: 31 patients; group B: 26 patients), including 35 (61%) men (mean age 56 ± 11 years), were treated at three centres. Twenty-six patients (46%) presented with non-specific abdominal pain: 15 (48%) in group A and 11 (42%) in group B (p = .80)., Results: No patient died during the post-operative period. At 30 days, all PDAAs following open repair and embolisation had been treated successfully. In group A, all CAs treated by MAL release or bypass were patent. In group B, 2/12 CA stentings failed at < 48 hours, and all MAL released by laparoscopy were successful. Median length of hospital stay was significantly greater in group A than in group B (5 vs. 3 days; p = .001). In group A, all PDAAs remained excluded. In group B, three PDAA recanalisations following embolisation were treated successfully (two redo embolisations and one open surgical resection). At six years, Kaplan-Meier estimates of freedom for PDAA recanalisation were 100% in group A, and 88% ± 6% in group B (p = .082). No PDAA ruptured during follow up. In group A, all 37 CAs treated by MAL release were patent, and one aortohepatic bypass occluded. In group B, five CAs occluded: four after stenting and the other after laparoscopic MAL release with two redo stenting and three aortohepatic bypasses. Estimates of freedom from CA restenosis/occlusion were 95% ± 3% for MAL release or visceral bypass, and 60% ± 9% for CA stenting (p = .001). Two late restenoses following CA stenting were associated with PDAA recanalisation., Conclusion: Current data suggest that open and endovascular treatment of PDAA can be performed with excellent post-operative results in both groups. However, PDAA embolisation was associated with few midterm recanalisations and CA stenting with a significant number of early and midterm failures., (Copyright © 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2021
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38. Results of resection of carotid body tumors with and without lymphnodes' dissection.

Author

Illuminati G, Pasqua R, Nardi P, Fratini C, Minni A, and Calio' FG

Subjects
Adult, Aged, Carotid Body Tumor diagnostic imaging, Carotid Body Tumor pathology, Female, Humans, Male, Middle Aged, Operative Time, Patient Selection, Retrospective Studies, Treatment Outcome, Young Adult, Carotid Body Tumor surgery, Lymph Node Excision
Abstract

Background: Carotid body tumor (CBT) is a slow-growing tumor arising from the carotid body, a chemoceptor organ lying behind the carotid artery bifurcation. Although rarely, metastases can occur distally through the hematogenous route and through the lymphatic route.to the cervical lymphnodes. The purpose of this study was to assess whether lymphnodes' resection should systematically be associated with the primary resection of a CBT., Methods: A retrospective analysis of 82 patients, 52 women of a mean age of 42 years undergoing resection of 88 CBT from 1994 to 2019. CBT were divided into 2 groups. Tumors in group A (n = 23, 26%) were treated by resection of the mass followed by a selective latero-cervical lymphadenectomy; tumors in group B (n = 65, 74%) underwent isolated resection of the mass. The study's primary endpoints were postoperative stroke/mortality rate, disease-specific survival and rate of local and distant recurrence of the disease., Results: Postoperative stroke-mortality rate was nil. One patient in group A (4.3%) presented a minor weakness of the contralateral arm, completely regressive within 12 h. One patient in group B (1.5%) died of liver and lung metastases 51 months after operation, no patient died of recurrent disease in group A (p = .62). No nodal recurrence was observed in group A, whereas one patient in group B (1.5%) presented nodal recurrence 39 months after primary tumor resection (p = .58) CONCLUSION: Selective lymphadenectomy associated with CBT resection does not increase the overall long-term survival and cannot be considered mandatory. It may help to better define the stage of the disease and to plan eventual adjuvant treatments., (Copyright © 2021. Published by Elsevier Ltd.)

Published
2021
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39. Standard versus eversion-modified double-staple technique for low colorectal anastomoses after resection of rectal cancer.

Author

Illuminati G, Pasqua R, Perotti B, Urciuoli P, Nardi P, Fratini C, Carboni F, and Valle M

Subjects
Adult, Aged, Aged, 80 and over, Digestive System Surgical Procedures methods, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Anastomosis, Surgical methods, Anastomosis, Surgical standards, Colon surgery, Rectal Neoplasms surgery, Rectum surgery, Surgical Stapling methods
Abstract

Purpose: The double-staple technique, performed as either the standard procedure or after eversion of the rectal stump, is a well-established method of performing low colorectal anastomoses following the resection of rectal cancer. Eversion of the tumor-bearing ano-rectal stump was proposed to allow the linear stapler to be fired at a safe distance of clearance from the tumor. We conducted this study to compare the results of the standard versus the eversion-modified double-staple technique., Methods: The subjects of this retrospective study were 753 consecutive patients who underwent low stapled colorectal anastomosis after resection of rectal cancer. The patients were divided into two groups according to the method of anastomosis used: Group A comprised 165 patients (22%) treated with the modified eversion technique and group B comprised 588 patients (78%) treated with the standard technique. The primary endpoints of the study were postoperative mortality, surgery-related morbidity, the number of sampled lymph nodes in the mesorectum, and late disease-related survival., Results: Postoperative mortality was 1.2% in group A and 1.7% in group B (p = 0.66). Postoperative morbidity was 12% in group A and 11% in group B (p = 0.75). The mean number of sampled lymph nodes in the mesorectum was 23 (range 17-27) in group A and 24 (range 19-29) in group B (p = 0.06). The 5-year disease-related survival was 73% in group A and 74% in group B (p = 0.75)., Conclusion: The standard and eversion-modified double-staple techniques yield comparable results.

Published
2021
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40. Outcome of Surgical Resection and Chemotherapy Versus Chemotherapy Alone for the Treatment of Isolated Primary Adrenal Lymphoma: A Retrospective Cohort Study of 16 Consecutive Patients.

Author

Illuminati G, Nardi P, Fratini C, Pasqua R, Giordano C, Girolami M, and Carboni F

Subjects
Adrenal Gland Neoplasms pathology, Aged, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Antineoplastic Combined Chemotherapy Protocols adverse effects, Cohort Studies, Combined Modality Therapy, Cyclophosphamide administration & dosage, Cyclophosphamide adverse effects, Doxorubicin administration & dosage, Doxorubicin adverse effects, Female, Humans, Lymphoma pathology, Male, Middle Aged, Prednisone administration & dosage, Prednisone adverse effects, Progression-Free Survival, Retrospective Studies, Treatment Outcome, Vincristine administration & dosage, Vincristine adverse effects, Adrenal Gland Neoplasms drug therapy, Adrenal Gland Neoplasms surgery, Lymphoma drug therapy, Lymphoma surgery
Abstract

Background/aim: Primary adrenal lymphoma (PAL) is rare and aggressive. The aim of this retrospective study was to compare the results of surgery and chemotherapy compared to chemotherapy alone for the treatment of this condition., Patients and Methods: Sixteen patients, 10 men and 6 women of a median age of 63 years (IQR=56-70.5 years), admitted for the treatment of PAL, were retrospectively reviewed. Six patients (37.5%) underwent surgical resection of the mass followed by CHOP (cyclophosphamide, doxorubicin, vincristine, bleomycin and prednisone) - based chemotherapy (Group A). Ten patients (62.5%) underwent chemotherapy alone, consisting of CHOP alone in one case and Rituximab-CHOP (R-CHOP) in 9 cases (Group B). As primary study endpoints of the study, overall survival (OS) and progression-free survival (PFS) were considered., Results: At two years follow-up, OS was 50% in Group A and 60% in group B (p=0.69). The PFS was 50% in group A and 30% in group B (p=0.42)., Conclusion: PAL exhibits overall a dismal prognosis. Chemotherapy remains the most appropriate treatment, although unable to ensure long-term survival. Surgery combined with chemotherapy is ineffective in improving survival and may, at best, have a limited role in relieving the pain related to the local mass effect., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2021
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41. Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers.

Author

Illuminati G, Pasqua R, Nardi P, Fratini C, Calio FG, and Ricco JB

Subjects
Aged, Aorta, Thoracic diagnostic imaging, Aortic Diseases diagnostic imaging, Blood Vessel Prosthesis, Endoleak etiology, Female, Humans, Length of Stay, Male, Middle Aged, Operative Time, Retrospective Studies, Stents, Time Factors, Treatment Outcome, Ulcer diagnostic imaging, Aorta, Thoracic surgery, Aortic Diseases surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Ulcer surgery, Ultrasonography, Interventional
Abstract

Background: Penetrating aortic ulcer (PAU) is an atherosclerotic lesion penetrating the elastic lamina and extending into the media of the aorta. It may evolve into intramural hematoma, focal dissection, pseudoaneurysm, and eventually rupture. The purpose of this study was to evaluate the effectiveness of a totally intravascular ultrasound (IVUS)-assisted endovascular exclusion of PAU., Methods: Thirteen consecutive patients (median age 66 years) underwent IVUS-assisted endovascular exclusion of PAU. The primary end points were fluoroscopy time, radiation dose, and occurrence of type I primary endoleak. Secondary end points were postoperative mortality and morbidity, arterial access complications, postoperative length of stay in the hospital, and occurrence of type II endoleaks., Results: The median fluoroscopy time was 4 min (4-5). The median radiation dose was 4.2 mGy (3.9-4.5). A proximal and distal landing zone of at least 2 cm could be obtained in all the patients. No patient presented a type I endoleak. No postoperative mortality, no morbidity, or arterial access complication was observed. The median length of postoperative stay in the hospital was 2 days (2-3). The median length of follow-up was 25 months (9.2-38.7). One late type II endoleak was observed (7.7%), because of reflux from the intercostal arteries, without the need for additional treatment., Conclusions: IVUS-assisted endovascular treatment of PAU allows durable exclusion of PAU with a short fluoroscopy time and no need for injection of contrast media. Further series are needed to confirm the results of this preliminary study., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Published
2021
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42. Results of Standard Stapler Closure of Pancreatic Remnant After Distal Spleno-Pancreatectomy for Adenocarcinoma.

Author

Illuminati G, Cerasari S, Pasqua R, Nardi P, Fratini C, Frey S, Iannelli A, and Marini P

Abstract

Background/Aim: The purpose of this study was to evaluate the results of stapled closure of the pancreatic remnant after cold-knife section of the pancreatic isthmus and distal pancreatectomy for adenocarcinoma. Methods: A retrospective evaluation of 57 consecutive patients undergoing distal spleno-pancreatectomy for adenocarcinoma was performed. The pancreatic isthmus was systematically straight-sectioned with a cold knife, and the remnant was stapled close without additional stitches or adjuncts. The study's main endpoints were postoperative mortality, the occurrence of a pancreatic fistula, the need for a re-operation, the postoperative length of stay in the hospital, the rate of re-admission, and late survival. Results: Postoperative mortality was absent. Seventeen patients (29.8%) presented a pancreatic fistula of grade A in seven cases (41.2%), grade B in eight cases (47.1%), and grade C in two cases (11.8%). Re-operation was required in the two patients (3.5%) with grade C fistula in order to drain an intra-abdominal abscess. The mean postoperative length of stay in the hospital was 15 days (range, 6-62 days). No patient required re-admission. Twenty-nine patients (50.8%) were alive and free from disease, respectively, 12 patients (21.1%) at 12 months, 13 patients (22.8%) at 60 months, and four patients (7.0%) at 120 months from the operation. The remaining patients died of metastatic disease 9-37 months from the operation. Lastly, disease-related mortality was 49.1%. Conclusion: Stapler closure of the pancreatic remnant allows good postoperative results, limiting the formation of pancreatic fistula to the lower limit of its overall reported incidence., (Copyright © 2020 Illuminati, Cerasari, Pasqua, Nardi, Fratini, Frey, Iannelli and Marini.)

Published
2020
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43. Long-term results of polytetrafluoroethylene versus saphenous vein repair of degenerative carotid artery aneurysm.

Author

Illuminati G, Pizzardi G, Pasqua R, Nardi P, Calio' FG, and Ricco JB

Subjects
Aged, Aneurysm mortality, Blood Vessel Prosthesis adverse effects, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Carotid Artery Diseases mortality, Coronary Artery Bypass adverse effects, Coronary Artery Bypass instrumentation, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Polytetrafluoroethylene adverse effects, Postoperative Complications etiology, Saphenous Vein transplantation, Treatment Outcome, Vascular Patency, Aneurysm surgery, Blood Vessel Prosthesis Implantation methods, Carotid Artery Diseases surgery, Coronary Artery Bypass methods, Postoperative Complications epidemiology
Abstract

Objective: To compare the results of polytetrafluoroethylene (PTFE) and great saphenous vein (GSV) bypass after resection of a degenerative aneurysm of the carotid artery., Methods: From January 1994 to November 2017, 37 patients (27 men) with a mean age of 58 years (range, 39-82 years) with a degenerative aneurysm of the carotid artery (median diameter, 28 mm; range, 19-42 mm), underwent resection of the aneurysm followed by a bypass with either a GSV (n = 10) or a PTFE prosthesis (n = 27). Although 31 patients were asymptomatic, 6 patients were symptomatic: transient ischemic attack (n = 4), minor stroke (n = 1), and compression of the hypoglossal nerve (n = 1). The preoperative workup included duplex ultrasound examination of the arteries to the head, and angiography or computed tomography angiography. All patients were operated under general anesthesia and six were intubated through the nose. Sixteen patients were monitored through transcutaneous oximetry. No shunt was used in this series. In 10 patients receiving a PTFE graft, the external carotid artery was implanted in the prosthesis. Mean follow-up was 16.9 ± 2 years (95% confidence interval, 14.5-19.3 years). Primary end points were the 30-day combined stroke/death rate, graft infection, late graft patency, and late stroke-free survival. Secondary end points were cranial nerve injury and length of postoperative hospital stay., Results: Postoperative mortality was nil in both groups. One postoperative stroke was observed in the PTFE group, whereas none occurred in the GSV group (P = .84). No graft infection was observed in either group. At 10 years, survival in the GSV group was 80 ± 12%, and survival in the PTFE group was 76 ± 8% (log-rank [Mantel-Cox], P = .85). In the GSV group, graft patency at 7 and 10 years was 85 ± 13%. In the PTFE group B, graft patency was 100% (log-rank [Mantel-Cox], P = .12). No late stroke was observed. Two transient cranial nerve injuries were observed in the GSV group (20%) and two in the PTFE group (8%) (P = .97). Length of hospital stay was comparable in both groups (GSV group, 6 days; PTFE group, 5 days; P = .12)., Conclusions: This study suggests that, after resection of a degenerative aneurysm of the carotid artery, bypass with a PTFE prosthesis gives comparable results to those obtained with the GSV. We recommend sparing the GSV and instead using a PTFE prosthesis in patients with a degenerative aneurysm of the carotid artery., (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Published
2020
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44. Collective information processing in human phase separation.

Author

Jayles B, Escobedo R, Pasqua R, Zanon C, Blanchet A, Roy M, Tredan G, Theraulaz G, and Sire C

Subjects
Humans, Models, Psychological, Group Processes, Interpersonal Relations, Pedestrians psychology
Abstract

In our digital societies, individuals massively interact through digital interfaces whose impact on collective dynamics can be important. In particular, the combination of social media filters and recommender systems can lead to the emergence of polarized and fragmented groups. In some social contexts, such segregation processes of human groups have been shown to share similarities with phase separation phenomena in physics. Here, we study the impact of information filtering on collective segregation behaviour of human groups. We report a series of experiments where groups of 22 subjects have to perform a collective segregation task that mimics the tendency of individuals to bond with other similar individuals. More precisely, the participants are each assigned a colour (red or blue) unknown to them, and have to regroup with other subjects sharing the same colour. To assist them, they are equipped with an artificial sensory device capable of detecting the majority colour in their 'environment' (defined as their k nearest neighbours, unbeknownst to them), for which we control the perception range, k = 1, 3, 5, 7, 9, 11, 13. We study the separation dynamics (emergence of unicolour groups) and the properties of the final state, and show that the value of k controls the quality of the segregation, although the subjects are totally unaware of the precise definition of the 'environment'. We also find that there is a perception range k = 7 above which the ability of the group to segregate does not improve. We introduce a model that precisely describes the random motion of a group of pedestrians in a confined space, and which faithfully reproduces and allows interpretation of the results of the segregation experiments. Finally, we discuss the strong and precise analogy between our experiment and the phase separation of two immiscible materials at very low temperature. This article is part of the theme issue 'Multi-scale analysis and modelling of collective migration in biological systems'.

Published
2020
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45. Resection for Internal Jugular Vein Thrombosis and Cervical Lymph Nodes' Involvement from Gastric Cancer.

Author

Illuminati G, Pasqua R, Nardi P, Fratini C, Minni A, and Giordano C

Subjects
Female, Humans, Lymph Nodes pathology, Male, Middle Aged, Stomach Neoplasms pathology, Stomach Neoplasms surgery, Jugular Veins pathology, Lymph Nodes surgery, Stomach Neoplasms complications, Venous Thrombosis surgery
Abstract

Background/aim: Thrombosis internal jugular vein (IJV) with cervical adenopathy, as first manifestation of gastric cancer is rare. We aimed to compare resection of the cervical mass followed by gastrectomy with gastrectomy alone., Patients and Methods: Nine patients presenting thrombosis of the IJV for gastric carcinoma were divided into two groups. Patients in group A (n=3) underwent anticoagulation treatment, gastrectomy and adjuvant treatment. Patients in group B (n=6) underwent resection of the cervical mass and internal jugular vein (radical neck dissection), and then gastrectomy and adjuvant treatment., Results: Median survival was 15.3 months in group A (range=11-19 months) and 31.2 months in group B (range=7-44 months) (p=0.11). Late cervical recurrence/complications occurred in 2 patients in group A and none in group B (p=0.02)., Conclusion: Resection of thrombosed IJV and satellite lymph nodes, due to a primary gastric cancer may contribute to diagnosis of the disease, limit pulmonary embolic complications and improve quality of life., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2020
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46. Endovascular Exclusion of Abdominal Aortic Aneurysms and Simultaneous Resection of Colorectal Cancer.

Author

Illuminati G, Pizzardi G, Pasqua R, Caliò FG, Chakfé N, and Ricco JB

Subjects
Adult, Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal complications, Aortic Aneurysm, Abdominal diagnostic imaging, Aortography methods, Blood Vessel Prosthesis, Colorectal Neoplasms complications, Colorectal Neoplasms pathology, Computed Tomography Angiography, Female, Humans, Male, Middle Aged, Neoplasm Grading, Postoperative Complications etiology, Prosthesis Design, Retrospective Studies, Risk Factors, Time Factors, Time-to-Treatment, Treatment Outcome, Ultrasonography, Doppler, Duplex, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Colectomy adverse effects, Colorectal Neoplasms surgery, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation
Abstract

Background: No consensus exists on the optimal strategy for treatment of abdominal aortic aneurysm (AAA) associated with colorectal cancer (CRC). The purpose of this study was to evaluate the results of endovascular treatment of AAA with simultaneous resection of CRC., Methods: Twenty-two consecutive patients presenting with AAA associated with a CRC were treated by endovascular AAA exclusion and simultaneous CRC resection. Median diameter of the aneurysm was 6.5 cm (range, 4.8-8 cm). Two patients (9%) had grade I cancer, 5 patients (23%) grade II, 13 patients (59%) grade III, and 2 patients (9%) grade IV. The 2 surgical procedures were performed under the same general anesthesia. Aneurysm exclusion was achieved using an infrarenal aorto-bi-iliac endoprosthesis (13 patients) and using an aorto-bi-iliac endoprosthesis with suprarenal fixation (9 patients), with 1 patient receiving bilateral renal chimney stent implantation. In all cases, vascularization of the hypogastric arteries was preserved. After AAA exclusion, colic resection was carried out by laparotomy with right colectomy (7 patients) and anterior rectocolic resection (15 patients). In all patients, AAA exclusion was controlled by a computed tomographic angioscan (CTA) at 1 month and duplex ultrasound every 6 months, and at some later stage, it was through inclusion of CTA as part of oncology surveillance. The mean duration of follow-up was 42 months (10-120 months). The primary endpoint was composite and regrouped any death occurring during the first 30 days after procedures, any type I endoleak, any aortic reintervention, and any AAA-related mortality., Results: No patient died during the first 30 postoperative days, and no patient was lost to follow-up. No aortic endoprosthesis infection and no type I endoleak were observed. Five endoleaks arising from the lumbar arteries (n = 4) or from the inferior mesenteric artery (n = 1) were identified. As they were not associated with an increase of the AAA diameter >5 mm, they were not treated. 1 colic anastomotic leak and 2 incisional abscesses were successfully cured by local care only. Nine patients (41%) died of cancer evolution during the follow-up period., Conclusions: In this series, treatment of AAA and CRC during the same operative session yields results comparable to those observed when surgery is performed in 2 distinct operative sessions. Synchronous treatment reduced waiting time of colic resection. It may also shorten total hospitalization duration, although this last hypothesis is not supported by comparison with a control group., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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47. Laparoscopic lavage/drainage as a bridge treatment for perforated diverticulitis with purulent peritonitis associated with an abdominal aortic aneurysm A retrospective case-control study.

Author

Illuminati G, Krizzuk D, Calio FG, Urciuoli P, Pizzardi G, and Pasqua R

Subjects
Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal complications, Case-Control Studies, Diverticulitis complications, Female, Humans, Intestinal Perforation complications, Male, Peritonitis complications, Retrospective Studies, Suppuration complications, Suppuration surgery, Therapeutic Irrigation methods, Diverticulitis surgery, Drainage methods, Intestinal Perforation surgery, Laparoscopy, Peritonitis surgery
Abstract

Aim: Laparoscopic lavage /drainage (LALA) or surgical resection are both methods of treatment for perforated diverticulitis with purulent peritonitis (Hinchey Stage III). In case of associated abdominal aortic aneurysm (AAA), laparoscopic lavage/drainage could be an interesting bridge option to treat sepsis before endovascular exclusion of the aneurysm and resection of the sigmoid. We performed LALA as a bridge treatment of peritonitis before elective, staged endovascular exclusion of the aneurysm (EE) and elective resection of the colon., Material and Methods: Seven patients presenting a perforated diverticulitis with purulent peritonitis (Hinchey III), associated with an uncomplicated AAA of a mean diameter of 6 cm, underwent LALA followed by staged EE and resection. They were retrospectively reviewed for a case-control study. The mean length of follow-up after completing all the procedures was 28 months. Primary endpoints were mortality and morbidity of each procedure, complications related to each procedure and to the untreated disease in the interval between each one of them, late outcome and complications related to each treatment method. As secondary endpoints, the mean length of surgery for resection, of stay in the hospital, of the interval between each procedure, and of time required for the treatment of both the diseases were considered., Results: Postoperative mortality was absent. Morbidity consisted of a sigmoido-vescical fistula 18 days after resolution of peritonitis and sepsis, not hindering EE,and a delayed healing of the surgical wound for access to the common femoral artery (28.6%). No complications of untreated disease in the interval between each procedure were observed. No late complications of both diseases occurred. The mean interval between LALA and EE,and between EE and resection was, respectively, 19 days and 18 days. Both the diseases were treated within a mean delay of 37 days after LALA (range, 24-61 days)., Conclusions: LALA, as a bridge treatment, before EE and resection, in patients presenting a perforated diverticulitis with purulent peritonitis, associated with an uncomplicated AAA, may be an effective treatment option., Key Words: Perforated diverticulitis, Purulent peritonitis, Abdominal aortic aneurysm.

Published
2019

48. Simultaneous resection of an adenocarcinoma of the cardia and a synchronous adenocarcinoma of the sigmoid: Report of a case.

Author

Illuminati G, Perotti B, Pizzardi G, Pasqua R, Prezioso G, Schiratti M, and Angelici A

Abstract

Introduction: Adenocarcinoma of the cardia synchronous with other intraabdominal neoplasms is very rare. We report the case of a Siewert type II adenocarcinoma of the cardia synchronous with an adenocarcinoma of the sigmoid both treated simultaneously by transjatal oesophago-gastrectomy and anterior resection of the sigmoid., Case Report: A 62 year-old male was admitted for a progressing dysphagia and weight loss. Oesophago-gastric fibroscopy detected an adenocarcinoma of the cardia extending to the distal 2 cm of the esophagus (Siewert typeII). A CT-scan of the chest and abdomen confirmed the cancer of the cardia and also decealed a synchronous tumor of the sigmoid. Both neoplasms were resected through a xipho-pubic laparotomy, with an ileostomy completing the procedure. Postoperative course was uneventful and ileostomy was closed four weeks later. The patient was subsequently addressed to oncological for adjuvant treatment., Discussion: This report supports the indication of aggressive, simultaneous treatment of an adenocarcinoma of the cardia associated with a synchronous abdominal neoplasm, provided that both are resectable through the same surgical access, as anticipated at a preoperative, through diagnostic work-up., Conclusion: Simultaneous resection of synchronous adenocarcinoma of the cardia and the sigmoid is feasible and avoids possible progression of the untreated neoplasm during the interval between two separate resections, provided that a curative resection can be obtained for both diseases.

Published
2018
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49. Results of subclavian to carotid artery bypass for occlusive disease of the common carotid artery: A retrospective cohort study.

Author

Illuminati G, Pizzardi G, Calio FG, Masci F, Pasqua R, Frezzotti F, and Peschillo S

Subjects
Aged, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Carotid Artery, Common surgery, Carotid Stenosis surgery, Coronary Artery Bypass methods, Subclavian Artery surgery
Abstract

Background: Optimal treatment of significant atherosclerosis of the common carotid artery (CCA) is not well-defined. The purpose of this study was to evaluate the long-term results of prosthetic subclavian to carotid bypass for occlusive disease of the CCA., Material and Methods: From January 1994 to December 2015, 45 patients, mean age 67 years, underwent an ipsilateral subclavian to carotid bypass for occlusive disease of the CCA. Thirty-eight patients (84%) presented with neurologic symptoms, including transitory ischemic attacks in 29 cases and minor strokes in 9 cases. The graft material consisted of a 7 mm polytetrafluoroethylene conduit, and the distal anastomosis was done on the carotid bulb in 21 patients, on the internal carotid artery in 19 cases, and on the distal CCA in 5 cases. Median length of follow-up was 58 months. Study endpoints were the combined postoperative stroke/mortality rate, graft infection, overall late survival, freedom from ipsilateral stroke, and graft patency., Results: Postoperative stroke/mortality rate was 2%. No graft infection was observed throughout follow-up. At 60 months, overall survival, freedom from stroke, and graft patency were 71% (standard error [SE] = 0.07), 98% (SE = 0.02), and 95.5% (SE = 0.06), respectively., Conclusions: Subclavian to carotid bypass allows very good patency rates and excellent protection from postoperative and late stroke, remaining a benchmark for any other treatment method., (Copyright © 2018. Published by Elsevier Ltd.)

Published
2018
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50. Hybrid treatment of tandem, common carotid/innominate artery and ipsilateral carotid bifurcation stenoses by simultaneous, retrograde proximal stenting and eversion carotid endarterectomy: Preliminary results of a case series.

Author

Illuminati G, Pizzardi G, Pasqua R, Frezzotti F, Palumbo P, Macrina F, and Calio' F

Subjects
Aged, Aged, 80 and over, Angioplasty, Balloon adverse effects, Carotid Arteries pathology, Carotid Arteries surgery, Combined Modality Therapy adverse effects, Combined Modality Therapy methods, Endarterectomy, Carotid adverse effects, Female, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Retrospective Studies, Survival Rate, Treatment Outcome, Angioplasty, Balloon methods, Carotid Stenosis surgery, Endarterectomy, Carotid methods, Stents adverse effects
Abstract

Background: Tandem stenoses of the internal carotid artery (ICA) and proximal, ipsilateral common carotid artery (CCA) or innominate artery can be treated with a hybrid approach, combining conventional carotid endarterectomy (CEA) and retrograde stenting of the proximal stenosis, through surgical exposure of the carotid bifurcation. The purpose of this study was to evaluate the results of combining eversion CEA with retrograde CCA/innominate artery stenting., Material and Methods: From January 2015 to July 2017, 7 patients, 6 men of a mean age of 72 years (range 59-83 years) underwent simultaneous, retrograde stenting of the proximal CCA/innominate artery and an eversion CEA of the ipsilateral ICA, through surgical exposure of the carotid bifurcation, for severe tandem stenoses. The proximal stenosis involved the left proximal CCA in 4 patients, the proximal innominate artery in 2 patients and the right CCA in one patient. The procedure was performed under general anesthesia in a conventional operating room equipped with a mobile C-arm. A covered, balloon expandable stent was deployed over the proximal stenosis via a 6-F sheath directly introduced into the proximal CCA through the obliquely transected carotid bulb. After removing the sheath, debris were flushed through the carotid bulb and eversion CEA completed the procedure. Study endpoints were: postoperative stroke/mortality rate, cardiac mortality and morbidity, peripheral nerve injury, cervical hematoma, overall late survival, freedom from ipsilateral stroke and patency of arterial reconstruction., Results: No postoperative mortality or neurologic morbidity was observed in any patient. Cervical hematomas and peripheral nerve injuries were likewise absent. At a mean follow-up of 18 months, all the patients were alive, free from neurologic events of new onset and free from restenosis., Conclusion: Combined proximal stenting and eversion CEA for tandem lesions seems a valid treatment, with the advantages of eversion CEA over other techniques of carotid bifurcation revascularization., (Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Published
2018
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