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1. Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Author: Coccolini, F, Mazzoni, A, Cremonini, C, Cobuccio, L, Pucciarelli, M, Vetere, G, Borelli, B, Strambi, S, Musetti, S, Miccoli, M, Cremolini, C, Salvetti, F, Fugazzola, P, Ceresoli, M, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Catena, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Benedetti, F, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Akhmeteli, L, Doklestic, K, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Dimitrov, E, Chowdhury, S, Patel, T, Sartelli, M, Tartaglia, D, Chiarugi, M, Coccolini F., Mazzoni A., Cremonini C., Cobuccio L., Pucciarelli M., Vetere G., Borelli B., Strambi S., Musetti S., Miccoli M., Cremolini C., Salvetti F., Fugazzola P., Ceresoli M., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Catena F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Benedetti F., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Akhmeteli L., Doklestic K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Dimitrov E., Chowdhury S., Patel T., Sartelli M., Tartaglia D., Chiarugi M., Coccolini, F, Mazzoni, A, Cremonini, C, Cobuccio, L, Pucciarelli, M, Vetere, G, Borelli, B, Strambi, S, Musetti, S, Miccoli, M, Cremolini, C, Salvetti, F, Fugazzola, P, Ceresoli, M, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Catena, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Benedetti, F, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Akhmeteli, L, Doklestic, K, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Dimitrov, E, Chowdhury, S, Patel, T, Sartelli, M, Tartaglia, D, Chiarugi, M, Coccolini F., Mazzoni A., Cremonini C., Cobuccio L., Pucciarelli M., Vetere G., Borelli B., Strambi S., Musetti S., Miccoli M., Cremolini C., Salvetti F., Fugazzola P., Ceresoli M., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Catena F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Benedetti F., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Akhmeteli L., Doklestic K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Dimitrov E., Chowdhury S., Patel T., Sartelli M., Tartaglia D., and Chiarugi M.
Abstract: Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild–moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild–moderate IC were reported such malignancy (753–100%), diabetes (103–13.7%), malnutrition (26–3.5%) and uremia (1–0.1%), while severe IC causes were steroids treatment (14–16.3%); neutropenia (7–8.1%), malignancy on chemotherapy (71–82.6%). Preoperative risk classification were reported as follow: mild–moderate: ASA 1–14 (1.9%); ASA 2–202 (26.8%); ASA 3–341 (45.3%); ASA 4–84 (11.2%); ASA 5–7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2–16 patients (18.6%); ASA 3–41 patients (47.7%); ASA 4–19 patients (22.1%); ASA 5–3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild–moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild–moderate and severe groups. Long-term survival data: in mild–moderate disease-free survival (median, IQR) is 28 (10–91) and in severe IC, it is 21 (10–94). Overall survival (median, IQR) is 44 (18–99) and 26 (20–90) in mild–moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16–81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild–moderate and severe IC is
Published: 2023

2. The unrestricted global effort to complete the COOL trial

Author: Kirkpatrick, A, Coccolini, F, Tolonen, M, Minor, S, Catena, F, Gois, E, Doig, C, Hill, M, Ansaloni, L, Chiarugi, M, Tartaglia, D, Ioannidis, O, Sugrue, M, Colak, E, Hameed, S, Lampela, H, Agnoletti, V, Mckee, J, Garraway, N, Sartelli, M, Ball, C, Parry, N, Voght, K, Julien, L, Kroeker, J, Roberts, D, Faris, P, Tiruta, C, Moore, E, Ammons, L, Anestiadou, E, Bendinelli, C, Bouliaris, K, Carroll, R, Ceresoli, M, Favi, F, Gurrado, A, Rezende-Neto, J, Isik, A, Cremonini, C, Strambi, S, Koukoulis, G, Testini, M, Trpcic, S, Pasculli, A, Picariello, E, Abu-Zidan, F, Adeyeye, A, Augustin, G, Alconchel, F, Altinel, Y, Hernandez Amin, L, Aranda-Narvaez, J, Baraket, O, Biffl, W, Baiocchi, G, Bonavina, L, Brisinda, G, Cardinali, L, Celotti, A, Chaouch, M, Chiarello, M, Costa, G, De'Angelis, N, De Manzini, N, Delibegovic, S, Di Saverio, S, De Simone, B, Dubuisson, V, Fransvea, P, Garulli, G, Giordano, A, Gomes, C, Hayati, F, Huang, J, Ibrahim, A, Huei, T, Jailani, R, Khan, M, Luna, A, Malbrain, M, Marwah, S, Mcbeth, P, Mihailescu, A, Morello, A, Mulita, F, Murzi, V, Mohammad, A, Parmar, S, Pak, A, Wong, M, Pantalone, D, Podda, M, Puccioni, C, Rasa, K, Ren, J, Roscio, F, Gonzalez-Sanchez, A, Sganga, G, Scheiterle, M, Slavchev, M, Smirnov, D, Tosi, L, Trivedi, A, Vega, J, Waledziak, M, Xenaki, S, Winter, D, Wu, X, Zakaria, A, Zakaria, Z, Kirkpatrick A. W., Coccolini F., Tolonen M., Minor S., Catena F., Gois E., Doig C. J., Hill M. D., Ansaloni L., Chiarugi M., Tartaglia D., Ioannidis O., Sugrue M., Colak E., Hameed S. M., Lampela H., Agnoletti V., McKee J. L., Garraway N., Sartelli M., Ball C. G., Parry N. G., Voght K., Julien L., Kroeker J., Roberts D. J., Faris P., Tiruta C., Moore E. E., Ammons L. A., Anestiadou E., Bendinelli C., Bouliaris K., Carroll R., Ceresoli M., Favi F., Gurrado A., Rezende-Neto J., Isik A., Cremonini C., Strambi S., Koukoulis G., Testini M., Trpcic S., Pasculli A., Picariello E., Abu-Zidan F., Adeyeye A., Augustin G., Alconchel F., Altinel Y., Hernandez Amin L. A., Aranda-Narvaez J. M., Baraket O., Biffl W. L., Baiocchi G. L., Bonavina L., Brisinda G., Cardinali L., Celotti A., Chaouch M., Chiarello M., Costa G., de'Angelis N., De Manzini N., Delibegovic S., Di Saverio S., De Simone B., Dubuisson V., Fransvea P., Garulli G., Giordano A., Gomes C., Hayati F., Huang J., Ibrahim A. F., Huei T. J., Jailani R. F., Khan M., Luna A. P., Malbrain M. L. N. G., Marwah S., McBeth P., Mihailescu A., Morello A., Mulita F., Murzi V., Mohammad A. T., Parmar S., Pak A., Wong M. P. -K., Pantalone D., Podda M., Puccioni C., Rasa K., Ren J., Roscio F., Gonzalez-Sanchez A., Sganga G., Scheiterle M., Slavchev M., Smirnov D., Tosi L., Trivedi A., Vega J. A. G., Waledziak M., Xenaki S., Winter D., Wu X., Zakaria A. D., Zakaria Z., Kirkpatrick, A, Coccolini, F, Tolonen, M, Minor, S, Catena, F, Gois, E, Doig, C, Hill, M, Ansaloni, L, Chiarugi, M, Tartaglia, D, Ioannidis, O, Sugrue, M, Colak, E, Hameed, S, Lampela, H, Agnoletti, V, Mckee, J, Garraway, N, Sartelli, M, Ball, C, Parry, N, Voght, K, Julien, L, Kroeker, J, Roberts, D, Faris, P, Tiruta, C, Moore, E, Ammons, L, Anestiadou, E, Bendinelli, C, Bouliaris, K, Carroll, R, Ceresoli, M, Favi, F, Gurrado, A, Rezende-Neto, J, Isik, A, Cremonini, C, Strambi, S, Koukoulis, G, Testini, M, Trpcic, S, Pasculli, A, Picariello, E, Abu-Zidan, F, Adeyeye, A, Augustin, G, Alconchel, F, Altinel, Y, Hernandez Amin, L, Aranda-Narvaez, J, Baraket, O, Biffl, W, Baiocchi, G, Bonavina, L, Brisinda, G, Cardinali, L, Celotti, A, Chaouch, M, Chiarello, M, Costa, G, De'Angelis, N, De Manzini, N, Delibegovic, S, Di Saverio, S, De Simone, B, Dubuisson, V, Fransvea, P, Garulli, G, Giordano, A, Gomes, C, Hayati, F, Huang, J, Ibrahim, A, Huei, T, Jailani, R, Khan, M, Luna, A, Malbrain, M, Marwah, S, Mcbeth, P, Mihailescu, A, Morello, A, Mulita, F, Murzi, V, Mohammad, A, Parmar, S, Pak, A, Wong, M, Pantalone, D, Podda, M, Puccioni, C, Rasa, K, Ren, J, Roscio, F, Gonzalez-Sanchez, A, Sganga, G, Scheiterle, M, Slavchev, M, Smirnov, D, Tosi, L, Trivedi, A, Vega, J, Waledziak, M, Xenaki, S, Winter, D, Wu, X, Zakaria, A, Zakaria, Z, Kirkpatrick A. W., Coccolini F., Tolonen M., Minor S., Catena F., Gois E., Doig C. J., Hill M. D., Ansaloni L., Chiarugi M., Tartaglia D., Ioannidis O., Sugrue M., Colak E., Hameed S. M., Lampela H., Agnoletti V., McKee J. L., Garraway N., Sartelli M., Ball C. G., Parry N. G., Voght K., Julien L., Kroeker J., Roberts D. J., Faris P., Tiruta C., Moore E. E., Ammons L. A., Anestiadou E., Bendinelli C., Bouliaris K., Carroll R., Ceresoli M., Favi F., Gurrado A., Rezende-Neto J., Isik A., Cremonini C., Strambi S., Koukoulis G., Testini M., Trpcic S., Pasculli A., Picariello E., Abu-Zidan F., Adeyeye A., Augustin G., Alconchel F., Altinel Y., Hernandez Amin L. A., Aranda-Narvaez J. M., Baraket O., Biffl W. L., Baiocchi G. L., Bonavina L., Brisinda G., Cardinali L., Celotti A., Chaouch M., Chiarello M., Costa G., de'Angelis N., De Manzini N., Delibegovic S., Di Saverio S., De Simone B., Dubuisson V., Fransvea P., Garulli G., Giordano A., Gomes C., Hayati F., Huang J., Ibrahim A. F., Huei T. J., Jailani R. F., Khan M., Luna A. P., Malbrain M. L. N. G., Marwah S., McBeth P., Mihailescu A., Morello A., Mulita F., Murzi V., Mohammad A. T., Parmar S., Pak A., Wong M. P. -K., Pantalone D., Podda M., Puccioni C., Rasa K., Ren J., Roscio F., Gonzalez-Sanchez A., Sganga G., Scheiterle M., Slavchev M., Smirnov D., Tosi L., Trivedi A., Vega J. A. G., Waledziak M., Xenaki S., Winter D., Wu X., Zakaria A. D., and Zakaria Z.
Abstract: Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) (https://clinicaltrials.gov/ct2/show/NCT03163095). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. Methods: The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by co
Published: 2023

3. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Author: Tartaglia, D, Cremonini, C, Annunziata, E, Catena, F, Sartelli, M, Kirkpatrick, A, Musetti, S, Strambi, S, Chiarugi, M, Coccolini, F, Salvetti, F, Fugazzola, P, Ceresoli, M, Benedetti, F, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Dimitrov, E, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Doklestic, L, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Chowdhury, S, Patel, T, Tartaglia D., Cremonini C., Annunziata E., Catena F., Sartelli M., Kirkpatrick A. W., Musetti S., Strambi S., Chiarugi M., Coccolini F., Salvetti F., Fugazzola P., Ceresoli M., Benedetti F., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Dimitrov E., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Doklestic L. A. K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Chowdhury S., Patel T., Tartaglia, D, Cremonini, C, Annunziata, E, Catena, F, Sartelli, M, Kirkpatrick, A, Musetti, S, Strambi, S, Chiarugi, M, Coccolini, F, Salvetti, F, Fugazzola, P, Ceresoli, M, Benedetti, F, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Dimitrov, E, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Doklestic, L, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Chowdhury, S, Patel, T, Tartaglia D., Cremonini C., Annunziata E., Catena F., Sartelli M., Kirkpatrick A. W., Musetti S., Strambi S., Chiarugi M., Coccolini F., Salvetti F., Fugazzola P., Ceresoli M., Benedetti F., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Dimitrov E., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Doklestic L. A. K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Chowdhury S., and Patel T.
Abstract: Background: Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods: We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results: Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann’s procedure is mainly performed in grades 1–2 (p < 0.0001). Major complications increased significantly after a Hartmann’s procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). Conclusions: Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann’s procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also requ
Published: 2023

4. Cervical Lymph Node Metastases of Papillary Thyroid Carcinoma, in the Central and Lateral Compartments, in Children and Adolescents: Predictive Factors

Author: Spinelli, C., Tognetti, F., Strambi, S., Morganti, R., Massimino, M., and Collini, P.
Published: 2018
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5. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Author: Tartaglia, D., Cremonini, C., Annunziata, E., Catena, F., Sartelli, M., Kirkpatrick, A. W., Musetti, S., Strambi, S., Chiarugi, M., Coccolini, F., Salvetti, F., Fugazzola, P., Ceresoli, M., Benedetti, F., Elisa, N. G., Litvin, A., Lostoridis, E., Ahmed, A. Y. Y. M., Manatakis, D., Negoi, I., Ioannidis, O., Uzunoglu, M. Y., Tochie, J. N., Cillara, N., Tomadze, G., Bala, M., Isik, A., Fonseca, V. C., Bellanova, G., Ghannam, W., Yalkin, O., Garcia, F. H., Altintoprak, F., Hadzhiev, D., Chirica, M., Zese, M., Balalis, D., Cui, Y., Luppi, D., Romeo, L., Muratore, A., Lunghi, E. G., Yovtchev, Y., Dimitrov, E., Nikolopoulos, I., Omerovic, M., Zizzo, M., Ugoletti, L., Costa, G., Scalzone, R., Perrone, S., Occhionorelli, S., Nardi, M., Gubbiotti, F., Muhtaroglu, A., Scaramuzzo, R., Corte, H., Yanez, C., Zakaria, A. D., Seretis, C., Gelmini, R., Pappalardo, V., Paratore, F., Sydorchuk, R., Mulita, F., Kara, Y., Toma, E. A., Vailas, M., Sotiropoulou, M., Elbahnasawy, M., Sibilla, M. G., Martines, G., Goksoy, B., Parini, D., Zaghi, C., Podda, M., Osipov, A., Brisinda, G., Gambino, G., Doklestic, L. A. K., Loncar, Z., Micic, D., Lesevic, I., D'Agostino, F., Garzali, I. U., Caicedo, Y., Marcela, L., Marin, P. A. G., Perivoliotis, K., Ntentas, I., Kuptsov, A., Chowdhury, S., Patel, T., Tartaglia, D, Cremonini, C, Annunziata, E, Catena, F, Sartelli, M, Kirkpatrick, A, Musetti, S, Strambi, S, Chiarugi, M, Coccolini, F, Salvetti, F, Fugazzola, P, Ceresoli, M, Benedetti, F, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Dimitrov, E, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Doklestic, L, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Chowdhury, S, and Patel, T
Subjects: Medical therapy, Acute diverticuliti, Gastroenterology, Acute diverticulitis, Surgery, Immunocompromised
Abstract: Background Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann’s procedure is mainly performed in grades 1–2 (p p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). Conclusions Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann’s procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay.
Published: 2023

6. Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Author: Coccolini F., Mazzoni A., Cremonini C., Cobuccio L., Pucciarelli M., Vetere G., Borelli B., Strambi S., Musetti S., Miccoli M., Cremolini C., Salvetti F., Fugazzola P., Ceresoli M., Elisa N. G., Litvin A., Lostoridis E., Ahmed A. Y. Y. M., Manatakis D., Negoi I., Ioannidis O., Uzunoglu M. Y., Tochie J. N., Cillara N., Tomadze G., Bala M., Isik A., Fonseca V. C., Bellanova G., Ghannam W., Yalkin O., Garcia F. H., Altintoprak F., Hadzhiev D., Chirica M., Zese M., Balalis D., Cui Y., Luppi D., Romeo L., Muratore A., Lunghi E. G., Yovtchev Y., Nikolopoulos I., Omerovic M., Zizzo M., Ugoletti L., Costa G., Scalzone R., Perrone S., Occhionorelli S., Nardi M., Gubbiotti F., Catena F., Muhtaroglu A., Scaramuzzo R., Corte H., Yanez C., Zakaria A. D., Seretis C., Gelmini R., Pappalardo V., Paratore F., Sydorchuk R., Mulita F., Kara Y., Toma E. A., Vailas M., Sotiropoulou M., Benedetti F., Elbahnasawy M., Sibilla M. G., Martines G., Goksoy B., Parini D., Zaghi C., Podda M., Osipov A., Brisinda G., Gambino G., Akhmeteli L., Doklestic K., Loncar Z., Micic D., Lesevic I., D'Agostino F., Garzali I. U., Caicedo Y., Marcela L., Marin P. A. G., Perivoliotis K., Ntentas I., Kuptsov A., Dimitrov E., Chowdhury S., Patel T., Sartelli M., Tartaglia D., Chiarugi M., Coccolini, F, Mazzoni, A, Cremonini, C, Cobuccio, L, Pucciarelli, M, Vetere, G, Borelli, B, Strambi, S, Musetti, S, Miccoli, M, Cremolini, C, Salvetti, F, Fugazzola, P, Ceresoli, M, Elisa, N, Litvin, A, Lostoridis, E, Ahmed, A, Manatakis, D, Negoi, I, Ioannidis, O, Uzunoglu, M, Tochie, J, Cillara, N, Tomadze, G, Bala, M, Isik, A, Fonseca, V, Bellanova, G, Ghannam, W, Yalkin, O, Garcia, F, Altintoprak, F, Hadzhiev, D, Chirica, M, Zese, M, Balalis, D, Cui, Y, Luppi, D, Romeo, L, Muratore, A, Lunghi, E, Yovtchev, Y, Nikolopoulos, I, Omerovic, M, Zizzo, M, Ugoletti, L, Costa, G, Scalzone, R, Perrone, S, Occhionorelli, S, Nardi, M, Gubbiotti, F, Catena, F, Muhtaroglu, A, Scaramuzzo, R, Corte, H, Yanez, C, Zakaria, A, Seretis, C, Gelmini, R, Pappalardo, V, Paratore, F, Sydorchuk, R, Mulita, F, Kara, Y, Toma, E, Vailas, M, Sotiropoulou, M, Benedetti, F, Elbahnasawy, M, Sibilla, M, Martines, G, Goksoy, B, Parini, D, Zaghi, C, Podda, M, Osipov, A, Brisinda, G, Gambino, G, Akhmeteli, L, Doklestic, K, Loncar, Z, Micic, D, Lesevic, I, D'Agostino, F, Garzali, I, Caicedo, Y, Marcela, L, Marin, P, Perivoliotis, K, Ntentas, I, Kuptsov, A, Dimitrov, E, Chowdhury, S, Patel, T, Sartelli, M, Tartaglia, D, and Chiarugi, M
Subjects: Survival, Colon, Emergency, Acute care, Surgery, Morbidity, Mortality, Immunosuppression, Cancer
Abstract: Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild–moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild–moderate IC were reported such malignancy (753–100%), diabetes (103–13.7%), malnutrition (26–3.5%) and uremia (1–0.1%), while severe IC causes were steroids treatment (14–16.3%); neutropenia (7–8.1%), malignancy on chemotherapy (71–82.6%). Preoperative risk classification were reported as follow: mild–moderate: ASA 1–14 (1.9%); ASA 2–202 (26.8%); ASA 3–341 (45.3%); ASA 4–84 (11.2%); ASA 5–7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2–16 patients (18.6%); ASA 3–41 patients (47.7%); ASA 4–19 patients (22.1%); ASA 5–3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild–moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild–moderate and severe groups. Long-term survival data: in mild–moderate disease-free survival (median, IQR) is 28 (10–91) and in severe IC, it is 21 (10–94). Overall survival (median, IQR) is 44 (18–99) and 26 (20–90) in mild–moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16–81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild–moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients.
Published: 2023

7. Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients

Author: Spinelli, C., Strambi, S., Rossi, L., Bakkar, S., Massimino, M., Ferrari, A., Collini, P., Cecchetto, G., Bisogno, G., Inserra, A., Bianco, F., and Miccoli, P.
Published: 2016
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8. Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases

Author: Spinelli, C., Rossi, L., Strambi, S., Piscioneri, J., Natale, G., Bertocchini, A., and Messineo, A.
Published: 2016
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9. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review

Author: Spinelli, C., Rossi, L., Barbetta, A., Ugolini, C., and Strambi, S.
Published: 2015
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10. BLUNT TRAUMATIC SMALL BOWEL AND MESENTERIC INJURIES –A CAREFUL INTERPRETATION OF ABDOMINAL CT FINDINGS HELPS TO AVOID A DELAYED TREATMENT

Author: Fantacci, R., Strambi, S., Tartaglia, D., Ghio, G., Cobuccio, L., Bertolucci, A., Cengeli, I., Galatioto, C., and Chiarugi, M.
Published: 2019

11. Surgical management of adnexal torsion in children and adolescents: update and review of the literature

Author: Spinelli, Claudio, Piscioneri, J., Strambi, S., Bertocchini, A., Martin, A., Lo Piccolo, R., Ghionzoli, M., and Messineo, A.
Published: 2015

12. Differentiated thyroid carcinoma in childhood and adolescence: indication for conservative surgery. An italian multicentric study on 260 patients

Author: Spinelli, Claudio, Rossi, L, Strambi, S, Ferrari, A, Bisogno, G, Massimino, M, Inserra, A, and Miccoli, P.
Published: 2015

13. Effect on normalized testicular atrophy index (TAIn) in crptorchid infants treated with GNRHa pre and post operative vs surgery alone

Author: Spinelli, Claudio, Strambi, S, and Bianco, F.
Published: 2014

14. Malformazioni branchiali del collo in età pediatrica:esperienza chirurgica su 50 casi

Author: Spinelli, Claudio, Busetta, M, Strambi, S, Piccini, L, Fregoli, L, Lo Piccolo, R, Ghionzoli, M, and Messineo, A.
Published: 2014

15. GNRHa therapy in criptorchid children

Author: Spinelli, Claudio and Strambi, S.
Published: 2014

16. New protocol for treatment of cryptorchidi infants: GnRH a therapy before and after orchiopexy

Author: Spinelli, Claudio, Strambi, S, and Busetto, M.
Published: 2014

17. La chirurgia dei disordini della differenziazione sessuale

Author: Spinelli, Claudio and Strambi, S.
Published: 2014

18. Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases

Author: Spinelli, C., primary, Rossi, L., additional, Strambi, S., additional, Piscioneri, J., additional, Natale, G., additional, Bertocchini, A., additional, and Messineo, A., additional
Published: 2015
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19. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review

Author: Spinelli, C., primary, Rossi, L., additional, Barbetta, A., additional, Ugolini, C., additional, and Strambi, S., additional
Published: 2014
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20. Cross-correlation time frequency analysis for multiple EMG signals in Parkinson's disease: a wavelet approach

Author: DE MICHELE, G., Sello, S., Carboncini, MARIA CHIARA, Rossi, Bruno, and Strambi, S.
Published: 2003

21. System and method of processing electromyographic signals for the diagnosis of Parkinson's disease

Author: Carboncini, MARIA CHIARA, De Michele, G, Rossi, Bruno, Sello, S, and Strambi, S.
Subjects: EMG, Parkinson's disease, Parkinson's disease, EMG
Published: 2003

22. The relation between EMG activity and kinematic parameters strongly supports a role of the action tremor in parkinsonian bradykinesia. Movement Disorders, 16(1): 47-57, 2001

Author: Carboncini, M. C, Manzoni, D, Strambi, S, Bonuccelli, U, Pavese, N, Andre, Paolo, and Rossi, B.
Subjects: Bradykinesia, Action tremor, Parkinson's disease
Published: 2001

23. Kinematic and EMG characteristics of voluntary movement in unaffected district in spasmodic torticollis

Author: Carboncini, MARIA CHIARA, Strambi, S, and Rossi, Bruno
Published: 2001

24. Wavelet analysis of biomedical signals

Author: Ambrosino, N., primary, De Michele, G., additional, Sello, S., additional, and Strambi, S.-K., additional
Published: 2006
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25. New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Author: Ambrosino, N., primary and Strambi, S., additional
Published: 2004
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26. The relation between EMG activity and kinematic parameters strongly supports a role of the action tremor in parkinsonian bradykinesia

Author: Carboncini, M.C., primary, Manzoni, D., additional, Strambi, S., additional, Bonuccelli, U., additional, Pavese, N., additional, Andre, P., additional, and Rossi, B., additional
Published: 2001
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27. Primary Retroperitoneal Müllerian Adenocarcinoma: A Case Report and Literature Review.

Author: Spinelli, C., Strambi, S., Tartaglia, D., Di Franco, G., Pucci, V., Faviana, P., and Lencioni, M.
Published: 2013
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28. FES system for the upper limb in hemiparetic subject: A possible approach,Protocollo FES per l'arto superiore nell'emiplegico

Author: Manca, M. L., Starita, A., Maria Chiara Carboncini, Strambi, S., Dario, P., Sabatini, A., Guglielmelli, E., Micera, S., Lisi, P., and Rossi, B.

29. Current trends of occupational diseases: A case record analysis,Aspetti attuali della patologia professionale: Analisi di una casistica clinica

Author: Baldassarre, M., Moscato, G., Martellosio, V., Strambi, S., Agosti, A., Perfetti, L., Pala, G., Canto, A., Minelli, C. M., Rosso, G. L., Scafa, F., and STEFANO CANDURA

30. The unrestricted global effort to complete the COOL trial

Author: Andrew W. Kirkpatrick, Federico Coccolini, Matti Tolonen, Samuel Minor, Fausto Catena, Emanuel Gois, Christopher J. Doig, Michael D. Hill, Luca Ansaloni, Massimo Chiarugi, Dario Tartaglia, Orestis Ioannidis, Michael Sugrue, Elif Colak, S. Morad Hameed, Hanna Lampela, Vanni Agnoletti, Jessica L. McKee, Naisan Garraway, Massimo Sartelli, Chad G. Ball, Neil G. Parry, Kelly Voght, Lisa Julien, Jenna Kroeker, Derek J. Roberts, Peter Faris, Corina Tiruta, Ernest E. Moore, Lee Anne Ammons, Elissavet Anestiadou, Cino Bendinelli, Konstantinos Bouliaris, Rosemarry Carroll, Marco Ceresoli, Francesco Favi, Angela Gurrado, Joao Rezende-Neto, Arda Isik, Camilla Cremonini, Silivia Strambi, Georgios Koukoulis, Mario Testini, Sandy Trpcic, Alessandro Pasculli, Erika Picariello, Fikri Abu-Zidan, Ademola Adeyeye, Goran Augustin, Felipe Alconchel, Yuksel Altinel, Luz Adriana Hernandez Amin, José Manuel Aranda-Narváez, Oussama Baraket, Walter L. Biffl, Gian Luca Baiocchi, Luigi Bonavina, Giuseppe Brisinda, Luca Cardinali, Andrea Celotti, Mohamed Chaouch, Maria Chiarello, Gianluca Costa, Nicola de’Angelis, Nicolo De Manzini, Samir Delibegovic, Salomone Di Saverio, Belinda De Simone, Vincent Dubuisson, Pietro Fransvea, Gianluca Garulli, Alessio Giordano, Carlos Gomes, Firdaus Hayati, Jinjian Huang, Aini Fahriza Ibrahim, Tan Jih Huei, Ruhi Fadzlyana Jailani, Mansoor Khan, Alfonso Palmieri Luna, Manu L. N. G. Malbrain, Sanjay Marwah, Paul McBeth, Andrei Mihailescu, Alessia Morello, Francesk Mulita, Valentina Murzi, Ahmad Tarmizi Mohammad, Simran Parmar, Ajay Pak, Michael Pak-Kai Wong, Desire Pantalone, Mauro Podda, Caterina Puccioni, Kemal Rasa, Jianan Ren, Francesco Roscio, Antonio Gonzalez-Sanchez, Gabriele Sganga, Maximilian Scheiterle, Mihail Slavchev, Dmitry Smirnov, Lorenzo Tosi, Anand Trivedi, Jaime Andres Gonzalez Vega, Maciej Waledziak, Sofia Xenaki, Desmond Winter, Xiuwen Wu, Andee Dzulkarnean Zakaria, Zaidi Zakaria, Kirkpatrick, A, Coccolini, F, Tolonen, M, Minor, S, Catena, F, Gois, E, Doig, C, Hill, M, Ansaloni, L, Chiarugi, M, Tartaglia, D, Ioannidis, O, Sugrue, M, Colak, E, Hameed, S, Lampela, H, Agnoletti, V, Mckee, J, Garraway, N, Sartelli, M, Ball, C, Parry, N, Voght, K, Julien, L, Kroeker, J, Roberts, D, Faris, P, Tiruta, C, Moore, E, Ammons, L, Anestiadou, E, Bendinelli, C, Bouliaris, K, Carroll, R, Ceresoli, M, Favi, F, Gurrado, A, Rezende-Neto, J, Isik, A, Cremonini, C, Strambi, S, Koukoulis, G, Testini, M, Trpcic, S, Pasculli, A, Picariello, E, Abu-Zidan, F, Adeyeye, A, Augustin, G, Alconchel, F, Altinel, Y, Hernandez Amin, L, Aranda-Narvaez, J, Baraket, O, Biffl, W, Baiocchi, G, Bonavina, L, Brisinda, G, Cardinali, L, Celotti, A, Chaouch, M, Chiarello, M, Costa, G, De'Angelis, N, De Manzini, N, Delibegovic, S, Di Saverio, S, De Simone, B, Dubuisson, V, Fransvea, P, Garulli, G, Giordano, A, Gomes, C, Hayati, F, Huang, J, Ibrahim, A, Huei, T, Jailani, R, Khan, M, Luna, A, Malbrain, M, Marwah, S, Mcbeth, P, Mihailescu, A, Morello, A, Mulita, F, Murzi, V, Mohammad, A, Parmar, S, Pak, A, Wong, M, Pantalone, D, Podda, M, Puccioni, C, Rasa, K, Ren, J, Roscio, F, Gonzalez-Sanchez, A, Sganga, G, Scheiterle, M, Slavchev, M, Smirnov, D, Tosi, L, Trivedi, A, Vega, J, Waledziak, M, Xenaki, S, Winter, D, Wu, X, Zakaria, A, and Zakaria, Z
Subjects: Intraperitoneal sepsi, Laparotomy, Peritoniti, Randomized controlled trial, Septic shock, Emergency Medicine, Global health, Surgery, Open abdomen, Multiple organ dysfunction
Abstract: Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) (https://clinicaltrials.gov/ct2/show/NCT03163095). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. Methods The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. Discussion OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of “damage control”; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. Trial registration: National Institutes of Health (https://clinicaltrials.gov/ct2/show/NCT03163095).
Published: 2023

31. The Challenge of Melanocytic Lesions in Pediatric Patients: Clinical-Pathological Findings and the Diagnostic Value of PRAME

Author: Letizia Trotta, Giuseppe D’Abbronzo, Claudio Spinelli, Giuseppina Rosaria Umano, Vittoria Donofrio, Maria Elena Errico, Renato Franco, Silvia Strambi, Andrea Ronchi, Giulia Delehaye, Alfonso Papparella, Umano, G. R., Errico, M. E., D'Onofrio, V., Delehaye, G., Trotta, L., Spinelli, C., Strambi, S., Franco, R., D'Abbronzo, G., Ronchi, A., and Papparella, A.
Subjects: Cancer Research, medicine.medical_specialty, Malignancy, atypical spitzoid tumor, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, children, PRAME, melanoma, Medicine, immunohistochemistry, Pathological, neoplasms, RC254-282, Original Research, business.industry, Melanoma, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Dermatology, Oncology, 030220 oncology & carcinogenesis, Cohort, Immunohistochemistry, Differential diagnosis, business, Rare disease
Abstract: Pediatric melanoma is a rare disease especially in children aged younger than 10 years old. Recent estimates report a rise of disease incidence in both adults and children. Diagnostic work-up is challenging in pediatric melanoma, as it displays a wide range of clinical presentations. Immunohistochemical biomarkers have been reported as predictors of malignancy in melanoma, however data specific to pediatric melanoma are poor. Our study aims to contribute to provide evidence of pediatric melanoma clinical features and differential diagnosis in this patient population. We describe our experience with a retrospective case series of pigmented skin lesions including malignant melanoma, atypical spitzoid tumor, and benign nevi in children and adolescents aged less than 16 years. We described the clinical and demographic characteristics of the cohort and evaluated the immunohistochemical expression of the PReferentially expressed Antigen in MElanoma (PRAME) for differential diagnosis of melanoma in children. The series displayed a similar distribution of melanoma between males and females, and the most common site of melanoma onset were the upper and lower limbs. In our cohort, PRAME was negative in most cases. Focal and slight positivity (from 1 to 5% of the neoplastic cells) was observed in four cases (two Spitz nevi and two atypical Spitz tumors). A moderate positivity in 25% of the neoplastic cells was observed in one case of atypical Spitz tumor. Immunohistochemical expression of PRAME might be useful in the differential diagnosis of malignant melanoma.
Published: 2021

32. Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases.

Author: Coccolini F, Martinez-Perez A, Licitra G, De Angelis N, Cremonini C, Strambi S, Zocco G, Puglisi A, Tartaglia D, and Chiarugi M
Subjects: Humans, Male, Female, Prospective Studies, Adult, Middle Aged, Young Adult, Adolescent, Sensitivity and Specificity, Acute Disease, Aged, Appendicitis diagnostic imaging, Appendicitis surgery, Ultrasonography methods, Tomography, X-Ray Computed methods, Appendectomy
Abstract: Background: Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide., Material and Methods: A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes., Results: Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p < 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT-scan groups, respectively (p < 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT-scan (4.1%) (p < 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4-6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08)., Conclusion: The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low-resource settings worldwide. CT-scan association may improve the detection of patients who may potentially be submitted to conservative treatment., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
Published: 2024
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33. Adhesive small bowel obstruction: predictive factors of laparoscopic failure.

Author: Morelli M, Strambi S, Cremonini C, Musetti S, Tonerini M, Coccolini F, Chiarugi M, and Tartaglia D
Subjects: Humans, Tissue Adhesions complications, Tissue Adhesions surgery, Retrospective Studies, Postoperative Complications epidemiology, Postoperative Complications surgery, Treatment Outcome, Intestinal Obstruction diagnostic imaging, Intestinal Obstruction etiology, Intestinal Obstruction surgery, Laparoscopy methods
Abstract: The adoption of laparoscopy for the management of adhesive small bowel obstruction (ASBO) patients is debated. The laparoscopic approach has been associated with a considerable conversion-to-open rate. Nonetheless, reliable predictors of conversion are still unclear. The present study aimed to identify factors associated with conversion to open in ASBO patients who underwent laparoscopic surgery. Patients who underwent laparoscopic surgery for ASBO and were admitted to our unit between December 2014 and October 2022 were retrospectively evaluated. The patients were categorized into two groups: patients who underwent complete laparoscopy approach (Group 1) and patients converted to open technique (Group 2). Demographic, clinical, and radiological features, intraoperative findings, and postoperative outcomes were compared. A total of 168 patients were enrolled: 100 patients (59.5%) were included in Group 1, and 68 patients (40.5%) were included in Group 2. The rate of ischemia (p = 0.023), surgical complications (p = 0.001), operative time (p < 0.0001), days of nasogastric tube maintenance (p < 0.0001), time to canalization (p < 0.0001), and length of hospital stay (p < 0.0001) were significantly higher in Group 2 than Group 1. Following univariate analysis, the presence of feces signs (p = 0.044) and high mean radiodensity of intraperitoneal free fluid (p = 0.031) were significantly associated with Group 2 compared with Group 1. Following multivariate analysis, the feces sign was a significant predictive factor of conversion (OR 1.965 [IC 95%]; p = 0.046). Laparoscopic treatment is a safe and effective approach in patients affected by ASBO. The feces sign may be a predictive factor of conversion and could guide the surgeon in selecting the appropriate management of patients affected by ASBO., (© 2023. Italian Society of Surgery (SIC).)
Published: 2024
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34. What are the differences between the three most used classifications for acute colonic diverticulitis? A comparative multicenter study.

Author: Cremonini C, Biloslavo A, Robustelli V, Giannessi S, Rossi Del Monte S, Mastronardi M, Musetti S, Strambi S, Coccolini F, Chiarugi M, and Tartaglia D
Subjects: Humans, Prognosis, Retrospective Studies, Diverticulitis, Diverticulitis, Colonic diagnostic imaging, Diverticulitis, Colonic surgery
Abstract: Background: Acute left-sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. Currently, the most popular classifications, based on radiological findings, are the modified Hinchey, American Association for the Surgery of Trauma (AAST), and World Society of Emergency Surgery (WSES) classifications. We hypothesize that all classifications are equivalent in predicting outcomes., Methods: This is a retrospective study of 597 patients from four medical centers between 2014 and 2021. Based on clinical, radiological, and intraoperative findings, patients were graded according to the three classifications. Regression analysis and receiver operating characteristic curve analysis were used to compare six outcomes: need for intervention, complications, major complications (Clavien-Dindo >2), reintervention, hospital length of stay, and mortality., Results: A total of 597 patients were included. Need for intervention, morbidity, and reintervention rates significantly increased with increasing AAST, modified Hinchey, and WSES grades. The area under the curve (AUC) for the need for intervention was 0.84 for AAST and 0.81 for modified Hinchey ( p = 0.039). The AUC for major complications was 0.75 for modified Hinchey and 0.70 for WSES ( p = 0.009). No differences were found between the three classifications when comparing AUCs for mortality, complications, and reintervention rates., Conclusion: The AAST, WSES, and modified Hinchey classifications are similar in predicting complications, reintervention, and mortality rates. American Association for the Surgery of Trauma and modified Hinchey scores result the most adequate for predicting the need for surgery and the occurrence of major complications., Level of Evidence: Prognostic and Epidemiological; Level III., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Published: 2024
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35. Complication analysis in acute appendicitis, results from an international multicenter study.

Author: Coccolini F, Licitra G, De'Angelis N, Martinez Perez A, Cremonini C, Musetti S, Strambi S, Zampieri F, Cengeli I, Tartaglia D, and Chiarugi M
Subjects: Female, Humans, Young Adult, Adult, Male, Prospective Studies, Retrospective Studies, Appendectomy methods, Postoperative Complications epidemiology, Postoperative Complications etiology, Acute Disease, Appendicitis diagnostic imaging, Appendicitis surgery
Abstract: Purpose: Acute appendicitis (AA) is frequent, its diagnosis is challenging, and the surgical intervention is not risk free. An accurate diagnosis will reduce unnecessary surgeries and associated risks. This study aimed to analyze the rate of appendectomies' postoperative complications., Methods: Multicenter, prospective, observational study conducted at three large hospitals (Pisa University Hospital, Italy; Henri Mondor University Hospital, Paris, France; and Valencia University Hospital, Spain)., Results: A total of 3070 patients with a median age of 28 years (IQR 20-43) were enrolled. 1403 (45.7%) were females. Eight hundred ninety patients (29%) did not undergo preoperative imaging. Ultrasound and CT scans were performed in 1465 (47.7%) and 715 (23.3%) patients. Patients requiring CT scan were older [median 38 (IQR 26-53) vs. no imaging median 24 (IQR 16-35), Ultrasound median 28 (IQR 20-41); p < 0.0001]. Laparoscopic appendectomy was performed in 58.6%. Complications developed in 1279 (41.7%) patients: Clavien-Dindo grades I-II in 1126 (33.9%); Clavien-Dindo grades III-IV in 146 (5.2%). Overall mortality was 0.2%. Following resection of a normal appendix, 15% experienced major complications (Clavien-Dindo grades IIIb and above). Multivariable analysis revealed that age, Charlson comorbidity index, histopathology, and Alvarado score over 7 were associated with a higher risk of Clavien-Dindo complication grades IIIa and higher., Conclusion: Appendectomy may be associated with serious postoperative complications. Complications were associated with older age, Charlson comorbidity index, histopathology, and high Alvarado scores. The definition of accurate diagnostic and therapeutic pathways may improve results. The association between clinical scores and radiology is recommended., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Published: 2024
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36. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T).

Author: Tartaglia D, Cremonini C, Annunziata E, Catena F, Sartelli M, Kirkpatrick AW, Musetti S, Strambi S, Chiarugi M, and Coccolini F
Subjects: Humans, Middle Aged, Aged, Treatment Outcome, Colostomy adverse effects, Anastomosis, Surgical adverse effects, Immunocompromised Host, Internet, Diverticulitis, Colonic surgery, Diverticulitis, Colonic complications, Diverticulitis complications, Intestinal Perforation etiology, Intestinal Perforation surgery, Peritonitis etiology
Abstract: Background: Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis., Methods: We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2)., Results: Data from 482 patients were analyzed-229 patients (47.5%) [M:F = 1:1; median age: 60 (24-95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26-94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann's procedure is mainly performed in grades 1-2 (p < 0.0001). Major complications increased significantly after a Hartmann's procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002)., Conclusions: Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann's procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay., (© 2023. The Author(s).)
Published: 2023
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37. Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial).

Author: Coccolini F, Mazzoni A, Cremonini C, Cobuccio L, Pucciarelli M, Vetere G, Borelli B, Strambi S, Musetti S, Miccoli M, Cremolini C, Tartaglia D, and Chiarugi M
Subjects: Humans, Aged, Immunocompromised Host, Internet, Emergencies, Colorectal Neoplasms surgery
Abstract: Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild-moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild-moderate IC were reported such malignancy (753-100%), diabetes (103-13.7%), malnutrition (26-3.5%) and uremia (1-0.1%), while severe IC causes were steroids treatment (14-16.3%); neutropenia (7-8.1%), malignancy on chemotherapy (71-82.6%). Preoperative risk classification were reported as follow: mild-moderate: ASA 1-14 (1.9%); ASA 2-202 (26.8%); ASA 3-341 (45.3%); ASA 4-84 (11.2%); ASA 5-7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2-16 patients (18.6%); ASA 3-41 patients (47.7%); ASA 4-19 patients (22.1%); ASA 5-3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild-moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild-moderate and severe groups. Long-term survival data: in mild-moderate disease-free survival (median, IQR) is 28 (10-91) and in severe IC, it is 21 (10-94). Overall survival (median, IQR) is 44 (18-99) and 26 (20-90) in mild-moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16-81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild-moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients., (© 2023. The Author(s).)
Published: 2023
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38. Ovarian torsion in the pediatric population: predictive factors for ovarian-sparing surgery-an international retrospective multicenter study and a systematic review.

Author: Spinelli C, Tröbs RB, Nissen M, Strambi S, Ghionzoli M, Bertocchini A, Cagnetta Domass V, Sanna B, Morganti R, Molinaro F, Messina M, Tursini S, Briganti V, Gennari F, Lisi G, and Lelli Chiesa P
Subjects: Female, Child, Humans, Retrospective Studies, Ovarian Torsion, Torsion Abnormality diagnosis, Torsion Abnormality surgery, Abdominal Pain etiology, Multicenter Studies as Topic, Ovarian Diseases diagnosis, Ovarian Diseases surgery, Cysts
Abstract: Study Objective: Ovarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making., Design: We conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010-2020)., Participants: Patients aged 0-18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions., Results: Ninety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary., Conclusions: Our results showed that a post-menarchal age (p = .001), a pre-operative US ovarian size < 5 cm, (p = .001), the presence of severe abdominal pain (p = .002), a laparoscopic approach (p < .001), and the presence of a functional cyst (p = .002) were significantly associated with conservative surgery., (© 2022. The Author(s).)
Published: 2023
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39. The unrestricted global effort to complete the COOL trial.

Author: Kirkpatrick AW, Coccolini F, Tolonen M, Minor S, Catena F, Gois E Jr, Doig CJ, Hill MD, Ansaloni L, Chiarugi M, Tartaglia D, Ioannidis O, Sugrue M, Colak E, Hameed SM, Lampela H, Agnoletti V, McKee JL, Garraway N, Sartelli M, Ball CG, Parry NG, Voght K, Julien L, Kroeker J, Roberts DJ, Faris P, Tiruta C, Moore EE, Ammons LA, Anestiadou E, Bendinelli C, Bouliaris K, Carroll R, Ceresoli M, Favi F, Gurrado A, Rezende-Neto J, Isik A, Cremonini C, Strambi S, Koukoulis G, Testini M, Trpcic S, Pasculli A, Picariello E, Abu-Zidan F, Adeyeye A, Augustin G, Alconchel F, Altinel Y, Hernandez Amin LA, Aranda-Narváez JM, Baraket O, Biffl WL, Baiocchi GL, Bonavina L, Brisinda G, Cardinali L, Celotti A, Chaouch M, Chiarello M, Costa G, de'Angelis N, De Manzini N, Delibegovic S, Di Saverio S, De Simone B, Dubuisson V, Fransvea P, Garulli G, Giordano A, Gomes C, Hayati F, Huang J, Ibrahim AF, Huei TJ, Jailani RF, Khan M, Luna AP, Malbrain MLNG, Marwah S, McBeth P, Mihailescu A, Morello A, Mulita F, Murzi V, Mohammad AT, Parmar S, Pak A, Wong MP, Pantalone D, Podda M, Puccioni C, Rasa K, Ren J, Roscio F, Gonzalez-Sanchez A, Sganga G, Scheiterle M, Slavchev M, Smirnov D, Tosi L, Trivedi A, Vega JAG, Waledziak M, Xenaki S, Winter D, Wu X, Zakaria AD, and Zakaria Z
Subjects: Humans, Inflammation, Multiple Organ Failure etiology, Prospective Studies, United States, Abdomen, Laparotomy adverse effects
Abstract: Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study., Methods: The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer., Discussion: OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of "damage control"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention., Trial Registration: National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 )., (© 2023. The Author(s).)
Published: 2023
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40. Laparoscopic versus open repair of perforated peptic ulcers: analysis of outcomes and identification of predictive factors of conversion.

Author: Tartaglia D, Strambi S, Coccolini F, Mazzoni A, Miccoli M, Cremonini C, Cicuttin E, and Chiarugi M
Subjects: Humans, Retrospective Studies, Ulcer complications, Ulcer surgery, Risk Factors, Length of Stay, Postoperative Complications etiology, Treatment Outcome, Peptic Ulcer Perforation surgery, Peptic Ulcer Perforation etiology, Laparoscopy adverse effects
Abstract: Background: The surgical treatment for perforated peptic ulcers (PPUs) can be safely performed laparoscopically. This study aimed to compare the outcomes of patients who received different surgical approaches for PPU and to identify the predictive factors for conversion to open surgery., Methods: This retrospective study analyzed patients treated for PPUs from 2002 to 2020. Three groups were identified: a complete laparoscopic surgery group (LG), a conversion to open group (CG), and a primary open group (OG). After univariate comparisons, a multivariate analysis was conducted to identify the predictive factors for conversion., Results: Of the 175 patients that underwent surgery for PPU, 104 (59.4%) received a laparoscopic-first approach, and 27 (25.9%) required a conversion to open surgery. Patients treated directly with an open approach were older (p < 0.0001), had more comorbidities (p < 0.0001), and more frequently had a previous laparotomy (p = 0.0001). In the OG group, in-hospital mortality and ICU need were significantly higher, while the postoperative stay was longer. Previous abdominal surgery (OR 0.086, 95% CI 0.012-0.626; p = 0.015), ulcer size (OR 0.045, 95% CI 0.010-0.210; p < 0.0001), and a posterior ulcer location (OR 0.015, 95% CI 0.001-0.400; p = 0.012) were predictive factors for conversion to an open approach., Conclusion: This study confirms the benefits of the laparoscopic approach for the treatment of PPUs. Previous laparotomies, a greater ulcer size, and a posterior location of the ulcer are risk factors for conversion to open surgery during laparoscopic repair., (© 2022. The Author(s).)
Published: 2023
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41. Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA).

Author: Sibilla MG, Cremonini C, Portinari M, Carcoforo P, Tartaglia D, Cicuttin E, Musetti S, Strambi S, Sartelli M, Radica MK, Catena F, Chiarugi M, and Coccolini F
Subjects: Humans, Male, Middle Aged, Female, Asia, Europe, Vacuum
Abstract: Background: International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents., Material and Methods: A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA)., Trial Registration: NCT02382770., Results: 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49-74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero-atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2-7). The overall intensive care unit and hospital length-of-stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001)., Conclusion: There is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome., (© 2022. The Author(s).)
Published: 2023
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42. Factors associated with postoperative hypocalcemia following thyroidectomy in childhood.

Author: Spinelli C, Ghionzoli M, Bertocchini A, Sanna B, Plessi C, Strambi S, De Napoli L, Frustaci G, Materazzi G, Antonelli A, Morganti R, Gennari F, Inserra A, Bisogno G, Gamba P, Ferrari A, and Massimino M
Subjects: Aged, Calcium, Child, Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Thyroidectomy adverse effects, Hypocalcemia epidemiology, Hypocalcemia etiology, Hypoparathyroidism epidemiology, Hypoparathyroidism etiology, Thyroid Neoplasms pathology
Abstract: Background: Postoperative hypocalcemia is a frequent complication after thyroidectomy. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. We analyzed factors associated with the development of postoperative hypoparathyroidism and in detail PtHP following thyroid surgery in a pediatric population., Procedure: A retrospective multicenter study analyzing 326 patients was carried out. We recorded gender, age, tumor size, thyroiditis, extrathyroidal extension, lymph node dissection (central/lateral compartment, unilateral/bilateral), parathyroid autotransplantation, and histology. Additionally, calcium levels were acquired postoperatively., Results: We analyzed pediatric patients ≤18 years who underwent thyroidectomy clustered into age groups (≤15 or > 15). Patients' mean follow-up was 5.8 years (1-11 years). Postoperative hypoparathyroidism occurred in 36 (11.0%): 20 cases (6.13%) developed PtHP. Postoperative hypoparathyroidism was more frequent in younger patients (P = 0.014), in larger tumors (P < 0.001), in case of extrathyroidal extension (P = 0.037), and in central compartment (P = 0.020) and bilateral lymph node dissection (P = 0.030). PtHP was more frequent in older patients (P = 0.014), in case of thyroiditis (P < 0.001), and extrathyroidal extension (P < 0.001). Concerning the first postoperative calcium level measurement, in the postoperative hypoparathyroidism group, we registered a 8.17 mg/dL value with 14% pre/postoperative decrease (Δ Ca ), whereas in PtHP patient group calcium level was 7.91 mg/dL with 16.7% Δ Ca ., Conclusions: The risk of postoperative hypoparathyroidism is related to younger age, tumor size, central compartment and bilateral lymph node dissection, extrathyroidal extension, and decrease in postoperative calcium levels. The risk of PtHP is related to older age, thyroiditis, extrathyroidal extension, and decrease in postoperative calcium levels., (© 2022 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)
Published: 2022
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43. Thyroid cancer in children: A multicenter international study highlighting clinical features and surgical outcomes of primary and secondary tumors.

Author: Martucci C, Crocoli A, De Pasquale MD, Spinelli C, Strambi S, Brazzarola P, Morelli E, Cassiani J, Mancera J, Luengas JP, Lobos P, Liberto D, Astori E, Sarnacki S, Couloigner V, Simon F, Lambert C, Abib SCV, Cervantes O, Caran E, Delgado Lindman D, Jones MO, Shukla R, Losty PD, and Inserra A
Abstract: Background: Thyroid gland malignancies are rare in pediatric patients (0.7% of tumors); only 1.8% are observed in patients aged <20 years, with a higher prevalence recorded in women and adolescents. Risk factors include genetic syndromes, MEN disorders, autoimmune diseases, and exposure to ionizing radiation. Radiotherapy is also associated with an increased risk of secondary thyroid cancer. This study describes the clinical features and surgical outcomes of primary and secondary thyroid tumors in pediatric patients., Methods: Institutional data were collected from eight international surgical oncology centers for pediatric patients with thyroid cancer between 2000 and 2020. Statistical analyses were performed using the GraphPad Prism software., Results: Among 255 total cases of thyroid cancer, only 13 (5.1%) were secondary tumors. Primary thyroid malignancies were more likely to be multifocal in origin (odds ratio [OR] 1.993, 95% confidence interval [CI].7466-5.132, p = 0.2323), have bilateral glandular location (OR 2.847, 95% CI.6835-12.68, p = 0.2648), and be metastatic at first diagnosis (OR 1.259, 95% CI.3267-5.696, p > 0.999). Secondary tumors showed a higher incidence of disease relapse (OR 1.556, 95% CI.4579-5.57, p = 0.4525) and surgical complications (OR 2.042, 95% CI 0.7917-5.221, p = 0.1614), including hypoparathyroidism and recurrent laryngeal nerve injury. The overall survival (OS) was 99% at 1 year and 97% after 10 years. No EFS differences were evident between the primary and secondary tumors (chi-square 0.7307, p = 0.39026)., Conclusions: This multicenter study demonstrated excellent survival in pediatric thyroid malignancies. Secondary tumors exhibited greater disease relapse (15.8 vs. 10.5%) and a higher incidence of surgical complications (36.8 vs. 22.2%)., (Copyright © 2022 Martucci, Crocoli, De Pasquale, Spinelli, Strambi, Brazzarola, Morelli, Cassiani, Mancera, Luengas, Lobos, Liberto, Astori, Sarnacki, Couloigner, Simon, Lambert, Abib, Cervantes, Caran, Delgado Lindman, Jones, Shukla, Losty and Inserra.)
Published: 2022
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44. Correlation between testicular volume and histological findings in children with unilateral cryptorchidism: Potential impact on future fertility.

Author: Spinelli C, Morelli G, Cito G, Bertocchini A, Ghionzoli M, Pucci A, Cocci A, Morganti R, and Strambi S
Subjects: Biopsy, Child, Fertility, Humans, Infant, Male, Prospective Studies, Testis pathology, Cryptorchidism surgery
Abstract: Objectives: Our aim is to assess the correlation between testicular volume and histological findings in children with unilateral cryptorchidism., Methods: From September 2016 to August 2018, from 60 patients surgically treated for cryptorchidism, 45 children were enrolled in this single-center prospective study. Depending on the degree of testicular volume reduction, patients were divided into Group 1 with <20% reduction and Group 2 with reduction ⩾20%. Patients underwent unilateral orchidopexy and simultaneous biopsy of the undescended testis. Tanner stage was assigned. Tubular Fertility Index was measured., Results: Group 1 included 20 patients (44.4%) and Group 2 included 25 patients (55.5%). Mean age was 2.10 years (range 12 months-3.8 years) in Group 1 and 2.8 years (range 18 months-4.41 years) in Group 2. Although there is a positive correlation between testicular volume and Tubular Fertility Index, no significant association was found between groups ( p -value = 0.29). Furthermore, histological patterns did not differ significantly among groups., Conclusions: The degree of volume reduction in undescended testis does not seem to correlate significantly with the severity of histological changes that accompany cryptorchidism. Tubular Fertility Index could serve as objective tool for the assessment of future fertility.
Published: 2022
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45. Intestinal Ischemia: Unusual but Fearsome Complication of COVID-19 Infection.

Author: Strambi S, Proietti A, Galatioto C, Coccolini F, Cremonini C, Musetti S, Basolo F, Chiarugi M, and Tartaglia D
Abstract: The pathophysiology of gastrointestinal damage in coronavirus disease (COVID-19) is probably multifactorial. It is not clear whether the etiology of intestinal ischemia may be directly related to viral replication or may result from hyper-coagulability following SARS-CoV-2 infection.To confirm a pathogenic role of COVID-19, we retrospectively investigated the presence of SARS-CoV-2 virus in the ischemic bowel of five COVID-19 patients undergoing emergency surgery for intestinal ischemia in the period of March 2020-May 2021. Immunohistochemical positivity with weak intensity was observed in four out of five cases, but only one case was strongly positive both at immunohistochemistry and at molecular analysis. The histological alterations in the intestinal tissue samples showed similarity with the well-known alterations described in typical targetorgans of the virus (e.g., the lung). This observation suggests a similar mechanism of action of the virus. Further larger studies are, thus, required to confirm this preliminary finding. Clinicians should carefully monitor all COVID-19 patients for the possible presence of a SARS-CoV-2 intestinal infection, a potential cause of ischemia and bowel perforation.
Published: 2022
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46. Sarcina Ventriculi infection: a rare but fearsome event. A Systematic Review of the Literature.

Author: Tartaglia D, Coccolini F, Mazzoni A, Strambi S, Cicuttin E, Cremonini C, Taddei G, Puglisi AG, Ugolini C, Di Stefano I, Basolo F, and Chiarugi M
Subjects: Anti-Bacterial Agents therapeutic use, Clostridium, Female, Humans, Middle Aged, Sarcina, Stomach Diseases
Abstract: Objectives: This study is aimed to report a case of SV-related gastritis and the results of a systematic literature review of SV infections., Methods: Following a case presentation, we systematically searched different databases (MEDLINE, PubMed, Scopus, Web of Science, EMBASE, google scholar) for the items "sarcina," "ventriculi," "clostridium" with AND/OR., Results: A total of 55 articles reporting 65 cases of Sarcina Ventriculi were found. Thus, 66 patients, including our case, were reviewed. The median age was 51 years (IQR: 0-87 years). Females accounted for 51% of cases. 68% of patients had one or more comorbidities. SV was isolated in the gastrointestinal tract (88%), respiratory (5%), urine (4%), and bloodstream (3%) systems. Upper endoscopy was performed in 52 patients (79%). Biopsies were obtained in all 52 cases and were normal in 23%. Surgery was warranted in 15 patients (23%), and specific antimicrobial therapy was delivered in 34 (52%) patients. Mortality was 14%. At follow-up, 88% of patients showed complete eradication of the SV infection., Conclusions: Upper gastrointestinal biopsy positive for SV should prompt an evaluation of the clinical conditions, considering the risk of gastric perforation is not negligible. Antibiotic therapy may eradicate the infection and prevent complications. Emergency surgery is required in case of source control., Competing Interests: Declaration of Competing Interest No conflict of interest to declare., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Published: 2022
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47. The fat anchor orchiopexy technique: results and outcomes from 150 cases surgical experience.

Author: Spinelli C, Bertocchini A, Cito G, Ghionzoli M, and Strambi S
Subjects: Child, Child, Preschool, Humans, Infant, Male, Retrospective Studies, Scrotum surgery, Treatment Outcome, Cryptorchidism surgery, Orchiopexy
Abstract: Purpose: The purpose of the study is to evaluate results and outcomes in a long-time follow-up period, by performing a novel testicular fixation procedure, known as "fat anchor orchidopexy" (FAO), for the treatment of palpable low inguinal undescended testis., Materials and Methods: We retrospectively reviewed all patients who underwent scrotal orchiopexy technique, from May 2013 to May 2019, at the Pediatric Surgery Division of Department of Surgical Pathology, University of Pisa (Italy). FAO (Spinelli's technique) consists in anchoring the testicles to sub-scrotal fat with a single trans-scrotal incision. All the patients enrolled had history of unilateral or bilateral undescended testis. Data collected included patient's age, operative times and complications., Results: A total of 150 children with cryptorchidism were treated using a single trans-scrotal orchiopexy. Of them, 130 patients (86.7%) had unilateral undescended testis and 20 (13.3%) bilateral cryptorchidism. Mean patient's age was 21 months (range: 14-28 months). All the procedures were planned in a day-surgery setting. Trans-scrotal orchiopexy was successful in all cases and no patients required an additional groin incision. No intraoperatively and postoperatively major complications were observed. Patients' post-operative pain was mild (mean pediatric visual analog scale = 2). In all cases, the healing process was rapid and no surgical wounds infections were reported during the post-operative period, referring excellent cosmesis results. During a mean 48-month follow-up period, no testicular retraction, recurrence or testis atrophy was reported., Conclusion: The original Spinelli's technique (FAO) proves to be a safe and effective method for the treatment of palpable or distal-to-external-inguinal-ring testes. No immediate and delayed post-surgery complications were reported. In all cases, the anchored testicle remained in the scrotal position with normal vascularization. This novel surgical technique could give better options for scrotal fixation in case of low-lying cryptorchid testes., (© 2021. The Author(s).)
Published: 2022
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48. Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence.

Author: Cicuttin E, Sartelli M, Scozzafava E, Tartaglia D, Cremonini C, Brevi B, Ramacciotti N, Musetti S, Strambi S, Podda M, Catena F, Chiarugi M, and Coccolini F
Abstract: Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.
Published: 2022
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49. Laparoscopic cholecystectomy for acute calculous cholecystitis in elderly. More complex but equally safe and effective.

Author: Tartaglia D, Coccolini F, Cremonini C, Strambi S, Musetti S, Cicuttin E, Di Dato A, Cobuccio L, Cengeli I, Pucciarelli M, and Chiarugi M
Subjects: Aged, Aged, 80 and over, Humans, Male, Cholecystectomy, Common Bile Duct, Length of Stay, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Retrospective Studies, Treatment Outcome, Female, Cholecystectomy, Laparoscopic adverse effects, Cholecystitis, Acute surgery, Gallstones complications, Gallstones surgery
Abstract: Aim: Acute calculous cholecystitis (ACC) is one of the most common pathologies in the elderly. Laparoscopy is the gold standard for ACC treatment, regardless of age. This study aimed to compare different classes of elderly patients affected by ACC and assess whether laparoscopy has the same safety and effectiveness as younger patients., Materials and Methods: Patients aging ≠ 70 y-o presenting with ACC treated with laparoscopic cholecystectomy were prospectively enrolled from 2010 to 2020. Three groups were identified: age 70-75 (Group 1); age 76-80 (Group 2); Age > 80 (Group 3). Major postoperative complications were considered as more than grade II according to the Clavien and Dindo classification. Demographic, intra-, and postoperative outcomes were compared. A multivariate analysis was also performed to identify predictive factors of morbidity., Results: We reviewed 832 patients: 302 (36.3%) were ≠ 70 y-o. Group 1 accounted for 124 patients (41.1%), group 2 for 74 (24.5%) and group 3 for 104 (34.3%). Male gender was significantly less represented with increasing ages (p<0.001). ASA score >2 (p=0.010), CACI score (p<0.001), and ERD score (p<0.001) were more frequent in group 3. No significant differences were found about AAST distribution and comorbidities. Conversion to open rate was significantly higher in group 1 (6.5%) and group 3 (8.7%) (p=0.019). Common bile duct stones rate was higher in group 3 (14.5% vs 13.5% vs 31.7%; p<0.001). Median postoperative hospital length of stay was increasingly longer (p<0.001). AAST grade ≠ 3 (OR 3.187; 95% CI 1.356-7.489; p=0.008), age ≠ 70 y-o (OR 3.358; p<0.001), and CBD stones (OR 2.912; 95% CI 1.456-5.824; p=0.003) were identified as predictive factors of morbidity between < and ≠ 70 ys. Among the three groups of elderly, age > 80 ys was associated with an increase of OR of postoperative complication by 2.94 (95% CI 1.099-7.912; p = 0.032)., Conclusions: Laparoscopy can be safely offered in elderly patients, although longer postoperative hospital stay. The presence of associated CBD stones may increase the risk of morbidity., Key Words: Acute calculous cholecystitis, Cholecystectomy, Common bile duct lithiasis, Elderly, Frailty, Laparoscopy.
Published: 2022

50. Surgical management of ovarian teratomas in childhood: a multicentric study on 110 cases and a literature review.

Author: Spinelli C, Strambi S, Masoni B, Ghionzoli M, Bertocchini A, Sanna B, Morganti R, Messina M, Molinaro F, Tursini S, Briganti V, Lisi G, and Lelli Chiesa P
Subjects: Adolescent, Child, Child, Preschool, Female, Fertility Preservation methods, Humans, Infant, Laparoscopy, Ovarian Neoplasms epidemiology, Ovarian Neoplasms pathology, Ovariectomy, Retrospective Studies, Teratoma epidemiology, Teratoma pathology, Ovarian Neoplasms surgery, Teratoma surgery
Abstract: Aim of the Study: To compare a multicentric surgical experience on ovarian teratomas in childhood with the current management trends., Design: A retrospective multicentric pediatric ovarian teratomas surgically treated between January 2000 and August 2020 at four Italian institutions. PubMed database was used to search for Reviews and Systematic Reviews published between January 2010 and August 2020: 15 manuscripts reported 3633 ovarian neoplasms in pediatric age, 1219 (33,5%) of which were ovarian teratomas., Results: A hundred-ten patients with a mean age at diagnosis of 11.8 years were enrolled. Mature cystic teratomas accounted for the 90% of the masses. At surgery, 78 were oophorectomies and 32 were ovary sparing surgeries. Laparoscopy occurred in 16.3% of the surgeries.As regarding the current management trends, the mean age at diagnosis was 11.9 years and 80.5% of the cases were represented by mature teratomas. Of 430 procedures, 331 were oophorectomies while 99 were ovary sparing surgeries and laparoscopy was performed in 23.8% of cases., Conclusions: Ovary-sparing surgery with laparoscopic approach is increasingly offered as standard treatment for benign masses that fit the criteria for mature teratomas, in the attempt to achieve the best compromise between the preservation of fertility and the prevention of recurrences. Awareness should be raised among pediatric surgeons to reduce unnecessary radical surgery.
Published: 2021
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