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1. Predicting a Prolonged Air Leak After Video-Assisted Thoracic Surgery, Is It Really Possible?

Author

Mancuso, M., Pernazza, F., Refai, M., Srella, F., Argnani, D., Marulli, G., De Palma, A., Bortolotti, L., Rizzardi, G., Solli, P.G., Dolci, G.P., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Sollitto, F., Ardò, N., Pariscenti, G.L., Risso, C., Surrente, C., Lopez, C., Droghetti, A., Giovanardi, M., Breda, C., Giudice, Lo F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Nosotti, M., Tosi, D., Negri, G.P., Bandiera, A., Baisi, A., Raveglia, F., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Curcio, C., Amore, D., Rena, O., Nicotra, S., Dell’ Amore, A., Bertani, A., Tancredi, G., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Cardillo, G., Carleo, F., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Crisci, R., Divisi, D., Lausi, P., Guerrera, F., Fontana, D., Beffa, V. Della, Morelli, A., Londero, F., Imperatori, A., Rotolo, N., Terzi, A., Viti, A., Infante, M., Benato, C., Zaraca, Francesco, Pipitone, Marco, Feil, Birgit, Perkmann, Reinhold, Bertolaccini, Luca, Curcio, Carlo, and Crisci, Roberto

Published
2021
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2. Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

Author

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

Abstract

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

Published
2024

3. Comparison of operative and postoperative characteristics and outcomes between thoracoscopic segmentectomy and lobectomy for non-small-cell lung cancer: a propensity score matching study from the Italian VATS Group Registry

Author

Dell'Amore, A., Lomangino, I., Cannone, G., Terzi, S., Pangoni, A., Lorenzoni, G., Nicotra, S., Schiavon, M., Zuin, A., Gregori, D., Crisci, R., Curcio, C., Rea, F., Mancuso, M., Pernazza, F., Refai, M., Bortolotti, L., Rizzardi, G., Solli, P., Brandolini, I., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Stella, F., Argnani, D., Pariscenti, G. L., Iurilli, S., Surrente, C., Lopez, C., Droghett, A., Giovanardi, M., Breda, C., Lo Giudice, F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Nosotti, M., Rosso, L., Negri, G. P., Bandiera, A., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Amore, D., Baietto, G., Casadio, C., Bertani, A., Russo, E., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Andreetti, C., Poggi, C., Cardillo, G., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Zaccagna, G., Lausi, P., Guerrera, F., Fontana, D., Della Beffa, V., Morelli, A., Londero, F., Imperatori, N., Rotolo, A., Terzi, A., Viti, A., Infante, M., and Benato, C.

Subjects
Segmentectomy, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, VATS lobectomy, Video-assisted thoracic surgery, Context (language use), Mastectomy, Segmental, Postoperative outcome, Postoperative Complications, Lobectomy, Non-small-cell lung cancer, Carcinoma, Non-Small-Cell Lung, Humans, Medicine, Registries, Thoracotomy, Pneumonectomy, Propensity Score, Lung cancer, Retrospective Studies, Thoracic Surgery, Video-Assisted, business.industry, Confounding, Postoperative complication, General Medicine, medicine.disease, Surgery, Propensity score matching, Non small cell, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes. METHODS We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry. RESULTS The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality. CONCLUSIONS Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.

Published
2021

5. A Delphi Consensus report from the 'Prolonged Air Leak: A Survey' study group on prevention and management of postoperative air leaks after minimally invasive anatomical resections

Author

Zaraca, F., Brunelli, A., Pipitone, M. D., Abdellateef, A., Abu Akar, F., Augustin, F., Batchelor, T., Bertani, A., Crisci, R., D'Amico, T., D'Journo, X. B., Droghetti, A., Fang, W., Gonfiotti, A., Janík, M., Jimenez, M., Kirschbaum, A., Kostic, M., Lazzaro, R., Lucchi, M., Marra, Angelo Alessandro, Murthy, S., Ng, C. S. H., Nachira, Dania, Pardolesi, A., Perkmann, R., Petersen, R. H., Pischik, V., Russo, M. D., Opitz, I., Spaggiari, L., Ugalde, P. A., Vannucci, F., Veronesi, G., Bertolaccini, L., Marra A. (ORCID:0000-0001-8384-5081), Nachira D. (ORCID:0000-0003-2937-9678), Zaraca, F., Brunelli, A., Pipitone, M. D., Abdellateef, A., Abu Akar, F., Augustin, F., Batchelor, T., Bertani, A., Crisci, R., D'Amico, T., D'Journo, X. B., Droghetti, A., Fang, W., Gonfiotti, A., Janík, M., Jimenez, M., Kirschbaum, A., Kostic, M., Lazzaro, R., Lucchi, M., Marra, Angelo Alessandro, Murthy, S., Ng, C. S. H., Nachira, Dania, Pardolesi, A., Perkmann, R., Petersen, R. H., Pischik, V., Russo, M. D., Opitz, I., Spaggiari, L., Ugalde, P. A., Vannucci, F., Veronesi, G., Bertolaccini, L., Marra A. (ORCID:0000-0001-8384-5081), and Nachira D. (ORCID:0000-0003-2937-9678)

Abstract

OBJECTIVES: This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice.METHODS: A panel of 45 questions was developed and submitted to an international working group of experts in minimally invasive lung cancer surgery. Modified Delphi methodology was used to review responses, including 3 rounds of voting. The consensus was defined a priori as >50% agreement among the experts. Clinical practice standards were graded as recommended or highly recommended if 50-74% or >75% of the experts reached an agreement, respectively.RESULTS: A total of 32 experts from 18 countries completed the questionnaires in all 3 rounds. Respondents agreed that PAL are defined as >5 days and that current risk models are rarely used. The consensus was reached in 33/45 issues (73.3%). IAL were classified as mild (<100 ml/min; 81%), moderate (100-400 ml/min; 71%) and severe (>400 ml/min; 74%). If mild IAL are detected, 68% do not treat; if moderate, consensus was not; if severe, 90% favoured treatment.CONCLUSIONS: This expert consensus working group reached an agreement on the majority of issues regarding the detection and management of IAL and PAL. In the absence of prospective, randomized evidence supporting most of these clinical decisions, this document may serve as a guideline to reduce practice variation.

Published
2022

6. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database

Author

Tosi, D, Nosotti, M, Bonitta, G, Mazzucco, A, Righi, I, Mendogni, P, Rosso, L, Palleschi, A, Rocco, G, Crisci, R, Mancuso, M, Pernazza, F, Refai, M, Bortolotti, L, Rizzardi, G, Gargiulo, G, Dolci, Gp, Perkmann, R, Zaraca, F, Benvenuti, M, Gavezzoli, D, Cherchi, R, Ferrari, P, Mucilli, F, Camplese, P, Melloni, G, Mazza, F, Cavallesco, G, Maniscalco, P, Voltolini, L, Gonfiotti, A, Stella, F, Argnani, D, Pariscenti, Gl, Lurilli, Surrente, C, Lopez, C, Droghetti, A, Giovanardi, M, Breda, C, Lo Giudice, F, Alloisio, M, Bottoni, E, Spaggiari, L, Gasparri, R, Torre, M, Rinaldo, A, Negri, Gp, Bandiera, A, Stefani, A, Natali, P, Scarci, M, Pirondini, E, Curcio, C, Amore, D, Baietto, G, Casadio, C, Nicotra, S, Dell'Amore, A, Bertani, A, Russo, E, Ampollini, L, Carbognani, P, Puma, F, Vinci, D, Andreetti, C, Poggi, C, Cardillo, G, Margaritora, S, Meacci, Elisa, Luzzi, L, Ghisalberti, M, Zaccagna, G, Lausi, P, Guerrera, F, Fontana, D, Della Beffa, V, Morelli, A, Londero, F, Imperatori, A, Rotolo, N, Terzi, A, Viti, A, Infante, M, Benato, C, Tosi, D., Nosotti, M., Bonitta, G., Mazzucco, A., Righi, I., Mendogni, P., Rosso, L., Palleschi, A., Rocco, G., Crisci, R., Mancuso, M., Pernazza, F., Refai, M., Bortolotti, L., Rizzardi, G., Gargiulo, G., Dolci, G. P., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Stella, F., Argnani, D., Pariscenti, G. L., Surrente, C., Lopez, C., Droghetti, A., Giovanardi, M., Breda, C., Lo Giudice, F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Negri, G, Bandiera, A., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Curcio, C., Amore, D., Baietto, G., Casadio, C., Nicotra, S., Dell'Amore, A., Bertani, A., Russo, E., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Andreetti, C., Poggi, C., Cardillo, G., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Zaccagna, G., Lausi, P., Guerrera, F., Fontana, D., Della Beffa, V., Morelli, A., Londero, F., Imperatori, A., Rotolo, N., Terzi, A., Viti, A., Infante, M., Benato, C., Tosi D., Nosotti M., Bonitta G., Mazzucco A., Righi I., Mendogni P., Rosso L., Palleschi A., Rocco G., Crisci R., Mancuso M., Pernazza F., Refai M., Bortolotti L., Rizzardi G., Gargiulo G., Dolci G.P., Perkmann R., Zaraca F., Benvenuti M., Gavezzoli D., Cherchi R., Ferrari P., Mucilli F., Camplese P., Melloni G., Mazza F., Cavallesco G., Maniscalco P., Voltolini L., Gonfiotti A., Stella F., Argnani D., Pariscenti G.L., Surrente C., Lopez C., Droghetti A., Giovanardi M., Breda C., Lo Giudice F., Alloisio M., Bottoni E., Spaggiari L., Gasparri R., Torre M., Rinaldo A., Negri G.P., Bandiera A., Stefani A., Natali P., Scarci M., Pirondini E., Curcio C., Amore D., Baietto G., Casadio C., Nicotra S., Dell'amore A., Bertani A., Russo E., Ampollini L., Carbognani P., Puma F., Vinci D., Andreetti C., Poggi C., Cardillo G., Margaritora S., Meacci E., Luzzi L., Ghisalberti M., Zaccagna G., Lausi P., Guerrera F., Fontana D., Della Beffa V., Morelli A., Londero F., Imperatori A., Rotolo N., Terzi A., Viti A., Infante M., and Benato C.

Subjects
Male, Lung Neoplasms, Thoracic, Italian VATS Group, computer.software_genre, Postoperative pain, Settore MED/21 - CHIRURGIA TORACICA, Carcinoma, Non-Small-Cell Lung, Lobectomy, Three-portal, Uniportal, Video-assisted thoracic surgery, Aged, Equipment Design, Female, Humans, Neoplasm Staging, Operative Time, Pneumonectomy, Retrospective Studies, Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed, Stage (cooking), Non-Small-Cell Lung, Tomography, Database, Thoracic Surgery, X-Ray Computed, Cardiothoracic surgery, Cohort, Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, Italian VATS Group, Lobectomy, Postoperative pain, Three-portal, Uniportal, Video-assisted thoracic surgery, medicine.medical_specialty, VATS lobectomy, Video-Assisted, NO, medicine, Lung cancer, business.industry, Carcinoma, Odds ratio, medicine.disease, Confidence interval, Propensity score matching, Surgery, business, computer
Abstract

OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I–II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

Published
2019

7. What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

Author

Infante, Maurizio V, Benato, Cristiano, Silva, Ronaldo, Rocco, Gaetano, Bertani, Alessandro, Bertolaccini, Luca, Gonfiotti, Alessandro, Giovannetti, Riccardo, Bonadiman, Cinzia, Lonardoni, Alessandro, Canneto, Barbara, Falezza, Giovanni, Gandini, Paola, Curcio, Carlo, Crisci, Roberto, Alloisio, M, Amore, D, Ampollini, L, Andreetti, C, Argnani, D, Baietto, G, Bandiera, A, Benato, C, Benvenuti, M, Bertani, A, Bertolaccini, L, Bortolotti, L, Bottoni, E, Breda, C, Camplese, P, Carbognani, P, Cardillo, G, Casadio, C, Cavallesco, G, Cherchi, R, Crisci, R, Curcio, C, Dell'Amore, A, Beffa, V, Dolci, G, Droghetti, A, Ferrari, Pa, Fontana, D, Gargiulo, G, Gasparri, R, Gavezzoli, D, Ghisalberti, M, Giovanardi, M, Gonfiotti, A, Guerrera, F, Imperatori, A, Infante, M, Iurilli, L, Lausi, P, Logiudice, F, Londero, F, Lopez, C, Luzzi, L, Mancuso, M, Maniscalco, P, Margaritora, S, Meacci, E, Melloni, G, Morelli, A, Mucilli, F, Natali, P, Negri, G, Nicotra, S, Nosotti, M, Pariscenti, G, Perkmann, R, Pernazza, F, Pirondini, E, Poggi, C, Puma, F, Refai, M, Rinaldo, A, Rizzardi, G, Rosso, L, Rotolo, N, Russo, E, Sabbatini, A, Scarci, M, Spaggiari, L, Stefani, A, Solli, P, Surrente, C, Terzi, A, Torre, M, Vinci, D, Viti, A, Voltolini, L, Zaccagna, G, Zaraca, F., Infante M.V., Benato C., Silva R., Rocco G., Bertani A., Bertolaccini L., Gonfiotti A., Giovannetti R., Bonadiman C., Lonardoni A., Canneto B., Falezza G., Gandini P., Curcio C., Crisci R., Zaraca F., Alloisio M., Amore D., Ampollini L., Andreetti C., Argnani D., Baietto G., Bandiera A., Benvenuti M., Bortolotti L., Bottoni E., Breda C., Camplese P., Carbognani P., Cardillo G., Casadio C., Cavallesco G., Cherchi R., Dell'Amore A., Beffa V., Dolci G., Droghetti A., Ferrari P.A., Fontana D., Gargiulo G., Gasparri R., Gavezzoli D., Ghisalberti M., Giovanardi M., Guerrera F., Imperatori A., Iurilli L., Lausi P., Lo Giudice F., Londero F., Lopez C., Luzzi L., Mancuso M., Maniscalco P., Margaritora S., Meacci E., Melloni G., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Pariscenti G., Perkmann R., Pernazza F., Pirondini E., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabbatini A., Scarci M., Spaggiari L., Stefani A., Solli P., Surrente C., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaccagna G., Infante, M. V., Benato, C., Silva, R., Rocco, G., Bertani, A., Bertolaccini, L., Gonfiotti, A., Giovannetti, R., Bonadiman, C., Lonardoni, A., Canneto, B., Falezza, G., Gandini, P., Curcio, C., Crisci, R., the Italian VATS group, Member, and Negri, G.

Subjects
Male, Registrie, Conversion, Morbidity, Postoperative complications, Video-assisted thoracoscopic surgery lobectomy, Lung Neoplasms, Intraoperative Complication, Aged, Female, Hospitals, Humans, Intraoperative Complications, Lung, Middle Aged, Pneumonectomy, Postoperative Complications, Registries, Retrospective Studies, Risk Factors, Thoracic Surgery, Video-Assisted, medicine.medical_treatment, Interquartile range, Retrospective Studie, Settore MED/21 - CHIRURGIA TORACICA, Conversion, Morbidity, Postoperative complications, Video-assisted thoracoscopic surgery lobectomy, Thoracic Surgery, General Medicine, Video-assisted thoracoscopic surgery, Cardiology and Cardiovascular Medicine, Human, Pulmonary and Respiratory Medicine, medicine.medical_specialty, VATS lobectomy, Video-Assisted, NO, Hospital, medicine, business.industry, Risk Factor, Retrospective cohort study, Perioperative, medicine.disease, Comorbidity, Surgery, Postoperative complication, Lung Neoplasm, Complication, business
Abstract

OBJECTIVESInherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry.METHODSThe registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications.RESULTSFour thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (CONCLUSIONSVATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

Published
2019

8. Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry

Author

Marulli, G., Faccioli, E., Mammana, M., Nicotra, S., Comacchio, G., Verderi, E., De Palma, A., Curcio, C., Rea, F., Bertani, A., Russo, E., Voltolini, L., Gonfiotti, A., Nosotti, M., Rosso, L., Muriana, G., Droghetti, A., Crisci, R., Zaccagna, G., Amore, D., di Rienzo, G., Lopez, C., Morelli, A., Londero, F., Spaggiari, L., Gasparri, R., Baietto, G., Casadio, C., Infante, M., Benato, C, Alloisio, M., Bottoni, E, Cardillo, G., Carleo, F., Stella, F., Dolci, G., Puma, F., Vinci, D., Cavallesco, G., Maniscalco, P., Ampollini, L., Carbognani, P., Terzi, A., Viti, A, Negri, G., Bandiera, A., Perkmann, R., Zaraca, F., Andreetti, C., Poggi, C., Mucilli, F., Camplese, P., Luzzi, L., Ghisalberti, M., Imperatori, A., Rotolo, N., Bortolotti, L., Rizzardi, G., Torre, M., Rinaldo, A., Sabbatini, A., Refai, M., Benvenuti, M. R., Benetti, D., Stefani, A., Natali, P., Lausi, P., Guerrera, F., Melloni, G., Mazza, F., Argnani, D., Sanna, S., Fontana, D., Beffa, V. D., Meda, S., Pernazza, F. a, and Italian VATS Group

Subjects
Oncology, Male, Lung Neoplasms, medicine.medical_treatment, non-small cell lung cancer (NSCLC), Nodal upstaging, VATS lobectomy, 0302 clinical medicine, Risk Factors, Carcinoma, Non-Small-Cell Lung, 80 and over, Registries, Non-Small-Cell Lung, Child, Pneumonectomy, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), Aged, 80 and over, Thoracic Surgery, Video-Assisted, Thoracic Surgery, General Medicine, Middle Aged, Lymph node dissection, Mediastinal staging, Predictive risk factors, Adolescent, Adult, Aged, Disease Progression, Female, Humans, Italy, Lymph Node Excision, Neoplasm Staging, Predictive Value of Tests, Young Adult, 030220 oncology & carcinogenesis, Predictive value of tests, 030211 gastroenterology & hepatology, Lymph node dissection, Mediastinal staging, Nodal upstaging, Predictive risk factors, VATS lobectomy, medicine.medical_specialty, Video-Assisted, NO, 03 medical and health sciences, Internal medicine, medicine, In patient, business.industry, Disease progression, Carcinoma, medicine.disease, Surgery, Neoplasm staging, business
Abstract

Accurate staging of early non-small cell lung cancer is fundamental for selecting the best treatment. The aim of this study was to identify risk factors for nodal upstaging after video-assisted thoracoscopic lobectomy for clinical T1-3N0 tumors.From 2014 to 2017, 3276 thoracoscopic lobectomies were recorded in the prospective database "Italian VATS Group". Linear and multiple logistic regression models were adapted to identify independent predictors of nodal upstaging and factors associated with progression in postoperative N status.Nodal upstaging was found in 417 cases (12.7%), including 206 cases (6.2%) of N1-positive nodes, 81 cases of N2 nodes (2.4%), and 130 cases (4%) of involvement of both N1 + N2 nodes. A total of 241 (7.3%) patients had single-station nodal involvement, whereas 176 (5.3%) had multiple-station involvement. In the final regression model, the tumor grade, histology, pathologic T status, and 12 resected nodes were independent predictors of nodal upstaging.The number of resected lymph nodes seems to predict nodal upstaging better than the type of intraoperative lymph node management. Other preoperative risk factors correspond to those for which the current guidelines of the European Society of Thoracic Surgery recommend more extensive preoperative mediastinal staging.

Published
2020

9. Correction to: Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry (Surgery Today, (2020), 50, 7, (711-718), 10.1007/s00595-019-01939-x)

Author

Marulli, G., Faccioli, E., Mammana, M., Nicotra, S., Comacchio, G., Verderi, E., De Palma, A., Curcio, C., Rea, F., Bertani, A., Russo, E., Voltolini, L., Gonfiotti, A., Nosotti, M., Rosso, L., Muriana, G., Droghetti, A., Crisci, R., Zaccagna, G., Amore, D., di Rienzo, G., Lopez, C., Morelli, A., Londero, F., Spaggiari, L., Gasparri, R., Baietto, G., Casadio, C., Infante, M., Benato, C., Alloisio, M., Bottoni, E., Cardillo, G., Carleo, F., Stella, F., Dolci, G., Puma, F., Vinci, D., Cavallesco, G., Maniscalco, P., Ampollini, L., Carbognani, P., Terzi, A., Viti, A., Negri, G., Bandiera, A., Perkmann, R., Zaraca, F., Andreetti, C., Poggi, C., Mucilli, F., Camplese, P., Luzzi, L., Ghisalberti, M., Imperatori, A., Rotolo, N., Bortolotti, L., Rizzardi, G., Torre, M., Rinaldo, A., Sabbatini, A., Refai, M., Benvenuti, M. R., Benetti, D., Stefani, A., Natali, P., Lausi, P., Guerrera, F., Melloni, G., Mazza, F., Argnani, D., Sanna, S., Fontana, D., Beffa, V. D., Meda, S., and Pernazza, F.

Subjects
NO
Published
2020

10. Predicting a Prolonged Air Leak After Video-Assisted Thoracic Surgery, Is It Really Possible?

Author

Zaraca, Francesco, primary, Pipitone, Marco, additional, Feil, Birgit, additional, Perkmann, Reinhold, additional, Bertolaccini, Luca, additional, Curcio, Carlo, additional, Crisci, Roberto, additional, Mancuso, M., additional, Pernazza, F., additional, Refai, M., additional, Srella, F., additional, Argnani, D., additional, Marulli, G., additional, De Palma, A., additional, Bortolotti, L., additional, Rizzardi, G., additional, Solli, P.G., additional, Dolci, G.P., additional, Perkmann, R., additional, Zaraca, F., additional, Benvenuti, M., additional, Gavezzoli, D., additional, Cherchi, R., additional, Ferrari, P., additional, Mucilli, F., additional, Camplese, P., additional, Melloni, G., additional, Mazza, F., additional, Cavallesco, G., additional, Maniscalco, P., additional, Voltolini, L., additional, Gonfiotti, A., additional, Sollitto, F., additional, Ardò, N., additional, Pariscenti, G.L., additional, Risso, C., additional, Surrente, C., additional, Lopez, C., additional, Droghetti, A., additional, Giovanardi, M., additional, Breda, C., additional, Giudice, Lo F., additional, Alloisio, M., additional, Bottoni, E., additional, Spaggiari, L., additional, Gasparri, R., additional, Torre, M., additional, Rinaldo, A., additional, Nosotti, M., additional, Tosi, D., additional, Negri, G.P., additional, Bandiera, A., additional, Baisi, A., additional, Raveglia, F., additional, Stefani, A., additional, Natali, P., additional, Scarci, M., additional, Pirondini, E., additional, Curcio, C., additional, Amore, D., additional, Rena, O., additional, Nicotra, S., additional, Dell’ Amore, A., additional, Bertani, A., additional, Tancredi, G., additional, Ampollini, L., additional, Carbognani, P., additional, Puma, F., additional, Vinci, D., additional, Cardillo, G., additional, Carleo, F., additional, Margaritora, S., additional, Meacci, E., additional, Luzzi, L., additional, Ghisalberti, M., additional, Crisci, R., additional, Divisi, D., additional, Lausi, P., additional, Guerrera, F., additional, Fontana, D., additional, Beffa, V. Della, additional, Morelli, A., additional, Londero, F., additional, Imperatori, A., additional, Rotolo, N., additional, Terzi, A., additional, Viti, A., additional, Infante, M., additional, and Benato, C., additional

Published
2021
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11. National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: The Italian VATS register evaluation

Author

Divisi D., Bertolaccini L., Barone M., Amore D., Argnani D., Zaccagna G., Solli P., Di Rienzo G., Curcio C., Crisci R., Ampollini L., Alloisio M., Andreetti C., Baietto G., Bandiera A., Benato C., Benetti D., Benvenuti M., Bertani A., Bortolotti L., Bottoni E., Camplese P., Carbognani P., Cardillo G., Carleo F., Casadio C., Cavallesco G., Negri A. D., Dolci G., Droghetti A., Gasparri R., Ghisalberti M., Gonfiotti A., Guerrera F., Imperatori A., Infante M., Lausi P., Londero F., Lopez C., Luzzi L., Maineri P., Maniscalco P., Marulli G., Monteverde M., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Perkmann R., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabatini A., Spaggiari L., Stefani A., Stella F., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaraca F., Divisi D., Bertolaccini L., Barone M., Amore D., Argnani D., Zaccagna G., Solli P., Di Rienzo G., Curcio C., Crisci R., Ampollini L., Alloisio M., Andreetti C., Baietto G., Bandiera A., Benato C., Benetti D., Benvenuti M., Bertani A., Bortolotti L., Bottoni E., Camplese P., Carbognani P., Cardillo G., Carleo F., Casadio C., Cavallesco G., Negri A.D., Dolci G., Droghetti A., Gasparri R., Ghisalberti M., Gonfiotti A., Guerrera F., Imperatori A., Infante M., Lausi P., Londero F., Lopez C., Luzzi L., Maineri P., Maniscalco P., Marulli G., Monteverde M., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Perkmann R., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabatini A., Spaggiari L., Stefani A., Stella F., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaraca F., Divisi, Duilio, Bertolaccini, Luca, Barone, Mirko, Amore, Dario, Argnani, Desideria, Zaccagna, Gino, Solli, Piergiorgio, Di Rienzo, Gaetano, Curcio, Carlo, Crisci, Roberto, Italian VATS, Group, and Negri, G

Subjects
Database, Learning curve, Learning tools, Non-small cell lung cancer, Training, Video-assisted thoracoscopic surgery lobectomy (VATS lobectomy), Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, VATS lobectomy, Air leak, NO, 03 medical and health sciences, 0302 clinical medicine, Learning tool, database, learning curve, learning tools, non-small cell lung cancer, training, medicine, Thoracotomy, business.industry, General surgery, Database, Learning curve, Learning tools, Non-small cell lung cancer, Training, Video-assisted thoracoscopic surgery lobectomy (VATS lobectomy), 030228 respiratory system, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Video-assisted thoracoscopic surgery, Operative time, Original Article, business
Abstract

Background: The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold. The purpose of our study was the examination of the variables related to the learning curve of the video-assisted approach, to establish what may be an expression of the technical maturity of the surgeon. Methods: The National Register for VATS lobectomy built in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3,700 patients enrolled, only information from Units with ≥100 VATS lobectomies were retrospectively analysed. Unpaired Student’s t-tests, Fisher’s exact tests, Pearson’s χ 2 were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy. Results: Ten institutions contributed a total of 1,679 patients, who were divided into three uniform groups according to the chronological sequence of surgery. The length of utility incision, the number of dissected lymph nodes and the operative time were not statistically significant (P=0.999, P=0.972 and P=0.307, respectively) among groups. Conversion to thoracotomy and postoperative air leaks occurred in 125 (7.44%) and 109 (6.49%) patients, gradually declined in Group 3 with statistical signi cance (P=0.048 and P=0.00086). Conclusions: The conversion rate and the percentage of air leaks seem to de ne the expertise of VATS lobectomy, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.

Published
2018

13. Corrigendum to: What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry (European Journal of Cardio-thoracic Surgery (2019) DOI: 10.1093/ejcts/ezz187)

Author

Infante, M. V., Benato, C., Silva, R., Rocco, G., Bertani, A., Bertolaccini, L., Gonfiotti, A., Giovannetti, R., Bonadiman, C., Lonardoni, A., Canneto, B., Falezza, G., Gandini, P., Curcio, C., Crisci, R., Zaraca, F., Alloisio, M., Amore, D., Ampollini, L., Andreetti, C., Argnani, D., Baietto, G., Bandiera, A., Benvenuti, M., Bortolotti, L., Bottoni, E., Breda, C., Camplese, P., Carbognani, P., Cardillo, G., Casadio, C., Cavallesco, G., Cherchi, R., Dell'Amore, A., Beffa, V., Dolci, G, Droghetti, A, Ferrari, P. A., Fontana, D., Gargiulo, G., Gasparri, R., Gavezzoli, D., Ghisalberti, M., Giovanardi, M., Guerrera, F., Imperatori, A., Iurilli, L., Lausi, P., Lo Giudice, F., Londero, F., Lopez, C., Luzzi, L., Mancuso, M., Maniscalco, P., Margaritora, S., Meacci, E., Melloni, G., Morelli, A., Mucilli, F., Natali, P., Negri, G., Nicotra, S., Nosotti, M., Pariscenti, G., Perkmann, R., Pernazza, F., Pirondini, E., Poggi, C., Puma, F., Refai, M., Rinaldo, A., Rizzardi, G, Rosso, L., Rotolo, N., Russo, E., Sabbatini, A., Scarci, M., Spaggiari, L., Stefani, A., Solli, P., Surrente, C., Terzi, A., Torre, M., Vinci, D., Viti, A., Voltolini, L., Zaccagna, G., and the Italian VATS group members

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, Thoracic, medicine.medical_treatment, MEDLINE, NO, Postoperative Complications, Risk Factors, Pulmonary lobectomy, Humans, Medicine, Registries, Intraoperative Complications, Pneumonectomy, Lung, Aged, Retrospective Studies, Thoracic Surgery, Video-Assisted, business.industry, General surgery, General Medicine, Perioperative, Middle Aged, Corrigenda, Hospitals, Video-assisted thoracoscopic surgery, Female, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (

Published
2019

14. What counts more: the patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

Author

Infante, Mv, Benato, C, Silva, R, Rocco, G, Bertani, A, Bertolaccini, L, Gonfiotti, A, Giovannetti, R, Bonadiman, C, Lonardoni, A, Canneto, B, Falezza, G, Gandini, P, Curcio, C, Crisci, R, Alloisio, M, Amore, D, Ampollini, L, Andreetti, C, Argnani, D, Baietto, G, Bandiera, A, Benvenuti, Mr, Bortolotti, L, Bottoni, E, Breda, C, Camplese, P, Carbognani, P, Cardillo, G, Casadio, C, Cavallesco, G, Cherchi, R, Dell'Amore, A, Della Beffa, V, Dolci, G, Droghetti, A, Ferrari, Pa, Fontana, D, Gargiulo, G, Gasparri, R, Gavezzoli, D, Ghisalberti, M, Giovanardi, M, Guerrera, F, Imperatori, A, Infante, M, Iurilli, L, Lausi, P, Lo Giudice, F, Londero, F, Lopez, C, Luzzi, L, Mancuso, M, Maniscalco, P, Margaritora, Stefano, Meacci, Elisa, Melloni, G, Morelli, A, Mucilli, F, Natali, P, Negri, G, Nicotra, S, Nosotti, M, Pariscenti, G, Perkmann, R, Pernazza, F, Pirondini, E, Poggi, C, Puma, F, Refai, M, Rinaldo, A, Rizzardi, G, Rosso, L, Rotolo, N, Russo, E, Sabbatini, A, Scarci, M, Spaggiari, L, Stefani, A, Solli, P, Surrente, C, Terzi, A, Torre, M, Vinci, D, Viti, A, Voltolini, L, Zaccagna, G, Zaraca, F, Margaritora, S (ORCID:0000-0002-9796-760X), Meacci, E (ORCID:0000-0001-8424-3816), Infante, Mv, Benato, C, Silva, R, Rocco, G, Bertani, A, Bertolaccini, L, Gonfiotti, A, Giovannetti, R, Bonadiman, C, Lonardoni, A, Canneto, B, Falezza, G, Gandini, P, Curcio, C, Crisci, R, Alloisio, M, Amore, D, Ampollini, L, Andreetti, C, Argnani, D, Baietto, G, Bandiera, A, Benvenuti, Mr, Bortolotti, L, Bottoni, E, Breda, C, Camplese, P, Carbognani, P, Cardillo, G, Casadio, C, Cavallesco, G, Cherchi, R, Dell'Amore, A, Della Beffa, V, Dolci, G, Droghetti, A, Ferrari, Pa, Fontana, D, Gargiulo, G, Gasparri, R, Gavezzoli, D, Ghisalberti, M, Giovanardi, M, Guerrera, F, Imperatori, A, Infante, M, Iurilli, L, Lausi, P, Lo Giudice, F, Londero, F, Lopez, C, Luzzi, L, Mancuso, M, Maniscalco, P, Margaritora, Stefano, Meacci, Elisa, Melloni, G, Morelli, A, Mucilli, F, Natali, P, Negri, G, Nicotra, S, Nosotti, M, Pariscenti, G, Perkmann, R, Pernazza, F, Pirondini, E, Poggi, C, Puma, F, Refai, M, Rinaldo, A, Rizzardi, G, Rosso, L, Rotolo, N, Russo, E, Sabbatini, A, Scarci, M, Spaggiari, L, Stefani, A, Solli, P, Surrente, C, Terzi, A, Torre, M, Vinci, D, Viti, A, Voltolini, L, Zaccagna, G, Zaraca, F, Margaritora, S (ORCID:0000-0002-9796-760X), and Meacci, E (ORCID:0000-0001-8424-3816)

Abstract

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry.METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications.RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity.CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

Published
2019

15. First italian consensus conference on VATS lobectomy for NSCLC

Author

Nosotti, Mario, Droghetti, Andrea, Luzzi, Luca, Solli, Piergiorgio, Crisci, Roberto, VATS Group Italia, Alloisio, M, Amore, D, Ampollini, D, Andreetti, C, Aresu, Argnani, D, Baletto, G, Bandiera, A, Benato, C, Bertani, A, Bertolaccini, L, Bortolotti, L, Camplese, P, Carbognani, P, Cardillo, G, Carleo, F, Cavallesco, G, Curcio, C, Dell’Amore, D, De Monte, L, Denegri, A, De Vico, A, Di Rienzo, G, Divisi, D, Dolci, Gp, Ghisalberti, M, Giovanardi, M, Gonfiotti, A, Gotti, G, Imperatori, A, Infante, M, Lo faso, F, Lopez, C, Magnanelli, G, Maineri, P, Mancuso, M, Maniscalco, P, Marulli, G, Morelli, A, Mucilli, F, Muriana, G, Negri, Gp, Nicotra, S, Palleschi, A, Perkmann, R, Pernazza, F, Poggi, C, Puma, F, Rinaldo, A, Rizzardi, G, Roncon, A, Rosso, L, Rotolo, N, Solaini, L, Stella, F, Terzi, A, Torre, M, Vinci, D, Voltolini, L, and Zaraca, F

Subjects
medicine.medical_specialty, Surgical strategy, medicine, consensus conference, medicine.medical_treatment, VATS lobectomy, practical recommendations, thoracotomy, 030204 cardiovascular system & hematology, carcinoma, lung neoplasms, 03 medical and health sciences, 0302 clinical medicine, Carcinoma, Non-Small-Cell Lung, Medicine, Thoracotomy, lung cancer, non-small-cell lung, humans, Italy, thoracic surgery, video-assisted, oncology, cancer research, video-assisted, Perioperative management, business.industry, Thoracic Surgery, Video-Assisted, General surgery, Consensus conference, General Medicine, thoracic surgery, 030228 respiratory system, Cardiothoracic surgery, business
Abstract

Purpose Video-assisted thoracoscopic surgery (VATS) lobectomy has become an accepted procedure for the treatment of selected cases of lung cancer. The aim of this project was to establish national practical recommendations for the management of patients suitable for VATS lobectomy. Methods The Scientific Committee of the VATS Lobectomy Group (a branch of the Italian Society of Thoracic Surgery) identified the consensus conference as an appropriate tool for a national debate. The consensus conference was organized following indications of the Italian Department of Health: a panel of experts reviewed the literature, the jury board revised the experts’ reports, and the national conference discussed and voted on statements. The strength of recommendation for a statement was classified as weak, fair, or high when the total score ranged between 51% and 67%, 68% and 84%, or 85% and 100%, respectively. Results Eighty-six Italian thoracic surgeons attended the 1st Italian Consensus Conference on VATS lobectomy in Giulianova, Italy, on October 29-30, 2015. Thirty-three topics were discussed: indications, surgical strategy, perioperative management, and training were the main topics. Consensus was reached on 24 statements that were consequently recommended. Conclusions The Italian Consensus Conference is the first attempt to discuss VATS lobectomy-related issues in a national scientific community. Such experience determined an improvement in epistemic knowledge among the Italian thoracic surgeons and could be a suggestion for other national communities.

Published
2017

16. The ILAILL Study: Iloprost as Adjuvant to Surgery for Acute Ischemia of Lower Limbs

Author

de Donato, Gaetano, Gussoni, Gualberto, de Donato, Gianmarco, Andreozzi, Giuseppe Maria, Bonizzoni, Erminio, Mazzone, Antonino, Odero, Attilio, Paroni, Giovanni, Setacci, Carlo, Settembrini, Piergiorgio, Veglia, Fabrizio, Martini, Romeo, Setacci, Francesco, Palombo, Domenico, de Laurentiis, R., Bianco, G., Baldi, I., Pratesi, C., Pulli, R., Romano, E., Martino, A., la Marca, G., Ebner, H., Sbraga, P., Zaraca, F., Spinelli, F., Mandolfino, T., Benedetto, F., Baccellieri, D., Ferrari, M., Adami, D., del Corso, A., Ruggieri, M., Novali, C., Mangiacotti, B., Ponzio, F., Capaldi, G., Cao, P., Parente, B., Parlani, G., Maltempi, P., Ferrero, S., Colotto, P., Nardella, L., Pastorino, S., Rauti, G., Chiesa, R., Marone, E. M., Bertoglio, C., Cristiani, A. M., Carissimi, T., Deriu, G., Antonello, Michele, Nessi, F., Cumbo, P., Ferrero, E., Mattassi, R., Callini, E., Ippoliti, A., Ascoli Marchetti, A., di Giulio, L., Spartera, C., Petrassi, C., Saracino, G., Biasi, G., Mingazzini, P., Thsomba, Y., Regina, G., Impedovo, G., Lillo, A., Angiletta, D., Marotta, V., De Donato, G, Gussoni, G, Andreozzi, Gm, Bonizzoni, E, Mazzone, A, Odero, A, Paroni, G, Setacci, C, Settembrini, P, Veglia, F, Martini, R, Setacci, F, Palombo, D, The Members of the ILAILL Study, Group, Chiesa, Roberto, Tshomba, Yamume, and Ferrari, Maurizio

Subjects
Male, Vasodilator Agents, medicine.medical_treatment, Fasciotomy, Placebos, lower limbs ischemia: surgery, Ischemia, Risk Factors, Cause of Death, Amputation, Infusions, Intravenous, Adjuvant, Treatment Outcome, Injections, Intra-Arterial, Lower Extremity, Chemotherapy, Adjuvant, Randomized, Controlled Trials, Anesthesia, Platelet aggregation inhibitor, Female, Hypotension, Intravenous, medicine.drug, Infusions, medicine.medical_specialty, Aged, Anticoagulants, Double-Blind Method, Follow-Up Studies, Heparin, Humans, Iloprost, Platelet Aggregation Inhibitors, Postoperative Hemorrhage, Surgery, Revascularization, Amputation, Surgical, Injections, medicine, Chemotherapy, acute ischemia of lower limbs, Intra-Arterial, business.industry, Perioperative, Vascular surgery, medicine.disease, business
Abstract

Acute limb ischemia (ALI) is a serious medical emergency leading to high rate of complications, being not only limb- but even life-threatening, often despite early successful revascularization.1 Improvements in surgical techniques and perioperative patient care may have reduced the incidence of major complications in ALI patients over the years, but the results of trials published recently seem to document a persistent high risk, with reported 30-day amputation rate of 5% to 12%, mortality risk at 10% to 38%, combined incidence of amputation and death of 25% to 37.5%, at 1- to 6-month follow-up.2–7 Concomitant underlying diseases, the metabolic derangement that seems as a result of the acute insult, and a possible reperfusion injury following revascularization may account for this severe prognosis.8 Only anticoagulation, fasciotomy (when indicated), and perioperative supportive treatment are established strategies in ALI patients.1,8,9 Possible benefit from cardiovascular active therapies has recently been suggested in patients undergoing peripheral revascularization or noncardiac major surgical intervention.10,11 Moreover, several categories of compounds, potentially acting on pathobiological mechanisms of ischemia-reperfusion syndrome, have been tested in experimental models, but none of them has as yet been proven effective in clinical studies in patients with ALI.12–18 Because of their pharmacologic profile, prostanoids represent a potentially interesting category as adjuvant treatment of ALI patients.19 Several ischemia-reperfusion studies described the use of prostaglandins for reduction of postischemic tissue injuries, and even recently both PGE1 and PGI2 appeared as potent inhibitors of reflow-paradox in a preclinical model of reperfusion injury.20 Iloprost is a widely studied synthetic analogue of prostacyclin, with a 10-fold higher half-life than the native compound, and indicated in the treatment of severe chronic limb ischemia.1,21–23 Results from pilot studies and case reports also described the positive effects of iloprost in the management of acute ischemia secondary to various causes, particularly after accidental intra-arterial administration of drugs or toxic agents.24–26 Several preclinical studies have assessed the effects of iloprost in experimental ischemia-reperfusion injury and documented the actions of the compound on different pathophysiologic mechanisms potentially relevant for damage following ALI.27–32 A diagram indicating where iloprost can interfere in the mechanisms, leading from ischemia and reperfusion, to the development of no-reflow and reflow-paradox, is reported in Figure 1. 33 FIGURE 1. Pathobiological mechanisms leading from ischemia-reperfusion, to “no-reflow”/“reflow-paradox.” Points where iloprost can act are indicated (from de Donato et al33). Some years ago, we performed a placebo-controlled, double-blind pilot study in 30 patients with ALI undergoing Fogarty's thromboembolectomy. Encouraging results were obtained with the use of intraoperative and postoperative iloprost (lower incidence of major clinical events, more evident metabolic improvement by means of transcutaneous tensiometry).34 In this paper, we report the results of ILoprost in Acute Ischemia of Lower Limbs (ILAILL) study, a larger, multicenter trial including patients undergoing all types of surgical revascularization, who received iloprost or placebo administration during intervention and therefore for 4 to 7 days, and were observed for a 3-month postoperative period.

Published
2006

17. Acute limb ischemia in elderly patients: Can iloprost be useful as an adjuvant to surgery? Results from the ILAILL study

Author

de Donato G, Gussoni G, Cao P, Setacci C, Pratesi C, Mazzone A, Ferrari M, Veglia F, Bonizzoni E, Settembrini P, Ebner H, Martino A, Palombo D, Paroni G, Odero A, de Laurentiis R, Bianco G, Baldi I, Pulli R, Romano E, la Marca G, Sbraga P, Zaraca F, Spinelli F, Mandolfino T, Benedetto F, Baccellieri D, Adami D, Del Corso A, Ruggieri M, Novali C, Mangiacotti B, Ponzio F, Capaldi G, Parente B, Parlani G, Maltempi P, Ferrero S, Colotto P, Nardella L, Pastorino S, Rauti G, Marone EM, Setacci F, Bertoglio C, Caristiani AM, Carissimi T, Deriu G, Antonello M, Nessi F, Cumbo P, Ferrero E, Mattassi R, Callini E, Ippoliti A, Ascoli Marchetti A, di Giulio L, Spartera C, Petrassi C, Saracino G, Biasi G, Mingazzini P, Regina G, Impedovo G, Lillo A, Angiletta D, Marotta V., CHIESA , ROBERTO, TSHOMBA, YAMUME, de Donato, G, Gussoni, G, Cao, P, Setacci, C, Pratesi, C, Mazzone, A, Ferrari, M, Veglia, F, Bonizzoni, E, Settembrini, P, Ebner, H, Martino, A, Palombo, D, Paroni, G, Odero, A, de Laurentiis, R, Bianco, G, Baldi, I, Pulli, R, Romano, E, la Marca, G, Sbraga, P, Zaraca, F, Spinelli, F, Mandolfino, T, Benedetto, F, Baccellieri, D, Adami, D, Del Corso, A, Ruggieri, M, Novali, C, Mangiacotti, B, Ponzio, F, Capaldi, G, Parente, B, Parlani, G, Maltempi, P, Ferrero, S, Colotto, P, Nardella, L, Pastorino, S, Rauti, G, Chiesa, Roberto, Marone, Em, Setacci, F, Bertoglio, C, Caristiani, Am, Carissimi, T, Deriu, G, Antonello, M, Nessi, F, Cumbo, P, Ferrero, E, Mattassi, R, Callini, E, Ippoliti, A, Ascoli Marchetti, A, di Giulio, L, Spartera, C, Petrassi, C, Saracino, G, Biasi, G, Mingazzini, P, Tshomba, Yamume, Regina, G, Impedovo, G, Lillo, A, Angiletta, D, and Marotta, V.

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Acute limb ischemia, Elderly patients, Iloprost, Reperfusion, Surgical revascularization, Acute Disease, Aged, Aged, 80 and over, Cardiovascular Agents, Chemotherapy, Adjuvant, Double-Blind Method, Extremities, Female, Humans, Incidence, Ischemia, Kaplan-Meier Estimate, Proportional Hazards Models, Risk Factors, Treatment Outcome, Amputation, Vascular Surgical Procedures, Surgery, Cardiology and Cardiovascular Medicine, Placebo, Amputation, Surgical, Bolus (medicine), medicine, 80 and over, Chemotherapy, Adjuvant, Medicine(all), business.industry, Hazard ratio, Perioperative, Acute limb ischemia, Elderly patients, Iloprost, Reperfusion, Surgical revascularization, Relative risk, Cardiovascular agent, acute limb ischemia, elderly patients, iloprost, business, medicine.drug
Abstract

Objectives To evaluate the effects of iloprost, in addition to surgery, on the outcome of acute lower limb ischemia (ALLI). Design Post-hoc analysis of a randomized, double-blind, placebo-controlled study. Methods In the context of the ILAILL (ILoprost in Acute Ischemia of Lower Limbs) study, 192 elderly patients (>70 years old) undergoing surgery for ALLI were assigned to receive perioperative iloprost (intra-arterial, intra-operative bolus of 3000ng, plus intravenous infusion of 0.5–2.0ng/kg/min for six hours/day for 4–7 days following surgery), or placebo (iloprost: n =100; placebo: n =92). Patients were followed-up for three-months following surgical revascularization. Results The combined incidence of death and amputation (primary study end-point) was significantly reduced in patients treated with iloprost (16.0% vs 27.2% in the placebo group; hazard ratio 1.99, 95% confidence interval 1.05–3.75, p =0.03). A statistically significant lower mortality (6.0%) was reported in patients receiving iloprost, compared to controls (15.2%) (hazard ratio 2.93, 1.11–7.71, p =0.03). The overall incidence of death and major cardiovascular events was lower in patients receiving iloprost compared to those assigned placebo (24.0% and 35.9%, respectively), at the limits of statistical significance (relative risk 1.64, 0.97–2.79, p =0.06). Conclusions These results confirm the poor outcome in elderly patients with ALLI. Based on a subgroup analysis iloprost, as an adjuvant to surgery, appears to reduce the combined end-point of death and amputation.

Published
2007

18. Correspondence

Author

Zaraca F, Francesco Gossetti, and Catarci M

Subjects
medicine.medical_specialty, Text mining, medicine.diagnostic_test, business.industry, General surgery, medicine, Surgery, business, Laparoscopy, Laparoscopic cholecystectomy
Published
1998

20. Surgical resection and survival of patients with unsuspected single node positive lung cancer (NSCLC) invading the descending aorta

Author

Wex, P, Graeter, T, Zaraca, F, Haas, V, Decker, S, Bugdayev, H, Ebner, H, Wex, P, Graeter, T, Zaraca, F, Haas, V, Decker, S, Bugdayev, H, and Ebner, H

Abstract

Background: Surgical treatment of non-small cell lung cancer (NSCLC) with aortic invasion is still debated. Methods: Thirteen patients with locally advanced (T4) NSCLC and invasion of the descending aorta underwent pneumonectomy (n=9) or lobectomy (n=4) together with aorta en bloc resection and reconstruction (n=8) or subadventitial dissection (n=5), complete lymph node dissection, and had microscopic unsuspected node metastasis at N1 (n=5) and N2/3 (n=8) levels of whom 12 received radiation therapy. Clamp-and-sew was used to resect and reconstruct the aorta. Results: Operative mortality and morbidity rate was 0% and 23%, respectively. Four patients died of systemic tumor relapse and 2 of local recurrence. Six patients were alive after a median follow-up of 40 months (range 15-125 months). Overall 5-year survival rate was 45%. Median survival time and 5-year survival rate of patients after aortic resection was 35 months and 67%, respectively, and was 17 months and 0%, respectively, after aortic subadventi-tial dissection (p=0.001). N1 and N2 nodal status adversely affected survival, but survival difference was not significant (N1 versus N2/3; 52% versus 39% at 5 years; p=0.998). Conclusions: Aortic resection with single station node positive T4 lung cancer can achieve long-term survival. The data indicate that aortic resection-reconstruction is associated with better outcome than subadventitial dissection., Hintergrund: Die chirurgische Behandlung nicht-kleinzelliger Lungentumore mit Aortawandinvasion wird kontrovers diskutiert. Methoden: 13 Patienten mit lokal fortgeschrittenem (T4) nicht-kleinzelligen Lungencarcinom, tumoröser Invasion der Aorta descendens und präoperativ negativem N-Staging wurden in kurativer Intention primär operiert. Operative Prozeduren: Pneumonektomie 8-mal, Lobektomie 4-mal in Kombination mit segmental aortaler en-bloc-Resektion "clamp-and-sew" in 8 Fällen oder subadventitieller Aortawanddissektion in 5 Fällen und systematischer Lymphknotendissektion. 12 Patienten mit definitiv solitärer, mikroskopischer Lymphknotenmetastase in N1- (n=5) oder N2-Position (n=8) erhielten eine adjuvante Radiotherapie. Ergebnisse: Die Krankenhaus-, resp. 90-Tage-Mortalität betrug 0%, die Morbidität 23%. Im weiteren Verlauf verstarben 4 Patienten an disseminierter Metastasierung und 2 Patienten am lokalen Tumorrezidiv. Bei einem mittleren Nachbeobachtungszeitraum von 40 Monaten leben noch 6 Patienten (15-125 Monate). Die kumulativ prospektive 5-Jahresüberlebensrate der 13 Patienten betrug 45%. Die mittlere Überlebenszeit und 5-Jahresüberlebensrate nach Aortaresektion betrug 35 Monate und 67%, nach Aortawanddissektion respektive 17 Monate und 0% (p=0,001). Der N1- und N2/3-Lymphknotenstatus beeinträchtigten das Langzeitüberleben (N1 versus N2/3; 52% versus 39% nach 5 Jahren). Der Überlebensunterschied erreichte kein Signifikanzniveau (p=0,998). Schlussfolgerungen: Bei einer lokal fortgeschrittenen Lungenkrebserkrankung ist in ausgewählten Fällen, auch bei Vorliegen einer solitären Lymphknotenmetastase, mit einer primären, erweiterten Resektionstherapie ein Langzeitüberleben erzielbar. Nach unseren Ergebnissen ist bei umschriebener aortaler Infiltration der aortalen en-bloc-Resektion gegenüber der subadventitiellen Aortawanddissektion der Vorzug zu geben. Weitere Studien sollten den Nutzen multimodaler Therapiekonzepte evaluieren.

Published
2009

28. [History of reconstruction following total gastrectomy]

Author

Catarci, M, Proposito, Delia, Guadagni, S, Tuscano, Domenico, Flati, Giancarlo, Zaraca, F, Scaccia, M, Scardamaglia, F, and Carboni, Manlio

Subjects
Jejunum, Colon, Duodenum, Gastrectomy, Anastomosis, Surgical, Humans, History, 19th Century, History, 20th Century
Abstract

Near a century after the first successful total gastrectomy for gastric cancer, the authors review the various technical proposals for digestive tract reconstruction following total gastrectomy. Following a classification based on duodenal circuit, on the viscerum employed and on the creation of pouches and/or anti-reflux mechanisms, pros and cons of the various classes of reconstructions are clearly depicted, suggesting the reasons that made Roux-en-Y esophago-jejunostomy and jejunal interposition the most used reconstructive procedure in worldwide clinical practice.

Published
1995

39. Il computer in endoscopia digestiva

Author

Catarci, M, Trecca, A, Lombardi, L, Gaj, F, Scardamaglia, F, Zaraca, F, Pistoia, F, Scaccia, M, Veneziano, M, Guadagni, S, Pistoia, Ma, and Carboni, M.

Published
1995

43. CARCINOMA A CELLULE DI HURTHLE DELLA TIROIDE

Author

Agnifili, Alessio, Saputelli, A., Marino, M., Carboni, I., Guadagni, Stefano, Zaraca, F., Di Renzo, M., Talarico, C., Carboni, F., and De Bernardinis, G.

Subjects
thyroid neoplasms, Hurthle cell carcinoma, Surgery
Published
1994

46. [Technique and immediate results of the Moreno Gonzalez-Carboni reconstruction after total gastrectomy]

Author

Carboni, Manlio, Catarci, M, Proposito, Delia, Saputelli, A, Zaraca, F, Gossetti, Francesco, Flati, Giancarlo, Guadagni, S, Tuscano, Domenico, and Negro, Paolo

Subjects
Esophagus, Jejunum, Duodenum, Evaluation Studies as Topic, Gastrectomy, Stomach Neoplasms, Humans
Abstract

Reconstruction following total gastrectomy for gastric cancer is still matter of debate. The Roux-en-Y esophagojejunostomy and the interposed loop esophago-jejunoduodenostomy are the techniques commonly employed. The Authors describe their modification of Henley's jejunal interposition and report early results achieved in a series of 60 consecutive patients.

Published
1992

48. Eterotopie epiteliali nel retto

Author

Guadagni, Stefano, Pistoia, M. A., Catarci, M., Lombardi, L., Zaraca, F., Leocata, Pietro, and Tuscano, D.

Published
1992

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