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Safer intestinal invagination for a solid pancre-atico-jejunal anastomosis in presence of a soft texture pancreatic remnant and non-dilated duct

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Hepatobiliary & Pancreatic Diseases International 2016年第3期15卷 324-328页

作者： francesco giudici benedetta pesi daniela zambonin stefano scaringi paolo bechi giacomo batignani Author Affiliations:Unit of Surgery Department of Surgery and Translational MedicineUniversity of Florence Medical SchoolCareggi University HospitalFlorenceItaly

Pancreatico-jejunal anastomosis after pancreato- duodenectomy still represents the Achilles＇ heel of the proce- dure： the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic fistula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico- jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia- tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.

关键词： pancreatico-jejunal anastomosis anastomosis pancreatoduodenectomy invagination novel variation

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Biliary tree gastrinomas in multiple endocrine neoplasia type 1 syndrome

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World Journal of Gastroenterology 2013年第45期19卷 8312-8320页

作者： Francesco Tonelli Francesco Giudici Gabriella Nesi giacomo batignani Maria Luisa Brandi Department of Surgery and Translational Medicine University of Florence50014 Florence Italy

AIM:To describe our patients affected with ectopic biliary tree gastrinoma and review the literature on this ***:Between January 1992 and June 2012,28 patients affected by duodenopancreatic endocrine tumors in multiple endocrine neoplasia type 1(MEN1)syndrome underwent surgery at our *** retrospective review article analyzes our experience regarding seventeen of these patients subjected to duodenopancreatic surgery for Zollinger-Ellison syndrome(ZES).Surgical treatment consisted of duodenopancreatectomy(DP)or total pancreatectomy(TP).Regional lymphadenectomy was always *** hepatic tumoral lesions found were removed during *** MEN1 patients,removal of duodenal lesions can sometimes lead to persistence or recurrence of *** possible explanation for this unfavorable outcome could be unrecognized ectopic localization of gastrin-secreting *** study described three cases among the seventeen patients who were found to have an ectopic gastrinoma located in the biliary ***:Seventeen MEN1 patients affected with ZES were *** mean age was 40 *** patients underwent DP and two *** histopathological examination,duodeno pancreatic endocrine tumors were found in all 17 ***-one gastrinomas were detected in the first three portions of the *** one gastrinoma was found in the *** mean number of gastrinomas per patient was 5(range 1-16).Malignancy was established in 12 patients(70.5%)after lymph node,liver and omental metastases were *** patients exhibited biliary tree gastrinomas as well as duodenal gastrinoma(s).In two cases,the ectopic gastrinoma was removed at the same time as pancreatic surgery,while in the third case,the biliary tree gastrinoma was resected one year after DP because of recurrence of ***:These findings suggest the importance of checking for the presence of ectopic gastrinomas in the biliary tree in MEN1 patients undergoing Z

关键词： Gastrinoma Multiple endocrine neoplasia type 1 Zollinger-Ellison Syndrome Ectopic gastrinoma Biliary tree Duodenopancreatectomy

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Small diameter H-graft porta-caval shunt performed at different stages of liver disease

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Hepatobiliary & Pancreatic Diseases International 2004年第4期3卷 516-521页

作者： giacomo batignani Francesco Vizzutti Luigi Rega Michele Zuckermann Geri Fratini Massimo Pinzani Francesco Tonelli Dipartimento di Fisiopatologia Clinica-Unità di Chirurgia Firenze Italy Diparti- mento di Medicina Interna Sezione Clinica Medica ed Epatologia Laboratono di Emodinamica Epatica Firenze Italy Dipartimento di Fisiopatologia Clinica Unità di Radiodiagnostica Firenze Italy

BACKGROUND: Partial porto-systemic shunts have been popularized because of reported low rate of mortality and morbidity (especially encephalopathy, liver failure and oc- clusion). To further investigate these assumptions, we ret- rospectively reviewed the results of partial porta-caval shunts performed at different stages of liver disease. METHODS: Twenty-nine cirrhotic patients underwent a partial porta-caval shunt with a ringed polytetrafluoroethy- lene interposition prosthesis of 8-mm ( 20 patients) or 10- mm (9 patients) in diameter. Pre- and post-shunt porta- caval pressure was measured in all patients. Twelve patients (41.4%) belonged to Child A, 11 Child B (37.9%), and 6 Child C (20.7%). Eleven patients (37.9%) suffered from hepatic encephalopathy preoperatively. Twelve patients (41%) were operated on in emergency/urgency. RESULTS: Porta-caval pressure gradient, reduced signifi- cantly using either 8- or 10-mm prosthesis. The overall ear- ly mortality and morbidity were 13. 8% and 48% respec- tively. The early mortality and morbidity were different be- tween patients of Child A and B when compared to those of Child C (0 vs 66.6% and 34.8% vs 66.6% respectively). No patient re-bled early from varices. The overall late mor- tality and morbidity were 40% and 64% respectively. Shunt thrombosis and stenosis took place in 16% and 8% of the two groups of patients respectively; variceal re-bleeding oc- curred in 4 patients (16%). Encephalopathy occurred post- operatively in 5 patients (20%), acute in 3 patients (12%), and chronic in 2 (8%). The actuarial survival rate at 3 and 5 years was 92% and 75% for patients of Child A, 70% and 60% for patients of Child B, and 0% for patients of Child C. CONCLUSIONS: Our results indicate that partial porta-ca- val shunt with a small diameter interposition H-graft is an effective procedure for the treatment of variceal bleeding, as well as for the prevention of re-bleeding in patients of Child A and those of Child B, as an electi

关键词： partial porto-systemic shunts portal hypertension cirrhosis variceal bleeding encephalopathy.

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Evaluating the best treatment for multifocal hepatocellular carcinoma:A propensity score-matched analysis

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World Journal of Gastroenterology 2022年第29期28卷 3981-3993页

作者： Matteo Risaliti Ilenia Bartolini Claudia Campani Umberto Arena Carlotta Xodo Valentina Adotti Martina Rosi Antonio Taddei Paolo Muiesan Amedeo Amedei giacomo batignani Fabio Marra Department of Experimental and Clinical Medicine AOU CareggiFlorence 50134Italy

BACKGROUND Hepatocellular carcinoma(HCC)is a common tumour often diagnosed with a multifocal *** with multifocal HCC represent a heterogeneous *** Trans-Arterial ChemoEmbolization(TACE)is the most frequently employed treatment for these patients,previous data suggested that liver resection(LR)could be a safe and effective *** To compare LR and TACE in patients with multifocal HCC in terms of procedurerelated morbidity and oncologic *** All patients with multifocal HCC who underwent LR or TACE as the first procedure between May 2011 and March 2021 were *** decision to perform surgery or TACE was made after a multidisciplinary team *** patients in Child-Pugh class A or B7 and stage B(according to the Barcelona Clinic Liver Cancer staging system,without severe portal hypertension,vascular invasion,or extrahepatic spread)were included in the final *** score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group[number and diameter of lesions,presence of cirrhosis,alpha-fetoprotein(AFP)levels,and Model for End-Stage Liver Disease score].The Kaplan-Meier method was used to estimate overall survival(OS)and disease-free survival(DFS).The outcomes of LR and TACE were compared using the log-rank *** After matching,30 patients were eligible for the final analysis,15 in each *** rates were 42.9% and 40% for LR and TACE,respectively(P=0.876).Median OS was not different in the LR and TACE groups(53 mo vs 18 mo,P=0.312),while DFS was significantly longer with LR(19 mo vs 0 mo,P=0.0001).Subgroup analysis showed that patients in the Italian Liver Cancer(***)B2 stage,with AFP levels lower than 400 ng/mL,less than 3 lesions,and lesions bigger than 41 mm,benefited more from LR in terms of *** classified as *** B3,with AFP levels higher than 400 ng/mL and with more than 3 lesions,appeared to receive more benefi

关键词： Hepatocellular carcinoma Multifocal hepatocellular carcinoma Liver resection Trans-arterial chemoembolization Guidelines Liver tumour management

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Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma

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Journal of Cancer Therapy 2014年第14期5卷 1344-1353页

作者： Benedetta Pesi Luca Moraldi Daniela Zambonin Francesco Giudici Tiziana Cavalli Rami Addasi Francesca Leo Stefano Scaringi giacomo batignani Gastro-Intestinal Surgery Unit Department of Surgery and Translational Medicine Careggi University Hospital Florence Italy

Background: Hepatocellular carcinoma (HCC) is one of the most common cancer in the world. Liver resection (LR) is the most used therapy in well compensated liver cirrhosis and maybe used as a first-line treatment. Aim of the study is to evaluate survival rates in patients who underwent LR for HCC and to identify risk factors able to influence the prognosis. Material/Method: A retrospective study was carried out in 115 patients whounderwent LR for HCC. We evaluated overall and disease-free survival rates at 1, 3 and 5years (y) and a series of variables included: type of resection, clamping, blood loss, transfusions, tumor size, presence of capsule, satellite nodules and vascular invasion. Results: The 1-, 3-, 5-y survival rates were 90.2%, 67% and 52.7%, and disease-free survival rates were 75.3%, 44.7% and 28.4%, respectively. We have found presence/ absence of capsulated tumor (p = 0.05), satellite nodules (p = 0.004) and vascular invasion (p = 0.001) as factors able to influence the overall survival and the disease-free survival (p = 0.04 for capsulated tumor, p = 0.01 for satellite nodules and p = 0.006 for vascular invasion). Conclusion: LR is the best therapeutic option for HCC when liver transplantation is contraindicated, with good survival rates. Presence of capsule, satellite nodules and vascular invasion are the most important factors able to influence the prognosis.

关键词： Liver Resection Hepatocellular Carcinoma Prognostic Factors Vascular Invasion Satellite Nodules

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Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma

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Journal of Cancer Therapy 2014年第14期

作者： Benedetta Pesi Luca Moraldi Daniela Zambonin Francesco Giudici Tiziana Cavalli Rami Addasi Francesca Leo Stefano Scaringi giacomo batignani

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Comparison of Wirsung-jejunal duct-tomucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2005年第3期4卷 450-455页

作者： Unita di Chirurgia, Dipartimento di Fisiopatologia Clinica (batignani G, Fratini G, Zuckermann M and Tonelli F) and Dipartimento di Statistica (Bianchini E), Universitd degli Studi di Firenze, Flo rence, Italy Unita di Chirurgia-Dipartimento di Fisiopatologia Clinica Universita degli Studi di Firenze Viale GB Morgagni 85 50134-Firenze Italy. giacomo.batignani@unifi.it

Pancreato-enteric reconstruction after pancreatoduodenectomy (PD) is still a source of debate because of the high incidence of complications. Among the various types of pancreato-jejunostomies we don't know yet which is the best in terms of anastomotic failure and related complications rates. Wirsung-jejunal duct-to-mucosa anastomosis (WJ) and 'dunking' pancreato-jejunal anastomosis (DPJ) are the two most used ones worldwide but conflicting results are reported. To determine which is the safer anastomosis and to define when an anastomosis should be preferred, we retrospectively reviewed two groups of patients who underwent WJ or DPJ. METHODS:Twenty-three patients underwent PD with WJ (n=17) with dilated (WJD) (n=9) or not-dilated Wirsung's duct (WJND) (n=8) or with a DPJ (n=6) over a 3-year period at a single institution. RESULTS: The complications rate was high in all groups of patients (33.3% in WJD, 37.5% in WJND and 66.7% in DPJ). A pancreatic fistula developed in one patient in each group (11. 1% in WJD, 12. 5% in WJND and 16. 7% in DPJ). All these patients were managed conservatively. Anastomotic disruption took place in the WJ patients especially in the WJND group (n=2) compared to the WJD (n=1) (25% vs 11.1%) or DPJ groups (0%) : these three patients required a re-operation. Overall, the anastomotic defects were higher in patients who underwent WJND (37.5%), compared to WJD (22.2%) and to DPJ (16.7%). However, no statistical differences were found among the groups. Delayed gastric emptying (DGE) and total parenteral nutrition (TPN) along with anastomotic defects were responsible for a prolonged hospital stay. CONCLUSIONS:Our results were not able to demonstrate any statistical difference between the two different techniques in preventing anastomotic failure. WJ can represent a valid choice in case of a dilated duct and a firm, fibrotic enlarged gland that could not be properly invaginated in a small jejunal loop. DGE may occur in those patients who experienc

关键词： pancreatoduodenectomy pancreas jejunal anastomosis Wirsung

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