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indocyanine green-based fluorescence imaging in visceral and hepatobiliary and pancreatic surgery:State of the art and future directions

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World Journal of Gastroenterology 2018年第27期24卷 2921-2930页

作者： gian luca baiocchi Michele Diana Luigi Boni Department of Clinical and Experimental Sciences University of BresciaBrescia 25125Italy IHU-Strasbourg Institute of Image-Guided SurgeryStrasbourg 67000France General and Emergency Surgery IRCCS-Ca’Granda-Policlinico HospitalMilan 20122Italy

In recent years, the use of fluorescence-guided surgery(FGS) to treat benign and malignant visceral, hepatobiliary and pancreatic neoplasms has significantly increased. FGS relies on the fluorescence signal emitted by injected substances(fluorophores) after being illuminated by ad hoc laser sources to help guide the surgical procedure and provide the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible. This review surveys and discusses the most common and emerging clinical applications of indocyanine green(ICG)-based fluorescence in visceral, hepatobiliary and pancreatic surgery. The analysis, findings, and discussion presented here rely on the authors' significant experience with this technique in their medical institutions, an up-to-date review of the most relevant articles published on this topic between 2014 and 2018, and lengthy discussions with key opinion leaders in the field during recent conferences and congresses. For each application, the benefits and limitations of this technique, as well as applicable future directions, are described. The imaging of fluorescence emitted by ICG is a simple, fast,relatively inexpensive, and harmless tool with numerous different applications in surgery for both neoplasms and benign pathologies of the visceral and hepatobiliary systems. The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future. Further studies are needed to evaluate the strengths and weaknesses of each application of ICG-based fluorescence imaging in abdominal surgery.

关键词： indocyanine green fluorescence imaging gastrointestinal surgery liver surgery biliary surgery pancreatic surgery visceral perfusion biliary anatomy peritoneal carcinomatosis

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Dysplasia in perforated intestinal pneumatosis complicating a previous jejuno-ileal bypass:A cautionary note

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World Journal of Gastroenterology 2009年第33期15卷 4189-4192页

作者： Nazario Portolani gian luca baiocchi Stefano Gadaldi Simona Fisogni Vincenzo Villanacci Department of Medical and Surgical Sciences Surgical ClinicBrescia University 2nd Department of Pathology Spedali Civili

We present the case of an elderly woman who developed a bowel perforation related to pneumatosis intestinalis, 33 years after a jejuno-ileal bypass for severe obesity. Final histological examination revealed the presence of dysplasia in the resected specimen. On the basis of our case and a review of the literature, we discuss the etiopathogenesis, the clinical aspects and the treatment of this rare condition.

关键词： Acute abdomen Pneumatosis intestinalis Peritonitis Obesity Dysplasia

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Pancreatic transection from blunt trauma associated with vascular and biliary lesions: A case report

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World Journal of Gastroenterology 2008年第30期14卷 4826-4829页

作者： gian luca baiocchi Guido AM Tiberio Federico Gheza Marco Gardani Massimiliano Cantù Nazario Portolani Stefano Maria Giulini Surgical Clinic Department of Medical and Surgical Sciences Spedali Civili di Brescia P.le Spedali Civili

Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries. In such cases, a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient. We herein describe a case of blunt abdominal trauma in a 29-year- old man whose pancreatic rupture was associated with hepatic artery, splenic vein and extrahepatic bile duct damage. Immediate surgery was performed after computer tomograghy (CT), the haemorrhagic lesions dictat the emergency transfer to the operating room. Spleno-pancreatic resection was done with reconstruction of the hepatic artery, ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion. The early post-operative course was complicated by stenosis of the arterial reconstruction, which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst, rest and antibiotics. Finally, the patient was discharged and was alive without clinical problems at the time when we wrote this case report. The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma.

关键词： Pancreas Trauma Vascular lesions Biliary lesions Sepsis

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Follow-up after gastrectomy for cancer:results of an international web round table

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World Journal of Gastroenterology 2014年第34期20卷 11966-11971页

作者： gian luca baiocchi Yasuhiro Kodera Daniele Marrelli Fabio Pacelli Paolo Morgagni Franco Roviello Giovanni De Manzoni Department of Medical and Surgical Sciences Surgical ClinicBrescia UniversityBrescia 25123Italy Department of Gastroenterological Surgery Surgery ⅡNagoya UniversityNagoya 452-0813Japan Department of Human Pathology and Oncology Surgical OncologySiena UniversitySiena 53011Italy Department of Surgical Sciences Digestive SurgeryCatholic UniversityRome 00118Italy Department of General Surgery MorgagniPierantoni HospitalForlì 47121Italy 1~(st) Department of General Surgery Borgo Trento HospitalUniversity of VeronaVerona 37121Italy

Oncological follow-up after radical gastrectomy for cancer still represents a discrepancy in the field, with many retrospective series demonstrating that early diagnosis of recurrence does not result in an improvement in patient survival; yet, many centers with high quality of care still provide routine patient follow-up after surgery by clinical and instrumental controls. This was the topic for a web round table entitled “Rationale and limits of oncological follow-up after gastrectomy for cancer” that was launched one year before the 10th International Gastric Cancer Congress. Authors having specific expertise were invited to comment on their previous publications to provide the subject for an open debate. During a three-month-long discussion, 32 authors from 12 countries participated, and 2299 people visited the dedicated web page. Substantial differences emerged between the participants: authors from Japan, South Korea, Italy, Brazil, Germany and France currently engage in instrumental follow-up, whereas authors from Eastern Europe, Peru and India do not, and British and American surgeons practice it in a rather limited manner or in the context of experimental studies. Although endoscopy is still considered useful by most authors, all the authors recognized that computed tomography scanning is the method of choice to detect recurrence; however, many limit follow-up to clinical and biochemical examinations, and acknowledge the lack of improved survival with early detection.

关键词： Gastric cancer Recurrence Follow-up Diagnosis Prognosis Surgery Chemotherapy

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Recurrence in node-negative advanced gastric cancer:Novel findings from an in-depth pathological analysis of prognostic factors from a multicentric series

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World Journal of Gastroenterology 2017年第45期23卷 8000-8007页

作者： gian luca baiocchi Sarah Molfino Carla Baronchelli Simone Giacopuzzi Daniele Marrelli Paolo Morgagni Maria Bencivenga luca Saragoni Carla Vindigni Nazario Portolani Maristella Botticini Giovanni De Manzoni Department of Clinical and Experimental Sciences University of Brescia Department of Pathology Spedali Civili di Brescia 1st Department of General Surgery Borgo Trento HospitalUniversity of Verona Department of Human Pathology and Oncology Surgical OncologyUniversity of Siena Department of General Surgery Morgagni-Pierantoni Hospital Department of Pathology Morgagni-Pierantoni Hospital Department of Pathology Azienda Ospedaliera Universitaria Senese IGIER Università Bocconi

AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up. METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1). We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2). We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis) of 41 cases matched with Group 1 according to demographic and pathological characteristics. RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients. In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns: lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for *** The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.

关键词： N0 gastric cancer Recurrence Prognostic factors Pathological analysis Lymphatic embolization Perineural infiltration p53 Ki67

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Incidence and treatment of mediastinal leakage after esophagectomy:Insights from the multicenter study on mediastinal leaks

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World Journal of Gastroenterology 2019年第3期25卷 356-366页

作者： Uberto Fumagalli gian luca baiocchi ANDrea Celotti Paolo Parise ANDrea Cossu Luigi Bonavina Daniele Bernardi Giovanni de Manzoni Jacopo Weindelmayer Giuseppe Verlato Stefano Santi Giovanni Pallabazzer Nazario Portolani Maurizio Degiuli Rossella Reddavid Stefano de Pascale Department of Digestive Surgery IEO European Institute of Oncology IRCCS Nazario Portolani Department of Clinical and Experimental StudiesSurgical Clinic University of Brescia General Surgery 2 ASST Spedali Civili di Brescia Department of Gastrointestinal Surgery San Raffaele HospitalVita-Salute San Raffaele University Department of Surgery IRCCS Policlinico San DonatoUniversity of Milan General and Upper GI Surgery Division University of Verona Department of Diagnostics and Public Health University of Verona Esophageal Surgery Unit Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease Cisanello Hospital University of Turin Department of Oncology Surgical Oncology and Digestive Surgery San Luigi University Hospital

BACKGROUND Mediastinal leakage(ML) is one of the most feared complications of esophagectomy. A standard strategy for its diagnosis and treatment has beendifficult to establish because of the great variability in their incidence and mortality rates reported in the existing *** To assess the incidence, predictive factors, treatment, and associated mortality rate of mediastinal leakage using the standardized definition of mediastinal leaks recently proposed by the Esophagectomy Complications Consensus Group(ECCG).METHODS Seven Italian surgical centers(five high-volume, two low-volume) affiliated with the Italian Society for the Study of Esophageal Diseases designed and implemented a retrospective study including all esophagectomies(n = 501) with intrathoracic esophagogastric anastomosis performed from 2014 to *** MLs were defined according to the classification recently proposed by the *** Fifty-nine cases of ML were recorded, yielding an overall incidence of 11.8%(95%CI: 9.1%-14.9%). The surgical approach significantly influenced the occurrence of ML: the proportion of leakage was 10.5% and 9% after open and hybrid esophagectomy(HE), respectively, and doubled(20%) after totally minimally invasive esophagectomy(TMIE)(P = 0.016). No other predictive factors were found. The 30-and 90-d overall mortality rates were 1.4% and 3.2%,respectively; the 30-and 90-d leak-related mortality rates were 5.1% and 10.2%,respectively; the 90-d mortality rates for TMIE and HE were 5.9% and 1.8%,respectively. Endoscopy was the first-line treatment in 49% of ML cases, with the need for retreatment in 17.2% of cases. Surgery was needed in 44.1% of ML *** treatment had the lowest mortality rate(6.9%). Removal of the gastric tube with stoma formation was necessary in 8(13.6%) *** The incidence of ML after esophagectomy was high mainly in the TMIE ***, the general and specific(leak-related) mortality rates were low. Early treatme

关键词： Transthoracic esophagectomy Minimally invasive esophagectomy Mediastinal leak Esophagectomy complications

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Multimodal treatment of gastric cancer in the west: Where are we going?

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World Journal of Gastroenterology 2015年第26期21卷 7954-7969页

作者： Daniele Marrelli Karol Polom Giovanni de Manzoni Paolo Morgagni gian luca baiocchi Franco Roviello Department of Medicine Surgery and NeurosciencesUniversity of Siena Department of Surgery University of Verona Depertment of Surgery "Morgani-Pierantoni" Hospital Surgical Clinic University of Brescia

The incidence of gastric cancer(GC) is decreasing worldwide,especially for intestinal histotype of the distal third of the *** the contrary,proximal location and diffuse Lauren histotype have been reported to be generally stable over *** the west,no clear improvement in long-term results was observed in clinical and population-based *** of treatment in these neoplasms are strictly dependent on tumor *** surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however,results are still unsatisfactory for advanced stages(Ⅲ and Ⅳ),for which additional treatments could provide a survival *** implies a tailored approach to *** aim of this review was to summarize the main multimodal treatment options in advanced resectable *** or postoperative treatments,including chemotherapy,chemoradiotherapy,targeted therapies,and hyperthermic intraperitoneal chemotherapy have been reviewed,and the main ongoing and completed trials have been *** original tailored multimodal approach to non-cardia GC has been also proposed.

关键词： Epidemiology Hyperthermic intraperitonealchemotherapy Chemotherapy Radiotherapy Gastriccancer Targeted therapy

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Increased risk of second malignancy in pancreatic intraductal papillary mucinous tumors: Review of the literature

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World Journal of Gastroenterology 2015年第23期21卷 7313-7319页

作者： gian luca baiocchi Sarah Molfino Barbara Frittoli Graziella Pigozzi Federico Gheza Giacomo Gaverini Antonio Tarasconi Chiara Ricci Francesco Bertagna Luigi Grazioli Guido AM Tiberio Nazario Portolani Department of Medical and Surgical Sciences Surgical Clinic University of Brescia 1~(st) Department of Radiology Brescia Civil Hospital Department of Medical and Surgical Sciences Gastroenterological Unit University of Brescia Department of Surgical Specialties Radiological and Forensic Sciences Nuclear Medicine SectionUniversity of Brescia

AIM: To analyze the available evidence about the risk of extrapancreatic malignancies and pancreatic ductal adenocarcinoma associated to pancreatic intraductal papillary mucinous tumors(IPMNs).METHODS: A systematic search of literature was undertaken using MEDLINE, EMBASE, Cochrane and Web-of-Science libraries. No limitations for year of publication were considered; preference was given to English papers. All references in selected articles were further screened for additional publications. Both clinical series and Literature reviews were selected. For all eligible studies, a standard data extraction form was filled in and the following data were extracted: study design, number of patients, prevalence of pancreatic cancer and extrapancreatic malignancies in IPMN patients and control groups, if ***: A total of 805 abstracts were selected and read; 25 articles were considered pertinent and 17 were chosen for the present systematic review. Eleven monocentric series, 1 multicentric series, 1 casecontrol study, 1 population-based study and 3 case report were included. A total of 2881 patients were globally analyzed as study group, and the incidence of pancreatic cancer and/or extrapancreatic malignancies ranged from 5% to 52%, with a mean of 28.71%.When a control group was analyzed(6 papers), the same incidence was as low as 9.4%.CONCLUSION: The available Literature is unanimous in claiming IPMNs to be strongly associated with pancreatic and extrapancreatic malignancies. The consequences in IPMNs management are herein discussed.

关键词： Intraductal papillary mucinous neoplasm Pancreas Diagnosis Follow-up Tumors Computedtomography scan 18FDG-PET

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In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

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Eye and Vision 2020年第1期7卷 136-149页

作者： Stefano baiocchi Cosimo Mazzotta Arianna Sgheri Alessandro Di Maggio Simone Alex Bagaglia Matteo Posarelli Leonardo Ciompi Alessandro Meduri gian Marco Tosi Department of Medicine Surgery and NeurosciencesOphthalmology UnitPoliclinico Santa Maria alle ScotteUniversity of SienaViale Bracci 8ZIP code 53100 SienaItaly Ophthalmology Unit Department of Biomedical SciencesUniversity of MessinaMessinaItaly

Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open angle glaucoma(POAG)patients treated by Xen 45 Gel Stent,medical therapy and ***:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by *** were divided into 3 groups:Group 1 eyes underwent the Xen 45 Gel Stent procedure,Group 2 eyes were under medical therapy,Group 3 eyes were surgically treated by *** patients underwent HRT II IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and ***:The Xen 45 Gel stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface *** corneal epithelial cells with micro-cysts,and normo-reflective sub-epithelial nerve plexus are documented by *** sub Tenon’s implants an alternative lamellar intra-scleral filtration is *** surgical procedures show a noticeable number of inflammatory cells with rare ***-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is ***:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel stents.

关键词： Glaucoma Primary open angle glaucoma POAG MIGS Xen 45 gel stent Ocular surface Inflammation Confocal microscopy IVCM

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