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Facial nerve monitoring in parotid gland surgery:Design and feasibility assessment of a potential standardized technique

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第4期9卷 280-287页

作者： Carlos S.Duque Andrés F.Londoño Ana M.Duque Jhon J.Zuleta Marcela Marulanda Lina M.Otálvaro Miguel Agudelo Juan P.Dueñas María F.Palacio gianlorenzo dionigi Hospital Pablo Tobón Uribe Departmento deCancerologíaMedellinColombia Clínica de Otorrinolaringología de Antioquia“Orlant” MedellínColombia Sección Otorrinolaringología Departamentode CirugíaFacultad de MedicinaUniversidadde AntioquiaMedellínColombia Hospital Pablo Tobón Uribe DirecciónCientíficaMedellinColombia Sección Cirugia de Cabeza y Cuello Departamento de CirugíaFacultad deMedicinaUniversidad de AntioquiaMedellinColombia Department of Internal Medicine IsraelMedical CenterNewarkNew JerseyUSA Departamento de Cirugía Clínica El RosarioEl TesoroMedellínColombia Sección Cabeza y Cuello Instituto deCancerologíaClínica Las Américas–AunaMedellínColombia Chirurgia Generale Capitanio AuxiologicoMilanItaly

Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.

关键词： amplitude facial nerve intraoperative neural monitoring latency loss of signal nerve monitoring parotid gland

A decade in gastric cancer curative surgery:Evidence of progress(1999-2009)

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World Journal of Gastrointestinal Surgery 2012年第3期4卷 45-54页

作者： Stefano Rausei gianlorenzo dionigi Francesca Rovera Luigi Boni Caterina Valerii Luisa Giavarini Francesco Frattini Renzo dionigi Department of Surgical Sciences University of Insubria

To investigate the progress in evidence-based surgical treatment of non-metastatic gastric cancer,we re- viewed the last ten years'literature.The data used in this review were identified by searches made on MED-LINE,Current Contents,PubMed,and other references taken from relevant original articles(on prospective and retrospective studies)concerning gastric cancer surgery.Only papers published in English between January 1999 and December 2009 were selected.Data from ongoing studies were obtained in December 2009, from the trials registry of the United States National Institutes of Health(http://www.***.gov).The citations list was presented according to evidence based relevance(i.e.,randomized controlled trials,pro- spective studies,retrospective series).In the last ten years,many challenges have been faced relating to the extension of gastric resection and nodal dissection as well as surgical timing,but we found only limited evidence,regardless of latitude of study.The ongoing phase-Ⅲ trials may provide answers that will be valid for the coming decades,and which may bring definitive answers for the currently unresolved questions.

关键词： Gastric cancer Evidence-based surgery D2 lymphadenectomy Laparoscopic gastrectomy Endo-scopic treatment Neoadjuvant therapy

Usefulness of PET-CT scan in recurrent thyroid cancer

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第3期6卷 182-187页

作者： gianlorenzo dionigi Fausto Fama Salvatore Antonio Pignata Antonella Pino Alessandro Pontin Ettore Caruso Yantao Fu Shijie Li Carmelo Mazzeo Hui Sun Sergio Baldari Division for Endocrine and Minimally Invasive Surgery Department of Human Pathology in Adulthood and Childhood"G.Borresi"University Hospital G.MartinoUniversity of MessinaMessinaItaly Nuclear Medicine Unit Department of Biomedical and Dental Sciences and Morpho-Functional ImagingUniversity Hospital G.MartinoUniversity of MessinaMessinaItaly Jilin Provincial Key Laboratory of Surgical Translational Medicine Division of Thyroid SurgeryChina-Japan Union Hospital of Jilin UniversityChangchunJilin ProvinceChina Division for Emergency Surgery Department of Human Pathology in Adulthood and Childhood"G.BarresiffUniversity Hospital G.MartinoUniversity of MessinaMessinaItaly

The aim of this paper is to discuss the risk of recurrence in patients with differentiated thyroid cancer and emphasize the importance of risk-group stratification,early recurrence identification and application of new imaging modalities,what is the PET-CT.Moreover,follow-up of patients with thyroid carcinoma should be carried out by specialized teams throughout life.Therefore,interdisciplinary case discussions in tumor conferences may improve the use of multimodal therapy especially in patients with poorly differentiated thyroid carcinomas.After baseline follow-up,if there is a suspicion of thyroid carcinoma,early PET-CT should be used for early detection and appropriate planning.Fortunately,due to the good localization possibility,the PET-CT enables a focused surgical procedure with avoidance of an unnecessary tumor search and thereby a reduction of the risk of injury of neighboring structures which is a concern with reoperative neck surgery.

关键词： Thyroid Thyroidectomy PET-CT Thyroid cancer Recurrence

In advanced gastric cancer:Prognosis and treatment of patients with positive peritoneal cytology

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World Journal of Gastrointestinal Surgery 2013年第5期5卷 135-137页

作者： Francesco Frattini Stefano Rausei Corrado Chiappa Francesca Rovera Luigi Boni gianlorenzo dionigi Department of Surgical Sciences University of Insubria School of Medicine

Positive peritoneal cytology in gastric cancer is classified as M1 disease by the 7thEdition of American Joint Committee on Cancer staging system.With the introduction of laparoscopy and peritoneal washing cytology in the staging of gastric cancer a new category of patients has been identified.These are patients with no macroscopic peritoneal metastases but with peritoneal cytology positive(P0C1).Prognosis and treatment of such patientsrepresent a controversial issue.We evaluate the state of the art of staging system in gastric cancer and discusss tandardisation in staging and treatment procedures.There is still a lack of uniformity in the use of laparoscopy with peritoneal cytology in clinical decision making and in the surgical treatment for gastric cancer.Survival of this patient subset remains poor.Multimodal therapies and new therapeutic strategies are required to improve the survival of these patients.

关键词： Advanced gastric cancer Peritoneal washing cytology Staging laparoscopy Reverse transcription-polymerase chain reaction

seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up

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World Journal of Gastroenterology 2016年第34期22卷 7748-7753页

作者： Stefano Rausei Laura Ruspi Federica Galli Vincenzo Pappalardo Giuseppe Di Rocco Francesco Martignoni Francesco Frattini Francesca Rovera Luigi Boni gianlorenzo dionigi Department of Surgery University of Insubria

Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity,due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases,positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however,its search in clinical practice is still far from being routinely performed,as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently,many controversies on lymph node staging are still ongoing,with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.

关键词： Gastric cancer Staging system Tumor node-metastasis Prognostic factors Clinical practice

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胃的癌症的多模式的治疗

World Journal of Gastrointestinal Surgery 2014年第4期6卷 55-58页

作者： Ilaria Proserpio Stefano Rausei Sabrina Barzaghi Francesco Frattini Federica Galli Domenico Iovino Francesca Rovera Luigi Boni gianlorenzo dionigi Graziella Pinotti Department of Oncology Ospedale di Circolo and University of Insubria Department of Surgery Ospedale di Circolo and University of Insubria

Gastric cancer is the second leading cause of death from malignant disease worldwide.Although complete surgical resection remains the only curative modality for early stage gastric cancer,surgery alone only provides long-term survival in 20%of patients with advancedstage disease.To improve current results,it is necessary to consider multimodality treatment,including chemotherapy,radiotherapy and surgery.Recent clinical trials have shown survival benefit of combining different neoadjuvant or adjuvant protocols compared with surgery with curative intent.Furthermore,the implementation of chemotherapy with novel targeted agents could play an important role in the multimodal management of advanced gastric cancer.In this paper,we focus on a multidisciplinary approach in the treatment of gastric cancer and discuss future strategies to improve the outcome for these patients.

关键词： Gastric cancer Gastrectomy Lymphadenectomy Multimodal treatment Adjuvant therapy Neoadjuvant therapy Chemotherapy Radiotherapy Targeted therapy