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Indocyanine green:The guide to safer and more effective surgery

World Journal of Gastrointestinal Surgery 2024年第3期16卷 641-649页

作者： Pietro Fransvea maria michela Chiarello Valeria Fico maria Cariati Giuseppe Brisinda Emergency Surgery and Trauma Center Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy department of Surgery Azienda Sanitaria Provinciale di CrotoneCrotone 88900Italy department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.

关键词： Indocyanine green Colorectal surgery Fluorescence-guided surgery Gastrointestinal surgery Hepato-biliary surgery Pancreatic surgery Surgical oncology

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How to identify early complications in patients undergoing distal gastrectomy?

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 974-981页

作者： Giuseppe Tropeano maria michela Chiarello Valeria Fico Giuseppe Brisinda Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy department of Medical and Surgical Sciences UniversitàCattolica del Sacro CuoreRome 00168Italy

In this editorial we comment on the article by Zhang et al published in a recent issue of the World Journal of Gastrointestinal Surgery.Gastrectomy with appropriate lymph node dissection is still standard curative treatment in locally advanced gastric cancer.Several studies point out that gastric cancer surgery is a complex procedure that leads to a high risk of morbidity and mortality.Many factors can contribute to the onset of complications with consequent effects on prognosis and increased mortality.The complications can be divided in complications related to anastomosis,to motility and to surgical site infection.The study presented by Zhang B et al represent an interesting analysis on the possibility to prevent postoperative morbidity.The study was performed on 131 patients with distal gastric cancer who underwent gastrectomy with d2 lymph node dissection.Of these patients,16%developed early postoperative complications.The univariate analysis showed that prealbumin level,hypertension,diabetes,history of abdominal surgery,R0 resection,and blood transfusion were factors influencing early postoperative complications after distal gastrectomy.Moreover,the inclusion of the above significant variables in the logistic regression analysis revealed that hypertension,diabetes,a history of abdominal surgery,and blood transfusion were independent predictors of postoperative complications.In conclusion,preoperative and intraoperative factors can be used to establish an early postoperative nomogram model.The results of the study presented by Zhang et al suggest that the prediction model can be used to guide the detection of postoperative complications and has clinical reference value.

关键词： Gastric cancer Gastrectomy Lymph node dissection Morbidity Mortality Surgical site infections

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Tubulointerstitial nephritis and uveitis syndrome post-COVId-19

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Pediatric Investigation 2023年第1期7卷 57-59页

作者： maria Cristina Maggio Filippo Collura maria michela d’alessandro Barbara Gramaglia Giovanni Corsello University department PROMISE"G.d’alessandro University of Palermo-Children Hospital"G.Di Cristina"A.R.N.A.S.PalermoItaly U.O.C.of Paediatric Nephrology Children Hospital"G.Di Cristina"A.R.N.A.S.PalermoItaly

To the editor:The angiotensin-converting-enzyme-2(ACE2)receptor is expressed in many extrapulmonary organs:eyes(conjunctival,corneal,and limbal epithelial cell,retina),nerves,vessels,small intestine enterocytes,kidney... 详细信息

关键词： ACE2 intestine organs

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Endoluminal vacuum-assisted therapy as a treatment for anastomotic leakage in colorectal surgery

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World Journal of Gastroenterology 2022年第28期28卷 3747-3752页

作者： maria michela Chiarello Valentina Bianchi Pietro Fransvea Giuseppe Brisinda department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168taly Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Anastomotic leakage(AL)has a wide range of clinical features ranging from radiological only findings to peritonitis and sepsis with multiorgan failure.An early diagnosis of AL is essential in order to establish the most appropriate treatment for this complication.despite AL continues to be a dreadful complication after colorectal surgery,there has been no consensus on its management.However,based on patient’s presentation and timing of the AL,there has been a gradual shift to a more conservative management,keeping surgery as the last option Reoperation for sepsis control is rarely necessary especially in those patients who already have a diverting stoma at the time of the leak.A nonoperative management is usually preferred in these patients.There are several treatment options,also for patients without a stoma who do not require a reoperation for a contained pelvic leak,including recently developed endoscopic procedures,such as clip placement or endoluminal vacuum-assisted therapy.More conservative treatments could be an option in patients who are clinically stable or in presence of a small defect.

关键词： Anastomotic leakage Colorectal cancer Colorectal surgery Mortality Morbidity

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Anastomotic leakage in rectal cancer surgery:Retrospective analysis of risk factors

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World Journal of Clinical Cases 2022年第36期10卷 13321-13336页

作者： Giuseppe Brisinda maria michela Chiarello Gilda Pepe maria Cariati Valeria Fico Paolo Mirco Valentina Bianchi department of Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Surgery UniversitàCattolica S CuoreRome 00168Italy department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Surgery Azienda Sanitaria Provinciale di CrotoneCrotone 88900Italy

BACKGROUNd Anastomotic leakage(AL)after restorative surgery for rectal cancer(RC)is associated with significant morbidity and mortality.AIM To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study.METHOdS To identify risk factors for AL,a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed.Clinical,demographic and operative features,intraoperative outcomes and oncological characteristics were evaluated.RESULTS The incidence of AL was 10.4%,with a mean time interval of 6.2±2.1 d.Overall mortality was 0.8%.Mortality was higher in patients with AL(4.9%)than in patients without leak(0.4%,P=0.009).Poor bowel preparation,blood transfusion,median age,prognostic nutritional indexdiameter and intraoperative blood loss were identified as risk factors for AL.Location of anastomosis,number of stapler cartridges used to divide the rectum,diameter of circular stapler,level of vascular section,T and N status and stage of disease were also correlated to AL in our patients.The diverting ileostomy did not reduce the leak rate,while the use of the transanastomic tube significantly did.CONCLUSION Clinical,surgical and pathological factors are associated with an increased risk of AL.It adversely affects the morbidity and mortality of RC patients.

关键词： Anastomosis Leak Anterior resection Morbidity Mortality Rectal surgery

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Postoperative mortality and morbidity after d2 lymphadenectomy for gastric cancer:A retrospective cohort study

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World Journal of Gastroenterology 2022年第3期28卷 381-398页

作者： Giuseppe Brisinda maria michela Chiarello Anna Crocco Neill James Adams Pietro Fransvea Serafino Vanella Abdominal Surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Medical and Surgical Sciences UniversitàCattolica del Sacro CuoreRome 00168Italy General Surgery Operative Unit Azienda Sanitaria Provinciale di CrotoneOspedale San Giovanni di DioCrotone 88900Italy Endocrine Surgery Operative Unit Istituto Nazionale TumoriIRCCS Fondazione PascaleNapoli 80100Italy Health Sciences Clinical Microbiology UnitMagna Grecia UniversityCatanzaro 88100Italy department of Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of General and Oncological Surgery Azienda Ospedaliera San Giuseppe MoscatiAvellino 83100Italy

BACKGROUNd Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory.Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and d2 lymphadenectomy for gastric cancer.METHOdS A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric cancer.For each patient we calculated the Kattan’s score.We arbitrarily divided the study population of patients into two groups based on the nomogram score(d subgroups in these analyses were defined according to age(≤65 years or>65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity.RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with d2 lymphadenectomy.Perioperative mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer patients.The removal of more than 35 lymph nodes does not lead to an increase in mortality.

关键词： Gastric cancer Total gastrectomy Subtotal gastrectomy Lymphadenectomy Kattan’s nomogram Mortality Postoperative complications Postoperative pancreatic fistula Hemoperitoneum Anastomotic leakage

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SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVId-19 positive patients?

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World Journal of Gastroenterology 2022年第36期28卷 5240-5249页

作者： Giuseppe Brisinda maria michela Chiarello Giuseppe Tropeano Gaia Altieri Caterina Puccioni Pietro Fransvea Valentina Bianchi department of Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Medicine and Surgery UniversitàCattolica del Sacro CuoreRome 00168Italy department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can cause pancreatic damage,both directly to the pancreas via angiotensin-converting enzyme 2 receptors(the transmembrane proteins required for SARS-CoV-2 entry,which are highly expressed by pancreatic cells)and indirectly through locoregional vasculitis and thrombosis.despite that,there is no clear evidence that SARS-CoV-2 is an etiological agent of acute pancreatitis.Acute pancreatitis in coronavirus disease 2019(COVId-19)positive patients often recognizes biliary or alcoholic etiology.The prevalence of acute pancreatitis in COVId-19 positive patients is not exactly known.However,COVId-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVId-19 negative patients.Acute respiratory distress syndrome is the most frequent cause of death in COVId-19 positive patients and concomitant acute pancreatitis.In this article,we reported recent evidence on the correlation between COVId-19 infection and acute pancreatitis.

关键词： Acute pancreatitis SARS-CoV-2 Severe acute pancreatitis Multiparametric scores Infected necrosis Step-up approach

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Therapeutic strategies in Crohn’s disease in an emergency surgical setting

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World Journal of Gastroenterology 2022年第18期28卷 1902-1921页

作者： maria michela Chiarello Gilda Pepe Valeria Fico Valentina Bianchi Giuseppe Tropeano Gaia Altieri Giuseppe Brisinda department of Surgery San Giovanni in Fiore HospitalAzienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Medical and Surgical Science UniversitàCattolica del Sacro CuoreRome 00168Italy

Crohn’s disease(Cd)remains a chronic,incurable disorder that presents unique challenges to the surgeon.Multiple factors must be considered to allow development of an appropriate treatment plan.Medical therapy often precedes or complements the surgical management.The indications for operative management of Cd include acute and chronic disease complications and failed medical therapy.Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype.Toxic colitis,acute obstruction,perforation,acute abscess,or massive hemorrhage represent indications for emergency surgery.These patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality.A multidisciplinary team including surgeons,gastroenterologists,radiologists,nutritional support services,and enterostomal therapists are required for optimal patient care and decision making.Management of each emergency should be individualized based on patient age,disease type and duration,and patient goals of care.Moreover,the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations.In this review,we aimed to discuss the acute complications of Cd and their treatment.

关键词： Crohn’s disease Intestinal obstruction Free perforation Intra-abdominal sepsis Perineal sepsis Acute bleeding

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Early gastric cancer:A challenge in Western countries

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World Journal of Gastroenterology 2022年第7期28卷 693-703页

作者： maria michela Chiarello Valeria Fico Gilda Pepe Giuseppe Tropeano Neill James Adams Gaia Altieri Giuseppe Brisinda department of Surgery Azienda Sanitaria Provinciale di CrotoneOspedale San Giovanni di DioCrotone 88900Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Health Sciences Clinical Microbiology UnitMagna Grecia UniversityCatanzaro 88100Italy department of Medical and Surgical Sciences Catholic School of MedicineRome 00168Italy department of Surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Early gastric cancer(EGC)is an invasive carcinoma involving only the stomach mucosa or submucosa,independently of lymph node status.EGC represents over 50%of cases in Japan and in South Korea,whereas it accounts only for approximately 20%of all newly diagnosed gastric cancers in Western countries.The main classification systems of EGC are the Vienna histopathologic classification and the Paris endoscopic classification of polypoid and non-polypoid lesions.A careful endoscopic assessment is fundamental to establish the best treatment of EGC.Generally,EGCs are curable if the lesion is completely removed by endoscopic resection or surgery.Some types of EGC can be resected endoscopically;for others the most appropriate treatment is surgical resection and d2 lymphadenectomy,especially in Western countries.The favorable oncological prognosis,the extended lymphadenectomy and the reconstruction of the intestinal continuity that excludes the duodenum make the prophylactic cholecystectomy mandatory to avoid the onset of biliary complications.

关键词： Early gastric cancer diagnosis Treatment Endoscopic resection Surgery Lymph nodes metastases

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Surgical complications of oncological treatments: A narrative review

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1056-1067页

作者： Valeria Fico Gaia Altieri Marta di Grezia Valentina Bianchi maria michela Chiarello Gilda Pepe Giuseppe Tropeano Giuseppe Brisinda Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy department of Medicine and Surgery Catholic School of MedicineRome 00168Italy

Gastrointestinal complications are common in patients undergoing various forms of cancer treatments,including chemotherapy,radiation therapy,and moleculartargeted therapies.Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract,small bowel,colon,and rectum.The mechanisms of action of these therapies are different.Chemotherapy includes cytotoxic drugs,which block the activity of cancer cells by targeting intracellular dNA,RNA,or proteins.Gastrointestinal symptoms are very common during chemotherapy,due to a direct effect on the intestinal mucosa resulting in edema,inflammation,ulceration,and stricture.Serious adverse events have been described as complications of molecular targeted therapies,including bowel perforation,bleeding,and pneumatosis intestinalis,which may require surgical evaluation.Radiotherapy is a local anti-cancer therapy,which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death.Complications related to radiotherapy can be both acute and chronic.Ablative therapies,including radiofrequency,laser,microwave,cryoablation,and chemical ablation with acetic acid or ethanol,can cause thermal or chemical injuries to the nearby structures.Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication.Furthermore,it is important to know the stage and prognosis of the disease,and a multidisciplinary approach is necessary to personalize the surgical treatment.The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.

关键词： Cancer Chemotherapy Radiotherapy Complications Bowel perforation Gastrointestinal bleeding

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