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Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

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World Journal of Clinical Cases 2020年第19期8卷 4450-4465页

作者： Emilio De Raffele mariateresa mirarchi Riccardo Casadei Claudio Ricci Eugenio Brunocilla Francesco Minni Dipartimento dell'Apparato Digerente Policlinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy Dipartimento Strutturale Chirurgico Ospedale SS Antonio e MargheritaTortona(AL)15057Italy Dipartimento di Scienze Mediche e Chirurgiche(DIMEC) Alma Mater StudiorumPoliclinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy Dipartimento di Medicina Specialistica Diagnostica e Sperimentale(DIMES)Alma Mater StudiorumPoliclinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy

BACKGROUND The therapeutic approach of metastatic renal cell carcinoma(RCC)represents a real challenge for clinicians,because of the variable clinical course;the recent availability of numerous targeted therapies that have significantly improved overall oncological results,but still with a low percentage of complete responses;and the increasing role of metastasectomy(MSX)as an effective strategy to achieve a durable cure,or at least defer initiation of systemic therapies,in selected patients and in the context of multimodality treatment ***^E SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC;he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy,with subsequent systemic therapy with Fluorouracil,Interferon-alpha and Interleukin *** subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences,successfully treated with multiple systemic treatments,repeated local treatments,including two pancreatic resections,conservative resection and ablation of multiple bilobar liver metastases,resection and stereotactic body radiotherapy of multiple lung *** is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites,including resection of more than 38 metastases,and 5 years after his last *** This case highlights that effective multimodality therapeutic strategies,including multiple systemic treatments and iterative aggressive surgical resection,can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.

关键词： Renal cell carcinoma Metastases Surgery Thermal ablation Radiation Case report Systemic therapy

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Evolving role of FDG-PET/CT in prognostic evaluation of resectable gastric cancer

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World Journal of Gastroenterology 2017年第38期23卷 6923-6926页

作者： Emilio De Raffele mariateresa mirarchi Dajana Cuicchi Ferdinando Lecce Bruno Cola Unità Operativa di Chirurgia Generale Dipartimento dell’Apparato Digerente Azienda Ospedaliero-Universitaria di Bologna U.O. di Chirurgia Generale Dipartimento Strutturale Chirurgico Ospedale 'SS Antonio e Margherita'

Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical 18F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.

关键词： Gastric cancer Prognosis 18F-fluorodeoxyglucose Positron emission tomography-computed tomography Bone marrow

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Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases:Between conventional and mini-invasive approaches

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World Journal of Gastroenterology 2020年第42期26卷 6529-6555页

作者： Emilio De Raffele mariateresa mirarchi Dajana Cuicchi Ferdinando Lecce Riccardo Casadei Claudio Ricci Saverio Selva Francesco Minni Division of Pancreatic Surgery Department of Digestive DiseasesAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi40138 BolognaItaly Dipartimento Strutturale Chirurgico Ospedale SS Antonio e Margherita15057 Tortona(AL)Italy Surgery of the Alimentary Tract Department of Digestive DiseasesAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi40138 BolognaItaly Division of Pancreatic Surgery Department of Medical and Surgical Sciences(DIMEC)Alma Mater StudiorumUniversity of Bologna40138 BolognaItaly

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under *** approach,with initial colorectal resection followed by liver resection(LR),or even the reverse,liver-first approach in specific situations,is traditionally *** resections,however,represent an appealing strategy,because may have perioperative risks comparable to staged resections in appropriately selected patients,while avoiding a second surgical *** patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases,simultaneous major hepatectomies may determine worse perioperative outcomes,so that parenchymal-sparing LR should represent the most appropriate option whenever ***-invasive colorectal surgery has experienced rapid spread in the last decades,while laparoscopic LR has progressed much slower,and is usually reserved for limited tumours in favourable ***,mini-invasive parenchymal-sparing LR is more complex,especially for larger or multiple tumours in difficult *** remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise,at least for more complex *** review aims to critically analyze the current status and future perspectives of simultaneous resections,and the present role of the available miniinvasive techniques.

关键词： Synchronous colorectal liver metastases Colorectal surgery Liver surgery Simultaneous resection Parenchymal-sparing liver resection Mini-invasive surgery Intraoperative ultrasonography

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Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

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World Journal of Gastrointestinal Oncology 2018年第10期10卷 293-316页

作者： Emilio De Raffele mariateresa mirarchi Dajana Cuicchi Ferdinando Lecce Claudio Ricci Riccardo Casadei Bruno Cola Francesco Minni Unità Operativa di Chirurgia Generale Dipartimento dell’Apparato DigerenteAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi U.O.di Chirurgia Generale Dipartimento Strutturale Chirurgico Ospedale "Antonio e Margherita" Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Alma Mater Studiorum Policlinico S.Orsola-Malpighi University of Bologna

Synchronous colorectal carcinoma(SCRC) indicates more than one primary colorectal carcinoma(CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases(CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown goodresults, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disea

关键词： Colorectal surgery Synchronous colorectal liver metastases Major hepatectomy Parenchymalsparing hepatectomy Intraoperative ultrasonography Simultaneous colorectal and liver surgery Synchronous colorectal carcinoma Ablative therapies

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Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study

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World Journal of Clinical Cases 2022年第24期10卷 8556-8567页

作者： Fabrizio D'Acapito Leonardo Solaini Daniela Di Pietrantonio Francesca Tauceri Maria Teresa mirarchi ElenaAntelmi Francesca Flamini Alessio Amato Massimo Framarini Giorgio Ercolani Department of General and Oncologic Surgery Morgagni-Pierantoni HospitalAUSL RomagnaForlì47121Italy Department of Medical and Surgical Sciences University of BolognaBologna 40126Italy

BACKGROUND Incidence of gallstones in those aged≥80 years is as high as 38%-53%.The decision-making process to select those oldest old patients who could benefit from cholecystectomy is *** To assess the risk of morbidity of the“oldest-old”patients treated with cholecystectomy in order to provide useful data that could help surgeons in the decision-making process leading to surgery in this *** A retrospective study was conducted between 2010 and *** variables were collected and compared between patients who had postoperative complications.A model was created and tested to predict severe postoperative *** The 269 patients were included in the study(193 complicated).The 9.7%of complications were grade 3 or 4 according to the Clavien-Dindo *** levels were lower in patients who did not have any postoperative *** Society of Anesthesiologists scale 4 patients,performing a choledocholithotomy and bilirubin levels were associated with Clavien-Dindo>2 complications(P<0.001).The decision curve analysis showed that the proposed model had a higher net benefit than the treating all/none options between threshold probabilities of 11%and 32%of developing a severe *** Patients with American Society of Anesthesiologists scale 4,higher level of bilirubin and need of choledocholithotomy are at the highest risk of a severely complicated postoperative *** endoscopic or percutaneous treatments should be considered in this subgroup of octogenarians.

关键词： Cholecystitis Gallstones Choledocholithotomy Elderly Post-operative complications

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