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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

Genomic and genetic alterations influence the progression of gastric cancer

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World Journal of Gastroenterology 2011年第3期17卷 290-299页

作者： Stefania Nobili Lorenzo Bruno Ida Landini Cristina Napoli paolo bechi Francesco Tonelli Carlos A Rubio Enrico Mini Gabriella Nesi Department of Preclinical and Clinical Pharmacology University of Florence Department of Critical Care Medicine and Surgery University of Florence Department of Clinical Physiopathology University of Florence Department of Pathology Karolinska Institute and University Hospital Division of Pathological Anatomy Department of Critical Care Medicine and SurgeryUniversity of Florence

Gastric cancer is one of the leading causes of cancerrelated deaths worldwide, although the incidence has gradually decreased in many Western countries. Two main gastric cancer histotypes, intestinal and diffuse, are recognised. Although most of the described genetic alterations have been observed in both types, different genetic pathways have been hypothesized. Genetic and epigenetic events, including 1q loss of heterozygosity (LOH), microsatellite instability and hypermethylation, have mostly been reported in intestinal-type gastric carcinoma and its precursor lesions, whereas 17p LOH, mutation or loss of E-cadherin are more often implicated in the development of diffuse-type gastric *** this review, we summarize the sometimes contradictory findings regarding those markers which influence the progression of gastric adenocarcinoma.

关键词： Gastric cancer Gene alterations Prognosis Molecular pathology

Multiple Detector-Row CT in Gastric Cancer Staging: Prospective Study

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Journal of Cancer Therapy 2014年第14期5卷 1438-1449页

作者： Lorenzo Bruno Lucia Barni Gaia Masini Sabrina Pacciani Edvige Lucarelli Antonella Masserelli Daniela Tomcykova Filippo Melli Luca Boni Giancarlo Freschi paolo bechi Surgery and Translational Medicine University of Florence Florence Italy Diagnostic Imaging 4 Azienda Ospedaliero-Universitaria Careggi Florence Italy Clinical Trials Coordinating Center Azienda Ospedaliero-Universitaria Careggi Florence Italy

The aim of this study was to evaluate the accuracy of multiple detector computed tomography (MDCT) in the preoperative staging of gastric cancer, prospectively comparing CT findings with pathological findings at surgery, in a single-center study. A total of 19 consecutive patients with primary cancer recruited between March and July 2014 were submitted to preoperative MDCT staging according to a standard protocol. All diagnostic procedures were performed by dedicated radiologists who were unaware of the final pathological results. Subsequently, 16 patients underwent surgical treatment and 15 were finally included in the study. The primary tumor was detected at CT in all 15 cases. CT results for T staging were in agreement with pathological findings in 12 of 15 cases, with overall accuracy of 80%. Stage-specific sensibility was high for advanced stages (sensibility for T1, T3, and T4 resulted 60%, 85.7%, and 100%, respectively), while earlier stages showed higher specificity (specificity for T1, T3, and T4 resulted 100%, 75%, and 91.7%, respectively). Overall N staging accuracy was 86.7%, with 13 of 15 patients correctly staged. Stage-specific sensibility was 75% for N0 and 100% for N3, while specificity was 100% for N0 and lower for advanced stages. Accuracy for peritoneal involvement was 100%. Our findings show a good performance of the diagnostic protocol performed with MDCT tested in this study.

关键词： Gastric Cancer MDCT Staging Oncologic Imaging

Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data

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Journal of Cancer Therapy 2014年第14期5卷 1454-1466页

作者： Lorenzo Bruno Lucia Barni Sabrina Pacciani Gaia Masini Lorenzo Tofani Federica Tofani Filippo Melli Antonio Taddei Manuela Andonova Miloeva Luca Boni Giancarlo Freschi paolo bechi Department of Surgery and Translational Medicine University of Florence Florence Italy Clinical Trials Coordinating Center Azienda Ospedaliero-Universitaria Careggi Florence Italy

Background and Aims: The complication rate after surgery for gastric cancer varies according to the particular definition of morbidity, so it’s necessary to report them using a standardized method, the Clavien-Dindo system. The purpose of this study was to prospectively analyze all post-gastrectomy complications in patients with gastric adenocarcinoma according to the severity grade using Clavien-Dindo system, in order to identify risk factors for postoperative complications and their prognostic significance on survival. Methods: This study is based on data from 90 consecutive patients who underwent gastrectomy for gastric neoplasia between January 2010 and February 2014 at the same unit. 15 patients were excluded (benign tumors, GISTs, missing data). Complications were categorized according to the Clavien-Dindo classification (uncomplicated patients vs patients classified ≥Grade I). The following risk factors were studied: age, BMI, sex, operation method, extent of resection, duration of surgery, transfusions, TNM staging, and lymph node ratio. Multivariate logistic regression was used to evaluate the association between risk factors and presence of complications. To assess the effect on overall survival, after selection of covariates using backward elimination, the Cox proportional hazard model was applied. Results: Among these patients, 49 (65.3%) developed complications, stratified as follows: Grade I, 6 (8%);Grade II, 24 (32%);Grade III, 6 (8%);Grade IV, 13 (17.3%). The laparoscopic technique (OR = 0.050;95% CI = 0.005 - 0.550, p = 0.0143) and no transfusions (OR = 0.219;95% CI = 0.058 - 0.827, p = 0.0251) were found to reduce the incidence of postoperative complications in the multivariate analysis. With regard to the survival analysis, lymph node ratio, malnutrition, extended resection and presence of complications were significant predictors of reduced survival in the multivariate analysis. Conclusions: Some variables can predict the risk of postoperative co

关键词： Gastric Cancer Complications Clavien-Dindo Classification Survival Probability

A New Early Gastric Cancer after Subtotal Gastric Resection for Early Cancer: Case Report and Review of the Literature

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Journal of Cancer Therapy 2014年第14期5卷 1450-1453页

作者： Lorenzo Bruno Lucia Barni Gabriella Nesi Sabrina Pacciani Gaia Masini Filippo Melli Gherardo Maltinti Tiku Zalla Lorenzo Dioscoridi Antonio Taddei Giancarlo Freschi paolo bechi Department of Surgery and Translational Medicine University of Florence Florence Italy Division of Pathological Anatomy Department of Surgery and Translational Medicine University of Florence Florence Italy

Although the prognosis of early gastric cancer (EGC) is considered to be satisfactory, some patients experience tumor relapse after curative surgery. Both pathogenesis and risk factors of recurrence remain unclear. We describe a case report of a 49-year-old male who underwent subtotal gastric resection D2A for angular gastric cancer. Histological examination revealed gastric adenocarcinoma with low grade of differentiation and colloid areas, intramucosal, and absence of neoplastic proliferation in the surgical margins, in omental stroma and in the six examined lymph nodes (pT1, pN0). 11 years later, the same patient underwent D2 total gastrectomy for gastric cancer in the remnant stomach. New histological examination revealed again gastric adenocarcinoma, intramucosal, medium degree of differentiation, no documentable neoplastic proliferation within the limits of surgical resection, in the thirty-three examined lymph nodes and in the omentum (pT1, pN0).

关键词： Early Gastric Cancer Remnant Gastric Cancer Long Term Follow-Up