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Total mesorectal excision for mid and low rectal cancer: laparoscopic vs robotic surgery

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World Journal of Gastroenterology 2016年第13期22卷 3602-3610页

作者： Francesco Feroci Andrea Vannucchi paolo pietro bianchi Stefano Cantafio Alessia Garzi Giampaolo Formisano Marco Scatizzi Department of General and Oncological Surgery Santo Stefano Hospital Department of General and Minimally Invasive Surgery Misericordia Hospital

AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal ***: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and ***: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between ***: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.

关键词： Robotic surgery Laparoscopic surgery Rectal cancer Total mesorectal excision Minimally invasive surgery

Dealing with robot-assisted surgery for rectal cancer:current status and perspectives

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World Journal of Gastroenterology 2016年第2期22卷 546-556页

作者： Roberto Biffi Fabrizio Luca paolo pietro bianchi Sabina Cenciarelli Wanda Petz Igor Monsellato Manuela Valvo Maria Laura Cossu Tiago Leal Ghezzi Kassem Shmaissany Department of Gastrointestinal Surgery European Institute of Oncology20141 MilanItaly

The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition threedimensional vision, it translates the surgeon's hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors' centre.

关键词： Rectal cancer Robotic total mesorectalexcision Robotic surgery Robotic resection Circumferentialresection margin Lymph node yield Distalresection margin positivity

Endoscopic ultrasound-guided drainage of pancreatic fluid collections: The impact of evolving experience and new technologies in diagnosis and treatment over the last two decades

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 68-73页

作者： pietro Gambitta Anna Maffioli Jean Spiropoulos Antonio Armellino Maurizio Vertemati paolo Aseni Endoscopy Unit ASST Grande Ospedale Metropolitano NiguardaMilanItaly Endoscopy Unit ASST Fatebenefratelli SaccoMilanItaly Chirurgia Generale 1 ASST Fatebenefratelli SaccoMilanItaly Endoscopy Division Ospedale San Leopoldo Mandic di MerateASST LeccoLeccoItaly Dipartimento di Scienze Biomediche Dipartimento di Scienze Biomediche Cliniche“L.Sacco” Universitàdegli Studi di MilanoMilanItaly Department of Emergency Medicine ASST Grande Ospedale Metropolitano NiguardaMilanItaly

Background: Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pan- creatic uid collections (PFCs) due to the better experience and signi cant progress using newer stents and access devices during last decade. This study aimed to evaluate the role of the evolving experience and possible in uence of new technological devices on the outcome of patients evaluated for PFCs and submitted to EUS-guided drainage during two different periods: the early period at the beginning of experience when a standardized technique was used and the late period when the increased experience of the operator, combined with different stents quality were introduced in the management of PFCs. Methods: We retrospectively analyzed the clinical data of a cohort of 91 consecutive patients, who underwent EUS-guided drainage of symptomatic PFCs from October 2001 to September 2017. Demographic, therapeutic results, complications, and outcomes were compared between early years’ group (2001 2008) and late years’ group (2009 2017). Results: Endoscopic treatment was successfully achieved in 55.6% (20/36) of patients in the early years’ group, and in 96.4% (53/55) in the late years’ group. Eighteen patients (12 in early years’ and 6 in the late year’s group) required additional open surgery. Procedural complications were observed in 5 patients, 4 in early years’ and 1 in late years’ group. Mortality was registered in two patients (2.2%), one for each group. Conclusions: During our long-term survey using EUS-guided endoscopic drainage of PFCs, signi cantly better outcomes in term of improved success rate and decrease complications rate were observed during the late period.

关键词： Endoscopic ultrasound Acute necrotizing pancreatitis Pancreatic fluid collections Pancreatic pseudocyst

Ablative therapies for intrahepatic cholangiocarcinoma

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Hepatobiliary Surgery and Nutrition 2018年第3期7卷 192-194页

作者： Antonio Giorgio pietro Gatti paolo Matteucci Valentina Giorgio Interventional Ultrasound Unit Tortorella Clinical HospitalSalernoItaly Internal Medicine Division Ostuni HospitalOstuni BRItaly Radiation Oncology Institute Campus Biomedico UniversityRomeItaly Pediatric Gastroenterology Unit Sacred Heart UniversityPoliclinico GemelliRomeItaly

Among the 3 sub-types of cholangiocarcinoma (CH), [intrahepatic CH, hylar (CH) and extrahepatic (CH)], intrahepatic cholangiocarcinoma (ICC) accounts for up 8–10% of cholangiocarcinomas and 10–20% of all primary liv... 详细信息

关键词： carcinoma liver for

Developments in diagnosis and management of post-liver transplantation biliary complications:the radiologist’s perspective

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 457-461页

作者： paolo Marra pietro Andrea Bonaffini Davide Ippolito Sandro Sironi Department of Radiology Papa Giovanni XXIII HospitalBergamoItaly School of Medicine University of Milano-BicoccaMilanItaly Department of Diagnostic Radiology San Gerardo HospitalMonzaItaly

Biliary complications are the most common source of morbidity after liver transplantation as they may occur in up to 45%of patients(1).The review by Magro et al.(2)provides comprehensive insights on this topic and offers a cue for in-depth remarks form a radiological perspective regarding both diagnostic and interventional ***(US)-based techniques,including B-mode and color-Doppler,are the milestone of post-transplant *** assessment of graft vascularization is crucial since many biliary complications are supposed to be induced by arterial *** this regard,however,it must be emphasized that US imaging is hampered by a limited panoramic view,especially in difficult abdomens,therefore it is not possible to rely exclusively on this technique.

关键词： diagnosis complications graft

Endoscopic ultrasound-guided fine-needle aspiration for suspected malignancies adjacent to the gastrointestinal tract

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World Journal of Gastroenterology 2014年第26期20卷 8599-8605页

作者： pietro Gambitta Antonio Armellino Edoardo Forti Maurizio Vertemati Paola Enrica Colombo paolo Aseni Unità di Chirurgia Endoscopica ed Ecoendoscopia Ospedale Niguarda Ca’ Granda Dipartimento di Scienze Biomediche e Cliniche "L. Sacco" Università degli Studi di Milano Servizio di Fisica Sanitaria Ospedale Niguarda Ca’ Granda HPB and Transplantation Surgery Ospedale Niguarda Ca’ Granda

AIM: To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.

关键词： Gastrointestinal neoplasm Endoscopic ultrasonography Clinical scoring system Fine needle aspiration Clinical decision support system

Editorial on "Role of thermal ablation in the management of colorectal liver metastasis"

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Hepatobiliary Surgery and Nutrition 2020年第1期9卷 62-64页

作者： Antonio Giorgio pietro Gatti Massimo De Luca paolo Matteucci Valentina Giorgio Liver Unit and Interventional Ultrasound Unit Athena Clinical InstitutePiedimonte Matese(CE)Italy Internal Medicine Unit Brindisi General HospitalBrindisiItaly Liver Unit Cardarelli HospitalNaplesItaly Radiation Oncology Unit Campus BiomedicoRomaItaly Fondazione Policlinico A.Gemelli IRCCS Department of Woman and Child Health and Public HealthRomaItaly

The last 30 years have shown the increasing role of Ablation in the treatment of malignant liver tumors. By the introduction of percutaneous ethanol injection (PEI) as first ablation tool for percutaneous treatment of hepatocellular carcinoma (HCC) in cirrhosis that firstly showed very high efficacy (1), several ablation techniques (mainly thermal) have been introduced in clinical practice aimed at destroying primary and secondary hepatic tumors as alternative or substitute tools to surgery. Radiofrequency ablation (RFA) was the first thermal technique that showed a good efficacy to ablate liver metastases (2). Among the secondary liver tumors, colorectal liver metastases (CRLM) represent the unique indication for ablation (2). Unlike HCC in cirrhosis where the role of RFA is well defined as first line therapy for HCC nodules < or equal to 2 cm or as alternative to surgery in 1-3 HCC nodules with the maximum diameter<3 cm (3), in the case of CRLM it is not possible to reproduce the same paradigm. Liver resection remains the standard of care for CRLM and the indications to ablation remain confined to nonresectable patients (4). The review article by Takahashi and Berber recently published in HBSN wells illustrates the current role of ablation in treatment of CRLM (5).

关键词： colorectal metastasis surgery

Hepatocellular carcinoma and liver transplant: beyond the Milan criteria and the risk of "short-blanket" syndrome

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Hepatobiliary Surgery and Nutrition 2020年第4期9卷 518-521页

作者： Stefano Gitto Stefano Di Sandro paolo Magistri pietro Andreone Fabrizio Di Benedetto Department of Experimental and Clinical Medicine University of FlorenceFlorenceItaly Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit AOU di Modena and University of Modena and Reggio EmiliaModenaItaly Internal and Metabolic Medicine AOU di Modena and University of Modena and Reggio EmiliaModenaItaly

Liver transplant(LT)is considered the best option for patients with hepatocellular carcinoma(HCC)confined into the liver and generally associated with liver cirrhosis(1).The Milan criteria(MC)represent a milestone in the selection of these patients(2).Therefore,basing on MC,the 5-year survival rate after LT could increase to 70%,with a HCC recurrence rate lower than 10%(2).Despite that,too many patients affected by HCC may not benefit from LT due to a tumor stage beyond the selection *** the last two decades,authors and physicians tried to overcome the MC exploring the opportunity to safely transplant patients beyond(3).Notably,the donor shortage and the competition between patients listed due to HCC and those listed for other indications,force physicians in selecting candidates with the best transplant benefit(3).

关键词： beyond listed overcome

One step minilaparotomy-assisted transmesenteric portal vein recanalization combined with transjugular intrahepatic portosystemic shunt placement: A novel surgical proposal in pediatrics

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World Journal of Gastroenterology 2017年第15期23卷 2811-2818页

作者： Gloria Pelizzo pietro Quaretti Lorenzo paolo Moramarco Riccardo Corti Marcello Maestri Giulio Iacob Valeria Calcaterra Department of Clinical SurgicalDiagnostic and Pediatric SciencesUniversity of Pavia Pediatric Surgery Unit Ospedale dei Bambini“G.di Cristina”Istituto Mediterraneo di Eccellenza Pediatrica Unit of Interventional Radiology Fondazione IRCCS Policlinico San Matteo Radiology Department IRCCS Policlinico San Matteo Foundation Department of Surgery IRCCS Policlinico San Matteo Foundation Pediatric Unit Department of Maternal and Children's HealthFondazione IRCCS Policlinico San Matteo Department of Internal Medicine and Therapeutics University of Pavia

Transjugular intrahepatic portosystemic shunt(TIPS) placement is a standard procedure for the treatment of portal hypertension complications. When this conventional approach is not feasible, alternative procedures for systemic diversion of portal blood have been proposed. A one-step interventional approach, combining minilaparotomy-assisted transmesenteric(MAT) antegrade portal recanalization and TIPS, is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma(PC). A 16-yearold girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC. A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed. In the case of failed portal recanalization, this approach, would also be useful for varice endovascular embolization. Postoperative recovery was uneventful. Treatment consisting of propanolol, enoxaparin and a proton pump inhibitor was prescribed after the procedure. One month post-op, contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts. No residual peritoneal fluid was detected nor opacification of the large varices. Endoscopy showed good improvement of the varices. Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches. Three months post-op, TIPS maintained its hourglass shape despite a slight expansion. Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization. MAT-TIPS is feasible and safe for the treatment of PC even in children. This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.

关键词： Portal cavernoma Pediatrics Transjugular intrahepatic portosystemic shunt Minilaparotomy-assisted transmesenteric