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World Journal of Gastroenterology 2014年第42期20卷 15674-15681页

作者： Calogero Iacono Andrea Ruzzenente Luca Bortolasi alfredo guglielmi Department of Surgery Division of General Surgery "A" Unit of Hepato-Biliary-Pancreatic Surgery University of Verona Medical School "GB Rossi" University Hospital

Central pancreatectomy(CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection(SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot(1957) and Letton and Wilson(1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came.

关键词： Pancreatic history Pancreatic surgery Central pancreatectomy Conservative pancreatectomy

Hepatocellular carcinoma in cirrhotic patients with portal hypertension:Is liver resection always contraindicated?

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World Journal of Gastroenterology 2011年第46期17卷 5083-5088页

作者： Andrea Ruzzenente Alessandro Valdegamberi Tommaso Campagnaro Simone Conci Silvia Pachera Calogero Iacono alfredo guglielmi Department of Surgery Division of General Surgery"A"GB Rossi HospitalUniversity of Verona

AIM:To analyze the outcome of hepatocellular car-cinoma(HCC)resection in cirrhosis patients,related to presence of portal hypertension(PH)and extent of ***:A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver ***:PH was present in 44(32.5%)*** mortality and morbidity were 2.2% and 33.7%,*** survival time in patients with or without PH was 31.6 and 65.1 mo,respectively(P=0.047);in the subgroup with Child-Pugh class A cirrhosis,median survival was 65.1 mo and 60.5 mo,respectively(P=0.257).Survival for patients submitted to limited liver resection was not significantly different in presence or absence of ***,median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo,respectively(P=0.035).CONCLUSION:PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients,but resection of 2 or more segments should not be recommended in patients with PH.

关键词： Liver surgery Hepatic resection Hepatocellular carcinoma Portal hypertension

Transhepatic fibrinolysis of mesenteric and portal vein thrombosis in a patient with uIterative colitis: A case report

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World Journal of Gastroenterology 2005年第13期11卷 2035-2038页

作者： alfredo guglielmi Francesca Fior Orsolya Halmos Gian Franco Veraldi Lorenzo Rossaro Andrea Ruzzenente Claudio Cordiano First Department of General Surgery Department of Internal Medicine Claudio Cordiano

AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal ***: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic ***: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently ***: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis.

关键词： Acute mesenteric Portal vein thrombosis

Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation: A prospective study

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World Journal of Gastroenterology 2005年第12期11卷 1872-1875页

作者： Corrado Pedrazzani Filippo Catalano Mara Festini Germana Zerman Anna Tomezzoli Andrea Ruzzenente alfredo guglielmi Giovanni de Manzoni First Department of General Surgery

AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal ***: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively ***: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo ***: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.

关键词： Barrett's esophagus Argon plasma coagulation Endoscopic treatment

Elevated fibrinogen plasma level is not an independent predictor of poor prognosis in a large cohort of Western patients undergoing surgery for colorectal cancer

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World Journal of Gastroenterology 2016年第45期22卷 9994-10001页

作者： Corrado Pedrazzani Guido Mantovani Gian Luca Salvagno Elisabeth Baldiotti Andrea Ruzzenente Calogero Iacono Giuseppe Lippi alfredo guglielmi Division of General and Hepatobiliary Surgery Department of Surgical Sciences Dentistry Gynecology and Pediatrics University of Verona Section of Clinical Biochemistry Department of Neurological Biomedical and Movement Sciences University of Verona

AIM To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal *** This retrospective study analysed 652 patients undergoing surgery for stage Ⅰ-Ⅳ colorectal cancer between January 2005 and December 2012, at the Division of General Surgery A, University of Verona Hospital Trust, in whom preoperative fibrinogen plasma values were assessed at baseline. Fibrinogen is involved in tumourigenesis as well as tumour progression in several malignancies. Correlations between preoperative plasma fibrinogen values and clinicopathological characteristics were investigated. Univariate and multivariate survival analyses were performed to identify factors associated with overall and tumour-related *** Among the 652 patients, the fibrinogen value was higher than the threshold of 400 mg/dL in 345 patients(53%). The preoperative mean ± SD of fibrinogen was 426.2 ± 23.2 mg/dL(median: 409 mg/dL; range: 143-1045 mg/d L). Preoperative fibrinogen values correlated with age(P = 0.003), completeness of tumour resection, potentially curative vs palliative(P < 0.001), presence of systemic metastasis(P < 0.001), depth of tumour invasion p T(P < 0.001), nodes involvement p N(P = 0.001) and CEA serum level(P < 0.001). The mean fibrinogen value(± SD) was 395.6 ± 120.4 mg/d L in G1 tumours, 424.1 ± 121.4 mg/dL in G2 tumours and 453.4 ± 131.6 mg/dL in G3 tumours(P = 0.045). The overall survival and tumourrelated survival were significantly higher in patients with fibrinogen values ≤ 400 mg/d L(P < 0.001). However, hyperfibrinogenemia did not retain statistical significance regarding either overall(P = 0.313) or tumour-related survival(P = 0.355) after controlling for other risk factors in a multivariate *** Preoperative fibrinogen levels correlate with cancer severity but do not help in predicting patient prognosis after colorectal cancer surgery.

关键词： Colorectal cancer Fibrinogen Tumour markers Prognosis Colorectal surgery

Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection

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World Journal of Gastrointestinal Surgery 2019年第10期11卷 395-406页

作者： Corrado Pedrazzani Cristian Conti Giulia Turri Enrico Lazzarini Marzia Tripepi Giovanni Scotton Matteo Rivelli alfredo guglielmi Division of General and Hepatobiliary Surgery Department of Surgical Sciences Dentistry Gynecology and Pediatrics University of Verona Hospital Trust

BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal *** To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal *** Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively *** groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or *** and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission *** in post-operative length of stay and adherence to ERP’s items were evaluated in the three study *** Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group ***-day overall morbidity was 32.9%whilst mortality was *** the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly *** discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.

关键词： Colorectal surgery Laparoscopic surgery Enhanced recovery protocol Age Elderly

Hepatocellular carcinoma:Surgical perspectives beyond the barcelona clinic liver cancer recommendations

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World Journal of Gastroenterology 2014年第24期20卷 7525-7533页

作者： alfredo guglielmi rea Ruzzenente Simone Conci Alessro Valdegamberi Marco Vitali Francesca Bertuzzo Michela De Angelis Guido Mantovani Calogero Iacono Department of Surgery Division of General Surgery AUnit of Hepato-Pancreatico-Biliary surgeryUniversity of Verona Medical School37134 VeronaItaly

The barcelona clinic liver cancer(BCLC)staging system has been approved as guidance for hepatocellular carcinoma(HCC)treatment guidelines by the main Western clinical liver *** to the BCLC classification,only patients with a small single HCC nodule without signs of portal hypertension or hyperbilirubinemia should undergo liver *** contrast,patients with intermediate-advanced HCC should be scheduled for palliative therapies,even if the lesion is *** studies report good short-term and long-term outcomes in patients with intermediate-advanced HCC treated by liver ***,this classification has been criticised because it excludes many patients who could benefit from curative *** aim of this review was to evaluate the role of surgery beyond the BCLC *** liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%.Surgery also offers good long-term result in selected patients with multiple or large HCCs with a reported 5-year survival rate of over 50%and 40%,*** macrovascular invasion is associated with a poor prognosis,liver resection provides better long-term results than palliative therapies or best supportive ***,researchers have identified several genes whose altered expression influences the prognosis of patients with *** genes may be useful for classifying the biological behaviour of different tumours.A revision of the BCLC classification should be introduced to provide the best treatment strategy and to ensure the best prognosis in patients with HCC.

关键词： Hepatocellular carcinoma Liver resection Hepatectomy Barcelona clinic liver cancer Surgical therapy

Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases

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Hepatobiliary Surgery and Nutrition 2023年第5期12卷 692-703,I0017页

作者： Alessandro Paro J.Madison Hyer Brandon S.Avery Diamantis I.Tsilimigras Fabio Bagante alfredo guglielmi Andrea Ruzzenente Sorin Alexandrescu George Poultsides Kazunari Sasaki Federico Aucejo Timothy M.Pawlik Department of Surgery The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research InstituteColumbusOHUSA University of Verona VeronaItaly Fundeni Clinical Institute BucharestRomania Stanford University StanfordCAUSA Cleveland Clinic Foundation ClevelandOHUSA

Background:We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases(CRLMs)using the win ratio,a novel methodological ***:CRLM patients undergoing curative-intent resection in 2001-2018 were identified from an international multi-institutional *** were paired and matched based on age,number and size of lesions,lymph node status and receipt of preoperative *** win ratio was calculated based on margin status,severity of postoperative complications,90-day mortality,time to recurrence,and time to ***:Among 962 patients,the majority underwent open hepatectomy(n=832,86.5%),while a minority underwent laparoscopic hepatectomy(n=130,13.5%).Among matched patient-to-patient pairs,the odds of the patient undergoing laparoscopic resection“winning”were 1.77[WR:1.77,95%confidence interval(CI):1.42-2.34].The win ratio favored laparoscopic hepatectomy independent of low(WR:2.94,95%CI:1.20-6.39),medium(WR:1.56,95%CI:1.16-2.10)or high(WR:7.25,95%CI:1.13-32.0)tumor burden,as well as unilobar(WR:1.71,95%CI:1.25-2.31)or bilobar(WR:4.57,95%CI:2.36-8.64)*** odds of“winning”were particularly pronounced relative to short-term outcomes(i.e.,90-day mortality and severity of postoperative complications)(WR:4.06,95%CI:2.33-7.78).Conclusions:Patients undergoing laparoscopic hepatectomy had 77%increased odds of“winning”.Laparoscopic liver resection should be strongly considered as a preferred approach to resection in CRLM patients.

关键词： Colorectal liver metastases(CRLMs) minimally invasive surgery laparoscopic liver resection win ratio

Prognostication and response assessment in liver and pancreatic tumors:The new imaging

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World Journal of Gastroenterology 2015年第22期21卷 6794-6808页

作者： Riccardo De Robertis Paolo Tinazzi Martini Emanuele Demozzi Gino Puntel Silvia Ortolani Sara Cingarlini Andrea Ruzzenente alfredo guglielmi Giampaolo Tortora Claudio Bassi Paolo Pederzoli Mirko D'Onofrio Department of Radiology Verona Comprehensive Cancer Network G.B. Rossi Hospital University of Verona Department of Radiology Casa di Cura Pederzoli Department of Oncology Verona Comprehensive Cancer Network G.B.Rossi Hospital University of Verona Department of Hepato-Biliary Surgery Verona Comprehensive Cancer NetworkG.B. Rossi Hospital University of Verona Department of Pancreatic Surgery Verona Comprehensive Cancer Network G.B. Rossi Hospital University of Verona Department of Pancreatic Surgery Casa di Cura Pederzoli

Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT ***, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography(PET)CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging,therefore these techniques could be used also for posttreatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart frommolecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations,prognostic stratification and post-treatment monitoring.

关键词： Diffusion magnetic resonance imaging Perfusion imaging Hepatocellular carcinoma Liverneoplasms Pancreatic neoplasms