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Multidisciplinary treatment of rectal cancer in 2014: Where are we going?

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World Journal of Gastroenterology 2014年第32期20卷 11249-11261页

作者： andrea vignali Paola De Nardi Department of Surgery San Raffaele Scientific Institute Vita Salute University

In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not *** preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.

关键词： Rectal cancer Cancer staging Cancer restaging Neoadjuvant chemoradiation Response Treatment Local control Local excision Complete pathologic response Rectal cancer surgery

Short and long-term outcomes of laparoscopic colectomy in obese patients

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World Journal of Gastroenterology 2013年第42期19卷 7405-7411页

作者： andrea vignali Paola De Nardi Luca Ghirardelli Saverio Di Palo Carlo Staudacher Department of Surgery San Raffaele Scientific InstituteUniversity Vita Salute20132 MilanItaly

AIM:To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal ***:A total of 98 obese(body mass index>30kg/m2)patients who underwent laparoscopic(LPS)right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open *** were selected to match for body mass index,site of primary disease,American Society of Anesthesiologists score,and year of surgery(±3 year).The parameters analyzed included age,gender,comorbid conditions,American Society of Anaesthesiologists class,diagnosis,procedure,and duration of operation,operative blood loss,and amount of homologous blood *** rate,intra and postoperative complications as were as reoperation rate,30 d and long-term morbidity rate were also *** continuous variables,the Student’s t test was used for normally distributed data the Mann-Whitney U test for nonnormally distributed *** Pearson’sχ2tests,or the Fisher exact test as appropriate,were used for ***:Conversion to open surgery was necessary in 13 of 98 patients(13.3%).In the LPS group,operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy(P=0.03,P=0.0001,respectively).Overall morbidity,anastomotic leak and readmission rate did not significantly differ between the two groups.A trend toward a reduction of wound complications was observed in the LPS when compared to open group(P=0.09).In the LPS group,an earlier recovery of bowel function(P=0.001)and a shorter length of stay(P=0.03)were *** a median follow-up of 62(range 12-132)mo 23patients in the LPS group and 38 in the open group experienced long-term complications(LPS vs open,P=0.03).Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the lapa

关键词： Obesity Colon cancer Laparoscopy Right colectomy Left colectomy Colorectal disease

Long-term outcomes after laparoscopic colectomy

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World Journal of Gastrointestinal Oncology 2011年第3期3卷 43-48页

作者： Marco Braga Nicolò Pecorelli Matteo Frasson andrea vignali Walter Zuliani Valerio Di Carlo Department of Surgery San Raffaele University

AIM:To evaluate long-term outcomes in a large series of patients who randomly received laparoscopic or open colorectal ***:From February 2000 to December 2004,six hundred sixty-two patients with colorectal disease were randomly assigned to laparoscopic(LPS,n = 330) or open(n = 332) colorectal *** patients were analyzed on an intention-to-treat ***-term follow-up was carried out every 6 mo by office *** 526 cancer patients five-year overall and disease-free survival were *** oncologic follow-up was 96 ***:Eight(4.2%) LPS group patients needed conversion to open *** long-term morbidity rate was 7.6%(25/330) in the LPS vs 11.1%(37/332) in the open group(P = 0.17).In cancer patients,fiveyear overall survival was 68.6% in the LPS group and 64.0% in the Open group(P = 0.27).Excluding stage Ⅳ patients,five-year local and distant recurrence rates were 32.5% in the LPS group and 36.8% in the Open group(P = 0.36).Further,no difference in recurrence rate was found when patients were stratified according to cancer ***:LPS colorectal resection was associated with a slightly lower incidence of long-term complications than open *** difference between groups was found in overall and disease-free survival rates.

关键词： Laparoscopy Colorectal cancer Postoperative complications Survival Long-term outcome

Laparoscopic surgery for rectal cancer:The state of the art

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World Journal of Gastrointestinal Surgery 2010年第9期2卷 275-282页

作者： Carlo Staudacher andrea vignali Department of Surgery IRCCS San RaffaeleUniversity Vita-SaluteVia Olgettina 6020132 MilanItaly

At present time,there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions,lower morbidity rate and earlier recovery compared to open *** limitations and a steep learning curve have limited the wide application of miniinvasive surgery for rectal *** present article discusses the current status of laparoscopic resection for rectal cancer.A review of the more recent retrospective,prospective and randomized controlled trial(RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed.A particular emphasis was dedicated to mid and low rectal *** prospective and RCT trials specif ically addressing laparoscopic rectal cancer resection are currently available in the *** short-term outcomes in term of lesser intraoperative blood loss,reduced analgesic requirements and a shorter hospital stay have been *** have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential *** data however was not conf irmed by other prospective comparative ***,a similar local recurrence rate has been reported in RCT and comparative *** f indings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any def initive *** the basis of available data in the literature,the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local *** respect to longterm survival,a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.

关键词： Postoperative complications Recurrence rate Transanal endoscopic microsurgery Robotics Long-term outcome Prognosis Rectal cancer Laparoscopy

Colorectal resection in deep pelvic endometriosis: Surgical technique and post-operative complications

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World Journal of Gastroenterology 2015年第47期21卷 13345-13351页

作者： Marco Milone andrea vignali Francesco Milone Giusto Pignata Ugo Elmore Mario Musella Giuseppe De Placido Antonio Mollo Loredana Maria Sosa Fernandez Guido Coretti Umberto Bracale Riccardo Rosati Department of Advanced Biomedical Science University of Naples "Federico Ⅱ" Department of Gastrointestinal Surgery San Raffaele Scientific Institute University Vita Salute General and Mini-invasive Surgery "San Camillo" Hospital

AIM: To investigate the impact of different surgical techniques on post-operative complications after colorectal resection for ***: A multicenter case-controlled study using the prospectively collected data of 90 women(22 with and 68 without post-operative complications) who underwent laparoscopic colorectal resection for endometriosis was designed to evaluate any risk factors of post-operative complications. The prospectively collected data included: gender, age, body mass index, American Society of Anesthesiologists risk class, endometriosis localization(from anal verge), operative time, conversion, intraoperative complications, and post-operative surgical complications such as anastomotic dehiscence, bleeding, infection, and bowel ***: A similar number of complicated cases have been registered for the different surgical techniques evaluated(laparoscopy, single access, flexure mobilization, mesenteric artery ligation, and transvaginal specimen extraction). A multivariate regression analysis showed that, after adjusting for major clinical, demographic, and surgical characteristics, complicated cases were only associated withendometriosis localization from the anal verge(OR = 0.8, 95%CI: 0.74-0.98, P = 0.03). After analyzing the association of post-operative complications and each different surgical technique, we found that only bowel dysfunction after surgery was associated with mesenteric artery ligation(11 out of 44 dysfunctions in the mesenteric artery ligation group vs 2 out of 36 cases in the no mesenteric artery ligation group; P = 0.03).CONCLUSION: Although further randomized clinical trials are needed to give a definitive conclusion, laparoscopic colorectal resection for deep infiltrating endometriosis appears to be both feasible and safe. Surgical technique cannot be considered a risk factor of post-operative complications.

关键词： Endometriosis Bowel Complication Technique Laparoscopy Mesenteric artery

Peripancreatic paraganglioma:Lesson from a round table

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World Journal of Gastroenterology 2022年第21期28卷 2396-2402页

作者： Federica Petrelli Geri Fratini andrea Sbrozzi-Vanni andrea Giusti Raffele Manta Claudio vignali Gabriella Nesi andrea Amorosi andrea Cavazzana Marco Arganini Maria Raffaella Ambrosio Pathology Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Surgery Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Endoscopic Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Endoscopic Unit Santa Maria Misericordia HospitalPerugia 06122Italy Interventional Radiology Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Department of Health Sciences University of FlorenceFlorence 50139Italy Pathology Unit UniversitàMagna GraeciaCatanzaro 88100Italy

We described the case of a peripancreatic paraganglioma(PGL)misdiagnosed as pancreatic *** exploration revealed an unremarkable pancreas and a large well-defined cystic mass originating at the mesocolon *** enucleation of the mass was performed,preserving the pancreatic ***,a diagnosis of PGL was ***,two previously unreported mutations,one affecting the KDR gene in exon 7 and another on the JAK3 gene in exon 4 were *** mutations are known to be *** and cytologic findings were blindly reviewed by an expert panel of clinicians,radiologists,and pathologists to identify possible causes of the *** major issue was lack of evidence of a cleavage plane from the pancreas at imaging,which prompted radiologists to establish an intraparenchymal *** blinded revision shifted the diagnosis towards an extrapancreatic lesion,as the pancreatic parenchyma showed no structural alterations and no dislocation of the Wirsung *** post,the identified biases were the emergency setting of the radiologic examination and the very thin mesocolon sheet,which hindered clear definition of the lesion *** endoscopic ultrasonography diagnosis was confirmed,emphasizing the intrinsic limit of this technique in detecting large ***,pathologic review favored a diagnosis of PGL due to the morphological features and immonohistochemical *** months after tumor excision,the patient is asymptomatic with no disease relapse evident by either radiology or laboratory *** report strongly highlights the difficulties in rendering an accurate preoperative diagnosis of PGL.

关键词： Peripancreatic paraganglioma Pancreatic neuroendocrine tumor Solid pseudopapillary neoplasm S100 Succinate dehydrogenase subunit B gene and expression Fine needle biopsy