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New totally intracorporeal reconstructive approach after robotic total gastrectomy: Technical details and short-term outcomes

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World Journal of Gastroenterology 2017年第23期23卷 4293-4302页

作者： Amilcare Parisi Francesco Ricci Alessandro Gemini Stefano Trastulli Roberto Cirocchi Giorgio Palazzini Vito D'Andrea Jacopo desiderio Department of Digestive Surgery St.Mary's Hospital of TerniUniversity of Perugia Department of General Surgery St.Mary's Hospital of TerniUniversity of Perugia Department of Surgical Science “La Sapienza”University

To show outcomes of our series of patients that underwent a total gastrectomy with a robotic approach and highlight the technical details of a proposed solution for the reconstruction *** of gastrectomies performed from May 2014 to October 2016, were extracted and analyzed. Basic characteristics of patients, surgical and clinical outcomes were reported. The technique for reconstruction (Parisi Technique) consists on a loop of bowel shifted up antecolic to directly perform the esophago-enteric anastomosis followed by a second loop, measured up to 40 cm starting from the esojejunostomy, fixed to the biliary limb to create an enteroenteric anastomosis. The continuity between the two anastomoses is interrupted just firing a linear stapler, so obtaining the Roux-en-Y by avoiding to interrupt the ***-five patients were considered in the present analysis. Estimated blood loss was 126.55 ± 73 ml, no conversions to open surgery occurred, R0 resections were obtained in all cases. Hospital stay was 5 (3-17) d, no anastomotic leakage occurred. Overall, a fast functional recovery was shown with a median of 3 (3-6) d in starting a solid *** surgery and the adoption of a tailored reconstruction technique have increased the feasibility and safety of a minimally invasive approach for total gastrectomy. The present series of patients shows its implementation in a western center with satisfying short-term outcomes.

关键词： Esophagojejunal anastomosis Gastric cancer Total gastrectomy Robotic surgery Minimally invasive surgery

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强化与标准血压控制对痴呆的影响:随机临床试验

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中华高血压杂志 2019年第4期27卷 367-367页

作者：刘青叶鹏 Williamson JD Pajewski NM Auchus AP Bryan RN Chelune G Cheung AK Cleveland Ml Coker lH Crowe MG Cushman WC Cutler JA Davatzikos C desiderio l Erus G Fine lJ Gaussoin SA Harris D Hsieh MK Johnson KC Kimmel Pl Tamura MK launer lJ lerner AJ lewis CE Martindale-Adams J Moy CS Nasrallah IM Nichols lO Oparil S Ogrocki PK Rahman M Rapp SR Reboussin DM Rocco MV Sachs BC Sink KM Still CH Supiano MA Snyder JK Wadley VG Walker J Weiner DE Whelton PK Wilson VM Woolard N Wright JT Jr Wright CB SPRINT MIND investigators for theSPRINT research group

目前还没有有效的治疗方法来降低轻度认知障碍和痴呆的风险。该文旨在探讨强化血压控制对老年痴呆风险的影响。研究人员在美国和波多黎各102个地点对年龄≥50岁有高血压但无糖尿病或脑卒中史的成人进行随机临床试验。于2010年11月8日开... 详细信息

目前还没有有效的治疗方法来降低轻度认知障碍和痴呆的风险。该文旨在探讨强化血压控制对老年痴呆风险的影响。研究人员在美国和波多黎各102个地点对年龄≥50岁有高血压但无糖尿病或脑卒中史的成人进行随机临床试验。于2010年11月8日开始,于2015年8月20日提前停止,获得其主要观察指标(复合心血管事件)和全因死亡率的数据。认知观察指标随访的最后日期为2018年7月22日。

关键词：随机临床试验老年痴呆血压控制轻度认知障碍标准心血管事件治疗方法研究人员

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新辅助化疗期间肌肉指数变化值预测胃癌根治术预后的临床价值

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中华消化外科杂志 2021年第9期20卷 955-966页

作者：唐逸辉马玉滨 desiderio Jacopo 林建贤刘奕楠李平谢建伟王家镔陆俊陈起跃曹龙龙郑朝辉 Amilcare Parisi 黄昌明福建医科大学附属协和医院胃外科福州350001 青海大学附属医院胃肠外科西宁810000 圣玛丽亚医院消化外科意大利特尔尼05100

目的探讨新辅助化疗期间肌肉指数变化值预测胃癌根治术预后的临床价值。方法采用回顾性队列研究方法。收集2010年1月至2017年12月3家医学中心收治的362例(福建医科大学附属协和医院163例、青海大学附属医院141例、圣玛丽亚医院58例)行... 详细信息

目的探讨新辅助化疗期间肌肉指数变化值预测胃癌根治术预后的临床价值。方法采用回顾性队列研究方法。收集2010年1月至2017年12月3家医学中心收治的362例(福建医科大学附属协和医院163例、青海大学附属医院141例、圣玛丽亚医院58例)行新辅助化疗联合胃癌根治术病人的临床病理资料;男270例,女92例;中位年龄为61岁,年龄范围为26~79岁。362例病人中,福建医科大学附属协和医院与青海大学附属医院收治的304例病人设为建模组;圣玛丽亚医院收治的58例病人设为验证组。观察指标:(1)建模组病人行新辅助化疗期间身体成分、肿瘤标志物及应激状态指标变化情况。(2)随访及生存情况。(3)影响建模组病人预后因素分析。(4)预后预测模型的构建与比较。(5)预后预测模型评价。采用门诊、电话、信件方式进行随访,了解病人术后生存情况。随访时间截至2021年4月。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。单因素和多因素分析采用COX比例风险模型。采用Kaplan-Meier法计算生存时间,采用log-rank检验进行生存分析。结果(1)建模组病人行新辅助化疗期间身体成分、肿瘤标志物及应激状态指标变化情况。建模组304例病人行新辅助化疗前皮下脂肪指数、内脏脂肪指数、肌肉指数、癌胚抗原(CEA)、CA19-9、体质量指数(BMI)、预后营养指数(PNI)、修正全身炎症评分(mSIS)分别为31.2 cm^(2)/m^(2)(0.6~96.0 cm^(2)/m^(2)),25.1 cm^(2)/m^(2)(0.1~86.3 cm^(2)/m^(2)),47.1 cm^(2)/m^(2)(27.6~76.6 cm^(2)/m^(2)),43.2μg/l(0.2~1000.0μg/l),108.7 U/ml(0.6~1000.0 U/ml),21.9 kg/m^(2)(15.6~29.7 kg/m^(2)),46.8(28.6~69.0),(1.0±0.8)分;行胃癌根治术前上述指标分别为32.5 cm^(2)/m^(2)(5.1~112.0 cm^(2)/m^(2)),25.4 cm^(2)/m^(2)(0.2~89.0 cm^(2)/m^(2)),47.0 cm^(2)/m^(2)(16.8~67.0 cm^(2)/m^(2)),17.0μg/l(0.2~1000.0μg/l),43.9 U/ml(0.6~1000.0 U/ml),21.6 kg/m^(2)(31.1~29.0 kg/m^(2)),47.7(30.0~84.0),(1.0±0.8)分;行新辅助化疗期间上述指标变化值分别为1.4 cm^(2)/m^(2)(-31.0~35.1 cm^(2)/m^(2)),0.2 cm^(2)/m^(2)(-23.5~32.6 cm^(2)/m^(2)),-0.1 cm^(2)/m^(2)(-18.2~15.9 cm^(2)/m^(2)),-26.2μg/l(-933.5~89.9μg/l),-64.9 U/ml(-992.1~178.6 U/ml),-0.3 kg/m^(2)(-9.7~7.1 kg/m^(2)),0.9(-27.1~38.2),(0.0±0.8)分。(2)随访及生存情况。建模组304例病人中,284获得随访,随访时间为3~130个月,中位随访时间为36个月;随访期间,130例病人因肿瘤复发转移死亡,9例病人因非肿瘤原因死亡,病人5年总体生存率为54.6%。验证组58例病人中,52例获得随访,随访时间为2~91个月,中位随访时间为29个月;随访期间,21例病人死亡,病人5年总体生存率为63.8%。(3)影响建模组病人预后因素分析。单因素分析结果显示:术后病理学类型、术后病理学分期是影响建模组304例胃癌病人行胃癌根治术后5年总体生存率[风险比=1.685,2.619,95%可信区间(CI)为1.139~2.493,1.941~3.533,P<0.05]和5年疾病无进展生存率的相关因素(风险比=1.468,2.577,95%CI为1.000~2.154,1.919~3.461,P<0.05)。多因素分析结果显示:术后病理学类型、术后病理学分期是建模组304例病人行胃癌根治术后5年总体生存率的独立影响因素(风险比=1.508,2.287,95%CI为1.013~2.245,1.691~3.093,P<0.05);术后病理学分期是建模组304例病人行胃癌根治术后5年疾病无进展生存率的独立影响因素(风险比=2.317,95%CI为1.719~3.123,P<0.05)。(4)预后预测模型的构建与比较。304例建模组胃癌病人皮下脂肪指数变化值、内脏脂肪指数变化值、CEA变化值、CA19-9变化值、

关键词：胃肿瘤新辅助化疗身体成分预后预测模型

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Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

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World Journal of Gastroenterology 2017年第13期23卷 2376-2384页

作者： Amilcare Parisi Daniel Reim Felice Borghi Ninh T Nguyen Feng Qi Andrea Coratti Fabio Cianchi Maurizio Cesari Francesca Bazzocchi Orhan Alimoglu Johan Gagnière Graziano Pernazza Simone D'Imporzano Yan-Bing Zhou Juan-Santiago Azagra Olivier Facy Steven T Brower Zhi-Wei Jiang lu Zang Arda Isik Alessandro Gemini Stefano Trastulli Alexander Novotny Alessandra Marano Tong liu Mario Annecchiarico Benedetta Badii Giacomo Arcuri Andrea Avanzolini Metin leblebici Denis Pezet Shou-Gen Cao Martine Goergen Shu Zhang Giorgio Palazzini Vito D'Andrea Jacopo desiderio Department of Digestive Surgery St.Mary's HospitalUniversity of Perugia Klinik und Poliklinik fuer Chirurgie Klinikum Rechts der IsarTechnical University Munich Department of Surgery General and Oncologic Surgery UnitSanta Croce e Carle Hospital Department of Surgery Division of Gastrointestinal SurgeryUniversity of CaliforniaIrvine Medical Center Gastrointestinal Surgery Tianjin Medical University General Hospital Division of Oncological and Robotic Surgery Department of OncologyCareggi University Hospital Unit of general and endocrine surgery Center of oncologic minimally invasive surgery(COMIS)Careggi University Hospital Department of General Surgery Hospital of Cittàdi CastelloUSL1 Umbria Department of General Surgery Division of GeneralGastroenterologic and Minimally Invasive SurgeryG.B.Morgagni Hospital Department of General Surgery School of MedicineIstanbul Medeniyet University Department of Digestive and Hepatobiliary Surgery Estaing University Hospital Department of Surgery Robotic General Surgery UnitSan Giovanni Addolorata Hospital Esophageal Surgery Unit Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal DiseaseMedical University of Pisa Department of General Surgery The Affiliated Hospital of Qingdao University Unitédes Maladies de l'Appareil Digestif et Endocrine Centre Hospitalier de Luxembourg Service de Chirurgie Digestive et Cancérologique CHU Bocage Department of Surgical Oncology and HPB Surgery Englewood Hospital and Medical Center Department of General Surgery Jinling HospitalMedical SchoolNanjing University Department of Surgery Ruijin HospitalShanghai Jiaotong UniversitySchool of Medicine Department of General Surgery Erzincan UniversitySchool of Medicine Department of Surgical Science “La Sapienza”University Department of Digestive Surgery St.Mary's Hospital of Terni-University of Perugia

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological *** This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(lG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also *** The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, lG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; lG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the lG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), lG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P lar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between *** laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recov

关键词： Gastric cancer Gastrectomy Minimally invasive surgery Robotic Robot-assisted laparoscopy

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