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How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy?

World Journal of Gastroenterology 2013年第36期19卷 5964-5972页

作者： paola de nardi Michele Carvello department of Surgery San Raffaele Scientific Institute department of Surgery Utrecht University Medical Center

In patients with advanced rectal cancer,neoadjuvant chemo radiotherapy provides tumor downstaging and downsizing and complete pathological response in up to 30%of *** proctectomy complete pathological response is associated with low rates of local recurrence and excellent long term *** authors claim a less invasive surgery or a non operative policy in patients with partial or clinical complete response respectively,however to identify patients with true complete pathological response before surgical resection remains a *** imaging techniques have been reported to be highly accurate in the primary staging of rectal cancer,however neoadjuvant therapy course produces deep modifications on cancer tissue and on surrounding structures such as overgrowth fibrosis,deep stroma alteration,wall thickness,muscle disarrangement,tumor necrosis,calcification,and inflammatory *** a result,the same imaging techniques,when used for restaging,are far less *** tumor extent may be overestimated or *** diagnostic accuracy of clinical examination,rectal ultrasound,computed tomography,magnetic resonance imaging,and positron emission tomography using 18F-fluoro-2’-deoxy-Dglucose ranges between 25%and 75%being less than 60%in most studies,both for rectal wall invasion and for lymph nodes *** particular the ability to predict complete pathological response,in order to tailor the surgical approach,remains *** to the radio-induced tissue modifications,combined with imaging technical aspects,low rate accuracy is achieved,making modern imaging techniques still unreliable in restaging rectal cancer after chemo-radiotherapy.

关键词： Rectal cancer Restaging Neoadjuvant therapies Diagnostic accuracy Complete pathological response

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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

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Endoluminal vacuum-assisted therapy to treat rectal anastomotic leakage:A critical analysis

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World Journal of Gastroenterology 2022年第14期28卷 1394-1404页

作者： Andrea Vignali paola de nardi department of Gastrointestinal Surgery IRCCS San Raffaele Scientific InstituteMilano 20132Italy department of Surgery Vita-Salute UniversityMilano 20132Italy

Endoluminal vacuum-assisted therapy(EVT)has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic *** application has been mainly reserved to low colorectal and colo-anal *** main advantage of this new procedure is to ensure continuous drainage of the abscess cavity,to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess *** reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement,percutaneous drainage,endoscopic clipping of the anastomotic defect or stent ***,despite this procedure is gaining acceptance among the surgical community,indications,inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous,making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new ***,long-term and functional results are poorly *** present review is focused on critically analyzing the theoretical benefits and risks of the procedure,short-and long-term functional results and future direction in the application of EVT.

关键词： Anastomotic leakage Rectal surgery Endoluminal vacuum therapy Endosponge Complications

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New approach to anal cancer:Individualized therapy based on sentinel lymph node biopsy

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World Journal of Gastroenterology 2012年第44期18卷 6349-6356页

作者： paola de nardi Michele Carvello Carlo Staudacher Surgical department San Raffaele Scientific Institute20132 MilanItaly

Oncological treatment is currently directed toward a tailored therapy *** cell carcinoma of the anal canal could be considered a suitable platform to test new therapeutic strategies to minimize treatment *** of care for patients with anal canal cancer consists of a combination of radiotherapy and *** treatment has led to a high rate of local control and a 60% cure rate with preservation of the anal sphincter,thus replacing surgical abdominoperineal *** node metastases represent a critical independent prognostic factor for local recurrence and *** and iliac lymph nodes are usually included in the radiation field,whereas the inclusion of inguinal regions still remains controversial because of the subsequent adverse side *** lymph node biopsies could clearly identify inguinal node-positive patients eligible for therapeutic groin irradiation.A sentinel lymph node navigation procedure is reported here to be a feasible and effective method for establishing the true inguinal node status in patients suffering from anal canal *** on the results of sentinel node biopsies,a selective approach could be proposed where node-positive patients could be selected for inguinal node irradiation while node-negative patients could take advantage of inguinal sparing irradiation,thus avoiding toxic side effects.

关键词： Anal carcinomal Lymphnode metastasis Sen-tinel lymphnode Tumor staging

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Relation between skeletal muscle volume and prognosis in rectal cancer patients undergoing neoadjuvant therapy

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World Journal of Gastrointestinal Oncology 2022年第2期14卷 423-433页

作者： paola de nardi Alessandro Giani Giulia Maggi Marco Braga department of Gastrointestinal Surgery IRCCS San Raffaele Scientific InstituteMilano 20132Italy department of Surgery School of MedicineUniversity of Milano-BicoccaMilan ItalyMonza 20900Italy department of Oncologic Surgery Policlinico CasilinoRome 00169Italy department of Surgery San Gerardo HospitalUniversity Milano BicoccaMonza 20900Italy

The prognostic role of body composition indexes,and specifically sarcopenia,has recently been explored in different cancer ***,conflicting results have been *** in cancer type,cancer stage or oncological treatments,as well as different methodology and definition of sarcopenia,could be accounted for different conclusions retrieved from *** focusing on colorectal cancer,it clearly appears that colon and rectal cancers are often treated as a single entity though they have different behaviors and ***,patients with advanced rectal cancer represent a peculiar group of patients that according to current guidelines are treated with neoadjuvant chemotherapy and radiotherapy followed by radical *** review was restricted to a homogeneous group of patients with advanced lower rectal cancer and the aim of exploring whether there is a correlation between skeletal muscle depletion and *** was searched for articles related to patients with advanced rectal cancer undergoing neoadjuvant chemo-radiotherapy(NCRT)followed by radical surgery,in whom muscle mass and/or change in muscle mass during neoadjuvant treatment were *** full-text articles were selected and included in the present *** main findings of our review were:(1)The majority of the studies defined sarcopenia as muscle mass alone over muscle strength or physical performance;(2)There was a great deal of heterogeneity in the definition and measures of sarcopenia,in the definition of cut-off values,and in the method to measure change in muscle mass;(3)There was not full agreement on the association between sarcopenia at baseline and/or after chemoradiotherapy and prognosis,and only few studies found a significance in the multivariate analysis;and(4)It seems that a loss in skeletal muscle mass during NCRT is associated with the worst outcomes in terms of disease-free *** conclusion,analysis of muscle mass might provid

关键词： Advanced rectal cancer Sarcopenia Neoadjuvant treatment Chemoradiotherapy Surgery Muscle mass change Prognosis Survival Review

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Intra-abdominal myositis ossificans-a clinically challenging disease:A case report

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World Journal of Orthopedics 2023年第5期14卷 362-368页

作者： Gabriele Carbone Valentina Andreasi paola de nardi department of Gastrointestinal Surgery IRCCS San Raffaele HospitalMilan 20132Italy

BACKGROUND Myositis ossificans(MO)is an uncommon disorder characterized by heterotopic ossification within soft *** a few cases of intra-abdominal MO(IMO)have been described in the *** could be difficult to understand and a wrong diagnosis could lead to an improper *** SUMMARY We herein report the case of IMO in a healthy 69-year-old *** patient presented with an abdominal mass in the left lower quadrant.A computed tomography scan showed an inhomogeneous mass with multiple *** patient underwent radical excision of the *** findings were compatible with *** months later the patient showed a recurrence causing hemorrhagic shock due to intractable intralesional *** patients eventually died within three months since *** The case described could be classified as post-traumatic MO that developed close to the previously fractured iliac *** subsequent surgical procedure was ineffective and the disease rapidly *** misleading intraoperative diagnosis led to improper surgical treatment with a dramatic evolution.

关键词： Myositis ossificans Post-traumatic Diagnosis Surgical treatment Prognosis Case report

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Prognostic role of ultrasonography staging in patients with anal cancer

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World Journal of Gastrointestinal Oncology 2020年第7期12卷 732-740页

作者： paola de nardi Giaime G Arru Giovanni Guarneri Iliyan Vlasakov Luca Massimino Gastrointestinal Surgery IRCCS San Raffaele Scientific InstituteMilan 20132Italy Vita-Salute University San Raffaele Milan 20132Italy Laboratory of Immunopathology in Gastroenterology Humanitas UniversityMilan 20132Italy

BACKGROUND Carcinomas of the anal canal are staged according to the size and extent of the disease;however,we propose including a novel ultrasound(US)staging system,based on depth of tumor *** this study the clinical American Joint Committee on Cancer(AJCC)staging guidelines and the US classificationss in patients with anal cancer were *** To evaluate the prognostic role of the US staging system in patients with anal *** The data of 48 patients with anal canal squamous cells carcinoma,observed at our University Hospital between 2007 and 2017,who underwent pre-treatment assessment with pelvic magnetic resonance imaging(MRI),total body computed tomography(CT)scan and endoanal US were retrospectively *** canal tumors were clinically staged according to AJCC,determined by MRI by measurement of the longest tumor diameter,and CT *** US was performed with a high multi-frequency(9-16 MHz),360°rotational mechanical probe;US classification was based on depth of tumor penetration through the anal wall,according to Giovannini’s *** patients were treated with definitive radiation combined with 5-fluorouracile and *** treatment patients were followed-up *** At baseline there were 30 and 32 T1-2,18 and 16 T3-4,31 and 19 N+patients classified according to the clinical AJCC and US staging system *** a mean follow-up of 98 months,38 patients(79.1%)are alive and 28(58.3%)are disease *** follow up 20 patients(41.6%)experienced *** univariate analysis,American Society of Anesthesiologists(ASA)score(P=0.00000001)and US staging(P=0.009)were significantly related to disease-free survival(DFS).When overall survival and DFS functions were compared,a statistically significant difference was observed for DFS survival when the US staging was applied with respect to the clinical AJCC *** combining the 2 significant prognostic variables,namely the US staging with the ASA s

关键词： Anal cancer Ultrasonography staging American Joint Committee on Cancer staging Prognosis Disease-free survival Staging

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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

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Muscle Loss in Cancer Patients: Pathophysiology and Impact on the Outcome

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Journal of Nutritional Oncology 2016年第1期1卷 15-20页

作者： Maria Chiara Salandini Nicolo Pecorelli paola de nardi Marco Braga department of Surgery Vita-Salute San Raffaele University Milan 20132 Italy

A generalized loss of skeletal muscle can be associated with malnutrition, cancer, inflammation or neurodegenerative processes. Most cancer patients undergoing surgery are sarcopenic although only a minority of them suffer from severe weight loss. The cancer stage is a major determinant of sarcopenia, while nutritional factors seem to be less important. In cancer patients sarcopenia has been associated with a worse physical performance, a reduced response to chemotherapy and radiotherapy, a higher postoperative morbidity rate, and a reduced life expectancy.

关键词： Cancer Cachexia Sarcopenia Visceral fat Body composition

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Impact of Neoadjuvant Therapy on Body Composition and Prognosis in Rectal Cancer Patients

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Journal of Nutritional Oncology 2018年第4期3卷 165-169页

作者： paola de nardi Mariachiara Salandini Damiano Chiari Nicolo Pecorelli Giulia Cristel Anna Damascelli Monica Ronzoni Marco Braga department of Surgery San Raffaele University Hospital Via Olgettina 60 20132 Milan Italy department of Radiology San Raffaele University Hospital Via Olgettina 60 20132 Milan Italy department of Medical Oncology San Raffaele University Hospital Via Olgettina 60 20132 Milan Italy

Objectives The aim of this study was to assess the impact of neoadjuvant chemo-radiotherapy (nCRT) on body composition in patients who subsequently underwent curative surgery for low rectal cancer. Methods Thirty-eight consecutive patients who underwent nCRT and subsequent laparoscopic proctectomy for locally advanced low rectal cancer have been studied. In all patients body composition was measured by computed tomography before and after nCRT. Pathology response on CRT, postoperative short-term outcome, overall and disease-free long-term survival were assessed. Results Twelve patients (31.5%) had skeletal muscle loss 2% after nCRT. No correlation was found between changes in body composition and postoperative complications. Skeletal muscle loss after nCRT significantly correlated with a shorter 5-year disease-free survival. Conclusion Preliminary data suggests that skeletal muscle loss after nCRT negatively impacted on disease-free survival in patients with locally advanced rectal cancer.

关键词： Neoadjuvant Therapy Rectal Cancer

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