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Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi:A case report

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World Journal of Clinical Cases 2019年第12期7卷 1461-1466页

作者： Luca Morelli Niccolò Furbetta Desirée Gianardi Matteo Palmeri Gregorio Di Franco Matteo Bianchini Gianni Stefanini simone guadagni Giulio Di Candio General Surgery Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa 56124 Italy EndoCAS (Center for Computer Assisted Surgery) University of Pisa Pisa 56124 Italy

BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.

关键词： Case report da Vinci Xi EndoWrist stapler Walled-off pancreatic necrosis TilePro Minimally-invasive surgery

Tissue microarray-chip featuring computerized immunophenotypical characterization more accurately subtypes ampullary adenocarcinoma than routine histology

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World Journal of Gastroenterology 2020年第43期26卷 6822-6836页

作者： Matteo Palmeri Niccola Funel Gregorio Di Franco Niccolo Furbetta Desiree Gianardi simone guadagni Matteo Bianchini Luca E Pollina Claudio Ricci Marco Del Chiaro Giulio Di Candio Luca Morelli General Surgery Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy Division of Surgical Pathology University-Hospital of PisaPisa 56124Italy Department of Surgical MedicalMolecular Pathology and Critical AreaUniversity of PisaPisa 56124Italy Department of Surgery University of ColoradoDenverCO 80045United States

BACKGROUND Ampullary adenocarcinomas(AACs)are heterogeneous tumors currently classified into three important sub-classes(SC):Intestinal(INT),Pancreato-Biliary(PB)and Mixed-Type(MT).The different subgroups have similar clinical presentation and are treated by pancreatoduodenectomy with curative ***,they respond differently to chemotherapy and have different prognostic *** SC are often difficult to identify with conventional histology *** clinical outcome of all three remains unclear,particularly for *** To identify two main subtypes of AACs,using an immunohistochemical(IHC)score based on CDX2,CK7 and *** Tissue samples from 21 patients who had undergone resection of AAC were classified by HE histology and IHC expression of CDX2,CK7 and CK *** IHC score was obtained for each marker by counting the number of positive cells(0=no stained cells;150%)and their intensity(1=weak;2=moderate and 3=strong).A global score(GS)was then obtained by summation of the IHC scores of each *** MT tumors were grouped either with the INT or PB group based on the predominant immuno-molecular phenotype,obtaining only two AACs *** overall survival in INT and PB patients was obtained by Kaplan-Meier *** Histological parameters defined the AACs subtypes as follows:15%INT,45%PB and 40%*** IHC expression and the GS,75%and 25%of MT samples were assigned to either the INT or the PB *** mean value of the GS was 9.5(range 4-16).All INT samples had a GS above the average,distinct from the PB samples which had a GS score significantly below the average(P=0.0011).The INT samples were identified by high expression of CDX2 and CK20,whereas PB samples exhibited high expression of CK7 and no expression of CK20(P=0.0008).The INT group had a statistically significant higher overall survival than in the PB group(85.7 mo vs 20.3 mo,HR:8.39;95%CI:1.38 to 18.90;P=0.0152).CONCLUSION The combination of histopathological a

关键词： Ampullary adenocarcinoma Histo-molecular phenotype Prognostic CK7 CK20 CDX2

Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging

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World Journal of Gastroenterology 2019年第18期25卷 2217-2228页

作者： Luca Morelli simone guadagni Valerio Borrelli Roberta Pisano Gregorio Di Franco Matteo Palmeri Niccolò Furbetta Dario Gambaccini Santino Marchi Piero Boraschi Luca Bastiani Alessandro Campatelli Franco Mosca Giulio Di Candio General Surgery Unit Department of Surgery Translational and New Technologies in Medicine University of Pisa EndoCAS (Center for Computer Assisted Surgery) University of Pisa Diagnostic and Interventional Ultrasound in Transplants Unit Azienda Ospedaliero-Universitaria Pisana Gastroenterology Unit University of Pisa 2~(nd) Radiology Unit Department of Diagnostic Imaging Azienda Ospedaliero-Universitaria Pisana Institute of Clinical Physiology National Council of Research

BACKGROUND Patients with pancreatic cystic neoplasms(PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime imagebased surveillance follow-up. In these patients, the current European evidencedbased guidelines advise magnetic resonance imaging(MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound(US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by *** To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of *** We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US *** this communication, we reported the clinical results of this alternative followup, and the results of a comparative cost-analysis between our surveillance protocol(abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance *** In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients(1%) because of the appearance of suspicious features at imaging(with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN

关键词： Ultrasound Pancreatic cystic neoplasms Magnetic resonance imaging Surveillance

Use of zebrafish embryos as avatar of patients with pancreatic cancer:A new xenotransplantation model towards personalized medicine

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World Journal of Gastroenterology 2020年第21期26卷 2792-2809页

作者： Gregorio Di Franco Alice Usai Niccola Funel Matteo Palmeri Ida Elena Rosamaria Montesanti Matteo Bianchini Desirée Gianardi NiccolòFurbetta simone guadagni Enrico Vasile Alfredo Falcone Luca Emanuele Pollina Vittoria Raffa Luca Morelli General Surgery Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy Department of Biology University of PisaPisa 56127Italy Division of Surgical Pathology Department of Laboratory of MedicineHospital-University of PisaPisa 56124Italy Division of Medical Oncology Pisa University HospitalPisa 56124Italy Department of Translational Research and New Technologies in Medicine and Surgery University of PisaPisa 56124Italy EndoCAS(Center for Computer Assisted Surgery) University of PisaPisa 56124Italy

BACKGROUND The response to chemotherapy treatment of patients with pancreatic ductal adenocarcinoma(PDAC)is difficult to predict and the identification of patients who most likely will benefit from aggressive chemotherapy approaches is *** concept of personalized medicine has emerged in the last years with the objective to tailor the medical treatment to the individual characteristics of each patient,and particularly to the tumor biology of each *** need for invivo xenotransplantation models for cancer patients has increased exponentially,and for this reason zebrafish avatars have gained *** studies were conducted also with PDAC *** To develop a simple,not expensive,diffusible zebrafish embryo model as avatar for patients affected by *** Tumor tissue was taken from the surgical specimen by the *** its fragmentation into small pieces,they are stained with *** pieces of stained tissue were transplanted into the yolk of wt AB zebrafish embryos with a glass capillary *** were incubated at 35°C in E3 medium supplemented with 1%Pen/Strep in the presence or absence of drugs for the following days in respect of the treatment plan(Gemcitabine;Gemcitabine and Oxaliplatin;Gemcitabine and nab-Paclitaxel;5-Fluorouracil and Folinic acid and Oxaliplatin and Irinotecan).The response of zebrafish xenografts to the chemotherapy options has been analyzed by monitoring the fluorescent stained area at 2 h post injection(hpi),1 d and 2 d post injection(dpi).In each time point,the mean size of the stained area was measured by ImageJ and it was normalized with respect to the 1 dpi time point mean relative tumor area(RTA).We evaluated the effect of the chemotherapy exposition comparing the mean RTA of each treated subgroup and the control group and evaluating the percentage reduction of the mean RTA by comparing each treated subgroup with the control *** Between July 2018 and October 2019,a t

关键词： Pancreatic ductal adenocarcinoma Zebrafish embryos Personalized medicine Xenotransplantation Chemotherapy efficacy Avatar of oncological patients

Detailing the ultrastructure’s increase of prion protein in pancreatic adenocarcinoma

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World Journal of Gastroenterology 2021年第42期27卷 7324-7339页

作者： Matteo Bianchini Maria Anita Giambelluca Maria Concetta Scavuzzo Gregorio Di Franco simone guadagni Matteo Palmeri NiccolòFurbetta Desirée Gianardi Niccola Funel Claudio Ricci Raffaele Gaeta Luca Emanuele Pollina Alfredo Falcone Caterina Vivaldi Giulio Di Candio Francesca Biagioni Carla Letizia Busceti Luca Morelli Francesco Fornai General Surgery Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy Human Anatomy Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy Division of Surgical Pathology Department of SurgicalMedicalMolecular Pathology and Critical AreaUniversity of PisaPisa 56124Italy Division of Medical Oncology Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy IRCCS Neuromed Istituto Neurologico MediterraneoPozzilli 86077Italy EndoCAS(Center for Computer Assisted Surgery) University of PisaPisa 56124Italy

BACKGROUND Recent evidences have shown a relationship between prion protein(PrPc)expression and pancreatic ductal adenocarcinoma(PDAC).Indeed,PrPc could be one of the markers explaining the aggressiveness of this ***,studies investigating the specific compartmentalization of increased PrPc expression within PDAC cells are lacking,as well as a correlation between ultrastructural evidence,ultrastructural morphometry of PrPc protein and clinical *** data,as well as the quantitative stoichiometry of this protein detected by immuno-gold,provide a significant advancement in understanding the biology of disease and the outcome of surgical *** To analyze quantitative stoichiometry and compartmentalization of PrPc in PDAC cells and to correlate its presence with prognostic data METHODS Between June 2018 and December 2020,samples from pancreatic tissues of 45 patients treated with pancreatic resection for a preoperative suspicion of PDAC at our Institution were *** the frozen section excluded a PDAC diagnosis,or the nodules were too small for adequate sampling,patients were ruled out from the present *** blotting was used to detect,quantify and compare the expression of PrPc in PDAC and control tissues,such as those of non-affected neighboring pancreatic tissue of the same *** quantify the increase of PrPc and to detect the subcellular compartmentalization of PrPc within PDAC cells,immuno-gold stoichiometry within specific cell compartments was analyzed with electron ***,an analysis of quantitative PrPc expression according to prognostic data,such as cancer stage,recurrence of the disease at 12 mo after surgery and recurrence during adjuvant chemotherapy was *** The amount of PrPc within specimen from 38 out of 45 patients was determined by semi-quantitative analysis by using Western blotting,which indicates that PrPc increases almost three-fold in tumor pancreatic tissue compared with healthy panc

关键词： Pancreatic ductal adenocarcinoma Prion protein Western blotting Electron microscopy Cellular compartmentalization Neuroinvasion