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Gastrointestinal stromal tumour of the rectum: Report of a case and review of literature

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World Journal of Gastroenterology 2008年第8期14卷 1302-1304页

作者： Nello Grassi Calogero Cipolla Adriana Torcivia Stefano Mandalà Giuseppa Graceffa Alessandro Bottino Federica Latteri Department of Oncology Division of General and Oncological Surgery University of Palermo Via del Vespro 129 Palermo 90127 Italy

Gastrointestinal stromal tumour （GIST） is a rare tumour of the gastrointestinal tract which does not generally originate in the rectum. The authors describe a case of a 70-year-old man who underwent an anterior resection of the rectum for a low-risk GIST. The patient was not given adjuvant chemotherapy with imatinib and is still disease-free 30 mo after surgery. The authors conclude that although rectal GIST is extremely uncommon, it should be included in differential diagnosis when a tumour in the rectum is detected. Biopsy of the tumour is essential, since this makes it possible to reach a sure preoperative diagnosis based on the immunohistological features of the CDl17 and CD34. Although complete surgical resection with negative tumour margins is the principal curative procedure for primary and nonmetastatic tumours, further studies are still needed for the determination of the most effective treatment strategy for patients with rectal GIST.

关键词： Rectal Gastrointestinal stromal tumour Diagnosis Treatment surgery

Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases

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World Journal of Gastrointestinal Oncology 2017年第5期9卷 218-227页

作者： Min Hoe Chew Yu-Ting Yeh Ee-Lin Toh Stephen Aditya Sumarli Ghee Kheng Chew Lui Shiong Lee Mann Hong Tan Tiffany Priyanthi Hennedige Shin Yi Ng Say Kiat Lee Tze Tec Chong Hairil Rizal Abdullah Terence Lin Hon Goh Mohamed Zulfikar Rasheed Kok Chai Tan Choong Leong Tang Department of Colorectal surgery Singapore General Hospital Department of Obstetrics and Gynaecology Singapore General Hospital Department of Urology Singapore General Hospital Department of Orthopaedic surgery Singapore General Hospital division of oncological Imaging National Cancer Centre Singapore Department of Anaesthesiology Singapore General Hospital Vascular surgery Singapore General Hospital Department of Plastic Reconstructive and Aesthetic SurgerySingapore General Hospital

To critically appraise short-term outcomes in patients treated in a new Pelvic Exenteration (PE) Unit. METHODSThis retrospective observational study was conducted by analysing prospectively collected data for the first 25 patients (16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit between January 2012 and October 2016. Data evaluated included age, co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment, intra-operative blood loss, procedural duration, perioperative adverse event, lengths of intensive care unit (ICU) stay and hospital stay, and oncological outcome. Quantitative data were summarized as percentage or median and range, and statistically assessed by the χ2 test or Fisher’s exact test, as applicable. RESULTSAll 25 patients received comprehensive preoperative assessment via our dedicated multidisciplinary team approach. Long-course neoadjuvant chemoradiotherapy was provided, if indicated. The median age of the patients was 61.9-year-old. The median ASA and ECOG scores were 2 and 0, respectively. The indications for PE were locally invasive rectal adenocarcinoma (n = 13), advanced colonic adenocarcinoma (n = 5), recurrent cervical carcinoma (n = 3) and malignant sacral chordoma (n = 3). The procedures comprised 10 total PEs, 4 anterior PEs, 7 posterior PEs and 4 isolated lateral PEs. The median follow-up period was 17.6 mo. The median operative time was 11.5 h. The median volume of blood loss was 3306 mL, and the median volume of red cell transfusion was 1475 mL. The median lengths of ICU stay and of hospital stay were 1 d and 21 d, respectively. There was no case of mortality related to surgery. There were a total of 20 surgical morbidities, which occurred in 12 patients. The majority of the complications were grade 2 Clavien-Dindo. Only 2 patients experienced grade 3 Clavien-Dindo complications, and both required procedura

关键词： Colorectal cancer Advanced pelvic tumour Sacrectomy oncological outcome Pelvic exenteration Chordoma

Granular cell tumor of stomach: A case report and review of literature

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World Journal of Gastroenterology 2006年第21期12卷 3442-3445页

作者： Rosalia Patti Piero Luigi Almasio Gaetano Di Vita Department of Surgical and oncological Science division of General surgery University of PalermoPalermoItaly Chair in Gastroenterology University of Palermo PalermoItaly

Granular cell tumor （GCT） was described for the first time by Abrikosoff in 1926. It is a relatively rare neoplasm that may occur at many sites, but most commonly in the skin or soft tissues. The occurrence of GCT in the gastrointestinal tract is rare, accounting approximately for 8% of all tumors, among which the most common site is the esophagus, whereas gastric localization is very rare. Gastric GCTs can be solitary or, more frequently, associated with other gastrointestinal localization. Although GCTs are usually clinically and histologically benign, some malignant cases have been reported. Histologically, these tumors consist of polygonal and fusiform cells disposed in compact ＂nests＂ and immunohistochemical staining for S-100 protein supports the proposed derivation from Schwann cells. A correct preoperative diagnosis of this tumor can only be made in 50% of all patients and it is always based on endoscopic biopsy. Laparoscopic or conventional wedge resection represents the treatment of choice. In this study, the authors reported a case of a 49-year-old woman with a solitary granular cell tumor of the stomach with infiltrative pattern, successfully treated with surgical resection. A review of literature is also presented with emphasis on diagnostic criteria concerning the malignant form.

关键词： Granular cell tumor Stomach Benign Surgical resection

Pancreatic cancer: open or minimally invasive surgery?

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World Journal of Gastroenterology 2016年第32期22卷 7301-7310页

作者： Yu-Hua Zhang Cheng-Wu Zhang Zhi-Ming Hu De-Fei Hong division of Hepatobiliary and Pancreatic surgery and Minimally Invasive surgery Zhejiang Provincial People’s Hospital

Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the shortand long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy(MIPD) is as safe and feasible as open PD(OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy.

关键词： Laparoscopic Minimally invasive Robotic Pancreaticoduodenectomy Distal pancreatectomy Pancreatic cancer

Robotic liver surgery is the optimal approach as bridge to transplantation

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World Journal of Hepatology 2017年第4期9卷 224-226页

作者： Paolo Magistri Giuseppe Tarantino Roberto Ballarin Andrea Coratti Fabrizio Di Benedetto Department of Medical and Surgical Sciences and Translational Medicine Sapienza - University of Rome Hepato-Pancreato-Biliary surgery and Liver Transplantation Unit University of Modena and Reggio Emilia Department of Oncology Division of Oncological and Robotic General Surgery Careggi University Hospital

The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas(HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of:(1) the small impact on abdominal wall;(2) the gentle manipulation on the liver;(3) the limited surgical trauma; and(4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.

关键词： Hepatocellular carcinomas Liver transplant Robotic surgery Bridge to transplantation Da vinci Barcelona Clinic Liver Cancer Patient safety

Minimally invasive liver resection: has the time come to consider robotics a valid assistance?

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Hepatobiliary surgery and Nutrition 2018年第3期7卷 195-198页

作者： Stefano Caruso Alberto Patriti Graziano Ceccarelli Andrea Coratti Department of General surgery and Surgical Specialties Unit of General Surgery“Santa Maria Annunziata”HospitalLocal Health Unit Center Tuscany CompanyFlorenceItaly Department of surgery Division of General SurgeryHospitals of Pesaro and Fano“Ospedali Riuniti Marche Nord”Hospital CompanyMarcheItaly Department of Medicine and General surgery Unit of Minimally Invasive and General SurgeryLocal Health Unit South-East Tuscany Company“San Donato”HospitalArezzoItaly division of oncological and Robotic General surgery “Careggi”University HospitalLargo Brambilla 3FlorenceItaly

Minimally invasive liver resection (MILR) has been steadily increasing worldwide. Since its introduction in the early 1990s, initially adopted in cases of wedge and minor anatomical resection for benign hepatic lesions, MILR has been extended to major liver resection and for malignant hepatic lesions (1). Laparoscopic lateral sectionectomy has progressively become a standard operation (2).

关键词： liver lesions has

Robot-assisted laparoscopic vs open gastrectomy for gastric cancer:Systematic review and meta-analysis

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World Journal of Clinical Oncology 2017年第3期8卷 273-284页

作者： Stefano Caruso Alberto Patriti Franco Roviello Lorenzo De Franco Franco Franceschini Graziano Ceccarelli Andrea Coratti Department of General surgery and Surgical Specialties Unit of General Surgery"Santa Maria Annunziata" HospitalLocal Health Unit Center Tuscany Company Department of surgery Division of General SurgeryHospitals of Pesaro and Fano"Ospedali Riuniti Marche Nord" Hospital Company Department of Medical Surgical and NeuroscienceUnit of General and Minimally Invasive SurgeryUniversity of Siena Department of Medicine and General surgery Unit of Minimally Invasive and General SurgeryLocal health Unit South-Est Tuscany Company"San Donato" Hospital division of oncological and Robotic General surgery "Careggi" University Hospital

AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer *** A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric *** of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to *** primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital *** among postoperative complications,wound infection,bleeding and anastomotic leakage were also *** A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the *** was associated with longer operation time than OG(weighted mean difference 72.20 min;P oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.

关键词： Robot-assisted gastrectomy Gastric resection Open gastrectomy Gastric cancer

Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

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World Journal of Gastroenterology 2016年第25期22卷 5694-5717页

作者： Stefano Caruso Alberto Patriti Franco Roviello Lorenzo De Franco Franco Franceschini Andrea Coratti Graziano Ceccarelli Department of General surgery and Surgical Specialties Unit of General Surgery 'Santa Maria Annunziata' Hospital ASL Firenze 50012 Florence Italy Department of surgery General Minimally Invasive and Robotic Surgery 'San Matteo degli Infermi' Hospital 06049 Spoleto (PG) Italy Department of Medical Surgical and Neuroscience/ Unit of General and Minimally Invasive Surgery University of Siena 53100 Siena Italy division of oncological and Robotic General surgery 'Careggi' University Hospital 50134 Florence Italy Department of Medicine and General surgery Unit of Minimally Invasive and General Surgery ASL8 Arezzo 'San Donato' Hospital 52100 Arezzo Italy

Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are nee

关键词： Gastric cancer Gastric resection Minimally invasive surgery Laparoscopic gastrectomy Robot-assisted gastrectomy

Pancreaticoduodenectomy in elderly patients:a special place for minimally invasive surgery?

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 665-665页

作者： francesco guerra lapo bencini giovanni battista levi sandri division of oncological and robotic general surgery careggi university hospital FlorenceItaly division of general surgery and liver transplantation san camillo hospitalRomeItaly

To the Editor： We read with keen interest the recent paper by El Nakeeb et al, and the subsequent editorial published by Dudeja and Livingstone. Globally, the authors have correctly and timely portrayed the current r... 详细信息

关键词： Pancreaticoduodenectomy in elderly patients