18 research outputs found
The role of staging laparoscopy in stage IV gastric cancer patients
No full textIntroduction: Evidence regarding staging laparoscopy(SL)for clinical metastatic(cM+)gastric cancer(GC)patients is limited. Recently,Italian Gastric Cancer Research Group(GIRCG)study showed SL changed peritoneal status in over 20% of cases. This study aims to evaluate SL's role in cM+ patients and refine indications.
Methods: Data of cM+ GC patients who underwent SL between 2010 and 2022 at nine GIRCG Centers were retrospectively analyzed.Primary outcome was SL's yield,defined as peritoneal status changed by SL,over all SLs.
Results: Among 182 cM+ patients who received SL,38(20.9%)had SL-findings changing peritoneal status.10.1% of cases with preoperative signs of peritoneal carcinomatosis(PC)had no peritoneal disease,while 46.3% with extraperitoneal disease alone had PC at SL.Thirty-one patients(17.0%)underwent R0 resection:17(54.8%)with PC,3(9.7%)with liver metastases,4(12.9%)with PC and nodal metastases,2(6.4%)with lung and 1(3.2%)with bone metastases.17 patients with suspected preoperative PC underwent curative treatment:9 had peritoneal disease ruled out by SL,other 8 had limited PC,allowing R0 resection.Logistic regression revealed inverse correlation between diffuse histotype and absence of PC at SL,in patients with peritoneal involvement at imaging(p=0.02).
Conclusions: SL aids in directing cM+ GC patients to appropriate treatment,with a 20.9% yield.For those with peritoneal involvement at imaging,SL helps identify candidates for curative treatment.In patients with extraperitoneal disease,SL should be considered to assess potential radical strategies
Neuromodulation for fecal incontinence: Outcome in 16 patients with definitive implant: The Initial Italian Sacral Neurostimulation Group (GINS) experience
No full textPurpose: Sacral nerve modulation appears to offer a valid treatment option for some patients with fecal incontinence and functional defects of the internal anal sphincter or of the striated muscle. Methods: Sixteen patients with fecal incontinence (4 males; mean age, 51.4 (range, 27-79) years) with intact or surgically repaired (n = 1) anal sphincter underwent permanent sacral nerve stimulation implant. Cause was traumatic in two patients, and associated disorders included scleroderma (2 patients) and spastic paraparesis (1 patient); eight (50 percent) of the patients also had urinary incontinence, and two (12.5 percent) had nonobstructive urinary retention. All patients were selected on the basis of positive findings from at least one peripheral nerve evaluation. The stimulating electrode was positioned in the S2 (1 patient), S3 (14 patients), or S4 (1 patient) sacral foramen. Results: Mean follow-up was 15.5 (range, 3-45) months. Mean preimplant Williams score decreased from 4.1 ± 0.9 (range, 2-5) to 1.25 ± 0.5 (range, 1-2) (P = 0.01, Wilcoxon test), and the number of incontinence accidents for liquid or solid stool in 14 days decreased from 11.5 ± 4.8 (range, 2-20) before implant to 0.6 ± 0.9 (range, 0-2) at the last follow-up. Important manometric data were an increase in mean maximal pressure at rest of 37.7 ± 14.9 mmHg (implantable pulse generator 49.1 ± 18.7, P = 0.04) and in mean maximal pressure during squeeze (prestimulation 67.3 ± 21.1 mmHg, implantable pulse generator 82.6 ± 21.0, P = 0.09). Conclusions: Neuromodulation can be considered an option for fecal incontinence. However, an accurate clinical and instrumental evaluation and careful patient selection are required to optimize outcome
The Legal Method: Differents Methological Lines and One Proposal of Synthesis
No full textEl propósito de este escrito es poner de manifiesto las principales características de
los métodos jurídicos contemporáneos, así como sus principales carencias. Todos estos métodos
parten de una comprensión parcial del fenómeno jurídico, lo que exige una posición
metodológica que aglutine las virtudes de las diferentes líneas metodológicas al tiempo que
permita su ordenación conforme a la finalidad de toda praxis jurídica: la búsqueda de lo
racional, razonable o “justo” en el caso concreto. Con un espíritu conclusivo se exponen las
principales características del método propuesto por el autor, dentro del marco teórico del
realismo clásico o metódicoThis work aims to put on the principal features of the contemporary legal methods and their main shortages. All of these methods depart from a partial comprehension of the legal phenomenon. The object of this article is to find a methodological position able to connect the different methodological lines, that allow arrange their virtues in order to the search of the logical, reasonable or “fair” in the concrete case. Summarily it will be present the main characteristics of the method proposed by the author, inside the theoretical framework of the classic or methodical realis
Short-term outcomes of minimally invasive gastrectomy in population with obesity versus population without obesity: the obesity paradox
No full textThis study aims to compare the short-term outcomes after minimally invasive gastrectomy between obese and non-obese population. Our analysis included data of 713 patients from ten departments of surgery. They were divided in non-obese group and obese group with 617 and 96 patients respectively. Significant differences were found in terms of mortality at 90 days (obese: 0 vs non-obese: 27, p = 0.037). Intraoperative data showed no significant differences in terms of conversion (obese: 4 vs non-obese: 43, p = 0.303). About postoperative complications, significant differences between the two groups were found only in terms of surgical infection (obese: 13 vs non-obese: 38, p = 0.009). About oncological outcomes, no differences were found about retrieved lymph nodes (obese: 30.71 +/- 18.44 vs non-obese: 32.93 +/- 17.62, p = 0.596) and about surgical radicality (R0) (obese:94 vs non-obese:594, p = 0.415). Obesity doesn't worsen postoperative outcomes and minimally invasive gastrectomy in obese patients is related to a lower postoperative mortality
The role of staging laparoscopy in stage IV gastric cancer patients
No full textIntroduction: Evidence regarding staging laparoscopy(SL)for clinical metastatic(cM+)gastric cancer(GC)patients is limited. Recently,Italian Gastric Cancer Research Group(GIRCG)study showed SL changed peritoneal status in over 20% of cases. This study aims to evaluate SL's role in cM+ patients and refine indications. Methods: Data of cM+ GC patients who underwent SL between 2010 and 2022 at nine GIRCG Centers were retrospectively analyzed.Primary outcome was SL's yield,defined as peritoneal status changed by SL,over all SLs. Results: Among 182 cM+ patients who received SL,38(20.9%)had SL-findings changing peritoneal status.10.1% of cases with preoperative signs of peritoneal carcinomatosis(PC)had no peritoneal disease,while 46.3% with extraperitoneal disease alone had PC at SL.Thirty-one patients(17.0%)underwent R0 resection:17(54.8%)with PC,3(9.7%)with liver metastases,4(12.9%)with PC and nodal metastases,2(6.4%)with lung and 1(3.2%)with bone metastases.17 patients with suspected preoperative PC underwent curative treatment:9 had peritoneal disease ruled out by SL,other 8 had limited PC,allowing R0 resection.Logistic regression revealed inverse correlation between diffuse histotype and absence of PC at SL,in patients with peritoneal involvement at imaging(p=0.02). Conclusions: SL aids in directing cM+ GC patients to appropriate treatment,with a 20.9% yield.For those with peritoneal involvement at imaging,SL helps identify candidates for curative treatment.In patients with extraperitoneal disease,SL should be considered to assess potential radical strategies
ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report
No full textBackground Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery. However, it is difficult to obtain full adherence to the protocol into clinical practice and has still not been identified the threshold beyond which improved functional results can be reached. Methods The ERCOLE (ERas and COLorectal Endoscopic surgery) study was as a cohort, prospective, multi-centre national study evaluating the association between adherence to ERAS items and clinical outcomes after minimally invasive colorectal surgery. The primary endpoint was to associate the percentage of ERAS adherence to functional recovery after minimally invasive colorectal cancer surgery. The secondary endpoints of the study was to validate safety of the ERAS programme evaluating complications' occurrence according to Clavien-Dindo classification and to evaluate the compliance of the Italian surgeons to each ERAS item. Results 1138 patients were included. Adherence to the ERAS protocol was full only in 101 patients (8.9%), > 75% of the ERAS items in 736 (64.7%) and > 50% in 1127 (99%). Adherence to > 75% was associated with a better functional recovery with 90.2 +/- 98.8 vs 95.9 +/- 33.4 h (p = 0.003). At difference, full adherence to the ERAS components 91.7 +/- 22.1 vs 92.2 +/- 31.6 h (p = 0.8) was not associated with better recovery. Conclusions Our results were encouraging to affirm that adherence to the ERAS program up to 75% could be considered satisfactory to get the goal. Our study could be considered a call to simplify the ERAS protocol facilitating its penetrance into clinical practice
Correction: ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report
No full textThis article was updated to correct Nicolò Fabbri's name in the listing of the ERCOLE Study Group (in Acknowledgments)
Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)
No full textAcute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula
Practice of proctology among general surgery residents and young specialists in Italy: a snapshot survey
No full textAnal diseases are very common and, in most of the cases, require surgery of minor or medium complexity, and, therefore, are among the most accessible diseases for surgeons in training. Aim of this study is to investigate the status of the training in proctology in Italy. A 31-items questionnaire was administered to residents and young specialists (<= 2 years) in general surgery, using mailing lists, and the social media accounts of the Italian Society of Colorectal Surgery. Answers from 338 respondents (53.8% males) were included in the final analysis. Overall, 252 respondents (74.5%) were residents and 86 (25.5%) young specialists. Two hundred and fifty-five (75.4%) respondents practiced proctology for the first time early on during their postgraduate training, but only 19.5% did it continuously for >= 24 months. Almost all respondents (334; 98.8%) had the chance to participate in proctological procedures, 205 (60.5%) as first surgeon. This percentage decreases according to the complexity of the surgery. In fact, only 11 (3.3%) and 24 (7.1%) of the respondents were allowed to be the first surgeon in more complex proctological diseases such as surgery for rectal prolapse and fecal incontinence. The present survey suggests that, in Italy, most surgeons in training deal with anal diseases. However, only few of them could achieve sufficient professional skills in the management of proctological diseases to be able to practice autonomously as young specialists
Correction to: Practice of proctology among general surgery residents and young specialists in Italy: a snapshot survey
No full textThe originally published article the collaborators of ProctoSurvey Group has not been included. The original article has been updated
