24 research outputs found
Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives
No full textThe spleen is one of the organs most commonly injured by blunt abdominal trauma. It plays an important role in immune response to infections, especially those sustained by encapsulated bacteria. Nonoperative management (NOM), comprising clinical and radiological observation with or without angioembolization, is the treatment of choice for traumatic splenic injury in patients who are hemodynamically stable. However, this strategy carries a risk of failure, especially for high-grade injuries. No clear predictors of failure have been identified, but minimally invasive surgery for splenic injury is gaining popularity. Laparoscopic surgery has been proposed as an alternative to open surgery for hemodynamically stable patients who require surgery, such as after failed NOM. We reviewed research articles on laparoscopic surgery for hemodynamically stable patients with splenic trauma to explore the current knowledge about this topic. After presenting an overview of the treatments for splenic trauma and the immunological function of the spleen, we try to identify the future indications for laparoscopic surgery in the era of NOM
Predicting Postoperative Length of Stay in Patients Undergoing Laparoscopic Right Hemicolectomy for Colon Cancer: A Machine Learning Approach Using SICE (Società Italiana di Chirurgia Endoscopica) CoDIG Data
No full textThe evolution of laparoscopic right hemicolectomy, particularly with complete mesocolic excision (CME) and central vascular ligation (CVL), represents a significant advancement in colon cancer surgery. The CoDIG 1 and CoDIG 2 studies highlighted Italy’s progressive approach, providing useful findings for optimizing patient outcomes and procedural efficiency. Within this context, accurately predicting postoperative length of stay (LoS) is crucial for improving resource allocation and patient care, yet its determination through machine learning techniques (MLTs) remains underexplored. This study aimed to harness MLTs to forecast the LoS for patients undergoing right hemicolectomy for colon cancer, using data from the CoDIG 1 (1224 patients) and CoDIG 2 (788 patients) studies. Multiple MLT algorithms, including random forest (RF) and support vector machine (SVM), were trained to predict LoS, with CoDIG 1 data used for internal validation and CoDIG 2 data for external validation. The RF algorithm showed a strong internal validation performance, achieving the best performances and a 0.92 ROC in predicting long-term stays (more than 5 days). External validation using the SVM model demonstrated 75% ROC values. Factors such as fast-track protocols, anastomosis, and drainage emerged as key predictors of LoS. Integrating MLTs into predicting postoperative LOS in colon cancer surgery offers a promising avenue for personalized patient care and improved surgical management. Using intraoperative features in the algorithm enables the profiling of a patient’s stay based on the planned intervention. This issue is important for tailoring postoperative care to individual patients and for hospitals to effectively plan and manage long-term stays for more critical procedures
Multicenter retrospective cohort italian study on elective laparoscopic cholecystectomy performed by the surgical residents
No full textPurposeThis retrospective multicenter cohort study aimed to evaluate the clinical outcomes (mortality rate, operative time, complications) of elective laparoscopic cholecystectomy (LC) when performed by a surgical resident in comparison to experienced consultant in the backdrop of Italian academic centers.MethodsRetrospective review of all patients undergoing elective LC between January 2016 and January 2022 at six teaching hospitals across Italy was performed. Cases were identified using the Current Procedural Terminology (CPT) code 5123 (LC without cholangiogram). All cases of emergency surgery, ASA score > 3, or when cholecystectomy was performed with another surgical procedure, were excluded. All suitable cases were divided into 2 groups based on primary surgeon: consultant or senior resident. Main outcome was complication rates (intraoperative and peri/postoperative); secondary outcomes included operative time, the length of stay, and the rate of conversion to open.ResultsA total of 2331 cases (1425 females) were included, of which, consultants performed 1683 LCs (72%), while the residents performed 648 (28%) surgeries. The groups were statistically comparable regarding demographics, history of previous abdominal surgery, operative time, or intraoperative complications. The rate of conversion to open cholecystectomy was 1.42% for consultant and none for resident (p = 0.02). A statistically significant difference was observed between groups regarding the average length of stay (2.2 +/- 3 vs 1.6 +/- 1.3 days p = 0.03). Similarly, postoperative complications (1.7% vs 0.5%) resulted in statistically significant (p = 0.02) favoring resident group.ConclusionsOur study demonstrates that in selected patients, senior residents can safely perform LC when supervised by senior staff surgeons
Impact of Covid-19 on surgical activities and personnel: lessons for the future
No full textCovid-19 pandemic has impacted professional, economic and social activities. In the surgical field, it has brought changes to operating activities, the organization of workforces, the protection measures for patients and personnel against possible intraoperative transmissions as well as training young surgeons. This study intends to assess the extent of this impact in our institution
Is there a place for optimizing thoracic radiotherapy in limited-stage small cell lung cancer after twenty years?
No full textDisponible en: https://www.wjgnet.com/2218-4333/full/v12/i1/1.htmAbstract
Thoracic radiotherapy (TRT) is one of the main treatments in limited-stage small cell lung cancer (LS-SCLC). Hyperfractionated TRT (45 Gy, 1.5 Gy twice daily) has been the standard of care (SOC) since Turrisi and colleagues published the results of their clinical trial in 1999. Two meta-analyses have demonstrated the benefits of concurrent chemotherapy and TRT in terms of intrathoracic disease control at 2 years and 3-year overall survival (OS). The phase 2 trial by Grønberg et al (2016) comparing once-daily hypofractionated TRT to twice-daily hyperfractionated TRT in LS-SCLC found similar outcomes in both groups in terms of response rate, progression-free survival (PFS), grade 3-4 adverse effects, and OS. The CONVERT trial, published in 2017, failed to demonstrate the superiority of the conventional scheme (once-daily TRT) vs twice-daily radiotherapy, despite the application of modern radiotherapy techniques and a quality assurance programme, thus confirming the twice-daily hyperfractionated regimen as the SOC. At the 2020 American Society of Clinical Oncology (ASCO) annual meeting, Grønberg et al reported preliminary findings from a phase 2 trial comparing two different TRT dose regimens (45 Gy vs 60 Gy), both administered twice daily. Those data demonstrated a marked improvement in 2-year survival rates in the high dose arm (70.2% vs 46.1%, P = 0.002), despite similar objective response rates and PFS outcomes. Those findings provide a new treatment alternative to consider: Hyperfractionated, high-dose TRT. However, the results of that trial will need to be validated in a large, randomized phase 3 study. The results of the phase 2 CALCG 30610 trial will help to clarify the optimal dose and regimen. The potential role of upfront immunotherapy, which early data suggest may improve OS, also needs to be determined.
Keywords: American Society of Clinical Oncology; High dose; Hyperfractionated; Limited-stage small cell lung cancer; Small cell lung cancer; Thoracic radiotherapy.
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved
A Randomized Phase III Trial of Complete Mesocolic Excision Compared with Conventional Surgery for Right Colon Cancer: Interim Analysis of a Nationwide Multicenter Study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-in trial)
No full textBackground: Although complete mesocolic excision (CME) is supposed to be associated with a higher lymph node (LN) yield, decreased local recurrence, and survival improvement, its implementation currently is debated because the evidence level of these data is rather low and still not supported by randomized controlled trials. Method: This is a multicenter, randomized, superiority trial (NCT04871399). The 3-year disease-free survival (DFS) was the primary end point of the study. The secondary end points were safety (duration of operation, perioperative complications, hospital length of stay), oncologic outcomes (number of LNs retrieved, 3- and 5-year overall survival, 5-year DFS), and surgery quality (specimen length, area and integrity rate of mesentery, length of ileocolic and middle-colic vessels). The trial design required the LN yield to be higher in the CME group at interim analysis. Results: Interim data analysis is presented in this report. The study enrolled 258 patients in nine referral centers. The number of LNs retrieved was significantly higher after CME (25 vs. 20; p = 0.012). No differences were observed with respect to intra- or post-operative complications, postoperative mortality, or duration of surgery. The hospital stay was even shorter after CME (p = 0.039). Quality of surgery indicators were higher in the CME arm of the study. Survival data still were not available. Conclusions: Interim data show that CME for right colon cancer in referral centers is safe and feasible and does not increase perioperative complications. The study documented with evidence that quality of surgery and LN yield are higher after CME, and this is essential for continuation of patient recruitment and implementation of an optimal comparison. Trial registration The trial was registered at ClinicalTrials.gov with the code NCT04871399 and with the acronym CoME-In trial
Enterotomy closure after minimally invasive distal gastrectomy with intracorporeal anastomosis: a multicentric study
No full textIntroduction: Despite progressive improvements in technical skills and instruments have facilitate surgeons to perform intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging task is handsewn knot tying. We analysed the better way to fashion an handsewn intracorporeal enterotomy closure after a stapled anastomosis. Methods: All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer at thirteen high-volume institutions were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic vs. laparoscopic approach; laparoscopic HD vs. 3D vs. 4K technology; single layer vs. double layer enterotomies. Additionally, double layer enterotomies were analysed layer by layer, comparing running vs. interrupted suture; presence vs. absence of deep corner suture and type of suture thread (barbed, braided, non-braided suture). Results: Significant lower rates of bleeding (p = 0,011) and leakage (p = 0,048) from gastro-jejunal anastomosis were recorded in the double-layer group. Comparing barbed to braided and non-braided suture threads, the first was significantly associated to reduced intraluminal bleeding and leakage rates both in the first (p = 0,042 and p = 0,010) and second layer (p = 0,002 and p = 0,029). Conclusions: Our study found that double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure results in lower intraluminal bleeding and anastomotic leak rates
Molo Klutsch
No full textIl Molo Klutsch, ambientazione dell'acquerello, sorgeva in passato nell’area del Porto Vecchio di Trieste e doveva il suo nome all’omonimo torrente. Il torrente Klutsch (o Settefontane) era uno dei principali corsi d’acqua cittadini, esso scorreva dalla zona di Rozzol percorrendo le attuali Via Cumano, Viale Ippodromo, Via della Tesa, Largo Mioni, Via della Raffineria, Via Oriani. Giungeva infine presso via Carducci dove, all’altezza dei portici di Chiozza, si congiungeva allo Starebrech (o rio Farneto) dando origine al cosiddetto “Torrente grande”. Quest’ultimo proseguiva in direzione di Via Ghega, inglobando le acque del Rio Romagna e del Rio Scorcola, fino a gettarsi in mare nell’area dell’attuale molo IV, in corrispondenza del molo recante il suo nome. Come apprendiamo dal Godoli, la costruzione del molo fu ultimata nel 1841: “Fino al 1848 irrilevante è l’impegno del governo austriaco nell’ammodernamento delle infrastrutture portuali triestine. Tra il 1823 e il 1830 l’impresa di Matteo Pertsch esegue lavori di consolidamento e allungamento del Molo del sale, situato in corrispondenza dell’attuale Via Torrebianca; nel 1837 in corrispondenza del Lazzaretto Vecchio, Iver Borland provvede a costruire il molo che da lui prenderà il nome e che servirà l’officina meccanica da lui fondata; nel 1841 alla foce del Torrente è ultimato il molo Klutsch.” [E. Godoli, Trieste, Roma 1984]. In una corposa relazione sul porto di Trieste del console inglese Richard Francis Burton apprendiamo che: “The Klutsch was built partly by Government and partly by the Südbahn. (...) All the old piers were built with caissons and beton, except the long narrow Molo Klutsch, which was laid on slabs...” [The Port of Trieste, Ancient and Modern in “Journal of the society of Arts”, Vol. XXIII, 29 Ottobre 1875, pp. 976-1006]. Tale costruzione e parte delle rive ad esso adiacenti furono interrati nel corso dei lavori di costruzione della nuova stazione ferroviaria, progettata dall’ingegner Carlo Ghega ed inaugurata il 22 luglio 1957 alla presenza dell’imperatore austriaco Francesco Giuseppe. (Descrizione sintetica dell'opera: Architetture: Trieste: Molo Klutsch. Mare: Adriatico. Mezzi di trasporto: imbarcazioni. Oggetti: bitte.)Autore presunto. (Datazione opera incerta:1841-1857)acquerello su cartaIn basso a destra: Molo Klutsch/ 24 luglio; In basso a destra: W F Beuerlin.Dipartimento di Studi Umanistici (Via del Lazzaretto Vecchio 8, Trieste
From artifact to icon: an analysis of the Venus figurines in archaeological literature and contemporary culture
No full textThis thesis examines the body of material known as the Venus figurines, which date from the European Upper Palaeolithic period. The argument proceeds in two stages: the first examines this material through a detailed textual analysis of the archaeological literature that has discussed these figurines since their initial discovery at the end of the 19th century to the present day; the second investigates the utilisation of particular Venus figurines in the contemporary medium of the World Wide Web. The textual analysis identifies and discusses a number of factors relevant to the presentation and fundamental construction of the Venus figurines as an archaeological category. These include examination of the use of terminology to label and define the figurines as a class of material(Chapter 2); assessment of information presented in the literature pertaining to contextual and chronological factors (Chapter 3); evaluation of the evidence provided for both the homogeneity and diversity apparent within this category (Chapter 4); Chapter 5 isolates and discusses a number of methods implicit in the production of the literature by which aspects of both individual figurines and the wider class are prioritised to create and consolidate a particular impression of the archaeological material; Chapter 6 presents three detailed Case Studies of these processes as they are in practice applied to the Venus figurines. In Chapter 7 the specific use of these figurines in one medium of contemporary culture, the World Wide Web, is examined. Within this medium, the figurines are removed from their original archaeological context and contemporary meanings are attributed to them. This popular usage is then compared and contrasted with archaeological practice. My analysis demonstrates that parallels between the two approaches can be drawn, and identifies the role of the Venus figurines as a "commodity" within both archaeology and contemporary culture
