38 research outputs found
Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection
No full textBACKGROUNDThere is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIMTo investigate the impact of age on feasibility and short-term results of enhanced recovery protocol (ERP) after laparoscopic colorectal resection.METHODSData from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed. Three groups were considered according to patients' age: Group A, 65 years old or less, Group B, 66 to 75 years old and Group C, 76 years old or more. Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications, mortality and readmission rate. Differences in post-operative length of stay and adherence to ERP's items were evaluated in the three study groups.RESULTSAmong the 225 patients, 112 belonged to Group A, 57 to Group B and 56 to Group C. Thirty-day overall morbidity was 32.9% whilst mortality was nihil. Though the percentage of complications progressively increased with age (25.9% vs 36.8% vs 42.9%), no differences were observed in the rate of major complications (4.5% vs 3.5% vs 1.8%), prolonged post-operative ileus (6.2% vs 12.2% vs 10.7%) and anastomotic leak (2.7% vs 1.8% vs 1.8%). Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal (P = 0.032) and autonomous deambulation (P = 0.013) in elderly patients. Although discharge criteria were achieved later in older patients (3 d vs 3 d vs 4 d, P = 0.040), post-operative length of stay was similar in the 3 groups (5 d vs 6 d vs 6 d).CONCLUSIONERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection
Prognostic Value of Red Cell Distribution Width (RDW) In Colorectal Cancer. Results from a Single-Centre Cohort on 591 Patients
No full textAim: RDW has been extensively used to discriminate the types of anaemia, as it reflects the degree of heterogeneity of erythrocyte volume (anisocytosis). Recent studies suggested its role as an inflammatory marker, and an increased RDW has been regarded as a risk factor for mortality in a variety of acute and chronic conditions. Increasing evidence advocates the prognostic role of RDW in various tumours, including breast and ovarian cancer. The aim of this study was to investigate its role as a prognostic factor for overall (OS) and cancer-related survival (CRS) in patients who underwent surgery for colorectal cancer (CRC). Material and methods: From January 2005 to December 2016, 1347 patients underwent surgery for CRC at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust. Patients with evidence of infection or inflammatory conditions, and those who underwent emergency surgery were excluded; the minimum follow-up time was 24 months. The data were retrieved from a retrospective database. The optimal cut-off value for RDW was set at 14.1%; accordingly, two groups were considered: those with a value equal or lower than 14.1% (L-RDW), and those with a value higher than 14.1% (H-RDW). Results: A total of 591 patients met the inclusion criteria. The preoperative mean RDW value (±SD) was 15.2 (±3.2); 283 patients (47.9%) were classified as H-RDW. RDW was higher in patients with age above the median (p<0.001) and in colonic tumours (p<0.001). The mean value of RDW rose from pT1 to pT4 tumours (p=0.012). H-RDW correlated with age above the mean (p<0.001), colonic location of the lesion (p=0.012), pT (p=0.034) and TNM stage (p=0.049). Finally, H-RDW was significantly associated with the intent of surgery (p<0.001): almost 50% of patients who underwent a non-curative resection presented H-RDW, compared to 19.3% in R0 resections. OS was significantly lower in patients with H-RDW (p=0.043). Interestingly, OS was similar between groups up to 5 years after surgery (L-RDW 74.7% vs H-RDW 72.3%), whereas the difference increased on a longer follow-up (OS at 10 years 54% H-RDW vs 68.1% L-RDW). CRS was similar in the two groups (p=0.775). Survival rates were also examined stratifying patients according to TNM stage: worse OS was associated with H-RDW only in early stages (Stage 0-I; p=0.001), whereas there was no difference for stages II-IV. Multivariate analysis confirmed that H-RDW was not an independent prognostic factor. Conclusions: Although H-RDW correlated with some negative clinical-pathological factors, it did not seem to independently influence OS and CRS
Complete Mesocolic Excision Versus Standard Laparoscopic Colectomy in Right-Sided Colon Cancer: Analysis of Short-Term Results from a Single Italian Center
No full textBackground: Laparoscopic complete mesocolic excision (CME) right hemicolectomy is considered a demanding procedure and it is actually adopted in few centers from the West. The aim of the present study is to analyze the safety of laparoscopic CME right hemicolectomy and to compare its short-term results with standard right hemicolectomy in a single Western center. Materials and Methods: Prospectively collected data from 59 patients who underwent laparoscopic CME right hemicolectomy between September 2014 and February 2019 were retrospectively analyzed and compared with data from 55 patients submitted to standard laparoscopic right hemicolectomy between April 2013 and February 2019. Results: No differences were observed between CME and standard right hemicolectomy groups in terms of clinical characteristics. In the CME group, 37.3% of patients were ≥75 years old, 30.5% of patients were ASA class 3, 49.2% of patients had ≥2 comorbidities, 32.2% of patients had a BMI >28 and 13.6% of patients had ≥2 previous abdominal surgeries. No differences were observed in terms of duration of surgery (217±58min vs. 209±56min; P=0.456), intraoperative complications (5.1% vs. 3.6%; P=1) and blood loss (54±48mL Vs 75±63mL, P=0.089). between CME and S group. The percentage of overall (40.7% vs. 49.1%; P=0.451) and severe (Clavien-Dindo ≥3) complications (10.1% vs. 9.1%; P=0.862), redo surgery (5.1% vs. 7.3%; P=0.710) and readmission (5.1% vs. 5.5%; P=1) was comparable between CME group and S group. A significant difference was observed in the length of specimen (334±81mm vs. 273±95mm; P<0.001) as well as in the length of proximal (159±93mm vs.121±71mm; P=0.018) and distal margins (140±67mm vs.113±68mm; P=0.037) in favor of the CME group. The mean±SD number of lymph nodes harvested was higher in the CME group (26.6±11 vs. 21.7±9.2; P=0.011), as it was the percentage of cases with 12 or more retrieved lymph nodes (98.3% vs. 92.7%; P=0.195) though the difference did not reach statistical significance. Conclusions: This study demonstrated the safety of laparoscopic CME right hemicolectomy in a Western series. CME technique showed comparable short-term results and better quality specimens when compared with the standard procedure
An efficient MRI agent targeting extracellular markers in prostate adenocarcinoma
No full textPurpose: Prostate cancer (PCa) is the most widespread tumor affecting males in Western countries. We propose a novel MRI molecular tetrameric probe based on the heptadentate gadolinium (Gd)-AAZTA (6-amino-6-methylperhydro-1,4-diazepine-tetraacetic acid) that is able to in vivo detect PCa through the recognition of the fibrin-fibronectin (FB-FN) complex.Methods: The peptide CREKA (Cys-Arg-Glu-Lys-Ala), targeting the FB-FN complex in the reactive stroma of the tumor, was synthesized by solid phase peptide synthesis (SPPS) and conjugated to the tetramer dL-(Gd-AAZTA)(4). The resulting probe was characterized by H-1 relaxometry, tested in vitro on FB clots and in vivo on an orthotopic mouse model of PCa.Results: CREKA-dL-(Gd-AAZTA)(4) showed a remarkable relaxivity of 18.2 mM(Gd)(-1s-1) (0.47 T, 25 degrees C) because of the presence of 2 water molecules (q = 2) in the inner coordination sphere of each Gd3+ ion, whose rotational motion (tau(R)) is lengthened as the result of the relatively high molecular weight. The probe displayed a detectable affinity for plasma-derived FB clots. On intravenous injection of the probe in an orthotopic mouse model of PCa, a significant increase in the prostate T-1 contrast (similar to 40%) was observed. The MRI signal appears statistically higher either with respect to the one observed for the control probes and to the one detected when CREKA-dL-(Gd-AAZTA)(4) was administered to healthy animals.Conclusions: This study demonstrated the ability of the CREKA-dL-(Gd-AAZTA)(4) probe to specifically localize in prostate tumor after injection. The high relaxivity of the probe allows the reduction of the injected dose to 20 mu mol(Gd)/kg, yielding a good in vivo contrast enhancement in the region of prostate tumor
Use of Packed Red Blood Cells after Laparoscopic and Open Resection for Colorectal Tumors. A Case-Matched Study on 620 Patients
No full textBackground: Advantages of laparoscopic surgery over open approach include earlier recovery, less depletion of the systemic immune function and less intraoperative blood loss. RCTs comparing laparoscopic and open resection for colorectal cancer (CRC) demonstrated a reduced blood loss of 70-100 mL in favor of minimally invasive surgery. Nonetheless, little data are available on the use of red blood cell (RBC) transfusions after laparoscopic and open CRC resection. The hypothesis of this case-matched study is that postoperative RBC requirement in patients undergoing elective resection for CRC is lower after laparoscopic compared to open surgery Materials and Methods: Data from 310 patients undergoing laparoscopic surgery for CRC at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, between Apr 2013 and Dec 2017, were compared with data from 310 patients selected by case matching among 1108 patients undergoing open surgery between Jan 2005 and Dec 2017. Transfusion history included all data on RBCs transfused between 30 days before and 90 days after surgery. Results: Among the 1418 patients included in the dataset, 364 (25.7%) received one or more postoperative RBC transfusion, for a total number of units of 1234, a mean(SD) number of 0.9(2.0) units when considering the whole cohort and, a mean(SD) number of 3.4(2.8) units when considering transfused patients only. When matching laparoscopic and open cases for age and gender, the percentage of postoperatively transfused patients was doubled after open resection (26.1% vs. 15.8%; p<0.05). The total number of transfused RBC units was significantly higher after open surgery (353 vs. 180; p<0.01), while the mean(SD) number of units for transfused patients was comparable between the two groups [4.4 (3.7) vs 3.7 (3.4); p = 0.79]. Considering clinic-pathological variables, a significant difference was observed in R-category (p<0.01), pT (p<0.01), pN (p<0.01), M (p<0.01), preoperative Hb level (p<0.05) and preoperative RBC transfusion (p<0.05). Conversely, no differences were demonstrated for tumor location (p=0.87) and extent of surgery (p=0.55). When age, gender, extent of resection, R-category, pT, pN and M classes and preoperative Hb levels were used for case-matching, the percentage of patients requiring postoperative transfusion was comparable between open and laparoscopic surgery (18.1% vs. 15.8%; p=0.85). Similarly, the total number of transfused RBC units (174 vs. 180; p=0.86), the mean(SD) number of units in all the cohort [0.6(1.5) vs. 0.6(1.9); p=0.47] and the mean (SD) number of units in transfused patients only [3.1(3.3) vs. 3.7(3.5); p=0.86] were comparable between open and laparoscopic cases. Conclusions: Laparoscopic compared to open resection for CRC failed to demonstrate a lower requirement of RBC transfusions after case-matching for main clinic-pathological variable
Skin biopsy as a sensitive nonlethal technique for the ecotoxicological studies of South African great white shark (Carcharodon carcharias)
No full textROBOTIC LIVING-DONOR KIDNEY HARVESTING. DOES LONGER WARM ISCHEMIC TIME AFFECT THE TRANSPLANT OUTCOME?
No full textBackground: Warm Ischemia Time (WIT) has been proven to be detrimental
for graft recovery after transplantation. We herein report the outcome of
kidney transplants from living donor according to different WIT in our robotic
harvesting setting.
Methods: In our institution, since November 26th 2009, all kidneys harvesting
from living donors have been performed using the Da Vinci robot. Different
surgical techniques, different surgical teams and different instruments
like, for example, the vascular stapler devices have been used. This is the
reason why we experienced wide range of WIT. We finally relate the kidney
transplant function to the Graft WIT in order to find out if our longest WIT
has somehow affected the transplants outcome.
Results: From November 26th 2009 to December 27th 2020 we performed
168 kidney transplants from living donors. WIT varied from 120 to 943 seconds
(median 235). WIT has been divided in three different time intervals:
A) Tertile: 1) up to 210 seconds (31.8%), 2) from 210 to 260 seconds
(35.7%), 3) more than 260 seconds (32.5%); B) Median: less than 235 seconds
(49%) and more than 235 seconds (51%); C) Deciles: first 9 deciles
<360 seconds (89.2%), last deciles > 360 seconds (10.8%). At statistical
analysis we did not find any statistically significant correlation between the
WIT of our series and the kidney transplants outcome as far as creatinine
at discharge, delayed graft function, acute rejections, thrombosis, urinary
fistula, lymphorrea and overall complications are concerned.
Conclusions: Although WIT should be kept as short as possible in organ
transplantation, WIT up to 943 seconds in living donor kidney transplant
doesn’t seem to have any detrimental effect on the kidney recovery after
transplantation. This finding can be useful to the surgeon who will not have
to rush while staplering perhaps in difficult conditions or in presence of multiple
vessels
Clinical Utility and Diagnostic Accuracy of ROMA, RMI, ADNEX, HE4, and CA125 in the Prediction of Malignancy in Adnexal Masses
No full textObjective: We aimed to compare the clinical utility and diagnostic accuracy of the ADNEX model, ROMA score, RMI I, and RMI IV, as well as two serum markers (CA125 and HE4) in preoperative discrimination between benign and malignant adnexal masses (AMs). Methods: We conducted a retrospective study extracting all consecutive patients with AMs seen at our Institution between January 2015 and December 2020. Accuracy metrics included sensitivity (SE), specificity (SP), and area under the receiver operating characteristic curve (AUC), and their 95% confidence intervals (CI) were calculated for basic discrimination between AMs. Model performance was evaluated in terms of discrimination ability and clinical utility (net benefit, NB). Results: A total of 581 women were included; 481 (82.8%) had a benign ovarian tumor and 100 (17.2%) had a malignant tumor. The SE and SP of CA125, HE4, ROMA score, RMI I, RMI IV, and ADNEX model were 0.60 (0.54–0.66) and 0.80 (0.76–0.83); 0.39 (0.30–0.49) and 0.96 (0.94–0.98); 0.59 (0.50–0.68) and 0.92 (0.88–0.95); 0.56 (0.46–0.65) and 0.98 (0.96–0.99); 0.54 (0.44–0.63) and 0.96 (0.94–0.98); 0.82 (0.73–0.88) and 0.91 (0.89–0.94), respectively. The overall AUC was 0.76 (0.74–0.79) for CA125, 0.81 (0.78–0.83) for HE4, 0.82 (0.80–0.85) for ROMA, 0.86 (0.84–0.88) for RMI I, 0.83 (0.81–0.86) for RMI IV, and 0.92 (0.90–0.94) for ADNEX. The NB for ADNEX was higher than other biomarkers and models across all decision thresholds between 5% and 50%. Conclusions: The ADNEX model showed a better discrimination ability and clinical utility when differentiating malignant from benign Ams, compared to CA125, HE4, ROMA score, RMI I, and RMI IV
Novel Gastrin-Releasing Peptide Receptor Targeted Near-Infrared Fluorescence Dye for Image-Guided Surgery of Prostate Cancer
No full textPurpose Prostate cancer (PCa), the most widespread male cancer in western countries, is generally eradicated by surgery, especially if localized. However, during surgical procedures, it is not always possible to identify malignant tissues by visual inspection. Among the possible consequences, there is the formation of positive surgical margins, often associated with recurrence. In this work, the gastrin-releasing peptide receptor (GRPR), overexpressed in the prostatic carcinoma and not in healthy tissues or in benign hyperplasia (BPH), is proposed as target molecule to design a novel near-infrared fluorescent (NIRF) probe for image-guided prostatectomy. Procedures The NIRF dye Sulfo-Cy5.5 was conjugated to a Bombesin-like peptide (BBN), targeting GRPR. The final product, called BBN-Cy5.5, was characterized and tested in vitro on PC-3, DU145, and LnCAP cell lines, using unconjugated Sulfo-Cy5.5 as control. In vivo biodistribution studies were performed by optical imaging in PC-3 tumor-bearing and healthy mice. Finally, simulation of the surgical protocol was carried out. Results BBN-Cy5.5 showed high water solubility and a good relative quantum yield. The ability of the probe to recognize the GRPR, highly expressed in PC-3 cells, was tested both in vitro and in vivo, where a significant tumor accumulation was achieved 24 h post-injection. Furthermore, a distinguishable fluorescent signal was visible in mice bearing PCa, when the surgery was simulated. By contrast, low signal was found in healthy or BPH-affected mice. Conclusions This work proposes a new NIRF probe ideal to target GRPR, biomarker of PCa. The promising data obtained suggest that the dye could allow the real-time intraoperative visualization of prostate cancer
Translational Research on Azacitidine Post-Remission Therapy of Acute Myeloid Leukemia in Elderly Patients (QOL-ONE Trans-2)
No full textThe achievement of complete remission (CR) is crucial for acute myeloid leukemia (AML) patients undertaking curative therapy, but relapse often occurs within months, highlighting the need for strategies to prolong disease-free survival (DFS). Our phase III study compared the efficacy and safety of azacitidine (AZA) to best supportive care (BSC) in elderly AML patients who achieved CR following intensive induction and consolidation therapy. This ancillary study (QOL-ONE Trans-2) evaluated biological changes in bone marrow using Next-Generation Sequencing (NGS). We analyzed baseline, randomization, and 6-month post-remission samples from 24 patients (median age of 71 and 12 males). High-throughput NGS targeted 350 myeloid malignancy-related genes, considering variants with a variant allele frequency ≥ 4%. At diagnosis, all patients had 5 to 17 (median = 10) mutations, with DNMT3A (42%), NPM1 (33%), and TET2 (33%) being most frequent. FANCA mutations in four patients were linked to a higher relapse risk (HR = 4.96, p = 0.02) for DFS at both 2 and 5 years. Further HLA-specific NGS analyses are ongoing to confirm these results and their therapeutic implications
