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Article ; Online: Esophageal oncologic surgery in SARS-CoV-2 (COVID-19) emergency.

Barbieri, Lavinia / Talavera Urquijo, Eider / Parise, Paolo / Nilsson, Magnus / Reynolds, John V / Rosati, Riccardo

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2020 Volume 33, Issue 5

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/psychology ; Elective Surgical Procedures ; Emergencies ; Esophageal Neoplasms/complications ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/therapy ; Humans ; Nutritional Status ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/psychology ; Preoperative Care ; Risk Factors ; SARS-CoV-2 ; Triage
Keywords	covid19
Language	English
Publishing date	2020-04-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doaa028
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Article ; Online: Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center.

Talavera-Urquijo, Eider / Parise, Paolo / Carresi, Agnese / Cossu, Andrea / Barbieri, Lavinia / Puccetti, Francesco / Elmore, Ugo / Rosati, Riccardo

Updates in surgery

2022 Volume 75, Issue 2, Page(s) 435–449

Abstract: A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF ... ...

Abstract	A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF after esophagectomy and compare it with other reported series. Patients who developed a TBEF after esophagectomy were identified retrospectively. Baseline and intraoperative characteristics, postoperative and TBEF details, treatments for TBEF, and main outcomes are described. A univariate analysis was performed to compare some of the analyzed variables with the overall sample. Finally, our results are compared with the previously described series. Altogether, 16 patients with TBEF (3.11%) were analyzed from 514 patients who received esophagectomies between January 2014 and February 2020. As a first treatment attempt, 14 (87.5%) were treated with surgery, one was treated conservatively, and one was treated endoscopically. Surgery both at a first or second treatment attempt achieved a survival rate of 62.5% and oral intake at discharge of 43.75%. Six patients died during their hospital stay (37.5%). The presence of an anastomotic leak showed a strong association with TBEF development (100% vs. 19.7%; OR 1.163, 95% CI 1.080-1.253, p = 0.000). In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. However, there is an urgent need to elaborate treatment guidelines based on international consensus.
MeSH term(s)	Humans ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Retrospective Studies ; Tertiary Care Centers ; Esophageal Neoplasms/surgery ; Esophageal Fistula/etiology ; Esophageal Fistula/surgery ; Anastomosis, Surgical/adverse effects
Language	English
Publishing date	2022-08-22
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-022-01364-9
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Article ; Online: Applicative Limitations of Indocyanine Green Fluorescence Assistance to Laparoscopic Lymph Node Dissection in Total Gastrectomy for Cancer.

Puccetti, Francesco / Cinelli, Lorenzo / Genova, Luana / Battaglia, Silvia / Barbieri, Lavinia A / Treppiedi, Elio / Cossu, Andrea / Elmore, Ugo / Rosati, Riccardo

Annals of surgical oncology

2022 Volume 29, Issue 9, Page(s) 5875–5882

Abstract: Background: Indocyanine green (ICG) fluorescence has been recently introduced as a novel imaging technique improving the accuracy of lymph node (LN) dissection in gastric cancer (GC) surgery, although procedure standardization and achievements have not ... ...

Abstract	Background: Indocyanine green (ICG) fluorescence has been recently introduced as a novel imaging technique improving the accuracy of lymph node (LN) dissection in gastric cancer (GC) surgery, although procedure standardization and achievements have not been clearly defined. This study analyzed the feasibility and effectiveness of ICG-guidance for laparoscopic D2-lymphadenectomy during total gastrectomy for cancer. Methods: This study retrospectively analyzed a single-center series of patients who underwent laparoscopic total gastrectomy for cancer between April 2015 and August 2021. All patients underwent surgery with standard D2 LN dissection. Intraoperative ICG-fluorescence was institutionally implemented in April 2018 and was performed routinely afterward. Primary outcomes were LN harvest and ratio. Secondary endpoints included operative time and subgroup analysis to assess variables potentially affecting LN retrieval. Results: The study population included 102 patients, and ICG-fluorescence was applied in 38 (37.3%). ICG and no-ICG groups presented similar median age, gender proportions, ASA score and comorbidities (age-adjusted Charlson Comorbidity Index), body mass index, and advanced pathological stage. The median of LNs retrieved was significantly higher after the intraoperative ICG-guidance (44 vs. 32; p = 0.004), although this association was not significant after neoadjuvant therapy or among patients with positive LNs. Lymph node ratio and operative time were not significantly impacted by ICG fluorescence. Multivariate analysis identified the ICG-assistance as the only independent determinant for LN harvest (p = 0.029). Conclusions: ICG-guidance contributes to a significantly wider LN retrieval after laparoscopic D2-lymphadenectomy during total gastrectomy for cancer. However, neoadjuvant therapy and positive LN stage appeared to limit the procedural effectiveness to ICG-assisted LN identification.
MeSH term(s)	Gastrectomy/methods ; Humans ; Indocyanine Green ; Laparoscopy/methods ; Lymph Node Excision/methods ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Retrospective Studies ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery
Chemical Substances	Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2022-06-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-11940-3
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Article ; Online: Endoscopic vacuum therapy versus self-expandable metal stent for treatment of anastomotic leaks < 30 mm following oncologic Ivor-Lewis esophagectomy: a matched case-control study.

Mandarino, Francesco Vito / Barchi, Alberto / Leone, Lorenzo / Fanti, Lorella / Azzolini, Francesco / Viale, Edi / Esposito, Dario / Salmeri, Noemi / Puccetti, Francesco / Barbieri, Lavinia / Cossu, Andrea / Treppiedi, Elio / Elmore, Ugo / Rosati, Riccardo / Danese, Silvio

Surgical endoscopy

2023 Volume 37, Issue 9, Page(s) 7039–7050

Abstract: Background: Management of anastomotic leaks after Ivor-Lewis esophagectomy remains a challenge. Although intracavitary endoscopic vacuum therapy (EVT) has shown great efficacy for large dehiscences, the optimal management of smaller leaks has not been ... ...

Abstract	Background: Management of anastomotic leaks after Ivor-Lewis esophagectomy remains a challenge. Although intracavitary endoscopic vacuum therapy (EVT) has shown great efficacy for large dehiscences, the optimal management of smaller leaks has not been standardized. This study aims to compare EVT versus self-expandable metal stent (SEMS) in the treatment of leaks < 30 mm in size, due to the lack of current data on this topic. Methods: Patients undergoing EVT (cases) or SEMS (controls) between May 2017 and July 2022 for anastomotic leaks < 3 cm following oncologic Ivor-Lewis esophagectomy were enrolled. Controls were matched in a 1:1 ratio based on age (± 3 years), BMI (± 3 kg/m Results: Cases (n = 22) and controls (n = 22) showed no difference in baseline characteristics and leak size, as per matching at enrollment. No differences were detected between the two groups in terms of time from surgery to endoscopic treatment (p = 0.11) or total number of procedures per patient (p = 0.05). Remarkably, the two groups showed comparable results in terms of leaks resolution (90.9% vs. 72.7%, p = 0.11). The number of procedures per patient was not significant between the two cohorts (p = 0.05). The most frequent complication in the SEMS group was migration (15.3% of procedures). Conclusion: EVT and SEMS seem to have similar efficacy outcomes in the treatment of anastomotic defects < 30 mm after Ivor-Lewis esophagectomy. However, larger studies are needed to corroborate these findings.
MeSH term(s)	Humans ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Case-Control Studies ; Negative-Pressure Wound Therapy/adverse effects ; Retrospective Studies ; Treatment Outcome ; Self Expandable Metallic Stents/adverse effects ; Anastomosis, Surgical/adverse effects ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/complications
Language	English
Publishing date	2023-06-23
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-023-10213-8
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Article: Esophageal oncologic surgery in SARS-CoV-2 (COVID-19) emergency

Barbieri, Lavinia / Talavera Urquijo, Eider / Parise, Paolo / Nilsson, Magnus / Reynolds, John V / Rosati, Riccardo

Dis. esophagus

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #108764
Database	COVID19

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Article ; Online: Does immunotherapy change the treatment paradigm in metastatic gastric cancer?

Camera, Silvia / Liscia, Nicole / Foti, Silvia / Barbieri, Lavinia / Cossu, Andrea / Puccetti, Francesco / Elmore, Ugo / Rosati, Riccardo / Scartozzi, Mario / Mazza, Elena / Cascinu, Stefano

Medical oncology (Northwood, London, England)

2022 Volume 39, Issue 12, Page(s) 224

Abstract: Gastric cancer represents one of the leading causes of cancer-related death worldwide. Even if the last decade has witnessed an improvement in surgical and systemic treatments, with an increase of overall life expectancy, survival rates still remain ... ...

Abstract	Gastric cancer represents one of the leading causes of cancer-related death worldwide. Even if the last decade has witnessed an improvement in surgical and systemic treatments, with an increase of overall life expectancy, survival rates still remain unsatisfactory, especially for patients with metastatic disease. Systemic therapies represent the gold standard in the management of stage IV gastric cancer. In this scenario, the availability of effective second and third lines has represented for a long time the only hope to offer an overall survival improvement to these patients. Recently, the advent of immune checkpoint inhibitors has involved also gastric cancer with encouraging efficacy data in the metastatic setting, becoming integral part of the management of selected patients.
MeSH term(s)	Humans ; Immune Checkpoint Inhibitors ; Immunologic Factors ; Immunotherapy ; Splenic Neoplasms ; Stomach Neoplasms/therapy
Chemical Substances	Immune Checkpoint Inhibitors ; Immunologic Factors
Language	English
Publishing date	2022-09-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1201189-7
ISSN	1559-131X ; 0736-0118 ; 1357-0560
ISSN (online)	1559-131X
ISSN	0736-0118 ; 1357-0560
DOI	10.1007/s12032-022-01819-4
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Article ; Online: Esophageal oncologic surgery in SARS-CoV-2 (COVID-19) emergency

Barbieri, Lavinia / Talavera Urquijo, Eider / Parise, Paolo / Nilsson, Magnus / Reynolds, John V / Rosati, Riccardo

Diseases of the Esophagus

2020 Volume 33, Issue 5

Keywords	Gastroenterology ; General Medicine ; covid19
Language	English
Publisher	Oxford University Press (OUP)
Publishing country	uk
Document type	Article ; Online
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doaa028
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Diaphragmatic hernia after Ivor Lewis esophagectomy for cancer: a retrospective analysis of risk factors and post-repair outcomes.

Puccetti, Francesco / Cossu, Andrea / Parise, Paolo / Barbieri, Lavinia / Elmore, Ugo / Carresi, Agnese / De Pascale, Stefano / Fumagalli Romario, Uberto / Rosati, Riccardo

Journal of thoracic disease

2021 Volume 13, Issue 1, Page(s) 160–168

Abstract: Background: Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with ... ...

Abstract	Background: Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with incidence and risk factors not clearly demonstrated. This study evaluates presenting characteristics and repair outcomes in PEDH after Ivor Lewis esophagectomy for cancer. Methods: All consecutive patients who underwent esophageal cancer surgery between March 1997 and April 2018 at two high-volume centers were included. The patients underwent Ivor Lewis esophagectomy and were managed according to a standardized follow-up care plan. The primary outcomes included PEDH incidence, risk factor identification, and surgical results after hernia repair. Patient characteristics and perioperative data were collected and a multivariate analysis was performed to identify risk factors for PEDH. Results: A total of 414 patients were enrolled and 22 (5.3%) were diagnosed with PEDH during a median follow-up period of 16 (range, 6-177) months. All patients underwent surgical repair and 16 (73%) required treatment within 24 hours. PEDH repair was mainly performed through a laparoscopic approach (77.3%), with an overall postoperative morbidity of 22.7% and one mortality case. The median length of hospital stay was 6 (range, 2-95) days, and no early recurrences were observed, although three (13.6%) cases relapsed over a median follow-up of 10.1 months after hernia repair. Univariate analysis demonstrated a statistically significant association between PEDH and neoadjuvant chemoradiotherapy (P=0.016), pathological complete response (P=0.001), and lymph node harvest (P=0.024). On the other hand, multivariate analysis identified pathological complete response [3.616 (1.384-9.449), P=0.009] and lymph node harvest [3.029 (1.140-8.049), P=0.026] as the independent risk factors for developing PEDH. Conclusions: PEDH represents a relevant surgical complication after Ivor Lewis esophagectomy for cancer, including a 5.3% incidence and requiring surgical repair. Pathological complete response and lymph node harvest were found to be independent risk factors for PEDH, independently of the esophagectomy technique.
Language	English
Publishing date	2021-01-25
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-20-1974
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Article ; Online: Application of ERAS protocol in esophagectomy: a national survey among Italian centers performing esophageal surgery.

Parise, Paolo / Turi, Stefano / Talavera-Urquijo, Eider / Carresi, Agnese / Barbieri, Lavinia / Cossu, Andrea / Elmore, Ugo / Puccetti, Francesco / Rosati, Riccardo

Updates in surgery

2021 Volume 73, Issue 1, Page(s) 297–303

Abstract: The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions ... ...

Abstract	The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions was mailed to Italian centers that performed at least 10 esophagectomies per year. It included questions about the type of hospital and unit and pre-, intra- and post-operative items. Difficulties encountered were investigated. Thirteen (65%) centers answered the survey, and all met the minimal safety requirements, e.g., the presence of intensive care units and 24-h on-call operative endoscopy and radiology facilities. Fifty percent of esophagectomies with a minimally invasive approach were performed in 84.6% of the centers. Regarding pre-operative items, the highest scores were for the application of nutritional support, dysphagia palliation and presence of a multidisciplinary tumor board, whereas the lowest score was for the use of immunonutrition. Regarding intra-operative items, hypothermia prevention and the use of goal-directed fluid therapy and volatile anesthesia were diffusely adopted, whereas the rate of using abdominal drains was high. Regarding post-operative items, nausea prevention, multimodal analgesia and early mobilization were applied frequently, whereas the use of nasogastric tubes and regular transfer to intensive care units was diffused. The primary barriers in enhanced recovery after surgery protocol application were resistance and a lack of paramedic personnel. This survey's results highlight the efforts undertaken by several centers to apply enhanced recovery after surgery philosophy and in this regard, demonstrate a good standing in Italy.
MeSH term(s)	Enhanced Recovery After Surgery ; Esophagectomy/methods ; Esophagectomy/statistics & numerical data ; Esophagus/surgery ; Humans ; Italy/epidemiology ; Minimally Invasive Surgical Procedures/methods ; Minimally Invasive Surgical Procedures/statistics & numerical data ; Perioperative Care ; Surgery Department, Hospital/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2021-01-13
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00963-8
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Article: Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis.

Mandarino, Francesco Vito / Barchi, Alberto / D'Amico, Ferdinando / Fanti, Lorella / Azzolini, Francesco / Viale, Edi / Esposito, Dario / Rosati, Riccardo / Fiorino, Gionata / Bemelman, Willem Adrianus / Elmore, Ugo / Barbieri, Lavinia / Puccetti, Francesco / Testoni, Sabrina Gloria Giulia / Danese, Silvio

Life (Basel, Switzerland)

2023 Volume 13, Issue 2

Abstract: Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the "gold standard" for many years, and Endoscopic Vacuum Therapy (EVT), which was recently ... ...

Abstract	Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the "gold standard" for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery. Methods: A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for the treatment of leaks after upper gastro-intestinal surgery for malignant or benign pathologies. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori-defined subgroup analysis for the oncologic surgery group. Results: Eight retrospective studies with 357 patients were eligible. Overall, the EVT group showed a higher success rate (odd ratio [OR] 2.58, 95% CI 1.43-4.66), a lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08-6.71), shorter treatment duration (pmd -9.18, 95% CI -17.05--1.32), lower short-term complication (OR 0.35, 95% CI 0.18-0.71) and mortality rates (OR 0.47, 95% CI 0.24-0.92) compared to stenting. In the oncologic surgery subgroup analysis, no differences in the success rate were found (OR 1.59, 95% CI 0.74-3.40, I Conclusions: Overall, EVT has been revealed to be more effective and less burdened by complications compared to stenting. In the oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data need to define a unique management algorithm for anastomotic leaks.
Language	English
Publishing date	2023-01-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life13020287
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