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  1. Article: Uniportal video-assisted thoracic surgery Ivor-Lewis oesophagectomy with circular stapling anastomosis.

    Nachira, Dania / Biondi, Alberto / D'Ugo, Domenico / Margaritora, Stefano

    Journal of minimal access surgery

    2024  

    Abstract: Abstract: Amongst all minimally invasive oesophagectomies, uniportal video-assisted thoracic surgery (VATS) Ivor-Lewis remains the most challenging procedure due to the skills required for performing the intrathoracic anastomosis. We present an easy and ...

    Abstract Abstract: Amongst all minimally invasive oesophagectomies, uniportal video-assisted thoracic surgery (VATS) Ivor-Lewis remains the most challenging procedure due to the skills required for performing the intrathoracic anastomosis. We present an easy and safe circular stapling latero-terminal anastomosis for performing uniportal VATS Ivor-Lewis. The patient had an uneventful post-operative recovery and was disease-free 9 months after surgery.
    Language English
    Publishing date 2024-01-19
    Publishing country India
    Document type Journal Article
    ZDB-ID 2186884-0
    ISSN 1998-3921 ; 0972-9941
    ISSN (online) 1998-3921
    ISSN 0972-9941
    DOI 10.4103/jmas.jmas_184_23
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  2. Article ; Online: Conversion rate to open surgery during transanal total mesorectal excision (TaTME) for rectal cancer: a single-center experience.

    Tirelli, Flavio / Lorenzon, Laura / Biondi, Alberto / Neri, Ilaria / Santoro, Gloria / Persiani, Roberto

    Updates in surgery

    2024  

    Abstract: Minimally invasive techniques for rectal cancer have demonstrated considerable advantages in terms of faster recovery and less post-operative complications. However, due to the complex anatomy and a limited surgical field, conversion to open surgery is ... ...

    Abstract Minimally invasive techniques for rectal cancer have demonstrated considerable advantages in terms of faster recovery and less post-operative complications. However, due to the complex anatomy and a limited surgical field, conversion to open surgery is still sometimes required, with a negative impact on the short-and long-term outcomes. The purpose of this study was to analyse the conversion rate to open abdominal surgery during laparoscopic transanal total mesorectal excision (TaTME) procedures performed at a high-volume Italian referral center. All consecutive TaTME performed for mid-to-low rectal cancer between 2015 and 2023 were reviewed, independently if treated with a primary anastomosis (with/without a diverting ostomy) or an end stoma. All procedures were performed using a standardized approach by the same surgical team. Patients with benign diagnosis that underwent different-from rectal resection procedures and cases pre-operatively scheduled for open surgery were excluded. The primary outcome of interest was the rate of conversion, defined as an un-planned intraoperative switch to open surgery using a midline laparotomy. Secondary aims included the comparison of patients who had a longer vs shorter operative time. Out of 220 patients, 210 were selected. In 187 cases, a primary anastomosis was performed, while 23 patients received a terminal colostomy (1 in the converted group; 22 in the full MIS- TaTME group, 10.6%). A surgical approach modification occurred in two cases, with a conversion rate of 0.95%. Median operative time was 281 min. Reasons for conversions included intra-operative difficulties impairing the mini-invasive procedure without intra-operative complications in one case, and difficulties in the laparoscopic control of an intraoperative bleeding due to a splenic lesion in another patient. Male sex and a higher BMI were found to be statistically significantly associated to longer operative time (respectively: p = 0.001 and p = 0.0025). In a high-volume center, a standardized TaTME is associated to a low conversion rate to open abdominal surgery.
    Language English
    Publishing date 2024-04-28
    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/s13304-024-01844-0
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  3. Article ; Online: The Authors Reply.

    Persiani, Roberto / Biondi, Alberto

    Diseases of the colon and rectum

    2019  Volume 62, Issue 1, Page(s) e2–e3

    MeSH term(s) Developing Countries ; Humans ; Laparoscopy ; Propensity Score ; Rectal Neoplasms
    Language English
    Publishing date 2019-02-04
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000001252
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  4. Article ; Online: '4-Check' protocol for intraoperative anastomotic assessment during transanal total mesorectal excision: retrospective cohort study.

    Tirelli, Flavio / Lorenzon, Laura / Biondi, Alberto / Neri, Ilaria / Santoro, Gloria / Persiani, Roberto

    BJS open

    2023  Volume 7, Issue 4

    Abstract: Background: Anastomotic leakage is a major complication following rectal cancer surgery. The primary aim of this study was to investigate the efficacy of a protocol based on a quadruple intraoperative anastomotic assessment (4-Check) during transanal ... ...

    Abstract Background: Anastomotic leakage is a major complication following rectal cancer surgery. The primary aim of this study was to investigate the efficacy of a protocol based on a quadruple intraoperative anastomotic assessment (4-Check) during transanal total mesorectal excision (TaTME).
    Methods: Patients who underwent TaTME for rectal cancer with primary anastomosis were reviewed and divided into two groups: before (pre-4-Check: April 2015 - April 2019) and after the implementation of the 4-Check protocol (May 2019 - May 2022). This protocol consisted of a multimodal anastomotic integrity assessment, including indocyanine green-evaluation of colonic stump and intraluminal anastomosis perfusion, a reverse air leak test and anastomotic doughnuts assessment. The primary outcome was incidence of clinical and/or radiological anastomotic leakage. The secondary outcome included intraoperative anastomosis defects and repairs and 30-day complication rate. Propensity score matching and multivariable analyses were performed.
    Results: Of 186 patients, 160 were selected: 86 patients in the pre-4-Check and 74 in the 4-Check group. After propensity score matching, there was no difference in postoperative anastomotic leakage (pre-4-Check versus 4-Check: 11.1 per cent versus 7.4 per cent; P = 0.50). However, in the 4-Check group, the intraoperative detection of defects and repairs was significantly increased (P = 0.03), and the number of complications was reduced (pre-4-Check versus 4-Check: 33.3 per cent versus 9.3 per cent, P = 0.004). Multivariable analyses confirmed that the use of the 4-Check protocol, the detection of anastomotic defects and increased albumin levels were associated with a reduced number of complications.
    Conclusion: The 4-Check protocol allowed the intraoperative detection and repair of anastomotic defects. Anastomotic leakage rates were not reduced; however, 30-day complication rates were lower after implementation of this protocol.
    MeSH term(s) Humans ; Anastomotic Leak/diagnosis ; Anastomotic Leak/etiology ; Retrospective Studies ; Rectum/surgery ; Anastomosis, Surgical/adverse effects ; Rectal Neoplasms/surgery
    Language English
    Publishing date 2023-08-03
    Publishing country England
    Document type Journal Article
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrad072
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  5. Article ; Online: Comment on "Distal Resection Margin Status in Transanal Total Mesorectal Excision (TA-TME)".

    Biondi, Alberto / Persiani, Roberto

    Annals of surgery

    2018  Volume 270, Issue 2, Page(s) e34–e35

    MeSH term(s) Adenocarcinoma ; Humans ; Margins of Excision ; Rectal Neoplasms ; Robotic Surgical Procedures ; Transanal Endoscopic Surgery
    Language English
    Publishing date 2018-10-12
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000003069
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  6. Article ; Online: TaTME for the treatment of advanced rectal cancer.

    Grieco, Michele / Biondi, Alberto / Tirelli, Flavio / Persiani, Roberto

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2020  Volume 23, Issue 1, Page(s) 328–329

    MeSH term(s) Humans ; Laparoscopy ; Proctectomy ; Rectal Neoplasms/surgery ; Rectum ; Transanal Endoscopic Surgery
    Language English
    Publishing date 2020-10-28
    Publishing country England
    Document type Letter
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15399
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  7. Article: Quality Over Volume: Modeling Centralization of Gastric Cancer Resections in Italy.

    Lorenzon, Laura / Biondi, Alberto / Agnes, Annamaria / Scrima, Ottavio / Persiani, Roberto / D'Ugo, Domenico

    Journal of gastric cancer

    2022  Volume 22, Issue 1, Page(s) 35–46

    Abstract: Background: The correlation between hospital volume and postoperative outcomes has led to the centralization of complex procedures in several countries. However, the results reported in relation to gastric cancer (GC) are contradictory. This study aimed ...

    Abstract Background: The correlation between hospital volume and postoperative outcomes has led to the centralization of complex procedures in several countries. However, the results reported in relation to gastric cancer (GC) are contradictory. This study aimed to analyze GC surgical volumes and 30-day postoperative mortality in Italy and to provide a simulation for modeling centralization of GC resections based on district case volumes.
    Methods: A national registry was used to identify all GC resections, record mortality rates, and track the national in-border GC resection health travel. Hospitals were grouped according to caseload. Centralization of all GC procedures performed within the same district was modeled. The outcome measures were a minimal volume of 25 GC resections/year and the 30-day postoperative mortality.
    Results: In 2018, 5,873 GC resections were performed in 498 Italian hospitals (mean resections per hospital per year: 11.8); the postoperative mortality rate (5.51%) was tracked from 2016-2018. GC resection health travel ranged from 2% to 50.5%, with a significant (P<0.001) difference between northern and central/southern Italy. The mean mortality rate was 7.7% in hospitals performing one to 3 GC resections per year, compared with 4.7% in those with >17 GC resections/year (P≤0.01). Most Italian districts achieved 25 procedures/year after centralization; however, 66.3% of GC cases in southern Italy vs. 42.2% in central and 52.7% in the northern regions (P<0.001) required reallocation.
    Conclusion: Postoperative mortality after GC resection correlated with hospital volume. Despite health travel, most Italian districts can reach a high-volume threshold, but discrepancies in mortality rates are alarming.Trial Registration
    Language English
    Publishing date 2022-02-24
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2637180-7
    ISSN 2093-5641 ; 2093-582X
    ISSN (online) 2093-5641
    ISSN 2093-582X
    DOI 10.5230/jgc.2022.22.e4
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  8. Article ; Online: Predictors of Clostridium difficile infection after stoma reversal following TaTME surgery.

    Tirelli, Flavio / Lorenzon, Laura / Biondi, Alberto / Langellotti, Lodovica / Santoro, Gloria / Agnes, Annamaria / Pezzuto, Roberto / Persiani, Roberto / D'Ugo, Domenico

    Updates in surgery

    2023  Volume 75, Issue 6, Page(s) 1589–1596

    Abstract: Background:  The aim of this study was to determine the incidence of Clostridium Difficile infection (CDI) after stoma reversal in patients who underwent transanal Total Mesorectal Excision (TaTME) and to evaluate variables correlated with this post- ... ...

    Abstract Background:  The aim of this study was to determine the incidence of Clostridium Difficile infection (CDI) after stoma reversal in patients who underwent transanal Total Mesorectal Excision (TaTME) and to evaluate variables correlated with this post-operative infection.
    Methods:  Patients who underwent stoma reversal surgery following TaTME for rectal cancer between 2015 and 2023 at a high-volume Institution, were retrospectively reviewed for the post-operative occurrence of diarrhea and in-hospital CDI (positive toxin in the stools). Patients were divided into the following subgroups according to the post-operative course: Group A-no clinical symptoms; Group B-mild diarrhea (< 10 evacuations/day); Group C-severe watery diarrhea (> 10 evacuations/day) with CDI negative; and Group D-severe watery diarrhea (> 10 evacuations/day) CDI positive. Clinical and laboratory data were analyzed for their correlation with CDI. A machine learning approach was used to determine predictors of diarrhea following stoma reversal.
    Results:  A total of 126 patients were selected, of whom 79 were assessed as Group A, 16 Group B, 25 Group C and 6 (4.8%) Group D. Univariable analysis documented that delayed stoma reversal correlated with CDI (Group A mean interval 44.6 weeks vs. Group D 68.4 weeks, p 0.01). The machine learning analysis confirmed the delay in stoma closure as a probability factor of presenting diarrhea; also, diarrhea probability was 80.5% in males, 77.8% in patients who underwent neoadjuvant therapy, and 63.9% in patients who underwent adjuvant therapy.
    Conclusions:  Stoma reversal surgery can result in moderate rate of in-hospital CDI. Time-to stoma reversal is a crucial variable significantly related with this adverse outcome.
    MeSH term(s) Male ; Humans ; Retrospective Studies ; Surgical Stomas/adverse effects ; Clostridium Infections/epidemiology ; Clostridium Infections/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Rectal Neoplasms/surgery ; Diarrhea/epidemiology ; Diarrhea/etiology
    Language English
    Publishing date 2023-08-04
    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/s13304-023-01614-4
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    Zs.B 101: Show issues Location:
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  9. Article ; Online: Application of fluorescence-guided surgery in the acute care setting: a systematic literature review.

    Fransvea, Pietro / Fico, Valeria / Puccioni, Caterina / D'Agostino, Luca / Costa, Gianluca / Biondi, Alberto / Brisinda, Giuseppe / Sganga, Gabriele

    Langenbeck's archives of surgery

    2023  Volume 408, Issue 1, Page(s) 375

    Abstract: Purpose: Fluorescence-based imaging has found application in several fields of elective surgery, but there is still a lack of evidence in the literature about its use in emergency setting. The present review critically summarizes currently available ... ...

    Abstract Purpose: Fluorescence-based imaging has found application in several fields of elective surgery, but there is still a lack of evidence in the literature about its use in emergency setting. The present review critically summarizes currently available applications and limitations of indocyanine green (ICG) fluorescence in abdominal emergencies including acute cholecystitis, mesenteric ischemia, and trauma surgery.
    Methods: A systematic review was performed according to the PRISMA statement identifying articles about the use of ICG fluorescence in the management of the most common general surgery emergency. Only studies focusing on the use of ICG fluorescence for the management of acute surgical conditions in adults were included.
    Results: Thirty-six articles were considered for qualitative analysis. The most frequent disease was occlusive or non-occlusive mesenteric ischemia followed by acute cholecystitis. Benefits from using ICG for acute cholecystitis were reported in 48% of cases (clear identification of biliary structures and a safer surgical procedure). In one hundred and twenty cases that concerned the use of ICG for occlusive or non-occlusive mesenteric ischemia, ICG injection led to a modification of the surgical decision in 44 patients (36.6%). Three studies evaluated the use of ICG in trauma patients to assess the viability of bowel or parenchymatous organs in abdominal trauma, to evaluate the perfusion-related tissue impairment in extremity or craniofacial trauma, and to reassess the efficacy of surgical procedures performed in terms of vascularization. ICG injection led to a modification of the surgical decision in 50 patients (23.9%).
    Conclusion: ICG fluorescence is a safe and feasible tool also in an emergency setting. There is increasing evidence that the use of ICG fluorescence during abdominal surgery could facilitate intra-operative decision-making and improve patient outcomes, even in the field of emergency surgery.
    MeSH term(s) Adult ; Humans ; Fluorescence ; Mesenteric Ischemia ; Surgery, Computer-Assisted ; Elective Surgical Procedures ; Cholecystitis, Acute ; Indocyanine Green
    Chemical Substances Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2023-09-25
    Publishing country Germany
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-023-03109-7
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  10. Article ; Online: Profiling complete regression after pre-operative therapy in gastric cancer patients using clinical and pathological data.

    Biondi, Alberto / Lorenzon, Laura / Santoro, Gloria / Agnes, Annamaria / Laurino, Antonio / Persiani, Roberto / D'Ugo, Domenico

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2023  Volume 49, Issue 11, Page(s) 106969

    Abstract: Introduction: The consistent use of pre-operative treatment before surgery for gastric cancer (GC) has resulted in increased rates of complete response. However, factors associated with response have been scantly investigated.: Methods: Patients with ...

    Abstract Introduction: The consistent use of pre-operative treatment before surgery for gastric cancer (GC) has resulted in increased rates of complete response. However, factors associated with response have been scantly investigated.
    Methods: Patients with GCs treated between 2017 and 2022 undergoing pre-operative treatment followed by resection were included. Clinicopathological data were analyzed for the association with tumor regression grades (TRG); secondary outcomes included the short-term overall (OS), disease-free (DFS) and disease specific survival (DSS).
    Results: Among 108 patients, 35.1% had an intestinal histotype GC, and 70.4% were treated with FLOT. Complete tumor regression (TRG1) was documented in 6.5% of patients. Univariable analyses documented that a higher pre-operative albumin (p = 0.04) and the expression of HER2 (p = 0.01) were associated to TRG1. In the multinominal regression model, the log-odds of being classified as TRG1 increased with the expression of HER2 by 170.247 times and with higher pre-operative albumin by 34.525 times, while with a higher Charlson Index and a diffuse hystotipe reduced it by 25.467 times and 3759.126 times, respectively. Among 49 patients (mean follow-up: 17.1 months), TRG1-2 was associated to better OS, DFS and DSS curves compared to TRG 3-5 (respectively p < 0.01, p 0.007 and p < 0.01), altogether with the reported negative impact of comorbidities in OS and DSS multivariable analyses (respectively p 0.04 and p 0.006). The random survival forest further confirmed the impact of HER2 and comorbidity on DSS.
    Conclusion: A better clinical profile, HER2 expression and intestinal histotype significantly correlated with GC regression. A complete-major response was an independent factor for survival.
    MeSH term(s) Humans ; Prognosis ; Stomach Neoplasms/surgery ; Stomach Neoplasms/drug therapy ; Treatment Outcome ; Disease-Free Survival ; Neoadjuvant Therapy ; Albumins
    Chemical Substances Albumins
    Language English
    Publishing date 2023-06-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2023.06.021
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