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  1. Article ; Online: Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry.

    Ceresoli, M / Carissimi, F / Nigro, A / Fransvea, P / Lepre, L / Braga, M / Costa, G

    Hernia : the journal of hernias and abdominal wall surgery

    2020  Volume 26, Issue 1, Page(s) 165–175

    Abstract: Purpose: The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can ... ...

    Abstract Purpose: The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed.
    Methods: This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson's comorbidity index, P-POSSUM and CR-POSSUM were assessed.
    Results: 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson's comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality CONCLUSION: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson's comorbidity index could be adopted to select patients for elective operation.
    MeSH term(s) Aged ; Aged, 80 and over ; Hernia, Femoral/surgery ; Hernia, Inguinal/complications ; Herniorrhaphy/adverse effects ; Humans ; Morbidity ; Multivariate Analysis ; Postoperative Complications/etiology ; Registries ; Retrospective Studies
    Language English
    Publishing date 2020-07-31
    Publishing country France
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-020-02269-5
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  2. Article: Non-anatomical liver resection for hepatocellular carcinoma: the SegSubTe classification to overcome the problem of heterogeneity.

    Garancini, Mattia / Fogliati, Alessandro / Scotti, Mauro Alessandro / Ciulli, Cristina / Carissimi, Francesca / Rovere, Antonio / Gianotti, Luca / Romano, Fabrizio

    Hepatobiliary & pancreatic diseases international : HBPD INT

    2023  Volume 23, Issue 3, Page(s) 265–271

    Abstract: Background: The superiority of anatomical resection (AR) vs. non-anatomical resection (NAR) in the surgical management of hepatocellular carcinoma (HCC) is debated. ARs are well-defined procedures, whereas the lack of NAR standardization results in ... ...

    Abstract Background: The superiority of anatomical resection (AR) vs. non-anatomical resection (NAR) in the surgical management of hepatocellular carcinoma (HCC) is debated. ARs are well-defined procedures, whereas the lack of NAR standardization results in heterogeneous outcomes. This study aimed to introduce the SegSubTe classification for NAR detailing the appropriateness of the level of surgical section of the Glissonean pedicles feeding the tumor.
    Methods: A single-center retrospective analysis of pre- and postoperative imaging of consecutive patients treated with NAR for single HCC between 2012 and 2020 was conducted. The quality of surgery was assessed classifying the type of vascular supply and the level of surgical section (segmental, subsegmental or terminal next to the tumor) of vascular pedicles feeding the HCCs; then, the population was divided in "SegSubTe-IN" or "SegSubTe-OUT" groups, and the tumor recurrence and survival were analyzed.
    Results: Ninety-seven patients who underwent NAR were included; 76% were SegSubTe-IN and 24% were SegSubTe-OUT. Total disease recurrence, local recurrence and cut-edge recurrence in the SegSubTe-IN vs. SegSubTe-OUT groups were 50% vs. 83% (P = 0.006), 20% vs. 52% (P = 0.003) and 16% vs. 39% (P = 0.020), respectively. SegSubTe-OUT odds ratio for local recurrence was 4.1 at univariate regression analysis. One-, three-, and five-year disease-free survival rates in the SegSubTe-IN vs. SegSubTe-OUT groups were 81%, 58% and 35% vs. 46%, 21% and 11%, respectively (P < 0.001).
    Conclusions: The SegSubTe classification is a useful tool to stratify and standardize NAR for HCC, aiming at improving long-term oncological outcomes and reducing the heterogeneity of quality of NAR for HCC.
    MeSH term(s) Humans ; Carcinoma, Hepatocellular/diagnostic imaging ; Carcinoma, Hepatocellular/surgery ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/surgery ; Retrospective Studies ; Neoplasm Recurrence, Local/surgery ; Hepatectomy/adverse effects ; Hepatectomy/methods
    Language English
    Publishing date 2023-02-04
    Publishing country Singapore
    Document type Journal Article
    ZDB-ID 2241386-8
    ISSN 1499-3872
    ISSN 1499-3872
    DOI 10.1016/j.hbpd.2023.02.002
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  3. Article ; Online: COVID-19: how the pandemic impacted the emergency department and urgent surgical activity in a medium-size Italian hospital.

    Pinotti, E. / Carissimi, F. / Baronio, G. / Montuori, M. / Ongaro, D. / Ciocca Vasino, M.

    Abstract: Backgrounds: COVID-19 has grown rapidly in Lombardy, particularly in the province of Bergamo. To deal with the pressure the pandemic has exerted on the Italian health system; many hospitals have had to reorganize their medical and surgical activities. ... ...

    Abstract Backgrounds: COVID-19 has grown rapidly in Lombardy, particularly in the province of Bergamo. To deal with the pressure the pandemic has exerted on the Italian health system; many hospitals have had to reorganize their medical and surgical activities. The aim of this study was to evaluate how the pandemic influenced the emergency department and urgent surgical activity in a medium-size hospital in the province of Bergamo. Methods: In this retrospective observational study, we analyzed the number of admissions to the medical and surgical Emergency Room and their severity compared with those in the same period in previous years (2011-2019). Admission in the medical and surgical department and urgent surgical operation was also assessed. Results: From March 7th to April 5th, 2020, we observe a reduction in emergency department access (-53%) when compared with the corresponding period of previous years. The number of medical admissions was similar to the past years (+0.9%), we observed a drastic reduction of surgical patients (-82.5%). We experienced a significant increase in hospitalizations in the medical department (+359%) and a reduction of admission in the surgical department (- 71.2%). Conclusion: SARS-CoV2 disease has spread so suddenly and severely that it has stressed Italian health system, in particular the Lombard one. Our data show the rise of critical medical ER accesses and the significant expansion in hospitalisation in the medical department with the necessary hospital reorganisation to face COVID-19 emergency. We also observed a reduction in both surgical ER accesses and urgent surgical activity.
    Keywords covid19
    Publisher MedRxiv; WHO
    Document type Article ; Online
    DOI 10.1101/2020.11.19.20234856
    Database COVID19

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  4. Article: COVID-19 and Liver Surgery: How the Pandemic Affected an Italian Medium-Volume HBP Center.

    Carissimi, Francesca / Scotti, Mauro Alessandro / Ciulli, Cristina / Fogliati, Alessandro / Uggeri, Fabio / Chiarelli, Marco / Braga, Marco / Romano, Fabrizio / Garancini, Mattia

    Frontiers in surgery

    2022  Volume 9, Page(s) 918348

    Abstract: Introduction: While the COVID-19 pandemic is still ongoing, it is even more evident that victims of the pandemic are not only those who contract the virus, but also the countless patients suffering from other serious diseases (i.e., tumor) who have ... ...

    Abstract Introduction: While the COVID-19 pandemic is still ongoing, it is even more evident that victims of the pandemic are not only those who contract the virus, but also the countless patients suffering from other serious diseases (i.e., tumor) who have undergone delayed potentially life-saving surgery due to a lack of beds. Like many hospitals, ours also initially blocked all elective oncologic surgery, but these operations were "recovered" and reintegrated in a relatively short time, thanks to the establishment of COVID-free wards and operating rooms with staff dedicated to oncological surgery. In tis context, our aim is to assess whether and how the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) pandemic has impacted our hepatobiliary surgery unit.
    Methods: From our prospective database, we retrospectively took data from patients undergoing liver surgery in 2018-2019 (pre-COVID) and 2020-2021 (COVID period). Patients admitted to COVID-free wards must necessarily have a negative nasal swab from the previous 24 h.
    Results: Between January 1, 2018, and December 31, 2019 (Group 1), 101 patients were treated; during the pandemic [January 1, 2020, and December 31, 2021 (Group 2)], 126 patients were treated. There was no statistical difference between the groups. The median postoperative hospital stay was 7 days for both groups; 7 patients had major complications (Clavien-Dindo > 3) in Group 1 and 11 in Group 2 (
    Conclusion: During the COVID pandemic, our HPB unit managed to offer a volume of tertiary-center hepatobiliary surgery without a significant impact in terms of length of stay, morbidity, or mortality despite the increase in tumor burden during the pandemic years.
    Language English
    Publishing date 2022-06-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2022.918348
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  5. Article: Left Anterior Sectorectomy: An Alternative to Left Hepatectomy for Tumors Invading the Distal Part of the Left Portal Vein.

    Garancini, Mattia / Scotti, Mauro Alessandro / Gianotti, Luca / Ciulli, Cristina / Carissimi, Francesca / Uggeri, Fabio / Degrate, Luca / Braga, Marco / Romano, Fabrizio

    Diagnostics (Basel, Switzerland)

    2022  Volume 12, Issue 2

    Abstract: Background: Liver tumors invading the distal part of the umbilical portion of the left portal vein usually require left hepatectomy. The recent introduction of the concept of left anterior sector, an independent anatomo-functional unit including the ... ...

    Abstract Background: Liver tumors invading the distal part of the umbilical portion of the left portal vein usually require left hepatectomy. The recent introduction of the concept of left anterior sector, an independent anatomo-functional unit including the anterior portion of the left liver and supplied by the distal part of the umbilical portion of the left portal vein, could represent the rational for an alternative surgical approach. The aim of this study was to introduce the novel surgical procedure of ultrasound-guided left anterior sectorectomy.
    Methods: Among 92 consecutive patients who underwent hepatectomy, 3 patients with tumor invading the distal part of the umbilical portion of the left portal (two with colorectal liver metastases and one with neuroendocrine tumor liver metastases) underwent left anterior sectorectomy alone or in association with liver multiple metastasectomies.
    Results: Mean operation time was 393 min; post-operative morbidity and mortality were not observed. After a mean FU of 23 months (range 19-28), no local recurrence occurred.
    Conclusions: In presence of tumors invading the distal part of the umbilical portion of the left portal, left anterior sectorectomy could be considered as an anatomic radical surgical option that is safe but more conservative than a left hepatectomy.
    Language English
    Publishing date 2022-02-21
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics12020545
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  6. Article ; Online: Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation.

    Tamini, Nicolò / Ceresoli, Marco / Aldè, Simone / Carissimi, Francesca / Ripamonti, Lorenzo / Nespoli, Luca / Dinelli, Marco / Braga, Marco / Gianotti, Luca

    International journal of colorectal disease

    2020  Volume 35, Issue 4, Page(s) 633–640

    Abstract: Purpose: Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. ... ...

    Abstract Purpose: Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages.
    Methods: From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method.
    Results: After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54 months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value.
    Conclusions: SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.
    MeSH term(s) Aged ; Colectomy ; Colon/surgery ; Colonic Neoplasms/surgery ; Colonoscopy ; Disease-Free Survival ; Elective Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome
    Language English
    Publishing date 2020-02-01
    Publishing country Germany
    Document type Comparative Study ; Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-020-03519-9
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  7. Article ; Online: COVID-19: how the pandemic impacted the emergency department and urgent surgical activity in a medium-size Italian hospital

    Pinotti, Enrico / Carissimi, Francesca / Baronio, Gianluca / Montuori, Mauro / Ongaro, Deborah / Vasino, Michele Ciocca

    medRxiv

    Abstract: Backgrounds: COVID-19 has grown rapidly in Lombardy, particularly in the province of Bergamo. To deal with the pressure the pandemic has exerted on the Italian health system; many hospitals have had to reorganize their medical and surgical activities. ... ...

    Abstract Backgrounds: COVID-19 has grown rapidly in Lombardy, particularly in the province of Bergamo. To deal with the pressure the pandemic has exerted on the Italian health system; many hospitals have had to reorganize their medical and surgical activities. The aim of this study was to evaluate how the pandemic influenced the emergency department and urgent surgical activity in a medium-size hospital in the province of Bergamo. Methods: In this retrospective observational study, we analyzed the number of admissions to the medical and surgical Emergency Room and their severity compared with those in the same period in previous years (2011-2019). Admission in the medical and surgical department and urgent surgical operation was also assessed. Results: From March 7th to April 5th, 2020, we observe a reduction in emergency department access (-53%) when compared with the corresponding period of previous years. The number of medical admissions was similar to the past years (+0.9%), we observed a drastic reduction of surgical patients (-82.5%). We experienced a significant increase in hospitalizations in the medical department (+359%) and a reduction of admission in the surgical department (- 71.2%). Conclusion: SARS-CoV2 disease has spread so suddenly and severely that it has stressed Italian health system, in particular the Lombard one. Our data show the rise of critical medical ER accesses and the significant expansion in hospitalisation in the medical department with the necessary hospital reorganisation to face COVID-19 emergency. We also observed a reduction in both surgical ER accesses and urgent surgical activity.
    Keywords covid19
    Language English
    Publishing date 2020-11-20
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2020.11.19.20234856
    Database COVID19

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  8. Article: Finding the seed of recurrence: Hepatocellular carcinoma circulating tumor cells and their potential to drive the surgical treatment.

    Carissimi, Francesca / Barbaglia, Matteo Nazzareno / Salmi, Livia / Ciulli, Cristina / Roccamatisi, Linda / Cordaro, Giuseppe / Mallela, Venkata Ramana / Minisini, Rosalba / Leone, Biagio Eugenio / Donadon, Matteo / Torzilli, Guido / Pirisi, Mario / Romano, Fabrizio / Famularo, Simone

    World journal of gastrointestinal surgery

    2021  Volume 13, Issue 9, Page(s) 967–978

    Abstract: The treatment for hepatocellular carcinoma (HCC) relies on liver resection, which is, however, burdened by a high rate of recurrence after surgery, up to 60% at 5 years. No pre-operative tools are currently available to assess the recurrence risk ... ...

    Abstract The treatment for hepatocellular carcinoma (HCC) relies on liver resection, which is, however, burdened by a high rate of recurrence after surgery, up to 60% at 5 years. No pre-operative tools are currently available to assess the recurrence risk tailored to every single patient. Recently liquid biopsy has shown interesting results in diagnosis, prognosis and treatment allocation strategies in other types of cancers, since its ability to identify circulating tumor cells (CTCs) derived from the primary tumor. Those cells were advocated to be responsible for the majority of cases of recurrence and cancer-related deaths for HCC. In fact, after being modified by the epithelial-mesenchymal transition, CTCs circulate as "seeds" in peripheral blood, then reach the target organ as dormant cells which could be subsequently "awakened" and activated, and then initiate metastasis. Their presence may justify the disagreement registered in terms of efficacy of anatomic
    Language English
    Publishing date 2021-09-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2573700-4
    ISSN 1948-9366
    ISSN 1948-9366
    DOI 10.4240/wjgs.v13.i9.967
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  9. Article ; Online: Megaesophagus in an elderly man with achalasia: a "not so benign" condition.

    Mazzola, Paolo / Carissimi, Francesca / Floris, Patrizia / Pittella, Francesca / Galeazzi, Marianna / Moretti, Daniela / Bellelli, Giuseppe / Dinelli, Marco / Annoni, Giorgio

    Aging clinical and experimental research

    2017  Volume 29, Issue 4, Page(s) 809–814

    Language English
    Publishing date 2017
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2104785-6
    ISSN 1720-8319 ; 1594-0667
    ISSN (online) 1720-8319
    ISSN 1594-0667
    DOI 10.1007/s40520-016-0633-3
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  10. Article ; Online: The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study.

    Famularo, Simone / Donadon, Matteo / Cipriani, Federica / Ardito, Francesco / Iaria, Maurizio / Carissimi, Francesca / Perri, Pasquale / Dominioni, Tommaso / Zanello, Matteo / Conci, Simone / Molfino, Sarah / D'Acapito, Fabrizio / Germani, Paola / Ferrari, Cecilia / Patauner, Stefan / Pinotti, Enrico / Sciannamea, Ivano / Garatti, Marco / Lodo, Enrico /
    Troci, Albert / Delvecchio, Antonella / Floridi, Antonio / Bernasconi, Davide Paolo / Fumagalli, Luca / Chiarelli, Marco / Memeo, Riccardo / Crespi, Michele / Zanus, Giacomo / Zimmitti, Giuseppe / Antonucci, Adelmo / Zago, Mauro / Frena, Antonio / Griseri, Guido / Tarchi, Paola / Ercolani, Giorgio / Baiocchi, Gian Luca / Ruzzenente, Andrea / Jovine, Elio / Maestri, Marcello / Grazi, GianLuca / Valle, Raffaele Dalla / Giuliante, Felice / Aldrighetti, Luca / Romano, Fabrizio / Torzilli, Guido

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2021  Volume 25, Issue 11, Page(s) 2823–2834

    Abstract: Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease- ... ...

    Abstract Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence.
    Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence.
    Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41-71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352-2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921-1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921-1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295-0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001).
    Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.
    MeSH term(s) Ascites/epidemiology ; Ascites/etiology ; Carcinoma, Hepatocellular/surgery ; Disease-Free Survival ; Hepatectomy/adverse effects ; Humans ; Liver Neoplasms/surgery ; Neoplasm Recurrence, Local/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies
    Language English
    Publishing date 2021-03-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-021-04952-z
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