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Article ; Online: Commentary on: Salvage surgery is an effective alternative for J pouch afferent limb stricture treatment.

Spinelli, Antonino / Carvello, Michele

2023 Volume 174, Issue 4, Page(s) 758

MeSH term(s)	Humans ; Colonic Pouches ; Constriction, Pathologic/surgery ; Proctocolectomy, Restorative ; Postoperative Complications/surgery ; Salvage Therapy ; Colitis, Ulcerative/surgery ; Anastomosis, Surgical
Language	English
Publishing date	2023-07-12
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.06.008
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Article ; Online: A surgical perspective on total neoadjuvant therapy for rectal cancer: Shades and lights of a new journey.

Spinelli, Antonino / Carvello, Michele

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

2021 Volume 23, Issue 9, Page(s) 2223–2224

MeSH term(s)	Chemoradiotherapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2021-09-13
Publishing country	England
Document type	Editorial
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15873
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Article: Surgery versus Medical Therapy in Luminal Ileocecal Crohn's Disease.

Carvello, Michele / Danese, Silvio / Spinelli, Antonino

Clinics in colon and rectal surgery

2022 Volume 35, Issue 1, Page(s) 72–77

Abstract: The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive ... ...

Abstract	The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive structural damage, ideal time windows for medical and surgical treatment have been identified. While complicated disease clearly profits from surgical treatment, uncomplicated disease has become, in the last years, the most debatable setting in terms of different approaches including early surgery. On one hand, the rationale of traditional escalating medical therapy (step-up approach) has been undermined by the top-down medical approach. Indeed, the step-up approach has the possible drawback of delaying, up to a later disease stage, the use of more effective agents such as anti-tumor necrosis factors. Conversely, the top-down approach might expose patients to an overtreatment along with side effects including hypersensitivity to biologic agents. More recently, it has been shown how early surgery could be a valid option in this subset of patients being more cost-effective than medical therapy. Involving the surgeon at an early stage is considered now a good clinical practice and, in this scenario full of possibilities, the surgeon should be included into the decision-making process from the very beginning of patient management.
Language	English
Publishing date	2022-01-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0041-1740031
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Article ; Online: The Management of the Hospitalized Ulcerative Colitis Patient, the Medical-Surgical Conundrum.

Carvello, Michele / Watfah, Joseph / Spinelli, Antonino

Current gastroenterology reports

2021 Volume 23, Issue 12, Page(s) 25

Abstract: Purpose of review: In this study we present the evidence based management for patients hospitalized for UC with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): ... ...

Abstract	Purpose of review: In this study we present the evidence based management for patients hospitalized for UC with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon. Recent findings: Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized ulcerative colitis patients is advocated. The colectomy rate has not changed over the years. Moreover delayed surgery after admission is burden by increase complication and mortality. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and to not prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial. Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy.
MeSH term(s)	Colectomy ; Colitis, Ulcerative/drug therapy ; Colitis, Ulcerative/surgery ; Hospitalization ; Humans ; Time Factors
Language	English
Publishing date	2021-10-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2041376-2
ISSN	1534-312X ; 1522-8037
ISSN (online)	1534-312X
ISSN	1522-8037
DOI	10.1007/s11894-021-00820-7
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Article: Intriguing Role of the Mesentery in Ileocolic Crohn's Disease.

Turri, Giulia / Carvello, Michele / Ben David, Nadav / Spinelli, Antonino

Clinics in colon and rectal surgery

2022 Volume 35, Issue 4, Page(s) 321–327

Abstract: Crohn's disease (CD) is a chronic relapsing inflammatory bowel disease with unknown etiology. Up to 80% of patients will eventually require surgery throughout their lifetime, and often repeated resections are required for disease recurrence. Observations ...

Abstract	Crohn's disease (CD) is a chronic relapsing inflammatory bowel disease with unknown etiology. Up to 80% of patients will eventually require surgery throughout their lifetime, and often repeated resections are required for disease recurrence. Observations of "creeping fat" surrounding the diseased intestine renewed interest in the mesentery, recently defined as an organ with endocrine and immune functions. According to the inside-out model, the mesentery may be primarily affected in CD and subsequent cause alterations in the mucosa. Recently, lower surgical recurrence rates have been reported with en-bloc excision of the mesentery adjoining the diseased intestine. Results of ongoing randomized controlled trials may clarify the role of the mesentery in CD and possibly lead to its adoption as standard during surgery for Crohn's disease.
Language	English
Publishing date	2022-04-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0042-1743590
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Article ; Online: Single-stapled anastomosis is associated with a lower anastomotic leak rate than double-stapled technique after minimally invasive total mesorectal excision for MRI-defined low rectal cancer.

Foppa, Caterina / Carvello, Michele / Maroli, Annalisa / Sacchi, Matteo / Gramellini, Marco / Montorsi, Marco / Spinelli, Antonino

Surgery

2023 Volume 173, Issue 6, Page(s) 1367–1373

Abstract: Background: After total mesorectal excision, distal rectal transection and anastomosis are critical for short-term, oncological, and functional outcomes, including anastomotic leak. A double-pursestring, single-stapled anastomosis avoids cross-stapling, ...

Abstract	Background: After total mesorectal excision, distal rectal transection and anastomosis are critical for short-term, oncological, and functional outcomes, including anastomotic leak. A double-pursestring, single-stapled anastomosis avoids cross-stapling, overcoming the potential drawbacks of transabdominal rectal transection and double-stapled anastomosis. This study aims to compare the anastomotic leak rate in double-stapled and single-stapled anastomoses after minimally invasive total mesorectal excision for magnetic resonance imaging-defined low rectal cancer. Methods: Adult patients (>18 years old) undergoing minimally invasive total mesorectal excision for magnetic resonance imaging-defined low rectal cancer with a stapled low anastomosis (below 5 centimeters from the anal verge) between January 2010 and January 2022 at a single institution were allocated to 2 groups according to the anastomosis: double-stapled (abdominal stapled transection and double-stapled anastomosis) or single-stapled (transanal rectal transection and double-pursestring single-stapled anastomosis). The exclusion criteria were nonrestorative procedures or any type of manual anastomosis. The primary endpoint was the rate of 90-day clinical and radiologic anastomotic leak. Results: In total, 185 single-stapled and 458 double-stapled were included. Clinical and tumor characteristics were comparable between the groups. The 90-day anastomotic leak rate was significantly lower in the single-stapled group (6.48% vs 15.28%; P = .002), with similar rates of grade and timing. Thirty- and 90-day complication rates were higher in the double-stapled group (P = .0001; P = .02), with comparable Clavien-Dindo grades. At multivariable analysis, double-stapled anastomosis (P = .01), active smoking (P = .03), and the presence of comorbidities (P = .01) resulted as independent risk factors for an anastomotic leak. Conclusion: Transanal transection and double-pursestring, single-stapled anastomosis were associated with a lower anastomotic leak rate after minimally invasive total mesorectal excision for magnetic resonance imaging-defined low rectal cancer.
MeSH term(s)	Adult ; Humans ; Adolescent ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/surgery ; Rectal Neoplasms/complications ; Rectum/diagnostic imaging ; Rectum/surgery ; Rectum/pathology ; Magnetic Resonance Imaging ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Retrospective Studies
Language	English
Publishing date	2023-03-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.02.018
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Article ; Online: The Impact of Crohn's Perianal Fistula on Quality of Life: Results of an International Patient Survey.

Spinelli, Antonino / Yanai, Henit / Girardi, Paolo / Milicevic, Slobodan / Carvello, Michele / Maroli, Annalisa / Avedano, Luisa

Crohn's & colitis 360

2023 Volume 5, Issue 3, Page(s) otad036

Abstract: Background: Crohn's perianal fistula is a disabling manifestation of Crohn's disease. However, the additional burden of perianal fistula on patients with only Crohn's disease remains to be addressed. This patient-reported survey considered outcomes of ... ...

Abstract	Background: Crohn's perianal fistula is a disabling manifestation of Crohn's disease. However, the additional burden of perianal fistula on patients with only Crohn's disease remains to be addressed. This patient-reported survey considered outcomes of two domains: "diagnosis" (eg, symptoms) and "living with the disease" (eg, quality of life, well-being, and relationships). Methods: Patients with perianal fistula and Crohn's disease completed an online, self-selective, anonymous, 46-item survey available in 11 languages hosted on the European Federation of Crohn's & Ulcerative Colitis Associations and national patient association websites. The survey was conducted between July and December 2019 in Europe and other regions. Likert scales and closed questions were used to assess outcomes. Results: Of the 820 respondents with Crohn's disease (67.2% women; median age, 40.0 years), 532 (64.9%) reported the presence of perianal fistula. Patients with perianal fistula reported a greater impact on overall quality of life ( Conclusions: Perianal fistulas impact several domains of the life of patients with Crohn's disease. These results may help healthcare practitioners plan therapeutic strategies that address the symptomatic and psychological burden experienced by patients with perianal fistulizing Crohn's disease.
Language	English
Publishing date	2023-07-25
Publishing country	England
Document type	Journal Article
ISSN	2631-827X
ISSN (online)	2631-827X
DOI	10.1093/crocol/otad036
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Article: Surgery versus Medical Therapy in Luminal Ileocecal Crohn's Disease

Carvello, Michele / Danese, Silvio / Spinelli, Antonino

Clinics in Colon and Rectal Surgery

(The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases)

2022 Volume 35, Issue 01, Page(s) 72–77

Series title	The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases
Abstract	The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive structural damage, ideal time windows for medical and surgical treatment have been identified. While complicated disease clearly profits from surgical treatment, uncomplicated disease has become, in the last years, the most debatable setting in terms of different approaches including early surgery. On one hand, the rationale of traditional escalating medical therapy (step-up approach) has been undermined by the top-down medical approach. Indeed, the step-up approach has the possible drawback of delaying, up to a later disease stage, the use of more effective agents such as anti-tumor necrosis factors. Conversely, the top-down approach might expose patients to an overtreatment along with side effects including hypersensitivity to biologic agents. More recently, it has been shown how early surgery could be a valid option in this subset of patients being more cost-effective than medical therapy. Involving the surgeon at an early stage is considered now a good clinical practice and, in this scenario full of possibilities, the surgeon should be included into the decision-making process from the very beginning of patient management.
Keywords	surgery ; ileocectomy ; Crohn's disease ; top-down
Language	English
Publishing date	2022-01-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2048635-2
ISSN	1530-9681 ; 1531-0043
ISSN (online)	1530-9681
ISSN	1531-0043
DOI	10.1055/s-0041-1740031
Database	Thieme publisher's database

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Article ; Online: The Authors Reply.

Spinelli, Antonino / Carvello, Michele / Foppa, Caterina / Pellino, Gianluca

Diseases of the colon and rectum

2020 Volume 63, Issue 12, Page(s) e596–e597

MeSH term(s)	COVID-19 ; Colorectal Neoplasms ; Disease Outbreaks ; Humans ; Italy ; SARS-CoV-2
Language	English
Publishing date	2020-11-04
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.0000000000001848
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Article ; Online: The Management of the Hospitalized Ulcerative Colitis Patient: the Medical-Surgical Conundrum.

Carvello, Michele / Watfah, Joseph / Włodarczyk, Marcin / Spinelli, Antonino

Current gastroenterology reports

2020 Volume 22, Issue 3, Page(s) 11

Abstract: Purpose of review: In this study, we present the evidence-based management for patients hospitalized for ulcerative colitis (UC) with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team ...

Abstract	Purpose of review: In this study, we present the evidence-based management for patients hospitalized for ulcerative colitis (UC) with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon. Recent findings: Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized UC patients is advocated. The colectomy rate has not changed over the years. Moreover, delayed surgery after admission is burden by increase complication and mortality rates. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and not to prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial. Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non-responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy.
MeSH term(s)	Anti-Inflammatory Agents/therapeutic use ; Colectomy/methods ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/diagnosis ; Colitis, Ulcerative/therapy ; Colorectal Surgery ; Disease Management ; Gastroenterology ; Gastrointestinal Agents/therapeutic use ; Glucocorticoids/therapeutic use ; Hospitalization ; Humans ; Patient Care Team ; Proctectomy/methods ; Time-to-Treatment
Chemical Substances	Anti-Inflammatory Agents ; Gastrointestinal Agents ; Glucocorticoids
Language	English
Publishing date	2020-02-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2041376-2
ISSN	1534-312X ; 1522-8037
ISSN (online)	1534-312X
ISSN	1522-8037
DOI	10.1007/s11894-020-0750-1
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