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Article ; Online: Application of ERAS protocols in esophagogastric emergency surgery: is it feasible and does it make sense?

Puccetti, Francesco / Elmore, Ugo / Rosati, Riccardo

2022 Volume 75, Issue 2, Page(s) 383–387

Abstract: Management and treatment of esophagogastric diseases have been evolving in terms of multimodal approach and quality of care. The recent introduction of standardized perioperative protocols has represented the opportunity to homogenize the multiple ... ...

Abstract	Management and treatment of esophagogastric diseases have been evolving in terms of multimodal approach and quality of care. The recent introduction of standardized perioperative protocols has represented the opportunity to homogenize the multiple factors enhancing patients' recovery after surgery worldwide. A further optimization would lead to the extension of the ERAS program to upper GI emergencies. This review provides a comprehensive collection of scientific basis, current supporting evidence, and potential applicative limitations.
MeSH term(s)	Humans ; Perioperative Care/methods ; Esophagectomy/methods ; Length of Stay ; Postoperative Complications
Language	English
Publishing date	2022-08-31
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-022-01362-x
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Article ; Online: ASO Author Reflections: Indocyanine Green Fluorescence to Optimize Lymphadenectomy in Gastric Cancer Surgery: Recommendations to Improve Radicality in D2 Lymphadenectomy.

Puccetti, Francesco / Cinelli, Lorenzo / Elmore, Ugo / Rosati, Riccardo

Annals of surgical oncology

2022 Volume 29, Issue 9, Page(s) 5883–5884

MeSH term(s)	Fluorescence ; Gastrectomy ; Humans ; Indocyanine Green ; Lymph Node Excision ; Stomach Neoplasms/surgery
Chemical Substances	Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2022-06-14
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-11986-3
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Article ; Online: Impact of powered circular stapler on anastomotic leak after anastomosis to the rectum: a propensity score matched study.

Vignali, Andrea / Gozzini, Lorenzo / Gasparini, Giulia / Calef, Riccardo / Rosati, Riccardo / Elmore, Ugo

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 211

Abstract: Purpose: The aim of the present study is to assess the impact of Echelon Circular: Methods: A single center cohort study was carried out on 552 consecutive patients, who underwent laparoscopic colorectal resection and anastomosis to the rectum ... ...

Abstract	Purpose: The aim of the present study is to assess the impact of Echelon Circular Methods: A single center cohort study was carried out on 552 consecutive patients, who underwent laparoscopic colorectal resection and anastomosis to the rectum between December 2017 and September 2022. Patients who underwent powered circular anastomosis to the rectum were matched to those who had a conventional stapled anastomosis using a propensity score matching. Main outcomes were anastomotic leak (AL) rate, anastomotic bleeding, and postoperative outcomes. Results: After adjusting cases with propensity score matching, two new groups of patients were generated: 145 patients in the PCS and 145 in the CCS. The two groups were homogeneous with respect to demographics and comorbidities on admission. Overall, AL occurred in 21 (7.3%) patients. No significant differences were observed with respect to AL (5.5% in PCS vs 9% in CCS; p = 0.66), fistula severity (p = 0.60) or reoperation rate (p = 0.65) in the two groups in study. A higher rate of anastomotic bleeding was observed in the CCS vs PCS (5.5% vs 0.7%, p = 0.03). At univariate analysis performed after propensity score matching, stapler diameter ≥ 31mm and age ≥ 70 years were the only variable significantly associated with anastomotic leak (p = 0.001 and p = 0.031; respectively). Conclusions: The powered circular stapler has no impact on AL, while it could affect bleeding rate at the anastomotic site.
MeSH term(s)	Humans ; Aged ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Rectum/surgery ; Cohort Studies ; Propensity Score ; Surgical Staplers/adverse effects ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Retrospective Studies ; Colorectal Neoplasms/surgery ; Surgical Stapling/adverse effects ; Surgical Stapling/methods
Language	English
Publishing date	2023-08-10
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04506-6
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Article ; Online: Surgical Training for Transanal Total Mesorectal Excision in a Live Animal Model: A Preliminary Experience.

Grieco, Michele / Elmore, Ugo / Vignali, Andrea / Caristo, Maria Emiliana / Persiani, Roberto

Journal of laparoendoscopic & advanced surgical techniques. Part A

2022 Volume 32, Issue 8, Page(s) 866–870

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Animals ; Cadaver ; Female ; Humans ; Laparoscopy/methods ; Operative Time ; Postoperative Complications/surgery ; Proctectomy/methods ; Rectal Neoplasms/surgery ; Rectum/surgery ; Swine ; Transanal Endoscopic Surgery/methods
Language	English
Publishing date	2022-02-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1381909-4
ISSN	1557-9034 ; 1092-6429
ISSN (online)	1557-9034
ISSN	1092-6429
DOI	10.1089/lap.2021.0845
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Article ; Online: Transanal total mesorectal excision (TaTME): current status and future perspectives.

Vignali, Andrea / Elmore, Ugo / Milone, Marco / Rosati, Riccardo

Updates in surgery

2019 Volume 71, Issue 1, Page(s) 29–37

Abstract: Total mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through ... ...

Abstract	Total mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through an enhanced visualization of the dissection plane. This potentially could result in a more accurate distal dissection with a lower rate of positive circumferential resection margins, increasing the rate of sphincter-saving procedures. The indications for TaTME are currently expanding, despite not being yet standardized, and structured training programs are ongoing to help overcome the steep learning curve related to the technique. The procedure is feasible and safe with similar intraoperative complications and readmission rates when compared with conventional open or laparoscopic TME. Favorable short-term oncologic results have been reported: in particular, TaTME is associated with mesorectal specimen of a better quality and a longer distal resection margin that is established at the beginning of the procedure under direct view. Robotics, when available, will probably overcome the steep learning curve related to the complexity of TaTME. Long-term follow-up and ongoing RCT trials data are awaited regarding functional results, local recurrence and survival, and to facilitate the comparison with standard laparoscopic or robotic rectal resections. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, its indications, short- and long-term results and future direction in the application of TaTME.
MeSH term(s)	Anal Canal/surgery ; Digestive System Surgical Procedures/methods ; Digestive System Surgical Procedures/standards ; Digestive System Surgical Procedures/trends ; Humans ; Laparoscopy ; Organ Sparing Treatments/methods ; Patient Selection ; Rectal Neoplasms/surgery ; Rectum/surgery ; Risk ; Robotic Surgical Procedures ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2019-02-08
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-019-00630-7
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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: 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: Correction to: SICE national survey: current state on the adoption of laparoscopic approach to the treatment of colorectal disease in Italy.

Elmore, Ugo / Vignali, Andrea / Rosati, Riccardo / Valeri, Andrea / Silecchia, Gianfranco

Updates in surgery

2019 Volume 72, Issue 1, Page(s) 229

Abstract: The surname and given name of author Riccardo Brachet Contul was incorrectly published. ...

Abstract	The surname and given name of author Riccardo Brachet Contul was incorrectly published.
Language	English
Publishing date	2019-10-15
Publishing country	Italy
Document type	Journal Article ; Published Erratum
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-019-00685-6
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Article ; Online: Electro-thermal bipolar vessel sealing versus clipping of the inferior mesenteric vessels during minimally invasive proctectomy.

Zuhdy, Mohamed / Metwally, Islam H / Elmore, Ugo / Roshdy, Sameh / Rosati, Riccardo

Cirugia y cirujanos

2020 Volume 88, Issue 6, Page(s) 738–744

Abstract: Introduction: The introduction of new energy vessel sealing devices in minimally invasive proctectomy led to better hemostatic effect, less blood loss, and shorter operating time. At present, the available evidence from literature about the use of ... ...

Title translation	Sellado electrotérmico de vasos bipolares versus recorte de los vasos mesentéricos inferiores durante la proctectomía mínimamente invasiva.
Abstract	Introduction: The introduction of new energy vessel sealing devices in minimally invasive proctectomy led to better hemostatic effect, less blood loss, and shorter operating time. At present, the available evidence from literature about the use of electro-thermal bipolar vessel sealers (EBVS) in laparoscopic rectal cancer surgery is weak where most studies are retrospective with non-homogenous patient groups. Methods: This is a retrospective cohort study where 40 rectal cancer patients operated by laparoscopic TME or laparoscopic assisted transanal total mesorectal excision were classified in two groups according to approach of inferior mesenteric vessels ligation (EBVS versus Clipping). Results: The operative time was significantly longer and the blood loss was significantly more in the EBVS group. However, hospital stay, time to oral, time to starting stoma function, and number of retrieved lymph nodes were not significantly affected by the method of vascular control. Conclusion: Both methods for control of vascular pedicle during minimally invasive rectal cancer surgery are safe, as such it is at the discretion of the operating surgeon to which method to use. Prospective well-designed trials are awaited to provide stronger evidence.
MeSH term(s)	Humans ; Laparoscopy ; Proctectomy ; Prospective Studies ; Rectal Neoplasms/surgery ; Retrospective Studies
Language	English
Publishing date	2020-11-30
Publishing country	Mexico
Document type	Journal Article
ZDB-ID	730699-4
ISSN	2444-054X ; 0009-7411
ISSN (online)	2444-054X
ISSN	0009-7411
DOI	10.24875/CIRU.19001745
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Article ; Online: Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients.

Vignali, Andrea / Elmore, Ugo / Guarneri, Giovanni / De Ruvo, Valentino / Parise, Paolo / Rosati, Riccardo

Updates in surgery

2020 Volume 73, Issue 1, Page(s) 111–121

Abstract: To identify factors associated with early deviation and delayed discharge within an Enhanced Recovery after Surgery (ERAS) pathway. This is a retrospective review of prospectively collected data of consecutive patients who underwent laparoscopic or open ... ...

Abstract	To identify factors associated with early deviation and delayed discharge within an Enhanced Recovery after Surgery (ERAS) pathway. This is a retrospective review of prospectively collected data of consecutive patients who underwent laparoscopic or open colorectal surgery and managed with a standardized ERAS pathway between April 2015 and October 2018. ERAS items were assessed within 48 h after surgery. Patients with early complications were excluded. The influence of factors on length of stay was calculated by univariate and multivariate analysis. A binary logistic regression was used to model a predicting score. Seven hundred and thirty-three patients met the inclusion criteria. Multivariate analysis showed that age ≥ 75 years (P = 0.02), ASA score ≥ 3 (P = 0.03), open surgery or conversion to open (P = 0.001), non-compliance with the intra-operative balanced fluid therapy (P = 0.049), failure to early removal of the urinary catheter (P = 0.001), to discontinue IV fluid (P = 0.02) and to early mobilization (P = 0.001) were independently associated with ERAS failure. The generated score had a specificity of 84% and a positive predictive value of 72%. Patients who would have a length of stay longer than the median for each surgical procedure were properly identified (Area under ROC Curve = 0.753, P < 0.001). The delayed discharge could be predicted at 48 h from the intervention. The ability of the model to weight the specific role of each statistically significant variable might be a useful tool to identify the most frail patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Colon/surgery ; Colonic Diseases/physiopathology ; Colonic Diseases/surgery ; Enhanced Recovery After Surgery ; Female ; Frailty ; Humans ; Laparoscopy/methods ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Recovery of Function ; Rectal Diseases/physiopathology ; Rectal Diseases/surgery ; Rectum/surgery ; Retrospective Studies ; Treatment Failure ; Young Adult
Language	English
Publishing date	2020-07-08
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/s13304-020-00848-w
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