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Article ; Online: Gut Microbiota Association with Diverticular Disease Pathogenesis and Progression: A Systematic Review.

Reitano, Elisa / Francone, Elisa / Bona, Elisa / Follenzi, Antonia / Gentilli, Sergio

2022 Volume 68, Issue 3, Page(s) 913–921

Abstract: Introduction: Growing evidence supports the role of the intestinal microbiome in the development of different intestinal and extraintestinal diseases. Diverticular disease (DD) is one of the most common disorders in western countries. In the last years, ...

Abstract	Introduction: Growing evidence supports the role of the intestinal microbiome in the development of different intestinal and extraintestinal diseases. Diverticular disease (DD) is one of the most common disorders in western countries. In the last years, different articles have suggested a possible role of the intestinal microbiome in DD pathogenesis and in the development of acute diverticulitis (AD). This systematic review aimed to clarify the current knowledge on the role of the intestinal microbiome in colonic diverticulitis in different stages according to the 2009 PRISMA guidelines. Materials and methods: Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register, ProQuest Dissertations and Theses Database, and Google Scholar. Patients with any stage of disease were included. The Newcastle-Ottawa scale for case-control and cohort studies was used for the quality assessment of the selected articles. Results: Overall, nine studies were included in the review. Only one article was focused on patients with AD, while all other articles only considered patients with DD without acute inflammation signs. Enterobacteriaceae seems to be the microbiota most associated with the disease, followed by Bifidobacteria. Conclusions: All the included studies showed great heterogeneity in population characteristics and sampling methods. Therefore, given the high prevalence of colonic diverticulitis in the general population, further studies are needed to clarify the role of the intestinal microbiome, paving the way to new target therapies with important social implications.
MeSH term(s)	Humans ; Diverticulitis, Colonic ; Gastrointestinal Microbiome ; Diverticular Diseases/etiology ; Diverticulitis/epidemiology ; Intestines
Language	English
Publishing date	2022-07-07
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	304250-9
ISSN	1573-2568 ; 0163-2116
ISSN (online)	1573-2568
ISSN	0163-2116
DOI	10.1007/s10620-022-07600-x
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Article ; Online: Combined robotic inguinal and iliac-obturator lymphadenectomy for stage III skin cancers: Surgical technique and preliminary results.

Francone, Elisa / Reina, Simona / Spagnolo, Francesco / Di Maira, Lorenzo / Cafiero, Ferdinando / Solari, Nicola

The international journal of medical robotics + computer assisted surgery : MRCAS

2022 Volume 18, Issue 4, Page(s) e2391

Abstract: Background: Ilio-inguinal lymphadenectomy for stage III melanoma and skin cancers still represents the best therapeutic option for a subset of patients, although the incidence of post-operative complications is dramatically high. Only a paucity of ... ...

Abstract	Background: Ilio-inguinal lymphadenectomy for stage III melanoma and skin cancers still represents the best therapeutic option for a subset of patients, although the incidence of post-operative complications is dramatically high. Only a paucity of papers on robotic approach have been published, reporting experiences on isolated pelvic or inguinal lymphadenectomy, and no series on combined dissections have been described yet. We present the preliminary results achieved with combined robotic approach, with special emphasis on lymph nodal mapping, dissection technique and postoperative complications linked with the lymphatic system. Methods: Between September 2019 and September 2021, 10 patients were submitted to robotic inguinal and iliac-obturator lymphadenectomy. Results: Post-operative course was characterised by early mobilisation and minimal post-operative pain. Only one lymphoedema occurred and lymph nodal harvesting was more than satisfactory. Conclusions: Robotic surgery provides meticulous lymph nodal dissections, with promising functional and oncologic outcomes. Further series are advocated to confirm these preliminary results.
MeSH term(s)	Humans ; Lymph Node Excision/methods ; Lymphatic Metastasis ; Melanoma/etiology ; Melanoma/surgery ; Postoperative Complications/etiology ; Robotic Surgical Procedures/methods ; Skin Neoplasms/etiology ; Skin Neoplasms/surgery
Language	English
Publishing date	2022-03-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2151860-9
ISSN	1478-596X ; 1478-5951
ISSN (online)	1478-596X
ISSN	1478-5951
DOI	10.1002/rcs.2391
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Article ; Online: MicroRNAs differential expression profile in metastatic colorectal cancer: A pilot study with literature review.

Francone, Elisa / Gentilli, Sergio / Santori, Gregorio / Stabilini, Cesare / Fornaro, Rosario / Frascio, Marco

Surgical oncology

2021 Volume 37, Page(s) 101524

Abstract: Background and objectives: Colorectal cancer is still one of the leading causes of cancer-related deaths worldwide and specific tools to improve disease assessment and treatment response are advocated. The aim of this study was to analyze miRNAs ... ...

Abstract	Background and objectives: Colorectal cancer is still one of the leading causes of cancer-related deaths worldwide and specific tools to improve disease assessment and treatment response are advocated. The aim of this study was to analyze miRNAs expression in metastatic and non-metastatic colorectal cancer, in order to identify reliable biomarkers suitable for prognosis, treatment and patient's monitoring. Material and methods: Among 25 patients (mean age 71 ± 12 years; Female/Male: 12/13) submitted to laparoscopic colorectal resection between August 2017 and February 2019, miRNAs were extracted from fresh frozen tissues of solid tumors. Gene expression's analysis arising from microarray technology was performed. Results: Pathological evaluation identified 15 metastatic patients (8 presenting with stage III and 7 with stage IV cancers) and 10 non-metastatic patients (4 presenting with stage I and 6 stage II cancers). Bioinformatic analysis of solid biopsies revealed 16 miRNAs (11 upregulated and 5 downregulated) differently expressed between metastatic and non-metastatic groups, with three miRNAs (miR-7515, miR-7109-5p and miR-6831-5p) never linked to colorectal cancer before. Conclusions: Our study showed an association between miRNAs and metastatic colorectal cancer, suggesting their potential role as biomarkers for tumor management, if confirmed by further studies.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor/analysis ; Biomarkers, Tumor/genetics ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/pathology ; Female ; Humans ; Male ; MicroRNAs/genetics ; Middle Aged ; Neoplasm Metastasis/genetics ; Neoplasm Metastasis/pathology ; Pilot Projects ; Prospective Studies
Chemical Substances	Biomarkers, Tumor ; MicroRNAs
Language	English
Publishing date	2021-01-31
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1107810-8
ISSN	1879-3320 ; 0960-7404
ISSN (online)	1879-3320
ISSN	0960-7404
DOI	10.1016/j.suronc.2021.101524
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Article ; Online: Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review.

Reitano, Elisa / de'Angelis, Nicola / Schembari, Elena / Carrà, Maria Clotilde / Francone, Elisa / Gentilli, Sergio / La Greca, Gaetano

ANZ journal of surgery

2021 Volume 91, Issue 9, Page(s) E554–E560

Abstract: Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear.: Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and ... ...

Abstract	Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle-Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy.
MeSH term(s)	Cholecystectomy, Laparoscopic ; Humans ; Learning Curve
Language	English
Publishing date	2021-06-28
Publishing country	Australia
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17021
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Article: Pre-operative Renal Artery Embolization in Laparoscopic Radical and Partial Nephrectomy: A Multidisciplinary Approach to Renal Tumors.

Salsano, Giancarlo / Palermo, Beatrice / Barattini, Matteo / Puccianti, Franca / Gentilli, Sergio / Romano, Nicola / Falco, Emilio / Berti, Stefano / Stefanini, Teseo / Francone, Elisa

Surgical technology international

2020 Volume 36, Page(s) 23–28

Abstract: Background: Despite being widely adopted, the laparoscopic approach to radical and partial nephrectomy is still burdened by high rates of hemorrhagic complications, which require blood transfusions and conversion to open surgery with increased morbidity. ...

Abstract	Background: Despite being widely adopted, the laparoscopic approach to radical and partial nephrectomy is still burdened by high rates of hemorrhagic complications, which require blood transfusions and conversion to open surgery with increased morbidity. While pre-operative renal artery embolization (PRAE) can prevent intraoperative blood loss and vascular injuries, its prophylactic use is still a matter of debate. This study evaluated the safety and efficacy of PRAE in overcoming the main pitfalls of laparoscopy, which are related to the absence of tactile feedback. Methods: Data from 48 patients who underwent laparoscopic nephrectomy for cancer (34 laparoscopic radical nephrectomy (LRN) and 14 "off-clamp" laparoscopic partial nephrectomy (LPN) after selective and superselective PRAE, respectively) were retrospectively evaluated. Results: The overall median blood loss was 50 ml and only 2 patients (4%) required one unit of blood products. While conversion to open surgery was not required in the LPN group, one case in the LRN group was converted to open surgery due to intraoperative incoercible bleeding from an unrecognized, and thus not embolized, aberrant inferior polar artery. Post-embolization syndrome occurred in 7 patients (15%), resulting in mild flank pain and nausea. No patients in the LPN group experienced new onset of acute renal failure. Conclusion: Our experience supports pre-operative renal embolization as a safe, minimally invasive procedure that is effective for reducing perioperative bleeding in the laparoscopic setting.
MeSH term(s)	Humans ; Kidney Neoplasms/surgery ; Laparoscopy ; Nephrectomy ; Renal Artery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1225512-9
ISSN	1090-3941
ISSN	1090-3941
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Article: Surgical treatment of metachronous rectal liver and lung metastases: A combined videolaparoscopic and videothoracoscopic approach.

Sucameli, Francesco / Francone, Elisa / Dova, Laura / Magistrelli, Prospero / Falco, Emilio / Berti, Stefano

Hepatobiliary & pancreatic diseases international : HBPD INT

2018 Volume 17, Issue 3, Page(s) 280–281

MeSH term(s)	Female ; Humans ; Laparoscopy ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Lung Neoplasms/secondary ; Lung Neoplasms/surgery ; Middle Aged ; Rectal Neoplasms/pathology ; Thoracic Surgery, Video-Assisted ; Treatment Outcome
Language	English
Publishing date	2018-03-26
Publishing country	Singapore
Document type	Case Reports ; Letter
ZDB-ID	2241386-8
ISSN	1499-3872
ISSN	1499-3872
DOI	10.1016/j.hbpd.2018.03.011
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Article: Is Needlescopic Cholecystectomy a Safe Way to Improve Mininvasiveness and Cosmesis in Young Female Patients?

Talamo, Giuseppina / Sucameli, Francesco / Imperatore, Mikaela / Moggia, Elisabetta / Dova, Laura / Francone, Elisa / Eretta, Costantino / Berti, Stefano

Surgical technology international

2019 Volume 34, Page(s) 129–133

Abstract: Introduction: Needlescopic cholecystectomy (NC) was introduced in the late 1990s. It uses a reduced trocar caliber in an otherwise standard four-port laparoscopic cholecystectomy (LC) and seeks to achieve "scarless" surgery without compromising patient ... ...

Abstract	Introduction: Needlescopic cholecystectomy (NC) was introduced in the late 1990s. It uses a reduced trocar caliber in an otherwise standard four-port laparoscopic cholecystectomy (LC) and seeks to achieve "scarless" surgery without compromising patient safety. Materials and methods: Between May 2016 and November 2017, 29 patients underwent elective NC at the Department of General Surgery of Sant'Andrea Hospital (La Spezia, Italy). Inclusion criteria were female sex, age between 18 and 45 years, good performance status (ASA 1-2) and BMI lower than 25. Twenty-one patients underwent a standard 4-port technique: 12mm port in the supraumbilical area, 5mm port in the subxiphoid position, 3mm port in the mid-epigastric area and another 3 mm port in the right mid-clavicular position. In 8 patients, 3mm ports were replaced by 2mm angiocath. A Critical View of Safety (CVS) was achieved in all procedures. Intra-operative cholangiography (IOC) via the cystic duct before any transection of the structures was routinely performed in selected cases, such as those with an unclear biliary anatomy or risk factors for main-duct stones. In our institution, laparoscopic transcystic common bile duct (CBD) exploration is routinely performed in CBD lithiasis. Results: The mean operative time was 66.79 min (range 25-120 min). IOC was performed in 12 patients (41.4%) with suspected choledocolythiasis. There was no conversion to conventional laparoscopic cholecystectomy or open cholecystectomy. The mean hospital stay was 1.48 days (1-7 days). A Clavien-Dindo IIIB complication occurred in one patient on the third postoperative day. The mean VAS pain score was 3 (0-7). Closure of the skin with primary intention was achieved in all patients. Mean return to work was 6.76 days (3-15 days) and the mean return to previous physical activity was 12.17 days (4-30 days). All of the patients completed the Scar Satisfaction Questionnaire: 26 (89.7% ) and 3 patients (10.3%) were very satisfied and satisfied, respectively. Conclusion: Any effort to reduce invasiveness and improve cosmesis must not jeopardize safety. Our case series demonstrates that needlescopy can be safely associated with intraoperative cholangiography to recognize CBD stones. This technique offers the advantage of minor postoperative pain, better cosmesis results, early return to routine life activities and great satisfaction for the patient. Needlescopy is a valuable and safe alternative that is suitable for elective cholecystectomy in properly selected patients, such as young female patients.
MeSH term(s)	Adolescent ; Adult ; Cholangiography/methods ; Cholecystectomy, Laparoscopic/instrumentation ; Cholecystectomy, Laparoscopic/methods ; Choledocholithiasis/surgery ; Cosmetic Techniques/instrumentation ; Female ; Humans ; Intraoperative Care ; Middle Aged ; Minimally Invasive Surgical Procedures/instrumentation ; Minimally Invasive Surgical Procedures/methods ; Young Adult
Language	English
Publishing date	2019-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1225512-9
ISSN	1090-3941
ISSN	1090-3941
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Article ; Online: Laparoscopic Inferior Mesenteric Artery Peeling: An Alternative to High or Low Vascular Ligation for Sigmoid Colon Cancer Resection.

Francone, Elisa / Bonfante, Pierfrancesco / Bruno, Maria Santina / Intersimone, Donatella / Falco, Emilio / Berti, Stefano

World journal of surgery

2016 Volume 40, Issue 11, Page(s) 2790–2795

Abstract: Background: In sigmoid cancer, both inferior mesenteric artery high or low ligations are accepted for curative purposes. Since inferior mesenteric artery ligation could compromise blood flow to the anastomosis, potentially increasing anastomotic leakage ...

Abstract	Background: In sigmoid cancer, both inferior mesenteric artery high or low ligations are accepted for curative purposes. Since inferior mesenteric artery ligation could compromise blood flow to the anastomosis, potentially increasing anastomotic leakage onset, real oncological benefits and possible disadvantages related to vascular transection level are still on debate. We introduce totally laparoscopic inferior mesenteric artery peeling technique to release from the concept of lymph nodal harvesting linked to arterial transection level. Methods: Over a period of 24 months, 31 patients presenting with sigmoid cancer were submitted to laparoscopic sigmoidectomy associated with inferior mesenteric artery peeling. Data on intraoperative and postoperative outcomes have been prospectively collected. Results: Mean operative time was 180 min (range 110-330 min); mean intraoperative blood loss was 60 ml (range 30-150 ml), and mean postoperative hospitalization was 6.2 days (range 4-11 days). Mean number of lymph node harvested was 16.7 (range 12-28). Conclusions: Given a proper selection of patients, laparoscopic sigmoidectomy comprehensive of sub-adventitial IMA skeletonization from its aortic origin could provide good oncological outcomes and recanalization rate. Further data are advocated to confirm these preliminary results.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; Male ; Mesenteric Artery, Inferior/surgery ; Middle Aged ; Operative Time ; Pilot Projects ; Prospective Studies ; Sigmoid Neoplasms/surgery
Language	English
Publishing date	2016-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-016-3611-1
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Article ; Online: Laparoscopic liver resection for large HCC: short- and long-term outcomes in relation to tumor size.

Levi Sandri, Giovanni Battista / Spoletini, Gabriele / Vennarecci, Giovanni / Francone, Elisa / Abu Hilal, Mohammed / Ettorre, Giuseppe Maria

Surgical endoscopy

2018 Volume 32, Issue 12, Page(s) 4772–4779

Abstract: Objective: In this study, we aim to assess the impact of tumor size on clinical and oncological outcomes in patients undergoing laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC).: Background: LLR has been shown to be feasible, ... ...

Abstract	Objective: In this study, we aim to assess the impact of tumor size on clinical and oncological outcomes in patients undergoing laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC). Background: LLR has been shown to be feasible, safe, and oncologically efficient. However, it has been slow to develop in patients with HCC who often suffer from chronic liver disease which represents an additional challenge for the surgeon. The experience with large HCCs is even more limited. Methods: Between 2003 and 2016, 172 patients from two high-volume liver surgery centers underwent LLR for HCC. Prospectively collected data were analyzed after stratification in 3 groups according to tumor major diameter (group 1: < 3 cm; group 2: between 3 and 5 cm; group 3: ≥ 5 cm). Perioperative and long-term outcomes were compared between the three groups and sub-analyses were carried out on the extent and location of the resections. Results: Groups 1, 2, and 3 consisted of 82, 52, and 38 patients, respectively. Minor and major resections were performed in 98.8% and 1.2% in group 1, in 90.4% and 9.6% in group 2, and in 68.4% and 31.6% in group 3, respectively. Postero-superior "technically major" resections were performed in 15.8% patients in group 1, in 19.2% in group 2, and in 15.8% in group 3, respectively. Group 3 had higher conversion rates (p < 0.001), more frequent (p = 0.056) and more prolonged (p = 0,075) pedicle clamping and longer operative time (p < 0.001), higher blood losses (p = 0.025), and longer total hospital and intensive care unit stays. These differences ceased after removing the major resections from the study population, except for the postoperative length of stay. There were no differences in morbidity, mortality, completeness of resection rates, and long-term outcomes between the three groups. Conclusion: LLR for HCC appears to be safe and oncologically efficient when performed in high-volume HPB and laparoscopic centers. Tumor size does not appear to impact negatively on the outcomes except for postoperative hospital stay.
MeSH term(s)	Aged ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery ; Female ; Hepatectomy/adverse effects ; Hepatectomy/methods ; Humans ; Italy ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery ; Long Term Adverse Effects ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Retrospective Studies ; Tumor Burden ; United Kingdom
Language	English
Publishing date	2018-05-16
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/s00464-018-6225-x
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Article ; Online: Laparoscopic perspectives for distal biliary obstruction.

Berti, Stefano / Ferrarese, Alessia / Feleppa, Cosimo / Francone, Elisa / Martino, Valter / Bianchi, Claudio / Falco, Emilio

International journal of surgery (London, England)

2015 Volume 21 Suppl 1, Page(s) S64–7

Abstract: Background: In patients affected by distal biliary obstruction deemed unsuitable for pancreatoduodenectomy, biliary diversion is the only proposable option. Defined goals of this treatment are: relief from jaundice preventing its related complications, ... ...

Abstract	Background: In patients affected by distal biliary obstruction deemed unsuitable for pancreatoduodenectomy, biliary diversion is the only proposable option. Defined goals of this treatment are: relief from jaundice preventing its related complications, reduction of in-hospital stay and adequate control of pain. Palliation can be obtained either by surgical or conservative procedures (endoscopic stenting or percutaneous treatment). Considering early complications' incidence, surgical approach has always been reserved for low surgical risk patients with longer survival perspectives, while recently developed long-lasting patency stents enlarged mini-invasive application resort. Comparative studies on these therapeutic options favour the conservative one in respect of conventional open surgery, but data on minimally invasive surgery to pursue palliative aims are lacking. We present our six-years casuistic and results referring to laparoscopic biliary diversions. Methods: We analyzed results obtained in distal biliary neoplastic obstruction management between December 2008 and November 2014. During this period, selected patients considered unsuitable for pancreatoduodenectomy were scheduled to receive a laparoscopic biliary decompression. Perioperative variables and 30-days postoperative outcomes have been prospectively collected. Results: In the six-years period, 12 patients affected by distal biliary neoplastic obstruction were submitted to laparoscopic palliative bypass. Four procedures were proposed for distal biliary cancer, one for advanced periampullary cancer and seven for pancreatic head cancer. Ten hepatico-jejunal bypasses and two choledochoduodenostomies have been performed. No conversions to open surgery were encountered in this series. Main operative time was 85 min, main blood loss was 75 ml and main hospitalization was 4.5 days. According to Clavien Dindo Classification one class II and one class IIIb complications occurred. Conclusions: Although the restricted number of patients, our results suggest that laparoscopic biliary bypass could be a valid option in managing distal biliary obstructions, resulting in low perioperative morbidity, effective long term palliation of symptoms and improved quality of life.
MeSH term(s)	Aged ; Aged, 80 and over ; Bile Duct Neoplasms/complications ; Cholestasis/etiology ; Cholestasis/surgery ; Decompression, Surgical/methods ; Female ; Humans ; Laparoscopy/methods ; Length of Stay ; Male ; Palliative Care/methods ; Pancreatic Neoplasms/complications ; Quality of Life
Language	English
Publishing date	2015-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2015.04.092
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