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Article: Immune response and locoregional treatments for peritoneal carcinomatosis.

Fiorentini, Caterina / Sarti, Donatella / Guadagni, Stefano / Fiorentini, Giammaria

International review of cell and molecular biology

2022 Volume 371, Page(s) 97–116

Abstract: Peritoneal Carcinomatosis (PC) is considered as a terminal disease with short survival. It is treated with palliative therapies, consisting of repeated drainages and sometimes instillation of chemotherapy. Since the nineties, surgery has been combined ... ...

Abstract	Peritoneal Carcinomatosis (PC) is considered as a terminal disease with short survival. It is treated with palliative therapies, consisting of repeated drainages and sometimes instillation of chemotherapy. Since the nineties, surgery has been combined with more effective systemic chemotherapy, intraperitoneal chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of PC. This combination therapy significantly increases the overall survival of selected PC patients. The understanding of how intraperitoneal chemotherapy and HIPEC can cure patients is still unclear. Experts hypothesized that the efficacy is obtained by the ability of high peritoneal drug exposure and hyperthermia to directly kill cancer cells. Several studies indicate that cancer cells death directly influences the response of the immune system. For this reason, the protective effect of intraperitoneal chemotherapy and HIPEC could be mediated by its ability to kill cancer cells in an immuno-genic way, causing an efficient anticancer immune response. In this review, we investigate the role of the innate peritoneal or locoregional therapy-induced immune response in PC therapy.
MeSH term(s)	Combined Modality Therapy ; Humans ; Hyperthermia, Induced ; Immunity ; Peritoneal Neoplasms/drug therapy ; Peritoneal Neoplasms/surgery
Language	English
Publishing date	2022-07-08
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2427220-6
ISSN	1937-6448 ; 0074-7696
ISSN	1937-6448 ; 0074-7696
DOI	10.1016/bs.ircmb.2022.04.016
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Article: Successful laparoscopic trans-peritoneal repair of an incisional inguinal hernia, resulting from deep lymph node dissection for melanoma: A case report.

Clementi, M / Di Furia, M / Sista, F / Mackay, A R / Guadagni, S

International journal of surgery case reports

2020 Volume 67, Page(s) 82–85

Abstract: Introduction: Deep pelvic lymph node dissection for cancer may result in incisional inguinal hernias. We present a case report of successful laparoscopic trans-peritoneal repair of a large ventral inguinal hernia that developed following ileo-inguinal ... ...

Abstract	Introduction: Deep pelvic lymph node dissection for cancer may result in incisional inguinal hernias. We present a case report of successful laparoscopic trans-peritoneal repair of a large ventral inguinal hernia that developed following ileo-inguinal lymph node dissection (CLND) for melanoma. Case presentation: A successful 3 port laparoscopic trans-peritoneal procedure was performed on a 56-year-old female for the repair of a left inguinal hernia, developed 13 months following CLND for melanoma. The large oval 18 × 14 cm inguinal defect, with superior margins bordering the conjoint tendon and inferior margins bordering the ileo-psoas muscle, femoral vessels and nerve, was not closed in order to avoid excessive tension and was repaired by fixing a 25 × 20 cm intra-peritoneal mesh to abdominal borders at superior and lateral margins with permanent fasteners and at the inferior margin by a cyanoacrylate-glued overlap to protect femoral vessels and nerves from damage. No hernia recurrence was observed 8 months following this procedure. Discussion: Incisional inguinal hernias, following CLND, are rare but present a challenge to surgeons due to the difficulty in identifying both anatomical plains and safe sites for stable repair. Conclusions: We report a laparoscopic trans-peritoneal approach for the safe, reproducible and efficacious repair of incisional inguinal hernias that result from CLND. In our opinion prevention of hernia recurrence can be achieved by a intraperitoneal large mesh fixed at superior and lateral margin borders with permanent fasteners and using cyanoacrylate glue to overlap inferior margin borders in order to prevent vessels and/or nerve injury.
Language	English
Publishing date	2020-01-23
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2020.01.019
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Article ; Online: The role of antral resection in sleeve gastrectomy. An observational comparative study.

Clementi, M / Carandina, S / Zulian, V / Guadagni, S / Cianca, G / Salvatorelli, A / Grasso, A / Sista, F

European review for medical and pharmacological sciences

2021 Volume 25, Issue 23, Page(s) 7204–7210

Abstract: Objective: The role of antral resection (AR) in laparoscopic sleeve gastrectomy (LSG) is still a greatly debated topic in the literature. The aim of this study was to evaluate the results and complications of AR in LSG.: Patients and methods: In this ...

Abstract	Objective: The role of antral resection (AR) in laparoscopic sleeve gastrectomy (LSG) is still a greatly debated topic in the literature. The aim of this study was to evaluate the results and complications of AR in LSG. Patients and methods: In this observational comparative study, 101 patients who underwent LSG were divided into two groups based on the extent of antral resection: 1 cm from the pylorus (1-DP group), or 6 cm from the pylorus (6-DP group). The %EWL (%Excess weight loss), resolution of T2D (Type 2 Diabetes Mellitus) and GLP-1 were investigated 48 hours before surgery and 3, 6 and 12 months after LSG. Postoperative complications in the first 30 days after surgery were also compared between the two groups using the Clavien-Dindo (CD) score. Results: A significant difference in %EWL was observed at 3 and 6 months in favor of the 1-DP group (38.9% and 57.8%, respectively) compared to the 6-DP group (31.4% and 49.7%, respectively). No difference in T2D resolution was observed between two groups during the follow-up period, with similar changes in GLP-1. Statistically significant differences were found between 1-DP and 6-DP group for the reintervention rate (CD III, 7.7% and 1.9%, respectively; p = 0.02) and life-threatening complications requiring intensive care unit management (CD IV, 3.8% and 0%, respectively, p = 0.03). Conclusions: In LSG, sparing the antrum is associated with a significant reduction in the rate of postoperative complications, but the metabolic and weight results are comparable to those for antrum resection.
MeSH term(s)	Adult ; Bariatric Surgery/methods ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Follow-Up Studies ; Gastrectomy/methods ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Weight Loss
Language	English
Publishing date	2021-12-17
Publishing country	Italy
Document type	Comparative Study ; Journal Article ; Observational Study
ZDB-ID	605550-3
ISSN	2284-0729 ; 1128-3602 ; 0392-291X
ISSN (online)	2284-0729
ISSN	1128-3602 ; 0392-291X
DOI	10.26355/eurrev_202112_27412
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Article: Loco-regional perfusions (stop-flow techniques): state of art and future.

Guadagni, S

Journal of experimental & clinical cancer research : CR

2003 Volume 22, Issue 4 Suppl, Page(s) 119–122

Abstract: The treatment of primary advanced or unresectable recurrent cancers is still one of the main medical challenges. The Stop-flow perfusion has been used as loco-regional chemotherapy based on blood supply blockage of the tumour-bearing area. The aim of the ...

Abstract	The treatment of primary advanced or unresectable recurrent cancers is still one of the main medical challenges. The Stop-flow perfusion has been used as loco-regional chemotherapy based on blood supply blockage of the tumour-bearing area. The aim of the present paper is to report the personal experience in the clinical use of stop-flow perfusions and discuss about future perspectives of research. Since December 1997 more than 400 Stop-flow perfusions have been performed at University of L'Aquila. The following types of indication have been selected: recurrent unresectable rectal cancer, advanced pancreatic cancer, thoracic lymphomas, recurrent non-small cell lung cancer, recurrent pelvic and limb melanoma, and recurrent limb melanoma. In this paper results are presented in terms of median survival. For recurrent rectal cancer median survival was 12.2 months, for advanced pancreatic cancer 9.6 months, for thoracic lymphomas 16 months, for recurrent non-small cell lung cancer 21 months, for recurrent pelvic and limb melanoma 34.4 months, for recurrent limb melanoma 23.8 months. Based on these encouraging results, Stop-flow perfusion should be considered an effective approach to locally advanced cancers. Future fields of research include personalized chemotherapy and perfusion under hyperthermic conditions.
MeSH term(s)	Antineoplastic Agents/administration & dosage ; Chemotherapy, Cancer, Regional Perfusion/methods ; Chemotherapy, Cancer, Regional Perfusion/trends ; Humans ; Neoplasm Recurrence, Local/drug therapy ; Neoplasms/drug therapy ; Neoplasms/mortality ; Survival Analysis ; Treatment Outcome
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2003-12
Publishing country	England
Document type	Journal Article
ZDB-ID	803138-1
ISSN	0392-9078
ISSN	0392-9078
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Article ; Online: Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts.

Catarci, Marco / Guadagni, Stefano / Masedu, Francesco / Ruffo, Giacomo / Viola, Massimo G / Borghi, Felice / Baldazzi, Gianandrea / Scatizzi, Marco

International journal of surgery (London, England)

2023 Volume 109, Issue 8, Page(s) 2312–2323

Abstract: Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to ... ...

Abstract	Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. Materials and methods: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) - true population of interest, anastomosis performed with a three-row circular stapler; group (B) - control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Results: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15-0.73; P =0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17-0.87; P =0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24-0.91; P =0.026). Conclusion: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage.
MeSH term(s)	Humans ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Anastomotic Leak/surgery ; Retrospective Studies ; Prospective Studies ; Propensity Score ; Anastomosis, Surgical/methods ; Surgical Stapling/adverse effects ; Surgical Stapling/methods ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/complications
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000000480
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Article ; Online: Intraoperative predictors of in-hospital mortality after open repair of ruptured abdominal aortic aneurysms.

Troisi, Nicola / Bertagna, Giulia / Saratzis, Athanasios / Guadagni, Simone / Minichilli, Fabrizio / Adami, Daniele / Ferrari, Mauro / Berchiolli, Raffaella

International angiology : a journal of the International Union of Angiology

2023 Volume 42, Issue 4, Page(s) 310–317

Abstract: Background: Several models and scores have been released to predict early mortality in patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA). These scores included above all preoperative factors and they could be useful to deny ... ...

Abstract	Background: Several models and scores have been released to predict early mortality in patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA). These scores included above all preoperative factors and they could be useful to deny surgical repair. The aim of the study was to evaluate intraoperative predictors of in-hospital mortality in patients undergoing open surgical repair (OSR) for a rAAA. Methods: Between January 2007 and December 2020, 265 patients were admitted at our tertiary referral hospital for a rAAA. Two-hundred-twenty-two patients underwent OSR. Intra-operative factors were analyzed by means of univariate analysis (step 1). Associations of procedure variables with in-hospital mortality rates were sought based on a multivariate Cox regression analysis (step 2). Results: Overall, in-hospital mortality rate was 28.8% (64 cases). Multivariate Cox regression analysis reported that operation time >240 minutes (P=0.032, OR 2.155, CI 95% 1.068-4.349), and hemoperitoneum (P<0.001, OR 3.582, CI 95% 1.749-7.335) were negative predictive factors for in-hospital mortality. Patency of at least one hypogastric artery (P=0.010; OR 0.128, CI 95% 0.271-0.609), and infrarenal clamping (P=0.001; OR 0.157, CI 95% 0.052-0.483) had a protective role in reducing in-hospital mortality rate. Conclusions: Operation time >240 minutes, and hemoperitoneum affected in-hospital mortality in patients undergoing OSR for rAAA. Patency of at least one hypogastric artery, and infrarenal clamping had a protective role. Further studies are needed to validate these outcomes. A validated predictive model could be useful to help the physicians in communication with patients' relatives.
Language	English
Publishing date	2023-06-28
Publishing country	Italy
Document type	Journal Article
ZDB-ID	604910-2
ISSN	1827-1839 ; 0392-9590
ISSN (online)	1827-1839
ISSN	0392-9590
DOI	10.23736/S0392-9590.23.04941-6
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Article ; Online: Minimally Invasive Surgery for the Treatment of Moderate to Critical Acute Pancreatitis: A Case-matched Comparison With the Traditional Open Approach Over 10 years.

Morelli, Luca / Guadagni, Simone / Palmeri, Matteo / Bechini, Bianca / Gianardi, Desirée / Furbetta, Niccolò / Di Franco, Gregorio / Di Candio, Giulio

Surgical laparoscopy, endoscopy & percutaneous techniques

2023 Volume 33, Issue 2, Page(s) 191–197

Abstract: Purpose: The purpose of this study is to compare short-term and midterm outcomes between patients with acute pancreatitis (AP) treated with minimally invasive surgery (MIS) and patients treated with open necrosectomy (ON).: Materials and methods: We ... ...

Abstract	Purpose: The purpose of this study is to compare short-term and midterm outcomes between patients with acute pancreatitis (AP) treated with minimally invasive surgery (MIS) and patients treated with open necrosectomy (ON). Materials and methods: We compared data of all patients who had undergone MIS for AP with a similar group of patients with ON patients between January 2012 and June 2021 using a case-matched methodology based on AP severity and patient characteristics. Inhospital and midterm follow-up variables, including quality-of-life assessment, were evaluated. Results: Starting from a whole series of 79 patients with moderate to critical AP admitted to our referral center, the final study sample consisted of 24 patients (12 MIS and 12 ON). Postoperative (18.7±10.9 vs. 30.3±21.7 d; P =0.05) and overall hospitalization (56.3±17.4 vs. 76.9±39.4 d; P =0.05) were lower in the MIS group. Moreover, the Short-Form 36 scores in the ON group were statistically significantly lower in role limitations because of emotional problems ( P =0.002) and health changes ( P =0.03) at 3 and 6 months and because of emotional problems ( P =0.05), emotional well-being ( P =0.02), and general health ( P =0.007) at 1 year. Conclusions: MIS for the surgical management of moderate to critical AP seems to be a good option, as it could provide more chances for a better midterm quality of life compared with ON. Further studies are needed to confirm our findings.
MeSH term(s)	Humans ; Treatment Outcome ; Quality of Life ; Acute Disease ; Pancreatitis/surgery ; Minimally Invasive Surgical Procedures/methods ; Retrospective Studies
Language	English
Publishing date	2023-04-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1475108-2
ISSN	1534-4908 ; 1530-4515 ; 1051-7200
ISSN (online)	1534-4908
ISSN	1530-4515 ; 1051-7200
DOI	10.1097/SLE.0000000000001157
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Article ; Online: Hand-Assisted Splenic Bed Laparoscopic Splenectomy for Massive Splenomegaly Secondary to Portal Hypertension and Liver Cirrhosis.

Guadagni, Simone / Gianardi, Desirée / Morelli, Luca

The American surgeon

2019 Volume 85, Issue 5, Page(s) e271–e272

MeSH term(s)	Humans ; Hypertension, Portal/complications ; Laparoscopy ; Liver Cirrhosis/complications ; Splenectomy/methods ; Splenomegaly/etiology ; Splenomegaly/surgery
Language	English
Publishing date	2019-05-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
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Article ; Online: Considerations on "Impact of ABO-incompatibility on hepatocellular carcinoma recurrence after living donor liver transplantation".

Gianardi, Desirée / Ghinolfi, Davide / Guadagni, Simone / Morelli, Luca

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

2019 Volume 45, Issue 4, Page(s) 715–716

MeSH term(s)	Carcinoma, Hepatocellular ; Humans ; Liver Neoplasms ; Liver Transplantation ; Living Donors ; Neoplasm Recurrence, Local
Language	English
Publishing date	2019-02-14
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2019.02.011
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Article ; Online: Costs-benefits of robot-assisted colorectal surgery: a different perspective.

Bianchini, Matteo / Guadagni, Simone / Morelli, Luca

Journal of robotic surgery

2019 Volume 13, Issue 4, Page(s) 607–608

Abstract: The costs of robot-assisted surgery (RAS) still represent a critical issue. Kulaylat et al. reported a propensity-matched study to compare the outcomes of colorectal surgery between a robotic and a laparoscopic group, concluding that RAS was burdened by ... ...

Abstract	The costs of robot-assisted surgery (RAS) still represent a critical issue. Kulaylat et al. reported a propensity-matched study to compare the outcomes of colorectal surgery between a robotic and a laparoscopic group, concluding that RAS was burdened by higher costs. However, authors did not mention what da Vinci system, Si or Xi, they used and this could be crucial, as recently data published by our group on rectal resections showed that the use of the da Vinci Xi and the surgeon's increased experience could improve the results and significantly reduce the costs of RAS.
MeSH term(s)	Colon/surgery ; Colorectal Surgery/economics ; Colorectal Surgery/methods ; Cost-Benefit Analysis ; Health Care Costs ; Humans ; Laparoscopy/economics ; Laparoscopy/methods ; Rectum/surgery ; Robotic Surgical Procedures/economics ; Robotic Surgical Procedures/methods
Language	English
Publishing date	2019-02-25
Publishing country	England
Document type	Letter
ZDB-ID	2268283-1
ISSN	1863-2491 ; 1863-2483
ISSN (online)	1863-2491
ISSN	1863-2483
DOI	10.1007/s11701-019-00936-z
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