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Article ; Online: Metastases to the breast. A clinical series from a single institution experience with review of the literature.

Sanguinetti, Alessandro / Avenia, Stefano / Pennella, Francesca Pennetti / Chiummariello, Stefano / Lucchini, Roberta / Galasse, Sergio / Macciò, Tiziana / Avenia, Nicola / Polistena, Andrea

Annali italiani di chirurgia

2021 Volume 92, Page(s) 141–148

Abstract: Introduction: Breast metastases although rare are challenging for diagnostic difficulties and management. Treatment differs according to morphological, immunophenotipycal and biologic features of the primary tumor and their general behaviour is ... ...

Abstract	Introduction: Breast metastases although rare are challenging for diagnostic difficulties and management. Treatment differs according to morphological, immunophenotipycal and biologic features of the primary tumor and their general behaviour is extremely different compared to primary breast cancer. The most frequent primary tumors include melanoma, lymphomas, gynecological, pulmonary, head and neck, gastroenteric and urinary tract cancers. Patient's prognosis is poor being generally associated to disseminated systemic disease with limited survival despite the effects of systemic treatment. Patients and methods: We report the analysis of the diagnostic and therapeutic approach on the institutional experience of four cases of breast metastases originating from melanoma, pulmonary adenocarcinoma and differentiated thyroid carcinomas. Conclusions: The management of breast secondarisms requires focused diagnosis and evaluation in order to provide an adequate treatment with a multidisciplinary approach especially when the primary tumor is unknown. Key words: Breast metastases, Melanoma, Pulmonary, Thyroid.
MeSH term(s)	Adenocarcinoma/diagnosis ; Adenocarcinoma/secondary ; Adenocarcinoma/therapy ; Adult ; Antineoplastic Agents/therapeutic use ; Breast Neoplasms/diagnosis ; Breast Neoplasms/secondary ; Breast Neoplasms/therapy ; Female ; Humans ; Lung Neoplasms/pathology ; Lung Neoplasms/therapy ; Mastectomy, Segmental ; Melanoma/diagnosis ; Melanoma/secondary ; Melanoma/therapy ; Metastasectomy ; Middle Aged ; Prognosis ; Retrospective Studies ; Skin Neoplasms/pathology ; Skin Neoplasms/therapy ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/therapy ; Thyroidectomy
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2021-05-25
Publishing country	Italy
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Breast metastasis from a pulmonary adenocarcinoma: Case report and review of the literature.

Sanguinetti, Alessandro / Puma, Francesco / Lucchini, Roberta / Santoprete, Stefano / Cirocchi, Roberto / Corsi, Alessia / Triola, Roberta / Avenia, Nicola

Oncology letters

2019 Volume 18, Issue 6, Page(s) 6305

Abstract: This retracts the article DOI: 10.3892/ol.2012.995.]. ...

Abstract	[This retracts the article DOI: 10.3892/ol.2012.995.].
Language	English
Publishing date	2019-10-04
Publishing country	Greece
Document type	Journal Article ; Retraction of Publication
ZDB-ID	2573196-8
ISSN	1792-1082 ; 1792-1074
ISSN (online)	1792-1082
ISSN	1792-1074
DOI	10.3892/ol.2019.10965
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Article ; Online: Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy.

Polistena, Andrea / Sanguinetti, Alessandro / Lucchini, Roberta / Avenia, Stefano / Galasse, Sergio / Farabi, Raffaele / Monacelli, Massimo / Avenia, Nicola

BMC surgery

2019 Volume 18, Issue Suppl 1, Page(s) 22

Abstract: Background: TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic ...

Abstract	Background: TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic mutations usually may influences the surgical approach. Methods: We retrospectively analyzed 52 cases of TIR3B underwent between 2015 and 2017 total thyroidectomy (TT) and lobectomy (L), focusing mainly on the observed rate of malignancy. Chi-squared test and Fisher's exact probability test were used for analysis, considering a P values less than 0.05 as significant. Results: Out of 52 patients 49 underwent TT and 3 L. In TT group a multinodular goiter was associated in 67.3% of patients. Malignancy rate was 81.6 and 33.3% respectively after TT and L (P 0.003). Multicentric and contralateral tumors were detected respectively in 36.7% and in 32.6% of patients underwent TT. No main post-operative complications were registered. Conclusions: Ultrasound and elastography are useful to define within the TIR3B group those lesions at higher risk and therefore requiring a more radical approach. TT seems an appropriate approach to TIR3B lesions, especially in multinodular goiter, considering the incidence of malignancy with probably higher rate than previously reported.
MeSH term(s)	Cell Proliferation ; Chi-Square Distribution ; Female ; Humans ; Incidence ; Male ; Retrospective Studies ; Thyroid Neoplasms/surgery ; Thyroid Nodule/diagnosis ; Thyroidectomy/adverse effects ; Thyroidectomy/methods
Language	English
Publishing date	2019-04-24
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-019-0485-9
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Article: The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer.

Polistena, Andrea / Ranalli, Monia / Avenia, Stefano / Lucchini, Roberta / Sanguinetti, Alessandro / Galasse, Sergio / Rondelli, Fabio / Vannucci, Jacopo / Patrone, Renato / Velotti, Nunzio / Conzo, Giovanni / Avenia, Nicola

Journal of clinical medicine

2021 Volume 10, Issue 18

Abstract: Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after ... ...

Abstract	Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015-2020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017-2020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials.
Language	English
Publishing date	2021-09-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10184246
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Article ; Online: Timing and extension of lymphadenectomy in medullary thyroid carcinoma: A case series from a single institution.

Polistena, Andrea / Sanguinetti, Alessandro / Lucchini, Roberta / Galasse, Sergio / Monacelli, Massimo / Avenia, Stefano / Boccolini, Andrea / Johnson, Louis Banka / Avenia, Nicola

International journal of surgery (London, England)

2017 Volume 41 Suppl 1, Page(s) S70–S74

Abstract: Background: Medullary thyroid carcinoma is an aggressive tumor and presents with significant morbidity and mortality and a high rate of lymph node metastases. The combination of total thyroidectomy and cervical lymphadenectomy is the essential treatment ...

Abstract	Background: Medullary thyroid carcinoma is an aggressive tumor and presents with significant morbidity and mortality and a high rate of lymph node metastases. The combination of total thyroidectomy and cervical lymphadenectomy is the essential treatment for those patients presenting with cervical lymph node metastases. Materials and methods: A retrospective analysis of 117 patients operated for medullary thyroid carcinoma over a period of 15 years at a single institution. Surgical complications and calcitonin levels were noted. Results: Nodal metastases were detected in the central compartment in 72.6% patients. Positive lymph nodes were detected in the lateral compartment of 34 patients who had undergone ipsilateral dissection and in all 10 patients of those with bilateral surgery. We found 3 cases of unilateral transient recurrent laryngeal nerve palsy, 15 cases of temporary hypoparathyroidism, a permanent accessory nerve lesion and a case of chylous fistula. Normalization of post-operative calcitonin was found in 82.6% and of patients who underwent total thyroidectomy and central neck dissection alone compared to 35.4% in those with ipsilateral and bilateral neck dissection. Conclusions: Total thyroidectomy and cervical lymphadenectomy planned on the ultrasound preoperative study and on the calcitonin level represent the standard of treatment for medullary thyroid carcinoma.
Language	English
Publishing date	2017-05
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.2017.04.026
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Article ; Online: Current Indications for Surgical Treatment of Primary Hyperparathyroidism in the Elderly.

Polistena, Andrea / Lucchini, Roberta / Monacelli, Massimo / Triola, Roberta / Avenia, Stefano / Barillaro, Ivan / Johnson, Louis Banka / Sanguinetti, Alessandro / Avenia, Nicola

The American surgeon

2017 Volume 83, Issue 3, Page(s) 296–302

Abstract: This study presents the results of surgery in the elderly for primary hyperparathyroidism (PHPT) from a single institution's experience. We retrospectively analyzed 898 cases of surgically treated PHPT, divided into two groups: 135 elderly patients (A) ... ...

Abstract	This study presents the results of surgery in the elderly for primary hyperparathyroidism (PHPT) from a single institution's experience. We retrospectively analyzed 898 cases of surgically treated PHPT, divided into two groups: 135 elderly patients (A) and 763 patients younger than 65 years (B). PHPT was symptomatic in 68.8 per cent patients in group A and in 81.6 per cent in group B. Unilateral temporary recurrent laryngeal nerve palsy was observed in 0.9 per cent in group A and 0.1 per cent in group B (P > 0.05). No cervical hematomas, mortality or major cardiovascular, neurological, respiratory or metabolic postoperative complications were registered. All the patients evaluated at one year had improvement in the quality of life, with increase of bone mineral density (BMD) in 85.6 per cent and 79.8 per cent of patients in groups A and B, with no significant differences between symptomatic and asymptomatic patients. Parathyroidectomy in elderly PHPT patients is safe, with rate of morbidity similar to what observed in younger individuals. Further investigations are recommended to confirm the role of surgery as an effective approach in elderly PHPT patients.
MeSH term(s)	Aged ; Bone Density ; Female ; Humans ; Hyperparathyroidism, Primary/surgery ; Italy ; Male ; Middle Aged ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2017-03-01
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: Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.

Polistena, Andrea / Sanguinetti, Alessandro / Lucchini, Roberta / Galasse, Segio / Avenia, Stefano / Monacelli, Massimo / Johnson, Louis Banka / Jeppsson, Bengt / Avenia, Nicola

Aging clinical and experimental research

2017 Volume 29, Issue Suppl 1, Page(s) 23–28

Abstract: Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated.: Aim: The aim of the ... ...

Abstract	Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. Aim: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Methods: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. Results: In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Discussion: Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Conclusions: Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Frail Elderly ; Humans ; Hyperparathyroidism, Secondary/etiology ; Hyperparathyroidism, Secondary/surgery ; Male ; Middle Aged ; Parathyroidectomy/classification ; Parathyroidectomy/methods ; Postoperative Period ; Recurrence ; Renal Insufficiency, Chronic/complications ; Reoperation ; Retrospective Studies ; Transplantation, Autologous/methods ; Treatment Outcome
Language	English
Publishing date	2017-02
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/s40520-016-0669-4
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Article ; Online: Breast cancer and reconstruction: can surgical technique, reconstructive time and adjuvant treatment influence the result?

Sanguinetti, Alessandro / Polistena, Andrea / Bistoni, Giovanni / Lucchini, Roberta / Monacelli, Massimo / Triola, Roberta / Avenia, Stefano / Barillaro, Ivan / Cirocchi, Roberto / Avenia, Nicola

Annali italiani di chirurgia

2016 Volume 87

Abstract: Introduction: Some techniques for the total reconstruction of the breast, regardless of the complexity, have specific complications, with varying degrees of morbidity. Therefore, we wanted to identify the most frequent complications of the main ... ...

Abstract	Introduction: Some techniques for the total reconstruction of the breast, regardless of the complexity, have specific complications, with varying degrees of morbidity. Therefore, we wanted to identify the most frequent complications of the main techniques used for breast reconstruction, and compare the relation to the relevant independent variables. Methods: Our study was conducted by examining the medical records of patients who had received complete reconstruction of the breast after a mastectomy due to breast cancer from January 2008 to December 2010, with a minimum follow-up of 3 years postoperatively. The data collected, such as the time of intervention, reconstruction techniques, operating time, and adjuvant treatment, were statistically correlated to the presence of complications. Results: Of the 40 total breast reconstructions analyzed, the technique in which they were used expanders followed by replacement with implants showed the lowest prevalence of complications (16.7%, p <0.000). Some surgical techniques have shown particular complications. The operative time for transplant transverse rectus abdominis musculocutaneous flap (363.57 ± 59.91 min) was significantly higher than that required for the techniques that use alloplastic materials (155.71 ± 38.02 min, p = 0, 01), but similar to that for the latissimus dorsi flap (309.69 ± 77.66 min). The operative time, the timing of reconstructive surgery, and type of adjuvant treatment was not correlated with the incidence of complications. Conclusions: Each technique has its indications, contraindications and complications. The application of each technique must be tailored to the individual characteristics of each patient. Key words: Adjuvant treatment, Reconstructive surgery, Results, Surgical procedure.
Language	English
Publishing date	2016-02-29
Publishing country	Italy
Document type	Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Complications of Neck Dissections in Papillary Thyroid Carcinoma: A Modified Procedure to Reduce Parathyroid Morbidity.

Ardito, Guglielmo / Revelli, Luca / Polistena, Andrea / Lucchini, Roberta / Giustozzi, Erica / Guidi, Maria Lavinia / Ardito, Francesco / Avenia, Nicola

In vivo (Athens, Greece)

2016 Volume 30, Issue 3, Page(s) 303–308

Abstract: Background/aim: Hypoparathyroidism is the most significant morbidity after neck dissection for thyroid cancer. Addition of lateral neck dissection (ND) to central ND combined with total thyroidectomy (TT) increases the risk of postoperative ... ...

Abstract	Background/aim: Hypoparathyroidism is the most significant morbidity after neck dissection for thyroid cancer. Addition of lateral neck dissection (ND) to central ND combined with total thyroidectomy (TT) increases the risk of postoperative hypoparathyroidism compared to TT plus central ND. The aim of this study was to verify if a modified procedure and different access to the neck for lateral ND may improve safety. Patients and methods: In 62 patients with papillary thyroid cancer (PTC) undergoing TT plus central and lateral ND between 2010 and 2013, lateral ND was performed as first step approaching the neck via extrathyroideal space. Calcium in serum and parathormone (PTH) were determined preoperatively, intraoperatively and during the follow-up. Results: Twenty patients (32%) developed postoperative hypocalcemia. Calcium levels and PTH completely recovered for 58 out of 62 patients from 3 to 6 months after surgery. After a mean of 12 months' follow-up, only four patients (6.5%) had developed permanent hypoparathyroidism. The incidence of parathyroid complication after TT plus central ND and lateral ND did not differ from postoperative hypoparathyroidim after TT plus central ND. Conclusion: The presented surgical procedure may provide a better outcome in terms of parathyroid morbidity.
MeSH term(s)	Adult ; Aged ; Calcium/blood ; Carcinoma, Papillary/surgery ; Female ; Humans ; Hypoparathyroidism/blood ; Hypoparathyroidism/etiology ; Intraoperative Period ; Male ; Middle Aged ; Monitoring, Physiologic ; Neck Dissection/adverse effects ; Neck Dissection/methods ; Outcome Assessment (Health Care)/statistics & numerical data ; Parathyroid Hormone/blood ; Postoperative Complications/blood ; Postoperative Complications/etiology ; Preoperative Period ; Reproducibility of Results ; Thyroid Neoplasms/surgery ; Thyroidectomy/adverse effects ; Thyroidectomy/methods
Chemical Substances	Parathyroid Hormone ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2016-05
Publishing country	Greece
Document type	Journal Article
ZDB-ID	807031-3
ISSN	1791-7549 ; 0258-851X
ISSN (online)	1791-7549
ISSN	0258-851X
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Article ; Online: Thyroid cancer invading the airway: diagnosis and management.

Avenia, Nicola / Vannucci, Jacopo / Monacelli, Massimo / Lucchini, Roberta / Polistena, Andrea / Santoprete, Stefano / Potenza, Rossella / Andolfi, Marco / Puma, Francesco

International journal of surgery (London, England)

2016 Volume 28 Suppl 1, Page(s) S75–8

Abstract: Introduction: Aim of this study is to analyze outcome and the decision making process to approach airway invasion by thyroid tumors.: Methods: Retrospective study of 30 years experience in thyroid surgery for cancer invading airway. Clinical records, ...

Abstract	Introduction: Aim of this study is to analyze outcome and the decision making process to approach airway invasion by thyroid tumors. Methods: Retrospective study of 30 years experience in thyroid surgery for cancer invading airway. Clinical records, surgical and pathology reports have been analyzed to assess which principles and procedural details are significant to facilitate efficient diagnosis, staging and treatment. Medical therapy was not evaluated. Results: Out of a consecutive series of 2165 thyroid cancer patients, T4a cancers are 303 (14%). Airway invasion was found in 141 (6.5%) cases. Well-differentiated pattern was determined in 110 (78%) while other histology was reported in 31 (22%). Airway-related symptoms have been recorded in 111 (78%) patients. Flexible bronchoscopy was performed in all patients. Rapidly evolving disease or non-resectable airway was found in 105 (74.5%) cases. Permanent tracheotomy was performed in 43 (30.5%) cases, airway lumen restoration with or without stenting in 39 (27.7%), laryngectomy in 8 (5.7%), segmental airway resection and reconstruction in 28 (19.9%). Perioperative mortality was recorded after palliative treatment only. In resected patients, completely radical surgery was not always achievable. All patients with positive margin after resection underwent adjuvant treatment and showed comparable survival to radical surgery patients after 5 years. Tumor relapse occurred in 8 (28.6%) cases (distant or locoregional). Patients with unresectable disease require treatment for symptoms relief but survival is poor. Conclusion: Although some patients are currently referred with a severely advanced disease, the indication for tracheotomy, salvage procedures or supportive care has decreased over time. Resection is feasible for differentiated tumors with an overall good outcome.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Airway Obstruction/etiology ; Airway Obstruction/surgery ; Clinical Decision-Making ; Female ; Humans ; Laryngectomy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Postoperative Complications ; Retrospective Studies ; Stents ; Survival Analysis ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/surgery ; Tracheostomy
Language	English
Publishing date	2016-04
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.2015.12.036
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