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Article: Urban-Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region.

Minerva, Eleonora Maddalena / Tessitore, Adele / Cafarotti, Stefano / Patella, Miriam

2022 Volume 9, Page(s) 884048

Abstract: Introduction: Rural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to ... ...

Abstract	Introduction: Rural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to differences in access to facilities. Switzerland is a small, rich country with peculiar geographic and urban characteristics.We explored the relationship between lung cancer diagnostic-surgical pathway and urban-rural residency in our region. Methods: We retrospectively analyzed the medical records of 280 consecutive patients treated for primary non-small cell lung cancer at our institution (2017-2021). This is a regional tertiary center for diagnosis and treatment, and data were extracted from a prospectively collected clinical database. We included anatomical lung resection. Collected variables included patients and surgical characteristics, risk factors, comorbidities, histology and staging, symptoms (vs. incidental diagnosis), general practitioner (GP) involvement, health insurance, and suspected test-treatment interval. The exposure was rurality, defined by the 2009 rural-urban residency classification from the Department of Land. Results: A total of 150 patients (54%) lived in rural areas. Rural patients had a higher rate of smoking history (93% vs. 82%; Conclusions: In our territory with inhomogeneous population distribution and geographic barriers, residency has an impact on the lung cancer pathway. It seems paradoxical that rural patients had a shorter route. The more constant involvement of GP might explain this finding, having suggested more tests for high-risk patients in the absence of symptoms or follow-ups. This did not change the staging of surgical patients, but it might be essential for the organization of an effective lung cancer screening program.
Language	English
Publishing date	2022-04-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2022.884048
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Article ; Online: Tracking the outcomes of surgical treatment of Stage 2 and 3 empyema: introduction and consolidation of minimally invasive approach.

Patella, Miriam / Minerva, Eleonora Maddalena / Porcellini, Iride / Cianfarani, Agnese / Tessitore, Adele / Cafarotti, Stefano

ANZ journal of surgery

2021 Volume 91, Issue 10, Page(s) 2182–2187

Abstract: Background: We described the results of surgical treatment of empyema, tracing outcomes throughout the passage from the open thoracotomy (OT) approach to video-assisted thoracoscopic surgery (VATS) in a single institute.: Methods: We retrospectively ... ...

Abstract	Background: We described the results of surgical treatment of empyema, tracing outcomes throughout the passage from the open thoracotomy (OT) approach to video-assisted thoracoscopic surgery (VATS) in a single institute. Methods: We retrospectively analyzed the records of 88 consecutive patients treated for Stage 2 and 3 empyema (2010-2019). We divided the study period into three groups: OT period (2010-2013), early VATS (2014-2017, from the introduction of VATS program, until acme of learning curve), and late VATS (2018-2019). Groups were compared to investigate the outcomes evolution. Results: Most relevant findings of the study were significant variation in postoperative length of stay (median [interquartile range]: 9 days [7.5-10], 10 [7.5-17.5], and 7 [5-10] for OT period, early VATS, and late VATS, respectively, p = 0.005), hospital admission referral to thoracic surgery interval (7.5 days [4.5-11], 6.5 [3-9], and 2.5 [1.5-5.5], p = 0.003), chest tube duration (5.5 days [5-7.5], 6 [4-6], 4 [3-5], p = 0.003), and proportion of operation performed by residents (3 [15%], 6 [16.7%], 14 [43.6%], p = 0.01). Conclusions: Our findings pictured the trajectory evolution of outcomes during introduction and consolidation of VATS treatment of empyema. During the early phase, we observed a decline in some indicators that improved significantly in the late VATS period. After a learning curve, all outcomes showed better results and we entered into a teaching phase.
MeSH term(s)	Chest Tubes ; Empyema, Pleural/surgery ; Humans ; Length of Stay ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy
Language	English
Publishing date	2021-08-17
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17133
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Article: Spiral wire localization of lung nodules: procedure effectiveness and oncological usefulness.

Patella, Miriam / Bartolucci, Dario Alberto / Mongelli, Francesco / Cartolari, Roberto / Minerva, Eleonora Maddalena / Inderbitzi, Rolf / Cafarotti, Stefano

Journal of thoracic disease

2020 Volume 11, Issue 12, Page(s) 5237–5246

Abstract: Background: In the last years, a large number of techniques and devices for localizing small pulmonary nodules prior to resection have been developed with the aim of facilitating minimally invasive surgery (VATS). However, each device presents pros and ... ...

Abstract	Background: In the last years, a large number of techniques and devices for localizing small pulmonary nodules prior to resection have been developed with the aim of facilitating minimally invasive surgery (VATS). However, each device presents pros and cons and there is no unanimous consensus. We report our experience with an uncommon wire system with spiral shape for percutaneous marking. Methods: We recorded 102 consecutive CT-guided spiral wire localizations in our Institution, and we evaluated the efficacy of the method according to 4 success rates (SR): (I) successful targeting rate (SR-1): number of successful targeting procedures/number of all localizations; (II) successful localization in operative field (SR-2): (number of successful targeting procedures -number of dislodgements in operative field)/number of all localizations; (III) successful VATS rate (SR-3): number of successful VATS procedures/(number of localizations-number of thoracotomies not due to wire dislocation); (IV) successful curative rate (SR-4): number of neoplastic nodules resected with curative intent with free margins (R0) on definitive tissue diagnosis/number of neoplastic nodules resected with curative intent. Complications rate was recorded as well. Results: SR-1: 100%, SR-2: 97.1%, SR-3: 100%, SR-4: 100%. Asymptomatic pneumothorax and minimal parenchymal hemorrhage were observed in 5 (4.9%) and 19 (18.6%) cases, respectively. Conclusions: Spiral wire localization showed very good results in terms of feasibility, stability in operative field and contributed to effective use of VATS during wedge resection performed for malignant nodules. In the era of widespread radiological investigations (as it is happening in lung cancer screening) and evolutions in cancer treatments, this appears to be clinically relevant.
Language	English
Publishing date	2020-01-22
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2019.11.74
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Article ; Online: Surgical treatment of pleural empyema in Coronavirus disease 19 patients: the Southern Switzerland experience.

Tessitore, Adele / Patella, Miriam / Giuliani, Mauro / Theologou, Thomas / Freguia, Stefania / Minerva, Eleonora Maddalena / Rugel, Gregor / Cafarotti, Stefano

Interactive cardiovascular and thoracic surgery

2020 Volume 32, Issue 3, Page(s) 367–370

Abstract: We report the first surgical series of patients developing pleural empyema after severe bilateral interstitial lung disease in confirmed severe acute respiratory syndrome coronavirus 2 infection. The empyema results in a complex medical challenge that ... ...

Abstract	We report the first surgical series of patients developing pleural empyema after severe bilateral interstitial lung disease in confirmed severe acute respiratory syndrome coronavirus 2 infection. The empyema results in a complex medical challenge that requires combination of medical therapies, mechanical ventilation and surgery. The chest drainage approach was not successful to relieve the symptomatology and to drain the excess fluid. After multidisciplinary discussion, a surgical approach was recommended. Even though decortication and pleurectomy are high-risk procedures, they must be considered as an option for pleural effusion in Coronavirus disease-positive patients. This is a life-treating condition, which can worsen the coronavirus disease manifestation and should be treated immediately to improve patient's status and chance of recovery.
MeSH term(s)	Aged ; COVID-19/epidemiology ; COVID-19/therapy ; Chest Tubes ; Drainage/methods ; Empyema, Pleural/epidemiology ; Empyema, Pleural/etiology ; Empyema, Pleural/surgery ; Humans ; Male ; Middle Aged ; Respiration, Artificial/adverse effects ; Switzerland/epidemiology ; Tomography, X-Ray Computed
Language	English
Publishing date	2020-11-19
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivaa269
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Article ; Online: Did outcomes improve in retroperitoneal sarcoma surgery?

Cananzi, Ferdinando Carlo Maria / Ruspi, Laura / Sicoli, Federico / Minerva, Eleonora Maddalena / Quagliuolo, Vittorio

Surgical oncology

2018 Volume 28, Page(s) 96–102

Abstract: In the last decades, the deeper understanding of the biological basis of the disease, along with the advances of surgical techniques and oncologic multimodal treatments, have led to an overall increase of survival of cancer patients. However, significant ...

Abstract	In the last decades, the deeper understanding of the biological basis of the disease, along with the advances of surgical techniques and oncologic multimodal treatments, have led to an overall increase of survival of cancer patients. However, significant amelioration of the prognosis of rare and under-investigated tumors such as soft tissue sarcoma is less evident. In this review, main changes in the surgical management of retroperitoneal sarcoma (RPS) are discussed in order to figure out whether actual improvement in RPS outcome has been occurred in the last years.
MeSH term(s)	Humans ; Prognosis ; Retroperitoneal Neoplasms/mortality ; Retroperitoneal Neoplasms/pathology ; Retroperitoneal Neoplasms/surgery ; Sarcoma/mortality ; Sarcoma/pathology ; Sarcoma/surgery ; Survival Rate
Language	English
Publishing date	2018-11-05
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.2018.11.004
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Article: Indocyanine Green (Icg)-Enhanced Fluorescence for Intraoperative Assessment of Bowel Microperfusion During Laparoscopic and Robotic Colorectal Surgery: The Quest for Evidence-Based Results.

Mangano, Alberto / Gheza, Federico / Chen, Liaohai Leo / Minerva, Eleonora Maddalena / Giulianotti, Pier Cristoforo

Surgical technology international

2018 Volume 32, Page(s) 101–104

Abstract: Anastomotic leakage is a severe complication after colonic/rectal surgery. One of the most important causes of anastomotic leakage is poor vascular supply. However, microvascular impairment at the anastomotic site is very often not detected ... ...

Abstract	Anastomotic leakage is a severe complication after colonic/rectal surgery. One of the most important causes of anastomotic leakage is poor vascular supply. However, microvascular impairment at the anastomotic site is very often not detected intraoperatively by observation under white light. Indocyanine green (ICG)-enhanced fluorescence is a technology that may be useful for detecting microvascular alterations and potentially preventing anastomotic leakage. The aim of this Editorial-Minireview is to briefly and critically assess the literature evidence regarding the feasibility of using an ICG ?uorescent tracer for detecting microvascular changes in the perianastomotic tissue and its potential role in preventing anastomotic leakage. We focused on minimally invasive (robotic and laparoscopic) colorectal surgery. Intraoperative ICG angiography and the quantification of ICG kinetics can be used to intraoperatively reveal the tissue-perfusion status during colorectal surgery. This may be useful for intraoperatively changing a previously planned resection/anastomotic level, and conceivably decreasing the degree of anastomotic leakage. At this stage, even though ICG technology appears to be very promising and some preliminary clinical studies have suggested that certain ICG pharmacokinetic parameters may be used to predict leakage, more reliable scoring and grading tools are needed. Furthermore, in minimally invasive colorectal surgery, more randomized prospective well-powered trials are needed to properly standardize this surgical technology.
MeSH term(s)	Anastomotic Leak/diagnostic imaging ; Anastomotic Leak/prevention & control ; Colorectal Surgery/methods ; Evidence-Based Medicine ; Fluorescent Dyes/therapeutic use ; Humans ; Indocyanine Green/therapeutic use ; Optical Imaging/methods ; Robotic Surgical Procedures/methods
Chemical Substances	Fluorescent Dyes ; Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2018-03-26
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1225512-9
ISSN	1090-3941
ISSN	1090-3941
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Article ; Online: Short-term outcomes after duodenal surgery for mesenchymal tumors: a retrospective analysis from a single tertiary referral center.

Cananzi, Ferdinando Carlo Maria / Ruspi, Laura / Samà, Laura / Sicoli, Federico / Gentile, Damiano / Minerva, Eleonora Maddalena / Cozzaglio, Luca / Quagliuolo, Vittorio

Updates in surgery

2019 Volume 71, Issue 3, Page(s) 451–456

Abstract: Duodenal resections are sometimes necessary for radical surgery. We analyzed technical aspects and post-operative outcomes in patients with RPS and GIST involving duodenum. We identified patients who underwent duodenal resection for RPS and GIST at our ... ...

Abstract	Duodenal resections are sometimes necessary for radical surgery. We analyzed technical aspects and post-operative outcomes in patients with RPS and GIST involving duodenum. We identified patients who underwent duodenal resection for RPS and GIST at our Institute between 2000 and 2016. Clinical, pathological and treatment variables were analyzed. Thirty patients were treated: 15 for GIST, 15 for RPS. Sixteen duodenal wedge resections (WR) and 14 segmental resections (SR) were performed. Multi-organ resection was frequently performed (63.4%). Median time to flatus was 3 days (range 1-6), to oral refeeding 4.5 (range 2-15). Overall postoperative morbidity rate was 53% (16/30): Clavien Dindo grade ≤ II: 10; duodenum-related complication rate was 33% (10/30), Clavien Dindo grade ≤ II: 9. Morbidity rates were higher in SR than WR. Duodenal resections for RPS and GIST have significant morbidity rate and whenever it is possible, WR is preferable to SR because of the lower morbidity rate.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Duodenum/surgery ; Female ; Gastrointestinal Neoplasms/surgery ; Gastrointestinal Stromal Tumors/surgery ; Humans ; Male ; Middle Aged ; Retroperitoneal Neoplasms/surgery ; Retrospective Studies ; Sarcoma/surgery ; Tertiary Care Centers/statistics & numerical data ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2019-07-03
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/s13304-019-00667-8
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Article ; Online: Prognostic factors for short-term and long-term outcomes of gastric cancer surgery for elderly patients: 10 years of experience at a single tertiary care center.

de Pascale, Stefano / Belotti, Daniele / Celotti, Andrea / Minerva, Eleonora Maddalena / Quagliuolo, Vittorio / Rosati, Riccardio / Romario, Uberto Fumagalli

Updates in surgery

2018 Volume 70, Issue 2, Page(s) 265–271

Abstract: This retrospective study aimed to verify the short-term and long-term outcomes of elderly patients who underwent gastric resection for gastric cancer and to compare the results between younger and elderly patients. 222 Patients, who underwent gastrectomy ...

Abstract	This retrospective study aimed to verify the short-term and long-term outcomes of elderly patients who underwent gastric resection for gastric cancer and to compare the results between younger and elderly patients. 222 Patients, who underwent gastrectomy between January 2005 and December 2014, were divided into 2 groups: ≤ 75 years old (group A) and > 75 years (group B). The groups were homogeneous except for more advanced pathological stage (p = 0.011) and higher number of comorbidities in group B (p < 0.001) and a higher rate of neoadjuvant or adjuvant complementary therapy in group A (p = 0.029 and p < 0.001). Perioperative morbidity rates were 38.7 and 65.5% (p = 0.001), and mortality rates were 2.5 and 7.9% (p = ns), respectively. The independent negative prognostic factors for morbidity were age older than 75 years [odds ratio (OR) 2.7], multiple organ resection (OR 2.4), and male gender (OR 1.8). The 36-month survival rates were 76.1% and 42.1% (p = 0.002) and disease-free survival rates were 85% and 76.3% (p = 0.017), respectively. Surgical indications should not be limited by age.
MeSH term(s)	Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrectomy/mortality ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/mortality ; Stomach Neoplasms/surgery ; Survival Analysis ; Tertiary Care Centers ; Treatment Outcome
Language	English
Publishing date	2018-06-30
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/s13304-018-0548-y
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Article ; Online: Preoperative monocyte-to-lymphocyte ratio predicts recurrence in gastrointestinal stromal tumors.

Cananzi, Ferdinando Carlo Maria / Minerva, Eleonora Maddalena / Samà, Laura / Ruspi, Laura / Sicoli, Federico / Conti, Lorenzo / Fumagalli Romario, Uberto / Quagliuolo, Vittorio Lorenzo

Journal of surgical oncology

2018 Volume 119, Issue 1, Page(s) 12–20

Abstract: Background and objectives: Several inflammation markers were found to have a prognostic value in cancer. We investigated the significance of preoperative white cell ratios in determining gastrointestinal stromal tumors (GISTs) outcome.: Methods: ... ...

Abstract	Background and objectives: Several inflammation markers were found to have a prognostic value in cancer. We investigated the significance of preoperative white cell ratios in determining gastrointestinal stromal tumors (GISTs) outcome. Methods: Clinicopathological features of patients who underwent surgery for GIST were reviewed. The following peripheral blood inflammation markers were calculated: neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), neutrophil-white blood cell ratio (NWR), lymphocyte-white cell ratio (LWR), monocyte-white cell ratio (MWR), and platelet-white cell ratio (PWR). Results: We analyzed 127 patients. Three- and five-year disease-free survival (DFS) were 89.7% and 86.9%, respectively. The univariate analysis selected tumor diameter (P = 0.003), gastric location ( P = 0.024), cell type ( P = 0.024), mitosis ( P < 0.001), MLR ( P = 0.014), NLR ( P = 0.016), and PLR ( P = 0.001) as the factors associated to DFS. The independent prognostic factors for DFS were mitosis ( P = 0.001), NLR ( P = 0.015), MLR ( P = 0.015), and PLR ( P = 0.031), with MLR showing the highest statistical significance and hazard ratio (HR) value. MLR, NLR, and PLR were the only prognostic factors in the subgroup of patients with moderate to high Miettinen's risk class. A high value of MLR was associated with reduced DFS. Conclusion: MLR, NLR, and PLR are independent prognostic factors for DFS in GISTs. We first demonstrated the role of MLR as a predictor of recurrence in GIST. Its inclusion into clinical management may improve the recurrence estimation.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Neoplasms/surgery ; Gastrointestinal Stromal Tumors/pathology ; Gastrointestinal Stromal Tumors/surgery ; Humans ; Lymphocytes/pathology ; Male ; Middle Aged ; Monocytes/pathology ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/surgery ; Preoperative Care ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult
Language	English
Publishing date	2018-11-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.25290
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Article ; Online: Effect of postoperative haemoglobin variation on major cardiopulmonary complications in high cardiac risk patients undergoing anatomical lung resections.

Patella, Miriam / Mongelli, Francesco / Minerva, Eleonora Maddalena / Previsdomini, Marco / Perren, Andreas / Saporito, Andrea / La Regina, Davide / Gavino, Lorenzo / Inderbitzi, Rolf / Cafarotti, Stefano

Interactive cardiovascular and thoracic surgery

2019 Volume 29, Issue 6, Page(s) 883–889

Abstract: Objectives: Recent evidence shows that permissive anaemia strategies are safe in different surgical settings. However, effects of variations in haemoglobin (Hb) levels could have a negative impact in high-risk patients. We investigated the combined ... ...

Abstract	Objectives: Recent evidence shows that permissive anaemia strategies are safe in different surgical settings. However, effects of variations in haemoglobin (Hb) levels could have a negative impact in high-risk patients. We investigated the combined effect of postoperative Hb concentration and cardiac risk status on major cardiopulmonary complications after anatomical lung resections. Methods: We retrospectively analysed the records, collected in a prospective clinical database, of 154 consecutive patients undergoing anatomical lung resections at our institution (February 2017-February 2019). Hb levels were displayed as preoperative concentration, nadir Hb level before onset of complications and delta Hb (ΔHb). Cardiac risk was stratified according to the Thoracic Revised Cardiac Risk Index (ThRCRI). Univariable and multivariable logistic regression analyses were used to test the associations between patients, surgical variables and cardiopulmonary complications according to the European Society of Thoracic Surgeons definitions. Results: Cardiopulmonary complications occurred in 63 patients (17%). In the fully adjusted multivariable model, higher values of ΔHb were associated with increased risk of complications [odds ratio (OR) 1.07; P < 0.001], along with higher ThRCRI classes (classes A-B versus C-D: OR 0.09; P < 0.001). Interaction terms with transfusion were not statistically significant, indicating that the harmful effect of ΔHb was independent. According to receiver operating characteristic curve analysis, a ΔHb of 29 g/l was found to be the best cut-off value for predicting complications. Conclusions: In our series, ΔHb, rather than nadir Hb, was associated with an increased risk of complications, particularly in patients with higher cardiac risk. Restrictive transfusion strategies should be carefully applied in patients undergoing lung resections and balanced according to individual clinical status.
MeSH term(s)	Aged ; Anemia/complications ; Blood Transfusion ; Female ; Hemoglobins/metabolism ; Humans ; Lung Neoplasms/blood ; Lung Neoplasms/complications ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Odds Ratio ; Pneumonectomy/adverse effects ; Postoperative Complications/blood ; Postoperative Complications/epidemiology ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies
Chemical Substances	Hemoglobins
Language	English
Publishing date	2019-08-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivz199
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