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  1. Article: Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study.

    Orsenigo, Elena / Gasparini, Giulia / Carlucci, Michele

    Gastroenterology research and practice

    2019  Volume 2019, Page(s) 5197914

    Abstract: Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the ... ...

    Abstract Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08 ± 11.4, 20.34 ± 11.8, and 15.33 ± 9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes (
    Language English
    Publishing date 2019-01-22
    Publishing country Egypt
    Document type Journal Article
    ZDB-ID 2435460-0
    ISSN 1687-630X ; 1687-6121
    ISSN (online) 1687-630X
    ISSN 1687-6121
    DOI 10.1155/2019/5197914
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  2. Article ; Online: Minimally invasive approach to colorectal cancer: an evidence-based analysis.

    Bissolati, Massimiliano / Orsenigo, Elena / Staudacher, Carlo

    Updates in surgery

    2016  Volume 68, Issue 1, Page(s) 37–46

    Abstract: Minimally invasive surgery (MIS) was initially used for the treatment of colorectal benign disease. However, the indications for MIS techniques have progressively been expanded to include cancers. Nowadays, the indications for MIS are almost the same as ... ...

    Abstract Minimally invasive surgery (MIS) was initially used for the treatment of colorectal benign disease. However, the indications for MIS techniques have progressively been expanded to include cancers. Nowadays, the indications for MIS are almost the same as those for open surgery. The scientific validation of MIS for colorectal cancer has favorably evolved. The advantages awaited for the short-term outcome were confirmed, although at the cost of longer operating time and higher costs. In parallel, tangible evidence of oncologic safety was demonstrated, and long-term results of MIS have been found comparable to those of open surgery. In the current state of MIS short-term superiority and log-term equality, less surgical injury, lower immune function depression and better postoperative outcome make MIS particularly suitable for delicate and difficult patients, such as elderly or obese; on the contrary, the lower costs have led to still consider open surgery as a valid alternative for low-impact resections (such as right colectomy). The continuous development in the field of MIS has recently led to the introduction of the single-port (SILS) and natural-orifice (NOTES) techniques, which allow better esthetic results, even if the their validation has not yet reached scientific evidence.
    MeSH term(s) Colectomy/methods ; Colorectal Neoplasms/surgery ; Evidence-Based Medicine/methods ; Humans ; Laparoscopy/methods
    Language English
    Publishing date 2016-03
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-016-0350-7
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  3. Article ; Online: Role of minimally invasive surgery in the treatment of diverticular disease: an evidence-based analysis.

    Bissolati, Massimiliano / Orsenigo, Elena / Staudacher, Carlo

    Updates in surgery

    2015  Volume 67, Issue 4, Page(s) 353–365

    Abstract: The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. While the presence of diverticula is common, symptomatic diverticulitis is ...

    Abstract The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. While the presence of diverticula is common, symptomatic diverticulitis is relatively uncommon, occurring in an estimated 10-30 % of patients. There is continued debate as to whether patients should undergo elective resection for diverticular disease and regarding the role of minimally invasive surgery. Since the first publication on laparoscopic colorectal procedures, the interest in minimally invasive surgery has kept growing. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. However, it still remains unclear whether laparoscopy should be recommended also for complicated sigmoid diverticulitis. The potential benefits of reduced pain and analgesic requirements, smaller scars, and shorter hospital stay but longer operative times are appealing to both patients and surgeons. Nevertheless, there many concerns regarding the time and the type of surgery. Although the role of minimally invasive surgery in the treatment of colonic diseases is progressively increased, current randomized controlled trials should demonstrate whether laparoscopic lavage, Hartmann's procedure or resection and anastomosis achieve the best results for patients. This review aimed to analyze the results of laparoscopic colonic resection for patients with uncomplicated and complicated forms of sigmoid diverticular disease and to determine what stages profit from a laparoscopic procedure and whether the approach can be performed with a low complication rate even for patients with complicated forms of the disease.
    MeSH term(s) Acute Disease ; Colectomy ; Conversion to Open Surgery ; Digestive System Fistula/surgery ; Diverticulitis/classification ; Diverticulitis/surgery ; Diverticulum, Colon/surgery ; Gastrointestinal Hemorrhage/surgery ; Humans ; Laparoscopy
    Language English
    Publishing date 2015-12
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-015-0329-9
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  4. Article ; Online: Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation.

    Liberatore, Carmine / Farina, Francesca / Greco, Raffaella / Giglio, Fabio / Clerici, Daniela / Oltolini, Chiara / Lupo Stanghellini, Maria Teresa / Barzaghi, Federica / Vezzulli, Paolo / Orsenigo, Elena / Corti, Consuelo / Ciceri, Fabio / Peccatori, Jacopo

    Journal of fungi (Basel, Switzerland)

    2021  Volume 7, Issue 5

    Abstract: Despite the recent introduction of mold-active antifungal prophylaxis (MAP), breakthrough invasive fungal infections (b-IFI) still represent a possible complication and a cause of morbidity and mortality in hematological patients and allogeneic ... ...

    Abstract Despite the recent introduction of mold-active antifungal prophylaxis (MAP), breakthrough invasive fungal infections (b-IFI) still represent a possible complication and a cause of morbidity and mortality in hematological patients and allogeneic hematopoietic stem-cell transplantation recipients (HSCT). Data on incidence and type of b-IFI are limited, although they are mainly caused by non-
    Language English
    Publishing date 2021-04-28
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2784229-0
    ISSN 2309-608X ; 2309-608X
    ISSN (online) 2309-608X
    ISSN 2309-608X
    DOI 10.3390/jof7050347
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  5. Article ; Online: Sentinel node mapping during laparoscopic distal gastrectomy for gastric cancer.

    Orsenigo, Elena / Staudacher, Carlo

    Surgical endoscopy

    2009  Volume 23, Issue 4, Page(s) 919

    MeSH term(s) Gastrectomy/methods ; Humans ; Intraoperative Period ; Laparoscopy ; Lymphatic Metastasis ; Reproducibility of Results ; Sentinel Lymph Node Biopsy/methods ; Stomach Neoplasms/secondary ; Stomach Neoplasms/surgery
    Language English
    Publishing date 2009-01-30
    Publishing country Germany
    Document type Comment ; Letter
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-008-0313-2
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  6. Article ; Online: Predictors of morbidity and mortality in patients submitted to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for ovarian carcinomatosis: a multicenter study.

    Macrì, Antonio / Accarpio, Fabio / Arcoraci, Vincenzo / Casella, Francesco / De Cian, Franco / De Iaco, Pierandrea / Orsenigo, Elena / Roviello, Franco / Scambia, Giovanni / Saladino, Edoardo / Galati, Marica

    Pleura and peritoneum

    2020  Volume 6, Issue 1, Page(s) 21–30

    Abstract: Objectives: The aim of this retrospective study is to assess the incidence of morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and to evaluate their predictors, in patients with ... ...

    Abstract Objectives: The aim of this retrospective study is to assess the incidence of morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and to evaluate their predictors, in patients with peritoneal metastasis of ovarian origin.
    Methods: A retrospective multicenter study was carried out investigating results from eight Italian institutions. A total of 276 patients met inclusion criteria. Predictors of morbidity and mortality were evaluated with univariate and multivariate analysis.
    Results: Overall morbidity was 71.4%, and severe complications occurred in 23.9% of the sample; 60-day mortality was 4.3%. According to univariate logistic regression models, grade 3-4 morbidity was related to Peritoneal Cancer Index (PCI) (OR 1.06; 95% CI 1.02-1.09; p<0.001), number of intraoperative blood transfusions (OR 1.21; 95% CI 1.10-1.34; p<0.001), Completeness of Cytoreduction (CC) score (OR 1.68; 95% CI 1.16-2.44; p=0.006) and number of anastomoses (OR 1.32; 95% CI 1.00-1.73; p=0.046). However, at the multivariate logistic regression analysis, only the number of intraoperative blood transfusions (OR 1.17; 95% CI 1.5-1.30; p=0.004) and PCI (OR 1.04; 95% CI 1.01-1.08; p=0.010) resulted as key predictors of severe morbidity. Furthermore, using multivariate logistic regression model, ECOG score (OR 2.45; 95% CI 1.21-4.93; p=0.012) and the number of severe complications (OR 2.16; 95% CI 1.03-4.52; p=0.042) were recorded as predictors of exitus within 60 days.
    Conclusions: The combination of CRS and HIPEC for treating peritoneal metastasis of ovarian origin has acceptable morbidity and mortality and, therefore, it can be considered as an option in selected patients.
    Language English
    Publishing date 2020-12-04
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2861909-2
    ISSN 2364-768X ; 2364-7671
    ISSN (online) 2364-768X
    ISSN 2364-7671
    DOI 10.1515/pp-2020-0139
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  7. Article ; Online: Effect of neoadjuvant chemotherapy on HER-2 expression in surgically treated gastric and oesophagogastric junction carcinoma: a multicentre Italian study.

    Chiari, Damiano / Orsenigo, Elena / Guarneri, Giovanni / Baiocchi, Gian Luca / Mazza, Elena / Albarello, Luca / Bissolati, Massimiliano / Molfino, Sarah / Staudacher, Carlo

    Updates in surgery

    2017  Volume 69, Issue 1, Page(s) 35–43

    Abstract: Predictors of response to neoadjuvant chemotherapy are not available for gastric and oesophago-gastric junction carcinoma. HER-2 over-expression in breast cancer correlates with poor prognosis and high incidence of recurrence. First aim of this study was ...

    Abstract Predictors of response to neoadjuvant chemotherapy are not available for gastric and oesophago-gastric junction carcinoma. HER-2 over-expression in breast cancer correlates with poor prognosis and high incidence of recurrence. First aim of this study was to evaluate if the HER-2 expression/amplification is predictive of response to neoadjuvant chemotherapy in terms of pathologic regression. Secondary aim was to evaluate if HER-2 expression varies after neoadjuvant treatment. Thirty-five patients with locally advanced gastric or oesophago-gastric junction carcinoma underwent preoperative chemotherapy and surgical resection at San Raffaele Scientific Institute and Spedali Civili of Brescia. HER-2 expression/amplification was evaluated on every biopsy at diagnosis time and on every surgical sample after neoadjuvant chemotherapy. Pathologic response to chemotherapy was evaluated according to TNM classification (ypT status and ypN status) and Mandard's tumour regression grade classification. In our series 10 patients (28.6%) showed a reduction in HER-2 overexpression and in 6 of them (17.1%) HER-2 expression completely disappeared. Only three of the six patients with HER-2 disappearance had a complete pathological response to neoadjuvant chemotherapy. There was a strong correlation between HER-2 negativity on biopsy and absence of lymph node metastasis in surgical samples after neoadjuvant chemotherapy, irrespective of nodal status before chemotherapy. A direct correlation between HER-2 reduction after neoadjuvant chemotherapy and pathologic regression (primary tumour and lymph nodes) in surgical samples was found. HER-2 negativity may represent a predictor of pathologic response to neoadjuvant chemotherapy for gastric and oesophago-gastric junction adenocarcinoma. Neoadjuvant treatment can reduce HER-2 overexpression.
    Language English
    Publishing date 2017-03
    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/s13304-017-0423-2
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  8. Article ; Online: Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience.

    Orsenigo, Elena / Bissolati, Massimiliano / Socci, Carlo / Chiari, Damiano / Muffatti, Francesca / Nifosi, Jacopo / Staudacher, Carlo

    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association

    2014  Volume 17, Issue 4, Page(s) 733–744

    Abstract: Background: Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy.: ...

    Abstract Background: Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy.
    Methods: All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications.
    Results: Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p < 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p < 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p < 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p < 0.001), liver cirrhosis (OR 13.2; p < 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses >300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p < 0.001) were found to be independent risk factors for DSF development.
    Conclusions: Duodenal stump fistula still remains a life-threatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.
    MeSH term(s) Aged ; Comorbidity ; Female ; Gastrectomy/adverse effects ; Gastrectomy/methods ; Humans ; Intestinal Fistula/epidemiology ; Intestinal Fistula/etiology ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/surgery
    Language English
    Publishing date 2014-01-08
    Publishing country Japan
    Document type Journal Article
    ZDB-ID 1463526-4
    ISSN 1436-3305 ; 1436-3291
    ISSN (online) 1436-3305
    ISSN 1436-3291
    DOI 10.1007/s10120-013-0327-x
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    Zs.A 5290: Show issues Location:
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  9. Article ; Online: Consensus Statement of the Italian Polispecialistic Society of Young Surgeons (SPIGC): Diagnosis and Treatment of Acute Appendicitis.

    Guaitoli, Eleonora / Gallo, Gaetano / Cardone, Eleonora / Conti, Luigi / Famularo, Simone / Formisano, Giampaolo / Galli, Federica / Giuliani, Giuseppe / Martino, Antonio / Pasculli, Alessandro / Patini, Romeo / Soriero, Domenico / Pappalardo, Vincenzo / Casoni Pattacini, Gianmaria / Sparavigna, Marco / Meniconi, Roberto / Mazzari, Andrea / Barra, Fabio / Orsenigo, Elena /
    Pertile, Davide

    Journal of investigative surgery : the official journal of the Academy of Surgical Research

    2020  Volume 34, Issue 10, Page(s) 1089–1103

    Abstract: Background: Acute appendicitis (AA) is one of the most common causes of abdominal pain requiring surgical intervention. Approximately 20% of AA cases are characterized by complications such as gangrene, abscesses, perforation, or diffuse peritonitis, ... ...

    Abstract Background: Acute appendicitis (AA) is one of the most common causes of abdominal pain requiring surgical intervention. Approximately 20% of AA cases are characterized by complications such as gangrene, abscesses, perforation, or diffuse peritonitis, which increase patients' morbidity and mortality. Diagnosis of AA can be difficult, and evaluation of clinical signs, laboratory index and imaging should be part of the management of patients with suspicion of AA.
    Methods: This consensus statement was written in relation to the most recent evidence for diagnosis and treatment of AA, performing a literature review on the most largely adopted scientific sources. The members of the SPIGC (Italian Polispecialistic Society of Young Surgeons) worked jointly to draft it. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Chest Physicians (CHEST) for the strength of the recommendations.
    Results: Fever and migratory pain tend to be present in patients with suspicion of AA. Laboratory and radiological examinations are commonly employed in the clinical practice, but today also scoring systems based on clinical signs and laboratory data have slowly been adopted for diagnostic purpose. The clinical presentation of AA in children, pregnant and elderly patients can be unusual, leading to more difficult and delayed diagnosis. Surgery is the best option in case of complicated AA, whereas it is not mandatory in case of uncomplicated AA. Laparoscopic surgical treatment is feasible and recommended. Postoperative antibiotic treatment is recommended only in patients with complicated AA.
    MeSH term(s) Acute Disease ; Aged ; Appendectomy ; Appendicitis/diagnosis ; Appendicitis/surgery ; Child ; Consensus ; Humans ; Italy ; Laparoscopy ; Retrospective Studies ; Surgeons
    Language English
    Publishing date 2020-03-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639444-9
    ISSN 1521-0553 ; 0894-1939
    ISSN (online) 1521-0553
    ISSN 0894-1939
    DOI 10.1080/08941939.2020.1740360
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  10. Article ; Online: Laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a monoinstitutional Western center experience.

    Orsenigo, Elena / Di Palo, Saverio / Tamburini, Andrea / Staudacher, Carlo

    Surgical endoscopy

    2010  Volume 25, Issue 1, Page(s) 140–145

    Abstract: Background: Laparoscopic gastrectomy (LAG) is safe for benign lesions; however, such surgery for cancer remains controversial. The aim of this study was to compare technical feasibility and oncologic efficacy of laparoscopic versus open gastrectomy for ... ...

    Abstract Background: Laparoscopic gastrectomy (LAG) is safe for benign lesions; however, such surgery for cancer remains controversial. The aim of this study was to compare technical feasibility and oncologic efficacy of laparoscopic versus open gastrectomy for gastric carcinoma.
    Methods: Between January 2002 and November 2008, 109 gastric cancer patients underwent LAG (92 distal gastrectomy and 17 total gastrectomy) at our hospital. These patients were compared with 269 gastric cancer patients who underwent conventional open gastrectomy (OG; 171 distal gastrectomy and 98 total gastrectomy) during the same period.
    Results: Operation time was significantly longer in the LAG group than in the OG group. Estimated blood loss in the LAG group was significantly less than in the OG group. The morbidity rate was higher than in the OG group (p < 0.0001). The distance of the proximal resection margin was significantly lower in the OG group (2.8 ± 1.9 vs. 3.8 ± 2.5; p = 0.014). The mean number of nodes resected with LAG was 31 ± 14 and that with OG was 27 ± 13 (p = 0.002). The mean survival time was 53 months in both groups. There were no differences regarding overall patient survival at a mean time of follow-up of 33 months.
    Conclusions: LAG with extended lymphadenectomy for gastric cancer is a feasible and safe procedure and has several advantages despite a higher rate of morbidity. Moreover, this method can achieve a radical oncologic equivalent resection and it does not have a deleterious effect on cancer-related outcome.
    MeSH term(s) Adenocarcinoma/surgery ; Aged ; Anastomotic Leak/epidemiology ; Blood Loss, Surgical/statistics & numerical data ; Feasibility Studies ; Female ; Gastrectomy/methods ; Hospitals, University/statistics & numerical data ; Humans ; Italy ; Laparoscopy/methods ; Lymph Node Excision ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Stomach Neoplasms/surgery ; Survival Analysis ; Treatment Outcome
    Language English
    Publishing date 2010-06-10
    Publishing country Germany
    Document type Comparative Study ; Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-010-1147-2
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