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Article ; Online: Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center.

Talavera-Urquijo, Eider / Parise, Paolo / Carresi, Agnese / Cossu, Andrea / Barbieri, Lavinia / Puccetti, Francesco / Elmore, Ugo / Rosati, Riccardo

Updates in surgery

2022 Volume 75, Issue 2, Page(s) 435–449

Abstract: A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF ... ...

Abstract	A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF after esophagectomy and compare it with other reported series. Patients who developed a TBEF after esophagectomy were identified retrospectively. Baseline and intraoperative characteristics, postoperative and TBEF details, treatments for TBEF, and main outcomes are described. A univariate analysis was performed to compare some of the analyzed variables with the overall sample. Finally, our results are compared with the previously described series. Altogether, 16 patients with TBEF (3.11%) were analyzed from 514 patients who received esophagectomies between January 2014 and February 2020. As a first treatment attempt, 14 (87.5%) were treated with surgery, one was treated conservatively, and one was treated endoscopically. Surgery both at a first or second treatment attempt achieved a survival rate of 62.5% and oral intake at discharge of 43.75%. Six patients died during their hospital stay (37.5%). The presence of an anastomotic leak showed a strong association with TBEF development (100% vs. 19.7%; OR 1.163, 95% CI 1.080-1.253, p = 0.000). In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. However, there is an urgent need to elaborate treatment guidelines based on international consensus.
MeSH term(s)	Humans ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Retrospective Studies ; Tertiary Care Centers ; Esophageal Neoplasms/surgery ; Esophageal Fistula/etiology ; Esophageal Fistula/surgery ; Anastomosis, Surgical/adverse effects
Language	English
Publishing date	2022-08-22
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/s13304-022-01364-9
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Article: A large anastomotic leakage after esophageal surgery treated with endoluminal vacuum-assisted closure: a case report.

Mandarino, Francesco Vito / Bonura, Giuliano Francesco / Esposito, Dario / Rosati, Riccardo / Parise, Paolo / Fanti, Lorella

Journal of surgical case reports

2020 Volume 2020, Issue 4, Page(s) rjaa071

Abstract: The treatment of anastomotic post-esophagectomy leaks and fistula is challenging. Endoluminal vacuum-assisted closure (EVAC) is an emerging technique that employs negative pressure wound therapy to treat anastomotic leaks endoscopically. Esosponge is ... ...

Abstract	The treatment of anastomotic post-esophagectomy leaks and fistula is challenging. Endoluminal vacuum-assisted closure (EVAC) is an emerging technique that employs negative pressure wound therapy to treat anastomotic leaks endoscopically. Esosponge is specifically designed for esophageal EVAC therapy. We report on a 49-year-old woman who underwent a totally mini-invasive Ivor-Lewis esophagectomy and developed a giant postoperative leak with a complex pleural collection, but she was not fit for surgical re-intervention. The patient healed almost completely after 14 exchange sessions of Esosponge over 35 days.
Language	English
Publishing date	2020-04-24
Publishing country	England
Document type	Case Reports
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjaa071
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Article ; Online: Esophageal oncologic surgery in SARS-CoV-2 (COVID-19) emergency.

Barbieri, Lavinia / Talavera Urquijo, Eider / Parise, Paolo / Nilsson, Magnus / Reynolds, John V / Rosati, Riccardo

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2020 Volume 33, Issue 5

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/psychology ; Elective Surgical Procedures ; Emergencies ; Esophageal Neoplasms/complications ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/therapy ; Humans ; Nutritional Status ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/psychology ; Preoperative Care ; Risk Factors ; SARS-CoV-2 ; Triage
Keywords	covid19
Language	English
Publishing date	2020-04-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doaa028
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Article ; Online: Re-laparoscopy in the treatment of anastomotic leak following laparoscopic right colectomy with intracorporeal anastomosis.

Vignali, Andrea / Elmore, Ugo / Aleotti, Francesca / Roberto, Delpini / Parise, Paolo / Rosati, Riccardo

Surgical endoscopy

2020 Volume 35, Issue 11, Page(s) 6173–6178

Abstract: Background: Anastomotic leak still represents the most feared surgical complication following colorectal resection and is associated with high morbidity and mortality rates. The aim of this study is to assess the feasibility and safety of laparoscopic ... ...

Abstract	Background: Anastomotic leak still represents the most feared surgical complication following colorectal resection and is associated with high morbidity and mortality rates. The aim of this study is to assess the feasibility and safety of laparoscopic reoperation for symptomatic anastomotic leak (AL) after laparoscopic right colectomy with mechanical intracorporeal anastomosis (IA). Methods: From January 2012 to December 2019, 428 consecutive laparoscopic right colectomy with IA were performed. Overall symptomatic AL rate requiring reoperation was 5.8% (26/428). Data on patient demographics as well as operative findings, time elapsed from primary surgery and from the onset of symptoms of anastomotic leak, time and duration of re-laparoscopy, ICU stay, morbidity, mortality rate, length of hospital stay and readmission, were all retrospectively reviewed. Results: Laparoscopic approach was attempted in 23 (88.4%) hemodynamically stable patients. Conversion rate was 21.4%. Reasons for conversion were gross fecal peritonitis (n = 2), colonic ischemia (n = 1), severe bowel distension (n = 2). Eighteen (78.2%) patients underwent successfully laparoscopic (LPS) reoperation. A repair of the anastomotic defect was done in 11 (61.1%) patients, while in 7 patients the intracorporeal mechanical anastomosis was refashioned. A diverting ileostomy was done in 22.2% of cases (n = 4). A second reoperation for leak persistence was necessary in two cases (11.1%). Median (range) length of postoperative hospital stay from re-laparoscopy was 15.5 (9-53) days. Overall morbidity rate was 38.7%. Mortality rate was 5.5% (n = 1) CONCLUSION: laparoscopic re-intervention for the treatment of anastomotic leak following LPS right colectomy with intracorporeal anastomosis in hemodynamically stable and highly selected patients in the experienced hands of dedicated laparoscopic surgeons, is a safe option with acceptable morbidity and mortality rate.
MeSH term(s)	Anastomosis, Surgical/adverse effects ; Anastomotic Leak/surgery ; Colectomy/adverse effects ; Humans ; Laparoscopy/adverse effects ; Postoperative Complications/surgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-10-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-020-08113-2
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Article ; Online: Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients.

Vignali, Andrea / Elmore, Ugo / Guarneri, Giovanni / De Ruvo, Valentino / Parise, Paolo / Rosati, Riccardo

Updates in surgery

2020 Volume 73, Issue 1, Page(s) 111–121

Abstract: To identify factors associated with early deviation and delayed discharge within an Enhanced Recovery after Surgery (ERAS) pathway. This is a retrospective review of prospectively collected data of consecutive patients who underwent laparoscopic or open ... ...

Abstract	To identify factors associated with early deviation and delayed discharge within an Enhanced Recovery after Surgery (ERAS) pathway. This is a retrospective review of prospectively collected data of consecutive patients who underwent laparoscopic or open colorectal surgery and managed with a standardized ERAS pathway between April 2015 and October 2018. ERAS items were assessed within 48 h after surgery. Patients with early complications were excluded. The influence of factors on length of stay was calculated by univariate and multivariate analysis. A binary logistic regression was used to model a predicting score. Seven hundred and thirty-three patients met the inclusion criteria. Multivariate analysis showed that age ≥ 75 years (P = 0.02), ASA score ≥ 3 (P = 0.03), open surgery or conversion to open (P = 0.001), non-compliance with the intra-operative balanced fluid therapy (P = 0.049), failure to early removal of the urinary catheter (P = 0.001), to discontinue IV fluid (P = 0.02) and to early mobilization (P = 0.001) were independently associated with ERAS failure. The generated score had a specificity of 84% and a positive predictive value of 72%. Patients who would have a length of stay longer than the median for each surgical procedure were properly identified (Area under ROC Curve = 0.753, P < 0.001). The delayed discharge could be predicted at 48 h from the intervention. The ability of the model to weight the specific role of each statistically significant variable might be a useful tool to identify the most frail patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Colon/surgery ; Colonic Diseases/physiopathology ; Colonic Diseases/surgery ; Enhanced Recovery After Surgery ; Female ; Frailty ; Humans ; Laparoscopy/methods ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Recovery of Function ; Rectal Diseases/physiopathology ; Rectal Diseases/surgery ; Rectum/surgery ; Retrospective Studies ; Treatment Failure ; Young Adult
Language	English
Publishing date	2020-07-08
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/s13304-020-00848-w
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Article: Diaphragmatic hernia after Ivor Lewis esophagectomy for cancer: a retrospective analysis of risk factors and post-repair outcomes.

Puccetti, Francesco / Cossu, Andrea / Parise, Paolo / Barbieri, Lavinia / Elmore, Ugo / Carresi, Agnese / De Pascale, Stefano / Fumagalli Romario, Uberto / Rosati, Riccardo

Journal of thoracic disease

2021 Volume 13, Issue 1, Page(s) 160–168

Abstract: Background: Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with ... ...

Abstract	Background: Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with incidence and risk factors not clearly demonstrated. This study evaluates presenting characteristics and repair outcomes in PEDH after Ivor Lewis esophagectomy for cancer. Methods: All consecutive patients who underwent esophageal cancer surgery between March 1997 and April 2018 at two high-volume centers were included. The patients underwent Ivor Lewis esophagectomy and were managed according to a standardized follow-up care plan. The primary outcomes included PEDH incidence, risk factor identification, and surgical results after hernia repair. Patient characteristics and perioperative data were collected and a multivariate analysis was performed to identify risk factors for PEDH. Results: A total of 414 patients were enrolled and 22 (5.3%) were diagnosed with PEDH during a median follow-up period of 16 (range, 6-177) months. All patients underwent surgical repair and 16 (73%) required treatment within 24 hours. PEDH repair was mainly performed through a laparoscopic approach (77.3%), with an overall postoperative morbidity of 22.7% and one mortality case. The median length of hospital stay was 6 (range, 2-95) days, and no early recurrences were observed, although three (13.6%) cases relapsed over a median follow-up of 10.1 months after hernia repair. Univariate analysis demonstrated a statistically significant association between PEDH and neoadjuvant chemoradiotherapy (P=0.016), pathological complete response (P=0.001), and lymph node harvest (P=0.024). On the other hand, multivariate analysis identified pathological complete response [3.616 (1.384-9.449), P=0.009] and lymph node harvest [3.029 (1.140-8.049), P=0.026] as the independent risk factors for developing PEDH. Conclusions: PEDH represents a relevant surgical complication after Ivor Lewis esophagectomy for cancer, including a 5.3% incidence and requiring surgical repair. Pathological complete response and lymph node harvest were found to be independent risk factors for PEDH, independently of the esophagectomy technique.
Language	English
Publishing date	2021-01-25
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-20-1974
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Article ; Online: Application of ERAS protocol in esophagectomy: a national survey among Italian centers performing esophageal surgery.

Parise, Paolo / Turi, Stefano / Talavera-Urquijo, Eider / Carresi, Agnese / Barbieri, Lavinia / Cossu, Andrea / Elmore, Ugo / Puccetti, Francesco / Rosati, Riccardo

Updates in surgery

2021 Volume 73, Issue 1, Page(s) 297–303

Abstract: The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions ... ...

Abstract	The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions was mailed to Italian centers that performed at least 10 esophagectomies per year. It included questions about the type of hospital and unit and pre-, intra- and post-operative items. Difficulties encountered were investigated. Thirteen (65%) centers answered the survey, and all met the minimal safety requirements, e.g., the presence of intensive care units and 24-h on-call operative endoscopy and radiology facilities. Fifty percent of esophagectomies with a minimally invasive approach were performed in 84.6% of the centers. Regarding pre-operative items, the highest scores were for the application of nutritional support, dysphagia palliation and presence of a multidisciplinary tumor board, whereas the lowest score was for the use of immunonutrition. Regarding intra-operative items, hypothermia prevention and the use of goal-directed fluid therapy and volatile anesthesia were diffusely adopted, whereas the rate of using abdominal drains was high. Regarding post-operative items, nausea prevention, multimodal analgesia and early mobilization were applied frequently, whereas the use of nasogastric tubes and regular transfer to intensive care units was diffused. The primary barriers in enhanced recovery after surgery protocol application were resistance and a lack of paramedic personnel. This survey's results highlight the efforts undertaken by several centers to apply enhanced recovery after surgery philosophy and in this regard, demonstrate a good standing in Italy.
MeSH term(s)	Enhanced Recovery After Surgery ; Esophagectomy/methods ; Esophagectomy/statistics & numerical data ; Esophagus/surgery ; Humans ; Italy/epidemiology ; Minimally Invasive Surgical Procedures/methods ; Minimally Invasive Surgical Procedures/statistics & numerical data ; Perioperative Care ; Surgery Department, Hospital/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2021-01-13
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/s13304-020-00963-8
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Article ; Online: Double layer stent for the treatment of leaks and fistula after upper gastrointestinal oncologic surgery: a retrospective study.

Mandarino, Francesco Vito / Esposito, Dario / Spelta, Greta Natalia Edmea / Cavestro, Giulia Martina / Rosati, Riccardo / Parise, Paolo / Gemma, Marco Fabio / Fanti, Lorella

Updates in surgery

2021 Volume 74, Issue 3, Page(s) 1055–1062

Abstract: Anastomotic dehiscence is one of the most morbidity related and deadly complication after foregut oncologic surgery. The aim of the study is to evaluate the effectiveness of double layer stents (Niti-S™ Beta™ Esophageal Stent) in the management of ... ...

Abstract	Anastomotic dehiscence is one of the most morbidity related and deadly complication after foregut oncologic surgery. The aim of the study is to evaluate the effectiveness of double layer stents (Niti-S™ Beta™ Esophageal Stent) in the management of dehiscences after upper gastrointestinal oncologic surgery. We retrospectively studied consecutive patients who underwent Niti-S™ Beta™ esophageal stent placement from June 2014 to September 2019 for the treatment of anastomotic leaks/fistula following esophagectomy or gastrectomy for cancer. Univariate two-sided logistic regression analysis was used to evaluate possible predictors of successful anastomotic leak/fistula closure. A total of 37 patients were studied and 75 stents were positioned in these patients during the endoscopic procedures. Effective leak/fistula closure was obtained in 23/37 (62.2%). No technical endoscopic failure or complications ensued during the placing of the devices. Regarding delayed complications, migration was observed in 17/75 (22.7%) procedures and stent leaking in 29/75 (38.6%). Three variables significantly favoured stent treatment failure, namely previous neoadjuvant therapy (OR 9.3, P = 0.01), fistula (instead of leak) (OR 6.5, P = 0.01), and stent leak (OR 17.0, P = 0.01). Placement of Beta Niti-S esophageal stent is a safe and effective method that could be considered for the management of leaks and fistula after upper gastrointestinal cancer. Crucial points in the management of post-surgical leaks with this technique are the prompt recognition of leaks and fistula, the prompt endoscopic/radiologic drain of collection and the choice of adequate size of the stent.
MeSH term(s)	Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Esophageal Fistula/etiology ; Esophageal Fistula/surgery ; Esophagectomy/adverse effects ; Humans ; Retrospective Studies ; Stents ; Treatment Outcome
Language	English
Publishing date	2021-09-12
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/s13304-021-01155-8
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Article ; Online: Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis.

Milone, Marco / Elmore, Ugo / Manigrasso, Michele / Vertaldi, Sara / Aprea, Giovanni / Servillo, Giuseppe / Parise, Paolo / De Palma, Giovanni Domenico / Rosati, Riccardo

American journal of surgery

2021 Volume 223, Issue 5, Page(s) 884–892

Abstract: Background: To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing ... ...

Abstract	Background: To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy. Methods: A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients' number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results. Results: 12 articles were included in the final analysis. A significant difference was observed in terms of "overall anastomotic complications" in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies. Conclusion: Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions.
MeSH term(s)	Anastomosis, Surgical/methods ; Constriction, Pathologic/surgery ; Gastrectomy/methods ; Humans ; Laparoscopy/methods ; Retrospective Studies ; Stomach Neoplasms/surgery ; Surgical Stapling/methods
Language	English
Publishing date	2021-10-01
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2021.09.024
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Article: Technical pro & cons of the laparoscopic lymphadenectomy.

Rosati, Riccardo / Parise, Paolo / Giannone Codiglione, Fabio

Translational gastroenterology and hepatology

2016 Volume 1, Page(s) 93

Abstract: Laparoscopy has been introduced in treatment of gastric cancer to reduce surgical trauma and to improve post-operative functional recovery. Most of international guidelines allow the use of this minimally invasive approach in general surgical practice ... ...

Abstract	Laparoscopy has been introduced in treatment of gastric cancer to reduce surgical trauma and to improve post-operative functional recovery. Most of international guidelines allow the use of this minimally invasive approach in general surgical practice only in clinical stage I. One of the most important concerns in fact is the feasibility of D2 lymphadenectomy through laparoscopy. Reduced numbers of harvested lymph nodes have been reported, particularly in stations with a more difficult access. Nevertheless subsequent papers reported adequate numbers of total number of nodes retrieved, even with D2 dissection and even in complex stations but results from randomized controlled trials still lack. Laparoscopic approach has been proven safe and effective also in extremely complex maneuvers as spleen-preserving retropancreatic lymphadenectomy. The minimally invasive approach in D2 lymphadenectomy seems to be associated to comparable incidence of specific complications as compared to open surgery. The use of laparoscopy has extended the operating time but has reduced the blood loss. Because of high complexity of this kind surgery, laparoscopic gastric surgery for cancer should be done only in referral centers.
Language	English
Publishing date	2016-12-27
Publishing country	China
Document type	Journal Article ; Review
ISSN	2415-1289
ISSN	2415-1289
DOI	10.21037/tgh.2016.12.04
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