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Article: State of the Art in Pancreatic Surgery: Some Unanswered Questions.

Perra, Teresa / Porcu, Alberto

2022 Volume 11, Issue 10

Abstract: Pancreatic surgery is one of the most technically challenging types of surgery, and many questions remain unanswered; therefore, an overview of the global advancement in surgical research and clinical practice is fundamental in this field [ ... ]. ...

Abstract	Pancreatic surgery is one of the most technically challenging types of surgery, and many questions remain unanswered; therefore, an overview of the global advancement in surgical research and clinical practice is fundamental in this field [...].
Language	English
Publishing date	2022-05-17
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11102821
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Article: Sarcopenia and Risk of Pancreatic Fistula after Pancreatic Surgery: A Systematic Review.

Perra, Teresa / Sotgiu, Giovanni / Porcu, Alberto

Journal of clinical medicine

2022 Volume 11, Issue 14

Abstract: Postoperative pancreatic fistula (POPF) is one of the most critical complications after pancreatic surgery. The relationship between sarcopenia and outcomes following this type of surgery is debated. The aim of this review was to assess the impact of ... ...

Abstract	Postoperative pancreatic fistula (POPF) is one of the most critical complications after pancreatic surgery. The relationship between sarcopenia and outcomes following this type of surgery is debated. The aim of this review was to assess the impact of sarcopenia on the risk of POPF. A literature search was performed using the PubMed database and the reference lists of relevant articles to identify papers about the impact of sarcopenia on POPF in pancreatic surgery. Twenty-one studies published between 2016 and 2021 with a total of 4068 patients were included. Some studies observed a significant difference in the incidence of POPF between the sarcopenic and non-sarcopenic patients undergoing pancreatoduodenectomy. Interestingly, there was a trend of a lower POPF rate in sarcopenic patients than in non-sarcopenic patients. Only one study included patients undergoing distal pancreatectomy specifically. The role of sarcopenia in surgical outcomes is still unclear. A combination of objective CT measurements could be used to predict POPF. It could be assessed by routine preoperative staging CT and could improve preoperative risk stratification in patients undergoing pancreatic surgery.
Language	English
Publishing date	2022-07-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11144144
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Article ; Online: Toxic Metal and Essential Element Concentrations in the Blood and Tissues of Pancreatic Ductal Adenocarcinoma Patients.

Forte, Giovanni / Pisano, Andrea / Bocca, Beatrice / Fenu, Grazia / Farace, Cristiano / Etzi, Federica / Perra, Teresa / Sabalic, Angela / Porcu, Alberto / Madeddu, Roberto

Toxics

2024 Volume 12, Issue 1

Abstract: Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive lethal neoplasm, and it has an average 5-year survival rate of less than 10%. Although the factors that influence PDAC development remain unclear, exposure to toxic metals or the ...

Abstract	Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive lethal neoplasm, and it has an average 5-year survival rate of less than 10%. Although the factors that influence PDAC development remain unclear, exposure to toxic metals or the imbalance in essential elements may have a role in PDAC-associated metabolic pathways. Methods: This study determined the concentrations of Cd, Cr, Cu, Fe, Mn, Ni, Pb, Se and Zn in whole blood, cancer and non-cancer tissues of patients affected by PDAC, and compared them with levels in healthy controls using inductively coupled plasma mass spectrometry. Results: Results of the whole blood showed significantly higher levels of Cr, Cu and Cu/Zn ratio in PDAC patients compared to the controls. In addition, the concentrations of Cu, Se, Fe and Zn significantly increased in cancer tissue compared to the healthy counterparts. Conclusions: This study revealed evidence of altered metal levels in the blood and pancreatic tissues of PDAC patients with respect to healthy controls. These changes may contribute to multiple mechanisms involved in metal-induced carcinogenesis, including oxidative stress, DNA damage, genetic alteration, decreased antioxidant barriers and inflammatory responses. Thus, the analysis of metals can be used in the diagnosis and monitoring of PDAC neoplasms.
Language	English
Publishing date	2024-01-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2733883-6
ISSN	2305-6304 ; 2305-6304
ISSN (online)	2305-6304
ISSN	2305-6304
DOI	10.3390/toxics12010032
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Article: Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review.

Fancellu, Alessandro / Sanna, Valeria / Deiana, Giulia / Ninniri, Chiara / Turilli, Davide / Perra, Teresa / Porcu, Alberto

World journal of gastrointestinal oncology

2021 Volume 13, Issue 6, Page(s) 625–637

Abstract: Background: Hepatopancreatoduodenectomy (HPD) is the simultaneous combination of hepatic resection, pancreaticoduodenectomy, and resection of the entire extrahepatic biliary system. HPD is not a universally accepted due to high mortality and morbidity ... ...

Abstract	Background: Hepatopancreatoduodenectomy (HPD) is the simultaneous combination of hepatic resection, pancreaticoduodenectomy, and resection of the entire extrahepatic biliary system. HPD is not a universally accepted due to high mortality and morbidity rates, as well as to controversial survival benefits. Aim: To evaluate the current role of HPD for curative treatment of gallbladder cancer (GC) or extrahepatic cholangiocarcinoma (ECC) invading both the hepatic hilum and the intrapancreatic common bile duct. Methods: A systematic literature search using the PubMed, Web of Science, and Scopus databases was performed to identify studies reporting on HPD, using the following keywords: 'Hepatopancreaticoduodenectomy', 'hepatopancreatoduodenectomy', 'hepatopancreatectomy', 'pancreaticoduodenectomy', 'hepatectomy', 'hepatic resection', 'liver resection', 'Whipple procedure', 'bile duct cancer', 'gallbladder cancer', and 'cholangiocarcinoma'. Results: This updated systematic review, focusing on 13 papers published between 2015 and 2020, found that rates of morbidity for HPD have remained high, ranging between 37.0% and 97.4%, while liver failure and pancreatic fistula are the most serious complications. However, perioperative mortality for HPD has decreased compared to initial experiences, and varies between 0% and 26%, although in selected center it is well below 10%. Long term survival outcomes can be achieved in selected patients with R0 resection, although 5-year survival is better for ECC than GC. Conclusion: The present review supports the role of HPD in patients with GC and ECC with horizontal spread involving the hepatic hilum and the intrapancreatic bile duct, provided that it is performed in centers with high experience in hepatobiliary-pancreatic surgery. Extensive use of preoperative portal vein embolization, and preoperative biliary drainage in patients with obstructive jaundice, represent strategies for decreasing the occurrence and severity of postoperative complications. It is advisable to develop internationally-accepted protocols for patient selection, preoperative assessment, operative technique, and perioperative care, in order to better define which patients would benefit from HPD.
Language	English
Publishing date	2021-06-17
Publishing country	China
Document type	Journal Article
ZDB-ID	2573696-6
ISSN	1948-5204
ISSN	1948-5204
DOI	10.4251/wjgo.v13.i6.625
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Article ; Online: Current management of incidental gallbladder cancer: A review.

Feo, Claudio F / Ginesu, Giorgio C / Fancellu, Alessandro / Perra, Teresa / Ninniri, Chiara / Deiana, Giulia / Scanu, Antonio M / Porcu, Alberto

International journal of surgery (London, England)

2022 Volume 98, Page(s) 106234

Abstract: Early-stage gallbladder cancer (GBC) is mostly discovered incidentally by the pathologist after cholecystectomy for a presumed benign disease. It is the most common malignancy of the biliary tract with a variable incidence rate all over the World. The ... ...

Abstract	Early-stage gallbladder cancer (GBC) is mostly discovered incidentally by the pathologist after cholecystectomy for a presumed benign disease. It is the most common malignancy of the biliary tract with a variable incidence rate all over the World. The majority of patients with GBC remain asymptomatic for a long time and diagnosis is usually late when the disease is at an advanced stage. Radical surgery consisting in resection of the gallbladder liver bed and regional lymph nodes seems to be the best treatment option for incidental GBC. However, recurrence rates after salvage surgery are still high and the addition of neoadjuvant/adjuvant chemotherapy may improve outcomes. The aim of the present review is to evaluate current literature for advances in management of incidental GBC, with particular focus on staging techniques and surgical options.
MeSH term(s)	Cholecystectomy ; Gallbladder Neoplasms/diagnosis ; Gallbladder Neoplasms/epidemiology ; Gallbladder Neoplasms/surgery ; Humans ; Incidental Findings ; Lymph Node Excision ; Neoplasm Staging
Language	English
Publishing date	2022-01-21
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2022.106234
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Article: How the COVID-19 pandemic has affected the colorectal cancer screening in Italy: A minireview.

Fancellu, Alessandro / Veneroni, Simone / Santoru, Antonio / Meloni, Arianna / Sanna, Valeria / Ginesu, Giorgio C / Deiana, Giulia / Paliogiannis, Panagiotis / Ninniri, Chiara / Perra, Teresa / Porcu, Alberto

World journal of gastrointestinal oncology

2022 Volume 14, Issue 8, Page(s) 1490–1498

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has caused detrimental effects on many aspects of healthcare practice. Screening programs for the commonest malignancies, namely colorectal cancer (CRC), breast cancer and cervical cancer have been ... ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic has caused detrimental effects on many aspects of healthcare practice. Screening programs for the commonest malignancies, namely colorectal cancer (CRC), breast cancer and cervical cancer have been discontinued or interrupted since the beginning of restriction measures aimed to limit transmission of the new coronavirus infection. Robust evidence exists in favour of the role of screening campaigns in reducing mortality from CRC. In fact, the majority of pre-malignant lesions of the colon and rectum can be diagnosed with colonoscopy and treated by endoscopic or surgical resection. Besides, colonoscopy screening allows the diagnosis of CRCs in their pre-clinical stage. Italy was one of the first European countries where a high level of COVID-19 infections and deaths was observed, and one of the first where lockdowns and strict measures were adopted to reduce the risk of COVID-19 diffusion among the population. A systematic review of the literature was performed, including the PubMed, Scopus, Web of Sciences, and Reference Citation Analysis databases, with the aim of critically evaluating the impact of the COVID-19 pandemic on CRC screening in Italy. We found that reduction of CRC screening activity surpassed 50% in most endoscopic units, with almost 600000 fewer CRC screening exams conducted in the first 5 mo of 2020
Language	English
Publishing date	2022-09-17
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2573696-6
ISSN	1948-5204
ISSN	1948-5204
DOI	10.4251/wjgo.v14.i8.1490
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Article ; Online: Inflammatory Indexes as Predictive Biomarkers of Postoperative Complications in Oncological Thoracic Surgery.

Ginesu, Giorgio Carlo / Paliogiannis, Panagiotis / Feo, Claudio F / Cossu, Maria Laura / Scanu, Antonio Mario / Fancellu, Alessandro / Fois, Alessandro Giuseppe / Zinellu, Angelo / Perra, Teresa / Veneroni, Simone / Porcu, Alberto

Current oncology (Toronto, Ont.)

2022 Volume 29, Issue 5, Page(s) 3425–3432

Abstract: The role of inflammatory responses in predicting outcomes in oncological thoracic surgery is still unclear. The aim of this study was to evaluate a series of blood count inflammation indexes as predicting factors for postoperative complications. We ... ...

Abstract	The role of inflammatory responses in predicting outcomes in oncological thoracic surgery is still unclear. The aim of this study was to evaluate a series of blood count inflammation indexes as predicting factors for postoperative complications. We retrospectively studied 249 patients undergoing elective thoracic surgery in our institution between 2008 and 2020. A total of 184 patients underwent open surgery, and 65 underwent VATS. The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios, Systemic Inflammation Response Index (SIRI) were calculated preoperatively and on the first and fourth postoperative days, as well as a new derivative index, the Aggregate Inflammation Systemic Index (AISI). Univariate correlations evidenced a statistically significant association between the NLR at the fourth postoperative day and the occurrence of surgical complications in the global cohort (rho = 0.15,
MeSH term(s)	Biomarkers ; Humans ; Inflammation ; Postoperative Complications/etiology ; Prospective Studies ; Retrospective Studies ; Thoracic Surgery
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-05-08
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol29050276
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Article: The Impact on Survival and Morbidity of Portal-Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies.

Fancellu, Alessandro / Petrucciani, Niccolò / Porcu, Alberto / Deiana, Giulia / Sanna, Valeria / Ninniri, Chiara / Perra, Teresa / Celoria, Valentina / Nigri, Giuseppe

Cancers

2020 Volume 12, Issue 7

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-07-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers12071976
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Article ; Online: Management of complex liver cystic hydatidosis: challenging benign diseases for the hepatic surgeon: A case series report from an endemic area.

Fancellu, Alessandro / Perra, Teresa / Vergari, Dario / Vargiu, Isabel / Feo, Claudio F / Cossu, Maria L / Deiana, Giulia / Porcu, Alberto

Medicine

2020 Volume 99, Issue 48, Page(s) e23435

Abstract: Hydatid cysts of the liver are benign lesions which require a wide range of surgical strategies for their treatment. We hypothesized that cysts larger than 15 cm, or compressing main vascular structures, or located in both hemilivers should be considered, ...

Abstract	Hydatid cysts of the liver are benign lesions which require a wide range of surgical strategies for their treatment. We hypothesized that cysts larger than 15 cm, or compressing main vascular structures, or located in both hemilivers should be considered, as well as complicated cysts, in the category of complex hydatid cysts.In a retrospective study including 55 patients, we evaluated the characteristics of complex hydatid cysts, and compared surgical outcomes between patients operated on for complex cysts (Complex Group) and those operated on for non-complex cysts (non-Complex Group).In the Complex Group, 19% of patients had cysto-biliary communication with recurrent cholangitis, 9.5% had cysts eroding the diaphragm or chest wall, or communicating with the bronchial tree, 31% had cysts with contact with main vascular structures, 11.9% had multiple bilobar cysts, 14.3% had giant cysts with organ displacement, and 14.3% had a combination of the above-mentioned types. Type of surgical treatment was different between the two groups (P < .001). Additional procedures were statistically more frequent in the Complex Group (P = .02). Postoperative morbidity was higher in the Complex Group, although not in a significant manner (P = .07). Median hospital stay was longer in the Complex Group (12 vs 7 days, P < .001). No 30-day mortality occurred. Four patients (7.3%), all belonging to the Complex Group, required reoperation for postoperative complications.Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. This kind of benign liver disease requires skill-demanding procedures and should be treated in centers with expertise in both hepato-biliary surgery and hydatid disease management.
MeSH term(s)	Adult ; Aged ; Echinococcosis/diagnostic imaging ; Echinococcosis/epidemiology ; Echinococcosis/surgery ; Echinococcosis, Hepatic/diagnostic imaging ; Echinococcosis, Hepatic/epidemiology ; Echinococcosis, Hepatic/surgery ; Endemic Diseases ; Female ; Hepatectomy ; Humans ; Italy/epidemiology ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult
Language	English
Publishing date	2020-11-20
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Video-Audio Media
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000023435
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Article ; Online: The emerging role of pectoral nerve block (PECS block) in breast surgery: A case-matched analysis.

Fancellu, Alessandro / Perra, Teresa / Ninniri, Chiara / Cottu, Pietrina / Deiana, Giulia / Feo, Claudio F / Porcu, Alberto

The breast journal

2020 Volume 26, Issue 9, Page(s) 1784–1787

Abstract: To evaluate the benefits of pectoral nerve block (PECS block) in breast cancer surgery, we compared outcomes of 100 patients receiving PECS vs 107 without PECS. Intraoperative use of fentanyl (P < .001) acetaminophen (P = .02), morphine (P < .01), and ... ...

Abstract	To evaluate the benefits of pectoral nerve block (PECS block) in breast cancer surgery, we compared outcomes of 100 patients receiving PECS vs 107 without PECS. Intraoperative use of fentanyl (P < .001) acetaminophen (P = .02), morphine (P < .01), and nonsteroidal anti-inflammatory drugs (NSAIDS) (P < .01) was lower in the PECS group. Occurrence of postoperative nausea and vomiting (PONV) was lower in the PECS group (P = .04). On postoperative day 1, the use of acetaminophen (P = .23), morphine (P = .83), and NSAIDS (P = .4) did not differ. Twenty-one patients received surgery with PECS block plus sedation alone. PECS block can reduce intraoperative use of opioids and analgesic drugs, and is associated with reduced occurrence of PONV. Selected patients can receive breast-conserving surgery with PECS plus sedation, avoiding general anesthesia.
MeSH term(s)	Breast Neoplasms/surgery ; Female ; Humans ; Mastectomy ; Nerve Block ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Thoracic Nerves
Language	English
Publishing date	2020-06-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1289960-4
ISSN	1524-4741 ; 1075-122X
ISSN (online)	1524-4741
ISSN	1075-122X
DOI	10.1111/tbj.13939
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