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Niccolò Petrucciani Tarek Debs Giuseppe Nigri Giulia Giannini Elena Sborlini Radwan Kassir Imed Ben Amor Antonio Iannelli Stefano Valabrega Francesco DAngelo Jean Gugenheim Giovanni Ramacciato 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):3-10
Background
Multivisceral resections combined with pancreatectomy have been proposed in selected patients with tumor invasion into adjacent organs, in order to allow complete tumor resection. Some authors have also reported multivisceral resection combined with metastasectomy in very selected cases. The utility of this practice is debated. The aim of the review is to compare the postoperative results and survival of pancreatectomies combined with multivisceral resections with those of standard pancreatectomies.Methods
A systematic literature search was performed to identify all studies published up to February 2017 that analyzed data of patients undergoing multivisceral and standard pancreatectomies. Clinical effectiveness was synthetized through a narrative review with full tabulation of results.Results
Three studies were retrieved, including 713 (80%) patients undergoing standard pancreatectomies and 176 (20%) undergoing multivisceral resections (MVR). Postoperative morbidity ranged from 37% to 50% after standard resections and from 56% to 69% after MVR. In-hospital mortality ranged from 4% after standard pancreatectomies to 10% after MVR. Median survival ranged from 20 to 23 months in standard resections and from 12 to 20 months after MVR, without significant differences.Discussion
The current literature suggests that multivisceral pancreatectomies are feasible and may increase the number of completely resected patients. Morbidity and mortality are higher than after standard pancreatectomies, and these procedures should be reserved to selected patients in referral centers. Further studies on the role of neoadjuvant therapy in this setting are advisable. 相似文献55.
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Cristina Mantovani Niccolo Giaj Levra Andrea R. Filippi Silvia Novello Lucio Buffoni Riccardo Ragona Umberto Ricardi 《Clinical lung cancer》2013,14(2):194-199
BackgroundAdjuvant radiotherapy in non–small-cell lung cancer (NSCLC) is still controversial. The purpose of this retrospective study was to evaluate the role of postoperative radiotherapy (PORT) in terms of local control and survival in pathologic N2 NSCLC.Patients and MethodsFrom January 2003 to December 2008, 66 patients with pathologic N2 NSCLC received PORT. Mediastinal lymph node metastases were classified into single (12 patients) or multiple (54 patients) stations. All patients received conformal radiation therapy, with a median total dose of 50.4 Gy. Target volumes included the bronchial stump, ipsilateral hilum, all pathologically involved lymph node regions, and all the lymph nodes between 2 noncontiguous pathologic nodal stations. The pattern of failure was considered as locoregional or systemic, or a combination of both. Locoregional failure was defined as in field or out of field.ResultsMedian follow-up time was 34.9 months (range 3.5-62.8 months). Local control was 80% at 12 months, 77.2% at both 24 and 36 months, and 72.1% at 60 months. The pattern of failure was locoregional in 3 patients (1 out of field and 2 in field) and systemic in 25 patients, with 12 patients presenting both locoregional and distant disease. Overall survival at 12, 36, and 60 months was 77%, 44%, and 37%, respectively. Median survival time was 34 months. The number of pathologically involved lymph node stations was a prognostic factor for local control (P = .05), cancer-specific survival (CSS) (P = .04), and disease-free survival (DFS) (P = .04).ConclusionDespite the limitations of the present study, mainly represented by its retrospective nature, our data support the role of PORT in terms of locoregional control and overall survival benefit; the number of involved mediastinal lymph nodes represents a significant prognostic factor in patients with pathologic N2 NSCLC. 相似文献
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Alessandro Di Rienzo Maurizio Iacoangeli Lorenzo Alvaro Roberto Colasanti Niccolo Nocchi Lucia Giovanna Maria Di Somma Massimo Scerrati 《Neurologia medico-chirurgica》2013,53(9):590-595
Temporalis muscle reconstruction is a necessary step during frontotemporal cranioplasty ensuing decompressive craniectomy (DC). During this procedure, scarring between the temporalis muscle and the dural layer may lead to complicated muscle dissection, which carries an increased risk of dura and muscle damage. At time of DC, temporalis muscle wrapping by an autologous vascularized dural flap can later on facilitate dissection and rebuilding during the subsequent cranioplasty. In a span of 2 years, we performed 57 DCs for different etiologies. In 30 cases, the temporalis muscle was isolated by wrapping its inner surface using the autologous dura. At cranioplasty, the muscle could easily be dissected from the duraplasty. The inner surface was easily freed from the autologous dural envelope, and reconstruction achieved in an almost physiological position. Follow-up examinations were held at regular intervals to disclose signs of temporalis muscle depletion. Twenty-five patients survived to undergo cranioplasty. Muscle dissection could always be performed with no injury to the dural layer. No complications related to temporalis muscle wrapping were recorded. Face asymmetry developed in four cases but it was always with bone resorption. None of the patients with a good neurological recovery reported functional or aesthetic complaints. In our experience, temporalis muscle wrapping by vascularized autologous dura proved to be effective in preserving its bulk and reducing its adhesion to duraplasty, thereby improving muscle dissection and reconstruction during cranioplasty. Functional and aesthetic results were satisfying, except in cases of bone resorption. 相似文献
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Yuval Freifeld Yin Xi Niccolo Passoni Solomon Woldu Brad Hornberger Kenneth Goldberg Aditya Bagrodia Ganesh Raj Vitaly Margulis Jeffrey A. Cadeddu Yair Lotan Franto Francis Ivan Pedrosa Claus G. Roehrborn Daniel N. Costa 《Urologic oncology》2019,37(1):57-62
Objectives
To determine the implications of different prostate sampling schemes on the diagnosis of clinically significant prostate cancer (csPCA, ISUP group 2–5) and clinically insignificant prostate cancer (ciPCA, ISUP group 1) in men with abnormal multiparametric magnetic resonance imaging (mpMRI) undergoing MRI-transrectal ulrasound fusion targeted biopsies.Materials and Methods
This is a retrospective analysis of a cohort including all men who had a single lesion on mpMRI of the prostate performed between January 2016 and June 2017. All men underwent an MRI-transrectal ulrasound fusion biopsy and systematic (SBx) sampling of the prostate, which combined and were considered the standard of reference. The hypothetical 3 biopsy sampling schemes were defined as follows: Targeted biopsy only (TBx), TBx?+?ipsilateral SBx (ipsi-SBx) and TBx?+?contralateral SBx (contra-SBx) and were evaluated for the detection of csPCA and ciPCA. Sensitivity and 95% intervals were calculated, McNemar test was used to compare sensitivities between the various sampling schemes.Results
TBx?+?SBx detected csPCa in 47% (55 of 116) of the 116 men who met eligibility criteria. Sensitivity and 95% confidence intervals for csPCa detection was 85.5% (73.3%–93.5%), 96.4% (87.5%–99.6%), and 92.7 (82.4%–98%) for TBx alone, TBx?+?ipsi-SBx and TBx?+?contra-SBx, respectively. csPCa detection rates were higher for both TBx?+?ipsi-SBx and TBx?+?contra-SBx compared to TBx alone. Clinically insignificant cancers alone were detected in 7.7% (9 of 116), 10.3% (12 of 116), and 14.6% (17 of 116) of the cohort by TBx only and TBx?+?ipsi-SBx, and TBx?+?contra-SBx, respectively.Conclusions
TBx?+?ipsi-SBx may increase the detection of csPCa while limiting overdiagnosis of indolent cancers. 相似文献59.
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Giovanni Ramacciato MD FACS Paolo Mercantini MD PhD Niccolò Petrucciani MD Valentina Giaccaglia MD Giuseppe Nigri MD Matteo Ravaioli MD Matteo Cescon MD Alessandro Cucchetti MD Massimo Del Gaudio MD 《Annals of surgical oncology》2009,16(4):817-825
Background Pancreatic carcinoma frequently infiltrates the portal vein or the superior mesenteric vein; pancreatectomy combined with
portal vein/superior mesenteric vein resection represents a potentially curative treatment in these cases but is still a controversial
procedure.
Methods After performing a computerized Medline search, 12 series published during the last 8 years were selected, enrolling 399 patients
who underwent pancreatectomy combined with portal vein/superior mesenteric vein resection for pancreatic carcinoma. Data were
examined for information about indications, operation, adjuvant therapies, histopathology of resected specimens, perioperative
results, and survival. Also, previous literature regarding the issue was extensively reviewed.
Results Operative mortality and postoperative complication rates ranged from 0 to 7.7% and 16.7% to 54%, respectively. Median survival
varied from 13 to 22 months; 5-year survival rate ranged from 9% to 18%.
Conclusions The current literature suggests that portal vein/superior mesenteric vein resection combined with pancreatectomy is a safe
and feasible procedure that increases the number of patients who undergo curative resection and, therefore, provides important
survival benefits to selected groups of patients. This procedure should always be considered in case of suspected tumor infiltration
of portal/superior mesenteric vein to achieve clear resection margins, in the absence of other contraindications for resection. 相似文献