Riccardo Bellagamba

The impact of splenectomy on outcomes after distal and total pancreatectomy

BackgroundSeveral authors advocate spleen preserving distal pancreatectomy, because of the increased complication rate after splenectomy.MethodsPostoperative complications and survival after distal and total pancreatectomy, were recorded and retrospectively analyzed according to spleen preservation. Patients, who underwent distal and total pancreatectomy without histologically proven adenocarcinoma, or extrapancreatic disease, were included in the cohort which was divided into splenectomy and no splenectomy groups. Statistical analysis was performed using Fishers test.ResultsThe study group consisted of 62 patients who underwent distal and total pancreatectomy between 26/11/1987 to 6/1/2006. Splenectomy was performed in 35 out of 62 patients (56.5%), distal pancreatectomy was performed in 49 out of 62 patients (79%). Morbidity rate was 28.6% in splenectomy group and 14.8% in the no splenectomy group (p = 0.235), while 30 days mortality rate was 2.9%; one patient died in the splenectomy group (p = 1).ConclusionSpleen-preservation did not influence the outcomes after distal and total pancreatectomy in our series.

Emergency laparotomy for misdiagnosed biliary cystadenoma originating from caudate lobe

BackgroundBiliary cystadenoma is a rare benign neoplasm, which is often misdiagnosed for a hepatic abscess or a hydatid cyst that tends to recur and is at risk for progression to malignant neoplasm.Case presentationThis case describes a 30-year-old woman admitted to our institution in an emergency setting. The patient was originally misdiagnosed as affected by a hepatic hydatid cyst at another hospital, and then emergently treated at our Institution for severe abdominal pain. Histologic evaluation of the cyst showed that it was a biliary cystadenoma and, therefore, the patient underwent a hepatic resection in order to completely remove the lesion.ConclusionComplete excision of any suspicious hepatic cystic lesion remains the best method for diagnosis and treatment of cystadenoma. Incomplete excision of most biliary cystadenoma results in a higher rate of recurrence and the risk of malignant transformation. We report this case to elucidate the clinical presentation, preoperative evaluation, and surgical treatment of these rare lesions.

Vascular endothelial growth factor C and microvessel density in gastric carcinoma: correlation with clinicopathological factors. Our experience and review of the literature.

Vascular endothelial growth factor (VEGF) has been reported to promote lymphangiogenesis and its overexpression may be related to lymph node metastasis in gastric carcinoma. Microvessel density (MVD) has been investigated as a promoting factor for angiogenesis with conflicting results about its relation to survival. The study aims to investigate the expression of one subtype of VEGF, vascular endothelial growth factor C (VEGF-C), and MVD in gastric carcinoma specimens and their relation with clinicopathological factors. Specimens from 72 patients who underwent gastric resection for gastric carcinoma were analyzed by immunohistochemistry for the VEGF-C study and by monoclonal antibodies for the study of MVD. The VEGF-C and MVD expressions were related to clinicopathological features. High MVD was significantly related to the T stage (p = 0.036); VEGF-C expression was significantly higher in N positive patients (p = 0.047). No relation was found between MVD and VEGF-C expression. An extensive review of the literature was made and data were compared to ours. VEGF-C and MVD resulted to have significant relation with cliniico-pathological features. Further studies are required to determine whether these factors may be used in clinical practice in order to define the relationship with prognosis and to better characterize the biologic features of gastric carcinoma.

Minimally invasive adrenalectomy for incidentally discovered cavernous hemangioma

Cavernous hemangiomas are rare, benign, non‐functioning neoplastic lesions that often involve liver and skin. Hemangiomas of the adrenal gland are very uncommon, and usually found accidentally in otherwise asymptomatic patients. This paper reports the only case of a large cavernous hemangioma removed with transperitoneal laparoscopic adrenalectomy and reviews the literature.

Comparison between transperitoneal and retroperitoneal minimal invasive adrenalectomy in 189 cases

Results Period I Twenty-nine patients were recorded. Mean operative time was 185.6 ± 37.2 min and 125.7 ± 37.7 min in the RLA and TLA subgroup (P < 0.005). Two procedures were converted in the TLA (splenic lesion and haemorrhage). The time of first oral intake was 1.25 ± 0.4 days after the RLA, and 2.76 ± 1.5 days after the TLA (P < 0.005). The mean hospital stay in the RLA subgroup was 3.8 ± 1.1 days versus 6.3 ± 2.7 days in the TLA subgroup (P < 0.005).