Riccardo Piagnerelli

Evolution and emerging future of cytoreducxtive surgery and hyperthermic intraperitoneal chemoperfusion in gastric cancer: From treating the incurable to preventing recurrence.

Abstract The number of new gastric cancer (GC) cases is decreasing, and these patients have longer survival thanks to new oncological treatments. In advanced GC a common evolution of this neoplasm is peritoneal metastases (PM). In the past this finding meant no chance for cure. However, today, using high quality operations and HIPEC, we are able to increase the number of patients treated with curative intention. New options in the diagnosis of PM, tumour susceptibility for different drugs, importance of quality of life, usage in ascites treatment, diagnostic tools in image-guided surgery, new targeted therapies and analysis of currently ongoing trials are presented together with today’s knowledge of HIPEC efficacy in order to evaluate gastric PM. HIPEC is an effective tool in the treatment of selected patients with PM from GC. Together with new diagnostic options such as targeted therapies, HIPEC may improve the prognosis of these patients, not only by treating clinically manifest carcinomatosis, but also in the prophylactic setting, addressing occult peritoneal seeding.

Robotic single docking total colectomy for ulcerative colitis: First experience with a novel technique

INTRODUCTION We describe a novel technique that could aid the surgeon to perform a total proctocolectomy with a single docking position of the da Vinci Si HD System. METHODS Patients were positioned in 20° Trendelenburg lithotomy split legs position. A 12-mm trocar was for camera and 3 more trocars were placed: two robotics on left and right flanks and one laparoscopic in left iliac fossa. The robot was docked between the legs of the patients. RESULTS Four proctocolectomies were performed. Mean operative time was 235 min (range 215-255); mean blood loss was 100 cc (range 50-200). Median post-operative stay was 6 days. Overall morbidity was 75%, whereas major complications occurred in 25%. Post-operative mortality was null. CONCLUSIONS The robotic single docking approach to perform total proctocolectomy for ulcerative colitis is a time-saving technique respect to the multiple docking approach.

Laparoscopy Versus Robotic Surgery for Colorectal Cancer: A Single-Center Initial Experience

Background. Minimally invasive approach has gained interest in the treatment of patients with colorectal cancer. The purpose of this study is to analyze the differences between laparoscopy and robotics for colorectal cancer in terms of oncologic and clinical outcomes in an initial experience of a single center. Materials and Methods. Clinico-pathological data of 100 patients surgically treated for colorectal cancer from March 2008 to April 2014 with laparoscopy and robotics were analyzed. The procedures were right colonic, left colonic, and rectal resections. A comparison between the laparoscopic and robotic resections was made and an analysis of the first and the last procedures in the 2 groups was performed. Results. Forty-two patients underwent robotic resection and 58 underwent laparoscopic resection. The postoperative mortality was 1%. The number of harvested lymph nodes was higher in robotics. The conversion rate was 7.1% for robotics and 3.4% for laparoscopy. The operative time was lower in laparoscopy for all the procedures. No differences were found between the first and the last procedures in the 2 groups. Conclusions. This initial experience has shown that robotic surgery for the treatment of colorectal adenocarcinoma is a feasible and safe procedure in terms of oncologic and clinical outcomes, although an appropriate learning curve is necessary. Further investigation is needed to demonstrate real advantages of robotics over laparoscopy.

Assessing the feasibility of full robotic interaortocaval nodal dissection for locally advanced gastric cancer

The clinical value of super‐extended lymph node dissection (D2+) is still debated. This procedure has not been reported using the laparoscopic or robotic approach. Although this technique, in low‐volume centres, could lead to an increased risk of morbidity, in high‐volume centres morbidity and mortality are similar to those of the standard D2 lymphadenectomy. Robotic surgery could overcome the limitations of laparoscopic surgery, especially in the removal of posterior nodal stations. In this report we describe the feasibility of fully robotic interaortocaval lymphadenectomy, following similar steps to those of the traditional open approach.

Cholangiocarcinoma: A Single-center Western Experience

Background: The purpose of this study was to summarize the surgical management and to evaluate survival rate and clinical outcome of cholangiocarcinoma, in patients hospitalized in our Unit of Oncology and General Surgery.Methods: This is a retrospective analysis of 76 consecutive patients with diagnosis of cholangiocarcinoma. The surgical procedure was selected based on the origin of the neoplasia. Tumor stage was defined according to the pathological tumour-node-metastasis classification (TNM 7th edtn, 2010). After resection, all patients underwent regular follow-up.Results: During the study period, 58 patients underwent explorative laparotomy. Forty-six patients were submitted to respective surgery with curative intent. A curative resection (R0) was achieved in 42/46 resected patients. The overall median survival time was 14.2 months, with 1, 3 and 5 year survival rates of 53.6%, 37.7%, and 19.6%, respectively. The survival rates, for the patients underwent R0 resection, was respectively 69%, 47.8% and 32.6% at 1, 3 and 5 years, with median survival time of 20.1 months.Conclusions: Our experience confirms the main role of R0 surgery in the curative treatment of cholangiocarcinoma.

Signet Ring Carcinoma in EGJ: What Is It?

Signet ring cell carcinoma (SRCc) of the esophagogastric junction (EGJ) is a histological subtype of adenocarcinoma (ADC). Its incidence in the literature series is variable, mainly due to a lack of reporting standardization and to variable incidence in different populations.

Intestinal Stenosis of Garré: An Old Problem Revisited

Background: Intestinal stenosis of Garré, first described in 1892, is a rare condition as a consequence of a complicated strangulated hernia. Preoperative diagnosis is challenging because of unspecific symptoms. Proper anamnesis, especially in terms of clinical and surgical history, as well as careful examination of both inguinal spaces is essential. Case Report: We herein present a case of intestinal stenosis of Garré in a 70-year-old female. Conclusion: Intestinal stenosis of Garré should be considered in cases of occlusive symptoms occurring after a non-operative or surgical reduction of a strangulated hernia. A correct diagnosis and an adequate surgical treatment are necessary to solve this rare complication favorably.