Fabio Potenti | Florida Atlantic University (original) (raw)

Papers by Fabio Potenti

Diseases of the Colon & Rectum, 2020

T he care of geriatric patients is complex, and patients are often treated inappropriately based ... more T he care of geriatric patients is complex, and patients are often treated inappropriately based on their age, degree of frailty, or both. Therefore, it is imperative to evaluate frailty and identify areas of intervention before surgery is undertaken. In addition, patient goals should be taken into account from the start of a treatment plan, and functional recovery should be measured and addressed. This compendium presents data to help colon and rectal surgeons evaluate and treat geriatric patients. In addition , to help all surgeons function in a multidisciplinary, geriatric-friendly environment, a financial framework is included. The framework can be used to advocate for the hiring of specialists trained in caring for older adults.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, Jan 15, 2018

With an expanding elderly population and median rectal cancer detection age of 70 years, the prev... more With an expanding elderly population and median rectal cancer detection age of 70 years, the prevalence of rectal cancer in elderly patients is increasing. Management is based on evidence from younger patients, resulting in substandard treatments and poor outcomes. Modern management of rectal cancer in the elderly demands patient-centered treatment, assessing frailty rather than chronological age. The heterogeneity of this group, combined with the limited available data, impedes drafting evidence-based guidelines. Therefore, a multidisciplinary task force convened experts from the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology and the American College Surgeons Commission on Cancer, with the goal of identifying the best practice to promote personalized rectal cancer care in older patients. A crucial element for personalized care was recognized as the routine screening for frailty and geriatrician involvement and ...

Southern Medical Journal, 2003

Surgical Endoscopy, 2015

Laparoscopic total proctocolectomy (TPC) with or without ileoanal pouch is a major operation for ... more Laparoscopic total proctocolectomy (TPC) with or without ileoanal pouch is a major operation for which the traditional benefits of laparoscopy were not immediately apparent, in part due to the longer operating times. The use of energy devices has been shown to improve operative outcomes for patients who undergo laparoscopic segmental colectomies, but there are limited data for laparoscopic TPC (LTPC). All patients who underwent LTPC between January 2002 and July 2011 were identified from a prospectively maintained institutional-review-board-approved database. Univariate and multiple linear regression analyses were performed to assess the impact of electrothermal bipolar vessel sealers (EBVS) for vessel ligation on operative time. Secondary outcomes included vessel ligation failures, estimated blood loss, and other intra- and postoperative outcomes. One hundred and forty-five patients underwent LTPC, including 126 restorative ileoanal pouch and diverting ileostomy operations and 19 TPC and end ileostomy procedures. Fifteen percent of LTPCs were totally laparoscopic, 45 % were laparoscopic-assisted, 32 % were hand-assisted, and 8 % were laparoscopic-converted cases. Laparoscopic vessel ligation was performed using EBVS (76 %), endoscopic staplers (12 %), or hybrid techniques (12 %). Vessel ligation groups were similar in demographics, body mass index, surgical indication, immunosuppression, and prior surgery. EBVS were associated with shorter median operative times (247 vs. 290 vs. 300 min, p = 0.018) and fewer vessel ligation failures (1 vs. 11 vs. 12 %, p = 0.027) compared with endoscopic staplers and hybrid techniques, respectively. There were no differences in estimated blood loss and intra-operative complications among the three groups. Length of stay, 30-day morbidity, and 30-day re-operation rates were also similar. On multiple linear regression analysis, EBVS were a significant predictor of operative time (p = 0.019). Routine use of electrothermal bipolar vessel ligation for LTPC is associated with shorter operative time and fewer vessel ligation failures without higher risk of complications than other vessel control methods.

Gastroenterology, 2012

Patient demographics, preoperative risk factors and intraoperative variables were recorded. The p... more Patient demographics, preoperative risk factors and intraoperative variables were recorded. The primary end point was mortality at 30 days in dialysis dependent chronic renal failure patients. Chronic renal failure was defined by dialysis use prior to index admission excluding patients with acute kidney injury within 48 hours of colectomy. Univariate (chi-squared), and multivariate analysis (linear regression) were performed to determine predictors of mortality. Results: The study population included 1685 ESRD patients undergoing colectomy, 750 were elective and 935 emergent. Median age was 65, median ASA score was 4 and there were 850 men (50.4%). Overall mortality and morbidity was 27.5% and 54.9%. Emergent surgery was associated with an increased mortality {36.3% vs. 16.5% (p>0.0001)} and morbidity {66.5% vs. 40.4% (p>0.0001)} when compared to elective surgery. Eight factors were independent predictors of 30-day mortality: age greater then 75, functional status, pulmonary, cardiac, hepatic, neurologic comorbidity, intraoperative time, and hypoalbuminemia. Hypoalbuminemia doubled the mortality risk (odds ratio 2.0 95% CI [1.4, 3.2]). Conclusion: This study demonstrates that colorectal surgery in ESRD confers a greater morbidity and mortality than previously described. Preoperative optimization of other organ systems and nutritional status will reduce the event rate in elective surgery in patients with ESRD.

The American surgeon, 2001

The aim of this study was to compare the morbidity of subtotal colectomy with ileorectal anastomo... more The aim of this study was to compare the morbidity of subtotal colectomy with ileorectal anastomosis performed for colonic inertia, Crohn's disease, familial adenomatous polyposis, and colorectal neoplasia. A retrospective review of all patients who underwent elective colectomy with ileorectal anastomosis between June 1988 and November 1996 was performed. The patients were divided into three groups: Group I, colonic inertia; Group II, Crohn's disease; and Group III, Familial Adenomatous Polyposis or other neoplasia. Outcome factors studied included the frequency of bowel movements, the incidence of small bowel obstruction, and the incidence of anastomotic leakage. Other factors assessed included operative time, intraoperative blood loss, length of hospitalization, level of ileorectal anastomosis, time of first bowel movement, and whether the operation was undertaken in one or two stages. Statistical analysis was undertaken by using the chi-square test and the Mann-Whitney U ...

Techniques in Coloproctology, 2000

Surgical Endoscopy And Other Interventional Techniques, 2001

In this study, we set out to examine the current attitudes among surgeons toward laparoscopic col... more In this study, we set out to examine the current attitudes among surgeons toward laparoscopic colorectal surgery (LCS). A total of 3628 questionnaires were sent to all North American members of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the American Society of Colon and Rectal Surgeons (ASCRS); 40% of the members of each society responded (B15 respondents). Currently, 85% of the respondents perform laparoscopic surgery; LCS was performed by 48% of the respondents in 21% of their patients. Although 35% of the members of SAGES have increased the number of laparoscopic colorectal operations they perform in the last 3 years, only 26% of ASCRS members did so. Our findings showed that 74% of the surgeons who perform LCS do so for diverticular disease, 68% for colonic polyps, 61% for villous adenoma, and 36% for ileal Crohn&amp;#39;s disease. However, only 15% operate for the cure of carcinoma of any stage (16% of SAGES members and 11% of ASCRS members), whereas 8.5% and 7% operate for the cure of all upper and lower rectal carcinomas, respectively. Thirty-six percent of the surgeons who perform LCS for cancer have done between one and 10 curative resections, 8% have done 11-20 procedures, and 14% have done &amp;gt;20 procedures. There were 80 cases of port site recurrence reported by 4.4% of surgeons. Although 56% of the respondents would themselves undergo laparoscopic colorectal surgery for a rectal villous adenoma, only 9% would do so for a distal-third rectal carcinoma (12% of SAGES and 5% of ASCRS respondents). The overall percentage of respondents performing LCS has decreased over the last 3 years; moreover, surgeons are more hesitant to perform laparoscopic surgery for the cure of colonic cancer. Due to the overall low response rate, the fact that 4.4% of those surgeons who did respond have seen port site recurrences does not allow any conclusions to be drawn about the prevalence of this problem.

Journal of Pharmacology and Experimental Therapeutics, 2004

International Journal of Colorectal Disease, 1999

This study compared the outcome factors of morbidity and the length of disability in older and yo... more This study compared the outcome factors of morbidity and the length of disability in older and younger patients following laparoscopic colorectal surgery. All patients undergoing laparoscopic segmental resection during the study period were included. Morbidity was determined by reviewing the medical records, and disability by a patient-administered questionnaire. The series was divided into two age cohorts (</=64 and >/=65 years), which did not differ significantly in gender or type of procedure. Between these two groups we found no significant differences in mean duration of ileus (3.3 days in both groups), the mean length of hospitalization (5.7 vs. 6.3 days, respectively), morbidity rate (18% vs. 21%), or time until returning to partial activity (1.6 vs. 1.6 weeks) or to full activity (3 vs. 2 weeks). Our findings demonstrate that neither the morbidity rate nor the disability period after laparoscopic techniques differ between elderly and younger patients. We therefore endorse the use of laparoscopy regardless of patient age.

Gastroenterology, 1998

PURPOSE: To determine the feasibility of laparoscopic resection of inflammatory bowel disease. ME... more PURPOSE: To determine the feasibility of laparoscopic resection of inflammatory bowel disease. METHODS: A retrospective chart review was performed of laparoscopic procedures for Crohn's disease (CD) or chronic ulcerative colitis (CUC). RESULTS: One hundred and forty four patients were reviewed, 89 females and 55 males, age 15 to 78 years (mean 38 years). The most common diagnosis was CD, in 128 patients, with CUC in 15 and indeterminate colitis in 1 patient. Of patients with CD, 58 (40%) had previous abdominal operations, 32 for prior resection of CD and 26 unrelated to CD. The indication for operation in CD was refractory disease in 27, and obstruction +/-stricture in 39 patients; 49 patients had a preoperative diagnosis of fistula, phlegmon or abscess. There were unexpected intraoperative findings in 41 patients, with phlegmon and fistula being the most common intraoperative findings. The conversion rate for patients with CD was 20/128 or 15.6%, and 2/15 or 13% in CUC. Among the 27 patients in whom the preoperative indication was solely refractory disease, only 4 had unexpected intraoperative findings, and there were no conversions. Among those patients who had a preoperative diagnosis of obstruction +/-stricture, 9 had unexpected findings at laparoscopy, and the conversion rate was 4/39 or 10%. Of those 49 patients with a preoperative diagnosis of fistula, abscess or phlegmon, the conversion rate was 14/49 or 29%, and 23 of these patients had additional unexpected findings at laparoscopy. Overall there were 8 intraoperative complications, for a rate of 5.6%. The post-operative complication rate was 17/144 or 12%; of these, 4 were wound infections, for a rate of 4/144 or 2.7%. There was no operative mortality. The mean length of stay for the whole series, including converted cases, was 5.7 days. CONCLUSIONS: The laparoscopic approach is highly feasible in CUC and in CD, with low conversion rates in the absence of preoperative findings of fistula, abscess or phlegmon. Even with a preoperative diagnosis of fistula, abscess or phlegmon, the laparoscopic approach is feasible in 70% of patients.

Diseases of the Colon & Rectum, 1996

Archives of Surgery, 2002