A. Zanghì - Academia.edu (original) (raw)
Papers by A. Zanghì
La Clinica terapeutica, 2012
Among adrenal masses only 0.06% to 0.18% are cysts and among them, pseudocysts are the second (39... more Among adrenal masses only 0.06% to 0.18% are cysts and among them, pseudocysts are the second (39%) most common lesions. Due to the increased use of imaging studies their incidence seems to have increased. Most of these lesions are incidentally found during radiologic investigation or at the time of autopsy, and only rarely they are detected in pregnant women. The latter scenario warrants emergency surgery, due to the risk of rupture. We present a case of a 39-years old woman presenting with unrelenting left flank pain due to a large adrenal pseudocyst soon after her first delivery. Four months after, she presented to our surgical division for persistent pain and anemia so underwent an extensive work up that showed a large pseudocystic mass (8 x 8 cm ) of the left adrenal gland. Once the neoplastic and parasitic etiology of the lesion were excluded, she underwent uneventful laparoscopic adrenalectomy. She was discharged home three days postoperatively. This case is the 13th case in ...
Annali italiani di chirurgia
In the current debate on the indications for the laparoscopic treatment of symptomatic simple hep... more In the current debate on the indications for the laparoscopic treatment of symptomatic simple hepatic cysts, we emphasize the importance of the exact indications, practicing in an area endemic for hepatic hydatidosis. 8 years ago we started treating laparoscopically the simple hepatic cysts and the polycystosis. Although the laparoscopic approach to parasitic hepatic cysts has been recently introduced, this method has to be the result of a conscious choice and with a presumptive diagnosis to support it. In fact, reviewing the literature on the subject, we realized how most of the intraoperative complications were due to an erroneous preoperative diagnosis, likely to be attributed to the infrequent observation of hepatic hydatid disease. Hence, it seems of primary importance to review the subject in light of the potential dangerous aspect of the laparoscopic approach. From 1992 to 2000 we treated 38 cases of benign liver cystic disease (29 echinococcal cysts, 8 symptomatic simple cys...
Minerva chirurgica, 1998
The role of lymphadenectomy in the treatment of large bowel cancer is still controversial, not on... more The role of lymphadenectomy in the treatment of large bowel cancer is still controversial, not only because it is deemed to be a basic element for a correct postoperative staging, but also because it brings about, according to some authors, an enhancement of survival and of "disease free survival" rates. The difficulty to collect case histories with homogeneous data and the impossibility to identify preoperatively with certainty the lymph nodes involved, makes it difficult to codify the most suitable surgical treatment, even if it is agreed at present, to extend lymph nodes dissection at least as far as Level II nodes. As a matter of fact, despite of slight enhancement of 5-year survival rate (6-8%), a significant increase in morbility occurs, as reported in the literature, particularly in terms of urological and neurological lesions. However, a few authors, perform systematically Level III dessection, reporting a 20% increase in survival. Our study, has been carried out o...
Gastric neuroendocrine tumors (g-NETs), which originate from gastric enterochromaffin-like (ECL) ... more Gastric neuroendocrine tumors (g-NETs), which originate from gastric enterochromaffin-like (ECL) mucosal cells and account for 2.4% of all carcinoids, are increasingly recognized due to expanding indications of upper gastrointestinal endoscopy.
International Journal of Surgery, 2014
Introduction: Gallbladder cancer (GBC) is the fifth most common neoplasm of the gastrointestinal ... more Introduction: Gallbladder cancer (GBC) is the fifth most common neoplasm of the gastrointestinal tract and the most common cancer of the biliary tract. GBC is suspected preoperatively in only 30e40% of patients. The other 60e70% are discovered incidentally (IGBC) by the pathologist on a gallbladder specimen following cholecystectomy for benign diseases such as polyps, gallstones, and cholecystitis. Materials and methods: Between 1995 and 2011, 30 cases of GBC, who underwent resection with curative intent in our institutions, were retrospectively reviewed. They were analyzed for demographic data, and type of operation, surgical morbidity and mortality, histopathological classification, and survival. Incidental GBC was compared with suspected or preoperatively diagnosed GBC. Overall survival, disease-free survival (DFS) and the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention were analyzed. The authors also present a systematic review to evaluate the role of extended surgery in the treatment of the incidental GBC. Results: GBC was diagnosed in 30 patients, 16 women and 14 men. The M/F ratio was 1:1.14 and the mean age was 69.4 years (range 45e83 years). A preoperative diagnosis was possible only in 14 cases; fourteen of the incidental cases were diagnosed postoperatively after the pathological examination; two were suspected intraoperatively at the opening of the surgical specimen and then confirmed by frozen sections. The ratio between incidental and nonincidental cases was 1, 14/1, with twelve cases discovered after laparoscopic cholecystectomy. Eighty-one per cent of the incidental cases were discovered at an early stage ( II). The preoperative diagnosis of the 30 patients with GBC was: GBC with liver invasion diagnosed by preoperative CT (nine cases); gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case); porcelain gallbladder (three cases); gallbladder adenoma (four cases); and chronic cholecystolithiasis (thirteen cases). Every case, except one, with a T1b or more advanced invasion underwent IVb þ V wedge liver resection and pericholedochic/hepatoduodenal lymphoadenectomy. One patient refused further surgery. Cases with Tis and T1a involvement were treated with cholecystectomy alone. Nine of the sixteen patients with incidental diagnosis reached 5-year DFS (56.25%) and eight of them are recurrence free. Surprisingly, one patient reached 38 mo survival despite a port-site recurrence (the only one in our experience) 2 years after the original surgery requiring further resection. Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5 years DFS .
Background: Breast cancer (BC) remains principally a disease of old ages; with 35-50% of cases oc... more Background: Breast cancer (BC) remains principally a disease of old ages; with 35-50% of cases occurring in women older than 65 years. Even mortality for cancer increases with aging: 19.7% between 65 and 74 years; 22.6% between 75 and 84 years; and 15.1% in 85 years or more. The study was aimed to investigate specific predictive factors for elderly patients so to select the best way to treat and follow these patients.
SURGICAL TREATMENT OF MUCOSAL HEMOR- RHOIDAL PROLAPSE USING A CIRCULAR STAPLER We present a retro... more SURGICAL TREATMENT OF MUCOSAL HEMOR- RHOIDAL PROLAPSE USING A CIRCULAR STAPLER We present a retrospective clinical study concerning our per- sonal experience with the circular stapler in the treatment of hemorrhoids; the aim of this study was to evaluate the risults of this surgical procedure, in terms of operative time, postoperative pain and rate of both short and long-term complications.
La Clinica terapeutica, 2012
Among adrenal masses only 0.06% to 0.18% are cysts and among them, pseudocysts are the second (39... more Among adrenal masses only 0.06% to 0.18% are cysts and among them, pseudocysts are the second (39%) most common lesions. Due to the increased use of imaging studies their incidence seems to have increased. Most of these lesions are incidentally found during radiologic investigation or at the time of autopsy, and only rarely they are detected in pregnant women. The latter scenario warrants emergency surgery, due to the risk of rupture. We present a case of a 39-years old woman presenting with unrelenting left flank pain due to a large adrenal pseudocyst soon after her first delivery. Four months after, she presented to our surgical division for persistent pain and anemia so underwent an extensive work up that showed a large pseudocystic mass (8 x 8 cm ) of the left adrenal gland. Once the neoplastic and parasitic etiology of the lesion were excluded, she underwent uneventful laparoscopic adrenalectomy. She was discharged home three days postoperatively. This case is the 13th case in ...
Annali italiani di chirurgia
In the current debate on the indications for the laparoscopic treatment of symptomatic simple hep... more In the current debate on the indications for the laparoscopic treatment of symptomatic simple hepatic cysts, we emphasize the importance of the exact indications, practicing in an area endemic for hepatic hydatidosis. 8 years ago we started treating laparoscopically the simple hepatic cysts and the polycystosis. Although the laparoscopic approach to parasitic hepatic cysts has been recently introduced, this method has to be the result of a conscious choice and with a presumptive diagnosis to support it. In fact, reviewing the literature on the subject, we realized how most of the intraoperative complications were due to an erroneous preoperative diagnosis, likely to be attributed to the infrequent observation of hepatic hydatid disease. Hence, it seems of primary importance to review the subject in light of the potential dangerous aspect of the laparoscopic approach. From 1992 to 2000 we treated 38 cases of benign liver cystic disease (29 echinococcal cysts, 8 symptomatic simple cys...
Minerva chirurgica, 1998
The role of lymphadenectomy in the treatment of large bowel cancer is still controversial, not on... more The role of lymphadenectomy in the treatment of large bowel cancer is still controversial, not only because it is deemed to be a basic element for a correct postoperative staging, but also because it brings about, according to some authors, an enhancement of survival and of "disease free survival" rates. The difficulty to collect case histories with homogeneous data and the impossibility to identify preoperatively with certainty the lymph nodes involved, makes it difficult to codify the most suitable surgical treatment, even if it is agreed at present, to extend lymph nodes dissection at least as far as Level II nodes. As a matter of fact, despite of slight enhancement of 5-year survival rate (6-8%), a significant increase in morbility occurs, as reported in the literature, particularly in terms of urological and neurological lesions. However, a few authors, perform systematically Level III dessection, reporting a 20% increase in survival. Our study, has been carried out o...
Gastric neuroendocrine tumors (g-NETs), which originate from gastric enterochromaffin-like (ECL) ... more Gastric neuroendocrine tumors (g-NETs), which originate from gastric enterochromaffin-like (ECL) mucosal cells and account for 2.4% of all carcinoids, are increasingly recognized due to expanding indications of upper gastrointestinal endoscopy.
International Journal of Surgery, 2014
Introduction: Gallbladder cancer (GBC) is the fifth most common neoplasm of the gastrointestinal ... more Introduction: Gallbladder cancer (GBC) is the fifth most common neoplasm of the gastrointestinal tract and the most common cancer of the biliary tract. GBC is suspected preoperatively in only 30e40% of patients. The other 60e70% are discovered incidentally (IGBC) by the pathologist on a gallbladder specimen following cholecystectomy for benign diseases such as polyps, gallstones, and cholecystitis. Materials and methods: Between 1995 and 2011, 30 cases of GBC, who underwent resection with curative intent in our institutions, were retrospectively reviewed. They were analyzed for demographic data, and type of operation, surgical morbidity and mortality, histopathological classification, and survival. Incidental GBC was compared with suspected or preoperatively diagnosed GBC. Overall survival, disease-free survival (DFS) and the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention were analyzed. The authors also present a systematic review to evaluate the role of extended surgery in the treatment of the incidental GBC. Results: GBC was diagnosed in 30 patients, 16 women and 14 men. The M/F ratio was 1:1.14 and the mean age was 69.4 years (range 45e83 years). A preoperative diagnosis was possible only in 14 cases; fourteen of the incidental cases were diagnosed postoperatively after the pathological examination; two were suspected intraoperatively at the opening of the surgical specimen and then confirmed by frozen sections. The ratio between incidental and nonincidental cases was 1, 14/1, with twelve cases discovered after laparoscopic cholecystectomy. Eighty-one per cent of the incidental cases were discovered at an early stage ( II). The preoperative diagnosis of the 30 patients with GBC was: GBC with liver invasion diagnosed by preoperative CT (nine cases); gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case); porcelain gallbladder (three cases); gallbladder adenoma (four cases); and chronic cholecystolithiasis (thirteen cases). Every case, except one, with a T1b or more advanced invasion underwent IVb þ V wedge liver resection and pericholedochic/hepatoduodenal lymphoadenectomy. One patient refused further surgery. Cases with Tis and T1a involvement were treated with cholecystectomy alone. Nine of the sixteen patients with incidental diagnosis reached 5-year DFS (56.25%) and eight of them are recurrence free. Surprisingly, one patient reached 38 mo survival despite a port-site recurrence (the only one in our experience) 2 years after the original surgery requiring further resection. Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5 years DFS .
Background: Breast cancer (BC) remains principally a disease of old ages; with 35-50% of cases oc... more Background: Breast cancer (BC) remains principally a disease of old ages; with 35-50% of cases occurring in women older than 65 years. Even mortality for cancer increases with aging: 19.7% between 65 and 74 years; 22.6% between 75 and 84 years; and 15.1% in 85 years or more. The study was aimed to investigate specific predictive factors for elderly patients so to select the best way to treat and follow these patients.
SURGICAL TREATMENT OF MUCOSAL HEMOR- RHOIDAL PROLAPSE USING A CIRCULAR STAPLER We present a retro... more SURGICAL TREATMENT OF MUCOSAL HEMOR- RHOIDAL PROLAPSE USING A CIRCULAR STAPLER We present a retrospective clinical study concerning our per- sonal experience with the circular stapler in the treatment of hemorrhoids; the aim of this study was to evaluate the risults of this surgical procedure, in terms of operative time, postoperative pain and rate of both short and long-term complications.