Fabrizio Luca - Academia.edu (original) (raw)
Papers by Fabrizio Luca
Journal of Robotic Surgery, Dec 16, 2010
To date, no studies have investigated the estimated blood loss (EBL) after full robotic low anter... more To date, no studies have investigated the estimated blood loss (EBL) after full robotic low anterior resection (R-LAR) in a case-matched model, comparing it with the conventional open approach (O-LAR). Forty-nine patients in the R-LAR and 105 in the O-LAR group were matched for age, gender, BMI (body mass index), ASA (American Society of Anesthesiology) class, tumor-nodemetastasis (TNM) classification and UICC (Union for International Cancer Control) stage, distance of the lower edge of the tumor from the anal verge, presence of comorbidities, and preoperative hemoglobin (Hb). EBL was significantly higher in the O-LAR group (P \ 0.001); twelve units of packed red blood cells were globally transfused in the O-LAR group, compared to one unit only in the R-LAR (P = 0.051). A significantly higher postoperative Hb drop (3.0 vs. 2.4 g/dL, P = 0.015) was registered in the O-LAR patients. The length of hospital stay was much lower for the R-LAR group (8.4 vs. 12.4 days, P \ 0.001). The number of harvested lymph nodes (17.4 vs. 13.5, P = 0.006) and extent of distal margin (2.9 vs. 1.9 cm, P \ 0.001) were significantly higher in the R-LAR group. Open surgery was confirmed as the sole variable significantly associated (P \ 0.001) with blood loss (odds ratio = 4.41, 95% CI 2.06-9.43). It was a confirmed prognosticator of blood loss (P = 0.006) when a preoperative clinical predictive model was built, using multivariate analysis (odds ratio = 3.95, 95% CI 1.47-10.6). In conclusion, R-LAR produced less operative blood loss and less drop in postoperative hemoglobin when compared to O-LAR. Other clinically relevant outcomes were similar or superior to O-LAR.
PubMed, Jun 1, 1996
Aim: To assess whether there is a correlation between the onset of postoperative sepsis and the 5... more Aim: To assess whether there is a correlation between the onset of postoperative sepsis and the 5-years survival rate in patients undergoing surgery for rectal cancer. Experimental design: A retrospective study of all patients, undergoing rectal cancer surgery during the period January 1981-December 1987. Place: General Surgery Unit, Hospital Arnau de Vilanova. Patients: All patients operated with Duke's stage B and C colorectal neoplasms, excluding cases with postoperative complications not directly correlated to surgery: pneumonia, thromboblebitis, urinary infection or fever of unknown origin. Findings: Postsurgical complications distinguished as minor (wall abscess) or major (anastomotic dehiscence, peritoneal abscess). 5-year survival rate. Results: The actuarial 5-year survival rate of patients with major septic complications was significantly lower (p < 0.05) than that in noncomplicated cases. No difference was observed in the survival of patients with and without minor septic complications. Conclusion: Major septic complications secondary to colorectal surgery are still a threat in spite of improved techniques and antibiotic prophylaxis, and negatively influence the long-term survival rate.
International Journal of Radiation Oncology Biology Physics, Oct 1, 2009
To evaluate the impact of neoadjuvant capecitabine, concomitant to radiotherapy, followed by cape... more To evaluate the impact of neoadjuvant capecitabine, concomitant to radiotherapy, followed by capecitabine monotherapy, in operable locally advanced rectal cancer (LARC) by measuring pathologic response and conservative surgery rate, toxicity profile, and disease-free survival (DFS). From October 2002 to July 2006, a total of 51 patients affected by LARC (T3-T4 or any node positive tumor), received capecitabine (825 mg/m(2), orally, twice daily continuously) concomitant to radiotherapy on the pelvis (50.4 Gy/ 28 fractions), followed by two cycles of capecitabine (1,250 mg/m(2), orally, twice daily, 14 days on 7 days off) up until 2 weeks before surgery. Tailored adjuvant systemic treatment was discussed according to pathologic stage. Of 51 patients, (median age 61 years, range 38-82 years; 19 women and 32 men; ECOG performance status 0/1/2: 46/4/1), 50 were evaluable for response: 18% complete pathologic remission; 12% T-downstaging, and 30% N-downstaging. One patient died before surgery from mesenteric stroke. Grade 3 acute toxicities were 2% diarrhea, 8% dermatitis, 2% liver function test elevation, and 2% hand-foot syndrome. Sphincter preservation rates for tumors &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =6 cm from the anal verge were 62% and 80% for the whole population. Median follow up was 43.0 months (range 0.8-68.6 months). Five-years DFS was 85.4% (95% CI = 75.3-95.4%). Based on our study results, we conclude that this regimen is well tolerated and active and compares favorably with existing capecitabine-based approaches.
Ejso, Sep 1, 2014
Background: Despite the several series in which the short-term outcomes of robotic-assisted surge... more Background: Despite the several series in which the short-term outcomes of robotic-assisted surgery were investigated, data concerning the long-term outcomes are still scarce. Methods: The prospectively collected records of 65 consecutive patients with extraperitoneal rectal cancer who underwent robotic total mesorectal excision (RTME) were compared with those of 109 consecutive patients treated with open surgery (OTME). Patient characteristics, pathological findings, local and systemic recurrence rates and 5-year survival rates were compared. Results: There were no statistically significant differences in postoperative complications, reoperation and 30-day mortality. There were significant differences comparing groups: number of lymph nodes harvested (RTME: 20.1 vs. OTME: 14.1, P < 0.001), estimated blood loss (RTME: 0 vs. OTME: 150 ml, P ¼ 0.003), operation time (RTME: 299.0 vs. OTME: 207.5 min, P < 0.001) and length of postoperative stay (RTME: 6 vs. OTME: 9 days, P < 0.001). The rate of circumferential resection margin involvement and distal resection margin were not statistically different between groups. There were no statistically significant differences at the 5-year follow-up: overall survival, disease-free survival and cancer-specific survival. The cumulative local recurrence rate was statistically lower in the robotic group (RTME: 3.4% vs. OTME: 16.1%, P ¼ 0.024). Conclusion: RTME showed a significant reduction in local recurrence rate and a higher, although not statistically significant, long-term cancer-specific survival with respect to OTME. Prospective randomized studies are needed to confirm or deny significantly better local control rates with robotic surgery.
Nutritional therapy & metabolism, 2012
Aim. To assess whether there is a correlation between the onset of postoperative sepsis and the 5... more Aim. To assess whether there is a correlation between the onset of postoperative sepsis and the 5-years survival rate in patients undergoing surgery for rectal cancer. Experimental design.: A retrospective study of all patients, undergoing rectal cancer surgery during the period January 1981-December 1987. Place. General Surgery Unit; Hospital Arnau de Vilanova. Patients. All patients operated with Duke's stage B and C colorectal neoplasms, excluding cases with postoperative complications not directly correlated to surgery: pneumonia, thromboblebitis, urinary infection or fever of unknown origin. Findings. Postsurgical complications distinguished as minor (wall abscess) or major (anastomotic dehiscence, peritoneal abscess). 5-year survival rate. Results. The actuarial 5-year survival rate of patients with major septic complications was significantly lower (p < 0.05) than that in noncomplicated cases. No difference was observed in the survival of patients with and without minor septic complications. Conclusion. Major septic complications secondary to colorectal surgery are still a threat in spite of improved techniques and antibiotic prophylaxis, and negatively influence the long-term survival rate
Transplantation proceedings, 1996
Transplantation Proceedings, 1997
European Journal of Cancer Care, 2001
Continuing medical education (CME) is now one of the key areas of development in medical educatio... more Continuing medical education (CME) is now one of the key areas of development in medical education. This paper describes the development of an intramural continuing medical education programme de novo in a newly opened cancer institute in Italy, which provided a unique opportunity to study attitudes towards the concepts and goals of continuing medical education as most of the individuals involved in this programme were exposed to continuing medical education for the first time. The continuing medical education programme was overseen by a CME committee for 1 year. Three 1-hour sessions were delivered each week and one credit point was awarded for each session. The sessions included grand rounds, clinical-based teaching and a 3-weekly rotating schedule of pathology, radiology and research. Participants were all the medical doctors attending the European Institute of Oncology. Attendance at greater than 50% of the total sessions available yearly qualified the individual for certification by the CME committee of the Institute. A questionnaire was circulated to all medical doctors at the Institute at the end of the academic year to assess attitudes to CME in general. Forty-six out of 84 questionnaires were returned. The majority of those involved in this CME intramural programme undertook self-directed CME activities and at least 50% had not previously attended either grand rounds or research seminars. Most felt that CME should not be mandatory but that its activities should be monitored. The greatest difficulty with CME was in its timing.
Clinical Nutrition, 2000
öSome ¢ndings suggest that needle catheter jejunostomy (NCJ) is associated with a signi¢cant rate... more öSome ¢ndings suggest that needle catheter jejunostomy (NCJ) is associated with a signi¢cant rate of potentially dangerous complications. The purpose of this study was to prospectively evaluate the rate and type of early and late complications associated with NCJ in patients with surgical treatment of upper gastrointestinal malignancy. Eighty patients underwent NCJ implant at the end of their scheduled surgical procedure. Enteral nutrition programme was started on postoperative day 1in the surgical ICU. NCJ was always removed in the outpatient clinic after hospital discharge. One case of tube blockage has been observed as single short-term complication in this series. No long-term complications have been detected after a mean follow-up of 12 months. Routine use of NCJ in malnourished patients undergoing major surgical procedures on upper gastrointestinal tract is safe and e¡ective.
ecancermedicalscience, 2008
Annali Italiani Di Chirurgia, 1997
Pancreatic cancer has a dismal prognosis also after resection with a 5 years' survival of abo... more Pancreatic cancer has a dismal prognosis also after resection with a 5 years' survival of about 5% in operated patients. The main clinical issue in patients with a malignant tumour is to identify the ones that would benefit from a surgical treatment. Resectability of pancreatic cancer has not an absolute value and the possible advantages in terms of prognosis and quality of life should be balanced with surgical mortality and morbidity. For this reason the management of this disease involves a multidisciplinary approach and the surgeon should join with the other specialists in experienced oncology centers. En exhaustive evaluation of the following prognostic factors should be made pre and intra-operatively to better define life expectancy with or without resection: Histotype: endocrine tumours and cystadenocarcinoma have, in general, a better prognosis, Staging: JPS classification has a better prognostic value if compared to the UICC. Completeness of the resection. Biological cha...
Techniques in Minimally Invasive Rectal Surgery, Oct 24, 2017
Several descriptions of the robotic low anterior resection have been reported in the literature. ... more Several descriptions of the robotic low anterior resection have been reported in the literature. The aim of this chapter is to analyze the indications and the limits of the different fully robotic surgical techniques used for the treatment of rectal cancer.
Journal of Clinical Oncology, 2010
e19020 Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinom... more e19020 Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. In sporadic cases nodes represent the only site of disease, anecdotally due to a spontaneous regression of the primary cutaneous tumor. Besides differential diagnosis primary/metastatic nodal localization is debated. No standard treatment exists in this setting. We report our multimodal management. Methods: Among patients with MCC examined at European Institute of Oncology of Milan between October 1995 and March 2009, we selected those with nodal involvement without evidence of primary tumor. Then we considered: histological diagnosis at IEO, no visceral sites of disease, staging with CT ± fluorodeoxyglucose (FDG) positron emission tomography (PET) ± somatostatin receptor scintigraphy (SRS), multidisciplinary discussion. We evaluated staging, multimodality, time to progression (TTP), median overall survival (mOS). Results: Among a total of 83 patients 28 had the above mentioned characteristics. All patients...
Journal of Robotic Surgery, Dec 16, 2010
To date, no studies have investigated the estimated blood loss (EBL) after full robotic low anter... more To date, no studies have investigated the estimated blood loss (EBL) after full robotic low anterior resection (R-LAR) in a case-matched model, comparing it with the conventional open approach (O-LAR). Forty-nine patients in the R-LAR and 105 in the O-LAR group were matched for age, gender, BMI (body mass index), ASA (American Society of Anesthesiology) class, tumor-nodemetastasis (TNM) classification and UICC (Union for International Cancer Control) stage, distance of the lower edge of the tumor from the anal verge, presence of comorbidities, and preoperative hemoglobin (Hb). EBL was significantly higher in the O-LAR group (P \ 0.001); twelve units of packed red blood cells were globally transfused in the O-LAR group, compared to one unit only in the R-LAR (P = 0.051). A significantly higher postoperative Hb drop (3.0 vs. 2.4 g/dL, P = 0.015) was registered in the O-LAR patients. The length of hospital stay was much lower for the R-LAR group (8.4 vs. 12.4 days, P \ 0.001). The number of harvested lymph nodes (17.4 vs. 13.5, P = 0.006) and extent of distal margin (2.9 vs. 1.9 cm, P \ 0.001) were significantly higher in the R-LAR group. Open surgery was confirmed as the sole variable significantly associated (P \ 0.001) with blood loss (odds ratio = 4.41, 95% CI 2.06-9.43). It was a confirmed prognosticator of blood loss (P = 0.006) when a preoperative clinical predictive model was built, using multivariate analysis (odds ratio = 3.95, 95% CI 1.47-10.6). In conclusion, R-LAR produced less operative blood loss and less drop in postoperative hemoglobin when compared to O-LAR. Other clinically relevant outcomes were similar or superior to O-LAR.
PubMed, Jun 1, 1996
Aim: To assess whether there is a correlation between the onset of postoperative sepsis and the 5... more Aim: To assess whether there is a correlation between the onset of postoperative sepsis and the 5-years survival rate in patients undergoing surgery for rectal cancer. Experimental design: A retrospective study of all patients, undergoing rectal cancer surgery during the period January 1981-December 1987. Place: General Surgery Unit, Hospital Arnau de Vilanova. Patients: All patients operated with Duke's stage B and C colorectal neoplasms, excluding cases with postoperative complications not directly correlated to surgery: pneumonia, thromboblebitis, urinary infection or fever of unknown origin. Findings: Postsurgical complications distinguished as minor (wall abscess) or major (anastomotic dehiscence, peritoneal abscess). 5-year survival rate. Results: The actuarial 5-year survival rate of patients with major septic complications was significantly lower (p < 0.05) than that in noncomplicated cases. No difference was observed in the survival of patients with and without minor septic complications. Conclusion: Major septic complications secondary to colorectal surgery are still a threat in spite of improved techniques and antibiotic prophylaxis, and negatively influence the long-term survival rate.
International Journal of Radiation Oncology Biology Physics, Oct 1, 2009
To evaluate the impact of neoadjuvant capecitabine, concomitant to radiotherapy, followed by cape... more To evaluate the impact of neoadjuvant capecitabine, concomitant to radiotherapy, followed by capecitabine monotherapy, in operable locally advanced rectal cancer (LARC) by measuring pathologic response and conservative surgery rate, toxicity profile, and disease-free survival (DFS). From October 2002 to July 2006, a total of 51 patients affected by LARC (T3-T4 or any node positive tumor), received capecitabine (825 mg/m(2), orally, twice daily continuously) concomitant to radiotherapy on the pelvis (50.4 Gy/ 28 fractions), followed by two cycles of capecitabine (1,250 mg/m(2), orally, twice daily, 14 days on 7 days off) up until 2 weeks before surgery. Tailored adjuvant systemic treatment was discussed according to pathologic stage. Of 51 patients, (median age 61 years, range 38-82 years; 19 women and 32 men; ECOG performance status 0/1/2: 46/4/1), 50 were evaluable for response: 18% complete pathologic remission; 12% T-downstaging, and 30% N-downstaging. One patient died before surgery from mesenteric stroke. Grade 3 acute toxicities were 2% diarrhea, 8% dermatitis, 2% liver function test elevation, and 2% hand-foot syndrome. Sphincter preservation rates for tumors &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =6 cm from the anal verge were 62% and 80% for the whole population. Median follow up was 43.0 months (range 0.8-68.6 months). Five-years DFS was 85.4% (95% CI = 75.3-95.4%). Based on our study results, we conclude that this regimen is well tolerated and active and compares favorably with existing capecitabine-based approaches.
Ejso, Sep 1, 2014
Background: Despite the several series in which the short-term outcomes of robotic-assisted surge... more Background: Despite the several series in which the short-term outcomes of robotic-assisted surgery were investigated, data concerning the long-term outcomes are still scarce. Methods: The prospectively collected records of 65 consecutive patients with extraperitoneal rectal cancer who underwent robotic total mesorectal excision (RTME) were compared with those of 109 consecutive patients treated with open surgery (OTME). Patient characteristics, pathological findings, local and systemic recurrence rates and 5-year survival rates were compared. Results: There were no statistically significant differences in postoperative complications, reoperation and 30-day mortality. There were significant differences comparing groups: number of lymph nodes harvested (RTME: 20.1 vs. OTME: 14.1, P < 0.001), estimated blood loss (RTME: 0 vs. OTME: 150 ml, P ¼ 0.003), operation time (RTME: 299.0 vs. OTME: 207.5 min, P < 0.001) and length of postoperative stay (RTME: 6 vs. OTME: 9 days, P < 0.001). The rate of circumferential resection margin involvement and distal resection margin were not statistically different between groups. There were no statistically significant differences at the 5-year follow-up: overall survival, disease-free survival and cancer-specific survival. The cumulative local recurrence rate was statistically lower in the robotic group (RTME: 3.4% vs. OTME: 16.1%, P ¼ 0.024). Conclusion: RTME showed a significant reduction in local recurrence rate and a higher, although not statistically significant, long-term cancer-specific survival with respect to OTME. Prospective randomized studies are needed to confirm or deny significantly better local control rates with robotic surgery.
Nutritional therapy & metabolism, 2012
Aim. To assess whether there is a correlation between the onset of postoperative sepsis and the 5... more Aim. To assess whether there is a correlation between the onset of postoperative sepsis and the 5-years survival rate in patients undergoing surgery for rectal cancer. Experimental design.: A retrospective study of all patients, undergoing rectal cancer surgery during the period January 1981-December 1987. Place. General Surgery Unit; Hospital Arnau de Vilanova. Patients. All patients operated with Duke's stage B and C colorectal neoplasms, excluding cases with postoperative complications not directly correlated to surgery: pneumonia, thromboblebitis, urinary infection or fever of unknown origin. Findings. Postsurgical complications distinguished as minor (wall abscess) or major (anastomotic dehiscence, peritoneal abscess). 5-year survival rate. Results. The actuarial 5-year survival rate of patients with major septic complications was significantly lower (p < 0.05) than that in noncomplicated cases. No difference was observed in the survival of patients with and without minor septic complications. Conclusion. Major septic complications secondary to colorectal surgery are still a threat in spite of improved techniques and antibiotic prophylaxis, and negatively influence the long-term survival rate
Transplantation proceedings, 1996
Transplantation Proceedings, 1997
European Journal of Cancer Care, 2001
Continuing medical education (CME) is now one of the key areas of development in medical educatio... more Continuing medical education (CME) is now one of the key areas of development in medical education. This paper describes the development of an intramural continuing medical education programme de novo in a newly opened cancer institute in Italy, which provided a unique opportunity to study attitudes towards the concepts and goals of continuing medical education as most of the individuals involved in this programme were exposed to continuing medical education for the first time. The continuing medical education programme was overseen by a CME committee for 1 year. Three 1-hour sessions were delivered each week and one credit point was awarded for each session. The sessions included grand rounds, clinical-based teaching and a 3-weekly rotating schedule of pathology, radiology and research. Participants were all the medical doctors attending the European Institute of Oncology. Attendance at greater than 50% of the total sessions available yearly qualified the individual for certification by the CME committee of the Institute. A questionnaire was circulated to all medical doctors at the Institute at the end of the academic year to assess attitudes to CME in general. Forty-six out of 84 questionnaires were returned. The majority of those involved in this CME intramural programme undertook self-directed CME activities and at least 50% had not previously attended either grand rounds or research seminars. Most felt that CME should not be mandatory but that its activities should be monitored. The greatest difficulty with CME was in its timing.
Clinical Nutrition, 2000
öSome ¢ndings suggest that needle catheter jejunostomy (NCJ) is associated with a signi¢cant rate... more öSome ¢ndings suggest that needle catheter jejunostomy (NCJ) is associated with a signi¢cant rate of potentially dangerous complications. The purpose of this study was to prospectively evaluate the rate and type of early and late complications associated with NCJ in patients with surgical treatment of upper gastrointestinal malignancy. Eighty patients underwent NCJ implant at the end of their scheduled surgical procedure. Enteral nutrition programme was started on postoperative day 1in the surgical ICU. NCJ was always removed in the outpatient clinic after hospital discharge. One case of tube blockage has been observed as single short-term complication in this series. No long-term complications have been detected after a mean follow-up of 12 months. Routine use of NCJ in malnourished patients undergoing major surgical procedures on upper gastrointestinal tract is safe and e¡ective.
ecancermedicalscience, 2008
Annali Italiani Di Chirurgia, 1997
Pancreatic cancer has a dismal prognosis also after resection with a 5 years' survival of abo... more Pancreatic cancer has a dismal prognosis also after resection with a 5 years' survival of about 5% in operated patients. The main clinical issue in patients with a malignant tumour is to identify the ones that would benefit from a surgical treatment. Resectability of pancreatic cancer has not an absolute value and the possible advantages in terms of prognosis and quality of life should be balanced with surgical mortality and morbidity. For this reason the management of this disease involves a multidisciplinary approach and the surgeon should join with the other specialists in experienced oncology centers. En exhaustive evaluation of the following prognostic factors should be made pre and intra-operatively to better define life expectancy with or without resection: Histotype: endocrine tumours and cystadenocarcinoma have, in general, a better prognosis, Staging: JPS classification has a better prognostic value if compared to the UICC. Completeness of the resection. Biological cha...
Techniques in Minimally Invasive Rectal Surgery, Oct 24, 2017
Several descriptions of the robotic low anterior resection have been reported in the literature. ... more Several descriptions of the robotic low anterior resection have been reported in the literature. The aim of this chapter is to analyze the indications and the limits of the different fully robotic surgical techniques used for the treatment of rectal cancer.
Journal of Clinical Oncology, 2010
e19020 Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinom... more e19020 Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. In sporadic cases nodes represent the only site of disease, anecdotally due to a spontaneous regression of the primary cutaneous tumor. Besides differential diagnosis primary/metastatic nodal localization is debated. No standard treatment exists in this setting. We report our multimodal management. Methods: Among patients with MCC examined at European Institute of Oncology of Milan between October 1995 and March 2009, we selected those with nodal involvement without evidence of primary tumor. Then we considered: histological diagnosis at IEO, no visceral sites of disease, staging with CT ± fluorodeoxyglucose (FDG) positron emission tomography (PET) ± somatostatin receptor scintigraphy (SRS), multidisciplinary discussion. We evaluated staging, multimodality, time to progression (TTP), median overall survival (mOS). Results: Among a total of 83 patients 28 had the above mentioned characteristics. All patients...