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Papers by andrea mabilia

Journal of surgical case reports, May 1, 2024

Journal of Gastrointestinal Surgery, Jul 27, 2017

Purpose We assessed the predictive value of the preoperative neutrophil-to-lymphocyte ratio (NLR)... more Purpose We assessed the predictive value of the preoperative neutrophil-to-lymphocyte ratio (NLR) in patients who underwent a two-stage treatment combining reductive surgery and percutaneous isolated hepatic perfusion for multiple hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods Forty-two patients underwent the two-stage treatment between January 2000 and December 2014 at Kobe University Hospital (Hyogo, Japan). The NLR was calculated from lymphocyte and neutrophil counts in the preoperative routine blood test. Clinical data and overall survival were compared statistically and multivariate analysis was done to identify prognostic factors. Results The median survival of patients with a preoperative NLR > 2.3 was 14.9 months (n = 13), whereas that of patients with a preoperative NLR ≤ 2.3 was 26.1 months (n = 29; P = 0.022). A preoperative NLR > 2.3 was an independent prognostic factor in patients with multiple HCC with PVTT [hazard ratio (HR) 2.329; 95 % confidence interval (CI) 1.058-5.667; P = 0.036]. Conclusion Based on the results of this study, an elevated preoperative NLR is an independent predictive risk factor for patients undergoing two-stage treatment for multiple HCC with PVTT.

Cancers, Oct 20, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Journal de Chirurgie Viscérale, Aug 1, 2021

Contexte Une etude a rapporte les resultats des resections R1vasc par rapport a R1par dans le cad... more Contexte Une etude a rapporte les resultats des resections R1vasc par rapport a R1par dans le cadre du cholangiocarcinome intrahepatique (iCCA), sans difference claire entre les deux types de resection R1. Patients et methodes Nous avons examine 81 patients consecutifs reseques pour iCCA entre 2013–2019 dans notre centre et analyse leur radicalite de resection, leur survie globale (OS), leur survie sans maladie (DFS) et leurs determinants (analyse univariee). Resultats Le suivi median de l’ensemble de la cohorte etait de 29,8 [1–88] mois. Les taux de R0, R1par et R1vasc etaient respectivement de 56 % (n = 45), 38 % (n = 31) et 6 % (n = 5). Il n’y avait pas de difference epidemiologique, preoperatoire ou peroperatoire entre les groupes R0/R1par/R1vasc. Le statut N+ etait plus frequent dans le groupe R1vasc (p = 0,006). La SG a 5 ans des groupes R0, R1par et R1vasc etait de 60,6, 29,5 et 0 % (p Conclusions La resection R1par offre des resultats OS intermediaires a ceux obtenus apres resection R0 ou R1vasc. Il peut etre propose en l’absence d’alternative. Contrairement aux metastases colorectales, la resection R1vasc doit etre evitee car elle ne donne pas de resultats oncologiques satisfaisants.

Frontiers in Endocrinology, Apr 14, 2023

International Journal of Colorectal Disease, Aug 28, 2013

Purpose Complete mesocolic excision (CME) with central vascular ligation (CVL) has been proposed ... more Purpose Complete mesocolic excision (CME) with central vascular ligation (CVL) has been proposed for treatment of colon cancers based on the same principles as total mesorectal excision. Impressive outcomes have been reported, however, direct comparisons with the classic procedure are lacking. Methods Forty-five consecutive patients operated on in the last 5 years with CME and CVL right hemicolectomy entered the study. Fifty-eight right-sided colon cancer patients operated in the previous 5 years with classic approach constituted the control group. Intra-and postoperative course assessed the safety of the procedure. Primary end-points for oncological adequacy were recurrence and survival rate. Results All operations were successful with no increase in postoperative complications (p =0.85). Number of harvested nodes and length of vascular ligation were shown to be significantly better in the CME group (p <0.01). A higher number of tumor deposits were harvested thus allowing chemotherapy in newly upstaged patients. Locoregional recurrences were never experienced in CME patients (p =0.03). The risk of cancer-related death was reduced by over one half in all CME patients, and even by three quarters in nodepositive tumors. The classic operation was significantly associated with poor outcome (p <0.01). Conclusion This study shows that CME with CVL is a safe and effective surgical approach for right colon cancer, thus confirming the previously reported oncological adequacy. The procedure was shown to significantly decrease local recurrences and to improve the survival rate, particularly in node-positive patients. Urgent diffusion of this technique is warranted.

Updates in Surgery

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN... more The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment...

Journal of surgical case reports, Aug 1, 2022

Internal hernias through the foramen of Winslow are considered as rare events. A 66-year-old fema... more Internal hernias through the foramen of Winslow are considered as rare events. A 66-year-old female patient presented to our emergency department with epigastric and right upper quadrant pain associated with abdominal distention, nausea and vomiting and signs of shock. A computed tomography scan showed bowel strangulation with distended loops identified within the lesser sac. The diagnosis was confirmed by a midline laparotomy procedure. The ileum, the caecum and the ascending colon were found to herniate into the foramen of Winslow. A right hemicolectomy with a resection of the necrotic segment was performed. The patient recovered well postoperatively and was discharged on 10th day after surgery. The diagnosis and management of this rare disease remains challenging. Cross-sectional imaging with reconstruction is considered as the diagnostic modality of choice. Moreover, right hemicolectomy is a preferred procedure in order to decrease the rate of recurrence.

Surgical Innovation, Jan 5, 2018

Background. After surgery for liver tumors, recurrence rates remain high because of residual posi... more Background. After surgery for liver tumors, recurrence rates remain high because of residual positive margins or undiagnosed lesions. It has been suggested that detection of hepatic tumors can be obtained with near-infrared fluorescence imaging (FI). Indocyanine green (ICG) has been used with contrasting results. The aims of this study were to explore ICG-FI-guided surgery methodology and to assess its potential applications. Materials and Methods. Out of 14 patients with liver tumors, 5 were not operated on, and 9 patients (3 primary and 6 metastatic tumors) underwent surgery. ICG (0.5 mg/kg) was injected intravenously 24 hours before surgery. Fluorescence was investigated prior to resection to detect liver lesions, during hepatic transection to guide surgery, on both cross-section and benchtop to assess surgical margins, and for pathological evaluation. Results. All operations were successful and had a short duration. ICG-FI detected all already known lesions (n = 10), and identified 2 additional small tumors (1 hepatocarcinoma and 1 metastasis, diagnostic improvement = 20%). Two hepatocarcinomas were hyperfluorescent; the remaining one, with a central hypofluorescent area and a hyperfluorescent ring, was indeed a mixed cholangiohepatocarcinoma. All metastatic nodules were hypofluorescent with a hyperfluorescent rim. In all cases, in vivo and ex vivo fluorescence revealed clear liver margins. Postoperative pathological examination greatly benefited of liver fluorescence to assess radicality. Conclusion. ICG-FI-guided surgery was shown to be an effective tool to improve both intraoperative staging and radicality in the surgical treatment of primary and metastatic liver tumors.

Cancers

Background: to date, long-term outcomes of R1 vascular (R1vasc) and R1 parenchymal (R1par) resect... more Background: to date, long-term outcomes of R1 vascular (R1vasc) and R1 parenchymal (R1par) resections in the setting of intrahepatic cholangiocarcinoma (iCCA) have been examined in only one study which did not find significant difference. Patients and Methods: we analyzed consecutive patients who underwent iCCA resection between 2000 and 2019 in two tertiary French medical centers. We report overall survival (OS) and disease-free-survival (DFS). Univariate and multivariate analyses were performed to determine associated factors. Results: 195 patients were analyzed. The number of R0, R1par and R1vasc patients was 128 (65.7%), 57 (29.2%) and 10 (5.1%), respectively. The 1- and 2-year OS rates in the R0, R1par and R1vasc groups were 83%, 87%, 57% and 69%, 75%, 45%, respectively (p = 0.30). The 1- and 2-year DFS rates in the R0, R1par and R1vasc groups were 58%, 50%, 30% and 43%, 28%, 10%, respectively (p = 0.019). Resection classification (HR 1.56; p = 0.003) was one of the independent...

Annali italiani di chirurgia, 2019

PURPOSE Oncological outcome depends not only on tumor behaviour but also on nutritional and immun... more PURPOSE Oncological outcome depends not only on tumor behaviour but also on nutritional and immune-inflammatory host status. Data in gastric cancer are limited. The main aim of this study was to prospectively assess Naples prognostic score (NPS) in gastric cancer patients. NPS was also compared with prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and systemic inflammation score (SIS). METHODS Overall survival (OS) and complication rates of 415 patients undergoing gastric cancer surgery from January 2000 to December 2015 were calculated. Disease-free survival (DFS) rates were assessed in 307 radically resected patients. MaxStat analysis was used to identify the best cut-off values. NPS scores were divided into 3 groups (NPS 0-3). The receiver-operating-characteristic (ROC) curve for censored survival data was used to compare the prognostic performance of scoring systems. RESULTS NPS positively correlated with current scoring systems (p<0.001) and a...

BACKGROUND Although D2 lymphadenectomy has been shown to improve outcomes in gastric cancer, it m... more BACKGROUND Although D2 lymphadenectomy has been shown to improve outcomes in gastric cancer, it may increase postoperative morbidity, mainly owing to splenopancreatic complications. In addition, the effects of nodal dissection along the proper hepatic artery have not been extensively elucidated. We hypothesized that modified D2 (ie, D1+) lymphadenectomy may decrease surgical risks without impairing oncologic adequacy. METHODS Patients with node-positive gastric cancer undergoing curative total gastrectomy were intraoperatively randomized to D1+ (group 1, 36 patients) or standard D2 lymphadenectomy (group 2, 37 patients), the latter including splenectomy and nodal group 12a. The index of estimated benefit was used to assess the efficacy of dissection of each nodal station. The primary endpoint for oncologic adequacy was the disease-free survival (DFS) rate. RESULTS Surgical complications were significantly more common in group 2, which also included 2 postoperative deaths. Overall, 3...

BackgroundIndocyanine green (ICG) is a near-infrared fluorescent contrast agent, which preferenti... more BackgroundIndocyanine green (ICG) is a near-infrared fluorescent contrast agent, which preferentially accumulates in cancer tissue. The aim of our study was to investigate the role of fluorescence imaging (FI) with ICG (ICG-FI) for detecting peritoneal carcinomatosis (PC) from colorectal cancer (CRC).MethodsFour CRC patients with PC scheduled for cytoreductive surgery + hyperthermic intraperitoneal chemotherapy were enrolled in this prospective study. At a median time of 50 min after 0.25 mg/kg ICG injected intravenously, intraoperative ICG-FI using Fluobeam® was performed in vivo and ex vivo on all specimens. The Peritoneal Cancer Index was used to estimate the likelihood of complete cytoreduction.ResultsNo severe complications were recorded. ICG-FI took a median of 20 min (range 10–30, IQR 15–25). Sixty-nine nodules were harvested. Fifty-two nodules had been diagnosed preoperatively by conventional imaging (n = 30; 43%) or intraoperatively by visual inspection/palpation (n = 22; 3...

Peritoneal carcinomatosis (PC) is a severe oncological condition originating from the mesothelium... more Peritoneal carcinomatosis (PC) is a severe oncological condition originating from the mesothelium or, more frequently, from gastrointestinal or gynecological tumors. The PC is believed to be a terminal phase of the oncological disease and, if left untreated, has a median survival of approximately 6 months after diagnosis. PC originating from colorectal cancer is often a metachronous disease, and only 10–15% of patients with colorectal cancer show PC at the time of primary diagnosis. However, the peritoneum is involved up to 50% of cases in patients with colorectal cancer who develop tumor recurrence after potentially curative surgery of the primary tumor; and in 10–35% of cases it is the only site of tumor recurrence. The only potentially curative treatment in primary and metastatic peritoneal carcinomatosis is cytoreductive surgery associated with intraperitoneal hyperthermic chemotherapy (HIPEC) with a 5-year survival rate of 30–48%, in selected cases. One of the most critical pro...

Editorial Peritoneal Carcinomatosis (PC) is a severe oncological condition originating from the m... more Editorial Peritoneal Carcinomatosis (PC) is a severe oncological condition originating from the mesothelium (primary PC) or, more frequently, from gastrointestinal or gynecological tumors (secondary PC). Every year, peritoneal carcinomatosis affects about 25,000 people in Italy [1]. Peritoneal involvement is considered the most serious event in tumor progression with a median survival of ≤ six months after diagnosis [2] and, even in patients resected for intra-abdominal carcinoma, PC is the most frequent cause of death [3]. Interestingly, PC often develops as a "local" disease in the absence of hematogenous or distant metastases [4] and occurs in 30%-40% of patients with colorectal carcinoma (CRC) as a metachronous disease [5]. A positive peritoneal cytology at the time of the curative resection represents an important risk factor of secondary PC [6].

Video Atlas of Intraoperative Applications of Near Infrared Fluorescence Imaging

Surgical Innovation

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, Jan 27, 2017

Cancer outcome is considered to result from the interplay of several factors, among which host in... more Cancer outcome is considered to result from the interplay of several factors, among which host inflammatory and immune status are deemed to play a significant role. The neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR) have been profitably used as surrogate markers of host immunoinflammatory status and have also been shown to correlate with outcome in several human tumors. However, only a few studies on these biomarkers have been performed in gastric cancer patients, yielding conflicting results. Data were retrieved from a prospective institutional database. Overall survival (OS) of 401 patients undergoing surgery for gastric cancer between January 2000 and June 2015 as well as disease-free survival (DFS) rates in 297 radically resected patients were calculated. MaxStat analysis was used to select cutoff values for NLR and LMR. NLR and LMR did not significantly correlate with tumor stage. Patients with a high NLR and a low LMR experienced more tumor rec...