Francesco Papadia | Università degli Studi di Genova (original) (raw)
Papers by Francesco Papadia
HPB, 2021
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JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, 2020
Background and Objectives:The purpose of the investigation was to compare clinical results and di... more Background and Objectives:The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution.Methods:A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique.Results:SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis.Conclusion:SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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European Journal of Clinical Investigation, Dec 12, 2021
In obese subjects with type 2 diabetes (T2DM), bariatric surgery is followed in most cases by a s... more In obese subjects with type 2 diabetes (T2DM), bariatric surgery is followed in most cases by a stable metabolic improvement, with complete T2DM remission or a satisfactory T2DM control.1 Bariatric surgery causes by itself a marked and wellmaintained weight loss: this entails a sharp decrease of insulin resistance and therefore an improvement of metabolic status.1,2 On the contrary, just after bariatric surgery, a marked increase in insulin secretion develops, which persists for years after the operation3: the postoperative rearrangement of the upper gastrointestinal tract causes increase in GLP1 production and then enhancement of insulin secretion,4 ensuing in a reduction of lipotoxicity and glycotoxicity with a consequent betacell– deficit restoring, that warrants positive metabolic outcomes at long term. This brief report aimed to indirectly assess the insulin resistance and the insulin secretion before biliopancreatic diversion (BPD) and at five and ten years after the operation in a clinical sample of T2DM overweight and class 1 obesity patients. Insulin resistance is measured by the triglyceride/ glucose index (TyG) calculated from fasting triglyceride and glucose serum concentration. In a large broad of individuals, the triglyceride/glucose index values are associated with the insulin resistance as measured by the oral glucose tolerance test and with the M rates after the euglycemichyperinsulinemic clamp test.5 Furthermore, triglyceride/glucose index values are very well correlated with the homeostatic model assessment (HOMA) as reference for insulin resistance in epidemiological studies. In addition, since values consider the presence and size of the ectopic fat, a component that markedly influences the metabolic and clinical attitude of T2DM patients, triglyceride/glucose index can predict the diabetes onset and in T2DM patients the glycaemic control and the occurrence of diabetesrelated cardiovascular complications better than weight gain or simple HOMA values.6,7 Serum Cpeptide values, normalized for serum glucose concentration (Cpeptide/FBG), is an indirect index of betacell mass size and therefore accurately reflects the insulin secretion capacity of the beta insular system in T2DM and not T2DM subjects.8
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Surgery for Obesity and Related Diseases, Apr 1, 2023
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Obesity Surgery, 2022
Background Long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients we... more Background Long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients were investigated reporting the results at 10 years after BPD performed in severely non-obese T2DM patients. Material and Methods Thirty T2DM patients with BMI lower than 35 kg/m2 were investigated at 1, 5, and 10 years after BPD, and the results are compared with those of 30 T2DM patients followed for 10 years on pharmacological and/or behavioral conventional therapy. Results Mean levels of fasting blood glucose (FBG) and serum glycated hemoglobin (HbA1C) showed a marked reduction 1 year after BPD, values remaining slightly above the diabetic range throughout the entire follow-up. T2DM remission was observed in about 50% of the cases at 5 and 10 years after the operation. In 16 patients (53%), severe BPD-related complications developed, in ten cases requiring a surgical revision of the operation. In the BPD group, one patient died for malignant lymphoma and two patients after surgical rev...
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Obesity Surgery
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Surgery for Obesity and Related Diseases, 2018
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Chirurgia italiana
Surgical treatment of rectal cancer is still controversial as regards the type of operation and t... more Surgical treatment of rectal cancer is still controversial as regards the type of operation and the extent of lymphadenectomy. Four hundred and fifty-eight patients with rectal cancer operated on at two different hospitals (206 patients, Surgical Department, S. Martino General Hospital and 252 patients, Surgical Department, Galliera General Hospital) in the decade 1980-1989 were studied. None of the patients were submitted to adjuvant or neoadjuvant therapy. The operations opted for were anterior resection for carcinoma of the upper rectum, anterior resection or abdominoperineal resection for carcinoma of the middle rectum, and abdominoperineal resection for lower rectal cancer. At the S. Martino General Hospital, anterior resection comprised ligation of the inferior mesenteric artery at its origin, with subsequent preaortic lymphadenectomy. In abdominoperineal resection, the pelvis was left open and was closed later. At the Galliera General Hospital, preaortic lymph node dissection...
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European Journal of Surgical Oncology, 2021
Background: The COVID-19 outbreak is burdening non-COVID elective surgery patients with figures s... more Background: The COVID-19 outbreak is burdening non-COVID elective surgery patients with figures similar to the SARS-Cov-2, by creating an overwhelming demand, increasing waiting times and costs New tools are urgently needed Our feasibility-pilot single cohort study assesses a modified Surgical Waiting List InfoSystem (SWALIS-2020) model to prioritize and optimize access to elective surgery throughout and beyond the pandemic (https://www isrctn com/ISRCTN11384058) Materials and Methods: In March-May 2020 we tested a software-aided, inter-hospital, multidisciplinary pathway All specialties elective urgent surgery referrals in the Genoa Metropolitan area have been centralized in the SWALIS-2020 pathway adopting a cumulative linear prioritization method (PAT-2020) by waiting time and clinical urgency categories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression) Results: Following the feasibility phase (N=55 patients), 240 referrals were prioritized in 4 weeks without major criticalities (M/F=73/167, Age=68 7±14 0), waiting lists monitored, and theatres allocated based on the demand The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88 7±45 2 at week 1, then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153 29±103 52) vs A1 (97 24±107 93) (p <0 001), and A3 vs A2 (88 05±77 51) (p <0 001) 222 patients underwent surgery, without related complications or delayed/failed discharges Conclusions: This is an early pilot study However the pathway has smoothly selected the very few patients with the greatest need, optimizing access even with +30% capacity modifications weekly, consistently managing active and backlog waiting lists We are looking for collaboration for further multi-center research to progress through the next pandemic phases Robotic surgery for Abdominal Cancers: How far can we go?
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European Journal of Surgical Oncology, 2020
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Surgical Management of Obesity, 2007
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Surgery for Obesity and Related Diseases, 2005
cedures (laparoscopic gastric banding, Roux-en-Y open and laparoscopic gastric bypass) for the tr... more cedures (laparoscopic gastric banding, Roux-en-Y open and laparoscopic gastric bypass) for the treatment of morbid obesity were performed in our institution. Retrospectively, hospital and ED admissions were then reviewed to determine which of these patients presented within 1 year of surgery. Results: Twenty percent of the total population (92 patients) treated surgically for morbid obesity (16% open procedures and 4% laparoscopic procedures) presented to the ED. Overall, 41% of laparoscopic and 43% of open procedure emergency visits resulted in patient discharge. The average number of ED visits for open bypass and laparoscopic procedures were 1.78 and 1.3, respectively (p 0.04). The average hospital length of stay from these visits was 4.2 days for the open procedure and 3.6 for the laparoscopic procedure (p 0.5). The most common causes of readmission were abdominal pain, nausea, vomiting, and wound complications for the open procedure. Meanwhile, nausea and vomiting were the most common causes of readmission for the laparoscopic cases. Conclusions: Emergency room visit rates are higher after open bariatric procedures than with laparoscopic procedures. However, nearly half of all ED visits after both open and laparoscopic procedures combined resulted in no hospital admission. PII: S1550-7289(05)00228-5
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The COVID-19 pandemic burdens non-covid elective surgical patients by reducing service capacity, ... more The COVID-19 pandemic burdens non-covid elective surgical patients by reducing service capacity, forcing extreme selection of patients most in need. Our study assesses the SWALIS- 2020 model ability to prioritize access to surgery during the highest viral outbreak peaks.A 2020 March - May feasibility-pilot study tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties patients in the Genoa Surgical Departments referred for urgent elective patients were prioritized by a modified Surgical Waiting List InfoSystem (SWALIS) cumulative prioritization method (PAT-2020) based on waiting time and clinical urgency, in three subcategories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression). We have studied the model’s applicability and its ability to prioritize patients by monitoring waiting list and service performance. https://www.isrctn.com/ISRCTN11384058.Following the feasibility study (N=55 p...
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Journal of Surgical Oncology, 2012
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Journal of Obesity, 2014
Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is... more Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is highly prevalent in obesity and has been associated with several clinical characteristics, but most studies have been based on relatively small sample sizes using a limited set of variables. We sought to identify clinical factors associated with liver fat accumulation in a large cohort of patients with extreme obesity.Methods. We analyzed 2929 patients undergoing intraoperative liver biopsy during a primary bariatric surgery. Univariate and multivariate regression modeling was used to identify associations with over 200 clinical variables with the presence of any fat in the liver and with moderate to severe versus mild fat accumulation.Results. A total of 19 data elements were associated with the presence of liver fat and 11 with severity of liver fat including ALT and AST, plasma lipid, glucose, and iron metabolism variables, several medications and laboratory measures, and sleep apnea...
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Obesity surgery, Jan 19, 2018
In severely obese patients with type 2 diabetes (T2DM), the metabolic benefits after biliopancrea... more In severely obese patients with type 2 diabetes (T2DM), the metabolic benefits after biliopancreatic diversion (BPD) are due to mechanisms independent of weight loss. Therefore, the anti-diabetic effect of BPD in overweight or mildly obese T2DM patients was investigated. Ninety T2DM patients with BMI 25-35 underwent BPD and were evaluated 1 and 5 years after the operation (follow-up rate 100 and 83%, respectively). T2DM control (Hb1Ac < 7%) and remission (Hb1Ac < 6 without antidiabetics) was observed in 86.6 and 65% of cases at 1 year and 64.0% and 26.5% at 5 years, respectively. The long-term T2DM remission was predicted by baseline BMI value. Both before BPD and throughout the follow-up period, HOMA values were similar in the metabolically successful and unsuccessful subjects, while C-peptide normalized for FBG value as a marker of beta cell mass and insulin secretion increased progressively only in the former from 1.06 ± 0.64 to 1.44 ± 1.08 mcg/l ml/dl * 100 (p < 0.002)....
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International journal of cardiology, Jan 13, 2017
We aimed at investigating whether the acute abrogation of leptin after bariatric surgery is able ... more We aimed at investigating whether the acute abrogation of leptin after bariatric surgery is able to reduce neutrophil activation and potentially affect type 2 diabetes mellitus (T2DM) remission. Metabolic and inflammatory parameters (i.e. leptin, IL-6 and neutrophil products) were compared at baseline (before bariatric surgery), one month, one and three years after surgery in morbid obese (MOB) T2DM patients (n=12) and non-MOB controls (n=32). In vitro, the effects of leptin on Il-6-induced human neutrophil degranulation and integrin upregulation were assessed. At baseline, MOB T2DM patients had a similar demographic, lipid and glycemic profiles than non-MOB T2DM controls, but higher levels of inflammatory mediators, such as CRP, fibrinogen, neutrophil-to-lymphocyte ratio (NLR), matrix metalloproteinase (MMP)-8 and leptin. One month after surgery, CRP, fibrinogen and MMP-8 were reduced only in MOB T2DM patients, while serum leptin was reduced in both groups. In the overall cohort, l...
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Surgery for Obesity and Related Diseases, 2015
Obesity surgery has been proposed as a treatment option for diabetic patients with body mass inde... more Obesity surgery has been proposed as a treatment option for diabetic patients with body mass index (BMI)&amp;amp;amp;amp;amp;lt;35 kg/m(2), but the efficacy of metabolic surgery has not been conclusively determined. To evaluate the long-term metabolic outcome of non-morbidly obese (NMO) patients with type 2 diabetes (T2D) after biliopancreatic diversion (BPD). Two groups of T2D patients with different degree of obesity (NMO, 17 cases, BMI 25-35 kg/m(2); and morbidly obese [MO], 13 cases, BMI&amp;amp;amp;amp;amp;gt;35 kg/m(2)) were studied before and at 1 and 5 years after BPD in a university hospital setting. Insulin secretion was assessed by acute insulin response (AIR) to intravenous glucose and by insulinogenic index (IGI). In all MO patients, T2D was remitted or controlled (1 case) at 1 year and results were maintained at 5 years; AIR (μU/mL) and IGI (μU/mg) improved (P&amp;amp;amp;amp;amp;lt;.001) at 1 year (from .1±3.1 to 18.52±21.9, and from 6.0±8.5 to 9.1±22.8, respectively) with a further increase (to 24.8±25.5 and to 14.3±13.8, respectively) at 5 years. Within the NMO group, T2D was remitted in 1/17 and controlled in 14/17 patients at 1 year, and in 2/17 and in 4/17 patients at 5 years, respectively; AIR (μU/mL) and IGI (μU/mg) remained unchanged throughout the postoperative period (from .31±9.26 to 1.5±2.8 at 1 yr and to .4±3.29 at 5 yr for AIR, and from 2.2±4.9 to 1.3±9.0 at 1 yr and to 2.3±3.3 at 5 yr for IGI). After BPD, restoration of β-cell secretion/production plays a pivotal role in determining postoperative T2D remission.
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International journal of obesity (2005), 2007
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HPB, 2021
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JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, 2020
Background and Objectives:The purpose of the investigation was to compare clinical results and di... more Background and Objectives:The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution.Methods:A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique.Results:SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis.Conclusion:SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
Bookmarks Related papers MentionsView impact
European Journal of Clinical Investigation, Dec 12, 2021
In obese subjects with type 2 diabetes (T2DM), bariatric surgery is followed in most cases by a s... more In obese subjects with type 2 diabetes (T2DM), bariatric surgery is followed in most cases by a stable metabolic improvement, with complete T2DM remission or a satisfactory T2DM control.1 Bariatric surgery causes by itself a marked and wellmaintained weight loss: this entails a sharp decrease of insulin resistance and therefore an improvement of metabolic status.1,2 On the contrary, just after bariatric surgery, a marked increase in insulin secretion develops, which persists for years after the operation3: the postoperative rearrangement of the upper gastrointestinal tract causes increase in GLP1 production and then enhancement of insulin secretion,4 ensuing in a reduction of lipotoxicity and glycotoxicity with a consequent betacell– deficit restoring, that warrants positive metabolic outcomes at long term. This brief report aimed to indirectly assess the insulin resistance and the insulin secretion before biliopancreatic diversion (BPD) and at five and ten years after the operation in a clinical sample of T2DM overweight and class 1 obesity patients. Insulin resistance is measured by the triglyceride/ glucose index (TyG) calculated from fasting triglyceride and glucose serum concentration. In a large broad of individuals, the triglyceride/glucose index values are associated with the insulin resistance as measured by the oral glucose tolerance test and with the M rates after the euglycemichyperinsulinemic clamp test.5 Furthermore, triglyceride/glucose index values are very well correlated with the homeostatic model assessment (HOMA) as reference for insulin resistance in epidemiological studies. In addition, since values consider the presence and size of the ectopic fat, a component that markedly influences the metabolic and clinical attitude of T2DM patients, triglyceride/glucose index can predict the diabetes onset and in T2DM patients the glycaemic control and the occurrence of diabetesrelated cardiovascular complications better than weight gain or simple HOMA values.6,7 Serum Cpeptide values, normalized for serum glucose concentration (Cpeptide/FBG), is an indirect index of betacell mass size and therefore accurately reflects the insulin secretion capacity of the beta insular system in T2DM and not T2DM subjects.8
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Surgery for Obesity and Related Diseases, Apr 1, 2023
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Obesity Surgery, 2022
Background Long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients we... more Background Long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients were investigated reporting the results at 10 years after BPD performed in severely non-obese T2DM patients. Material and Methods Thirty T2DM patients with BMI lower than 35 kg/m2 were investigated at 1, 5, and 10 years after BPD, and the results are compared with those of 30 T2DM patients followed for 10 years on pharmacological and/or behavioral conventional therapy. Results Mean levels of fasting blood glucose (FBG) and serum glycated hemoglobin (HbA1C) showed a marked reduction 1 year after BPD, values remaining slightly above the diabetic range throughout the entire follow-up. T2DM remission was observed in about 50% of the cases at 5 and 10 years after the operation. In 16 patients (53%), severe BPD-related complications developed, in ten cases requiring a surgical revision of the operation. In the BPD group, one patient died for malignant lymphoma and two patients after surgical rev...
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Obesity Surgery
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Surgery for Obesity and Related Diseases, 2018
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Bookmarks Related papers MentionsView impact
Chirurgia italiana
Surgical treatment of rectal cancer is still controversial as regards the type of operation and t... more Surgical treatment of rectal cancer is still controversial as regards the type of operation and the extent of lymphadenectomy. Four hundred and fifty-eight patients with rectal cancer operated on at two different hospitals (206 patients, Surgical Department, S. Martino General Hospital and 252 patients, Surgical Department, Galliera General Hospital) in the decade 1980-1989 were studied. None of the patients were submitted to adjuvant or neoadjuvant therapy. The operations opted for were anterior resection for carcinoma of the upper rectum, anterior resection or abdominoperineal resection for carcinoma of the middle rectum, and abdominoperineal resection for lower rectal cancer. At the S. Martino General Hospital, anterior resection comprised ligation of the inferior mesenteric artery at its origin, with subsequent preaortic lymphadenectomy. In abdominoperineal resection, the pelvis was left open and was closed later. At the Galliera General Hospital, preaortic lymph node dissection...
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European Journal of Surgical Oncology, 2021
Background: The COVID-19 outbreak is burdening non-COVID elective surgery patients with figures s... more Background: The COVID-19 outbreak is burdening non-COVID elective surgery patients with figures similar to the SARS-Cov-2, by creating an overwhelming demand, increasing waiting times and costs New tools are urgently needed Our feasibility-pilot single cohort study assesses a modified Surgical Waiting List InfoSystem (SWALIS-2020) model to prioritize and optimize access to elective surgery throughout and beyond the pandemic (https://www isrctn com/ISRCTN11384058) Materials and Methods: In March-May 2020 we tested a software-aided, inter-hospital, multidisciplinary pathway All specialties elective urgent surgery referrals in the Genoa Metropolitan area have been centralized in the SWALIS-2020 pathway adopting a cumulative linear prioritization method (PAT-2020) by waiting time and clinical urgency categories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression) Results: Following the feasibility phase (N=55 patients), 240 referrals were prioritized in 4 weeks without major criticalities (M/F=73/167, Age=68 7±14 0), waiting lists monitored, and theatres allocated based on the demand The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88 7±45 2 at week 1, then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153 29±103 52) vs A1 (97 24±107 93) (p <0 001), and A3 vs A2 (88 05±77 51) (p <0 001) 222 patients underwent surgery, without related complications or delayed/failed discharges Conclusions: This is an early pilot study However the pathway has smoothly selected the very few patients with the greatest need, optimizing access even with +30% capacity modifications weekly, consistently managing active and backlog waiting lists We are looking for collaboration for further multi-center research to progress through the next pandemic phases Robotic surgery for Abdominal Cancers: How far can we go?
Bookmarks Related papers MentionsView impact
European Journal of Surgical Oncology, 2020
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Surgical Management of Obesity, 2007
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Surgery for Obesity and Related Diseases, 2005
cedures (laparoscopic gastric banding, Roux-en-Y open and laparoscopic gastric bypass) for the tr... more cedures (laparoscopic gastric banding, Roux-en-Y open and laparoscopic gastric bypass) for the treatment of morbid obesity were performed in our institution. Retrospectively, hospital and ED admissions were then reviewed to determine which of these patients presented within 1 year of surgery. Results: Twenty percent of the total population (92 patients) treated surgically for morbid obesity (16% open procedures and 4% laparoscopic procedures) presented to the ED. Overall, 41% of laparoscopic and 43% of open procedure emergency visits resulted in patient discharge. The average number of ED visits for open bypass and laparoscopic procedures were 1.78 and 1.3, respectively (p 0.04). The average hospital length of stay from these visits was 4.2 days for the open procedure and 3.6 for the laparoscopic procedure (p 0.5). The most common causes of readmission were abdominal pain, nausea, vomiting, and wound complications for the open procedure. Meanwhile, nausea and vomiting were the most common causes of readmission for the laparoscopic cases. Conclusions: Emergency room visit rates are higher after open bariatric procedures than with laparoscopic procedures. However, nearly half of all ED visits after both open and laparoscopic procedures combined resulted in no hospital admission. PII: S1550-7289(05)00228-5
Bookmarks Related papers MentionsView impact
The COVID-19 pandemic burdens non-covid elective surgical patients by reducing service capacity, ... more The COVID-19 pandemic burdens non-covid elective surgical patients by reducing service capacity, forcing extreme selection of patients most in need. Our study assesses the SWALIS- 2020 model ability to prioritize access to surgery during the highest viral outbreak peaks.A 2020 March - May feasibility-pilot study tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties patients in the Genoa Surgical Departments referred for urgent elective patients were prioritized by a modified Surgical Waiting List InfoSystem (SWALIS) cumulative prioritization method (PAT-2020) based on waiting time and clinical urgency, in three subcategories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression). We have studied the model’s applicability and its ability to prioritize patients by monitoring waiting list and service performance. https://www.isrctn.com/ISRCTN11384058.Following the feasibility study (N=55 p...
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Journal of Surgical Oncology, 2012
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Journal of Obesity, 2014
Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is... more Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is highly prevalent in obesity and has been associated with several clinical characteristics, but most studies have been based on relatively small sample sizes using a limited set of variables. We sought to identify clinical factors associated with liver fat accumulation in a large cohort of patients with extreme obesity.Methods. We analyzed 2929 patients undergoing intraoperative liver biopsy during a primary bariatric surgery. Univariate and multivariate regression modeling was used to identify associations with over 200 clinical variables with the presence of any fat in the liver and with moderate to severe versus mild fat accumulation.Results. A total of 19 data elements were associated with the presence of liver fat and 11 with severity of liver fat including ALT and AST, plasma lipid, glucose, and iron metabolism variables, several medications and laboratory measures, and sleep apnea...
Bookmarks Related papers MentionsView impact
Obesity surgery, Jan 19, 2018
In severely obese patients with type 2 diabetes (T2DM), the metabolic benefits after biliopancrea... more In severely obese patients with type 2 diabetes (T2DM), the metabolic benefits after biliopancreatic diversion (BPD) are due to mechanisms independent of weight loss. Therefore, the anti-diabetic effect of BPD in overweight or mildly obese T2DM patients was investigated. Ninety T2DM patients with BMI 25-35 underwent BPD and were evaluated 1 and 5 years after the operation (follow-up rate 100 and 83%, respectively). T2DM control (Hb1Ac < 7%) and remission (Hb1Ac < 6 without antidiabetics) was observed in 86.6 and 65% of cases at 1 year and 64.0% and 26.5% at 5 years, respectively. The long-term T2DM remission was predicted by baseline BMI value. Both before BPD and throughout the follow-up period, HOMA values were similar in the metabolically successful and unsuccessful subjects, while C-peptide normalized for FBG value as a marker of beta cell mass and insulin secretion increased progressively only in the former from 1.06 ± 0.64 to 1.44 ± 1.08 mcg/l ml/dl * 100 (p < 0.002)....
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International journal of cardiology, Jan 13, 2017
We aimed at investigating whether the acute abrogation of leptin after bariatric surgery is able ... more We aimed at investigating whether the acute abrogation of leptin after bariatric surgery is able to reduce neutrophil activation and potentially affect type 2 diabetes mellitus (T2DM) remission. Metabolic and inflammatory parameters (i.e. leptin, IL-6 and neutrophil products) were compared at baseline (before bariatric surgery), one month, one and three years after surgery in morbid obese (MOB) T2DM patients (n=12) and non-MOB controls (n=32). In vitro, the effects of leptin on Il-6-induced human neutrophil degranulation and integrin upregulation were assessed. At baseline, MOB T2DM patients had a similar demographic, lipid and glycemic profiles than non-MOB T2DM controls, but higher levels of inflammatory mediators, such as CRP, fibrinogen, neutrophil-to-lymphocyte ratio (NLR), matrix metalloproteinase (MMP)-8 and leptin. One month after surgery, CRP, fibrinogen and MMP-8 were reduced only in MOB T2DM patients, while serum leptin was reduced in both groups. In the overall cohort, l...
Bookmarks Related papers MentionsView impact
Surgery for Obesity and Related Diseases, 2015
Obesity surgery has been proposed as a treatment option for diabetic patients with body mass inde... more Obesity surgery has been proposed as a treatment option for diabetic patients with body mass index (BMI)&amp;amp;amp;amp;amp;lt;35 kg/m(2), but the efficacy of metabolic surgery has not been conclusively determined. To evaluate the long-term metabolic outcome of non-morbidly obese (NMO) patients with type 2 diabetes (T2D) after biliopancreatic diversion (BPD). Two groups of T2D patients with different degree of obesity (NMO, 17 cases, BMI 25-35 kg/m(2); and morbidly obese [MO], 13 cases, BMI&amp;amp;amp;amp;amp;gt;35 kg/m(2)) were studied before and at 1 and 5 years after BPD in a university hospital setting. Insulin secretion was assessed by acute insulin response (AIR) to intravenous glucose and by insulinogenic index (IGI). In all MO patients, T2D was remitted or controlled (1 case) at 1 year and results were maintained at 5 years; AIR (μU/mL) and IGI (μU/mg) improved (P&amp;amp;amp;amp;amp;lt;.001) at 1 year (from .1±3.1 to 18.52±21.9, and from 6.0±8.5 to 9.1±22.8, respectively) with a further increase (to 24.8±25.5 and to 14.3±13.8, respectively) at 5 years. Within the NMO group, T2D was remitted in 1/17 and controlled in 14/17 patients at 1 year, and in 2/17 and in 4/17 patients at 5 years, respectively; AIR (μU/mL) and IGI (μU/mg) remained unchanged throughout the postoperative period (from .31±9.26 to 1.5±2.8 at 1 yr and to .4±3.29 at 5 yr for AIR, and from 2.2±4.9 to 1.3±9.0 at 1 yr and to 2.3±3.3 at 5 yr for IGI). After BPD, restoration of β-cell secretion/production plays a pivotal role in determining postoperative T2D remission.
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International journal of obesity (2005), 2007
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