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Pancreatic Neoplasms: HELP
Articles by Roberto Cirocchi
Based on 14 articles published since 2010
(Why 14 articles?)
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Between 2010 and 2020, R. Cirocchi wrote the following 14 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Systematic review and meta-analysis of prognostic role of splenic vessels infiltration in resectable pancreatic cancer. 2018

Crippa, Stefano / Cirocchi, Roberto / Maisonneuve, Patrick / Partelli, Stefano / Pergolini, Ilaria / Tamburrino, Domenico / Aleotti, Francesca / Reni, Michele / Falconi, Massimo. ·Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy. · Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Terni, Italy. · Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy. · Department of Surgery, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy. · Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Department of Oncology, San Raffaele Scientific Institute, Milan, Italy. · Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy. Electronic address: falconi.massimo@hsr.it. ·Eur J Surg Oncol · Pubmed #29183639.

ABSTRACT: BACKGROUND: Identification of factors associated with dismal survival after surgery in resectable pancreatic ductal adenocarcinoma is important to select patients for neoadjuvant treatment. The present meta-analysis aimed to compare the results of distal pancreatectomy for resectable adenocarcinoma of the pancreatic body-tail with and without splenic vessels infiltration. METHODS: A systematic search was performed of PubMed, Embase and the Cochrane Library in accordance with PRISMA guidelines. The inclusion criteria were studies including patients who underwent distal pancreatectomy for pancreatic cancer with or without splenic vessels infiltration. 5-year overall survival (OS) was the primary outcomes. Meta-analysis was carried out applying time-to-event method. RESULTS: Six articles with 423 patients were analysed. Patients with pathological splenic artery invasion had a worse survival compared with those without infiltration (Hazard ratio 1.76, 95% CI 1.36-2.28; P < 0.0001). A similar results was found when considering pathological splenic vessels infiltration, showing that survival was significantly poorer when splenic vein infiltration was present (Hazard ratio 1.51, 95% CI 1.19-1.93; P = 0.0009). CONCLUSIONS: This meta-analysis showed worse survival for patients with splenic vessels infiltration undergoing distal pancreatectomy for pancreatic cancer. Splenic vessels infiltration represents the stigmata of a more aggressive disease, although resectable.

2 Review Systematic review and meta-analysis on laparoscopic pancreatic resections for neuroendocrine neoplasms (PNENs). 2017

Tamburrino, Domenico / Partelli, Stefano / Renzi, Claudio / Crippa, Stefano / Muffatti, Francesca / Perali, Carolina / Parisi, Amilcare / Randolph, Justus / Fusai, Giuseppe Kito / Cirocchi, Roberto / Falconi, Massimo. ·a HPB and Liver Transplant Surgery , Royal Free Hospital, NHS Foundation Trust , London , UK. · b Pancreatic surgery Unit, Pancreas Translational & Clinical Research Center - IRCCS San Raffaele Scientific Institute , 'Vita e Salute' University , Milan , Italy. · c Department of General and Oncologic Surgery , University of Perugia, St. Mary's Hospital , Terni , Italy. · d Department of Digestive Surgery , University of Perugia, St. Mary's Hospital , Terni , Italy. · e Tift College of Education , Mercer University , Atlanta , GA , USA. ·Expert Rev Gastroenterol Hepatol · Pubmed #27781493.

ABSTRACT: INTRODUCTION: The safety of laparoscopic resections (LPS) of pancreatic neuroendocrine neoplasms (PNENs) has been well established in the literature. Areas covered: Studies conducted between January 2003 and December 2015 that reported on LPS and open surgery (OPS) were reviewed. The primary outcomes were the rate of post-operative complications and the length of hospital stay (LoS) after laparoscopic and open surgical resection. The rate of recurrence was the secondary outcome. Eleven studies were included with a total of 907 pancreatic resections for PNENs, of whom, 298 (32.8%) underwent LPS and 609 (67.2%) underwent open surgery. LPS resulted in a significantly shorter LoS (p < 0.0001) and lower blood loss (p < 0.0001). The meta-analysis did not show any significant difference in the pancreatic fistula rate, recurrence rate or post-operative mortality between the two groups. Expert commentary: LPS is a safe approach even for PNENs and it is associated with a shorter LoS.

3 Review Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. 2017

Partelli, S / Cirocchi, R / Crippa, S / Cardinali, L / Fendrich, V / Bartsch, D K / Falconi, M. ·Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy. · Department of Digestive and Liver Surgery Unit, St Maria Hospital, Terni, Italy. · Department of Surgery, Polytechnic University of Marche Region, Ancona, Italy. · Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany. ·Br J Surg · Pubmed #27706803.

ABSTRACT: BACKGROUND: The incidence of asymptomatic, sporadic, small non-functioning pancreatic neuroendocrine neoplasms (NF-PNENs) has increased in recent decades. Conservative treatment has been advocated for these tumours. The aim of this study was systematically to evaluate the literature on active surveillance and to compare this with surgical management for asymptomatic sporadic small NF-PNENs. METHODS: PubMed, Embase and the Cochrane Library were searched systematically for studies that compared the active surveillance of asymptomatic, sporadic, small NF-PNENs with surgical management. PRISMA guidelines for systematic reviews were followed. RESULTS: After screening 3915 records, five retrospective studies with a total of 540 patients were included. Of these, 327 patients (60·6 per cent) underwent active surveillance and 213 (39·4 per cent) had surgery. There was wide variation in the tumour diameter threshold considered as inclusion criterion (2 cm to any size). The median length of follow-up ranged from 28 to 45 months. Measurable tumour growth was observed in 0-51·0 per cent of patients. Overall, 46 patients (14·1 per cent) underwent pancreatic resection after initial conservative treatment. In most patients the reason was an increase in tumour size (19 of 46). There were no disease-related deaths in the active surveillance group in any of the studies. CONCLUSION: This systematic review suggests that active surveillance of patients affected by sporadic, small, asymptomatic NF-PNENs may be a good alternative to surgical treatment.

4 Review Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. 2016

Crippa, S / Cirocchi, R / Partelli, S / Petrone, M C / Muffatti, F / Renzi, C / Falconi, M / Arcidiacono, P G. ·Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy. · Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Terni, Italy. · Division of Pancreato-Biliary Endoscopy and Endoscopic Ultrasound, San Raffaele Scientific Institute, Milan, Italy. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. · Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy. Electronic address: falconi.massimo@hsr.it. ·Eur J Surg Oncol · Pubmed #27296728.

ABSTRACT: BACKGROUND: Preoperative biliary drainage (PBD) with stenting increases complications compared with surgery without PBD. Metallic stents are considered superior to plastic stents when considering stent-related complications. Aim of the present systematic review and meta-analysis is to compare the rate of endoscopic re-intervention before surgery and postoperative outcomes of metal versus plastic stents in patients with resectable periampullary or pancreatic head neoplasms. METHODS: We conducted a bibliographic research using the National Library of Medicine's PubMed database, including both randomized controlled trials (RCTs) and non-RCTs. Quantitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Statistical heterogeneity was assessed using the I(2) tests. RESULTS: One RCT and four non-RCTs were selected, including 704 patients. Of these, 202 patients (29.5%) were treated with metal stents and 502 (70.5%) with plastic stents. The majority of patients (86.4%) had pancreatic cancer. The rate of endoscopic re-intervention after preoperative biliary drainage was significantly lower in the metal stent (3.4%) than in the plastic stent (14.8%) group (p < 0.0001). The rate of postoperative pancreatic fistula was significantly lower in the meta stent group as well (5.1% versus 11.8%, p = 0.04). The rate of post-operative surgical complications and of - post-operative mortality did not differ between the two groups. CONCLUSIONS: Although the present systematic review and meta-analysis demonstrates that metal stent are more effective than plastic stents for PBD in patients with resectable periampullary tumors, randomized controlled trials are needed in order to confirm these data with a higher level of evidence.

5 Review Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum. 2014

Cirocchi, Roberto / Partelli, Stefano / Castellani, Elisa / Renzi, Claudio / Parisi, Amilcare / Noya, Giuseppe / Falconi, Massimo. ·Department of Digestive and Liver Surgery Unit, St Maria Hospital, Terni, Italy. · Pancreatic Surgery Unit, Università Politecnica delle Marche, Ancona, Italy. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: renzicla@virgilio.it. ·Surg Oncol · Pubmed #24726745.

ABSTRACT: INTRODUCTION: Pancreatic or duodenal invasion by locally advanced right colon cancer is an unusual event whose management still represents a surgical challenge. This review aims to compare results of limited vs. extended resection in case of primary right colon cancer invading pancreas and/or duodenum. METHODS: A systematic search in Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. All trials describing the surgical treatment of right colon cancer invading pancreas and/or duodenum were considered. A data extraction sheet was developed, based on the Cochrane Consumers and Communication Review Group's data extraction template. RESULTS: 5-years overall survival was 52% after en bloc pancreaticoduodenectomy plus right hemicolectomy vs. 0 and 25% in case of duodenal resection with correction by direct suture or pedicled ileal flap, respectively. 30-day postoperative morbidity rate was slightly higher after en block resections (12.8%) with respect to duodenal local resection and direct suture or pedicled ileal flap repair (0 and 12.2%, respectively). After extended resection the rate of pancreatico-jejunal anastomotic leakage was 7.7%. CONCLUSIONS: In patients with right colon cancer extended to the pancreas and/or duodenum surgical multivisceral resection is suggested when complete tumour removal (R0) is achievable. Even though no significant differences in postoperative morbidity and mortality have been shown, 5 y OS has improved in extended resections as compared to duodenal local resection with defect repair either by direct suture or by a pedicled ileal flap.

6 Review A systematic review on robotic pancreaticoduodenectomy. 2013

Cirocchi, Roberto / Partelli, Stefano / Trastulli, Stefano / Coratti, Andrea / Parisi, Amilcare / Falconi, Massimo. ·General Surgery, St. Maria Hospital, University of Perugia, Italy. Electronic address: cirocchiroberto@yahoo.it. ·Surg Oncol · Pubmed #24060451.

ABSTRACT: BACKGROUND: Robotic surgery might have several advantages in respect of the laparoscopic approach since might make more feasible the execution of a complex procedure such as pancreaticoduodenectomy (PD). The aim of the present systematic review is to evaluate the current state of the literature on robotic PD. METHODS: A systematic literature search was performed, from January 1st 2003 to July 31st 2012, for studies which reported PDs performed for neoplasm and in which at least one surgical reconstructive or resective step was robotically performed. RESULTS: Thirteen studies, representing 207 patients, met the inclusion criteria. The definition of the robotic approach was heterogeneous since the technique was defined as robotic, robotic-assisted, robot-assisted laparoscopic and robotic hybrid. Resection and reconstruction steps of robotic PD were also heterogeneous combining sequentially different approaches: totally robotic technique, laparoscopic-robotic resection and robotic reconstruction, laparoscopic resection and robotic reconstruction, hand port-assisted laparoscopic resection and robotic reconstruction, laparoscopic-robotic resection and reconstruction through mini-laparotomy. As regard the type of PD 66% were classic Whipple operations and 34% pylorus-preserving pancreatoduodenectomies. The management of pancreatic stump was a pancreaticogastrostomy in 23%, end-to-side pancreaticojejunostomy in 67%, and fibrin glue occlusion of the main pancreatic duct in 10% of cases. The overall procedure failure (rates of conversion to open surgery) was 14%. The overall morbidity rate was 58% and the reoperation rate was 7.3%. CONCLUSIONS: There have been an increasing number of recent case series suggesting increased utilization of robotic PD over the past decade. The technical approach is heterogenous. For highly selected patient, robotic PD is feasible with similar morbidity and mortality compared to open or purely laparoscopic approaches. Data on cost analysis are lacking and further studies are needed to evaluate also the cost-effectiveness of the robotic approach for PD in comparison to open or laparoscopic techniques. The current state of the art analysis on robotic DP can be also useful in planning future trials.

7 Review Current status of robotic distal pancreatectomy: a systematic review. 2013

Cirocchi, Roberto / Partelli, Stefano / Coratti, Andrea / Desiderio, Jacopo / Parisi, Amilcare / Falconi, Massimo. ·Digestive Surgery and Liver Unit, S. Maria Hospital, Via Tristano di Joannuccio n.4, Terni 05100, Italy. cirocchiroberto@yahoo.it ·Surg Oncol · Pubmed #23910929.

ABSTRACT: OBJECTIVE: The aim of this systematic review is to determine the potential advantages of robotic distal pancreatectomy (RDP). STUDY SELECTION: Both randomized and non-randomized studies. DATA EXTRACTION: Two investigators independently selected studies for inclusion by article abstraction and full text reviewing. DATA SYNTHESIS: Five non-RCTs were included in the review. The feasibility of RDP (95.4%) and spleen-preserving rate is between 50% and 100%. Mean OT varied between 298 min and 398 min with only completely robotic procedures, whereas mean OT was 293 in "laparoscopic/robotic" technique. Postoperative length of hospital stay ranged from 7 days to 13.7 days. The 30-day postoperative overall morbidity resulted between 0 and 18% of patients. CONCLUSIONS: RDP is an emergent technology for which there are not yet sufficient data to draw definitive conclusions with respect to conventional or laparoscopic surgery. The mean duration of RDP is longer with Da Vinci robot, but hospital stay is shorter even if it is influenced by hospital protocols. We cannot make any conclusions comparing the outcomes to laparoscopic or open procedures here, since none of these studies are randomized, and we all know that most of these surgeons selected the easier cases for robotic procedures. For these reasons randomized controlled trials are recommended to better evaluate RDP cost-effectiveness.

8 Article A systematic review of surgical resection of liver-only synchronous metastases from pancreatic cancer in the era of multiagent chemotherapy. 2020

Crippa, Stefano / Cirocchi, Roberto / Weiss, Matthew J / Partelli, Stefano / Reni, Michele / Wolfgang, Christopher L / Hackert, Thilo / Falconi, Massimo. ·Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy. · Division of Pancreatic Surgery, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. · Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Terni, Italy. · Department of Surgery, Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, University of Heidelberg, Heidelberg, Germany. · Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy. falconi.massimo@hsr.it. · Division of Pancreatic Surgery, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. falconi.massimo@hsr.it. ·Updates Surg · Pubmed #31997233.

ABSTRACT: Recent studies considered surgery as a treatment option for patients with pancreatic ductal adenocarcinoma (PDAC) and synchronous liver metastases. The aim of this study was to evaluate systematically the literature on the role of surgical resection in this setting as an upfront procedure or following primary chemotherapy. A systematic search was performed of PubMed, Embase and the Cochrane Library in accordance with PRISMA guidelines. Only studies that included patients with synchronous liver metastases published in the era of multiagent chemotherapy (after 2011) were considered, excluding those with lung/peritoneal metastases or metachronous liver metastases. Median overall survival (OS) was the primary outcome. Six studies with 204 patients were analyzed. 63% of patients underwent upfront pancreatic and liver resection, 35% had surgery after primary chemotherapy with strict selection criteria and 2% had an inverse approach (liver surgery first). 38 patients (18.5%) did not undergo any liver resection since metastases disappeared after chemotherapy. Postoperative mortality was low (< 2%). Median OS ranged from 7.6 to 14.5 months after upfront pancreatic/liver resection and from 34 to 56 months in those undergoing preoperative treatment. This systematic review suggests that surgical resection of pancreatic cancer with synchronous liver oligometastases is safe, and it can be associated with improved survival, providing a careful selection of patients after primary chemotherapy.

9 Article A Systematic review and meta-analysis on the role of palliative primary resection for pancreatic neuroendocrine neoplasm with liver metastases. 2018

Partelli, Stefano / Cirocchi, Roberto / Rancoita, Paola M V / Muffatti, Francesca / Andreasi, Valentina / Crippa, Stefano / Tamburrino, Domenico / Falconi, Massimo. ·Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy. · Department of Digestive and Liver Surgery Unit, St Maria Hospital, Terni, Italy. · University Centre for Statistics in the Biomedical Sciences, "Vita-Salute" University, Milan, Italy. · Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy; Digestive Oncology PhD Program, La Sapienza University, Rome, Italy. · Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy. Electronic address: falconi.massimo@hsr.it. ·HPB (Oxford) · Pubmed #29196022.

ABSTRACT: BACKGROUND: Role of palliative pancreatic neuroendocrine neoplasm (PanNEN) resection (pPanNEN-R) is controversial. This study was designed as a meta-analysis of studies which allow a comparison of pPanNEN-R and non-surgical management (PanNEN-nR). METHODS: All published studies until 2017 allowing for the comparison of pPanNEN-R and PanNEN-nR were reviewed. Primary outcome was overall survival (OS). Secondary outcomes measures included postoperative morbidity, reoperation, readmission, length of hospital stay (LOS), and quality of life (QoL). Risk of death was compared by computing the odds-ratio (OR), while 5- and 10-year OS using weighted mean differences. RESULTS: Seven studies were included. A total of 885 patients were included, of whom 252 (28%) underwent pPanNEN-R and 633 (72%) underwent PanNEN-nR. Overall quality of included studies was fair. The risk of death was significantly reduced in patients who underwent pPanNEN-R compared to those who underwent PanNEN-nR (OR = 0.38, 95% CI 0.23-0.65). Data on postoperative morbidity, reoperation, readmission, LOS, and QoL were not adequately reported therefore a meta-analysis for the secondary outcomes was not performed. DISCUSSION: pPanNEN-R in patients with unresectable LM seems to be associated with a better OS compared to non-surgical management but the limitations of included studies does not allow firm conclusions.

10 Article Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique. 2015

Boselli, Carlo / Barberini, Francesco / Listorti, Chiara / Castellani, Elisa / Renzi, Claudio / Corsi, Alessia / Grassi, Veronica / Cacurri, Alban / Desiderio, Jacopo / Trastulli, Stefano / Santoro, Alberto / Pironi, Daniele / Burattini, Federica / Cirocchi, Roberto / Avenia, Nicola / Noya, Giuseppe / Parisi, Amilcare. ·Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: carloboselli@yahoo.it. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: francescobarberini@hotmail.it. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: chiaralist@gmail.com. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: elisa.ecv@gmail.com. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: renzicla@virgilio.it. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: alessia.cor@libero.it. · Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: veronicagrassi@hotmail.it. · Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: albancacurri@gmail.com. · Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: djdesi85@hotmail.it. · Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: stefano.trastulli@hotmail.it. · Department of Surgical Sciences, Sapienza University of Rome, Italy. Electronic address: albert.santoro@tiscali.it. · Department of Surgical Sciences, Sapienza University of Rome, Italy. Electronic address: danielepironi@gmail.com. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: maria.burattini@unipg.it. · Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: roberto.cirocchi@unipg.it. · Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: nicolaavenia@libero.it. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: giuseppe.noya@unipg.it. · Department of Digestive Surgery, St. Maria Hospital, Terni, Italy. Electronic address: amilcareparisi@virgilio.it. ·Int J Surg · Pubmed #26118603.

ABSTRACT: INTRODUCTION: Spleen-preserving left pancreatectomy (SPDP) with splenic vessels preservation (SVP) or without (Warshaw technique, WT) has been described with robotic, laparoscopy and open surgery. Nevertheless, significant data on medium- and long-term follow-up are still not available, since data in literature are scarce and the level of evidence is low. METHODS: In this retrospective study, we describe and compare short and medium term results of spleen-preserving distal pancreatectomy in eight patients. RESULTS: In WT group the duration and the intraoperative bleeding was superior than SVP group. The incidence of perigastric collateral vessels and presence of submucosal varices evidenced at CT scan was 66% in WT group, while only one case occurred in SVP group. DISCUSSION: The limit of laparoscopic approach is the fact that it needs advanced laparoscopic skills, which might result in intraoperative bleeding and splenectomy. The most of literature considered salvage WT intraoperatively performed in case of classical SVP and not only elective WT. The consequence is that there is no difference in immediate postoperative results (operative time, intraoperative bleeding, hospital stay) that are in favour of SVP because WT is performed only in case of failure in preserving the splenic vessels. In fact when this intervention is performed electively, the procedure time is reduced as well as the intraoperative bleeding. CONCLUSIONS: WT is safe and feasible, even if there are not definitive evidences that demonstrate it is superior to classic SVP. RCTs are needed to determine advantages and disadvantages of WT compared to the classic SVP.

11 Article Retrospective analysis of short term outcomes after spleen-preserving distal pancreatectomy for sodid pseudopapillary tumours. 2015

Graziosi, Luigina / Marino, Elisabetta / Rivellini, Roberta / Ciaccio, Vincenzo / Cirocchi, Roberto / Sanguinetti, Alessandro / Hirota, Masahiko / Avenia, Nicola / Donini, Annibale. ·General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia. Electronic address: luiginagraziosi@yahoo.it. · General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia. Electronic address: elisabetta.marino1986@gmail.com. · General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia. Electronic address: roririvellini@gmail.com. · General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia. Electronic address: vincenzo.ciaccio@unipg.it. · Department of General and Oncologic Surgery, Santa Maria Hospital, University of Perugia, Terni. Electronic address: roberto.cirocchi@unipg.it. · Department of General Surgery, Santa Maria Hospital, University of Perugia, Terni. Electronic address: a.sanguinetti@aospterni.it. · Kumamoto Regional Medical Center, Japan. Electronic address: mhirota@krmc.or.jp. · Department of General Surgery, Santa Maria Hospital, University of Perugia, Terni. Electronic address: nicolaavenia@libero.it. · General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia. Electronic address: annibale.donini@unipg.it. ·Int J Surg · Pubmed #26118599.

ABSTRACT: Solid pseudopapillary pancreatic tumour (SPN) is a rare pancreatic tumour representing 0.1%-3% of all exocrine pancreatic tumours. Most SPN show benign and low-grade malignant behaviour; malignant degeneration is observed in 10-15% of the patients. More than 40% of SPN involve the tail of the pancreas leading to a minimal invasive distal pancreatectomy approach. In this report we present the case of a young 22 Caucasian woman suffering from SPN who successfully underwent laparoscopic spleen-preserving distal pancreatectomy. Postoperative course was uneventful. A CT scan control at six months was negative for recurrences. We have also made an analysis of all the laparoscopic treatment of SPN reported in English literature.

12 Article Can the measurement of amylase in drain after distal pancreatectomy predict post-operative pancreatic fistula? 2015

Cirocchi, Roberto / Graziosi, Luigina / Sanguinetti, Alessandro / Boselli, Carlo / Polistena, Andrea / Renzi, Claudio / Desiderio, Jacopo / Noya, Giuseppe / Parisi, Amilcare / Hirota, Masahiko / Donini, Annibale / Avenia, Nicola. ·Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: roberto.cirocchi@unipg.it. · General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy. Electronic address: luiginagraziosi@yahoo.it. · Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: a.sanguinetti@aospterni.it. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: carloboselli@yahoo.it. · Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: apolis74@yahoo.it. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: renzicla@virgilio.it. · Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: djdesi85@hotmail.it. · Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: giuseppe.noya@unipg.it. · Department of Digestive Surgery, St. Maria Hospital, Terni, Italy. Electronic address: amilcareparisi@virgilio.it. · Kumamoto Regional Medical Center, Japan. Electronic address: mhirota@krmc.or.jp. · General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy. Electronic address: annibale.donini@unipg.it. · Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: nicolaavenia@libero.it. ·Int J Surg · Pubmed #26117433.

ABSTRACT: INTRODUCTION: The most frequent reason for performing a distal pancreatectomy is the presence of cystic or neuroendocrine tumors, in which the distal pancreatic stump is often soft and non fibrotic. This parenchymal consistence represents the main risk factor for post-operative pancreatic fistula. In order to identify the fistula and assessing its severity postoperative monitoring of amylase from intraperitoneal drains is important. METHODS: From a retrospective multicentric database analysis were included 33 patients who underwent distal pancreatectomy for pancreatic neoplastic disease. RESULTS: Postoperative pancreatic fistula occurred in four cases. One patient had a ductal adenocarcinoma, two presented with pancreatic endocrine neoplasms and the last one had an intraductal papillary mucinous neoplasia. Two patients underwent open, the other two laparoscopic distal pancreatectomy. DISCUSSION: Postoperative pancreatic fistulas after distal pancreatectomy worsen the quality of life, prolong the post-operative stay and delay further adjuvant therapy. In patients who underwent distal pancreatectomy literature exposed some advantages deriving from the placement of abdominal drainages only in selected cases and from their early removal. Patients presenting a high risk of pancreatic fistula had higher amylase levels of drainage fluid in the first postoperative day. CONCLUSION: POPF is the most frequently complication after pancreatectomy. In our analysis DFA1>5000 can be considered as a predictive factor for pancreatic fistula. For this reason, the systematic measurement of amylase in drain fluid in first-postoperative day can be considered a good clinical practice.

13 Article Road accident due to a pancreatic insulinoma: a case report. 2015

Parisi, Amilcare / Desiderio, Jacopo / Cirocchi, Roberto / Grassi, Veronica / Trastulli, Stefano / Barberini, Francesco / Corsi, Alessia / Cacurri, Alban / Renzi, Claudio / Anastasio, Fabio / Battista, Francesca / Pucci, Giacomo / Noya, Giuseppe / Schillaci, Giuseppe. ·From the Unit of Digestive and Liver Surgery (AP, JD, VG, ST, AC), Santa Maria Hospital, Terni · Department of General and Oncologic Surgery (RC, FB, AC, CR, GN), University of Perugia, Perugia · Unit of Internal Medicine (FA, FB, GP, GS), Santa Maria Hospital, Terni · and Department of Medicine (FA, FB, GP, GS), University of Perugia, Perugia, Italy. ·Medicine (Baltimore) · Pubmed #25816027.

ABSTRACT: Insulinoma is a rare pancreatic endocrine tumor, typically sporadic and solitary. Although the Whipple triad, consisting of hypoglycemia, neuroglycopenic symptoms, and symptoms relief with glucose administration, is often present, the diagnosis may be challenging when symptoms are less typical. We report a case of road accident due to an episode of loss of consciousness in a patient with pancreatic insulinoma. In the previous months, the patient had occasionally reported nonspecific symptoms. During hospitalization, endocrine examinations were compatible with an insulin-producing tumor. Abdominal computerized tomography and magnetic resonance imaging allowed us to identify and localize the tumor. The patient underwent a robotic distal pancreatectomy with partial omentectomy and splenectomy. Insulin-producing tumors may go undetected for a long period due to nonspecific clinical symptoms, and may cause episodes of loss of consciousness with potentially lethal consequences. Robot-assisted procedures can be performed with the same techniques of the traditional surgery, reducing surgical trauma, intraoperative blood loss, and hospital stays.

14 Article Robotic distal pancreatectomy with or without preservation of spleen: a technical note. 2014

Parisi, Amilcare / Coratti, Francesco / Cirocchi, Roberto / Grassi, Veronica / Desiderio, Jacopo / Farinacci, Federico / Ricci, Francesco / Adamenko, Olga / Economou, Anastasia Iliana / Cacurri, Alban / Trastulli, Stefano / Renzi, Claudio / Castellani, Elisa / Di Rocco, Giorgio / Redler, Adriano / Santoro, Alberto / Coratti, Andrea. ·Department of Digestive and Liver Surgery Unit, St Maria Hospital, Viale Tristano di Joannuccio 1, 05100 Terni, Italy. veronicagrassi@hotmail.it. ·World J Surg Oncol · Pubmed #25248464.

ABSTRACT: BACKGROUND: Distal pancreatectomy (DP) is a surgical procedure performed to remove the pancreatic tail jointly with a variable part of the pancreatic body and including a spleen resection in the case of conventional distal pancreatectomy or not in the spleen-preserving distal pancreatectomy. METHODS: In this article, we describe a standardized operative technique for fully robotic distal pancreatectomy. RESULTS: In the last decade, the use of robotic systems has become increasingly common as an approach for benign and malignant pancreatic disease treatment. Robotic Distal Pancreatectomy (RDP) is an emerging technology for which sufficient data to draw definitive conclusions in surgical oncology are still not available because the follow-up period after surgery is too short (less than 2 years). CONCLUSIONS: RDP is an emerging technology for which sufficient data to draw definitive conclusions of value in surgical oncology are still not available, however this techniques is safe and reproducible by surgeons that possess adequate skills.