Publications by authors named "Carlo A Schena"
Background: While total mesorectal excision is the gold standard for rectal cancer, the optimal surgical approach to achieve adequate oncological outcomes remains controversial. This network meta-analysis aims to compare the histopathological outcomes of robotic (R-RR), transanal (Ta-RR), laparoscopic (L-RR), and open (O-RR) resections for rectal cancer.
Materials And Methods: MEDLINE, Embase, and the Cochrane Library were screened from inception to June 2024.
Colorectal surgery is one of the specialties that have significantly benefited from the adoption of robotic technology. Over 20 years since the first robotic rectal resection, the Intuitive Surgical Da Vinci system remains the predominant platform. The introduction of new robotic systems into the market has enabled the first documented total mesorectal excision (TME) using alternative platforms.
View Article and Find Full Text PDFThe introduction of new technologies in current digestive surgical practice is progressively reshaping the operating room, defining the fourth surgical revolution. The implementation of black boxes and control towers aims at streamlining workflow and reducing surgical error by early identification and analysis, while augmented reality and artificial intelligence augment surgeons' perceptual and technical skills by superimposing three-dimensional models to real-time surgical images. Moreover, the operating room architecture is transitioning toward an integrated digital environment to improve efficiency and, ultimately, patients' outcomes.
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- - The study investigated the effectiveness of robotic right colectomy (RRC) compared to laparoscopic right colectomy (LRC) for nonmetastatic pT4 colon cancer, focusing on surgical outcomes like cancer removal success, complication rates, and recovery times.
- - Results showed similar cancer removal rates and lymph node retrieval between RRC and LRC, but RRC had advantages like fewer conversions to open surgery, less blood loss, and fewer postoperative complications.
- - Both surgical methods had comparable long-term survival rates, indicating that RRC is a viable option for treating pT4 right colon cancer with better short-term results than LRC.
The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs. MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023.
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- This study investigates how the duration of progressive stapler closure affects the occurrence and severity of post-operative pancreatic fistula (POPF) after distal pancreatectomy (DP).* -
- Out of 155 patients, those with a stapler compression of 10 minutes or longer had a significantly lower incidence of POPF (34-47.2%) compared to those with less than 10 minutes (67-80.7%).* -
- The findings suggest that compressing the pancreas for at least 10 minutes is beneficial, especially for patients with a thick pancreatic gland, reducing the risk of clinically relevant POPF.*
Article Synopsis
- This study evaluates three minimally invasive surgical techniques for total mesorectal excision (TME) in treating low/mid locally advanced rectal cancer: laparoscopic, robotic, and transanal TME.
- An analysis of 468 patients revealed that robotic and transanal TME had lower complication and conversion rates compared to laparoscopic TME, with robotic TME showing fewer anastomotic leaks.
- The study concludes that robotic and transanal TME approaches can lead to quicker recovery times and fewer postoperative issues compared to laparoscopic TME, indicating their potential advantages for patient outcomes.
Article Synopsis
- * Higher levels of procalcitonin (>0.5 ng/mL) were found to be independent risk factors for complications, surgery, and even mortality in these patients.
- * The research suggests that measuring procalcitonin levels in the emergency department could be a valuable tool for risk stratification in managing this condition.
Article Synopsis
- Anomalies of the right hepatic artery (RHA) can complicate pancreatoduodenectomy (PD), leading to this study assessing how these variations affect surgical outcomes.
- The research involved analyzing 232 patients who underwent PD for tumors, categorizing them into groups based on normal or abnormal vascular patterns, and comparing their postoperative results.
- Findings showed that anomalies in the RHA did not significantly affect the rate of complications or the cancer tissue examination results, indicating that these variations may not impact surgery outcomes when performed in specialized centers.
Background: This systematic review and meta-analysis assessed the effectiveness of robotic surgery compared to laparoscopy or open surgery for inguinal (IHR) and ventral (VHR) hernia repair.
Methods: PubMed and EMBASE were searched up to July 2022. Meta-analyses were performed for postoperative complications, surgical site infections (SSI), seroma/hematoma, hernia recurrence, operating time (OT), intraoperative blood loss, intraoperative bowel injury, conversion to open surgery, length of stay (LOS), mortality, reoperation rate, readmission rate, use of opioids, time to return to work and time to return to normal activities.
Article Synopsis
- - Iatrogenic urinary tract injury (IUTI) is a serious complication that can arise from emergency digestive surgery, leading to increased health risks and long-term quality of life issues for patients.
- - The incidence of IUTIs varies from 0.3% to 1.5%, highlighting the need for clear strategies for prevention and management, especially given the high number of these surgeries done globally.
- - The World Society of Emergency Surgery (WSES) has developed guidelines based on extensive literature review and expert consultations, focusing on effective prevention measures, detection methods, and management strategies—including antibiotic use—pertaining to IUTIs in emergency settings.
Background: SBO is a potentially life-threatening condition that often affects older patients. Frailty, more than age, is expected to play a crucial role in predicting SBO prognosis in this population. This study aims to define the influence of Clinical Frailty Scale (CFS) on mortality and major complications in patients ≥80 years with diagnosis of SBO at the emergency department (ED).
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- Robotic surgery is becoming more common in general surgery, but access to this technology is still limited to a select number of hospitals worldwide.
- A systematic review identified 15 robotic platforms, with 7 used clinically, analyzing clinical outcomes, training processes, and costs based on 103 studies from various medical databases.
- The majority of procedures were in hepatopancreatobiliary surgery, with cholecystectomy being the most common; however, there are gaps in standardizing training and assessing surgical skills transferability that require further research.
Article Synopsis
- Many patients with gastric cancer are found to have peritoneal metastases during surgery, but detecting this condition before surgery is often difficult due to limitations in imaging techniques like CT scans.
- Staging laparoscopy can improve the detection of peritoneal metastases, potentially allowing for better treatment planning and reducing unnecessary surgeries.
- This review highlights the benefits and challenges of staging laparoscopy in gastric cancer, discusses recent advances including artificial intelligence and image-guided surgery, and explores future developments in preoperative management.
The Impact of Post-Pancreatectomy Acute Pancreatitis (PPAP) on Long-Term Outcomes after Pancreaticoduodenectomy: A Single-Center Propensity-Score-Matched Analysis According to the International Study Group of Pancreatic Surgery (ISGPS) Definition.
Cancers (Basel)
May 2023
Article Synopsis
- Post-pancreatectomy acute pancreatitis (PPAP) is a serious complication following pancreatic surgery that may affect long-term outcomes, though evidence on its impact is limited.
- A study evaluated 231 patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), matching 32 patients with PPAP to 32 without PPAP to minimize biases.
- Findings showed that while major complications and post-operative pancreatic fistulas were higher in the PPAP group, five-year overall survival rates were similar; however, the disease-free survival rate was lower for those with PPAP, indicating potential negative long-term outcomes that warrant further research.
Article Synopsis
- Locally advanced gastric cancer (LAGC) poses significant treatment challenges, particularly due to its interaction with adjacent organs, making the role of neoadjuvant therapies a debated topic among healthcare professionals.
- A study analyzed data from 113 LAGC patients treated between 2005 and 2018, focusing on outcomes and survival rates related to neoadjuvant therapy versus upfront surgery.
- Results indicated that neoadjuvant therapy improved five-year overall survival (46% vs. 32%) and disease-free survival (38% vs. 25%) compared to those undergoing only upfront surgery, highlighting its potential benefits in patient prognosis.
Article Synopsis
- Post-pancreatectomy acute pancreatitis (PPAP) is a complication that arises after pancreatic surgery, and the International Study Group of Pancreatic Surgery (ISGPS) has recently established a standardized definition for it.
- In a study involving 520 patients who underwent pancreatoduodenectomy, 12.1% experienced PPAP, which was linked to significantly higher rates of severe complications, including delayed gastric emptying and post-operative pancreatic fistula.
- The study identified soft pancreatic texture and a narrow Wirsung duct as risk factors for developing PPAP, and it confirmed that the ISGPS classification is effective for defining and assessing the severity of this condition, although more prospective studies
Background: Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS.
Methods: This position paper was conducted according to the World Society of Emergency Surgery methodology.
Article Synopsis
- * New techniques like sentinel lymph node biopsy and indocyanine green fluorescence aim to enhance stomach-sparing surgeries, improving patient quality of life, although their use is limited in Western countries.
- * For advanced gastric cancer, radical gastrectomy combined with multimodal treatments is effective, with ongoing research into chemotherapy approaches like HIPEC and PIPAC for patients with peritoneal carcinomatosis.
Purpose: Circular staplers for colorectal anastomoses significantly ameliorated post-operative outcomes after rectal resection. The more recent three-row technology was conceived to improve anastomotic resistance and, thus, lower the incidence of anastomotic complications. The aim of this study was to evaluate potential advantages of three-row circular staplers (Three-CS) on anastomotic leakage (AL), stenosis (AS), and hemorrhage (AH) rates after rectal resection as compared to two-row circular staplers (Two-CS).
View Article and Find Full Text PDFThe burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms.
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