Publications by authors named "Claudio Fiorillo"

Pancreatic surgery is complex and associated with higher rates of morbidity and mortality compared to other abdominal surgeries. Over the past decade, the introduction of new technologies, such as minimally invasive approaches, improvements in multimodal treatments, advancements in anesthesia and perioperative care, and better management of complications, have collectively improved patient outcomes after pancreatic surgery. In particular, the adoption of Enhanced Recovery After Surgery (ERAS) recommendations has reduced hospital stays and improved recovery times, as well as post-operative outcomes.

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  • The study investigates how preoperative glucose metabolism impacts the risk of clinically relevant pancreatic fistulas (CR-POPF) after pancreaticoduodenectomy (PD) surgery.
  • Out of 110 patients, those with normal glucose tolerance showed a higher incidence of CR-POPF at 51.7%, compared to those with impaired glucose tolerance or diabetes.
  • Fasting glucose levels and c-peptide values were found to be effective predictors for CR-POPF, indicating that both normoglycemia and normal beta cell function may increase the risk of complications post-surgery.
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The influencing role of resection margin (R) status on long-term outcomes, namely overall (OS) and disease-free survival (DFS), after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) is not still clear. The aim of this study is to evaluate the prognostic impact of R status after PD and to define tumor characteristics associated with a positive resection margin (R1). All PDs for PDAC performed between 2012 and 2023 were retrospectively enrolled.

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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.*
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  • Peritoneal carcinomatosis from gastric cancer has a very low median overall survival of just 4 months, with palliative systemic chemotherapy being the only standard treatment so far.
  • A systematic review and meta-analysis were conducted to compare the survival outcomes of patients treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) versus those receiving palliative systemic chemotherapy.
  • Results showed that patients receiving CRS + HIPEC had significantly better median overall survival (ranging from 9.8 to 28.2 months) compared to those on pSC (4.9 to 8 months), indicating that CRS + HIPEC could improve survival in these patients.
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The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice.

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  • The REDISCOVER consensus conference focused on creating guidelines for the perioperative care of patients with borderline-resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC).
  • Using a structured methodology and expert consensus, the conference developed 34 recommendations on various aspects of surgical care, patient selection, and management of pancreatic cancer.
  • Despite the low evidence quality for most recommendations, participants highlighted the importance of establishing an international registry to enhance understanding and care for this patient group.
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  • 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.
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Background: Accurate nodal restaging is becoming clinically more important in patients with locally advanced rectal cancer (LARC) with the emergence of organ-preserving treatment after a good response to neoadjuvant chemoradiotherapy (nCRT).

Purpose: To evaluate the accuracy of MRI in identifying negative N status (ypN0 patients) in LARC after nCRT.

Material And Methods: 191 patients with LARC underwent MRI before and 6-8 weeks after nCRT and subsequent total mesorectal excision.

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Background: The safety and efficacy of minimally invasive radical antegrade modular pancreatosplenectomy (MI-RAMPS) remain to be established in pancreatic cancer (PDAC) METHODS: Eighty-five open (O)-RAMPS were compared to 93 MI-RAMPS. The entropy balance matching approach was used to compare the two cohorts, eliminating the selection bias. Three models were created.

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(1) Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. The lack of validated disease biomarkers makes timely diagnosis challenging in most cases. Cell membrane and surface proteins play a crucial role in several routes of oncogenesis.

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  • 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.
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  • 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.
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  • 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.
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  • The study evaluates the impact of multidisciplinary tumor boards (MDTBs) on the management of pancreatic cancer (PC), particularly focusing on diagnosis, treatment response, and resectability assessment.
  • Data from 487 patients discussed at the MDTBs over two years showed that MDTB discussions changed treatment management in 18.3% of cases, particularly influencing resectability evaluations.
  • High concordance rates were observed between MDTB assessments and intraoperative findings, especially for resectable lesions, highlighting the importance of MDTBs in improving PC treatment outcomes.
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  • 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
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  • * 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.
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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).

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Background: To evaluate, in a prospective observational cohort study of adults ≥65 years old, the frailty status at the emergency department (ED) admission for the in-hospital death risk stratification of patients needing urgent cholecystectomy.

Methods: Clinical variables and frailty status assessed in the ED were evaluated for the association with major complications and the need for open surgery. The parameters evaluated were frailty, comorbidities, physiological parameters, surgical approach, and laboratory values at admission.

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Artificial intelligence (AI) and computer vision (CV) are beginning to impact medicine. While evidence on the clinical value of AI-based solutions for the screening and staging of colorectal cancer (CRC) is mounting, CV and AI applications to enhance the surgical treatment of CRC are still in their early stage. This manuscript introduces key AI concepts to a surgical audience, illustrates fundamental steps to develop CV for surgical applications, and provides a comprehensive overview on the state-of-the-art of AI applications for the treatment of CRC.

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  • The study investigates the impact of different histological subtypes of ampullary carcinomas (ACs) on long-term patient outcomes following pancreaticoduodenectomy (PD).
  • It includes data from 2004 to 2020, comparing overall survival (OS) and disease-free survival (DFS) among pancreatobiliary (Pb-AC), intestinal (Int-AC), and mixed (Mixed-AC) ACs.
  • Results show that Pb-AC patients have significantly worse 5-year OS and DFS compared to Int-AC patients, indicating a more aggressive tumor behavior in Pb-ACs and Mixed-ACs, while Int-ACs demonstrate better survival rates.
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Background: Few evidences are available on adhesive bowel obstruction (ASBO)management and outcomes in geriatric patients.

Methods: One-hundred-twenty-eight patients aged 65-79 years were retrospectively compared to 77 patients aged ≥80 years. Aim of this study was to compare ASBO management and in-hospital course between patients aged 65-79 years and those over 80 years.

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Background: Obesity has become a global epidemic. Bariatric surgery is considered the most effective therapeutic weapon in terms of weight loss and improvement of quality of life and comorbidities. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed procedures worldwide, although patients carry a nonnegligible risk of developing post-operative GERD and BE.

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