Publications by authors named "Francesco Pennestri'"

Article Synopsis
  • This study assesses the outcomes of adrenalectomy for pheochromocytoma in obese versus nonobese patients, using data from 46 centers from 2012 to 2022.
  • It finds that while obesity does not significantly increase the rate of complications or comprehensive complication index (CCI), it does lead to a longer hospital stay for patients.
  • Furthermore, minimally invasive surgical techniques, like laparoscopic and robotic surgeries, are associated with less morbidity in obese patients, and a retroperitoneal approach may provide additional benefits.
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Article Synopsis
  • Management of unifocal node-negative papillary thyroid carcinoma (PTMC) under 1 cm is debated, with nonsurgical options like active surveillance possibly insufficient for assessing aggressive traits or hidden lymph node metastases.
  • Out of 4216 thyroidectomies for malignancy, 203 patients underwent thyroid lobectomy plus neck dissection, revealing that 37.4% had positive lymph node involvement and biological aggressive features were found in a significant portion of patients.
  • The study identified younger age and multifocality as significant risk factors for hidden lymph node metastases, emphasizing that while PTMC is often seen as low-risk, some patients may exhibit aggressive characteristics, making cautious nonsurgical management essential to avoid undertreatment.
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Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) was proposed as a simplification of the biliopancreatic diversion (BPD) procedure with duodenal switch (DS) in order to reduce operative time and postoperative complications rate, however, keeping effectiveness in weight loss and in comorbidities' resolution. We performed a systematic review of the literature with the aim of summarizing the current evidence of SADI-S clinical outcomes in order to assess its effectiveness and safety, and a total of 17 studies were included. Short- and mid-term follow-up results were reported, with a mean TWL loss ≥ 25% at 12 months and > 44% after 24 months, comparable to BPD-DS, also in reoperative surgery.

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Purpose: In absence of nodal metastases or aggressive features, thyroid lobectomy (TL) should be preferred over total thyroidectomy (TT) for 1-4 cm unifocal, papillary thyroid carcinoma (PTC). However, occult, despite non-microscopic (≥2 mm), nodal metastases may be present in clinically node-negative (cN0) PTC.

Methods: Among 4216 thyroidectomies for malignancy (2014-2023), 110 TL plus ipsilateral central neck dissection (I-CND) were scheduled for unifocal cT1b/small cT2 (≤3 cm) cN0 PTCs.

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Article Synopsis
  • The study explores the effectiveness of desmoplastic stromal reaction as a marker for nodal metastases in sporadic medullary thyroid carcinoma, questioning the reliance on basal calcitonin levels for surgical decisions.
  • Researchers analyzed data from 246 cases of medullary thyroid carcinoma, finding that both desmoplastic stromal reaction positivity and high basal calcitonin levels (>113 pg/mL) were significant independent risk factors for nodal metastases.
  • The results indicate that patients with minimal desmoplastic stromal reaction might not need extensive neck surgeries, while those with significant markers should strongly consider undergoing lateral neck dissection.
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Background And Objective: Robotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients.

Methods: Data for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed.

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The application of a robotic platform in the bariatric surgical field is intended to enhance the already established advantages of minimally invasive surgery in terms of both technical and clinical outcomes. These advantages are especially relevant for technically challenging multiquadrant operations such as Roux-en-Y Gastric Bypass (RYGB). Consequently, robotic-assisted surgery has emerged as a possible application for bariatric surgeries.

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Background: Locally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent multidisciplinary evaluation and treatment is reported.

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Laparoscopic bariatric surgery provides many benefits including lower postoperative pain scores, reduced opioid consumption, shorter hospital stays, and improved quality of recovery. However, the anaesthetic management of obese patients requires caution in determining postoperative risk and in planning adequate postoperative pathways. Currently, there are no specific indications for intensive care unit (ICU) admission in this surgical population and most decisions are made on a case-by-case basis.

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Purpose: Sleeve Gastrectomy (SG) is the most performed bariatric surgery, but a considerable number of patients may require revisional procedures for suboptimal clinical response/recurrence of weight (SCR/RoW). Conversion options include One-Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Duodeno-Ileal Bypass (SADI). The study aims to compare SADI vs.

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The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m) patients in terms of outcomes and cost-effectiveness.

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Severe uncontrolled Cushing's syndrome (CS) is an acute life-threatening condition. As it is often not responsive to medical therapy, emergency bilateral adrenalectomy (BA) may present the only therapeutic option. Moreover, multiple bone fractures, representing one of the clinical consequences of hypercortisolism, may not permit both prone and lateral patient's positioning during surgery, thus making minimally invasive approaches nonfeasible.

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Robotic assisted surgery is a rapidly developing field in bariatric surgery. Its wide diffusion has led to the development and standardisation of robotic assisted approaches for various bariatric operations. However, further application has been limited thus far due to issues of cost-effectiveness and accessibility.

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Background: Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence.

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Introduction: Robotic assisted surgery is a rapidly developing field of minimally invasive bariatric surgery in the last 20 years. Its wide diffusion has led to the development and standardization of robotic assisted approaches for bariatric operations. In this study, we present the first four Roux-en-Y Gastric Bypass (RYGB) operations performed with the new Hugo™ RAS system (Medtronic, Minneapolis, MN, USA).

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Background: Observational studies suggest that bariatric-metabolic surgery might greatly improve non-alcoholic steatohepatitis (NASH). However, the efficacy of surgery on NASH has not yet been compared with the effects of lifestyle interventions and medical therapy in a randomised trial.

Methods: We did a multicentre, open-label, randomised trial at three major hospitals in Rome, Italy.

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: Partial adrenalectomy (PA) is an alternative option to total adrenalectomy for the treatment of hereditary pheochromocytoma (PHEO) to preserve cortical function and avoid life-long steroid replacement. The aim of this review is to summarize current evidence in terms of clinical outcome, recurrence, and corticosteroid therapy implementation after PA for MEN2-PHEOs. : From a total of 931 adrenalectomies (1997-2022), 16 of the 194 patients who underwent surgical treatment of PHEO had MEN2 syndrome.

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Introduction: Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S), like other hypoabsorptive procedures, could be burdened by long-term nutritional deficiencies such as malnutrition, anemia, hypocalcemia, and hyperparathyroidism.

Objectives: We aimed to report our experience in terms of mid-term (2 years) bariatric, nutritional, and metabolic results in patients who underwent SADI-S both as a primary or revisional procedure.

Methods: One hundred twenty-one patients were scheduled for SADI-S as a primary or revisional procedure from July 2016 to February 2020 and completed at least 2 years of follow-up.

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Robotic assisted surgery is the most rapidly developing field of minimally invasive surgery. Its wide diffusion has led to the development and standardization of robotic-assisted approaches also for adrenalectomy. In this study, we present the first five robotic-assisted lateral transabdominal adrenalectomies performed with the new Hugo RAS™ system (Medtronic, Minneapolis, MN, USA).

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Article Synopsis
  • * Out of 1172 thyroid surgeries, 59 cases of VFP were identified, with 42 patients developing vocal fold motility (VFM) recovery by 120 days post-op, while only 9 did not recover.
  • * Key predictors of recovery included arytenoid fixation and specific types of signal loss (LOS) observed early post-operation, suggesting these factors can be used in follow-up protocols to anticipate clinical outcomes for VFP patients.
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