Immunonutrition in patients who underwent major abdominal surgery: A comprehensive systematic review and component network metanalysis using GRADE and CINeMA approaches.

Background: The benefits of immunonutrition in patients who underwent major abdominal surgery have been recently established, but the optimal combination of immunonutrients has remained unclear. The aim is to clarify this point.

Methods: A systematic search of randomized clinical trials about immunonutrition in major abdominal surgery was made.

Value of immunonutrition in patients undergoing pancreatic resection: a trial sequential meta-analysis.

Background: The benefits of immunonutrition (IM) in patients who underwent pancreatic surgery are unclear.

Methods: A meta-analysis of randomized clinical trials (RCTs) comparing IM with standard nutrition (SN) in pancreatic surgery was carried out. A random-effects trial sequential meta-analysis was made, reporting Risk Ratio (RR), mean difference (MD), and required information size (RIS).

Trial sequential meta-analysis of laparoscopic versus open pancreaticoduodenectomy: is it the time to stop the randomization?

Background: The advantages of LPD compared with OPD remain debatable. The study aimed to compare the laparoscopic (LPD) versus open (OPD) for pancreaticoduodenectomy.

Methods: A meta-analysis of randomized studies (RCTs) comparing LPD and OPD was made.

Evolving knowledge in surgical oncology of pancreatic cancer: from theory to clinical practice-a fifteen-year journey at a tertiary referral centre.

Pancreatic ductal adenocarcinoma (PDAC) is an increasing disease having a poor prognosis. The aim of the present study was to evaluate the effect of different models of care for pancreatic cancer in a tertiary referral centre in the period 2006-2020. Retrospective study of patients with PDAC observed from January 2006 to December 2020.

Effect of malnutrition on postoperative results after pancreatic resection: An entropy balancing analysis.

Background & Aims: Malnutrition is a well-recognized risk factor for major surgery-related complications, but the impact of preoperative nutritional therapy is still debated due to a lack of high-level evidence. The study aims to evaluate the role of preoperative malnutrition in the postoperative course of patients who underwent pancreatic resection.

Methods: This is a retrospective study involving 488 patients who underwent pancreatic resection.

Converted laparoscopic distal pancreatectomy: is there an impact on patient outcome and total cost?

Purpose: Recent studies have reported worse outcomes of converted laparoscopic distal pancreatectomy (CLDP) with respect to total laparoscopic (TLDP) and open (ODP). The aim of the study was to evaluate the impact of conversion on patient outcome and on total cost.

Methods: Patients requiring a conversion (CLDP) were compared with both TLDP and ODP patients.

Preoperative carbohydrate loading before elective abdominal surgery: A systematic review and network meta-analysis of phase II/III randomized controlled trials.

Background & Aims: The preoperative use of carbohydrate loading (CHO) is recommended in patients undergoing abdominal surgery, even if the advantages remain debatable. The aim was to evaluate the CHO benefits in patients undergoing abdominal surgery.

Methods: A systematic search of randomized clinical trials was made.

Laparoscopic versus open distal pancreatectomy: a single centre propensity score matching analysis.

The laparoscopic approach is considered as standard practice in patients with body-tail pancreatic neoplasms. However, only a few randomized controlled trials (RCTs) and propensity score matching (PSM) studies have been performed. Thus, additional studies are needed to obtain more robust evidence.

Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases: Between conventional and mini-invasive approaches.

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate. Staged approach, with initial colorectal resection followed by liver resection (LR), or even the reverse, liver-first approach in specific situations, is traditionally preferred. Simultaneous resections, however, represent an appealing strategy, because may have perioperative risks comparable to staged resections in appropriately selected patients, while avoiding a second surgical procedure.

Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature.

Background: The therapeutic approach of metastatic renal cell carcinoma (RCC) represents a real challenge for clinicians, because of the variable clinical course; the recent availability of numerous targeted therapies that have significantly improved overall oncological results, but still with a low percentage of complete responses; and the increasing role of metastasectomy (MSX) as an effective strategy to achieve a durable cure, or at least defer initiation of systemic therapies, in selected patients and in the context of multimodality treatment strategies.

Case Summary: We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC; he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy, with subsequent systemic therapy with Fluorouracil, Interferon-alpha and Interleukin 2. The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences, successfully treated with multiple systemic treatments, repeated local treatments, including two pancreatic resections, conservative resection and ablation of multiple bilobar liver metastases, resection and stereotactic body radiotherapy of multiple lung metastases.

The use of comprehensive complication Index® in pancreatic surgery: a comparison with the Clavien-Dindo system in a high volume center.

Background: The Clavien-Dindo classification (CDC) system and Comprehensive Complication Index (CCI®) are both widely used methods for reporting the burden of postoperative complications. This study aimed to compare the accuracy of the CDC and CCI® in predicting outcomes associated with pancreatic surgery.

Methods: The CCI® and CDC were applied to 668 patients who underwent pancreatic resection.

Comparison of Blumgart Anastomosis with Duct-to-Mucosa Anastomosis and Invagination Pancreaticojejunostomy After Pancreaticoduodenectomy: A Single-Center Propensity Score Matching Analysis.

Background: The Blumgart anastomosis is a method of pancreaticojejunostomy after pancreaticoduodenectomy (PD) which combines the principle of duct-to-mucosa anastomosis with an invagination technique of the pancreas.

Methods: Retrospective study involving consecutive patients who underwent pancreaticoduodenectomy for pancreatic head cancer. Data predictive of pancreatic fistula and postoperative outcomes were collected.

Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases.

Synchronous colorectal carcinoma (SCRC) indicates more than one primary colorectal carcinoma (CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments.

Centrally located small unifocal hepatocellular carcinoma between minor conservative liver resection and major hepatectomy. Case reports.

Unlabelled: Hepatocellular carcinoma (HCC) is one of the leading cancer in the world, susceptible to potentially curative liver resection (LR) in selected cases. Centrally located HCC (CL-HCC) are sited in central liver segments and may require complex LR because of their relationship to major vascular and biliary structures and deep parenchymal location. Even though extended segment-oriented resections are recommended for oncological reasons, more conservative LR may be indicated in patients with cirrhosis to preserve an adequate function of the future remnant liver (FRL).

Evolving role of FDG-PET/CT in prognostic evaluation of resectable gastric cancer.

Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies.

Impact of octogenarians on surgical outcome in colorectal cancer.

Aim: Colorectal cancer's (CRC) incidence occupies the second place among malignant tumours in men and the third place in women. The aging of the population raises new questions on the management of CRC in octogenarian patients. The objective of this study was to assess the influence of age (≥80) on treatment and surgical outcome of colorectal cancer.

Successful surgical resection of solitary plasmacytoma of the liver mimicking hepatocellular carcinoma. A case report.

Unlabelled: Solitary extramedullary plasmacitomas (SEMP) of the liver are very rare. We report the case of an elderly woman with a huge symptomatic SEMP of the liver mimicking hepatocellular carcinoma (HCC). The patient was a 89-year-old woman who presented with severe abdominal pain and a huge solid mass in the right hypochondrium.

Multifocal intraductal papillary mucinous neoplasm of the pancreas from mild dysplasia to invasive carcinoma A case report.

Unlabelled: Intraductal papillary mucinous neoplasm (IPMN) is defined as an intraductal mucin-producing neoplasm of the pancreatic ducts. IPMNs may be multifocal, have malignant potential and exhibit a broad histological spectrum ranging from adenoma to invasive carcinoma. The "hyperplasia-dysplasia-carcinoma sequence" in the evolution of IPMNs is considered very similar to the "adenoma-carcinoma sequence" of colorectal tumours.

One stage curative resection of double intestinal neuroendocrine tumors with thirty-two bilobar liver metastases. A case report.

Neuroendocrine tumours (NETs) of the midgut are often multifocal and have a noticeable attitude to metastasize to locoregional lymph nodes and liver. Surgery is the only curative treatment for metastatic NETs of the midgut, even though only a minority of patients are candidates to radical surgical resection. The optimal timing for surgical resection in case of synchronous presentation of primary intestinal neoplasms and resectable LM is still controversial, especially when LM are multiple and/or involve multiple liver segments.

Intermittent clamping of the hepatic pedicle in simultaneous ultrasonography-guided liver resection and colorectal resection with intestinal anastomosis: is it safe?

Purpose: In patients with colorectal cancer (CRC) and synchronous colorectal liver metastases (CRLM) potentially candidates to combined liver (LR) and colorectal resection (CRR), the extent of LR and the need of hepatic pedicle clamping (HPC) in selected cases are considered risk factors for the outcome of the intestinal anastomosis. This study aimed to determine whether intermittent HPC is predictive of anastomotic leakage (AL) and has an adverse effect on the clinical outcome in patients undergoing combined restorative CRR and LR.

Methods: One hundred six LR have been performed for CRLM in our unit from July 2005.

Treatment strategy for rectal cancer with synchronous metastasis: 65 consecutive Italian cases from the Bologna Multidisciplinary Rectal Cancer Group.

Background: Twenty percent of rectal cancer patients have synchronous distant metastasis at diagnosis. At present, the treatment strategy in this patient setting is not well defined. This study in one institution evaluates the treatment strategy of three different patient groups.

[Synchronous adenocarcinoma of the sigmoid colon and multifocal intraductal papillary mucinous neoplasm of the pancreas in an elderly patient].

Intraductal papillary mucinous neoplasms are a well-recognized pathologic entity of the pancreas that is being reported with increasing frequency. These tumours carry a relatively favourable prognosis and are frequently associated with extrapancreatic malignancies. The combination of advanced age and co-existence of two neoplasms challenges the planning of the best treatment option.

[Hepatocellular carcinoma with neoplastic thrombosis of the common hepatic duct].

Biliary tract involvement in patients with hepatocellular carcinoma usually occurs in advanced stages and is due to tumour compression or infiltration. In a few cases, however, a tumour thrombus may grow into the biliary ducts (bile duct thrombosis). Identification of this condition is important because surgical treatment may be beneficial in selected cases.

Liver metastases from colorectal cancer: present surgical approach.

Background/aims: New developments in surgical techniques and strategies are modifying the indications to resection of liver metastases.

Methodology: From January 1986 to December 2000, 246 consecutive patients with colorectal liver metastases underwent curative hepatic resection. Surgical strategies included simultaneous resection of primary and metastatic colorectal tumor, re-resection of colorectal liver recurrences, two-stage resection and resection of the inferior vena cava when involved by the tumor.