Publications by authors named "Simone Frassini"

Background: Cystic echinococcosis (CE) is a significant public health issue, primarily affecting the liver. While several management strategies exist, there is a lack of predictive tools to guide surgical decisions for hepatic CE. This study aimed to develop predictive models to support surgical decision-making in hepatic CE, enhancing the precision of patient allocation to surgical or non-surgical management pathways.

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Background: Despite improved awareness of blunt traumatic hollow viscus and mesenteric injuries (THVMI), the accuracy of contrast-enhanced CT (CECT) varies considerably among studies. This systematic review and meta-analysis of test accuracy aims to explore the diagnostic performance of CECT in detecting THVMI in blunt trauma.

Methods: The study was conducted according to the Cochrane recommendations searching the PubMed, Scopus, and Cochrane Library datasets from 2000 to 8 September 2023 (PROSPERO ID: CRD42023473041).

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Introduction: The anterior approach (AA), whether or not associated with the liver hanging maneuver (LHM), has been advocated to improve survival and postoperative outcomes in HCC patients undergoing major liver resection. This systematic review and meta-analysis of randomized controlled trials aims to explore intra/perioperative and long-term survival outcomes of AA ± LHM compared to CA regardless of tumor histology.

Methods: The study was conducted according to the Cochrane recommendations searching the PubMed, Scopus, and EMBASE databases until January 27, 2024 (PROSPERO ID: CRD42024507060).

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Electric scooter (ES)-related injuries are increasing but poorly described. Clinicians need more information to be prepared for these patients. We supposed two prevalent patterns of patients: mildly injured (predominant upper-limb injuries) and severely injured (predominant head trauma).

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Background: The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits.

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Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361).

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The definition of Early Cholecystectomy (EC) is still debatable. This paper aims to find whether the timing of EC affects outcomes. The article reports a multicentric prospective observational study including patients with acute calculous cholecystitis (ACC) who had cholecystectomy within ten days from the onset of symptoms.

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Background: Existing guidelines for predicting common bile duct stones (CBDS) are not specific for acute calculous cholecystitis (ACC). This paper is a posthoc analysis of the S.P.

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Background: Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the laparotomy closure method in elective and emergency settings with the prophylactic mesh augmentation technique.

Methods: The Scopus, PubMed, and Web of Science databases were screened without time restrictions up to 21 June 2022 using the keywords 'laparotomy closure', 'mesh', 'mesh positioning', and 'prophylactic mesh', and including medical subject headings terms.

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Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking.

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Article Synopsis
  • Current international guidelines typically exclude patients with colorectal peritoneal carcinosis and a peritoneal cancer index (PCI) of 16 or higher from undergoing surgery.
  • This study retrospectively analyzed outcomes in 71 patients who received cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), finding that those with a higher PCI had longer surgeries and a greater likelihood of incomplete cytoreduction.
  • The results suggest that CRS and HIPEC may still provide reasonable local control for patients with a PCI of 16 or higher, indicating a need to reassess the guidelines that currently exclude these patients from this treatment option.
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  • * A systematic review of eight studies revealed that positive non-PLN involvement significantly increases the risk of death (HR: 2.97), with specific metastasis frequencies varying by lymph node station.
  • * While extended lymphadenectomy may improve survival outcomes, the study concludes that its routine use is not yet advisable for patients with pancreatic ductal adenocarcinoma (PDAC) in these locations.
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  • The study reviews two surgical techniques for spleen-preserving distal pancreatectomy (SPDP), namely Kimura and Warshaw, focusing on their short-term outcomes, especially regarding splenic infarction risks.
  • A systematic analysis of seventeen high-quality studies revealed that the Kimura technique significantly lowers the risk of splenic infarction and gastric varices compared to Warshaw technique.
  • Overall, while both techniques show similar postoperative outcomes, Kimura SPDP is suggested as the preferred method for treating benign pancreatic tumors and low-grade malignancies due to its advantages.
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  • Recent research highlights the growing use of less invasive treatments for acute calculous cholecystitis (ACC) and seeks a reliable method to identify high-risk patients who may benefit from these alternatives.
  • The S.P.Ri.M.A.C.C. study observed over 1,200 patients across various centers and assessed different preoperative risk prediction models, including the newly validated Chole-risk score.
  • Results indicated that while the Chole-risk score was validated, the POSSUM Physiological Score was found to be the best predictor of complications after early cholecystectomy, demonstrating very high sensitivity for both mortality and major morbidity outcomes.
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  • Post hepatectomy liver failure (PHFL) is a serious risk following liver surgery, with the indocyanine green (ICG) clearance test being commonly used for evaluation, though its predictive value for PHFL remains controversial.
  • A systematic review of 17 studies involving 4852 patients showed ICG's sensitivity for predicting PHFL ranged from 25% to 83%, and specificity from 66.1% to 93.8%, with a pooled AUC of 0.673.
  • The results suggest that while the ICG test provides some data, relying on it alone for PHFL prediction is insufficient; it should be combined with other clinical and imaging assessments for better accuracy.
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Background: Pancreatic cancer represents one of the leading causes of cancer-related death worldwide. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal chemotherapy (NIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proven with curative intent mainly for other tumors and there is a lack of consensus regarding possible benefits also in pancreatic cancer. The present systematic review and meta-analysis aim to provide an up-to-date overview of the effectiveness and safety of intraperitoneal treatments in the management of pancreatic cancer.

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  • REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a minimally invasive procedure that helps manage traumatic hemorrhage and is becoming a hot topic in terms of its effectiveness and application.
  • The systematic review shows that REBOA significantly improves 24-hour survival rates in patients with severe torso trauma, but does not have a notable impact on overall in-hospital mortality rates.
  • While patients undergoing REBOA needed fewer packed red blood cells and showed some hemodynamic improvement, they also faced an increased risk of complications, warranting cautious interpretation of these findings.
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  • Gastric cancer patients often face peritoneal metastases, leading to poor long-term survival, but cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) shows potential benefits.
  • This meta-analysis reviewed 12 randomized studies and found significant survival improvements for patients treated with CRS + HIPEC, especially when used as a preventative measure against peritoneal metastasis.
  • Although CRS + HIPEC can enhance prognosis in advanced gastric cancer cases, careful patient selection is essential due to the risks of postoperative complications and the impact of extraperitoneal disease on treatment eligibility.
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Pelvic trauma continues to have a high mortality rate despite damage control techniques for bleeding control. The aim of our study was to evaluate how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) impact the efficacy on mortality and hemodynamic impact. We retrospectively evaluated patients who sustained blunt trauma, pelvic fracture and hemodynamic instability from 2002 to 2018.

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Background: Gastrointestinal (GI) perforations are an acute surgical dilemma, with diagnostic workup often requiring abdominal imaging. Post-operative care for these patients may vary and oftentimes includes ICU care for sepsis, but not always. We evaluated if free fluid and air on computed tomography (CT) could be associated with sepsis, septic shock and mortality in GI perforations.

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Background: Hemodynamically unstable pelvic fractures often require a multi-modal approach including both operative and endovascular management. While an important adjunct in hemorrhage control, time to angioembolization even at the most advanced trauma centers may take hours. Extraperitoneal packing (EPP) is a fast and effective procedure that can immediately address pelvic hemorrhage from the retroperitoneal space in severe pelvic injuries.

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