Chirurgia robotica versus open nel trattamento dell'adenocarcinoma gastrico

Aim Gastric cancer is the fifht most common neoplasia and the third cause of death for tumor.Surgical treatment is the only curative option and open surgery is still the most common approach, while laparoscopic treatment is limited to high volume and high experienced centres. Robotic surgery allows to overcome limits of laparoscopic surgery, by reproducing the same gesture of open surgery and standardizing complex oncologic procedures. The aim of this study is to evaluate the oncological efficacy and safety of robotic surgery for gastric cancer, compared to open surgery. Methods We collected in a prospective database all patients treated for gastric cancer in the Surgical Unit of San Donato Hospital in Arezzo, from October 2012 to July 2016. 133 received curative surgery (R0/R1). Among these, 92 patients are treated with open approach, while 41 underwent to robotic treatment. Patients are not randomized and we chose the treatment, open versus robotic, considering patients charateristics, clinical stadiation, ASA risk and surgeon’s experience. We then corrected the lack of randomization by using the statistical matching by Propensity Score. Results We use the system SPSS for statistical analysis. Robotic surgery is related to longer operative time (295 min vs 160, p15) but the number of harvested lymhpnodes is higher in robotic group (25 vs 19 p<0,05). At short term results analysis there are no differences in time to oral feeding and post-operative stay. Robotica is related to less operative blood loss and lower rate of transfusion. Mean time of oncological follow-up was 22 months. Kaplan-Meier curves of OS and RFS show no differences between the two groups. Conclusions Robotic approach is introduced for treatment of gastric cancer a decade ago only. International literature agrees in confering to robotic surgery same oncological results to open surgery and better post-operative outcomes. Our analysis shows a better trend in intraoperative blood loss and transfusions for robotic surgery. At medium-term follow-up we have no differences in Overal Survival e Recurrence Free Survival, confirming the appropriateness of robotic approach

Renal cavernous hemangioma: robot-assisted partial nephrectomy with selective warm ischemia. Case report and review of the literature

Renal hemangioma is a relatively rare benign tumor with a wide range of clinical and radiological presentation, not easy to differentiate preoperatively from a renal cancer. Due to its benign nature complete surgical resection is the recommended therapy and is considered curative. A 73-year old male patient followed-up for a lung carcinoma anda chronic renal failure underwent a CT scan showing a 35-mm mass of the inferior pole of the left kidney. The patient underwent robot-assisted partial nephrectomy with left inferior pole selective warm ischemia. The outcome was favorable and no repercussions on the renal reserve were observed postoperatively. Histopathological characteristics of the surgical specimen were consistent with renal cavernous hemangioma. A robot-assisted operation allows the fine dissection required to carry out a bloodless nephron-sparing surgery without a complete warm ischemia. The use of robot could be noteworthy for nephron-sparing surgery in cases of concomitant chronic renal failure

Parotid gland tumours. Our experience and a review of the literature.

In this study the authors examine the experience of their department in treating parotid tumours, evaluating in particular the various surgical techniques as a function of the prognosis and the incidence of relapses. Between 1 January 1970 and 31 December 2002, 336 patients with parotid tumour were observed in the Department of Surgical Sciences of "La Sapienza" University in Rome. Two hundred and thirty-nine patients with benign tumours and 65 with malignant tumours were analysed. As far as histological forms were concerned, the benign forms presented a prevalence of pleomorphic adenomas (55.2%) and of Warthin's tumours (36.4%). In the case of malignant tumours, the highest incidence was found for mucoepidermoid carcinomas (29.3%). In the case of benign neoplasms, the surgical strategy opted for was preneural parotidectomy performed in 148 cases (61.9%). Relapsing pleomorphic adenomas were observed in 11.65% of patients controlled, and relapsing Warthin's tumours in 8.7%. In malignant tumours, total parotidectomy was performed in principle, with possible enlargement modulated as a function of tumour stage; owing to causes related to the neoplasm, 18 patients (38.3%) died. In the treatment of benign parotid tumours, preneural parotidectomy is the preferred surgical strategy as it significantly reduces the relapse rate and, when performed by skilled surgeons, is characterized by a complication rate comparable to that of conservative surgery. In the treatment of malignant tumours, total parotidectomy is the basic procedure; extension of the action and the use of ancillary techniques are dependent on tumour stage

Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience

Small renal masses (T1a) are commonly diagnosed incidentally and can be treated with nephron-sparing surgery, preserving renal function and obtaining the same oncological results as radical surgery. Bigger lesions (T1b) may be treated in particular situations with a conservative approach too. We present our surgical technique based on robotic assistance for nephron-sparing surgery. We retrospectively analysed our series of 32 consecutive patients (two with 2 tumours and one with 4 bilateral tumours), for a total of 37 robotic nephron-sparing surgery (RNSS) performed between June 2008 and July 2012 by a single surgeon (G.C.). The technique differs depending on tumour site and size. The mean tumour size was 3.6 cm; according to the R.E.N.A.L. Nephrometry Score 9 procedures were considered of low, 14 of moderate and 9 of hight complexity with no conversion in open surgery. Vascular clamping was performed in 22 cases with a mean warm ischemia time of 21.5 min and the mean total procedure time was 149.2 min. Mean estimated blood loss was 187.1 ml. Mean hospital stay was 4.4 days. Histopathological evaluation confirmed 19 cases of clear cell carcinoma (all the multiple tumours were of this nature), 3 chromophobe tumours, 1 collecting duct carcinoma, 5 oncocytomas, 1 leiomyoma, 1 cavernous haemangioma and 2 benign cysts. Associated surgical procedures were performed in 10 cases (4 cholecystectomies, 3 important lyses of peritoneal adhesions, 1 adnexectomy, 1 right hemicolectomy, 1 hepatic resection). The mean follow-up time was 28.1 months ± 12.3 (range 6-54). Intraoperative complications were 3 cases of important bleeding not requiring conversion to open or transfusions. Regarding post-operative complications, there were a bowel occlusion, 1 pleural effusion, 2 pararenal hematoma, 3 asymptomatic DVT (deep vein thrombosis) and 1 transient increase in creatinine level. There was no evidence of tumour recurrence in the follow-up. RNSS is a safe and feasible technique. Challenging situations are hilar, posterior or intraparenchymal tumour localization. In our experience, robotic technology made possible a safe minimally invasive management, including vascular clamping, tumour resection and parenchyma reconstruction

Transduodenal excision of giant tumour of the ampulla of Vater: a case report.

Carcinoma of the papilla is a rare cancer of the digestive tract; 5% of all gastrointestinal tract malignant neoplasms are periampullary. The authors report and discuss the case of one of their patients aged 79 years suffering from a tumour of the papilla. The case was characterized by the large size of the neoplasm (5.5 cm in diameter) and by the poor clinical conditions of the patient, who was suffering from Parkinson's disease and was at high operative risk. The surgical strategy chosen involved transduodenal excision of the tumour with duodenum-bile duct anastomosis and internal duodenum-Wirsung duct anastomosis. The authors first examine the hypothesis that carcinoma of the papilla may represent the evolution of an adenomatous lesion and then go on to assess the therapeutic strategy adopted in the treatment of these neoplasms: in patients at high operative risk a transduodenal excision of the tumour with duodenum-bile duct anastomosis and internal duodenum-Wirsung duct anastomosis may be a valid alternative to the conventional Whipple procedure