Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group)

Background: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). Methods: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. Results: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). Conclusions: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951

Laparoscopic right hemicolectomy: the SICE (Societ\ue0 Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Background: While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons\u2019 attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods: One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results: ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients\u2019 characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions: In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration: Clinical trial (Identifier: NCT03934151)

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 202

Acute cholecystitis during COVID-19 pandemic: A multisocietary position statement

Following the spread of the infection from the new SARS-CoV2 coronavirus in March 2020, several surgical societies have released their recommendations to manage the implications of the COVID-19 pandemic for the daily clinical practice. The recommendations on emergency surgery have fueled a debate among surgeons on an international level. We maintain that laparoscopic cholecystectomy remains the treatment of choice for acute cholecystitis, even in the COVID-19 era. Moreover, since laparoscopic cholecystectomy is not more likely to spread the COVID-19 infection than open cholecystectomy, it must be organized in such a way as to be carried out safely even in the present situation, to guarantee the patient with the best outcomes that minimally invasive surgery has shown to have

Correction to: SICE national survey: current state on the adoption of laparoscopic approach to the treatment of colorectal disease in Italy (Updates in Surgery, (2019), 71, 1, (77-81), 10.1007/s13304-018-0606-5)

The surname and given name of author Riccardo Brachet Contul was incorrectly published

SICE national survey : current state on the adoption of laparoscopic approach to the treatment of colorectal disease in Italy

The real diffusion of laparoscopy for the treatment of colorectal diseases in Italy is largely unknown. The main purpose of the present study is to investigate among surgeons dedicated to minimally invasive surgery, the volume of laparoscopic colorectal procedures, the type of operation performed in comparison to traditional approach, the indication for surgery (benign and malignant) and to evaluate the different types of technologies used. A structured questionnaire was developed in collaboration with an international market research institute and the survey was published online; invitation to participate to the survey was issued among the members of the Italian Society of Endoscopic Surgery (SICE). 211 surgeons working in 57 surgical departments in Italy fulfilled and answered the online survey. A total of 6357 colorectal procedures were recorded during the year 2015 of which 4104 (64.1%) were performed using a minimally invasive approach. Colon and rectal cancer were the most common indications for laparoscopic approach (83.1%). Left colectomy was the operation most commonly performed (41.8%), while rectal resection accounted for 23.5% of the cases. Overall conversion rate was 5.9% (242/4104). Full HD standard technology was available and routinely used in all the responders' centers. The proportion of colorectal resections that are carried out laparoscopically in dedicated centers has now reached valuable levels with a low conversion rate

Laparoscopic right hemicolectomy: the SICE (Societ\ue0 Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Background: While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons\u2019 attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods: One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results: ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients\u2019 characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions: In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration: Clinical trial (Identifier: NCT03934151)

Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Background: While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons’ attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods: One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results: ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients’ characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions: In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration: Clinical trial (Identifier: NCT03934151)

Correction to: Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospectivetrial on 1225 cases comparing intra corporeal versus extra corporeal ileo‑colic side‑to‑side anastomosis (Surgical Endoscopy, (2019), 10.1007/s00464-019-07255-2)

Due to an error in production the members of SICE CoDIG (Colon Dx Italian Group) listed in the Acknowledgments were not tagged correctly as authors in the XML of this article. This listing is presented again here: SICE CoDIG (ColonDxItalianGroup): V. Adamo (S Lazzaro Alba – CN), A. Agrusa (Palermo), G. Alemanno (Firenze), M.E. Allaix (Torino), A. Alò (Orbassano TO), A. Altamura (Tricase – LE), A. Ambrosi (Foggia), M. Antoniutti (Bassano del Grappa – VI), D. Apa (Roma), G. Arcuri (Gubbio – PG), G.L Baiocchi (Brescia), A. Balani (Gorizia), G. Baldazzi (Milano), M. Basti (Pescara), C. Benvenuto (Protogruaro – VE), S. Berti (La Spezia), L. Boni (Milano), F. Borghi (Cuneo), E. Botteri (Brescia), R. Brachet Contul (Aosta), A. Brescia (Roma), A. Budassi (Frabriano - AN), L. Cafagna (Andria), M. Calgaro (S Lazzaro Alba – CN), P.G. Calò (Cagliari), R. Campagnacci (Jesi – AN), G. Canova (Borgosesia – VC), G.L. Canu (Cagliari), V. Caracino (Pescara), P. Carcoforo (Ferrara), M. Carlini (Roma), L. Casali (Fidenza – PR), D. Cassetti (Siena), E. Cassinotti (Milano), M. Catarci (Ascoli Piceno), M. Cesari (Città di Castello – PG), P. Checcacci (Firenze), P. Ciano (Ascoli Piceno), M. Clementi (L’ Aquila), G. Cocorullo (Palermo), F. Colombo (Milano), G. Concone (Milano), A. Contine (Città di Castello – PG), M. Coppola (Lanusei – NU), A. Coratti (Firenze), F. Corcione (Napoli), P. Corleone (Trieste), L. Covotta (Contrada Pozzillo – AV), D. Cuccurullo (Napoli), P. Cumbo (Chieri – TO), G. D’Ambrosio (Roma), F. De Angelis (Latina), M. De Luca (Montebelluna –TV), N. De Manzini (Trieste), C. De Nisco (Nuoro), G.D. De Palma (Napoli), P. De Paolis (Torino), M. Degiuli (Orbassano – TO), D. Delogu (Lanusei – NU), P. Delrio (Napoli), A. Deserra (Cagliari), A. Donini (Perugia), U. Elmore (Milano), G. Ercolani (Forlì), E. Erdas (Cagliari), L. Fabris (Cles – TN), G. Ferrari (Milano), C. Feo (Valle Oppio – FE), F. Fidanza (Portogruaro – VE), D. Foschi (Milano),R. Galleano (Pietra Ligure – SV), G. Garulli (Rimini), F. Gatti (Milano), A. Gattolin (Mondovì – CN), S. Gelati (Conegliano Veneto – TV), R. Gelmini (Modena), O. Ghazouani (Pietra Ligure – SV), A. Gioffrè (Roma), S. Gobbi (Olbia), V. Grammatico (Chieri – TO), A. Guariniello (Ravenna), S. Giannessi (Pistoia), M. Guerrieri (Ancona), L. Guerriero (Napoli), G. Gullotta (Palermo), H. Impellizzeri (Peschiera del Garda – VR), M. Izzo (Firenze), E. Jovine (Bologna), G. Lezoche (Ancona), C. Lirusso (Udine), R. Lombardi (Bologna), M. Longoni (Milano), A. Lucchi (Riccione – RN), A.P. Luzzi (Genova), P. Marini (Roma), A.G. Marrosu (Sassari), A. Martino (Udine), R. Mazza (Perugia), S. Mazzoccato (Jesi – AN), F. Medas (Cagliari), A. Meloni (San Gavino Monreale – VS), M. Milone (Napoli), E. Minciotti (Gubbio – PG), F. Monari (Riccione – RN), G. Moretto (Peschiera del Garda – VR), I.A. Muttillo (Roma), G. Navarra (Messina), S. Neri (Sassuolo - MO), A. Oldani (Zingonia – BG), S. Olmi (Zingonia – BG), E. Opocher (Milano), E. Osenda (Trieste), R. Ottonello (Muravera – CA), V. Panebianco (Taormina - CT), M. Pavanello (Conegliano Veneto – TV), F. Pecchini (Modena), L. Pellegrino (Cuneo), D. Pennisi (Gorizia), N. Perrotta (Potenza), D. Pertile (Genova), R. Petri (Udine), A. Picchetto (Roma), M. Piccoli (Modena), B. Pirrera (Rimini), A. Pisani Ceretti (Milano), M. Pisano (Muravera – CA), M. Podda (Nuoro), N. Portolani (Brescia), L. Presenti (Olbia), A. Puzziello (Salerno), S. Razzi (Aosta), D. Rega (Napoli), E. Restini (Bari), G. Ricci (Roma), M. Rigamonti (Cles – TN), U. Rivolta (Magenta), V. Robustelli (Pistoia), E. Romairone (Genova), R. Rosati (Milano), E. Rosso (Brescia), F. Roviello (Siena), S. Sala (Sassuolo – MO), M. Santarelli (Torino), G. Sarro (Magenta), A. Sartori (Montebelluna –TV), S. Scabini (Genova), F. Scognamillo (Sassari), R. Sechi (San Gavino Monreale – VS), L. Solaini (Forlì), G. Soliani (Ferrara), P. Soliani (Ravenna), E. Soligo (Vercelli), M. Sorrentino (Latisana – UD); G. Spinoglio (Milano), E. Stratta (Genova), A. Taddei (Firenze), G. Talamo (La Spezia), S. Targa (Valle Oppio – FE), N. Tartaglia (Foggia), S. Testa (Vercelli), P. Ubiali (Pordenone), A. Valeri (Firenze), F. Vasta (Taormina - CT), A. Verzelli (Fabriano – AN), R. Vicentini (L’Aquila), G. Viola (Tricase – LE), V. Violi (Fidenza - PR), M. Zago (Borgosesia – VC), L. Zampino (Milano)