TRATTAMENTO ABLATIVO CON MICROONDE DI METASTASI EPATICHE DA TUMORE DELLA MAMMELLA: STUDIO DI FATTIBILITÀ ED EFFICACIA

INTRODUCTION Prognosis of patients with breast cancer liver metastases is still dismal. Some retrospective data support adjuvant surgery in selected patients. Ablative treatment in the management of breast cancer liver metastases remains controversial. MATERIAL AND METHODS We evaluated the efficacy (complete ablation and recurrence rate) and the safety (morbidity and mortality) of the microwave ablation treatment (MWA) of breast cancer liver metastases, performed in our Center from 2009 to 2016. Analysis was performed on a nodule-oriented and patient-oriented base. RESULTS Median time to liver metastases development was 52.13 months (IQR 25.5- 81.72), 92.5% of which were metachronous. Forty patients underwent 51 MWA sessions, percutaneously (27 sessions, 33 nodules) and laparoscopically (24 sessions, 67 nodules). Complete ablation rate for nodules ≤2 cm was 95.56% whereas the 3- and 6-months recurrence rate, irrespectively of the nodule dimension, was 12.73% and 26.19%, respectively. MWA was associated with no 90-day mortality. Morbidity rate was 20%. Two patients are alive and free of disease at 49 and 86 months, respectively

Surgery for Recurrent Pancreatic Cancer: Is It Effective?

Despite improvements to surgical procedures and novel combinations of drugs for adjuvant and neoadjuvant therapies for pancreatic adenocarcinoma, the recurrence rate after radical surgery is still high. Little is known about the role of surgery in the treatment of isolated recurrences of pancreatic cancer. The aim of this study was to review the current literature dealing with surgery for recurrent pancreatic cancer in order to examine its feasibility and effectiveness. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 14 articles dealing with re-resections for recurrent pancreatic adenocarcinoma were analyzed, focusing on the characteristics of the primary neoplasm and its recurrence, the surgical procedures used, and patient outcomes. Data were retrieved on a total of 301 patients. The interval between surgery for primary pancreatic cancer and the detection of a recurrence ranged from 2 to 120 months. The recurrence was local or regional in 230 patients, and distant in 71. The median overall survival was 68.9 months (range 3-152) after resection of the primary tumor, and 26.0 months (range 0-112) after surgery for recurrent disease. The disease-free interval after the resection of recurrences was 14.2 months (range 4-29). Although data analysis was performed on a heterogeneous and limited number of patients, some of these may benefit from surgery for isolated recurrence of pancreatic adenocarcinoma. Further studies are needed to identify these cases

Safety and Efficacy of Surgery for Metastatic Tumor to the Pancreas: A Single-Center Experience

Pancreatic metastases from other neoplasms are rare. The role of surgery for this clinical entity is unclear. The aim of this study was to investigate the role of resection in patients with pancreatic secondary lesions. We observed 44 patients with pancreatic metastases from other tumors. Renal cell carcinoma was the most common primary tumor (n = 19, 43.2%). Thirty-seven patients underwent surgery, and pancreatic resection with curative intent was feasible in 35 cases. Fifteen patients (43.2%) experienced major postoperative complications (Clavien-Dindo > 2), and postoperative mortality rate was 5.4%. The median overall survival and disease-free survival were 38 (range 0–186) and 11 (range 0–186) months, respectively. Overall survival and disease-free survival were significantly longer for pancreatic metastases from renal cell carcinoma when compared to other primary tumors. Multivariate analysis confirmed a pathological diagnosis of metastasis from RCC as an independent prognostic factor for overall survival (OR 2.48; 95% CI, 1.00–6.14; p = 0.05). In conclusion, radical resection of metastases to the pancreas is feasible and safe, and may confer a survival benefit for selected patients. There is a clear benefit of metastasectomy in terms of patient survival for metastases from renal cell carcinoma, while for those with other primary tumors, surgery seems to be mainly palliative

The Role of Positron Emission Tomography in Clinical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a heterogeneous group of tumors, increasingly diagnosed in clinical practice. An early differential diagnosis between malignant and benign lesions is crucial to patient management and the choice of surgery or observation. The therapeutic approach is currently based on a patient's clinical, biochemical, and morphological characteristics. The latest published International Consensus Guidelines (ICG) make no mention of the role of metabolic assessments of IPMNs. The aim of this study was to review the current literature, examining the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in IPMN management. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 10 articles were analyzed in detail, focusing on the value of PET as opposed to other standard imaging criteria. Data were retrieved on 419 patients. The 18-FDG-PET proved more sensitive, specific, and accurate than the ICG criteria in detecting malignant IPMNs (reaching 80%, 95%, and 87% vs. 67%, 58%, and 63%, respectively). Metabolic assessments may be used as an additional tool for the appropriate management of patients with doubtful imaging findings

Epigenetic targeting of bromodomain protein BRD4 counteracts cancer cachexia and prolongs survival

Cancer cachexia is a devastating metabolic syndrome characterized by systemic inflammation and massive muscle and adipose tissue wasting. Although it is responsible for approximately one-third of cancer deaths, no effective therapies are available and the underlying mechanisms have not been fully elucidated. We previously identified the bromodomain and extra-terminal domain (BET) protein BRD4 as an epigenetic regulator of muscle mass. Here we show that the pan-BET inhibitor (+)-JQ1 protects tumor-bearing mice from body weight loss and muscle and adipose tissue wasting. Remarkably, in C26-tumor-bearing mice (+)-JQ1 administration dramatically prolongs survival, without directly affecting tumor growth. By ChIP-seq and ChIP analyses, we unveil that BET proteins directly promote the muscle atrophy program during cachexia. In addition, BET proteins are required to coordinate an IL6-dependent AMPK nuclear signaling pathway converging on FoxO3 transcription factor. Overall, these findings indicate that BET proteins may represent a promising therapeutic target in the management of cancer cachexia

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

TRATTAMENTO ABLATIVO CON MICROONDE DI METASTASI EPATICHE DA TUMORE DELLA MAMMELLA: STUDIO DI FATTIBILITÀ ED EFFICACIA

INTRODUCTION Prognosis of patients with breast cancer liver metastases is still dismal. Some retrospective data support adjuvant surgery in selected patients. Ablative treatment in the management of breast cancer liver metastases remains controversial. MATERIAL AND METHODS We evaluated the efficacy (complete ablation and recurrence rate) and the safety (morbidity and mortality) of the microwave ablation treatment (MWA) of breast cancer liver metastases, performed in our Center from 2009 to 2016. Analysis was performed on a nodule-oriented and patient-oriented base. RESULTS Median time to liver metastases development was 52.13 months (IQR 25.5- 81.72), 92.5% of which were metachronous. Forty patients underwent 51 MWA sessions, percutaneously (27 sessions, 33 nodules) and laparoscopically (24 sessions, 67 nodules). Complete ablation rate for nodules ≤2 cm was 95.56% whereas the 3- and 6-months recurrence rate, irrespectively of the nodule dimension, was 12.73% and 26.19%, respectively. MWA was associated with no 90-day mortality. Morbidity rate was 20%. Two patients are alive and free of disease at 49 and 86 months, respectively.INTRODUZIONE La prognosi delle pazienti con metastasi epatiche da carcinoma mammario è ancora infausta. Alcuni dati retrospettivi suggeriscono un aumento della sopravvivenza nelle pazienti sottoposte a chirurgia adiuvante delle metastasi. Il trattamento ablativo delle metastasi da carcinoma mammario è ancora controverso. MATERIALI E METODI Abbiamo valutato l’efficacia (tasso di ablazione completo e di recidiva) e la sicurezza (morbilità e mortalità) del trattamento ablativo con microonde delle metastasi epatiche, eseguito presso il nostro Centro dal 2009 al 2016. L’analisi è stata condotta sulla base dei noduli e ablati e sulla base delle pazienti trattate. RISULTATI Il 92,5% delle metastasi sono metacrone con un tempo mediano di comparsa dalla diagnosi di tumore della mammella di 52,13 mesi (IQR 25,5- 81,72). Quaranta pazienti sono state sottoposte a 51 sessioni di trattamento ablativo con microonde, percutanea (27 sessioni, 33 noduli) e laparoscopica (24 sessioni, 67 noduli). Il tasso di ablazione completa per noduli ≤2 cm è risultata pari al 95,56% mentre il tasso di recidiva globale a 3 e 6 mesi, indipendentemente dalle dimensioni dei noduli, è stato del 12,73% e del 26,19%, rispettivamente. La mortalità a 90 giorni è stata nulla e il tasso di complicanze è stato del 20%. Due pazienti sono vive e libere da malattia a 49 e 86 mesi

Simultaneous laparoscopic resection of distal pancreas and liver nodule for pancreatic neuroendocrine tumor

Laparoscopic distal pancreatectomy (LDP) with or without splenic preservation is increasingly performed for benign or border-line neoplasms of the body and tail of the pancreas. Pancreatic neuroendocrine tumors appear as an excellent indication for laparoscopic resection and this procedure is becoming the gold standard for the surgical treatment of such neoplasms. The safety and advantage of laparoscopic resection over open distal pancreatectomy (ODP) have been proven. In this video, we present a LDP with splenectomy for a neuroendocrine tumor of distal pancreas, with associated wedge resection of a liver nodule. Technical considerations were also discussed