Robotic distal subtotal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a case report and technical description

Robotic systems have revolutionized the way we perform minimally invasive surgery and has facilitated the evolution of traditional laparoscopic gastric surgery. Surgeons have several advantages that can overcome some of the well-known limits of laparoscopy: three-dimensional vision, articulated instruments, the absence of tremors. These can give greater dexterity and precision in dissection and suturing movements that are key elements when performing complex and gentle reconstruction to restore digestive continuity. The present case shows the technical details and tips and tricks of a robotic surgical approach for a subtotal gastrectomy

The effect of ERAS management in gastric cancer: assessment from the IMIGASTRIC study

Background:Establish protocols to enhance the surgical management (ERAS) can improve outcomes, shortening hospital stay and save resources. Several studies have carried out for colorectal surgery, while a lack of evidence for gastrectomy remains.This study aims to evaluate the impact of ERAS strategies in a large series of patients underwent gastric cancer surgery.Methods:This is a propensity score-matched case-control study, comparing an ERAS group with a control group. Data were recorded through a tailored and protected web-based system. Primary outcomes: hospital stay, complications rate. Among the secondary outcomes, there are: POD of mobilization, POD of starting liquid diet and soft solid diet.Results:Patients in the ERAS and control groups were 1:1 matched by the closest propensity score on the logit scale and with a Caliber = 0.2. The successful matching resulted in a total sample of 440 patients. The two groups showed no differences in all baseline patients characteristics, type of surgery (P=0.31) and stage of the disease (P=0.61). A benefit in favor of the ERAS management was found in the length of hospital stay (P=0.0004) and complications rate (P=0.001).Conclusion:An ERAS program can safely be established in referral centers for gastric cancer, enabling to significantly improve the main clinical outcomes

Donor-to-recipient gender match in liver transplantation. A systematic review and meta-analysis

AIM To perform a systematic review and meta-analysis on donor-to-recipient gender mismatch as a risk factor for post-transplant graft loss. METHODS A systematic literature search was performed using PubMed, Cochrane Library database and EMBASE. The primary outcome was graft loss after liver transplantation. Odds ratios and 95% confidence intervals were calculated to compare the pooled data between groups with different donor-to-recipient gender matches. Three analyses were done considering (1) gender mismatches (F-M and M-F) vs matches (M-M and F-F); (2) Female-to-Male mismatch vs other matches; and (3) Male-to-Female mismatch vs other matches. RESULTS A total of 7 articles were analysed. Gender mismatch (M-F and F-M) was associated with a significant increase of graft loss respect to match (M-M and F-F) (OR: 1.30; 95%CI: 1.13-1.50; P < 0.001). When F-M mismatch was specifically investigated, it confirmed its detrimental role in terms of graft survival (OR: 1.83; 95%CI: 1.20-2.80; P = 0.005). M-F mismatch failed to present a significant role (OR: 1.09; 95%CI: 0.73-1.62; P = 0.68). CONCLUSION Gender mismatch is a risk factor for poor graft survival after liver transplantation. Female-to-male mismatch represents the worst combination. More studies are needed with the intent to better clarify the reasons for these results

Platelet-to-lymphocyte ratio in the setting of liver transplantation for hepatocellular cancer. A systematic review and meta-analysis

AIM: To perform a systematic review and meta-analysis on platelet-to-lymphocyte ratio (PLR) as a risk factor for post-transplant hepatocellular cancer (HCC) recurrence. METHODS: A systematic literature search was performed using PubMed. Participants of any age and sex, who underwent liver transplantation for HCC were considered following these criteria: (1) studies comparing pre-transplant low vs high PLR values; (2) studies reporting post-transplant recurrence rates; and (3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measure was set for HCC recurrence after transplantation. RESULTS: A total of 5 articles, published between 2014 and 2017, fulfilled the selection criteria. As for the quality of the reported studies, all the investigated articles presented an overall high quality. A total of 899 cases were investigated: 718 cases (80.0%) were males. Three studies coming from European countries and one from Japan presented HCV as the main cause of cirrhosis. On the opposite, one Chinese study presented a greater incidence of HBV-related cirrhotic cases. In all the studies apart one, the PLR cut-off value of 150 was reported. At meta-analysis, high PLR value was associated with a significant increase in recurrence after transplantation (OR = 3.33; 95%CI: 1.78-6.25; p &lt; 0.001). A moderate heterogeneity was observed among the identified studies according to the Higgins I 2 statistic value. CONCLUSION: Pre-transplant high PLR values are connected with an increased risk of post-operative recurrence of hepatocellular cancer. More studies are needed for better clarify the biological mechanisms of this results

Genome sequence analysis of a distinctive Italian infectious bursal disease virus.

ABSTRACT In a recent study, an emerging infectious bursal disease virus (IBDV) genotype (ITA) was detected in IBDV-live vaccinated broilers without clinical signs of infectious bursal disease (IBD). VP2 sequence analysis showed that strains of the ITA genotype clustered separately from vaccine strains and from other IBDV reference strains, either classic or very virulent. In order to obtain a more exhaustive molecular characterization of the IBDV ITA genotype and speculate on its origin, genome sequencing of the field isolate IBDV/Italy/1829/2011, previously assigned to the ITA genotype, was performed, and the sequences obtained were compared to the currently available corresponding sequences. In addition, phylogenetic and recombination analyses were performed. Interestingly, multiple amino acid (AA) sequence alignments revealed that the IBDV/Italy/1829/2011 strain shared several AA residues with very virulent IBDV strains as well as some virulence markers, especially in the VP1 protein. Nevertheless, sequence analysis demonstrated the presence of several residues typical of IBDV strains at a low degree of virulence in the IBDV/Italy/1829/2011 strain. Although homologous recombination and reassortant phenomena may occur naturally among different IBDV strains, no evidence of those events was found in the genome of the IBDV/Italy/1829/2011 strain, which was confirmed to be a genetically distinctive IBDV genotype

New Insights in the Setting of Transplant Oncology

: Background and Objectives: Liver transplantation (LT) is the best strategy for curing several primary and secondary hepatic malignancies. In recent years, growing interest has been observed in the enlargement of the transplant oncology indications. This paper aims to review the most recent developments in the setting of LT oncology, with particular attention to LT for unresectable colorectal liver metastases (CRLM) and cholangiocellular carcinoma (CCA). Materials and Methods: A review of the recently published literature was conducted. Results: Growing evidence exists on the efficacy of LT in curing CRLM and peri-hilar and intrahepatic CCA in well-selected patients when integrating this strategy with (neo)-adjuvant chemotherapy, radiotherapy, or locoregional treatments. Conclusion: For unresectable CCA and CRLM management, several prospective protocols are forthcoming to elucidate LT's impact relative to alternative therapies. Advances in diagnosis, treatment protocols, and donor-to-recipient matching are needed to better define the oncological indications for transplantation. Prospective, multicenter trials studying these advances and their impact on outcomes are still required

Product developments and dissemination activities

This document shows product developments and dissemination activities carried out within the framework of, or in close relation to, the project IEA SHC Task 41; Solar Energy and Architecture. This Task gathered researchers and practicing architects from 14 countries in the three year project whose aim was to identify the obstacles architects are facing when incorporating solar design in their projects, to provide resources for overcoming these barriers and to help improving architects’ communication with other stakeholders in the design of solar buildings. Participating countries were Australia, Austria, Belgium, Canada, Denmark, Germany, Italy, Norway, Portugal, Republic of Korea, Singapore, Spain, Sweden and Switzerland. The report gives not a complete list of activities, but shows the different types of activities to spread the findings in Task 41 and to initiate product developments in participating countries

Prospective, observational, multicenter study on minimally invasive gastrectomy for gastric cancer: robotic, laparoscopic and open surgery compared on operative and follow-up outcomes - IMIGASTRIC II study protocol: IMIGASTRIC II

Background:Several meta-analyses have tried to defi ne the role of minimally invasive approaches.&nbsp;However, further evidence to get a wider spread of these methods is necessary. Current&nbsp;studies describe minimally invasive surgery as a possible alternative to open surgery&nbsp;but deserving further clarifi cation. However, despite the increasing interest, the&nbsp;difficulty of planning prospective studies of adequate size accounts for the low level of&nbsp;evidence, which is mostly based on retrospective experiences.A multi-institutional prospective study allows the collection of an impressive amount&nbsp;of data to investigate various aspects of minimally invasive procedures with the&nbsp;opportunity of developing several subgroup analyses.A prospective data collection with high methodological quality on minimally invasive&nbsp;and open gastrectomies can clarify the role of diff erent procedures with the aim to&nbsp;develop specifi c guidelines.Methods and analysis:a multi-institutional prospective database will be established including information on&nbsp;surgical, clinical and oncological features of patients treated for gastric cancer with&nbsp;robotic, laparoscopic or open approaches and subsequent follow-up.The study has been shared by the members of the International study group on&nbsp;Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC)The database is designed to be an international electronic submission system and a&nbsp;HIPPA protected real time data repository from high volume gastric cancer centers.Ethics:This study is conducted in compliance with ethical principles originating from the&nbsp;Helsinki Declaration, within the guidelines of Good Clinical Practice and relevantlaws/regulations.Trial registration number:NCT0275108

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p &lt; 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p &lt; 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p &lt; 0.0001) or urgent (20.4% vs. 38.5%; p &lt; 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p &lt; 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice