REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

OBJECTIVE: The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).SUMMARY BACKGROUND DATA: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.METHODS: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines.RESULTS: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ).CONCLUSIONS: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.</p

REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

OBJECTIVE: The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).SUMMARY BACKGROUND DATA: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.METHODS: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines.RESULTS: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ).CONCLUSIONS: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.</p

Impatto dell’R1 come fattore prognostico di sopravvivenza e intervallo libero da malattia nelle resezioni pancreatiche con associata resezione vascolare per PDAC.

L’impatto prognostico della resezione R1 nella chirurgia pancreatica eseguita per adenocarcinoma del pancreas “resectable” è ad oggi ancora dibattuto. L’assenza di dati definitivi sul reale ruolo prognostico di tale dato è dovuta a da diversi fattori: non esiste tutt’ora una definizione universalmente accettata di margine positivo (R0 vs R1); la nomenclatura utilizzata per indicare i margini di resezione differisce nei vari centri; non è chiaro il ruolo prognostico di ciascuno dei margini analizzati in virtu’ di variabili anatomiche legate alla peculiarità delle resezioni pancreatiche e alle caratteristiche anatomiche dell’organo. Se l’argomento risulta largamente dibattuto nel carcinoma del pancreas “resectable”, ancor più lo è negli stadi “borderline resectable” e “localmente avanzato”. Tale dibattito è sostenuto dalla potenziale inaccuratezza dell’analisi istopatologica nel definire una resezione R1 a seguito delle cure chemioterapiche pre-operatorie eseguite che provocano delle significative modificazioni tissutali. Lo scopo di questa tesi è quello di indagare il ruolo prognostico delle resezioni chirurgiche R1 eseguite presso il nostro centro a seguito di CT neoadiuvante per adenocarcinoma del pancreas borderline resectable e localmente avanzato correlandolo ad altri, ormai riconosciuti, fattori prognostici di sopravvivenza e di intervallo libero da malattia. Nello specifico si cerca di studiare il ruolo prognostico dell’R1 vascolare negli interventi chirurgici che abbiano previsto una resezione venosa e/o arteriosa

Impatto del peso uterino in pazienti sottoposte ad isterectomia robotica: outcomes chirurgici e clinici

Mediante uno studio prospettico, sono stati raccolti , previo consenso informato fornito dalle pazienti per la gestione dei dati, gli specifici dati ricavati da cartelle cliniche di pazienti sottoposte ad isterectomia robotica tra Giugno 2014 e Dicembre 2016 con diagnosi di fibromatosi uterina presso il reparto di Ginecologia e Ostetricia 2. Lo scopo è stato quello di descrivere la tecnica chirurgica impiegata e studiare l'influenza del peso uterino nel determinare il verificarsi di varianti empiriche: complicanze, perdite ematiche, durata della degenza, tempi operatori e tempi di morcellazione

Pyoderma gangrenosum of the breast treated with adalimumab

Pyoderma gangrenosum is a rare infiltrative neutrophilic dermatosis, that is usually characterized by painful ulcers with violaceous, undermined borders on the lower extremities and less commonly by tender nodules or pustules It is often associated with systemic diseases, including inflammatory bowel disease, rheumatoid arthritis, and hematologic disorders The mainstay of treatment is long term immunosuppression often with high dose of corticosteroids, low dose of cyclosporin 3 6 mg/kg/day) or other immunosuppressors We reported the case of a 52 year old woman affected by pyoderma gangrenosum on her right breast She was successfully treated with adalimuma