1997-2004 School of Medicine, Bologna University Jun-2004 to Oct-2009: Resident in General Surgery - Bologna University School of Medicine, Surgical Depts of S.Orsola-Malpighi Hospital and Maggiore Hospital (Bologna)
Since Nov-2009: Surgical Dept of Maggiore Hospital (Bologna), Head of Dept: E. Jovine
Abstract: BACKGROUND: Pancreatic serous cystic tumors are considered to have a benign biological and clinical course with only few malignant cases. METHODS: We retrospectively analyzed data from 26 patients affected by serous cystic tumors consecutively observed in our Pancreas Unit. We explored the different clinical pictures in operated and nonoperated patients. RESULTS: Eighteen of the 26 patients were female (69%), median age at diagnosis was 61.5 years and 20 patients (77%) underwent surgery. The median diameter of the tumors was greater in patients who underwent surgery than in those who did not (5.5 versus 2.3 cm, p < 0.001). Major pancreatic resections were carried out in 15 of the 20 operated patients (75%). Postoperative morbidity and mortality were 20 and 5%, respectively. During follow-up, there was no observed development of malignancy or any significant increase in the diameter of the lesion among nontreated patients. CONCLUSIONS: In asymptomatic patients with a clear imaging diagnosis of serous cystic tumor a wait and see management should be recommended, with a careful follow-up. Surgery should be suggested in symptomatic patients or when the preoperative diagnosis is doubtful.
Abstract: Pancreatic fistula is the most frequent major complication after pancreaticoduodenectomy. Its rate may be related to several risk factors, among which pancreatic anastomotic reconstruction techniques. The study reported here was a prospective, non-randomized study of 38 consecutive patients who underwent pancreaticoduodenectomy from March 2006 to February 2007. Two groups were studied according to the type of treatment of the pancreatic remnant: group 1 (n = 18) in which an isolated Roux loop Wirsung-jejunal end-to-side anastomosis was performed; and group 2 (n = 20) in which a pancreaticojejunostomy was carried out in the same jejunal loop as the biliary and gastric anastomosis. The two groups of patients were compared regarding preoperative characteristics, surgical procedure and postoperative outcome. Postoperative mortality, morbidity and pancreatic fistula in all the patients in the two groups were evaluated in relation to several risk factors. The overall postoperative mortality and morbidity rates were 2.6% (1/38 cases) and 26.3% (10/38 cases), respectively. The pancreatic fistula rate was 13.1% (5 cases). There were no significant differences in postoperative outcome between the two groups. However, both mean and median postoperative postoperative hospital stay were shorter in group 1 than in group 2 (P < 0.001). Postoperative pancreatic fistula was not significantly more frequent in relation to any of the different risk factors. The isolated Roux loop Wirsung-jejunal end-to-side anastomosis after PD is safe, easy to perform and allows the same results of pancreaticojejunostomy in the same jejunal loop of the biliary and gastric anastomosis. Moreover the isolated Roux loop reconstruction allows a significant decrease of the length of postoperative hospital stay.
Abstract: CONTEXT: Splenic artery aneurysms are rare and they are usually easy to diagnose. Spiral computed tomography is the most sensitive diagnostic technique for this disease. Its primary treatment is interventional radiology; surgery is indicated in selected cases. CASE REPORT: We herein report a case of an elderly male patient with a completely thrombosed aneurysm of the splenic artery. The spiral computed tomography and color-Doppler ultrasonography findings were different; the first showed this entity to be a pancreatic solid tumor and the second showed it to be an aneurysmatic thrombosed dilation of the splenic artery. Thus, laparotomy was performed and the proper diagnosis was made. CONCLUSIONS: This case underlines the characteristics of completely thrombosed splenic artery aneurysm with the aim to avoid diagnostic and therapeutic mistakes.
Abstract: CONTEXT: Pancreatic fistulas are one of the most common and important complications after pancreatic resection and their consequences are a life-threatening event. Thus, they must be treated in the best way and resolved as soon as possible to avoid their morbidity. METHODS: Three cases of pancreatic fistula following pancreatic resection were reported. They were treated with percutaneous embolization using a sclerosing substance, prolamine, injected into the Wirsung duct via drainage catheter. RESULTS: No complications of the technique were revealed and closure of the pancreatic fistula was obtained shortly thereafter. CONCLUSIONS: The technique is safe and simple and can be repeated several times. It allows good results without complications. Finally, it avoids additional surgery allowing a shorter recovery time and a lower risk of morbidity.
Abstract: BACKGROUND: More than half of all patients with pancreatic adenocarcinoma are over 70 years of age. Life expectancy for the elderly population is increasing and currently major pancreatic resection provides the only meaningful chance of cure for periampullary and pancreatic tumors. Controversy over what constitutes the correct treatment of these tumors in elderly patients continues to this day. The aim of our study was to determine whether age alone or age plus some prognostic factors constitute contraindications to major pancreatic resections. METHODS: Between 2000 and 2005, data from 88 consecutive patients who had major pancreatic resection for periampullary or pancreatic tumors were entered into a prospective database. Fifty-three patients under 70 years of age (young patients), and 35 patients 70 years of age or older (elderly patients) were compared with respect to several characteristics and the postoperative course. RESULTS: Postoperative mortality and morbidity, length of hospital stay, and long-term survival were similar in the two groups. In the elderly group, the mortality rate was significantly higher in patients with chronic obstructive pulmonary disease (COPD), and the morbidity rate was significantly higher in patients with ASA 3 than in patients with ASA 1-2, in whom a pancreaticoduodenectomy or total pancreatectomy had been performed. CONCLUSIONS: Age alone is not a contraindication for major pancreatic resection. In elderly patients a careful evaluation of the co-morbidities and of the type of surgical procedure is mandatory in order to allow the proper selection of those patients best suited for surgery in specialized centers.
Abstract: Solid-cystic papillary tumors of the pancreas are very rare and, until today, 718 cases have been reported in a review of the literature. Four patients affected by solid-cystic papillary tumors, observed in our Institute between January 1985 and July 2005, are reported. The clinicopathological, operative and survival data of this tumor were reviewed comparing our experience with a review of the literature. Solid-cystic papillary tumor have a preference for young women (age between 19-50 yrs) and show a large round, well-defined pancreatic mass(greater than 5 cm), clinically silent or with unspecific symptoms. The tumor is more frequently localized in the pancreas (80%) and is rarely a metastatic disease (20%). Surgical treatment with radical pancreatic resection of the tumor was performed in approximately 95% of the cases. In 467 patients, two-year survival was 97% (16 deaths) and 5-year survival was 95% (21 deaths). In conclusion, preoperative diagnosis of solid-cystic tumors of the pancreas is difficult but knowledge of its characteristic findings can aid in reaching a proper diagnosis. Surgery is the treatment of choice; it should be conservative in localized tumors, and aggressive, in non-localized tumors. The prognosis is very good, with long-term survival also in patients with metastases or unresectable tumors.
Abstract: Pancreatic masses could be malignant or benign. Among these latter inflammatory pseudotumor is an uncommon mass rarely located in the pancreas and it must be considered in differential diagnosis with pancreatic cancer. A case report and literature review of inflammatory pseudotumor were recognized to well known this rare pathology regarding its clinical, diagnostic, therapeutic and histopathological feature. Twenty-one cases of inflammatory pseudotumor in the adult were reviewed from the literature; 10 (47.6%) were female, 11 (52.3%) male; mean age 53.3 years (range 23-73). They were solid single mass in 18 cases, with median size of 5.1 cm (range 1.5-13), cystic mass in one case; 18 were located in the head, 1 in the body. In 2 cases it appeared as a volumetric increase of the pancreas. Diagnosis was possible only histologically and surgical treatment was mandatory in 20 cases; only in one patient a corticosteroid treatment was performed. Pancreatic inflammatory pseudotumor is a rare lesion of the pancreas but it must be distinguished from pancreatic cancer. Pancreatic resectioning is mainly due to the preoperative diagnostic difficulties that must be resolved surely only with histopathological examination of the specimen.
Abstract: Surgical technique of total thyroidectomy is nowadays well known. Technology could determine some improvement of this kind of surgery. Two groups of patients that underwent total thyroidectomy were compared retrospectively. In group 1 we described 105 total thyroidectomies performed with ultrasonically activated shears; in group 2, 76 performed with conventional methods of haemostasis. Comparing the two groups for several parameters, it results that in the total thyroidectomies performed with ultrasonically actived shears, operative time is shorter of 24 minutes compared with conventional method (81 vs 105 minutes), the mean amount of intraoperative blood loss is smaller (70 ml vs 125 ml), the postoperative pain is less, the cosmetic result is better (length of incision 6 cm vs 10 cm) and the costs is not more expensive. Complications of thyroid surgery are similar between the two methods. The use of ultrasonically actived shears in total thyroidectomy is safe (no increase of complications) and useful because it reduces operative time, improves the recovery of the patient (less pain, better cosmetic results) and, finally, is not more expensive than conventional method of haemostasis.
Abstract: Context: There are few studies regarding quality of life (QoL) in subjects who
underwent pancreatic head resection (PHR). Aim: A 1-year follow-up study to evaluate the QoL in PHR patients.
Patients: 176 PHR consecutive patients (99 M, 77 F, mean age 62.1 yrs, range
20Y84) enrolled from Feb 2006 to Feb 2007 in 3 Italian surgical centers.
Methods: The patients were asked to fill out an EORTC QLQ-C30
questionnaire immediately before, as well as 6 and 12 months after surgery.
Presently, 115 patients (65.3%) filled-out the questionnaire at 6 months and
45 (25.6%) completed the study. The stratified mean T SD values of the
various domains and symptom scales referring to 176 sex- and age-matched
subjects of a normative group were also taken into account for the analysis.
The ANOVA was applied to analyze EORTC.
Results: The final histological diagnoses were: pancreatic neoplasia (PN) (128
patients, 72.7%; 83 ductal carcinomas, 33 IPMT, 7 endocrine tumors, 5 serous
cystadenomas); ampullary neoplasia (AN) (31, 17.6%); chronic pancreatitis
(CP) (6, 3.4%), other neoplasia (ON) (11, 6.3%; 5 duodenal, 3 common bile
duct, and 3 other neoplasia). Eight patients died (4.6%). At the baseline study,
global health, role functioning, emotional functioning, and social functioning
were significantly lower (P G 0.05) in PHR patients as compared to the
normative population; the symptom scales (fatigue, nausea-vomiting,
insomnia, loss of appetite, constipation and diarrhea) were significantly
higher (P G 0.05) in PHR patients as compared to the normative population,
whereas dyspnea was significantly lower (P G 0.05). At the baseline study, no
differences in the various domains and symptoms scale of the EORTC
questionnaire were found among patients with PN, AN, CP, and ON. No
significant differences in the various domains and symptoms scale of the
EORTC questionnaire were found among patients with ductal carcinoma,
IPMT, endocrine tumors, and serous cystadenoma. In the 45 patients who
completed the study, there was a significant progressive improvement
(P G 0.05) of the global health, emotional functioning, and cognitive
functioning, fatigue, pain, insomnia, loss of appetite, constipation. The
improvement of global health and fatigue was significantly higher (P G 0.05) in
AN (n = 9) than in pancreatic tumors (n = 34).
Conclusion: PHR patients had an impairment of the QoL as compared to the
reference population before the surgery and the impairment is not related to the
disease responsible for the surgery. The QoL improves in the 12 months
following surgery particularly in patients with AN.
