Salomone Di Saverio

Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Trauma Center

salo75@inwind.it

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SALOMONE DI SAVERIO
Via De’ Carbonesi 7 Via Indipendenza 9 Tel. +39-320-7091509- +39-0861-70183
40123 BOLOGNA ITALY 64010 COLONNELLA (TE) ITALY email: salo75@inwind.it
Curriculum Vitae
Born in Teramo, Italy on June 25th 1975
In the academic year 1993/94 graduated from Classical Studies High School with degrees 60/60 (GPA 4.0).
In the academic year 2001/02 graduated as Medical Doctor at University of Bologna School of Medicine with grades 110/100 Magna Cum Laude, presenting an experimental thesis on “Current treatment of Ductal Carcinoma In Situ of the Breast”, study conducted in the 1st Department of Surgery of S. Orsola Malpighi University Hospital, in cooperation with the Department of the Public Health and Biostatistics of the Bologna Local Health District.
In the academic year 2002/03 he was admitted in the Postgraduate School of General Surgery at University of Bologna School of Medicine. He completed his residency and graduated as specialist surgeon with grades 70/70 Magna Cum Laude on November 6th 2008, after being allocated in his final year in the Emergency and Trauma Surgery Unit - Trauma Center (Head Dr. F. Baldoni) of Maggiore Hospital in Bologna, having had training experience in the previous years in the departments of General and Colorectal Surgery, Breast Surgery, Emergency Surgery, Hepatopancreatobiliary Surgery and Transplant Unit of S. Orsola Malpighi University Hospital. After having attended in November and December 2008 as Specialist Surgeon in the Emergency and Trauma Surgery Unit - Trauma Center (Head Dr. F. Baldoni) of Maggiore Hospital, in January 2009 he was selected in a public competition (4th classified) and got a position as Attending/Consultant in the Emergency Department/Accident and Emergency Medicine/Trauma Casualty of Maggiore Hospital in Bologna, Italy. In June 2009 has been selected (5th classified out of 42 surgeons) and invited for a position as Consultant Surgeon by the Bologna Local Public Health District. From August 2009 to February 2010 he is Clinical Fellow in Upper GI Surgery at Frenchay Hospital, North Bristol NHS, UK (selected for the Clinical Fellowship Post). From January 2010 is appointed as substantive consultant surgeon in the Emergency and Trauma Surgery Unit of Maggiore Hospital – Bologna Local Health District.
He authored more than 110 scientific papers published in national and international journals, in 28 as a first author. He published more than 18 papers in peer reviewed journals with Impact Factor, 5 as a first author. He has been corresponding author of a paper published by “The Lancet”. In 2008 he has been invited as reviewer/referee for the New England Journal of Medicine. In 2009 he has been invited as a referee for the British Journal of Surgery (9 times) performing 5 reviews, as well as for the World Journal of Emergency Surgery, BMJ Case Reports (performed 4 reviews), Supportive Care in Cancer, Saudi Medical Journal and African Health Sciences. He is the first and corresponding author of a GI Snapshot about Small Bowel Obstruction from Adhesions, recently published on GUT as well as of a Learning Forum on diagnosis and Management of Bowel Obstruction and Chronic Constipation published by PLoS Medicine. He attended as a delegate, invited speaker, moderator, discussant or instructor faculty member to more than 50 scientific conferences, meetings and courses, in Italy and around the world; in particular he attended as speaker and presenting author in 2009 at the 95th Clinical Congress of the American College of Surgeons as well as at the 22nd Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, as a speaker in 2005 and 2007 to the International Surgical Week – World Congress of Surgery of the International Society of Surgery, in 2004 and 2008 to the congress of the European Society for Trauma and Emergency Surgery, in 2004 and 2006 to the 2nd and 3rd Interamerican Breast Cancer Conference, to the 2006 29th San Antonio Breast Cancer Symposium and the 2007 60th Society of Surgical Oncology Annual Meeting, and in 2008 at the 67th Annual Meeting of the American Association for the Surgery of Trauma.
He co-authored several chapters and contributions in scientific books and manuals, in Italian and english.
He is member of the Editorial Advisory Board of the Open Breast Cancer Journal.
At the 106th National Congress of the Italian Society of Surgery, in Rome 2004, he co-authored the two best presentations awarded with prizes from the society on the topics: “Surgery and HIV” and “Non-neoplastic intestinal obstruction”.
At the International Surgical Week 2007 – 42nd World Congress of Surgery held in Montreal August 2007, he was the presenting author of the study “Multicenter prospective randomized trial on water-soluble contrast medium (Gastrografin®) use in intestinal small bowel obstruction caused by adherences” presented in the ISS/SIC Lloyd M. Nyhus Prize Session (“The 12 best ISS/SIC free papers in Gastrointestinal Surgery”) and awarded with the 2nd prize given to the 6 best presentations by a jury of internationally recognized experts.
He has been involved as co-investigator or principal investigator in 17 research projects and international clinical trials, mostly multicenter prospective randomized.
He performed to date more than 1200 major surgical procedures; out of them more than 500 were urgent/emergency procedures and more than 100 laparoscopic cases. He performed more than 180 procedures as first operator, more than 280 minor surgical procedures in outpatient or inpatient setting.
He was a visiting doctor for short periods in several universities and hospitals in Italy and overseas, in France, Poland, United States, Mexico, South Africa.
In 2006 he spent 4 months in the University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, U.S.A.; he attended the Division of Surgical Oncology at the Sylvester Comprehensive Cancer Center, Division of General Surgery/Hepatopancreatobiliary Surgery, Colo-Rectal Surgery and Surgical ICU in the Jackson Memorial Hospital as well as the Division of Trauma Surgery and Trauma ICU of Ryder Trauma Center.
He was involved in research projects of UM in the fields of Trauma and Surgical Oncology.
In 2007 he spent 5 months, with the authorization of the University of Bologna and the Italian Ministry of Health, in the University of Kwazulu Natal, Nelson Mandela School of Medicine in Durban, South Africa, with the role of Supernumerary Surgical Registrar and registered as Medical Practitioner to the Health Professions Council of South Africa. As supernumerary Registrar, he attended and performed On Call duties and 80 procedures of Emergency and Trauma Surgery in Addington Hospital and in the Trauma Center of Inkosi Albert Luthuli Central Hospital. In South Africa he has got the BLS, ACLS and ATLS certification. In 2009 he successfully qualified as ALS Advanced Life Support Provider (European Resuscitation Council).
He is active member of several scientific surgical societies in Italy (Italian Society of Surgeons, Italian Society of Young Surgeons) and overseas (International Society of Surgery, Trauma Society of South Africa). He is member of the Executive Committee, National Secretariat and Editorial Staff of the Italian Society of Young Surgeons.
Since 2003 he is member of the Medical Board of the Province of Bologna (n. 14708); he was registered also to the Health Profession Council of South Africa (MP0641758). In 2007 he completed the verification of credentials and registration to the Educational Commission for Foreign Medical Graduates/International Credentials Services (ECFMG/EICS® number E176503). Since 2009 he is registered as Specialist in General Surgery to the English General Medical Council, in the Specialist Register (Ref. N. 7039978), for any work grade, including Consultant Surgeon.
He speaks fluent English, Spanish and French.
His main fields of interest are currently Emergency Surgery, Trauma, Abdominal and Laparoscopic Surgery, Surgical Oncology and Breast Surgery.


Journal articles

2009	DOI PMID Fausto Catena, Luca Ansaloni, Andrea Avanzolini, Salomone Di Saverio, Luigi D'Alessandro, Mario Maldini Casadei, Antonio Pinna (2009) Systemic cytokine response after emergency and elective surgery for colorectal carcinoma. Int J Colorectal Dis 24: 7. 803-808 Jul Abstract: BACKGROUND: Systemic cytokines (SC) are accepted mediators of host immune response. It is debated if long-term survival is influenced by emergency presentation of colorectal cancer, and the role of immunitary response is still unknown. The aim of this prospective study was to compare the SC response after emergency resection with that after elective resections of colorectal carcinoma. MATERIALS AND METHODS: One hundred six consecutive subjects with colorectal cancer were submitted to emergency (complete bowel obstruction; EMS, n = 50) or elective resection (ELS, n = 56) of the tumour. Sera were collected before surgery and at appropriate time points afterward and assayed for interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C-reactive protein (CRP). Five-year survival was analysed according to Kaplan-Meier test. The Cox proportional hazard model was used for the multivariate analysis. RESULTS: Pre-operative levels of IL-1beta, IL-6 and CRP were statistically higher in the EMS group. Levels of TNF-alpha were not elevated after surgery and there was no difference between the groups. Five-year survival was significantly lower in the EMS group (p < 0.05). CONCLUSIONS: Immunitary response, as reflected by SC, was better after elective resection than after emergency resection of colorectal carcinoma and this difference may have implication in the long-term survival. Notes:
	DOI PMID F Coccolini, F Catena, S Di Saverio, L Ansaloni, A Faenza, A D Pinna (2009) Colonic perforation after renal transplantation: risk factor analysis. Transplant Proc 41: 4. 1189-1190 May Abstract: INTRODUCTION: The incidence of gastrointestinal (GI) complication in renal transplantation is relatively high. These complications may be severe, leading to graft loss and patient death. MATERIALS AND METHODS: We reviewed 1651 patients who underwent renal transplantation between 1976 and 2007, analyzing the incidence of colonic perforations and the clinical prognostic factors. RESULTS: Twenty-one patients (1.3%) developed colonic perforations with 7 subsequent deaths. Diverticulitis and ischemia were the most common causes of perforation. Eleven patients (52.3%) were diagnosed and treated within the first 24 hours; their mortality was 18.1%. The 10 patients (47.7%) who were diagnosed and treated 24 hours after the clinical event displayed an high mortality rate (50%). Diverting stoma procedures were performed in all cases. CONCLUSIONS: The follow-up of the kidney transplant patients should include a careful evaluation for possible GI complications and colonic perforations. Early diagnosis and timely treatment were associated with improved outcomes, regardless of the surgical procedures, the cause of perforation or the clinical and laboratory parameters. Notes:
	DOI PMID S Di Saverio, G Tugnoli, F Catena, A Biscardi, F Baldoni (2009) A tenacious complete small bowel obstruction. Gut 58: 6. Jun Abstract: Notes:
	DOI PMID Fausto Catena, Luca Ansaloni, Salomone Di Saverio, Filippo Gazzotti, Federico Coccolini, Antonio Daniele Pinna (2009) Prospective analysis of 101 consecutive cases of laparoscopic cholecystectomy for acute cholecystitis operated with harmonic scalpel. Surg Laparosc Endosc Percutan Tech 19: 4. 312-316 Aug Abstract: BACKGROUND: Videolaparocholecystectomy (VLC) for acute cholecystitis (AC) is a technically demanding procedure, feasible by experienced surgeons, still affected by high conversion rate. Aim of this study was to prospectively evaluate whether the use of harmonic scalpel (HA) during VLC for AC, allowing a potentially better hemostasis and biliostasis, can decrease the conversion rate. METHODS: Hundred and one patients, with the mean age of 61.2+/-8.2 years (range: 39 to 81 y), admitted for AC, have been submitted to early VLC with HA within 6 years (from January 1, 2003 to December 31, 2008) at the Department of General, Emergency, and Transplant Surgery of St Orsola-Malpighi University Hospital in Bologna, Italy. The design of the study was prospective observational non-randomized. The control group consisted of 100 patients who underwent VLC for AC without HA at the same department in the same period. RESULTS: Mean operative time in VLC group with HA has been 71.4+/-14.3 minutes (range: 42 to 112 min) versus 87.4+/-10.8 minutes in the control group (P<0.001). Blood losses were significantly lower with the use of HA. Conversion rate has been 4.9%, mortality was 1%, and postoperative morbidity 7.9% in HA treated group, versus 12% conversion rate, 1% and 9% mortality and morbidity, respectively in the control group (P value not significant). CONCLUSIONS: The use of HA seems to be associated with lower conversion rate in VLC for AC, without any significant increase of morbidity. HA might be even more useful in the most technically demanding cases but further investigations are required. A prospective randomized trial comparing harmonic versus monopolar diathermy in laparoscopic cholecystectomy for AC in adults (Harmonic for Acute Cholecystitis Trial, NCT00746850) is currently enrolling patients and will clarify these observations. Notes:
	DOI PMID Fausto Catena, Luca Ansaloni, Salomone Di Saverio, Filippo Gazzotti, Federico Coccolini, Antonio Daniele Pinna (2009) The HAC Trial (Harmonic for Acute Cholecystitis) Study. Randomized, double-blind, controlled trial of Harmonic(H) versus Monopolar Diathermy (M) for laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in adults. Trials 10: 05 Abstract: BACKGROUND: In the developmental stage of laparoscopic cholecystectomy (LC) it was considered 'unsafe' or 'technically difficult' to perform laparoscopic cholecystectomy for acute cholecystitis (AC). With increasing experience in laparoscopic surgery, a number of centers have reported on the use of laparoscopic cholecystectomy for acute cholecystitis, suggesting that it is technically feasible but at the expense of a high conversion rate, which can be up to 35 per cent and common bile duct lesions.The HARMONIC SCALPEL (H) is the leading ultrasonic cutting and coagulating surgical device, offering surgeons important benefits including: minimal lateral thermal tissue damage, minimal charring and desiccation.Harmonic Scalpel technology reduces the need for ligatures with simultaneous cutting and coagulation: moreover there is not electricity to or through the patient Harmonic Scalpel has a greater precision near vital structures and it produces minimal smoke with improved visibility in the surgical field.In retrospective series LC performed with H was demonstrated feasible and effective with minimal operating time and blood loss: it was reported also a low conversion rate (3.9%).However there are not prospective randomized controlled trials showing the advantages of H compared to MD (the commonly used electrical scalpel) in LC. METHODS/DESIGN: Aim of this RCT is to demonstrate that H can decrease the conversion rate compared to MD in LC for AC, without a significant increase of morbidity.The patients will be allocated in two groups: in the first group the patient will be submitted to early LC within 72 hours after the diagnosis with H while in the second group will be submitted to early LC within 72 hours with MD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00746850. Notes:

	DOI PMID Salomone Di Saverio, Gregorio Tugnoli, Paolo Emilio Orlandi, Marco Casali, Fausto Catena, Andrea Biscardi, Omeshnie Pillay, Franco Baldoni (2009) A 73-year-old man with long-term immobility presenting with abdominal pain. PLoS Med 6: 7. Jul Abstract: Notes:
2008	DOI PMID Stefano Massimiliano Calderale, Raluca Sandru, Gregorio Tugnoli, Salomone Di Saverio, Mircea Beuran, Sergio Ribaldi, Massimo Coletti, Giorgio Gambale, Sorin Paun, Livio Russo, Franco Baldoni (2008) Comparison of quality control for trauma management between Western and Eastern European trauma center. World J Emerg Surg 3: 11 Abstract: ABSTRACT: BACKGROUND: Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. METHODS: We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT). RESULTS: Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. CONCLUSION: The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings. Notes:
	DOI PMID Salomone Di Saverio, Fausto Catena, Donatella Santini, Luca Ansaloni, Tommaso Fogacci, Stefano Mignani, Antonio Leone, Filippo Gazzotti, Stefano Gagliardi, Angelo De Cataldis, Mario Taffurelli (2008) 259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up. Breast Cancer Res Treat 109: 3. 405-416 Jun Abstract: BACKGROUND: The Van Nuys Prognostic Index (VNPI) is a simple score for predicting the risk of local recurrence (LR) in patients with Ductal Carcinoma In Situ (DCIS) conservatively treated. This score combines three independent predictors of Local Recurrence. The VNPI has recently been updated with the addition of age as a fourth parameter into the scoring system (University of Southern California/ VNPI). PATIENTS AND METHODS: Our database consisted of 408 women with DCIS. Applying the USC/VNPI we reviewed retrospectively 259 patients who were treated with breast conserving surgery with or without radiotherapy (RT). Of these patients 63.5% had a low VNPI score, 32% intermediate and 4.5% a high score. In the low score group, the majority of the patients underwent Conservative Surgery (CS) without RT while in the intermediate group, almost half of the patients received RT. Eighty-three percent (83%) of the patients with high VNPI were treated with Conservative Surgery plus RT. Nodal assessment by Sentinel Lymph Node Biopsy was obtained in 32 patients since 2002. RESULTS: Twenty-one Local Recurrences were observed (8%) with a mean follow up of 130 months: sixteen were invasive. No statistically significant differences in Disease Free Survival were reached in all groups of VNPI score between patients treated with Conservative Surgery or Conservative Surgery plus RT. However it was noted that the higher the VNPI score, the lower was the risk of local recurrence in the group treated additionally with RT, even though it was not statistically significant. Further analysis included those patients treated with Conservative Surgery alone and followed up. Disease-free survival (DFS) at 10 years was 94% with low VNPI and 83% in both intermediate and high score (P < 0.05). No significant differences were observed in the subgroups of VNPI. The Local Relapse rate after Conservative Surgery alone, increased with tumor size, margin width, and pathology classification (P < 0,05), while age was not found to be a significant factor. Lesions with only mammographic appearances are associated with lower DFS but it did not reach significance (P = ns), while assumption of estrogenic hormones and familial history of breast cancer are significant factors associated with a higher risk of local recurrence. After multivariate analysis including seven clinical and pathological factors, the only significant predictors of local recurrence remained margin width of surgical excision, previous therapy with estrogens (contraceptives or Hormone Replacement Therapy) and the Van Nuys pathologic classification. The overall survival breast cancer specific was 99% and no differences were observed between groups (P = ns). The comparison of patients treated with a total mastectomy and those conservatively treated showed a significantly better local relapse free survival rate obtained with mastectomy (98.2% vs. 89.7% at 10 years P = 0.02). However, the overall cause-specific survival did not prove any better outcome (98.7% in both groups). Of the 32 patients who underwent a Sentinel Lymph Node Biopsy, four were found to have micrometastases and all of them had a previous Directional Vacuum Assisted Biopsy. CONCLUSIONS: Although in our series there is not a significant difference in LR rates by the parameter of age, the new USC/VNPI is still a simple and reliable scoring system for therapeutic management of DCIS. We did not find any statistically significant advantage in groups treated with the addition of RT. Obtaining wide surgical margins appears to be the strongest prognostic factor for local recurrence, regardless of other pathological factors or the addition of adjuvant radiation therapy. However, only prospective randomized studies can precisely predict the risk of LR of conservatively treated DCIS. The clinical significance of Sentinel Lymph Nodes micrometastases Immuno-Histo-Chemistry-detected found in DCIS patients remains uncertain. However, we hypothesize that the anatomical disruption after preoperative biopsy procedures increases the likelihood of epithelial cell displacement and the frequency of IHC-positive Sentinel Lymph Nodes, both of which are directly proportional to the degree of manipulation. Notes:
	DOI PMID Gregorio Tugnoli, Salomone Di Saverio, Gian Piero Casadei, Andrea Biscardi, Franco Baldoni (2008) Houdini's last deception (or, Aristotle's bowel). Lancet 372: 9641. Sep Abstract: Notes:
	DOI PMID Salomone Di Saverio, Fausto Catena, Luca Ansaloni, Margherita Gavioli, Massimo Valentino, Antonio Daniele Pinna (2008) Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg 32: 10. 2293-2304 Oct Abstract: BACKGROUND: Patients with adhesive small intestine obstruction (ASIO) are difficult to evaluate and to manage and their treatment is still controversial. The diagnostic and therapeutic role of water-soluble contrast medium (Gastrografin) in ASIO is still debated. This study was designed to determine the therapeutic role of Gastrografin in patients with ASIO. METHODS: The study was a multicenter, prospective, randomized, controlled investigation. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of Gastrografin. A total of 76 patients were randomized into two groups: the control group received traditional treatment (TT), whereas the study group (GG) received in addition a Gastrografin meal and follow-through study immediately. Patients with Gastrografin in the colon within 36 hours were considered to be partially obstructed and submitted to nonoperative management. If after 36 hours, the Gastrografin had not entered the colon, the subjects were submitted to laparotomy. RESULTS: No significant differences were found in age, sex, intravenous administration of prokinetics, incidence and characteristics of the previous procedures in surgical history of the patients, previous episodes of ASIO and surgery for adhesiolysis, or duration of symptoms before admission. In the GG group obstruction resolved subsequently in 31 of 38 cases (81.5%) after a mean time of 6.4 hours. The remaining seven patients were submitted to surgery, and one of them needed bowel resection for strangulation. In the control group, 21 patients were not submitted to surgery (55%), whereas 17 showed persistent untreatable obstruction and required laparotomy: 2 of them underwent bowel resection for strangulation. The difference in the operative rate between the two treatment groups reached statistical significance (p = 0.013). The time from the hospital admission for obstruction to resolution of symptoms was significantly lower in the GG group (6.4 vs. 43 hours; p < 0.01). The length of hospital stay revealed a significant reduction in the GG group (4.7 vs. 7.8 days; p < 0.05). This reduction was more evident in the subset of patients who did not require surgery (3 vs. 5.1 days; p < 0.01). No GG-related complications or significant differences in major complications and the relapse rate were found (relapse rate, 34.2% after a mean time to relapse of 6.3 months in the GG group vs. 42.1% after 7.6 months in the TT; p = not significant). CONCLUSIONS: Data showed that the use of Gastrografin in ASIO is safe and reduces the operative rate and the time to resolution of obstruction, as well as the hospital stay. Notes:
	DOI PMID Fausto Catena, Luca Ansaloni, Salomone Di Saverio, Filippo Gazzotti, Stefano Gagliardi, Federico Coccolini, Luigi D'Alessandro, Giorgio Ercolani, Carlo Talarico, Uberto A Bassi, Leonardo Leone, Filippo Calzolari, Antonio D Pinna (2008) The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study: Multicenter randomized, double-blind, controlled trial of laparoscopic (LC) versus open (LTC) surgery for acute cholecystitis (AC) in adults. Trials 9: 01 Abstract: ABSTRACT: BACKGROUND: In some randomized trials successful laparoscopic cholecystectomy for cholecystitis is associated with an earlier recovery and shorter hospital stay when compared with open cholecystectomy. Other studies did not confirm these results and showed that the potential advantages of laparoscopic cholecystectomy for cholecystitis can be offset by a high conversion rate to open surgery. Moreover in these studies a similar postoperative programme to optimize recovery comparing laparoscopic and open approaches was not standardized. These studies also do not report all eligible patients and are not double blinded. DESIGN: The present study project is a prospective, randomized investigation. The study will be performed in the Department of General, Emergency and Transplant Surgery St Orsola-Malpighi University Hospital (Bologna, Italy), a large teaching institutions, with the participation of all surgeons who accept to be involved in (and together with other selected centers). The patients will be divided in two groups: in the first group the patient will be submitted to laparoscopic cholecystectomy within 72 hours after the diagnosis while in the second group will be submitted to laparotomic cholecystectomy within 72 hours after the diagnosis. TRIAL REGISTRATION: TRIAL REGISTRATION NUMBER ISRCTN27929536 - The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study. A multicentre randomised, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis in adults. Notes:
	DOI PMID Salomone Di Saverio, Juan Gutierrez, Eli Avisar (2008) A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma. Breast Cancer Res Treat 111: 3. 541-547 Oct Abstract: BACKGROUND: Pure mucinous breast carcinoma (PMBC) is a rare histologic type of mammary neoplasm. It has been associated with a better short-term prognosis than infiltrating ductal carcinoma (IDC) but identical long-term survival curves have been reported. The value of tumor size for TNM staging has been challenged because of the mucin content of the lesions. This study presents a large PMBC series with 20 years follow up as compared to IDC. The relative significance of a variety of common prognostic factors is calculated for this uncommon histology. MATERIALS AND METHODS: A retrospective analysis of all PMBC cases reported in the SEER database between 1973 and 2002 was conducted. Overall survival (OS) and disease specific survival (DSS) were calculated at 5, 10, 15 and 20 years of follow up. Those curves were compared with all the IDC cases reported into the database during the same period. The prognostic significance of gender, race, laterality, age at diagnosis, T and N status, estrogen and progesterone receptors and administration of radiation therapy was calculated by univariate and multivariate analysis. RESULTS: There were 11,422 PMBC patients reported. The median age at diagnosis was 71 years (Range 25-85). Fifty three percent of the tumors were well differentiated, 38% were moderately differentiated and the remaining 9% were poorly differentiated or anaplastic. The majority of the tumors were located in the upper outer quadrant (44%) the other 56% were roughly evenly divided between the upper inner, lower inner, lower outer and central quadrants. Eighty six percent of the patients had only localized disease at the time of surgery without nodal or distant disease while 12% had regional nodal involvement and 2% had distant metastases. The PMBC cases showed a better differentiation with lesions of lesser grade and more frequent ER/PR expression, smaller size and lesser nodal involvement when compared to the IDC cases of the same period. Kaplan Meier survival curves revealed a 5 years. breast cancer specific survival rate of 94%. Although slowly decreasing with time, 10, 15 and 20 years survival were 89%, 85% and 81% respectively compared to 82% (5 year), 72% (10 year), 66% (15 year) and 62% (20 year) for IDC. There were no significant differences in overall survival. Multivariate analysis by Cox regression revealed the nodal status (N) to be the most significant prognostic factor followed by age, tumor size (T), progesterone receptors and nuclear grade. Disease specific survival curves stratified for nodal status revealed a highly significant difference between node negative and node positive patients. The addition of radiation therapy after surgery did not significantly improve overall survival. CONCLUSIONS: This large retrospective comparative analysis confirms the less aggressive behavior of PMBC compared to IDC. This favorable outcome is maintained after 20 years. This tumor presents typically in older patients and is rarely associated with nodal disease. Positive nodal status appears to be the most significant predictor of worse prognosis. Notes:
	PMID Marco Casali, Salomone Di Saverio, Gregorio Tugnoli, Andrea Biscardi, Silvia Villani, Francesco Cancellieri, Valentina Ciaroni, Andrea Giordani, Giovanni Gordini, Franco Baldoni (2008) Penetrating abdominal trauma: 20 years experience in a Western European Trauma Center Ann Ital Chir 79: 6. 399-407 Nov/Dec Abstract: BACKGROUND: The incidence of penetrating abdominal trauma in Western Europe is low. While non-operative management of blunt trauma has become the gold standard, the management of penetrating trauma is still controversial. Nonoperative management (NOM) and laparoscopy are currently used in selected patients, reducing the rate of unnecessary laparotomy. METHODS: We retrospectively reviewed a 20-years period from the Trauma Registry of our Trauma Center. 6523 patients were admitted for thoraco-abdominal trauma (5861 blunt vs 662 penetrating). We sorted the 114 patients with penetrating abdominal trauma in 2 groups for period (1989-2000 vs 2001-08, before and after the establishment of dedicated trauma unit) analyzing their demographics, clinical, therapeutic characteristics and the outcome in comparison. RESULTS: In the latest period a significant increase in the incidence of penetrating trauma has been observed (doubled from 4.17/year up to 8.53/year, accounting now for 13.95% of all trauma laparotomies vs 7.8% in the past decade). A reduction of GSW (30% vs 12.5%, p = ns) occurred while no differences have been recorded in sex, age, prognostic parameters at arrival such as mean GCS (11.8 vs 13.2), ISS (22 vs 18), pH, BE and blood transfusion (6.4 vs 4.3 U) requirement. Interestingly a markedly significant change has been observed in the demographics of the victims (67.2% were of extra-EU origin vs 8% in the previous decade, p < 0.01). Recently the use of NOM spread widely in selected stable patients (21.9%). The failure rate of NOM was 14.3%. The percentage of unnecessary laparotomies decreased from 36% to 21.1% (p = ns). The introduction of laparoscopy was helpful in achieving a reliable, less invasive exploration, allowing detection of the peritoneal penetration and complete visceral exploration. Two GSW (4%) vs 3 (5.8%) cases of the latest years required Damage Control Surgery. A recent significant reduction in mortality and morbidity rate has been recorded (respectively 3.85% vs 18%, p < 0.05; 20% vs 39%, p = ns). CONCLUSION: The recent immigration phenomenon and social changes contributed towards a significant rise in the incidence of penetrating trauma in Italy in the last decade associated to changes in the mechanism of injury. The increased use of NOM and laparoscopy contributed in decreasing the incidence of unnecessary laparotomies as well as overall morbidity and mortality. Notes:
2007	DOI PMID F Catena, L Ansaloni, F Gazzotti, S Gagliardi, S Di Saverio, L D'Alessandro, A D Pinna (2007) Use of porcine dermal collagen graft (Permacol) for hernia repair in contaminated fields. Hernia 11: 1. 57-60 Feb Abstract: BACKGROUND: Complicated hernias often involve contaminating surgical procedures in which the use of polypropylene meshes can be hazardous. Prostheses made of porcine dermal collagen (PDC) have recently been proposed as a means to offset the disadvantages of polypropylene meshes and have since been used in humans for hernia repairs. The aim of our study was to evaluate the safety and efficacy of incisional hernia repair using PDC as a mesh in complicated cases involving contamination. METHODS: A prospective study of hernia repair of complicated incisional hernias with contamination using PDC grafts was carried out at the Department of General, Emergency and Transplant Surgery of St Orsola-Malpighi University Hospital. RESULTS: From January 2004 up to the writing of this article, seven patients were treated for complicated incisional hernias with a PDC prosthesis. In six out of seven patients a bowel resection was carried out. There were not surgical complications. Morbidity was 14.2%. No recurrences and wound infections were observed. CONCLUSIONS: Incisional hernioplasty using PDC grafts is a potentially safe and efficient approach in complicated cases with contamination. Notes:
	DOI PMID Luca Ansaloni, Paolo Cambrini, Fausto Catena, Salomone Di Saverio, Stefano Gagliardi, Filippo Gazzotti, Jason P Hodde, Dennis W Metzger, Luigi D'Alessandro, Antonio Daniele Pinna (2007) Immune response to small intestinal submucosa (surgisis) implant in humans: preliminary observations. J Invest Surg 20: 4. 237-241 Jul/Aug Abstract: Surgisis IHM is an acellular biomaterial derived from porcine small intestinal submucosa (SIS) that induces site-specific remodeling in the organ or tissue into which it is placed. Previous animal studies have shown that the graft recipient mounts a helper T type 2-restricted immune response to the SIS xenograft without signs of rejection. The aims of this study were to evaluate the immune response to the SIS implant in a small series of humans and to examine the long-term clinical acceptance of the xenograft in these patients. Five consecutive male patients (mean age 56 years, range 34-68) who underwent inguinal hernioplasty with Surgisis IHM were assessed at 2 weeks, 6 weeks, and 6 months after implant for SIS-specific, alpha-1,3-galactose (alpha-gal) epitope and type I collagen specific antibodies. All five patients were also clinically assessed up to 2 years for signs of clinical rejection, hernia recurrence, and other complications. All 5 patients implanted with Surgisis IHM produced antibodies specific for SIS and alpha -gal with a peak between 2 and 6 weeks after implantation. By 6 months, all patients showed decreasing levels of anti-SIS antibodies. Two patients developed a transient, mild local seroma that resolved spontaneously. None of the patients showed any clinical signs of rejection, wound infection, hernia recurrence, or other complications in the follow-up out to 2 years. Thus, this study showed that in a small series of patients the SIS elicits an antibody response without clinical rejection of the xenograft and minimal postoperative complications. Notes:
	DOI PMID Carlo Staudacher, Andrea Vignali, Di Palo Saverio, Orsenigo Elena, Tamburini Andrea (2007) Laparoscopic vs. open total mesorectal excision in unselected patients with rectal cancer: impact on early outcome. Dis Colon Rectum 50: 9. 1324-1331 Sep Abstract: PURPOSE: This study was designed to compare laparoscopic vs. open total mesorectal excision for cancer of the rectum on perioperative outcome and quality of life. METHODS: A total of 187 consecutive unselected patients with rectal cancer who underwent total mesorectal excision during a seven-year period were prospectively evaluated. Patients were monitored 30 days for postoperative complications. Quality of life was evaluated before and at one year after surgery. RESULTS: A total of 108 patients underwent laparoscopic total mesorectal excision, whereas 79 underwent open. Conversion rate was 12 percent. In the laparoscopic group, operating time was 33 minutes longer (P = 0.03) and intraoperative blood loss was lower (P = 0.001). Tumor stage and the number of lymph nodes that were intraoperatively collected were similar in the two groups. The overall morbidity rate was 29.6 percent in the laparoscopic and 27.8 percent in the open (P = 0.78) group. No patient died during the postoperative period. Anastomotic leak rate was similar in the two groups (14.8 percent in laparoscopic vs. 12.6 percent in open; P = 0.88). Patients in the laparoscopic group recovered earlier bowel function (P = 0.01) and experienced a shorter length of stay (P = 0.003). At one-year follow-up, overall quality of life was similar in the two groups. In the laparoscopic group, social functioning item was significantly better (P = 0.05) and trend to a better physical status was observed (P = 0.07). CONCLUSIONS: Laparoscopic total mesorectal excision is safe and feasible, does not jeopardize the complication rate, and has the benefits of much less blood during the operation and shorter hospitalization. Notes:
2006	DOI PMID Fausto Catena, Donatella Santini, Salomone Di Saverio, Annamaria Laneve, Luca Ansaloni, Tommaso Fogacci, Stefano Gagliardi, Filippo Gazzotti, Giorgio Guidi, Angelo De Cataldis, Mario Taffurelli (2006) Skin angiosarcoma arising in an irradiated breast: case-report and literature review. Dermatol Surg 32: 3. 447-455 Mar Abstract: BACKGROUND: Angiosarcoma (AS) is a rare, invasive malignancy originating from endothelial cells caused by many different clinical situations. AS following radiotherapy for breast cancer after conservative surgery is a rare but well-known association. OBJECTIVE: The aim of this article is to describe a case of AS after breast conserving surgery and to review the literature to date. RESULTS: We report the case of an 84-year-old woman who developed AS four years after she was subjected to quadrantectomy for invasive ductal cancer, followed by 30 tangent field radiotherapy sessions. She presented with a one-month history or red papular skin eruptions on the operated breast. Skin lesions were submitted for biopsy, and they were positive for AS. The patients was subjected to surgical excision of the remaining breast including all AS lesions. She is alive with no evidence of disease after 10 months follow-up. CONCLUSION: Post-radiotherapy AS is rare neoplasm, but it should be considered in the case of patients with red lesions after breast conserving surgery and adjuvant radiotherapy. Notes:

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