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- 저자 : Tozzi, Paolo (검색결과 9 건)
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Roberto Tozzi,Federico Ferrari,Joost Nieuwstad,Riccardo Garruto Campanile,Hooman Soleymani Majd 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.2
Objective: To introduce a systematic classification of diaphragmatic surgery in patients with ovarian cancer based on disease spread and surgical complexity. Methods: For all consecutive patients who underwent diaphragmatic surgery during Visceral-Peritoneal debulking (VPD) in the period 2009–2017, we extracted: initial surgical finding, extent of liver mobilization and type of procedure. Combining these features, we aimed to classify the surgical procedures necessary to tackle different presentation of diaphragmatic disease. We also report histology, intra- and post-operative specific complication rate based on the classification. Results: A total of 170 patients were included in this study, 110 (64.7%) had a peritonectomy, while 60 (35.3%) had a full thickness resection with pleurectomy. We identified 3 types of surgical procedures. Type I treated 28 out of 170 patients (16.5%) who only had anterior diaphragm disease, needed no liver mobilization, included peritonectomy and had no morbidity recorded. Type II pertained to 105 out of 170 patients (61.7%) who had anterior and posterior disease, needed partial and sometimes full liver mobilization, had a mix of peritonectomy and full thickness resection, and experienced 10% specific morbidity. Type III included 37 out of 170 patients (21.7%) who needed full mobilization of the liver, always had full thickness resection, and suffered 30% specific morbidity. Conclusion: Diaphragmatic surgery can be classified in 3 types. The adoption of this classification can facilitate standardization of the surgery, comparison of data and define the expertise required. Finally, this classification can be a benchmark to establish the training required to treat diaphragmatic disease.
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Roberto Tozzi,Hooman Soleymani Majd,Riccardo Garruto Campanile,Federico Ferrari 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: To describe the surgical technique and evaluate the safety, feasibility and efficacyof laparoscopic diaphragmatic peritonectomy during Visceral-Peritoneal Debulking (VPD) inpatients with stage IIIC-IV ovarian cancer (OC). Methods: This report is part of a Service Evaluation Protocol (Trust number 3267) onlaparoscopy in patients with OC following neo-adjuvant chemotherapy. Between April 2015and November 2017, all patients underwent to exploratory laparoscopy and a selected courtwas offered laparoscopic VPD. Laparoscopic diaphragmatic surgery was considered if therewas no full thickness involvement. Primary endpoints of this part of the study were the safety,feasibility and efficacy of laparoscopic diaphragmatic peritonectomy. We report the surgicaltechnique and outcomes. Results: Ninety-six patients underwent diaphragmatic surgery during the study period. Fiftypatients (52.1%) had intra-operative exclusion criteria and/or full thickness diaphragmaticresection, 46 (47.9%) had peritonectomy and were included in the study. Laparoscopicdiaphragmatic peritonectomy was performed in 21 patients (45.4%, group 1), while in 25patients (54.6%, group 2) laparotomy was necessary. Extent of disease and complexityof surgery were similar. Reasons for conversions were disease coalescing the liver to thediaphragm preventing safe mobilization (22 patients) and accidental pleural opening (3patients). Overall, intra- and post-operative morbidity was lower in group 1 and pulmonaryspecific morbidity was very low. Conclusion: Diaphragmatic peritonectomy can be safely accomplished by laparoscopy inalmost half of the patients with OC whose disease is limited to the diaphragmatic peritoneum.
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Roberto Tozzi,Marco Noventa,Carlo Saccardi,Giulia Spagnol,Orazio De Tommasi,Davide Coldebella,Matteo Marchetti 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2
Objective: A non-randomized prospective clinical trial (ULTRA-LAP) was registered to testsafety, side effects and efficacy of laparoscopic Visceral-Peritoneal Debulking (L-VPD) inpatients with stage III–IV ovarian cancer (OC). A pilot study was designed to identif y whichOC patients are suitable to undergo L-VPD. Methods: Between March 2016 and October 2021, all consecutive patients with OCunder went explorator y laparoscopy (EXL). All patients whose disease was deemed amenablefor a complete resection (CR) at imaging review and EXL, under went VPD. In all patients aconsistent attempt was made at completing L-VPD. Results: Two hundred and eight OC had EXL in the study period: 121 under went inter valVPD and 87 up-front VPD. Overall, 158 patients had VPD by laparotomy (75.9%) and 50(24.1%) had L-VPD, of which 34 patients as inter val (iL-VPD) and 16 as up-front (uL-VPD). Intra- and post-operative morbidity was ver y low in the L-VPD group. CR rate was 98% inL-VPD group and 94% in VPD. Most common reason for conversion was diaphragmaticdisease extending dorsally. Conclusion: In the pilot study of ULTRA-LAP, L-VPD was completed in 24,1% of OC. Initialanalysis supports the feasibility of L-VPD in 2 groups of OC: those with no gross disease atinter val surger y and those with gross visible disease at upfront or inter val surger y, but limitedto: pelvis (including recto-sigmoid), gastro colic omentum, peritoneum and diaphragm, thelatter not requiring dorsal liver mobilization. Both groups had 100% feasibility and have beenthus forth recruited to ULTRA-LAP. Trial Registration: ClinicalTrials.gov Identifier: NCT05862740
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Roberto Tozzi,Gaetano Valenti,Daniele Vinti,Riccardo Garruto Campanile,Massimo Cristaldi,Federico Ferrari 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.3
Objective: This study investigates the specific morbidity of rectosigmoid resection (RSR)during Visceral-Peritoneal Debulking (VPD) in a consecutive series of patients with stage IIIC-IVovarian cancer and compares the results of the colo-rectal vs. the gynaecologic oncology team. Methods: All patients with the International Federation of Gynecology and Obstetrics(FIGO) stage IIIC–IV ovarian cancer who had VPD and RSR were included in the study. Between 2009 and 2013 all operations were performed by the gynecologic oncology teamalone (group 1). Since 2013 the RSR was performed by the colorectal team together withthe gynecologic oncologist (group 2). All pre-operative information and surgical detailswere compared to exclude significant bias. Intra- and post-operative morbidity events wererecorded and compared between groups. Results: One hundred and sixty-two patients had a RSR during VPD, 93 in group 1 and 69in group 2. Groups were comparable for all pre-operative features other than: albumin (1<2)hemoglobin (2<1) and up-front surgery (1>2). Overall morbidity was 33% vs. 40% (p=0.53),bowel specific morbidity 11.8% vs. 11.5% (p=0.81), anastomotic leak 4.1% vs. 6.1% (p=0.43)and re-operation rate 9.6% vs. 6.1% (p=0.71) in groups 1 and 2, respectively. None of themwere significantly different. The rate of bowel diversion was 36.5% in group 1 vs. 46.3% ingroup 2 (p=0.26). Conclusions: Our study failed to demonstrate any significant difference in the morbidity rateof RSR based on the team performing the surgery. These data warrant further investigation asthey are interesting with regards to education, finance, and medico-legal aspects.
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Roberto Tozzi,Jvan Casarin,Ahmet Baysal,Gaetano Valenti,Yakup Kilic,Hooman Soleymani Majd,Matteo Morotti 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.2
Objective: To assess the morbidity associate with rectosigmoid resection (RSR) in patients with stage IIIC–IV ovarian cancer (OC) undergone primary debulking surgery (PDS) vs. interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). Methods: From the Oxford Advanced OC database, we retrieved all patients who underwent surgery between January 2009 and July 2016 and included all patients who underwent RSR. We compared the rates of overall related and not-related morbidity and bowel diversion in patients undergone RSR during PDS vs. IDS. Results: Three hundred and seventy-one patients underwent surgery: 126 in PDS group and 245 in IDS group. Fifty-two patients in the PDS group (41.3%) and 65 patients in IDS group (26.5%) underwent RSR (p<0.001). Overall not related morbidity rate was 37.5% and 28.6%, p=0.625. Bowel specific complications affected 16.3% vs. 11.1% of the patients (p=0.577). IDS group had higher rate of bowel diversion compared with PDS (46.0% vs. 26.5%, p=0.048). Conclusion: NACT was associated to an overall reduced rate of RSR compared to IDS. No differences in overall related and not-related complications in patients requiring RSR were seen between the 2 groups. Patients in the IDS group had a significantly higher rate of bowel diversion.
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Anything New about Paternal Contribution to Reproductive Outcomes? A Review of the Evidence
Montagnoli Caterina,Ruggeri Stefania,Cinelli Giulia,Tozzi Alberto E.,Bovo Chiara,Bortolus Renata,Zanconato Giovanni 대한남성과학회 2021 The World Journal of Men's Health Vol.39 No.4
Paternal health and behavioral lifestyles affect reproductive and neonatal outcomes and yet the magnitude of these effects remain underestimated. Even though these impacts have been formally recognized as a central aspect of reproductive health, health care services in Europe often neglect the involvement of fathers in their reproductive programs. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews, a literature search was carried out to assess the possible impact of paternal health on reproductive outcomes. The comprehensive strategy included cohort studies and meta-analysis available on PubMed, Web of Science, CINAHL, and Google scholar. Crossreferencing of bibliographies of the selected papers ensured wider study capture. Paternal factors were grouped into two categories respectively identified with the terms “Biological Paternal Factors” and “Lifestyle Paternal Factors”. Advanced age may impair male fertility and affect early pregnancy stages. Increased body mass index, smoking, alcohol and recreational drugs, all alter seminal fluid parameters. Hazardous alcohol use correlates with low birthweight in pregnancy and harmful behavioral lifestyles have been linked to congenital heart defects, metabolic and neurodevelopmental disorders in the offspring. Measures targeting paternal health and lifestyle within the first 1,000 days’ timeframe need to be implemented in couples undergoing reproductive decisions. Health professionals, as well as future fathers, must be aware of the benefits for the offspring associated with correct paternal behaviors. More research is needed to build guidelines and to implement specific programs aiming at reproductive health promotion.
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Girardi, M.,Mercurio, A.,Balestra, I.,Nonino, M.,Biviano, A.,Grillo, C.,Rosati, P.,Annunziatella, M.,Demarco, R.,Fritz, A.,Gobat, R.,Lemze, D.,Presotto, V.,Scodeggio, M.,Tozzi, P.,Bartosch Caminha, G. EDP Sciences 2015 Astronomy and astrophysics Vol.579 No.-
<P>Aims. In the effort to understand the link between the structure of galaxy clusters and their galaxy populations, we focus on MACSJ1206.2–0847at z ~ 0.44 and probe its substructure in the projected phase space through the spectrophotometric properties of a large number of galaxies from the CLASH–VLT survey. Methods. Our analysis is mainly based on an extensive spectroscopic dataset of 445 member galaxies, mostly acquired with VIMOS at VLT as part of our ESO Large Programme, sampling the cluster out to a radius ~2R<SUB>200</SUB> (4 h<SUB>70</SUB><SUP>−1</SUP>Mpc). We classify 412 galaxies as passive, with strong Hδ absorption (red and blue galaxies), and with emission lines from weak to very strong. A number of tests for substructure detection are applied to analyze the galaxy distribution in the velocity space, in 2D space, and in 3D projected phase-space. Results. Studied in its entirety, the cluster appears as a large-scale relaxed system with a few secondary, minor overdensities in 2D distribution. We detect no velocity gradients or evidence of deviations in local mean velocities. The main feature is the WNW-ESE elongation. The analysis of galaxy populations per spectral class highlights a more complex scenario. The passive galaxies and red strong Hδ galaxies trace the cluster center and the WNW–ESE elongated structure. The red strong Hδ galaxies also mark a secondary, dense peak ~2h<SUB>70</SUB><SUP>−1</SUP> Mpcat ESE. The emission line galaxies cluster in several loose structures, mostly outside R<SUB>200</SUB>. Two of these structures are also detected through our 3D analysis. The observational scenario agrees with MACS J1206.2–0847 having WNW–ESE as the direction of the main cluster accretion, traced by passive galaxies and red strong Hδ galaxies. The red strong Hδ galaxies, interpreted as poststarburst galaxies, date a likely important event 1–2 Gyr before the epoch of observation. The emission line galaxies trace a secondary, ongoing infall where groups are accreted along several directions.</P>
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