Sentinel Lymph Node Analysis in Colorectal Cancer Patients Using One-Step Nucleic Acid Amplification in Combination With Fluorescence and Indocyanine Green

Francesco Esposito,Adele Noviello,Nicola Moles,Enrico Coppola Bottazzi,Mario Baiamonte,Ina Macaione,Umberto Ferbo,Maria Lepore,Antonio Miro,Francesco Crafa 대한대장항문학회 2019 Annals of Coloproctolgy Vol.35 No.4

Purpose: Analysis of the sentinel lymph node (SLN) in colorectal cancer (CRC) patients was proposed for more accurate staging and tailored lymphadenectomy. The aim of this study was to assess the ability to predict lymph node (LN) involvement through analysis of the SLN with a one-step nucleic acid (OSNA) technique in combination with peritumoral injection of indocyanine green (ICG) and near-infrared (NIR) lymphangiography in CRC patients. Methods: A total of 34 patients were enrolled. Overall, 51 LNs were analyzed with OSNA. LNs of 17 patients (50%) were examined simultaneously with hematoxylin and eosin (H&E) and OSNA. Results: SLN analysis of 17 patients examined with H&E and OSNA revealed that OSNA had a higher sensitivity (1 vs. 0.55), higher negative predictive value (1 vs. 0.66) and higher accuracy (100% vs. 76.4%) in predicting LN involvement. Overall, OSNA showed a sensitivity of 0.69, specificity of 1, accuracy of 88.2%, and stage migration of 8.8%. Compared to those who were OSNA (−), OSNA (+) patients had a greater number of LN metastases (4.8 vs. 0.16, P = 0.04), higher G3 rate (44.4% vs. 4%, P = 0.01), more advanced stage of disease (stage III: 77.8% vs. 16%; P = 0.00) and were more rapidly subjected to adjuvant chemotherapy (39.1 days vs. 50.2 days, P = 0.01). Conclusion: SLN analysis with OSNA in combination with ICG-NIR lymphangiography is feasible and can detect LN involvement in CRC patients. Furthermore, it allows for more accurate staging reducing the delay between surgery and adjuvant chemotherapy.

Systematic intraoperative cholangiography during elective laparoscopic cholecystectomy: Is it a justifiable practice?

Francesco Esposito,Iolanda Scoleri,Rafika Cattan,Marie Cecile Cook,Dorin Sacrieru,Nouredine Meziani,Marco Del Prete,Morad Kabbej 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.2

How to prevent the postoperative pancreatic fistula with an ethylene vinyl alcohol copolymer (Onyx<SUP>Ⓡ</SUP>)

Francesco Crafa,Francesco Esposito,Adele Noviello,Nicola Moles,Enrico Coppola Bottazzi,Carmelo Lombardi,Antonio Miro,Giulio Lombardi 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.3

Backgrounds/Aims: Despite the advances in identifying risk factors, improving operative technique, and postoperative patient care, pancreatic leakage after pancreatic resection remains a highly debated topic. The aim of this study is to describe our technique and our initial experience with the intraoperative embolization of the main pancreatic duct with an Ethylene Vinyl Alcohol Copolymer (Onyx<SUP>Ⓡ</SUP>). Methods: Two patients of 63 and 64 years underwent pancreaticoduodenectomy for a cholangiocarcinoma of the extrahepatic bile duct and a pancreatic adenocarcinoma, respectively. At the time of pancreatic parenchyma resection, a Wirsung duct was identified and catheterized. A wirsungography was done and then, embolization with Onyx<SUP>Ⓡ</SUP> was carried out under fluoroscopic control. Results: Neither of the patients developed a postoperative pancreatic fistula. They were discharged to home on the 17<SUP>th</SUP> and 18<SUP>th</SUP> postoperative day, respectively. At the last follow-up, no recurrence was found. The two patients became diabetics; both needed the support of supplementary pancreatic enzymes. Conclusions: To our knowledge, we are the first to describe this technique, which seems safe and reliable. Studies on this subject with more patients are needed to confirm the validity of this procedure.

Diaphragmatic hernia following liver resection

Francesco Esposito,Chetana Lim,Chady Salloum,Michael Osseis,Eylon Lahat,Philippe Compagnon,Daniel Azoulay 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.3

Backgrounds/Aims: Postoperative diaphragmatic hernia, following liver resection, is a rare complication. Methods: Data of patients who underwent major hepatectomy for liver tumors, between 2011 and 2015 were retrospectively reviewed. The literature was searched for studies reporting the occurrence of diaphragmatic hernia following liver resection. Results: Diaphragmatic hernia developed in 2.3% of patients (3/131) with a median delay of 14 months (4-31 months). One patient underwent emergency laparotomy for bowel obstruction and two patients underwent elective diaphragmatic hernia repair. At last follow-up, no recurrences were observed. Fourteen studies including 28 patients were identified in the literature search (donor hepatectomy, n=11: hepatectomy for liver tumors, n=17). Diaphragmatic hernia was repaired emergently in 42.9% of cases and digestive resection was necessary in 28.5% of the cases. One patient died 3 months after hepatectomy, secondary to sepsis, from a segment of small bowel that perforated into the diaphragmatic hernia. Conclusions: Although rare, diaphragmatic hernia should be considered as an important complication, especially in living donor liver transplant patients. Diaphragmatic hernia should be repaired surgically, even for asymptomatic patients.

The “reverse air leak test”: a new technique for the assessment of low colorectal anastomosis

Francesco Crafa,Augusto Striano,Francesco Esposito,Amalia Rosaria Rita Rossetti,Mario Baiamonte,Valeria Gianfreda,Antonio Longo 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.1

Purpose: Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis was assessed transanally through the intrarectal irrigation of a few mL of saline solution. Methods: From October 2014 to November 2019, 11 patients with low rectal cancer (type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of indocyanine green was performed in order to evaluate the perfusion of the anastomosis. Results: The reverse air leak test was positive in 4 cases (36.4%). The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed no perfusion defect (grade 0) in low colorectal anastomosis. No postoperative fistula was detected in cohort study. A protective stoma was performed in 10 patients. On day 90, there were no complications and stoma closure was performed as planned. Conclusion: The reverse air leak test is a simple, feasible, and effective procedure to identify anastomotic leaks in low colorectal anastomoses.

Primary leiomyosarcoma of the liver: Two new cases and a systematic review

Francesco Esposito,Chetana Lim,Laurence Baranes,Chady Salloum,Cyrille Feray,Julien Calderaro,Daniel Azoulay 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.1

Primary hepatic leiomyosarcoma (PHL) is a rare malignant tumor, which originates from smooth muscles. Clinical presentation and imaging features are non-specific and can mimick the most frequent primary liver tumors namely hepatocellular carcinoma and intrahepatic cholangiocarcinoma. We report here two cases of PHL including one from the portal vein. The literature was searched for studies reporting cases of PHL reported from 2011 and 2019. The two patients were operated with R0 resection. Diagnosis of PHL was confirmed by histopathological and immunohistochemical examinations. Surgery remains the mainstay of the management of PHL. R0 resection is the main prognostic factor. Our literature search identified 16 additional cases from 12 reports. Preoperative diagnosis of PHL needs a high degree of suspicion due to atypical clinical presentation and non-specific imaging features. Surgery is the mainstay of the management of PHL. R0 resection is the main prognostic factor.

Partial splenectomy

Francesco Esposito,Adele Noviello,Nicola Moles,Nicola Cantore,Mario Baiamonte,Enrico Coppola Bottazzi,Antonio Miro,Francesco Crafa 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.2

Backgrounds/Aims: Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches. Methods: Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients. Results: Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5-50%) and in 3% of cases (range, 7-10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5-25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%). Conclusions: The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.

Hybrid operating room applications in the increasingly complex endovascular era: the trump card of modern vascular surgery

Davide Esposito,Francesco Gonfiantini,Aaron Thomas Fargion,Walter Dorigo,Flavio Villani,Rossella Di Domenico,Sara Speziali,Carlo Pratesi 대한외과학회 2021 Annals of Surgical Treatment and Research(ASRT) Vol.100 No.1

Hybrid operating room represents nowadays an important tool in the management of a constantly increasing number of complex surgical procedures which necessitate appropriate settings in order to be performed safely. We herein present the peculiarities and applications of such a versatile operating environment which is capable of guaranteeing the best performances in terms of equipment and imaging tools respecting the standards of asepsis that a simple angiographic room could not offer. In particular, we focus on its relevance in the field of complex vascular pathology, and on the importance of setting an appropriate management process in order to make the most of its potentialities without sacrificing the not negligible costs connected to it.

A Medical Food Formulation of Griffonia simplicifolia/Magnesium for Childhood Periodic Syndrome Therapy: An Open-Label Study on Motion Sickness

Maria Esposito,Francesco Precenzano,Michele Sorrentino,Deborah Avolio,Marco Carotenuto 한국식품영양과학회 2015 Journal of medicinal food Vol.18 No.8

Motion sickness (MS) is a disabling condition dominated by disagreement between visually perceived movement and the vestibular system’s sense of movement, with symptoms like dizziness, fatigue, and nausea, and other autonomic disabling symptoms. Preparations of Griffonia simplicifolia, containing high concentrations of 5-HTP, might be effective for serotonin-related disorders, including MS. Therefore, the aim of the present study is to assess the efficacy and safety of the G. simplicifolia/magnesium complex in a pediatric population with MS. The Griffonia/magnesium complex (50 and 200 mg, respectively) was orally administered as a prophylactic therapy for MS twice a day for 3 months to group A, and no therapy for MS was administered to group B. The MS clinical signs were recorded by parents or, where possible, directly from children by a specific module, which included validated questions for the diagnoses that were administered to all subjects and parents of both groups. Two study groups were matched for age (P = .224), sex (P = .801), and z-score body–mass index (P = .173). At T0, all recruited subjects in both groups complained about MS. After 3 months (T1), group A showed an MS prevalence of 36%, significantly lower than MS prevalence in group B (73%) (P < .001). The findings of the present study suggest the role of the Griffonia/magnesium complex as a potential treatment with middle-term efficacy even for MS.

Aircraft wings dynamics suppression by optimal NESs designed through an Efficient stochastic linearisation approach

Navarra, Giacomo,Iacono, Francesco Lo,Oliva, Maria,Esposito, Antonio Techno-Press 2020 Advances in aircraft and spacecraft science Vol.7 No.5

Non-linear energy sink (NES) is an emerging passive absorber able to mitigate the dynamic response of structures without any external energy supply, resonating with all the modes of the primary structure to control. However, its inherent non-linearities hinder its large-scale use and leads to complicated design procedures. For this purpose, an approximate design approach is herein proposed in a stochastic framework. Since loads are random in nature, the stochastic analysis of non-linear systems may be performed by means of computational intensive techniques such as Monte Carlo simulations (MCS). Alternatively, the Stochastic Linearisation (SL) technique has proven to be an effective tool to investigate the performance of different passive control systems under random loads. Since controlled systems are generally non-classically damped and most of SL algorithms operate recursively, the computational burden required is still large for those problems that make intensive use of SL technique, as optimal design procedures. Herein, a procedure to speed up the Stochastic Linearisation technique is proposed by avoiding or strongly reducing numerical evaluations of response statistics. The ability of the proposed procedure to effectively reduce the computational effort and to reliably design the NES is showed through an application on a well-known case study related to the vibrations mitigation of an aircraft wing.