Gennaro Nuzzo

Policlinico Universitario Agostino Gemelli, Roma, Latium, Italy

Are you Gennaro Nuzzo?

Claim your profile

Publications (176)487.61 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionAs mortality and morbidity after a curative resection remains high, it is essential to identify pre-operative factors associated with an early death after a major resection.Methods Between 1998 and 2008, we selected a population of 331 patients having undergone a major hepatectomy including segment I with a lymphadenectomy and a common bile duct resection for a proven hilar cholangiocarcinoma in 21 tertiary centres. The study's objective was to identify pre-operative predictors of early death (<12 months) after a resection.ResultsThe study cohort consisted of 221 men and 110 women, with a median age of 61 years (range: 24–85). The post-operative mortality and morbidity rates were 8.2% and 61%, respectively. The 1-, 3- and 5-year overall survival rates were 85%, 64% and 53%, respectively. The median tumour size was 23 mm on pathology, ranging from 8 to 40. A tumour size >30 mm [odds ratio (OR) 2.471 (95% confidence interval (CI) 1.136–7.339), P = 0.001] and major post-operative complication [OR 3.369 (95% CI 1.038–10.938), P = 0.004] were independently associated with death <12 months in a multivariate analysis.Conclusion The present analysis of a series of 331 patients with hilar cholangiocarcinoma showed that tumour size >30 mm was independently associated with death <12 months.
    HPB 08/2014; · 1.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the study was to analyze clinical presentation, surgical management, and long-term outcome of patients suffering from biliary diverticulum, namely Todani type II congenital bile duct cyst (BDC).
    Annals of surgery. 06/2014;
  • Critical care (London, England) 03/2014; 18(2):419. · 4.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background To evaluate the feasibility and long-term results of two-stage hepatectomy (TSH) in patients with bilobar colorectal liver metastases (CRLM). Study Design Retrospective multicenter study including 4 Italian hepatobiliary surgery units. One hundred-thirty patients were selected for TSH between 2002 and 2011. Primary endpoint was feasibility of TSH and the analysis of factors associated with failure to complete the procedure. Secondary endpoint was the long-term survival analysis. Results Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3 CRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to complete TSH was 21.5% and tumor progression was the most frequent reason of failure (18.5% of cases). Primary tumor characteristics, type, number and distribution of CRLM were not associated with significantly different risk of disease progression. The multivariable logistic regression analysis showed that tumor progression during pre-hepatectomy chemotherapy was the only independent risk factor for failure to complete TSH. The 5- and 10-year overall survival rates for patients who completed TSH were 32.1% and 24.1% with a median survival of 43 months. Duration of pre-hepatectomy chemotherapy ≥6 cycles was found to be the only independent predictor of overall and disease-free survival. Conclusions This study showed that selection of patients by response to pre-hepatectomy chemotherapy may be extremely important before planning TSH, because tumor progression while receiving pre-hepatectomy chemotherapy was associated with significantly higher risk of failure to complete the second stage. For patients who completed the TSH strategy, long-term outcome can be achieved with results similar to those observed following a single-stage hepatectomy.
    Journal of the American College of Surgeons 01/2014; · 4.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aims of the present research are to investigate the possible predictors of pancreatic cancer, in particular smoking status, alcohol consumption, hypercholesterolemia, and diabetes mellitus, in patients with histologically confirmed pancreatic carcinoma and to examine the synergism between risk factors. A case-control study (80 patients and 392 controls) was conducted at the Teaching Hospital "Agostino Gemelli" in Rome. A conditional logistic regression was used for the statistical analysis and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). We also investigated the possible interactions between risk factors and calculated the synergism index (SI). The multivariate analysis revealed that hypercholesterolemia and alcohol consumption resulted in important risk factors for pancreatic cancer even after the adjustment for all variables (OR: 5.05, 95% CI: 2.94-8.66; OR: 2.25, 95% CI: 1.30-3.89, resp.). Interestingly, important synergistic interactions between risk factors were found, especially between ever smoking status and alcohol consumptions (SI = 17.61) as well as alcohol consumption and diabetes (SI = 17.77). In conclusion, the study confirms that hypercholesterolemia and alcohol consumption represent significant and independent risk factors for pancreatic cancer. Moreover, there is evidence of synergistic interaction between diabetes and lifestyle factors (drinking alcohol and eating fatty foods).
    BioMed Research International 01/2014; 2014:481019. · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: After hepatectomy, bile leaks remain a major cause of morbidity, cost, and disability. This study was designed to determine if a novel intraoperative air leak test (ALT) would reduce the incidence of post-hepatectomy biliary complications. Rates of postoperative biliary complications were compared among 103 patients who underwent ALT and 120 matched patients operated on before ALT was used. All study patients underwent major hepatectomy without bile duct resection at 3 high-volume hepatobiliary centers between 2008 and 2012. The ALT was performed by placement of a transcystic cholangiogram catheter to inject air into the biliary tree, the upper abdomen was filled with saline, and the distal common bile duct was manually occluded. Uncontrolled bile ducts were identified by localization of air bubbles at the transection surface and were directly repaired. The 2 groups were similar in diagnosis, chemotherapy use, tumor number and size, resection extent, surgery duration, and blood loss (all, p > 0.05). Single or multiple uncontrolled bile ducts were intraoperatively detected and repaired in 62.1% of ALT vs 8.3% of non-ALT patients (p < 0.001). This resulted in a lower rate of postoperative bile leaks in ALT (1.9%) vs non-ALT patients (10.8%; p = 0.008). Independent risk factors for postoperative bile leaks included extended hepatectomy (p = 0.031), caudate resection (p = 0.02), and not performing ALT (p = 0.002) (odds ratio = 3.8; 95% CI, 1.3-11.8; odds ratio = 4.0; 95% CI, 1.1-14.3; and odds ratio = 11.8; 95% CI, 2.4-58.8, respectively). The ALT is an easily reproducible test that is highly effective for intraoperative detection and repair of open bile ducts, reducing the rate of postoperative bile leaks.
    Journal of the American College of Surgeons 12/2013; 217(6):1028-37. · 4.50 Impact Factor
  • Annals of surgery 11/2013; · 7.90 Impact Factor
  • Annals of surgery 11/2013; · 7.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess clinical presentation and long-term results of surgical management of congenital intrahepatic bile duct dilatation (IHBDD) (Caroli disease and syndrome) in a multicenter setting. Congenital IHBDD predisposes to biliary stasis, resulting in intrahepatic lithiasis, septic complications, and cholangiocarcinoma. Although liver resection (LR) is considered to be the treatment of choice for unilobar disease extent into the liver, the management of bilobar disease and/or associated congenital hepatic fibrosis remains challenging. From 1978 to 2011, a total of 155 patients (median age: 55.7 years) were enrolled from 26 centers. Bilobar disease, Caroli syndrome, liver atrophy, and intrahepatic stones were encountered in 31.0%, 19.4%, 27.7%, and 48.4% of patients, respectively. A complete resection of congenital intrahepatic bile ducts was achieved in 90.5% of the 148 patients who underwent surgery. Postoperative mortality was nil after anatomical LR (n = 111) and 10.7% after liver transplantation (LT) (n = 28). Grade 3 or higher postoperative morbidity occurred in 15.3% of patients after LR and 39.3% after LT. After a median follow-up of 35 months, the 5-year overall survival rate was 88.5% (88.7% after LT), and the Mayo Clinic score was considered as excellent or good in 86.0% of patients. The 1-year survival rate was 33.3% for the 8 patients (5.2%) who presented with coexistent cholangiocarcinoma. LR for unilobar and LT for diffuse bilobar congenital IHBDD complicated with cholangitis and/or portal hypertension achieved excellent long-term patient outcomes and survival. Because of the bad prognosis of cholangiocarcinoma and the sizeable morbidity-mortality after LT, timely indication for surgical treatment is of major importance.
    Annals of surgery 11/2013; 258(5):713-721. · 7.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The present study was designed to evaluate the role of intraoperative ultrasound (IOUS) in intrahepatic staging and the impact on surgical strategy for patients with colorectal liver metastases (CRLM). The study included 515 patients who had undergone liver resection for CRLM at two tertiary care referral centers. Data from a prospectively collected database were retrospectively analysed. Early intrahepatic recurrence was assessed at 3 and 6 months after resection and was considered as residual disease undetected by IOUS. Performance of imaging modalities was compared by analysis of studies on individual patients. A total of 1,370 liver metastases were detected preoperatively with a median of 3 imaging modalities. MRI and PET were performed in 51 and 42 % of the patients, respectively. Median number of days between last imaging and surgery was 18. Contrast-enhanced IOUS was performed in 136 patients (26.4 %). Intraoperatively, 293 new nodules were found in 132 patients: on histology 280 were CRLM (17.6 %). Surgical strategy was changed in 140 patients (27.2 %). On multivariate analysis synchronous and bilobar metastases ≥3 in number, BMI ≥30, and time between last imaging and surgery longer than 18 days resulted in predictive factors indicating new nodules detected by IOUS. Early intrahepatic recurrences were 3.7 and 7.9 % at 3 and 6 months. Performance of CT, MRI, FDG-PET, and intraoperative staging was compared: sensitivity was 63.6, 68.8, 53.6, and 92 % and specificity was 91, 92.3, 95.8, and 97.8 %, respectively CONCLUSIONS: The use of IOUS continues to be mandatory for correct staging of patients with CRLM undergoing liver resection.
    World Journal of Surgery 08/2013; · 2.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Large hepatocellular carcinoma (HCC) presents on cirrhosis or in the absence of cirrhosis. Prognostic factors include both tumor and liver factors. Evaluate clinical and tumor characteristics of a group of large resected HCC in European patients. Data for patients with HCC >7 cm who underwent liver resection between 1992 and 2011 were analyzed. Patients were dichotomized into those with tumor diameters of 7-10 cm or >10 cm and their characteristics and outcomes were compared. A total of 65 hepatectomies for HCC ≥7 cm were performed. Severe fibrosis or cirrhosis was present in 41.5 % of patients. Thirty-seven (56.9 %) patients had HCC ≥10 cm. Mortality and morbidity rates were 1.5 % and 37.5 %, respectively. Preoperative blood platelet levels and serum alkaline phosphatase (ALKP) levels showed significant differences between the groups. The 3-year survival was 43.5 % and 17.4 % for patients with tumors 7-10 and ≥10 cm, respectively. Patients with large size HCC and preserved liver function can be resected with low operative risk. ALKP levels and platelet counts were higher in the larger tumors. Given these patterns of clinical and biochemical characteristics, this group of tumors may be a selected subset of large HCCs and might potentially benefit from surgical resection.
    Journal of Gastrointestinal Cancer 08/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Portal vein embolization (PVE) is an effective procedure to increase the future remnant liver (FRL) before major hepatectomy. A controversial issue is that PVE may stimulate tumor growth and can be associated with poor prognosis after liver resection for colorectal liver metastases (CRLM). The aim of this study was to evaluate the impact of PVE on long-term survival following major hepatectomy for CRLM. METHODS: Between 1998 and 2010, 100 right and extended-right hepatectomies for unilobar, right-sided CRLM were performed. Of the group, 20 patients underwent preoperative PVE (group A). The control patients (group B; 20 patients) were selected by matching with the group A patients. RESULTS: It was found that 25 patients (25/40; 62.5%) had developed tumor recurrence. The rate of global recurrence was not significantly different in groups A and B (65% vs 60%, respectively; P = .744). The specific overall intrahepatic recurrence rate was 42.5% (17 of 40 patients) and was not significantly different in groups A and B (45% vs 40%, respectively; P = .749). The 5-year overall and disease-free survival rates were similar in groups A and B (42.9% and 33.6% vs 42.1% and 27.7%, respectively). The 5-year specific liver-disease-free survival was 45.3% in group A and 53.5% in group B (P = .572). On multivariate analysis of all 100 hepatectomies, R1 resection (P = .013) was found to be the only independent predictor of liver-disease-free survival. CONCLUSION: This study showed that PVE did not affect overall survival and specific liver-disease-free survival in patients undergoing right or right-extended hepatectomy for unilobar, right-sided CRLM.
    Surgery 06/2013; 153(6):801-810. · 3.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Gallbladder carcinoma is frequently discovered incidentally on pathologic examination of the specimen after laparoscopic cholecystectomy (LC) performed for presumed "benign" disease. The objective of the present study was to assess the role of excision of port-sites from the initial LC for patients with incidental gallbladder carcinoma (IGBC) in a French registry. METHODS: Data on patients with IGBC identified after LC between 1998 and 2008 were retrospectively collated in a French multicenter database. Among those patients undergoing re-operation with curative intent, patients with port-site excision (PSE) were compared with patients without PSE and analyzed for differences in recurrence patterns and survival. RESULTS: Among 218 patients with IGBC after LC (68 men, 150 women, median age 64 years), 148 underwent re-resection with curative intent; 54 patients had PSE and 94 did not. Both groups were comparable with regard to demographic data (gender, age>70, co-morbidities), surgical procedures (major resection, lymphadenectomy, main bile duct resection) and postoperative morbidity. In the PSE group, depth of tumor invasion was T1b in six, T2 in 24, T3 in 22, and T4 in two; this was not significantly different from patients without PSE (P=0.69). Port-site metastasis was observed in only one (2%) patient with a T3 tumor who died with peritoneal metastases 15 months after resection. PSE did not improve the overall survival (77%, 58%, 21% at 1, 3, 5 years, respectively) compared to patients with no PSE (78%, 55%, 33% at 1, 3, 5 years, respectively, P=0.37). Eight percent of patients developed incisional hernia at the port-site after excision. CONCLUSION: In patients with IGBC, PSE was not associated with improved survival and should not be considered mandatory during definitive surgical treatment.
    Journal of Visceral Surgery 05/2013; · 1.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: :Background/Aims: Surgical indications in patients with liver metastases from gastric cancer are debated. To analyze outcomes of surgery and the impact of neoadjuvant chemotherapy (NeoCTx). Methodology: Consecutive patients undergoing liver resection for gastric metastases between January 1997 and December 2008 were analyzed. Results: Liver metastases were synchronous in 9 patients and multiple in 5. Eight patients received NeoCTx. NeoCTx and non-NeoCTx groups had similar characteristics. Mortality was nil, morbidity was 40%. After a mean follow-up of 42.5 months, 5-year survival rate was 33.2%. Presence of multiple metastases was a negative prognostic factor (p=0.029), while synchronous presentation and NeoCTx were not. Disease-free survival rates were significantly different by stratifying patients according to response to chemotherapy: at 5 years 32.4% in non-NeoCTx group, 0% in disease progression (PD) while on NeoCTx group and 60.0% in non-PD while on NeoCTx group (p=0.018). One-year recurrence rates were 40%, 100% and 0%, (p=0.020). Conclusions: Liver resection for gastric metastases achieves good long-term results, especially in solitary metastases. NeoCTx helps to select candidates for surgery and, in patients without PD, is associated with improved disease-free survival.
    Hepato-gastroenterology 05/2013; 60(123). · 0.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND AND AIMS: Aim of this study was to compare liver resection and radiofrequency ablation in patients with single hepatocellular carcinoma ⩽ 3 cm and compensated cirrhosis. METHODS: The study involved 544 Child-Pugh A cirrhotic patients (246 in resection group and 298 in radiofrequency group) observed in 15 Italian Centers. Overall survival and tumor recurrence rates were analyzed using Kaplan Meier method before and after propensity score matching. Cox regression models were used to identify factors associated with overall survival and tumor recurrence. RESULTS: Two cases of perioperative mortality were observed in resection group and the rate of major complications was 4.5% in resection group and 2.0% in radiofrequency group (p=0.101). Four-year overall survival rates were 74.4% in resection group and 66.2% in radiofrequency group (p=0.353). Four-year cumulative HCC recurrence rates were 56% in resection group and 57.1% in radiofrequency group (p=0.765). Local tumor progression was detected in 20.5% of ablated patients and in one resected patient (p<0.001). After propensity score matching, both survival and tumor recurrence were still not significantly different although a trend towards lower recurrence was observed in RES patients. Older age and higher alpha-fetoprotein levels were independent predictors of poor overall survival while older age and higher alanine-aminotransferase levels resulted to be independent factors associated with higher recurrence rate. CONCLUSIONS: In spite of a higher rate of local tumor progression, radiofrequency ablation can provide results comparable to liver resection in the treatment of single hepatocellular carcinoma ⩽3 cm occurring in compensated cirrhosis.
    Journal of Hepatology 03/2013; · 9.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE:: The aim of this study was to investigate in a retrospective setting the patients' profile and results of those undergoing surgery for hepatocellular carcinoma (HCC) in high-volume surgical centers throughout the world. BACKGROUND:: Whether surgery for HCC is a suitable approach and for which subset of patients is still controversial. The EASL/AASLD (European Association for the Study of Liver Disease/American Association for the Study of Liver Disease) guidelines, based on the Barcelona Clinic Liver Cancer (BCLC) classification, leave little room for hepatic resection; inversely, other reports promote its wider application. METHODS:: On the basis of the network "Hepatocellular Carcinoma: Eastern & Western Experiences," data for 2046 consecutive patients resected for HCC in 10 centers were collected. According to the BCLC classification, 1012 (50%) were BCLC 0-A, 737 (36%) BCLC B, and 297 (14%) BCLC C. Analysis of overall survival and disease-free survival and multivariate analysis of prognostic factors were performed. FINDINGS.: The 90-day mortality rate was 2.7%. Overall morbidity was 42%. After a median follow-up of 25 months (range, 1-209 months), the 1-, 3-, and 5-year overall survival rates were 95%, 80%, and 61% for BCLC 0-A; 88%, 71%, and 57% for BCLC B; and 76%, 49%, and 38% for BCLC C (P = 0.000). The 1-, 3-, and 5-year disease-free survival rates were as follows: 77%, 41%, and 21% for BCLC 0-A; 63%, 38%, and 27% for BCLC B; and 46%, 28%, and 18% for BCLC C (P = 0.000). The multivariate analysis identified bilirubin, cirrhosis, esophageal varices, tumor size, and macrovascular invasion to be statistical and independent prognostic factors for overall survival. CONCLUSIONS:: This large multicentric survey shows that surgery is in current practice widely applied among patients with multinodular, large, and macrovascular invasive HCC, providing acceptable short- and long-term results and justifying an update of the EASL/AASLD therapeutic guidelines in this sense.
    Annals of surgery 02/2013; · 7.90 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To evaluate the effect of removal of the duodenum on the complex interplay between incretins, insulin, and glucagon in nondiabetic subjects.RESEARCH DESIGN AND METHODS For evaluation of hormonal secretion and insulin sensitivity, 10 overweight patients without type 2 diabetes (age 61 ± 19.3 years and BMI 27.9 ± 5.3 kg/m(2)) underwent a mixed-meal test and a hyperinsulinemic-euglycemic clamp before and after pylorus-preserving pancreatoduodenectomy for ampulloma.RESULTSAll patients experienced a reduction in insulin (P = 0.002), C-peptide (P = 0.0002), and gastric inhibitory peptide (GIP) secretion (P = 0.0004), while both fasting and postprandial glucose levels increased (P = 0.0001); GLP-1 and glucagon responses to the mixed meal increased significantly after surgery (P = 0.02 and 0.031). While changes in GIP levels did not correlate with insulin, glucagon, and glucose levels, the increase in GLP-1 secretion was inversely related to the postsurgery decrease in insulin secretion (R(2) = 0.56; P = 0.012) but not to the increased glucagon secretion, which correlated inversely with the reduction of insulin (R(2) = 0.46; P = 0.03) and C-peptide (R(2) = 0.37; P = 0.04). Given that the remaining pancreas presumably has preserved intraislet anatomy, insulin secretory capacity, and α- and β-cell interplay, our data suggest that the increased glucagon secretion is related to decreased systemic insulin.CONCLUSIONS Pylorus-preserving pancreatoduodenectomy was associated with a decrease in GIP and a remarkable increase in GLP-1 levels, which was not translated into increased insulin secretion. Rather, the hypoinsulinemia may have caused an increase in glucagon secretion.
    Diabetes care 02/2013; · 7.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: The aim of this study was to determine the prognostic significance of the preoperatively assessed tumor doubling time (DT) in patients undergoing liver resection for mass-forming intrahepatic cholangiocarcinoma (IHC). METHODS: We evaluated 79 patients who underwent curative resection for IHC, and in whom the same imaging technique was preoperatively available in two consecutive occasions, to allow the calculation of the DT. The influence of DT and other clinical and pathological variables on tumor recurrence and patient survival was determined by the Kaplan-Meier method and uni- and multivariate analysis. RESULTS: Median overall survival was 40 months; 1-, 3-, and 5-year survival rates were 86.1, 55.1, and 35.1 %, respectively. Median disease-free survival was 17 months; 1-, 3-, and 5-year disease-free survival rates were 62.0, 29.1, and 23.3 %, respectively. At univariate analysis, DT <70 days (p < 0.001) and advanced tumor stage (p = 0.024) were associated with worse overall survival and maintained significance at multivariate analysis. CONCLUSIONS: DT is a clinically useful parameter to estimate the prognosis of "mass-forming" IHC in patients undergoing liver resection.
    Journal of Gastrointestinal Surgery 01/2013; · 2.36 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of this study was to investigate in a retrospective setting the patients' profile and results of those undergoing surgery for hepatocellular carcinoma (HCC) in high-volume surgical centers throughout the world. Background: Whether surgery for HCC is a suitable approach and for which subset of patients is still controversial. The EASL/AASLD (European Asso-ciation for the Study of Liver Disease/American Association for the Study of Liver Disease) guidelines, based on the Barcelona Clinic Liver Cancer (BCLC) classification, leave little room for hepatic resection; inversely, other reports promote its wider application. Methods: On the basis of the network "Hepatocellular Carcinoma: Eastern & Western Experiences," data for 2046 consecutive patients resected for HCC in 10 centers were collected. According to the BCLC classification, 1012 (50%) were BCLC 0-A, 737 (36%) BCLC B, and 297 (14%) BCLC C. Anal-ysis of overall survival and disease-free survival and multivariate analysis of prognostic factors were performed. Findings. The 90-day mortality rate was 2.7%. Overall morbidity was 42%. After a median follow-up of 25 months (range, 1–209 months), the 1-, 3-, and 5-year overall survival rates were 95%, 80%, and 61% for BCLC 0-A; 88%, 71%, and 57% for BCLC B; and 76%, 49%, and 38% for BCLC C (P = 0.000). The 1-, 3-, and 5-year disease-free survival rates were as follows: 77%, 41%, and 21% for BCLC 0-A; 63%, 38%, and 27% for BCLC B; and 46%, 28%, and 18% for BCLC C (P = 0.000). The multivariate analysis identified bilirubin, cirrhosis, esophageal varices, tumor size, and macrovas-From the
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Incidental gallbladder cancer (IGBC) is frequently discovered on the specimen when laparoscopic cholecystectomy (LC) for a benign disease is performed. The objective of the present study was to assess the role of port site excision IGBC patients in a French registry. Methods Data on patients with IGBC identified after LC between 1998 and 2008 were retrospectively collated in a French, multicenter database. Those subjected to port site resection were compared with patients who underwent resection without port site removal and analyzed for differences in recurrence patterns and survival. Results Among 218 patients with IGBC after LC, 148 underwent re-resection with curative-intent; 54 patients had port site resection and 94 did not. Both groups were comparable according to demographic data (gender P = 0.54, age > 70 P = 0.85, co-morbidities), surgical procedures (major resection P = 0.08, lymphadenectomy P = 0.09, common bile duct resection P = 0.75) and postoperative morbidity (P = 0.29). In the resected port site group, depth of tumor invasion was T1b = 6, T2 = 24, T3 = 22, T4 = 2, no significantly different from patients with no port site excision (P = 0.69). Port site metastasis was observed in only one (2%) patient with T3 tumor who died with peritoneal metastases 15 months after resection. Port site excision did not improve the overall survival (77%, 58%, 21% at 1-, 3-, 5-year respectively) compared to patient with no port site excision (78%, 55%, 33% at 1-, 3-, 5-year respectively, P = 0.37). Conclusion In patients with IGBC, port site excision was not associated with improved survival and should not be considered mandatory during definitive surgical treatment.
    Journal de Chirurgie Viscérale. 01/2013; 150(4):304–312.

Publication Stats

2k Citations
487.61 Total Impact Points

Institutions

  • 2014
    • Policlinico Universitario Agostino Gemelli
      Roma, Latium, Italy
  • 1987–2014
    • Catholic University of the Sacred Heart
      • • Institute of Nuclear Medicine
      • • Dipartimento di Semeiotica Chirurgica
      • • Institute of Special Surgical Pathology
      Milano, Lombardy, Italy
  • 2003–2013
    • Ospedale Ordine Mauriziano di Torino, Umberto I
      Torino, Piedmont, Italy
  • 2008
    • Columbus-Gemelli University Hospital
      Roma, Latium, Italy
  • 1989–2007
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 2005
    • LIUCBM Libera Università Campus Bio-Medico di Roma
      • Unit of Medical Oncology
      Roma, Latium, Italy