Carlo Castoro

University of Padova, Padua, Veneto, Italy

Are you Carlo Castoro?

Claim your profile

Publications (97)184.22 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: AimThis multicentric prospective study aimed to investigate how postoperative complications after surgery for colorectal cancer affect patients’ quality of life and satisfaction with care.Method One hundred and sixteen patients operated on for colorectal cancer were enrolled in this study. Patients answered three questionnaires about generic (EORTC QLQ-C30) and disease specific quality of life (EORTC CR29) and treatment satisfaction (EORTC IN-PATSAT32) at the time of admission, and at one and six months after surgery. Non-parametric tests and linear multiple regression models were used for statistical analysis.ResultsTwelve patients had complications requiring further surgery (anastomotic leakage, abdominal bleeding, abdominal wall sepsis, wound infection). Patients with complications that required surgery reported a worse score of physical function, emotional function and anxiety than patients without such complications one month after surgery. These patients judged their general satisfaction with the quality of care and doctors’ interpersonal skills, technical skills, information provision and availability to be worse than in patients without such complications. The presence of postoperative psychiatric complications and anastomotic leakage were independent predictors of quality of life (β=-0.30, p=0.004 and β=-0.42, p<0.001)Conclusion In patients undergoing surgery for colorectal cancer, complications requiring any kind of surgical management significantly affected patients’ perception of all doctor-related items suggesting an impairment of the entire surgeon-patient relationship. Convincing patients that ‘‘zero risk’’ cannot be achieved in surgical practice is therefore a priority.This article is protected by copyright. All rights reserved.
    Colorectal Disease 08/2014; · 2.08 Impact Factor
  • Source
    Massimo Rugge, Marco Pizzi, Carlo Castoro
    [Show abstract] [Hide abstract]
    ABSTRACT: The definition of Barrett's esophagus (BE) is still a matter of debate. The diagnostic criteria adopted around the world for both BE and BE-related pre-cancerous lesions are inconsistent, particularly between Eastern and Western pathologists. From a clinical perspective, these different clinico-biological approaches may affect how the literature is interpreted, with detrimental effects on the clinical management of patients. The present review focuses on the major discrepancies in the field, covering both the non-neoplastic and the pre-cancerous lesions associated with Barrett's disease.
    World journal of surgery. 07/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ulcerative colitis (UC) is characterized by repeated flare-ups of inflammation that can lead to oncogenic insults to the colonic epithelial. UC-associated carcinogenesis presents a different sequence of tumorigenic events compared to those that contribute to the development of sporadic colorectal cancer. In fact, in UC, the early events are represented by oxidative DNA damage and DNA methylation that can produce an inhibition of oncosuppressor genes, mutation of p53, aneuploidy, and microsatellite instability. Hypermethylation of tumor suppressor and DNA mismatch repair gene promoter regions is an epigenetic mechanism of gene silencing that contribute to tumorigenesis and may represent the first step in inflammatory carcinogenesis. Moreover, p53 is frequently mutated in the early stages of UC-associated cancer. Aneuploidy is an independent risk factor for forthcoming carcinogenesis in UC. Epithelial cell-T-cell cross-talk mediated by CD80 is a key factor in controlling the progression from low to high grade dysplasia in UC-associated carcinogenesis.
    World journal of gastroenterology : WJG. 06/2014; 20(22):6774-6785.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To date, few studies of preoperative chemotherapy or chemoradiotherapy (crt) in gastroesophageal junction (gej) cancer have been statistically powered; indeed, gej tumours have thus far been grouped with esophageal or gastric cancer in phase iii trials, thereby generating conflicting results.
    Current oncology (Toronto, Ont.). 06/2014; 21(3):125-33.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aims of this prospective study were to analyze the predictors of postoperative sleep disturbance after esophagectomy for cancer and to identify patients at risk for postoperative hypnotic administration.
    World Journal of Surgical Oncology 05/2014; 12(1):156. · 1.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to assess the efficacy and safety of totally implanted vascular devices (TIVAD) using different techniques of insertion.
    BMC Surgery 05/2014; 14(1):27. · 1.97 Impact Factor
  • Annals of surgery 04/2014; · 7.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lymphoadenectomy is a cornerstone of esophageal cancer treatment, and sentinel node (SN) biopsy (SNB) might provide surgeons with an extra tool to limit unnecessarily extended lymphadenectomy and to implement a minimally invasive approach. The aim of our study was to review all the available literature on the use of SNB in esophageal surgery for malignancy. The review was conducted according to the PRISMA guidelines. A systematic search was performed in PubMed, EMBASE, and the Cochrane database to identify all original articles on the role of SNB in esophageal cancer. Data on methodologies, tumor stage and localization, and results were summarized and used to address relevant clinical questions related to the application of the SNB technique in esophageal cancer. Twelve studies were included, with a total of 492 patients. Different methods for SN identification were used (radionuclide, blue dye, computed tomography [CT] lymphography). The pooled values estimated using the random-effects model were, respectively: technetium-99 m overall detection rate (DR) 0.970 (95 % CI 0.814-0.996), accuracy (ACC) 0.902 (95 % CI 0.736-0.968); blue-dye DR 0.971 (95 % CI 0.890-0.993), ACC 0.790 (95 % CI 0.681-0.870); and CT lymphoscintigraphy DR 0.970 (95 % CI 0.814-0.996), ACC 0.902 (95 % CI 0.736-0.968). Based on these results, the concept of SN in esophageal cancer is technically feasible with an acceptable DR and ACC, and it might be applicable in the event of early-stage adenocarcinoma of the gastroesophageal junction in patients with a high surgical risk or in a patient where an endoscopic resection is taken into consideration. Further studies focused on a single tumor type and localizations are needed in order to predict the correct utilization of this concept in minimally invasive treatment of esophageal cancer.
    Surgical Endoscopy 11/2013; · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to evaluate the prognostic value of F-fluorodeoxyglucose PET/computed tomography (CT) after neoadjuvant therapy (NAT) in locally advanced esophageal cancer (EC) patients. We recruited 79 EC patients from a sample of 210 who underwent F-fluorodeoxyglucose PET/CT after NAT and who did not have evidence or suspicion of distant metastases. All patients were followed up for a median period of 18 months (range: 2-53 months) from nuclear imaging. PET/CT findings were correlated with surgical management and long-term prognosis. The χ-test was used for categorical variables and the Student t-test for continuous data. Survival curves were computed using the Kaplan-Meier method. A P value less than 0.05 was considered statistically significant. Twenty patients (25.3%) had negative PET/CT and 59 (74.7%) had positive PET/CT results after NAT. Of the 20 patients with negative PET/CT results, eight underwent radical-intent surgery and 12 did not, whereas of the 59 patients with positive PET/CT 44 were scheduled for surgery and 15 were not (P<0.05). On follow-up, 38 patients were seen to be disease free, whereas 23 had relapsed and 15 had died. The overall survival was different between patients with negative PET/CT and those with positive PET/CT scans (98 vs. 40%; P=0.019). Event-free survival was higher in patients with negative PET/CT than in those with positive PET/CT after NAT (78 vs. 0%; P=0.003). Considering patients with positive PET/CT, in the nonsurgical group only three patients were alive without evidence of disease, whereas in the surgical group 19 patients were disease free (20 vs. 46%; P<0.001). PET/CT is able to stratify the recurrence risk of EC patients. After a median follow-up period of 18 months, 91% of patients with negative PET/CT scans who did not undergo surgery were seen to be disease free. A positive PET/CT after NAT should be followed by surgery for improving event-free survival.
    Nuclear Medicine Communications 11/2013; · 1.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: At present, no consensus exists on the beneficial effect of preoperative cisplatin/5-fluorouracil (5-FU)-based chemotherapy versus primary surgery in the management of patients with esophageal cancer. The aim of this study was to evaluate the impact of some relevant genetic polymorphisms, within drug-related and DNA repair genes, on the clinical outcome of esophageal cancer patients subjected to cisplatin/5-FU-based neoadjuvant treatment. DNA from 143 esophageal cancer patients, 63 receiving neoadjuvant therapy and 80 receiving primary surgery, was analyzed for the following polymorphisms: the GSTM1 null, GSTT1 null, and GSTP1 Ile105Val (rs16953) in glutathione S-transferase (GST) family, 2 in thymidylate synthase (TS) gene, and the ERCC1 Asn118Asn (rs11615), ERCC1 C8092A (rs3212986), XPD/ERCC2 Asp312Asn (rs1799793), and XPD/ERCC2 Lys751Gln (rs13181) of the nucleotide excision repair pathway. We found that the ERCC1 rs3212986, although not associated with therapeutic response, is an independent predictive marker of better outcome in a cisplatin/5-FU-based neoadjuvant setting (hazard ratio: 0.38, 95% confidence interval: 0.2-0.73, P=0.008). In contrast, no association with clinical outcome was observed for this polymorphism in the primary surgery group. Our study indicates the ERCC1 rs3212986 as a predictive marker in the cisplatin/5-FU-based neoadjuvant setting, and also suggests its use as a marker to select the appropriate therapeutic approach in esophageal cancer patients.
    Pharmacogenetics and Genomics 08/2013; · 3.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Neoadjuvant chemoradiotherapy (CT-RT) before oesophagectomy is standard management for squamous cell carcinoma (SCC) of the thoracic oesophagus. The aim of this study was to compare the outcome of patients who had clinical complete response (CR) with neoadjuvant CT-RT + oesophagectomy with the survival of patients who had clinical CR and were not operated on. Seventy-seven consecutive patients with SCC of the thoracic oesophagus with CR with neoadjuvant CT-RT presenting at the Regional Center of Esophageal Diseases from 1992 to 2008 were included in this retrospective study on a prospectively collected database. Thirty-nine patients underwent oesophagectomy (CT-RT + oesophagectomy), while 38 (CT-RT) were not operated on because they were considered unfit for surgery or refused the operation. Patients' outcome and survival were compared. In the CT-RT + oesophagectomy group, clinical CR was confirmed after histological examination of the surgical specimen in 27/39 (69.2 %) patients. Five-year overall survival rates were 50.0 % in the CT-RT + oesophagectomy group and 57.0 % in the CT-RT group (p = 0.99); 5-year disease-free survival rates were 55.5 % in the CT-RT + oesophagectomy group and 34.6 % in the CT-RT group (p = 0.15). Even after adjusting for propensity score, age, ASA and clinical stage, the treatment regimen did not show a statistically significant effect on overall survival (adjusted p = 0.65) nor on disease-free survival (adjusted p = 0.15). In our group of patients with clinical CR after neoadjuvant CT-RT for SCC of the thoracic oesophagus, waiting for recurrence and then using salvage surgery did not negatively impact their survival compared to patients treated with surgery. More accurate restaging protocols are warranted to improve decision making after CR with neoadjuvant CT-RT.
    Journal of Gastrointestinal Surgery 06/2013; · 2.36 Impact Factor
  • The Annals of thoracic surgery 06/2013; 95(6):2210-2211. · 3.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A subset of gastric (intestinal-type) and esophageal (Barrett) adenocarcinoma features HER2 protein overexpression. Consistent evidence demonstrates that microRNAs have a major role in HER2 (dys)regulation. MiR-125a-5p and miR125b expressions were tested in the spectrum of lesions in the gastroesophageal carcinogenic cascade, also correlating miR-125a-5p/125b levels with HER2 status. MiR-125a-5p and miR-125b expression (quantitative reverse transcriptase polymerase chain reaction [qRT-PCR]) and HER2 status (immunohistochemistry [IHC] and chromogenic in situ hybridization [CISH]) were assessed in a series of 90 biopsy samples spanning the whole histologic spectrum of gastric and esophageal carcinogenesis. To support the obtained results, the qRT-PCR levels of microRNAs and their expression (in situ hybridization) were tested in an adjunctive series of gastric and esophageal adenocarcinoma, including (IHC/CISH validated) HER2-negative and HER2-positive cases. Both miR-125a-5p and miR-125b levels were significantly down-regulated throughout the gastric and esophageal carcinogenic cascade. HER2 status (IHC and CISH) correlated inversely with miR-125 expression (qRT-PCR and in situ hybridization). Dysregulation of miR-125a-5p/125b and HER2 is an early event in the gastric (intestinal-type) and esophageal (Barrett) oncogenesis. In both oncogenetic cascades, miR-125 expression correlates inversely with HER2 status. MiR-125a-5p/125b can be considered among the therapeutic targets in HER2-positive esophageal and gastric adenocarcinoma.
    Human pathology 04/2013; · 3.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The purpose of this multicentric prospective study was to evaluate postoperative HRQL and satisfaction with care after laparoscopic colonic resection for colorectal cancer in elderly patients. METHODS: A total of 116 patients were enrolled in this study: 33 patients older than age 70 years had laparoscopic colectomy, whereas 24 had open colectomy; 44 patients younger than age 70 years had laparoscopic colectomy and 15 of them had open colectomy. The patients answered to three questionnaires about generic (EORTC QLQ C30) and disease-specific quality of life (EORTC CR29) and about treatment satisfaction (EORTC IN-PATSAT32). Nonparametric tests and forward stepwise multiple regression analysis were used for statistical analysis. RESULTS: One month after surgery, global quality of life (QL2 item) was significantly impaired in elderly patients who had laparoscopic colectomy compared with younger patients who had the same operation (p = 0.003). Similarly, role function (RF), physical function (PF), emotional function (EF), cognitive function (CF), and social function (SF) were impaired in elderly patients who had laparoscopic colectomy compared with younger patients (p < 0.001, p < 0.001, p = 0.013, p < 0.001, p = 0.01, respectively). Fatigue (FA), sleep disturbances (SL), appetite loss (AP), and dyspnea (DY) affected the quality of life of these patients more than younger patients (p < 0.001, p = 0.055, p = 0.051, and p = 0.003, respectively). CONCLUSIONS: Elderly patients undergoing laparoscopic colectomy for cancer experience less postoperative local complications than elderly patients undergoing open colectomy. Nevertheless, in the first postoperative month, these patients experience a worse global quality of life than younger patients undergoing the same operation with impairment of all the functions and the presence of fatigue, sleep disturbances, appetite loss, and dyspnea.
    Surgical Endoscopy 03/2013; · 3.43 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 03/2013; 145(3):895-6. · 3.41 Impact Factor
  • Source
    World Journal of Surgery 02/2013; · 2.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study is to validate the accuracy of HER2 assessment on biopsies by comparing matched biopsy/surgical material from the same patients. HER2 status was evaluated by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) in 103 cases of gastric and gastroesophageal junction cancers in coupled biopsy and surgical material. Complete concordance between IHC and FISH results on biopsy versus surgical samples was noted in 80% and 95% of cases, respectively. At comprehensive comparison, including IHC and FISH data on biopsy and surgical samples, 89% of biopsies were predictive of HER2 status in surgical samples, whereas 11% showed variable inconsistencies. The majority of these (10 of 12 cases) showed IHC score 0/1+ on biopsy but were all IHC positive and amplified at surgery; in particular, three (3 of 35; 8.5%) IHC score 0 and four (4 of 16; 25%) IHC score 1+ cases were FISH amplified on biopsy material also, whereas the remaining three cases were FISH non-amplified on biopsy. The percentage of cases, which were FISH amplified with IHC score 1+ or 2+ on biopsies, were similar (25% and 33%, respectively) and they also shared a similar grade of amplification. These data suggest that both IHC score 1+ and 2+ on biopsy material represent "equivocal cases" that may merit further investigation. The predictive value of HER2 IHC in biopsies is high. FISH analysis should be considered for IHC score 2+ and 1+ biopsy cases. Approximately 8% of cases will not be accurately predicted by biopsy evaluation.
    Translational oncology 02/2013; 6(1):10-6. · 3.40 Impact Factor
  • Source
    Journal of Cancer Research and Therapeutics 01/2013; 8(4):619-625. · 0.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The main outcome parameters in oesophageal surgery have traditionally been morbidity and mortality, but quality of life (QL) has become an important consideration in view of the severity and persistence of postoperative symptoms. The aim of this study was to analyse QL before and after oesophagectomy for oesophageal cancer and to explore possible association with patient's and disease characteristics. PATIENTS AND METHODS: One hundred twenty-six consecutive patients presenting with oesophageal cancer to the Oncological Surgery Unit of the Veneto Institute of Oncology between 2009 and 2011 were enrolled in this prospective study. The patients were asked to answer three QL questionnaires (the Italian versions of the QLQ-C30, the QLQ-OES18, and the IN-PATSAT32 modules developed by the European Organization for Research and Treatment of Cancer) at the time of disease diagnosis, after neoadjuvant therapy, immediately after surgery and at 1, 3, 6 and 12 months postoperatively. RESULTS: Global quality of life (QL2 item) seemed to improve after neoadjuvant therapy but it dropped markedly after surgery. It then rose to a value in between the one registered after neoadjuvant therapy and the one at diagnosis. Emotional function and dysphagia were associated to QL2 at diagnosis. After neoadjuvant therapy, age, oesophageal stenosis, emotional function and dysphagia were associated to good quality of life at that stage. After surgery, pain was associated to quality of life at that stage. During the early follow-up phase (1-3 months after surgery), role function and postoperative urinary complications were associated to QL2. In the long-term follow-up (6-12 months), adjuvant therapy, eating disorders and postoperative complications were associated to poor quality of life. CONCLUSIONS: Postoperative complications are associated to long-term emotional and physical function impairment which can lead to a significantly impaired global quality of life. Postoperative pain relief plays a key role in achieving a good postoperative quality of life. Finally, HRQL after oesophagectomy seems to be a function of therapeutic efficacy rather than of the specific surgical procedure used.
    Journal of Gastrointestinal Surgery 01/2013; · 2.36 Impact Factor
  • Current Oncology 12/2012; 19(6):e501. · 1.63 Impact Factor

Publication Stats

441 Citations
184.22 Total Impact Points

Institutions

  • 1988–2012
    • University of Padova
      • • Department of Medicine DIMED
      • • Department of Surgery, Oncology and Gastroenterology DISCOG
      • • Dipartimento di Scienze Mediche e Chirurgiche
      Padua, Veneto, Italy
  • 2007–2010
    • Istituto Oncologico Veneto
      Padua, Veneto, Italy
  • 1998–2009
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 1996
    • University of Milan
      • Unitá di Patologia
      Milano, Lombardy, Italy
  • 1989
    • Ospedale Generale Regionale "F. Miulli"
      Acquaviva delle Fonti, Apulia, Italy