Roberto Dell'Avanzato

Publications (8)8.7 Total impact

• Article: Laparoscopic resection of sporadic synchronous gastric and jejunal gastrointestinal stromal tumors: report of a case.

  Roberto Dell'Avanzato, Fabio Carboni, Maria Beatrice Palmieri, Raffaele Palmirotta, Fiorella Guadagni, Giovanna Pippa, Giuseppe Santeusanio, Mauro Antimi, Massimo Lopez, Massimo Carlini
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  ABSTRACT: Multicentricity of gastrointestinal stromal tumors (GISTs) has been described only in patients with neurofibromatosis type 1 (NF1) or within the small intestine, and different pathogenetic mechanisms are involved. We report a case of synchronous sporadic gastric and jejunal GISTs, which were resected laparoscopically in a 67-year-old man. Immunohistochemical analysis revealed that both lesions were KIT (CD117)-positive, but that the gastric lesion was CD34-positive, whereas the jejunal one was Vimentin-, S-100-, and SMA-positive. Molecular analysis of mutations in KIT exons 9, 11, 13, and 17, and in PDGFRA exons 12 and 18 revealed the presence of a gastric sporadic GIST with a KIT mutation of the exon 11 and a jejunal sporadic GIST without KIT or PDGFRA mutations. To our knowledge, this is the first report of laparoscopically resected synchronous sporadic gastric and jejunal GISTs.
  Surgery Today 02/2009; 39(4):335-9. · 1.22 Impact Factor
• Article: Catamenial Bernard-Horner's syndrome related to thoracic endometriosis.

  Edoardo Mercadante, Cristiano Giovannini, Fabio Castaldi, Umberto Passaro, Roberto Dell'Avanzato, Elisabetta Abruzzese, Massimo Carlini
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  ABSTRACT: We describe the case of a young woman with a recurrent right Bernard-Horner's syndrome associated with the onset of intermittent supraclavicular mass. Surgical excision of the mass revealed the endometrial pattern of the tumor and the close relationship between Bernard-Horner's syndrome and thoracic endometriosis. No other case of this syndrome has been reported in the literature.
  The Annals of thoracic surgery 10/2006; 82(3):e24-5. · 3.74 Impact Factor
• Article: Major iatrogenic tracheal injury during pneumonectomy: conservative treatment.

  Edoardo Mercadante, Cristiano Giovannini, Fabio Castaldi, Roberto Dell'Avanzato, Settimio Zazza, Giorgio Andreozzi, Domenico Curatola, Massimo Carlini
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  ABSTRACT: We hereby present the case of a 55-year-old woman with an iatrogenic tracheal laceration that occurred during double lumen intubation for left pneumonectomy. Conservative treatment was performed and the patient was discharged 12 days after surgery. No major sequelae after 3 months of follow-up were observed.
  The Annals of thoracic surgery 07/2006; 81(6):2285-7. · 3.74 Impact Factor
• Article: [Incidental thyroid microcarcinoma in benign thyroid disease. Incidence in a total of 100 consecutive thyroidectomies].

  Massimo Carlini, Cristiano Giovannini, Edoardo Mercadante, Fabio Castaldi, Roberto Dell'Avanzato, Settimio Zazza
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  ABSTRACT: Over the past few years, incidental thyroid microcarcinoma has become a frequent disease and its incidence in some reports is considerable. Discovering new cases depends on the extended indications for total thyroidectomy for benign disease, on progress in the field of diagnostic instruments (ultrasound, scintigram, fine needle biopsy for cytology, CT scan, MRI), and on the pathology examination of very thin slices of specimens. In spite of the high incidence reported in some autopsy series, suggesting that this tumour may have a good prognosis, some Authors report an overall incidence of up to 11% of local recurrence, metastasis or mortality. For all these reasons the surgical treatment of incidental thyroid microcarcinoma is still controversial. The aim of this study was to estimate the incidence and examine the clinical-pathological findings of incidental thyroid microcarcinoma in a series of 100 consecutive thyroidectomies and to evaluate whether complete removal of the gland should be adopted in all cases. In the present series the incidence of incidental thyroid microcarcinoma was 21.6% (19/88). Total thyroidectomy was considered the treatment of choice for diffuse benign disease and appeared to be necessary for both the diagnosis and treatment of incidental thyroid microcarcinoma.
  Chirurgia italiana 58(4):441-7.
• Article: Surgical treatment of a severe, massive, symptomatic Zenker's diverticulum in a very elderly patient.

  Massimo Carlini, Roberto Dell'Avanzato, Edoardo Miercadante, Marco E Bazuroa, Domenico Curatola, Fabio Castaldi, Cristiano Giovannini
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  ABSTRACT: Zenker's diverticula commonly occur in the elderly, and quality of life is often impaired by typical symptoms such as dysphagia, regurgitation, halitosis, cough and aspiration pneumonia, malnutrition and weight loss. The "gold standard" treatment for pharyngo-oesophageal diverticula is the resection of the sac via left lateral cervicotomy and cricopharingeal myotomy. In the last decade, with the fast development of minimally invasive techniques, an endoscopic stapled approach has been proposed. This procedure rapidly encountered the favour of gastroenterologists because patients with Zenker's diverticulum often present serious co-morbidities and seem to benefit from the minimally invasive technique; but the crucial point in the treatment of Zenker's diverticula, in addition to the sac resection, is the myotomy of the cricopharyngeal muscle fibres and this could not be safely and completely achieved in endoscopic stapling owing to the risk of vascular lesions and incomplete sectioning of the sac. Moreover, many studies have reported similar results between open and endoscopic procedures in terms of postoperative morbidity and mortality, showing better functional outcomes in surgical patients even if elderly and presenting co-morbidities. In this report, the case of a 95 year-old patient, one of the oldest operated on for this disease and reported in the literature, is described. He was affected by a massive 8 cm Zenker's diverticulum and an oesophageal motility disorder (dyskinesia), with significant co-morbidity. Surgical diverticulectomy combined with cricopharyngeal myotomy was performed with excellent early and late results.
  Chirurgia italiana 59(3):397-403.
• Article: [Single symptomatic small bowel metastasis from primary lung cancer. A clinical case].

  Roberto Dell'Avanzato, Antonio De Martino, Francesco Maria Consiglio, Walter Testi, Riccardo Malatesti, Sergio Mancini
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  ABSTRACT: Small bowel metastases from primary lung cancer have rarely been reported and a single symptomatic metastasis to the small bowel is a rare occurrence. In the case reported here there was no evident additional site of metastatic disease and the diagnosis was made on the basis of morphology and immunohistochemistry analysis using CK 07, CK 20 and TTF-1 monoclonal antibodies. However, even in patients in whom the intestine is the sole metastatic site, the prognosis is dismal and most of patients die within 2 months.
  Chirurgia italiana 58(5):637-41.
• Source

  Available from: sichirurgia.org

  Article: Single gallbladder and multiple pancreatic metastases from renal cell carcinoma sixteen years after nephrectomy.

  Veronica Ricci, Salvatore Francesco Carbone, Walter Testi, Riccardo Malatesti, Marianna Lo Gatto, Roberto Dell'Avanzato, Chiara Ginanneschi, Luca Volterrani
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  ABSTRACT: We describe a case of female patient presenting with acute biliary symptoms and severe haemobilia due to the presence of a large metastasis in the gallbladder wall from renal cell carcinoma treated by radical nephrectomy 16 years before. CT examination also showed the presence of multiple small round metastases from renal carcinoma in the pancreas, subsequently confirmed surgically and pathologically.
  Chirurgia italiana 60(2):311-4.
• Article: Giant symptomatic myelolipoma of the right adrenal gland: a case report.

  Roberto Dell'Avanzato, Fabio Castaldi, Cristiano Giovannini, Edoardo Mercadante, Paolo Cianciulli, Massimo Carlini
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  ABSTRACT: Adrenal myelolipoma is an uncommon tumour of the adrenal gland, usually unilateral, frequently associated with hypertension and obesity, with a benign biological behaviour and without hormonal activity, first described in 1905. The neoplasm consists of adipose tissue and myelopoietic cells of the bone marrow. These tumours have a very slow but continued growth and their volume and weight vary significantly from small lesions of a few grams to huge masses weighing up to several kilograms. If symptoms occur, surgery should be performed without delay, especially for large myelolipomas that are at high risk of spontaneous rupture with haemorrhage and life-threatening shock. In this report a case of a 43-year-old male with a 22 x 18 x 9 cm giant myelolipoma, weighing 3500 g and originating from the right adrenal gland is described. The large mass dislocating and compressing the inferior vena cava, was removed surgically. The early postoperative course and the late outcome were favourable without recurrence after 30 months. The different aetiological hypotheses of this rare neoplasm and its clinical features, diagnosis and treatment are discussed.
  Chirurgia italiana 61(2):231-6.