Sandro Zonta

Publications (14)40.6 Total impact

• Article: Incidental carcinoma in multinodular goiter: risk factors.

  Ivan Botrugno, Federico Lovisetto, Lorenzo Cobianchi, Sandro Zonta, Catherine Klersy, Alberto Vailati, Paolo Dionigi, Vassili Jemos
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  ABSTRACT: The aim of the study was to analyze the frequency of incidental thyroid carcinoma (unknown tumor smaller than or equal to 10 mm) in a consecutive series of 462 total thyroidectomies for multinodular goiter and to investigate the clinical risk factors for this type of malignancy. A retrospective, single-center study of outcome data collected from patients with preoperative diagnosis of multinodular goiter who underwent total thyroidectomy at the General Surgery Unit of Pavia (Italy) between January 2000 and December 2008 was performed. Possible risk factors for malignancy were: gender, age, time of evolution of goiter, presence of a dominant nodule in multinodular goiter, hyperthyroidism, history of radiation to the neck, residence in an area of endemic goiter, prior thyroid surgery, calcifications in the goiter detected by neck ultrasound or chest X-rays, and a family history of thyroid diseases. In a 9-year period, 462 patients underwent total thyroidectomy. We found 41 cases of incidental thyroid carcinoma; the most common histopathological type was papillary. The multivariable analysis demonstrated that the clinical variables associated with occult carcinoma were a personal history of radiation therapy to the neck, the presence of calcifications detected by ultrasound or neck X-rays, and a family history of thyroid diseases; residence in an area of endemic goiter was a protective factor. A personal history of radiation to the neck, detection of calcifications by ultrasound or by neck X-rays, and a family history of thyroid diseases should be considered clinical risk factors for malignancy in multinodular goiter.
  The American surgeon 11/2011; 77(11):1553-8. · 1.28 Impact Factor
• Article: Laparoscopic treatment of splenomegaly: a case for hand-assisted laparoscopic surgery.

  Andrea Pietrabissa, Luca Morelli, Andrea Peri, Luigi Pugliese, Sandro Zonta, Paolo Dionigi, Franco Mosca
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  ABSTRACT: Hand-assisted laparoscopic surgery (HALS) is a safe therapeutic approach to remove megaspleens of any size. Conventional laparoscopic splenectomy for splenomegaly is difficult because of limited exposure and complex vascular control, with increased risk of intraoperative bleeding and conversion to open surgery. HALS can overcome some of these limitations, reducing the risk of conversion to open surgery and resulting in a postoperative course similar to that of conventional laparoscopy. Single-institution single-surgeon retrospective review. University hospital. An analysis was performed of all patients with splenomegaly (splenic weight, >700 g) seen during a 10-year period. Preoperative data, indications for splenectomy, splenic weight, operative variables, clinical outcome, and rates of conversion to open surgery, complications, and operative mortality were compared between patients undergoing HALS vs conventional laparoscopy. Splenomegaly was present in 85 patients, of whom 43 underwent HALS splenectomy and 42 underwent conventional laparoscopic splenectomy. The HALS group had larger spleens. Rates of conversion to open surgery and operative mortality were similar in the HALS group vs the conventional laparoscopy group (2.3% [1 of 43] vs 2.4% [1 of 42] and 2.3% [1 of 43] vs 0.0% [0 of 42], respectively), with no difference in hospital length of stay in the absence of morbidity. Portal system thrombosis was the most serious complication. HALS can minimize surgical trauma in patients with massive splenomegaly who otherwise would be candidates only for open surgery and results in a clinical outcome similar to that of conventional laparoscopy. With the availability of HALS, any patient with splenomegaly can be offered a minimally invasive surgical option. Portal system thrombosis is common, regardless of the surgical technique.
  Archives of surgery (Chicago, Ill.: 1960) 07/2011; 146(7):818-23. · 4.32 Impact Factor
• Article: Unique vascular tumor primary arising in the liver and exhibiting histopathological features consistent with so-called polymorphous hemangioendothelioma.

  Lorenzo Cobianchi, Marco Lucioni, Renato Rosso, Sandro Zonta, Giacomo Fiandrino, Mario Alessiani, Marco Doni, Alberta Ferrari, Umberto Magrini, Marco Paulli, Paolo Dionigi
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  ABSTRACT: Reported herein is an unusual vascular tumor primary arising in the liver and exhibiting unique histopathological features. A 47-year-old woman underwent left hepatectomy because of a large hepatic mass. On histology the tumor had a composite pattern, consisting of angiomatous, retiform and solid areas, formed by oval to cuboidal to spindle cells, that expressed only endothelial markers (CD31 and factor VIII-related antigen). These findings led to the diagnosis of a low-grade vascular neoplasm with morphological features consistent with so-called polymorphous hemangioendothelioma. The tumor was completely resected. At 24 month follow up the patient was alive, without evidence of disease. Polymorphous hemangioendothelioma is a rare vascular neoplasm, with borderline malignant potential, which usually occurs in lymph nodes and, rarely, at extranodal sites. Its classification as an entity has been questioned recently. The unusual morphological features of the present case, which do not fit neatly with any other recognized hemangioendothelioma subtype, indicate that the family of vascular tumors is broader than currently accepted. In addition the present case widens the spectrum of primary vascular tumors arising in the liver.
  Pathology International 12/2009; 59(12):890-4. · 1.62 Impact Factor
• Article: Standard requirements for randomized controlled trials in surgery.

  Sandro Zonta, Michela De Martino
  Surgery 12/2008; 144(5):838-9. · 3.10 Impact Factor
• Article: Requirements for applying a case-control study model and clinical significance of changes in the visual analogue scale score in abdominal pain.

  Sandro Zonta, Michela De Martino, Paolo Dionigi
  Surgical Endoscopy 11/2008; 23(1):227-8. · 4.01 Impact Factor
• Article: Transvaginal laparoscopic cholecystectomy: endoscopically assisted.

  Mario Alessiani, Costanza Alvisi, Lorenzo Cobianchi, Sandro Zonta, Andrea Bottazzi, Maurizio Perego, Paolo Dionigi
  Surgical Endoscopy 10/2008; 22(12):2763-4. · 4.01 Impact Factor
• Article: Use of Human Fibrin Glue (Tissucol) Versus Staples for Mesh Fixation in Laparoscopic Transabdominal Preperitoneal Hernioplasty

  Sandro Zonta, Federico Lovisetto, Mauro Longoni
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  ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
  Annals of Surgery 10/2007; 246(5):903-904. · 7.49 Impact Factor
• Article: Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study.

  Federico Lovisetto, Sandro Zonta, Emanuela Rota, Massimiliano Mazzilli, Marco Bardone, Luca Bottero, Giuseppe Faillace, Mauro Longoni
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  ABSTRACT: The aim of this study was to compare the morbidity of fixation of prosthetic meshes using Tissucol fibrin glue versus staples in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal and femoral hernias. In patients undergoing laparoscopic hernia repair, fixation of mesh prostheses with staples may affect inguinocrural nerves causing early postoperative neuralgia and chronic neuralgia. Between June 2003 and February 2005, 197 patients with inguinal or femoral hernia were enrolled in this prospective, randomized study, to assess morbidity following hernia repair with staples (n = 98) or Tissucol (n = 99). The primary outcomes were early postoperative and late neuralgia recorded using a visual analog scale (VAS). The effects of neuralgia on functional status were evaluated using the modified SF-36 questionnaire. Secondary outcomes included complications such as nonspecific pain and recurrence. Assessments took place at 1, 3, 6, and 12 months, with all patients completing each follow-up visit. Mean VAS scores were significantly lower in the Tissucol group versus the staples group (MANOVA, P < 0.05). Higher scores for the modified SF-36 questionnaire at 1 month were demonstrated in the Tissucol group compared with the staples group (23.2 and 22.6, respectively; P < 0.05). The mean recovery time for normal physical activity was significantly shorter in the Tissucol group compared with the staples group (7.9 vs. 9.1 day, respectively; P < 0.001). One recurrence was seen in the fibrin glue group, which was attributable to a technical error in fixation of the mesh. The use of Tissucol provides distinct advantages in laparoscopic treatment of inguinal/femoral hernias compared with conventional TAPP, including a lower incidence of postoperative neuralgia and an earlier resumption of physical and social activities.
  Annals of Surgery 03/2007; 245(2):222-31. · 7.49 Impact Factor
• Article: Left pneumothorax secondary to colonoscopic perforation of the sigmoid colon: a case report.

  Federico Lovisetto, Sandro Zonta, Emanuela Rota, Massimiliano Mazzilli, Giuseppe Faillace, Alessandro Bianca, Alessio Fantini, Mauro Longoni
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  ABSTRACT: We present here the case of a 75-year-old woman who complained of acute abdominal pain after a diagnostic colonoscopy. Abdominal x-rays demonstrated pneumoperitoneum, whereas chest x-rays showed pneumomediastinum and left pneumothorax. A chest drain was placed and subsequently an exploratory laparoscopy was performed, during which air was found in the subserosa of the sigmoid colon and in the mesosigmoid secondary to perforation of a sigmoid diverticulum. The perforation was repaired and a protective loop colostomy was fashioned. The patient was discharged 8 days postoperatively in a good general condition. Although numerous cases of pneumoretroperitoneum and pneumomediastinum secondary to iatrogenic perforation of the colon have been described, reports of pneumothorax are much rarer. We, therefore, discuss the anatomic bases and the possible physiopathologic mechanisms responsible for this clinical complication.
  Surgical laparoscopy, endoscopy & percutaneous techniques 03/2007; 17(1):62-4. · 1.23 Impact Factor
• Article: Thoracic-abdominal approach in primary pulmonary synovial sarcoma.

  Sandro Zonta, Federico Lovisetto, Patrizia Morbini, Lorenzo Cobianchi, Stefano Nazari
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  ABSTRACT: We report a case of primary synovial sarcoma of the lung. The patient was a 32-year-old male who presented with a mass in the right hemithorax invading the peritoneal cavity. The neoplasm was resected through a thoracic-abdominal approach. The patient is doing well 21 months after surgery. Within the last decade thoracic localizations of synovial sarcoma are an emerging histopathological entity thanks to the molecular analysis of the SYT-SSX fusion gene transcript.
  Asian cardiovascular & thoracic annals 04/2005; 13(1):85-7.
• Article: Uretero-neocystostomy in a swine model of kidney transplantation: a new technique.

  Sandro Zonta, Federico Lovisetto, Cobianchi Lorenzo, Francesca Abbiati, Mario Alessiani, Paolo Dionigi, Aris Zonta
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  ABSTRACT: Swine constitute a well-characterized large animal model for kidney transplantation (K-Tx) although the uretero-neocystostomy represents a crucial aspect because of the very small caliber of the ureter and the mucosal susceptibility to the edema during surgical management. Besides infectious and occlusive complications limited the employment of a stent and the peculiar anatomy of the species prevents its removal without an operative approach. These features find an equivalent in children (<4 year old) candidates to urological surgery. We investigated an uretero-neocystostomy technique to be applied in case of narrow caliber without using endoluminal device. Thirty unrelated large-white piglets, divided into three equal groups (n = 10) on the basis of the uretero-neocystostomy technique used, underwent K-Tx while receiving a double immunosuppressive regimen. We developed a direct uretero-neocystostomy (Direct) technique and compare this with the gold standard Lich-Gregoir (LG) and Leadbetter-Politano (LP) techniques. After 60 days, the ureteral complication rates were: group 1 (LG): 60% (6/10, three early and three late strictures); group 2 (LP): 40% (4/10, two leakages, one early stricture, and one isolated ureteral dilatation); group 3 (Direct): 10% (1/10, one isolated ureteral dilatation). No bacterial cystitis or nephritis occurred; retrograde cystograms were negative for refluxes in every group. The comparison between the old techniques and the new one (LG and LP versus Direct) showed a lower incidence of complications among the animals that underwent the new direct technique (P < 0.05). This technique could be applied clinically in selected pediatric cases either of transplantation or reflux.
  Journal of Surgical Research 04/2005; 124(2):250-5. · 2.25 Impact Factor
• Article: The influence of surgery, immunosuppressive drugs, and rejection, on graft function after small bowel transplantation: a large-animal study.

  Mario Alessiani, Fabrizio De Ponti, Filiberto Fayer, Francesca Abbiati, Sandro Zonta, Ermanno Zitelli, Eloisa Arbustini, Patrizia Morbini, Nicoletta Poggi, Catherine Klersy, Ilaria Blangetti, Paolo Dionigi, Aris Zonta
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  ABSTRACT: In this study we assessed functional changes (motility and absorption) of intestinal allografts in a large-animal model of orthotopic small bowel transplantation in swine. Studies were performed on non-rejecting animals in the early and late stages after transplantation and after induction of different grades of acute rejection. Immunosuppression consisted of oral FK506 and mycophenolate mofetil. In each study group we regulated drug administration, in terms of dosage and timing, in order to induce different grades of acute rejection or to prevent it. Migrating myoelectrical complexes were recorded in fasting animals so that motility could be assessed. Mucosal biopsy of the allograft and D-xylose absorption tests were performed on the same day as the motility study. In the early stages following intestinal transplantation, we observed in non-rejecting animals a slightly increased graft motility and a marked carbohydrate malabsorption. Recovery of the carbohydrate absorption capacity occurs within 2 months, but the persistence of diarrhea leads to partial malabsorption and to a lack of normal weight gain. Motility reduction correlates with the grade of acute rejection and becomes significant at a later stage, when rejection is severe. Allograft carbohydrate absorption, on the contrary, is markedly reduced in all rejecting pigs, irrespective of the grade of rejection. In summary, the early functional impairment of non-rejecting animals has multifactorial causes due to surgery and immunosuppression (drug toxicity), and its occurrence suggests the need for specific guidelines for clinical early postoperative enteral feeding. The functional studies adopted here are helpful in defining the grade of functional impairment with or without acute rejection; however, they are not useful for early detection of ongoing acute rejection of the small bowel graft.
  Transplant International 06/2003; 16(5):327-35. · 2.92 Impact Factor
• Article: [Mesenchymal stromal cells injection reduces acute rejection damage in a rat experimental model of kidney transplantation].

  Teresa Rampino, Marilena Gregorini, Francesca Bosio, Giulia Bedino, Valeria Corradetti, Chiara Rocca, Teresa Valsania, Eleonora Francesca Pattonieri, Giovanni Piotti, Grazia Soccio, Sandro Zonta, Michela De Martino, Paolo Dionigi, Francesco Frassoni, Antonio Dal Canton
  Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia 28(2):132-4.
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  Available from: tumorionline.it

  Article: Low-grade fibromatosis-like spindle cell metaplastic carcinoma: a basal-like tumor with a favorable clinical outcome. Report of two cases.

  Michele Podetta, Gioacchino D'Ambrosio, Alberta Ferrari, Adele Sgarella, Barbara Dal Bello, Gian Silvio Fossati, Sandro Zonta, Enrico Silini, Paolo Dionigi
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  ABSTRACT: Fibromatosis-like spindle-cell metaplastic carcinoma (FLSpCC) is an atypical variant of spindle-cell carcinoma with a particular clinical behavior characterized by frequent local recurrence, very low potential for axillary lymph node metastasis, and uncommon distant metastases. Although it presents the typical immunoprofile of basal-like carcinomas, FLSpCC is associated with a favorable clinical outcome and conservative treatment is generally indicated. Because of the lack of specific clinical and radiological characteristics, the criteria for the differential diagnosis from other benign and malignant tumors are based only on histological findings and immunostaining. We report on two FLSpCC patients treated with wide local excision and mastectomy associated with axillary lymph node dissection. Although the biological behavior of this subtype of breast cancer has not been adequately evaluated, wide local excision or mastectomy with clear resection margins but no axillary dissection appears to be an adequate treatment approach.
  Tumori 95(2):264-7. · 0.86 Impact Factor