Gaya Spolverato

• Johns Hopkins University

The role of adjuvant chemotherapy (adj-CT) in stage II colon cancer remains controversial. Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual disease (MRD) and predicting recurrence. This systematic review and meta-analysis evaluated the prognostic value of ctDNA in stage II colorectal cancer (CRC), focusing on po...

This editorial announces the need for a consensus conference on definitions of surgical nomenclature, which is evolving due to the introduction of non-human (hardware, software) devices and applications, including robotics. A recently created entity, the Artificial Intelligence Organization for Next Generation Surgeons (AIONS), comprised primarily...

Lynch syndrome is the most common hereditary cancer predisposition, accounting for 1-5% of colorectal cancer cases, and is driven by germline mutations in DNA mismatch repair genes. Despite established diagnostic criteria, such as the Amsterdam guidelines, Lynch syndrome remains largely underdiagnosed. To address this gap, universal tumour screenin...

Anastomotic leakage (AL) is a significant complication following rectal cancer surgery, adversely affecting both quality of life and oncological outcomes. Recent advancements in artificial intelligence (AI), particularly machine learning and deep learning, offer promising avenues for predicting and preventing AL. These technologies can analyze exte...

Background Transabdominal pre-peritoneal inguinal hernia repair using the da Vinci Single-Port robot (SP-TAPP) is currently performed in few centers. We aimed to define the learning curve for SP-TAPP by analyzing operative times. Methods The operative times of 122 SP-TAPP performed between 2019 and 2024 were retrospectively analyzed. The following...

Purpose of Review Trace the history and current advances in minimally invasive robotic-assisted abdominal solid organ transplantation, addressing intraoperative concerns regarding technical challenges, prolonged warm ischemia time, and postoperative outcomes. Recent Findings Organ transplantation has rapidly evolved from its beginnings as an exper...

Lynch syndrome is rarely associated with rectal cancer (RC) and thus, metachronous RC has been scarcely investigated. This study aimed to analyze the mucosal immune microenvironment in sporadic and metachronous RC. We analyzed the mucosal immune microenvironment in the 25 metachronous RCs present in the IMMUNOREACT 1 and 2 multicentre observational...

Background: With rectum-sparing protocols becoming more common for rectal cancer treatment, this study aimed to predict the pathological complete response (pCR) to preoperative chemoradiotherapy (pCRT) in rectal cancer patients using pre-treatment MRI and a radiomics-based machine learning approach. Methods: We divided MRI-data from 102 patients in...

Objective The aim of this study is to provide solid evidence to update the management of stage I colon cancer (CC) after surgery. Background Given the low risk of recurrence of stage I CC, some international guidelines do not recommend intensive follow-up after surgery. However, data on the actual incidence, risk factors, and site of recurrences a...

Pouchitis is an idiopathic inflammatory disease that may occur in ileal pouches, and it can lead to ileal pouch failure. This was a single-center, randomized, double-blinded, placebo-controlled trial that assessed the effect of Lactobacillus casei (L. casei) DG®, a probiotic strain, on the ileal pouch mucosa to determine the crosstalk between micro...

AI is revolutionizing the landscape of colorectal cancer (CRC) surgery, permeating diverse facets ranging from intraoperative guidance to predictive modeling of postoperative outcomes. This scoping review aims to comprehensively delineate the breadth of artificial intelligence (AI) applications in CRC surgery. A search of PubMed, Embase, and Ebsco...

Background/Objectives: The textbook outcome (TO) is a composite tool introduced to uniform surgical units and regulate surgical quality and outcomes. A patient is considered TO only if all predetermined items are met. In colorectal surgery, TO represents a new tool that can achieve important results given the prevalence of colorectal cancers. Howev...

Background The da Vinci Single-Port Robot System (DVSP) allows three robotic instruments and an articulated scope to be inserted through a single small incision. It received FDA approval in 2014 and was first introduced in 2018. The aim of this new system was to overcome the limitations of single-incision laparoscopic and robotic surgery. Since the...

Inflammatory bowels diseases (IBD) are high risk conditions for colorectal cancer (CRC). The discovery of IBD and CRC noninvasive protein/peptide biomarkers using saliva and feces was the aim of this study involving 20 controls, 25 IBD (12 Crohn’s Disease-CD), 37 CRC. By untargeted proteomic (LTQ-Orbitrap/MS), a total of 152 proteins were identifie...

Background: Quality-of-life metrics are increasingly important for oncological patients alongside traditional endpoints like mortality and disease progression. Statistical tools such as Win Ratio, Win Odds, and Net Benefit prioritize clinically significant outcomes using composite endpoints. In randomized trials, Win Statistics provide fair compari...

Objective: this study seeks to examine the status of female gynecological surgeons in Italy concerning both discriminatory practices and the availability of opportunities of improvement within the operating theatre. Design, setting and population: a National Survey addressed to a group of 3242 female surgeons all over Italy carried out and approved...

Background Long‐term daily use of aspirin reduces incidence and mortality due to colorectal cancer (CRC). This study aimed to analyze the effect of aspirin on the tumor microenvironment, systemic immunity, and on the healthy mucosa surrounding cancer. Methods Patients with a diagnosis of CRC operated on from 2015 to 2019 were retrospectively analy...

Introduction. Gender influences survival outcomes after colorectal cancer (CRC) treatments; however, its impact on CRC surgery remains largely unclear. This retrospective study aims to investigate gender differences in patients undergoing CRC resection, focusing on surgical treatments and postoperative outcomes. Methods. A total of 9,683 patients w...

Background Rectal-sparing approaches for patients with rectal cancer who achieved a complete or major response following neoadjuvant therapy constitute a paradigm of a potential shift in the management of patients with rectal cancer, however their role remains controversial. The aim of this study was to investigate the feasibility of rectal-sparing...

Cellular elements that infiltrate and surround tumours and pre‐metastatic tissues have a prominent role in tumour invasion and growth. The extracellular vesicles specifically entrapped and stored within the extracellular matrix (ECM‐EVs) may reflect the different populations of the tumour microenvironment and their change during tumour progression....

Women involvement in surgical practice has been recorded since ancient times, and numerous female surgeons have marked the history of surgery. Moreover, during the last 50 years several women’s surgical societies were founded with the common aim to collect experiences of female surgeons in different surgical subspecialties and provide support to wo...

Background SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2...

Aim Local excision (LE) in selected cases after neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer in clinically complete or major responders has been recently reported as an alternative to standard radical resection. Completion total mesorectal excision (cTME) is generally performed when high‐risk pathological features are foun...

Background The connection between academic career advancement and publishing research articles is important, as it can impact promotion and compensation decisions. Gender bias in academic publishing is a known issue, with studies showing low numbers in key roles in female representation. This article aims to analyze the ratio of women to men as fir...

Background Women’s participation in the surgical workforce has increased. The aim of the study is to acquire objective data regarding practice, training, satisfaction, and discrimination of women surgeons working in cardiothoracic and vascular surgery in Italy. Methods An 83-item questionnaire was distributed through social media and sent to e-mai...

In patients with locally advanced rectal carcinoma (LARC), negative nodal status after neoadjuvant chemoradiotherapy (nCRT) may allow for rectum-sparing protocols rather than total mesorectal excision; however, current MRI criteria for nodal staging have suboptimal accuracy. The aim of this study was to compare the diagnostic accuracy of different...

Stricture is a common complication of Crohn’s disease (CD) and may be treated with bowel-sparing procedures. Our study analyzed what happens in terms of intestinal and systemic inflammation when the diseased bowel is left behind following surgery. In this retrospective study, we enrolled 42 consecutive patients who underwent strictureplasty (alone...

The journal Artificial Intelligence Surgery was established to explore the integration of Artificial Intelligence (AI) in surgery. It originated from the desire to understand the potential of true robotic surgery, as existing robotic systems are tele-manipulators rather than autonomous robots. AI’s role in surgery involves levels of autonomy and a...

Introduction: Hepatic artery anomalies (HAA) may have an impact on surgical and oncological outcomes of patients undergoing pancreaticoduodenectomy (PD). Methods: Patients who underwent PD at our institution between July 2015 and January 2020 were retrospectively reviewed and classified into two groups: group 1, with presence of HAA, and group 2...

Background: Urinary tract infections (UTIs) cause postoperative morbidity in patients undergoing lower gastrointestinal (GI) surgery that can prolong postoperative hospital stays. In patients with a fever of unknown origin (FUO), clinicians ignore what to do while waiting for the results of the urine culture test. This study aimed to develop a nom...

Background The main therapy for rectal cancer patients is neoadjuvant therapy (NT) followed by surgery. Immune biomarkers are emerging as potential predictors of the response to NT. We performed a meta-analysis to estimate their predictive significance. Methods A systematic literature search of PubMed, Ovid MEDLINE and EMBASE databases was performe...

Background Colon cancer in young patients is often associated with hereditary syndromes; however, in early-onset rectal cancer, mutations of these genes are rarely observed. The aim of this study was to analyse the features of the local immune microenvironment and the mutational pattern in early-onset rectal cancer. Methods Commonly mutated genes...

This white paper documents the consensus opinion of the Artificial Intelligence Surgery (AIS) task force on Artificial Intelligence (AI) Ethics and the AIS Editorial Board Study Group on Ethics on the ethical considerations and current trustworthiness of artificial intelligence and autonomous actions in surgery. The ethics were divided into 6 topic...

Despite a growing number of women choosing to pursue surgical specialties, surgery is still perceived as a woman-unfriendly career. The difficulties of conciliating a demanding career with the requirements of both personal and family life for women surgeons have been investigated by several authors. The current study aims to summarize existing evid...

Objectives: The aim of this study was to determine the accuracy of three state-of-the-art MRI sequences for the detection of extramural venous invasion (EMVI) in locally advanced rectal cancer (LARC) patients after preoperative chemoradiotherapy (pCRT). Methods: This retrospective study included 103 patients (median age 66 years old [43-84]) sur...

Introduction To investigate the differences in the professional and personal life and the perception of gender-bias, among Italian female surgeons working in Otolaryngology–Head and Neck Surgery (OHNS), as compared to those involved in other surgical fields (overall group [OG]). Materials and Methods An online survey was administered to female med...

Background: The role of the gut-brain axis has been recently highlighted as a major contributor to Parkinson's disease (PD) physiopathology, with numerous studies investigating bidirectional transmission of pathological protein aggregates, such as α-synuclein (αSyn). However, the extent and the characteristics of pathology in the enteric nervous s...

Background: Studies evaluating sex differences in colorectal cancer (CRC) tumor microenvironment are limited, and no previous study has focused on rectal cancer patients’ constitutive immune surveillance mechanisms. The authors aimed to assess gender-related differences in the immune microenvironment of rectal cancer patients. Methods: A systema...

Background: Approximately 15 % of colorectal adenocarcinomas (CRCs) are characterized by an altered expression of DNA mismatch repair (MMR) proteins (i.e. MMR deficiency [MMRd]). Lymph node ratio (LNR) represents one of the most important prognostic markers in non-advanced CRCs. No significant data are available regarding LNR distribution dependin...

Background Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare disease and current efforts are focused on the prognosis and on the development of efficient and specific treatments. This study aimed to review the latest evidence regarding FL-HCC treatment and prognosis. Methods A systematic review of the literature over the past 10 years rega...

Background: The aim of this study is to evaluate the impact of major pathological response on overall survival (OS) in borderline resectable and locally advanced pancreatic ductal adenocarcinoma following neoadjuvant treatment, and to identify predictors of major pathological response. Methods: Patients surgically resected following neoadjuvant...

Local Excision (LE) or Watch and Wait (WW) for patients with complete clinical response or near-complete clinical response after neoadjuvant chemoradiotherapy (nCRT) were proposed to avoid morbidity and impairment of quality of life after rectal resection. The aim of this study is to perform a systematic review of the literature, and to compare rec...

Bidirectional communication between cells and their microenvironment has a key function in normal tissue homeostasis, and in disease initiation, progression and a patient’s prognosis, at the very least. The extracellular matrix (ECM), as an element of all tissues and cellular microenvironment, is a frequently overlooked component implicated in the...

BACKGROUND: An accurate clinical restaging is required to select patients who respond to neoadjuvant chemoradiotherapy for locally advanced rectal cancer, and who may benefit from an organ preservation strategy. OBJECTIVE: The purpose of this study was to review our experience with the clinical restaging of rectal cancer after neoadjuvant ther...

All authors have declared no conflict of interest. Results • The literature search retrieved a total of 321 unique study. • Thirty-six articles were included in the final review, fulfilling all inclusion criteria, but 17 studies had insufficient data for meta-analysis and were published between 2014 and 2021 (Figure 1). • There were no eligible stu...

Pancreatic ductal adenocarcinoma (PDAC) has high metastatic potential. The “genometastasis” theory proposes that the blood of some cancer patients contains elements able to transform healthy cells by transferring oncogenes. Since findings on genometastasis in PDAC are still scarce, we sought supporting evidence by treating non-tumour HEK293T and hT...

Mentorship is important for the personal and professional development of a surgeon. Surgical mentoring includes technical and non-technical skills necessary for clinical activities, career improvement, leadership acquisition and research development. Mentors are important in different phases of surgical career, conferring various forms of support....

Background Gender inequity in surgery has increasingly been a matter of debate. Contributions of female neurosurgeons to academic medicine and societies are poorly highlighted. The aim of this study was to evaluate several aspects of the professional and work-life balance of female neurosurgeons in Italy. Methods Data of the female neurosurgical p...

Pancreatic cancer is likely to become one of the leading causes of cancer-related death in many countries within the next decade. Surgery is the potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC), although only 10–20% of patients have a resectable disease after diagnosis. Despite recent advances in curative surgery the curre...

Background: The purpose of the study was to determine whether contrast-enhanced CT texture features relate to, and can predict, the presence of specific genetic mutations involved in CRC carcinogenesis. Materials and methods: This retrospective study analyzed the pre-operative CT in the venous phase of patients with CRC, who underwent testing for m...

Background: Recurrence after curative-intent surgery can occur in more than 50% of gastric cancer (GC) patients. We sought to identify predictors of very early recurrence (VER) among GC patients who underwent curative-intent surgery. Methods: A multi-institutional database of GC patients undergoing curative-intent surgery between 2000 and 2020 a...

The aim of this work is to offer a panoramic view on how artificial intelligence (AI) can help to break down gender disparity in enrollment and training of women in surgery. Nowadays, many visible and concealed obstacles still exist for women who pursue a surgical career. Impediments due to gender disparity prevent women from choosing surgical spec...

Peritoneal dissemination represents a poor prognostic indicator in gastric cancer. Despite a comprehensive molecular characterization of this disease, no peritoneal dissemination-specific signature has been identified, limiting the tailoring of the surgical and oncological treatments. In this review, we outline the available literature focusing on...

Objective This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles. Background Visible and invisible impediments can hinder female doctors’ pursuit of a surgical career, from choosing a surgical specialty to training opp...

Background: The current study aimed to develop a dynamic prognostic model for patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) using landmark analysis. Methods: Patients who underwent curative-intent surgery for ICC from 1999 to 2017 were selected from a multi-institutional international database. A landmar...