Antonio Macrì

Università degli Studi di Messina, Messina, Sicily, Italy

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Publications (77)111.41 Total impact


  • No preview · Article · Oct 2015 · Journal of Gynecologic Surgery
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    ABSTRACT: Background: Peritoneal carcinomatosis of gastric origin is a frequent event with poor survival. A new promising approach is the association of the Cytoreductive Surgery (CRS) with the Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which yet is characterized by high morbidity and mortality. We report, to our knowledge, the first case of Wernicke Encephalopathy (WE) complicating CRS plus HIPEC. WE, caused by a deficiency of thiamine, is characterized by ataxia, ocular motor cranial neuropathies and changes in consciousness. Methods: A patient affected by gastric cancer with peritoneal seeding, submitted to CRS plus HIPEC, in 4th post-operative day had manifested the appearance of flapping tremors, with positive manoeuvre of Mingazzini, impaired vision and mental confusion. The brain Magnetic Resonance Imaging (MRI) confirmed the clinical suspicion of WE. Even though the appropriate therapy was promptly applied, the patient died in 10th post-operative day. Conclusion: WE is an uncommon neurological disorder. Only 16% of these patients inadequately treated recover fully, with a mortality rate of 10-20%. We consider useful to report this case, because it is the first time that WE is correlated to CRS plus HIPEC.
    Full-text · Article · Sep 2015 · International Journal of Surgery Case Reports
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    ABSTRACT: BACKGROUND: Peritoneal carcinomatosis of gastric origin is a frequent event with poor survival. Anew promising approach is the association of the Cytoreductive Surgery (CRS) with the HyperthermicIntraperitoneal Chemotherapy (HIPEC), which yet is characterized by high morbidity and mortality.We report, to our knowledge, the first case of Wernicke Encephalopathy (WE) complicating CRS plusHIPEC. WE, caused by a deficiency of thiamine, is characterized by ataxia, ocular motor cranial neu-ropathies and changes in consciousness. METHODS: A patient affected by gastric cancer with peritoneal seeding, submitted to CRS plus HIPEC,in 4th post-operative day had manifested the appearance of flapping tremors, with positive manoeu-vre of Mingazzini, impaired vision and mental confusion. The brain Magnetic Resonance Imaging (MRI)confirmed the clinical suspicion of WE. Even though the appropriate therapy was promptly applied, thepatient died in 10th post-operative day. CONCLUSION: WE is an uncommon neurological disorder. Only 16% of these patients inadequately treatedrecover fully, with a mortality rate of 10–20%. We consider useful to report this case, because it is thefirst time that WE is correlated to CRS plus HIPEC.
    Full-text · Article · Sep 2015 · International Journal of Surgery Case Reports
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    Antonio Macrì

    Preview · Article · Jul 2015 · Journal of Gynecologic Oncology
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    ABSTRACT: Retroperitoneal soft-tissue sarcomas are relatively uncommon diseases, the most frequent histotype, ranging from 20% to 45% of all cases, is represented by liposarcoma, which is a hard-to treat condition for its local aggressiveness and clinical aspecificity. We report a case of a 64-years-old woman who underwent surgical resection for a giant pleomorphic retroperitoneal liposarcoma. Currently chemotherapy for retroperitoneal soft-tissue sarcomas is no effective, and radiotherapy has limited efficacy due to the toxicity affecting adjacent intra-abdominal structures, showed validity only in case of high-grade malignancy by reducing local recurrence, but with no advantage in overall survival. Nowadays only, the complete surgical resection remains the most important predictor of local recurrence and overall survival. The removal of a retroperitoneal sarcoma of remarkable size is a challenge for the surgeon owing to the anatomical site, to the absence of an anatomically evident vascular-lymphatic peduncle and to the adhesions contracted with the contiguous organs and with the great vessels. Therefore, we believe that, particularly for large-size diseases associated to high-grade malignancy, a complete surgical resection with removal of the contiguous intra and retroperitoneal organs when infiltrated represents the only therapeutic option to obtain a negative margin and therefore an oncological radicality. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Feb 2015 · International Journal of Surgery Case Reports

  • No preview · Article · Jan 2015 · European Journal of Surgical Oncology
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    Full-text · Article · Nov 2014 · Renal Failure
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    ABSTRACT: Aim: The pancreas is a preferred site of metastasis from renal cell carcinoma (RCC), that may occur even after many years from a radical nephrectomy. Surgical R0 resection remains the only potentially curative treatment for solitary tumor. The possibility of a multifocality of the lesions (20-45%) must be considered. Material of study: We report a case of metachronous pancreatic metastasis from RCC that occurred twice. After five years from a right polar inferior nephrectomy for a RCC, two nodular lesions were identified in the body-tail of the pancreas and were treated with distal pancreatectomy and splenectomy. After six months the CT imaging revealed a nodular lesion of few millimeters in the residual pancreatic body; we followed the slow growth and in October 2012, when the size reached 2 cm, the patient was operated to remove the residual portion of pancreatic body. After 16 months of follow-up the patient is well and there isn't relapse of disease. Discussion: Patients with metachronous pancreatic lesions represent a particular group with a more indolent course of RCC, the appearance of metastases after a prolonged interval from nephrectomy is related to a more favorable prognosis. Radical lymph-node dissection is not necessary for the uncommon involvement of peripancreatic nodes, condition that explains the positive outcomes achieved with surgery. Conclusion: Patients with resected metastasis present an 88% survival rate at 5 years versus 47% observed in nonoperated patients; studies provide encouraging results in survival and quality of life of surgically treated patients.
    No preview · Article · Oct 2014 · Annali italiani di chirurgia
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    ABSTRACT: Aim: To assess the incidence of morbidity and mortality of Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy. Patients and methods: A retrospective multicentric study was performed. Six hundred and eighty-three patients were recorded. Predictors of morbidity and mortality were evaluated with univariate and multivariate analysis. Results: In univariate analysis, older age, Eastern Cooperative Oncology Group score, a greater value of Peritoneal Cancer Index (PCI) and sub-optimal cytoreduction were correlated with higher mortality, while older age, presence of ascites, ovarian origin of carcinomatosis, closed technique, a greater value of PCI, longer operative time and sub-optimal cytoreduction were predictors of higher morbidity. In multivariate analysis, older age and a greater value of PCI were correlated with higher mortality; older age, ovarian origin of tumor, presence of ascites, closed technique and longer operative time were predictors of higher morbidity. Conclusion: Careful patient selection has to be performed to improve clinical outcomes.
    No preview · Article · Oct 2014 · Anticancer research
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    ABSTRACT: Aim: Intrathoracic extension in patients with pseudomixoma peritonei is a rare event, but spread of the tumour beyond the abdomen in to pleuropulmonary cavity has been reported. Materials and methods: We report a case of a 50-years-old woman with synchronous pleural manifestation of pseudomixoma peritonei by a mucinous ovarian cancer. During the abdominal cytoreductive surgery an extensive disease under the right hemidiaphragm was noted, requiring partial diaphragmatic resection. Once the pleural space was entered,mucinous neoplastic implants on the pleural surface was observed. The diaphragmatic defect was left open during the hyperthermic chemoperfusion to treat both the pleural and peritoneal surfaces. After a postoperative course uneventful she died after 6 months for a myocardial infarction, in presence of a left side pleural effusion with a positive cytology for high-grade malignant cells with a smear background contained wispy mucin. Discussion: Despite the aggressive spread of the pseudomixoma peritonei within the peritoneal cavity, lymphatic and hematogenous metastasis are rare. However, extension of disease into pleuropolmonary cavity has been well described as pleural effusion or pleuropulmonary metastases. This is the first report in literature, to our knowledge, in which the thoracic extension is due to a mucinous ovarian cancer, and is the second case in which a simultaneous bicavitary hyperthermic chemoperfusion was done as a management option for thoracic extension of pseudomixoma peritonei. Conclusion: Due to the rarity of the thoracic involvement by pseudomixoma peritonei, its correct treatment is still unclear. Simultaneous cytoreductive surgery associated to intraoperative intraperitoneal and intrathoracic chemohyperthermia can be a potential therapeutic option for these patients.
    No preview · Article · Sep 2014 · Annali italiani di chirurgia
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    ABSTRACT: Peritoneal carcinomatosis of gastric origin is associated with poor survival. The use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) did not significantly improve the survival of patients with this disease. A promising approach can be based on the use of HIPEC as prophylaxis of peritoneal dissemination. From our database, we have sampled 12 patients with advanced gastric cancer. In all cases, a D2 total gastrectomy was performed, associated with splenectomy in four cases. All patients were submitted to HIPEC. Morbidity and mortality were 33.3% and 8.3%, respectively. The median survival was 24 months, with only one case (8.3%) of peritoneal recurrence. In light of our experience and supported by literature data, we can affirm that HIPEC has a potential role in the prevention of gastric carcinomatosis. Certainly further studies are required on a larger scale to validate this new but promising approach.
    Full-text · Article · Apr 2014 · Anticancer research
  • A Macrì · F Fleres · E Cucinotta · E Saladino

    No preview · Article · Jan 2014 · Indian Journal of Cancer
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    ABSTRACT: Paragangliomas are neural crest-derived neuroendocrine tumors, originating from paraganglia, which are dispersed neuroendocrine organs characterized by catecholamine and peptide-producing cells. With an annual incidence estimated at 1/100,000, paragangliomas represent 10% of catecholamine secreting tumors. We report a case of a 76-year-old man who was submitted to a subtotal gastrectomy with omentectomy and gastrojejunal anastomosis. The Hystologic exam has revealed an ulcerative polypoid gastric carcinoma with cell poorly cohesive and infiltration of the muscular gastric wall and an incidental parietal gastric lesion which was a paraganglioma with immunocytochemical investigations positive for NSE and negative for CD117, S100, CD34 e SMA. Pheochromocytoma indicates exclusively tumors arising from the adrenal medulla, while the extra-adrenal paraganglioma suggests tumors of the chromaffin cells with other locations. Gastric or paragastric localization, as in our case, is very rare for these neoplasms, and in literature there are only isolated case reports. Genetical predisposition is observed in 30% of these tumors and can be responsible of hereditary disease characterized for differences in tumor distribution, catecholamine production, risk of metastasis, and association with others types of tumors. In asymptomatic patients and when biochemical and clinical suspicion of neuroendocrine tumor is strong, you have to perform anatomical and functional investigations to detect these neoplasms. The first line treatment for resectable tumors is complete surgical resection, that can be performed with open surgery or laparoscopic technique. Surgical therapy is also indicated to palliative intent when a complete eradication of disease is not achievable for metastatic status of malignancies. Autonomic nervous system, Gastrectomy, Gastric cancer, Gastric paraganglioma.
    No preview · Article · Jan 2014 · Annali italiani di chirurgia
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    ABSTRACT: Metastatic lesions of the gallbladder are an infrequent clinical condition. The metastatic lesions of gallbladder from primary breast tumors are rarely described in literature. We report a case of an 83-year-old woman who underwent cholecystectomy for cholelithiasis by video laparoscopy (VL), and in whom a metastatic lesion was detected at the histological examination of surgical specimen. For this reason, the patient was subjected to diagnostic-instrumental investigation with the aim of detecting the primary tumor, which showed the presence of infiltrating lobular carcinoma, pleomorphic variety, in the upper outer quadrant of the right breast. Breast cancer and in particular the histological type "ductal infiltrating" is frequently associated with locoregional and distant metastases, the latter especially to bones, liver, lungs and central nervous system. An analysis of literature was conducted on secondary lesions of the gallbladder from breast cancer that has allowed us to confirm the rarity of this disease only described in 18 patients: 12 from infiltrating lobular, 1 ductal origin and 2 mixed ductal and lobular infiltrating. The most frequent tumor histology associated with the above-mentioned metastatic localization is the metastatic infiltrating lobular carcinoma. Clinically speaking, it is difficult to suspect a metastatic localization from primary breast cancer in the gallbladder, but it is necessary to be well aware of the possibility of metastasis and to bear this in mind during the follow-up of patients with breast cancer. Although cholecystectomy is regarded as a palliative treatment in patients with metastasis in the gallbladder from breast cancer, it is intead recommended in symptomatic cases. video laparoscopy; ERCP: endoscopic retrograde cholangiopancreatography; MRI: magnetic resonance imaging. Breast cancer, Cholelithiasis, Metastases of gallbladder.
    No preview · Article · Jan 2014 · Annali italiani di chirurgia
  • F Fleres · E Saladino · C Famulari · A Macrì
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    ABSTRACT: The creation of a stoma, although considered a simple surgical procedure, is burdened by various complications, one of the most common being prolapse. Usually prolapse increases gradually, involving generally limited functional disorders and it can be well managed with non-operative measures. Occasionally it requires major surgery, for severe skin excoriation, bleeding or incarceration of the bowel. However, for critical clinical conditions of patients, often is not possible to use classical techniques, as bowel-pexy fixation or resection of the prolapse. Maeda has described a simple method for the correction of prolapse of the transverse colon using a stapler device that can be applied in this type of patients. In this report, we describe the first application of this technique to treat the prolapse of the ileocecal loop in an 81-year old woman, suffering from Parkinson's disease. A definitive ciecum stoma was performed the previous year for an Olgivie syndrome. At 6 months, follow-up showed no recurrence of prolapse with a functional stoma and without any skin irritation. In conclusion, this approach is recommended especially for high-risk patients who cannot be submitted to a much more invasive treatment. In fact, the main advantages consist of a minimally invasive technique, with minimal blood loss and with a rapid recovery of a normal quality of life.
    No preview · Article · Sep 2013
  • E Saladino · F Fleres · S Irato · C Famulari · A Macrì
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    ABSTRACT: Nowadays the standard clinical management for advanced epithelial ovarian cancer is constituted by primary cytoreductive surgery associated to adjuvant systemic chemotherapy. Even if this first-line chemotherapy shows a high rate of complete responses, the disease recurrences occur especially in stage-III patients. Actually an option for this subset of patients is represented by secondary cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy that represents a promising therapy, having shown positive results in terms of median overall survival, progression free survival and overall survival. However, a much more research is still required especially by prospective randomised trials to improve outcomes in recurrent ovarian cancer.
    No preview · Article · Aug 2013
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    ABSTRACT: To assess the efficacy and morbidity and mortality of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent epithelial ovarian cancer (EOC). A retrospective study conducted using information extracted from a multi-institutional prospective database on peritoneal surface malignancies (PSMs). Setting Four Italian centres specializing in locoregional treatment of PSM. Patients with recurrent EOC. Fifty-six patients underwent 57 combined procedures. CRS was performed using peritonectomy procedures and HIPEC using the closed-abdomen technique with cisplatin and doxorubicin or cisplatin and mitomycin-C. Overall survival (OS), progression-free survival (PFS), morbidity and mortality rates. The median age of the patients was 55.2 years (range 30-75 years). The median peritoneal cancer index was 15.2 (range 4-30). Forty-seven patients had microscopic residual disease (completeness of cytoreduction, CC-0), seven had residual disease ≤2.5 mm (CC-1) and one had residual disease >2.5 mm (CC>2). Major complications occurred in 15 patients (26.3%), and procedure-related mortality occurred in three patients (5.3%). The median follow-up time was 23.1 months. The median OS and PFS were 25.7 (95% CI 20.3-31.0) and 10.8 (95% CI 5.4-16.2) months, respectively. The 5-year OS and PFS were 23% and 7%, respectively. Independent prognostic factors affecting OS according to the multivariate analysis were Eastern Cooperative Oncology Group performance status, preoperative serum albumin, and completeness of cytoreduction. Patients with recurrent EOC treated with CRS and HIPEC showed promising results in terms of outcome. The combined treatment strategy could benefit subsets of patients wider than that defined for conventional secondary debulking surgery without HIPEC. These data warrant further evaluation in randomised clinical trials.
    Preview · Article · Jun 2012 · BJOG An International Journal of Obstetrics & Gynaecology
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    ABSTRACT: To evaluate the role of the hepatic perfusion in the assessment of the colorectal cancer. For this research 18 patients affected by colorectal cancer were enrolled. All the patients were submitted to the evaluation of the Doppler Perfusion Index (DPI) which represents the ratio of hepatic arterial to total liver blood flow. The correlation between the evaluation of the Doppler Perfusion Index and the occurrence of the liver metastases did not show false negative but has highlighted 6 false positive, achieved a good sensitivity and very low specificity. A review of the literature and the results obtained in our study suggest that DPI may be helpful in detection of hepatic metastases.
    No preview · Article · May 2012 · Hepato-gastroenterology
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    Antonio Macrì · Anna Fortugno · Edoardo Saladino
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    ABSTRACT: The evolution of loco-regional treatments has occurred in the last two decades and has deeply changed the natural history of primitive and secondary peritoneal surface malignancies. Several phase II-III studies have proved the effectiveness of the combination of cytoreductive surgery with peritoneal chemohyperthermia. Cytoreductive surgery allows the reduction of the neoplastic mass and increases tumoral chemosensitivity. The development of chemohyperthermia finds its origins in the necessity to exceed the limits of intraperitoneal chemotherapy performed in normothermia. It permits a continuous high concentration gradient of chemotherapeutic drugs between the peritoneal cavity and the plasma compartment to and a more uniform distribution throughout the abdominal cavity compared to systemic administration.
    Full-text · Article · Dec 2011
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    ABSTRACT: The treatment of peritoneal malignancies in elderly patients with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is an ongoing question due to the high associated surgical risk. Thirty patients, 11 (36.7%) older than 65 years, were submitted to CRS plus HIPEC. Criteria of patient eligibility were: peritoneal carcinomatosis of different origin, T3-4 gastric cancer, ECOG performance status ≤2, no extra-abdominal extension and no evidence of bowel obstruction. The median follow-up was 21.5 months (range: 1-63). The purpose of this retrospective study, was to evaluate the feasibility of this approach in elderly patients, with special reference to postoperative morbidity, mortality and survival. We have recorded, in elderly patients, higher grade 3 and 4 morbidity and mortality, similar mean duration of cytoreductive surgery, of postoperative hospital stay, of median survival and of overall survival rates. Since there no statistical differences, in terms of morbidity and mortality, CRS with HIPEC may also be suitable for elderly patients.
    No preview · Article · Jul 2011 · In vivo (Athens, Greece)

Publication Stats

662 Citations
111.41 Total Impact Points

Institutions

  • 1996-2015
    • Università degli Studi di Messina
      • • Dipartimento di Neuroscienze
      • • Dipartimento di Patologia Umana
      • • Dipartimento di Medicina Clinica e Sperimentale
      • • Dipartimento di Scienze Radiologiche
      Messina, Sicily, Italy
  • 2003
    • Azienda Ospedaliera Universitaria “G. Martino”
      Messina, Sicily, Italy