Background: COVID-19 is having a worldwide impact on surgical treatment. Our aim was to investiga... more Background: COVID-19 is having a worldwide impact on surgical treatment. Our aim was to investigate the impact of the pandemic in a rural hospital serving a low densely populated area. Methods: We investigated the volume and type of surgical performed operations during both the pandemic (March 2020 - February 2021) and pre-pandemic periods (March 2019 - February 2020) as well as during the first and second pandemic waves compared to the pre-pandemic period. We compared the volume and timing of emergency appendectomy and cholecystectomy performed during the pandemic with those of the pre-pandemic period, doing the same with the volume, timing and stages of elective gastric and colorectal resections for cancer. Results: In the pre-pandemic period a higher number of appendectomies (42 vs. 24) and urgent and elective cholecystectomies (174 vs. 126) was performed. The patients operated during the pandemic period (both for appendectomy and cholecystectomy) were on average older (58 vs. 52 years old, p=0.006), including for cholecystectomy (73 vs. 66 years old, p=0.01) and appendectomy (43 vs. 30 years old, p =0.04). The logistic regression analysis with regard to the cholecystectomies and appendectomies performed in emergency showed that male sex and age were associated with gangrenous type histology, both in the pandemic and pre-pandemic period. Finally, we found a reduction in the stage I and IIA colorectal cancers operated during the pandemic compared to those of the pre-pandemic period, with no increase of the advanced stages. Conclusions: The reduction in services imposed by governments during the first months of total lock down could not justify the whole decrease in surgical interventions in the year of the pandemic. Data suggest that greater "non-operative management" for appendicitis and acute cholecystitis does not lead to an increase of cases operated over time, nor to an increase in the "gangrenous" pattern, this seems to depend on age advanced and male population. Key words: COVID-19, Emergency Surgery, General Surgery, Pandemics.
The main purpose was to determine the impact on postoperative outcome of a standardized enhanced ... more The main purpose was to determine the impact on postoperative outcome of a standardized enhanced recovery program (ERP) for elective colorectal surgery in a rural hospital. Methods A prospective series of patients (N = 80) undergoing elective colorectal resection completing a standardized ERP protocol in 2018-2020 (ERP group) was compared to patients (N = 80) operated at the same rural hospital in 2013-2015 (pre-ERP group), before the implementation of the program. The exclusion criteria for both groups were: ASA score IV, TNM stage IV, in ammatory bowel disease, emergency surgery, and rectal cancer. The primary outcome was hospital length of stay (LoS) which was used as an estimate of functional recovery. Secondary outcomes included 30-day readmission and mortality rates as well as factors predicting both postoperative complications and prolonged hospital LoS. Results Baseline characteristics were comparable in both groups. Laparoscopic approach was performed in 95% of patients in the ERP group versus 0% in pre-ERP group. The median adherence to ERP protocol elements was 68% as opposed to 12% in the retrospective control group. The median hospital LoS in the ERP-group was signi cantly lower than in the pre-ERP group (5 vs. 10 days) with no increase in 30-day readmission and mortality rates. The Body Mass Index ≥ 30 and the traditional perioperative protocol were the independent predictive factors of postoperative complications, while following a traditional perioperative protocol was the only factor predicting a prolonged hospital LoS. Conclusions Although limited hospital resources are perceived as a barrier to ERP implementation, the current experience demonstrates how adopting an ERP program in a rural area is feasible and effective, despite it requires greater effort. For patients in such areas, colorectal ERP in elective surgery may also reduce time to functional recovery, postoperative hospital LoS and complications, with no increase in mortality and 30-day re-admissions.
Gli autori descrivono le basi razionali e fisiopatologiche della terapia chirurgica e soppression... more Gli autori descrivono le basi razionali e fisiopatologiche della terapia chirurgica e soppressione della secrezione acida per il trattamento dell'ulcera peptic
Background: COVID-19 is characterized by interstitial pneumonia, but a presentation of the diseas... more Background: COVID-19 is characterized by interstitial pneumonia, but a presentation of the disease with digestive symptoms only may occur. This work was aimed at evaluating: (1) the prevalence of presentation with digestive symptoms only in our cohort of COVID-19 inpatients; (2) differences between patients with and without gastrointestinal onset; (3) differences among males and females with gastrointestinal presentation; (4) outcomes of the groups of subjects with and without gastrointestinal onset. Method: We retrospectively divided the patients hospitalized with COVID-19 into two groups: (1) the one with digestive symptoms (DSG) and (2) the other without digestive symptoms (NDSG). We compared the subjects of DSG with those of NDSG and males with females in the DSG group only, in terms of demographics (age, sex), inflammation and organ damage indexes, length of stay, in-hospital and 100-day mortality. Results: The prevalence of gastrointestinal symptoms at presentation was 12.5%. The DSG group showed a prevalence of females, and these tended to a shorter hospital stay; DSG patients were younger and with a higher load of comorbidities, but no differences concerning inflammation and organ damage indexes, need for intensification of care, in-hospital and 100-day mortality were detected. Among DSG patients, males were younger than females, more comorbid, with higher serum CRP and showed a longer length of hospital stay. Survival functions of DSG patients, in general, are more favourable than those of NDSG if adjusted for sex, age and comorbidities. Conclusions: (1) The prevalence of gastrointestinal presentation among hospitalized COVID-19 patients was 12.5%; (2) DSG patients were on average younger, more comorbid and with a prevalence of females, with a shorter hospital stay; (3) in the DSG group, males had a higher Charlson Comorbidity Score and needed a longer hospital stay; (4) DSG subjects seem to survive longer than those of the NDSG group.
ABSTRACT We report the case of a 65-year-old woman with a 10-year history of dysphagia, regurgita... more ABSTRACT We report the case of a 65-year-old woman with a 10-year history of dysphagia, regurgitation, cough, and 10-kg weight loss caused by an epiphrenic diverticulum associated with esophageal achalasia managed with a laparoscopic approach. A preoperative barium swallow showed a dilated sigmoid esophagus with a 6-cm epiphrenic diverticulum. Esophageal manometry confirmed the absence of peristalsis in the esophageal body. We performed a laparoscopic diverticulectomy and a 7-cm distal esophageal myotomy with a Dor fundoplication. The postoperative course was uneventful. On the third postoperative day a barium swallow showed no leak, and the patient started oral intake. She was discharged home 5 days after the operation free of symptoms and tolerating a soft diet. Sixteen months after surgery, she was asymptomatic and had gained 8 kg. A barium swallow showed a normal-size esophagus with regular emptying. We reaffirm the feasibility, safety, and efficacy of the laparoscopic diverticulectomy and distal myotomy with Dor fundoplication to manage epiphrenic diverticula resulting from esophageal achalasia.
Incisional hernia is one of the most common complications after surgery. In the past two decades,... more Incisional hernia is one of the most common complications after surgery. In the past two decades, laparoscopic mesh repair has been proposed as an alternative approach to standard open mesh repair. The aims of this study were: 1) to compare laparoscopic and open incisional hernia repairs with regard to complications, operative time, and hospital length of stay (LOS) and 2) to identify predictive factors of postoperative complications and prolonged hospital LOS. This is a retrospective observational cohort study on 270 consecutive patients operated on between May 2004 and July 2014 at the Departments of Surgery of the S. Anna University Hospital in Ferrara, Italy. Patients were divided in two groups according to the surgical approach, laparoscopic surgery (laparoscopic group) or open surgery (open group). Patients’ characteristics, wall defect (European Hernia Society – EHS classification), adhesions (Zuhlke classification), type of mesh, conversions to open, peri-operative complications (Clavien-Dindo classification), hospital LOS, and follow up data were all collected in a database. The analysis of the data was by intention to treat. The laparoscopic group (N=94) and the open group (N=176) were well balanced regarding baseline characteristics. Both small and single wall defects were prevalent in the open group (W1-W2=72% and N1=86%, respectively), while big and multiple defects were mainly represented in the laparoscopic group (W3-W4=66% and N≥2=52%, respectively) (p<0.001). Median operative time and hospital LOS were both increased in the open vs. laparoscopic group (148 vs. 138 min, p=0.001 and 5 vs. 3 days, p<0.001, respectively) (Tab 1). No difference was found within the two groups in postoperative complications and recurrence (Tab 1). Full-adjusted logistic regression analysis showed that open approach and increasing width of wall defect were not significantly associated to major complications (Clavien Dindo ≥III) (Tab 2). Full adjusted Cox regression analysis showed that increasing age [HR 0.97( 95%CI 0.95-0.99), p=0.02], increasing width of wall defect [HR 0.79 (95%CI 0.61-1.00), p=0.05], and the open surgical approach [HR 0.55 (95%CI 0.34-0.89), p=0.02) were independent factors predictive of prolonged hospital LOS (Tab 3). These data suggest that, in high-volume centers, laparoscopic incisional hernia repair is feasible and safe; compared to the open procedure, it has similar postoperative outcomes, offering the advantage of reduced operating time and hospital LOS . The type of surgical approach and size of wall defect were not associated to a higher risk of major complications. Increasing patients’ age and size of wall defect, and open approach independently predicted prolonged hospital LOS. Further analysis focused on the correlation between the hospital LOS, complications, feasibility, and costs for the Health Care System are warranted in the perspective of a balance between technical innovation and economic sustainability of optimal health care
: Colorectal cancer represents the second leading cause of cancer deaths in western countries wit... more : Colorectal cancer represents the second leading cause of cancer deaths in western countries with elevated costs for health service. It's very important to develop screening and surveillance programs for cancer prevention with "cost-effective" means. We present a surveillance program with colonoscopy focused on first degree relatives of CRC patients. Colonoscopy is a "cost-effective" mean of screening for high risk subjects.
Background and aims: The Region of Emilia-Romagna (Italy), and particularly Ferrara, has the top ... more Background and aims: The Region of Emilia-Romagna (Italy), and particularly Ferrara, has the top national incidence and mortality rates for colorectal cancer (CRC). In March 2005, a population-based CRC screening campaign was started in Emilia-Romagna. The aim of this study was two-fold: (1) to analyse the results of the screening program in Ferrara in both early (March 2005 - March 2009) and late (April 2009 - March 2013) screening periods and (2) to compare the cohort of screenes undergoing CRC surgical treatment in the early and late screening periods with an unselected pre-screening (April 2003 - March 2005) control population who underwent CRC surgical resection at the same institution. Patients and methods: All residents in Ferrara aged 50-69 years took part of the screening program receiving an invitation letter for immunological Faecal Occult Blood Test (i-FOBT). If i-FOBT positive, the screenees were offered a colonoscopy, while if i-FOBT negative were invited by letter to repeat the test after two years. Adenomas were classified in: (a) low-risk adenomas (diameter <10 mm, villous component <25%, and low-grade dysplasia) and (b) high-risk adenomas (diameter 10 mm, at least 25% of villous component or high-grade dysplasia). If colonoscopy was negative, the screenees were invited to repeat endoscopy after 5 years, while if adenomatous polyps were found endoscopic follow-up was started accordingly. In case of CRC diagnosis, necessary surgery was performed within 30 days. Demographic, surgical, and pathology data were reviewed for: (a) screenees undergoing surgical treatment for CRC in early and late screening periods and (b) all patients submitted to elective surgical resection for CRC at the S. Anna University Hospital in Ferrara during the pre-screening period April 2003 - March 2005. Statistical analysis. Data are presented as median (interquartile range 25-75) for normal distribution. Kruskal-Wallis, chi-square, and log rank tests were used to compare non-parametric data, proportions, and hospital length of stay (LOS), respectively. Results: From March 2005 to April 2009 (early screening period), 76,767 people in Ferrara were invited for i-FOBT. Of these, 36,930 (48%) adhered to the screening program and executed the test; 2,004 (5%) were i-FOBT positive, and 1,688 (84%) subsequently agreed to undergo colonoscopy. Endoscopy revealed 853 tumours (adenoma or cancer) confirmed on hystopathologic analysis. In the late screening period (April 2009 - March 2013), 86,763 subjects were invited for i-FOBT and 20,384 (46%) adhered; 1,827 (5%) were positive and 1,506 (82%) agreed to undergo colonoscopy. The endoscopy detected 731 histology proven adenomas or cancers. Data in early and late screening and pre-screening periods were as follows: Variables Pre-screening period (2003-2005) N=275 Early screening period (2005-2009) N=230 Late screening period (2009-2013) N=110 p Age (years) 72.3 (63.5-78.8) 64.0 (58.3-67.8) 64.1 (57.3-68.0) <0.001 Gender (Men:Women) 145 (53%):130 (47%) 149 (65%):81 (35%) 58 (53%):52 (47%) 0.014 Tumor stage 0 I IIa IIb IIIa IIIb IIIc IV 22 (8%) 31 (11%) 99 (36%) 18 (7%) 4 (1%) 56 (20%) 28 (10%) 17 (6%) 54 (24%) 48 (21%) 49 (21%) 2 (1%) 7 (3%) 37 (16%) 30 (13%) 3 (1%) 24 (22%) 38 (34%) 17 (15%) 3 (3%) 0 21 (19%) 6 (6%) 1 (1%) <0.001 . Tumor Site Right colon Transverse colon Left colon-rectum 103 (37%) 13 (5%) 159 (58%) 74 (32%) 7 (3%) 149 (65%) 35 (32%) 5 (4%) 70 (64%) 0.505 Hospital LOS (days) 12 (9-17) 10 (9-13) 9 (7-11) <0.001 Conclusions: The adherence to i-FOBT remained low throughout the screening periods (48% early period vs. 46% late period); adequate campaigns of sensitization to CRC screening are therefore needed. The highest adherence rate in Italy was observed for colonscopy adherence among i-FOBT positive screeenes (≥82%). The screening program did not detect an increased proportion of proximal colorectal cancers, in contrast to other Authors. As expected, decreased patients’ age as well as earlier stage CRC diagnosis was achieved with the screening program. Reduction in postoperative hospital LOS was likely due to younger patients’ age and increased adoption of minimally invasive techniques
Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful ... more Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful in clinical practice to assess the progression of chronic venous insufficiency. We carried out a study to assess the clinical feasibility of routine, non-invasive determination of saphenous vein wall compliance, and the reliability of such measure in discriminating between early and advanced stages of varicose vein disease.
To evaluate long saphenous vein sparing surgical procedures alternative to high ligation and dist... more To evaluate long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was... more Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were n...
Background: COVID-19 is having a worldwide impact on surgical treatment. Our aim was to investiga... more Background: COVID-19 is having a worldwide impact on surgical treatment. Our aim was to investigate the impact of the pandemic in a rural hospital serving a low densely populated area. Methods: We investigated the volume and type of surgical performed operations during both the pandemic (March 2020 - February 2021) and pre-pandemic periods (March 2019 - February 2020) as well as during the first and second pandemic waves compared to the pre-pandemic period. We compared the volume and timing of emergency appendectomy and cholecystectomy performed during the pandemic with those of the pre-pandemic period, doing the same with the volume, timing and stages of elective gastric and colorectal resections for cancer. Results: In the pre-pandemic period a higher number of appendectomies (42 vs. 24) and urgent and elective cholecystectomies (174 vs. 126) was performed. The patients operated during the pandemic period (both for appendectomy and cholecystectomy) were on average older (58 vs. 52 years old, p=0.006), including for cholecystectomy (73 vs. 66 years old, p=0.01) and appendectomy (43 vs. 30 years old, p =0.04). The logistic regression analysis with regard to the cholecystectomies and appendectomies performed in emergency showed that male sex and age were associated with gangrenous type histology, both in the pandemic and pre-pandemic period. Finally, we found a reduction in the stage I and IIA colorectal cancers operated during the pandemic compared to those of the pre-pandemic period, with no increase of the advanced stages. Conclusions: The reduction in services imposed by governments during the first months of total lock down could not justify the whole decrease in surgical interventions in the year of the pandemic. Data suggest that greater "non-operative management" for appendicitis and acute cholecystitis does not lead to an increase of cases operated over time, nor to an increase in the "gangrenous" pattern, this seems to depend on age advanced and male population. Key words: COVID-19, Emergency Surgery, General Surgery, Pandemics.
The main purpose was to determine the impact on postoperative outcome of a standardized enhanced ... more The main purpose was to determine the impact on postoperative outcome of a standardized enhanced recovery program (ERP) for elective colorectal surgery in a rural hospital. Methods A prospective series of patients (N = 80) undergoing elective colorectal resection completing a standardized ERP protocol in 2018-2020 (ERP group) was compared to patients (N = 80) operated at the same rural hospital in 2013-2015 (pre-ERP group), before the implementation of the program. The exclusion criteria for both groups were: ASA score IV, TNM stage IV, in ammatory bowel disease, emergency surgery, and rectal cancer. The primary outcome was hospital length of stay (LoS) which was used as an estimate of functional recovery. Secondary outcomes included 30-day readmission and mortality rates as well as factors predicting both postoperative complications and prolonged hospital LoS. Results Baseline characteristics were comparable in both groups. Laparoscopic approach was performed in 95% of patients in the ERP group versus 0% in pre-ERP group. The median adherence to ERP protocol elements was 68% as opposed to 12% in the retrospective control group. The median hospital LoS in the ERP-group was signi cantly lower than in the pre-ERP group (5 vs. 10 days) with no increase in 30-day readmission and mortality rates. The Body Mass Index ≥ 30 and the traditional perioperative protocol were the independent predictive factors of postoperative complications, while following a traditional perioperative protocol was the only factor predicting a prolonged hospital LoS. Conclusions Although limited hospital resources are perceived as a barrier to ERP implementation, the current experience demonstrates how adopting an ERP program in a rural area is feasible and effective, despite it requires greater effort. For patients in such areas, colorectal ERP in elective surgery may also reduce time to functional recovery, postoperative hospital LoS and complications, with no increase in mortality and 30-day re-admissions.
Gli autori descrivono le basi razionali e fisiopatologiche della terapia chirurgica e soppression... more Gli autori descrivono le basi razionali e fisiopatologiche della terapia chirurgica e soppressione della secrezione acida per il trattamento dell'ulcera peptic
Background: COVID-19 is characterized by interstitial pneumonia, but a presentation of the diseas... more Background: COVID-19 is characterized by interstitial pneumonia, but a presentation of the disease with digestive symptoms only may occur. This work was aimed at evaluating: (1) the prevalence of presentation with digestive symptoms only in our cohort of COVID-19 inpatients; (2) differences between patients with and without gastrointestinal onset; (3) differences among males and females with gastrointestinal presentation; (4) outcomes of the groups of subjects with and without gastrointestinal onset. Method: We retrospectively divided the patients hospitalized with COVID-19 into two groups: (1) the one with digestive symptoms (DSG) and (2) the other without digestive symptoms (NDSG). We compared the subjects of DSG with those of NDSG and males with females in the DSG group only, in terms of demographics (age, sex), inflammation and organ damage indexes, length of stay, in-hospital and 100-day mortality. Results: The prevalence of gastrointestinal symptoms at presentation was 12.5%. The DSG group showed a prevalence of females, and these tended to a shorter hospital stay; DSG patients were younger and with a higher load of comorbidities, but no differences concerning inflammation and organ damage indexes, need for intensification of care, in-hospital and 100-day mortality were detected. Among DSG patients, males were younger than females, more comorbid, with higher serum CRP and showed a longer length of hospital stay. Survival functions of DSG patients, in general, are more favourable than those of NDSG if adjusted for sex, age and comorbidities. Conclusions: (1) The prevalence of gastrointestinal presentation among hospitalized COVID-19 patients was 12.5%; (2) DSG patients were on average younger, more comorbid and with a prevalence of females, with a shorter hospital stay; (3) in the DSG group, males had a higher Charlson Comorbidity Score and needed a longer hospital stay; (4) DSG subjects seem to survive longer than those of the NDSG group.
ABSTRACT We report the case of a 65-year-old woman with a 10-year history of dysphagia, regurgita... more ABSTRACT We report the case of a 65-year-old woman with a 10-year history of dysphagia, regurgitation, cough, and 10-kg weight loss caused by an epiphrenic diverticulum associated with esophageal achalasia managed with a laparoscopic approach. A preoperative barium swallow showed a dilated sigmoid esophagus with a 6-cm epiphrenic diverticulum. Esophageal manometry confirmed the absence of peristalsis in the esophageal body. We performed a laparoscopic diverticulectomy and a 7-cm distal esophageal myotomy with a Dor fundoplication. The postoperative course was uneventful. On the third postoperative day a barium swallow showed no leak, and the patient started oral intake. She was discharged home 5 days after the operation free of symptoms and tolerating a soft diet. Sixteen months after surgery, she was asymptomatic and had gained 8 kg. A barium swallow showed a normal-size esophagus with regular emptying. We reaffirm the feasibility, safety, and efficacy of the laparoscopic diverticulectomy and distal myotomy with Dor fundoplication to manage epiphrenic diverticula resulting from esophageal achalasia.
Incisional hernia is one of the most common complications after surgery. In the past two decades,... more Incisional hernia is one of the most common complications after surgery. In the past two decades, laparoscopic mesh repair has been proposed as an alternative approach to standard open mesh repair. The aims of this study were: 1) to compare laparoscopic and open incisional hernia repairs with regard to complications, operative time, and hospital length of stay (LOS) and 2) to identify predictive factors of postoperative complications and prolonged hospital LOS. This is a retrospective observational cohort study on 270 consecutive patients operated on between May 2004 and July 2014 at the Departments of Surgery of the S. Anna University Hospital in Ferrara, Italy. Patients were divided in two groups according to the surgical approach, laparoscopic surgery (laparoscopic group) or open surgery (open group). Patients’ characteristics, wall defect (European Hernia Society – EHS classification), adhesions (Zuhlke classification), type of mesh, conversions to open, peri-operative complications (Clavien-Dindo classification), hospital LOS, and follow up data were all collected in a database. The analysis of the data was by intention to treat. The laparoscopic group (N=94) and the open group (N=176) were well balanced regarding baseline characteristics. Both small and single wall defects were prevalent in the open group (W1-W2=72% and N1=86%, respectively), while big and multiple defects were mainly represented in the laparoscopic group (W3-W4=66% and N≥2=52%, respectively) (p<0.001). Median operative time and hospital LOS were both increased in the open vs. laparoscopic group (148 vs. 138 min, p=0.001 and 5 vs. 3 days, p<0.001, respectively) (Tab 1). No difference was found within the two groups in postoperative complications and recurrence (Tab 1). Full-adjusted logistic regression analysis showed that open approach and increasing width of wall defect were not significantly associated to major complications (Clavien Dindo ≥III) (Tab 2). Full adjusted Cox regression analysis showed that increasing age [HR 0.97( 95%CI 0.95-0.99), p=0.02], increasing width of wall defect [HR 0.79 (95%CI 0.61-1.00), p=0.05], and the open surgical approach [HR 0.55 (95%CI 0.34-0.89), p=0.02) were independent factors predictive of prolonged hospital LOS (Tab 3). These data suggest that, in high-volume centers, laparoscopic incisional hernia repair is feasible and safe; compared to the open procedure, it has similar postoperative outcomes, offering the advantage of reduced operating time and hospital LOS . The type of surgical approach and size of wall defect were not associated to a higher risk of major complications. Increasing patients’ age and size of wall defect, and open approach independently predicted prolonged hospital LOS. Further analysis focused on the correlation between the hospital LOS, complications, feasibility, and costs for the Health Care System are warranted in the perspective of a balance between technical innovation and economic sustainability of optimal health care
: Colorectal cancer represents the second leading cause of cancer deaths in western countries wit... more : Colorectal cancer represents the second leading cause of cancer deaths in western countries with elevated costs for health service. It's very important to develop screening and surveillance programs for cancer prevention with "cost-effective" means. We present a surveillance program with colonoscopy focused on first degree relatives of CRC patients. Colonoscopy is a "cost-effective" mean of screening for high risk subjects.
Background and aims: The Region of Emilia-Romagna (Italy), and particularly Ferrara, has the top ... more Background and aims: The Region of Emilia-Romagna (Italy), and particularly Ferrara, has the top national incidence and mortality rates for colorectal cancer (CRC). In March 2005, a population-based CRC screening campaign was started in Emilia-Romagna. The aim of this study was two-fold: (1) to analyse the results of the screening program in Ferrara in both early (March 2005 - March 2009) and late (April 2009 - March 2013) screening periods and (2) to compare the cohort of screenes undergoing CRC surgical treatment in the early and late screening periods with an unselected pre-screening (April 2003 - March 2005) control population who underwent CRC surgical resection at the same institution. Patients and methods: All residents in Ferrara aged 50-69 years took part of the screening program receiving an invitation letter for immunological Faecal Occult Blood Test (i-FOBT). If i-FOBT positive, the screenees were offered a colonoscopy, while if i-FOBT negative were invited by letter to repeat the test after two years. Adenomas were classified in: (a) low-risk adenomas (diameter <10 mm, villous component <25%, and low-grade dysplasia) and (b) high-risk adenomas (diameter 10 mm, at least 25% of villous component or high-grade dysplasia). If colonoscopy was negative, the screenees were invited to repeat endoscopy after 5 years, while if adenomatous polyps were found endoscopic follow-up was started accordingly. In case of CRC diagnosis, necessary surgery was performed within 30 days. Demographic, surgical, and pathology data were reviewed for: (a) screenees undergoing surgical treatment for CRC in early and late screening periods and (b) all patients submitted to elective surgical resection for CRC at the S. Anna University Hospital in Ferrara during the pre-screening period April 2003 - March 2005. Statistical analysis. Data are presented as median (interquartile range 25-75) for normal distribution. Kruskal-Wallis, chi-square, and log rank tests were used to compare non-parametric data, proportions, and hospital length of stay (LOS), respectively. Results: From March 2005 to April 2009 (early screening period), 76,767 people in Ferrara were invited for i-FOBT. Of these, 36,930 (48%) adhered to the screening program and executed the test; 2,004 (5%) were i-FOBT positive, and 1,688 (84%) subsequently agreed to undergo colonoscopy. Endoscopy revealed 853 tumours (adenoma or cancer) confirmed on hystopathologic analysis. In the late screening period (April 2009 - March 2013), 86,763 subjects were invited for i-FOBT and 20,384 (46%) adhered; 1,827 (5%) were positive and 1,506 (82%) agreed to undergo colonoscopy. The endoscopy detected 731 histology proven adenomas or cancers. Data in early and late screening and pre-screening periods were as follows: Variables Pre-screening period (2003-2005) N=275 Early screening period (2005-2009) N=230 Late screening period (2009-2013) N=110 p Age (years) 72.3 (63.5-78.8) 64.0 (58.3-67.8) 64.1 (57.3-68.0) <0.001 Gender (Men:Women) 145 (53%):130 (47%) 149 (65%):81 (35%) 58 (53%):52 (47%) 0.014 Tumor stage 0 I IIa IIb IIIa IIIb IIIc IV 22 (8%) 31 (11%) 99 (36%) 18 (7%) 4 (1%) 56 (20%) 28 (10%) 17 (6%) 54 (24%) 48 (21%) 49 (21%) 2 (1%) 7 (3%) 37 (16%) 30 (13%) 3 (1%) 24 (22%) 38 (34%) 17 (15%) 3 (3%) 0 21 (19%) 6 (6%) 1 (1%) <0.001 . Tumor Site Right colon Transverse colon Left colon-rectum 103 (37%) 13 (5%) 159 (58%) 74 (32%) 7 (3%) 149 (65%) 35 (32%) 5 (4%) 70 (64%) 0.505 Hospital LOS (days) 12 (9-17) 10 (9-13) 9 (7-11) <0.001 Conclusions: The adherence to i-FOBT remained low throughout the screening periods (48% early period vs. 46% late period); adequate campaigns of sensitization to CRC screening are therefore needed. The highest adherence rate in Italy was observed for colonscopy adherence among i-FOBT positive screeenes (≥82%). The screening program did not detect an increased proportion of proximal colorectal cancers, in contrast to other Authors. As expected, decreased patients’ age as well as earlier stage CRC diagnosis was achieved with the screening program. Reduction in postoperative hospital LOS was likely due to younger patients’ age and increased adoption of minimally invasive techniques
Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful ... more Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful in clinical practice to assess the progression of chronic venous insufficiency. We carried out a study to assess the clinical feasibility of routine, non-invasive determination of saphenous vein wall compliance, and the reliability of such measure in discriminating between early and advanced stages of varicose vein disease.
To evaluate long saphenous vein sparing surgical procedures alternative to high ligation and dist... more To evaluate long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was... more Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were n...
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