Papers by Piero Chirletti
Acta Anaesthesiologica Scandinavica, 2011
Background: The surgical/anesthesia trauma is associated with an increased production of reactive... more Background: The surgical/anesthesia trauma is associated with an increased production of reactive oxygen species (ROS). This enhanced oxidative stress leads to cell damage resulting in various complications such as sepsis, myocardial injury and increased mortality. The aim of this study was to investigate the role of antioxidant treatment with Lcarnitine in oxidative stress and platelet activation in patients undergoing major abdominal surgery. Methods: Forty patients scheduled for abdominal surgery were randomly allocated to L-carnitine, administered with a rapid infusion (0.05 g/kg) diluted in 250 ml of saline solution, vs. placebo treatment just before the surgical intervention. At baseline and after treatment, oxidative stress was evaluated by detection of circulating levels of soluble NOX2-derived peptide (sNOX2-dp), a marker of NADPH oxidase activation, and by analyzing platelet ROS formation. Platelet activation was studied by dosing sCD40L. Results: We observed an increase of soluble sNOX2-dp, sCD40L and ROS production in the placebo group com
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2018
Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal ca... more Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.0...
Delayed gastric emptying (DGE) is a frequent complication after pylorus-preserving pancreatoduode... more Delayed gastric emptying (DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy (PpPD). Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy (PrPD) with antecolic gastrojejunal anastomosis to obviate DGE occurring after PpPD. Here we debate the reported differences in the prevalence of DGE in antecolic and retrocolic gastro/duodeno-jejunostomies after PrPD and PpPD, respectively. We concluded that the route of the gastro/duodeno-jejunal anastomosis with respect to the transverse colon; i.e., antecolic route or retrocolic route, is not responsible for the differences in prevalence of DGE after pancreatoduodenectomy (PD) and that the impact of the reconstructive method on DGE is related mostly to the angulation or torsion of the gastro/duodeno-jejunostomy. We report a prevalence of 8.9% grade A DGE and 1.1% grade C DGE in a series of 89 subtotal stomach-preserving PDs with Roux-en Y retrocolic reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct. Retrocolic anastomosis of the isolated first jejunal loop to the gastric remnant allows outflow of the gastric contents by gravity through a "straight route".
Copyright © 2012 Roberto Caronna et al. This is an open access article distributed under the Crea... more Copyright © 2012 Roberto Caronna et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. The best pancreatic anastomosis technique after pancreaticoduodenectomy (PD) is still debated. Pancreatic fistula (PF) is the most important complication but is also related to postoperative bleedings and pancreatic remnant involution. We support pancreaticojejuno anastomosis (PJ) advantages describing our technique with brief technical considerations. Materials and Methods. 89 consecutive patients underwent PD with suprapyloric gastric resection and double loop reconstruction. Pancreaticojejunal end-to-end anastomosis was done by simple invagination with a single layer of interrupted pledget-supported
Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia, 2016
Atrophy of the pancreatic remnant after pancreaticoduodenectomy might be consequent to dereg- ula... more Atrophy of the pancreatic remnant after pancreaticoduodenectomy might be consequent to dereg- ulation of pancreatic endocrine stimuli after duodenal removal. Relative technical surgical solu- tion could be the anastomosis of the 1st jejunal loop to the stomach and the 2nd to the pancreatic stump. Data on the distribution of endocrine cells within the proximal intestine might represent the lacking tile of the problem. Our aims were to investigate the distribution pattern of seroto- nin, cholecystokinin and secretin cells in the duodenum, the 1st and 2nd jejunal loops of humans. Bowel specimens of ten patients submitted to pancreaticoduodenectomy were collected; immuno- histochemical reactions and morphometric analyses were performed. A general ab-oral decrease of enteroendocrine cells was found. The rate of serotonin cells showed a significant 30.67±8.13% reduction starting from the 1s' jejunal loop versus duodenum. The rate of both cholecystokinin and secretin cells in the duode...
In Vivo, 2021
tumors (PHT), and, through that, to identify which patients are suitable for up-front surgical re... more tumors (PHT), and, through that, to identify which patients are suitable for up-front surgical resection and which for neoadjuvant chemotherapy.
International Journal of Surgery, 2019
Traditionally, overnight fasting before elective surgery has been the routine in medical practice... more Traditionally, overnight fasting before elective surgery has been the routine in medical practice for risk reduction of pulmonary aspiration of gastric contents. Several original study and international societies recommend a 2‐h preoperative fast for clear fluids and a 6‐h fast for solids in most elective patients. We conducted a narrative review of the literature, searching electronic databases (Medline and CINAHL). We used PICO approach. The results of our review suggest that nutrition support in the perioperative period is very important to reduce length of hospital stay and reduced postoperative complication.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Sep 1, 2018
Laparoscopy has now been implemented as a standard of care for elective colonic resection around ... more Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (l...
Medicine, 2016
Calcitonin is the hallmark of medullary thyroid carcinoma. However,extrathyroidalneuroendocrinetu... more Calcitonin is the hallmark of medullary thyroid carcinoma. However,extrathyroidalneuroendocrinetumorscanalsoreleasecalcitonin. We report 2 cases of calcitonin-secreting pancreatic tumors found in asymptomatic patients with thyroid nodules referred to our center within 11 months. Case 1: A man initially referred for thyroid nodule characterization was found to have hypercalcitoninemia (>200 pg/mL) during nonneoplastic fine-needle aspiration. Case 2: A woman evaluated for liver metastasis was found to have hypercalcitoninemia and multinodular goiter. Our research emphasizes that marked hypercalcitoninemia in the presence of thyroid nodules is not necessarily due to medullary thyroid carcinoma; awareness of this could avoid unnecessary thyroidectomy. The lack of specific symptoms related to hypercalcitoninemia may be the reason that the prevalence of calcitonin-secreting pancreatic tumors is underestimated.
World Journal of Surgical Oncology, 2019
Background: Intrapancreatic accessory spleen (IPAS) is an uncommon finding of pancreatic mass. Di... more Background: Intrapancreatic accessory spleen (IPAS) is an uncommon finding of pancreatic mass. Differential diagnosis with pancreatic tumor, especially with non-functional neuroendocrine tumor (NF-NET), may be very hard and sometimes it entails unnecessary surgery. A combination of CT scan, MRI, and nuclear medicine can confirm the diagnosis of IPAS. 68-Ga-Dotatoc PET/CT is the gold standard in NET diagnosis and it can allow to distinguish between IPAS and NET. Case presentation: A 69-year-old man was admitted to our hospital for an incidental nodule in the tail of the pancreas with focal uptake of 68-Ga-dotatate at PET/CT. NET was suspected and open distal splenopancreatectomy was performed. Pathologic examination revealed an IPAS. Conclusion: This is the second IPAS case in which a positive 68Ga-Dotatoc uptake led to a false diagnosis of pancreatic NET. Here is a proposal of a literature review.
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
Journal of the Pancreas, 2013
Context The study of the immune responses to pancreatic cancer is an emerging field of clinical a... more Context The study of the immune responses to pancreatic cancer is an emerging field of clinical and laboratory research since accumulating evidence indicate that the lymphocyte count, the Th2 polarization, the profile of cytokines and chemokines produced by cancer and immune cells and the presence of CD8+ tumor-infiltrating lymphocytes (TILs) correlate with the tumor prognosis. Objective The purpose of our study is to analyze the lymphocyte population distribution and natural killer (NK) cell cytotoxic activity before and after curative pancreatic resection (radical exeresis of mesopancreas and extended lymphadenectomy). Methods We collected blood samples from 17 pancreatic cancer patients at three different time points, before surgery and 7 and 30 days after surgery, and we evaluated the peripheral blood lymphocyte profile by cytofluorimetric analysis and the NK cytotoxic activity by a 51 chromium release assay. Seventeen blood samples from healthy subjects were used as control. Re...
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Papers by Piero Chirletti