Clinical impact of the new SIAPEC-IAP classification on the indeterminate category of thyroid nodules.

BACKGROUND: The increasing frequency in the diagnosis of thyroid nodules has raised a growing interest in the search for new diagnostic tools to better select patients deserving surgery. In 2014, the major Italian Societies involved in the field drafted a new cytological classification, to better stratify pre-surgical risk of thyroid cancer, especially for the indeterminate category, split into TIR3A and TIR3B subclasses, associated to different therapeutic decisions. MATERIALS AND METHODS: This retrospective cross-sectional survey analyzed thyroid fine-needle aspiration biopsy performed at our outpatient clinic before and after the introduction of the new SIAPEC-IAP consensus in May 2014. RESULTS: 8956 thyroid nodules were included in the analysis: 5692 were evaluated according to the old classification and 3264 according to the new one. The new criteria caused the overall prevalence of TIR3 to increase from 6.1 to 20.1%. Of those, 10.7 and 9.4% were included in the TIR3A and TIR3B subgroups, respectively. Each of the 213 TIR3B nodules underwent surgery and 86 (40.4%) were diagnosed as thyroid cancer, while among the 349 TIR3A nodules, only 15 of the 60 that underwent surgery were found to be thyroid cancer. CONCLUSIONS: This analysis shows that the new SIAPEC-IAC criteria significantly increased the proportion of the overall TIR3 diagnosis. The division of TIR3 nodules into two subgroups (A and B) allowed a better evaluation of the oncologic risk and a better selection of patients to be referred to surgery.

Robot-assisted gastrectomy for cancer.

BACKGROUND: Laparoscopic gastrectomy for cancer is commonly considered a challenging procedure. The technical drawbacks of laparoscopy have been addressed by robotic technology, which can facilitate demanding reconstructions and fine dissection. These features confer potential advantages in the execution of lymphadenectomy. OBJECTIVES: Here, we illustrate our technique of robotic gastrectomy and discuss advantages and drawbacks by reviewing the current literature. MATERIALS AND METHODS: We describe our technique for robot-assisted distal and total gastrectomy for cancer and assess the current literature dealing with short-term outcomes, immediate oncologic measures, and long-term oncologic outcomes of robot-assisted gastrectomy, in comparison with conventional laparoscopic and open surgery. RESULTS: The robotic procedure seems to be as safe and effective as conventional gastrectomy for gastric cancer, with a longer operative time and decreased blood loss in comparison with laparoscopic gastrectomy. CONCLUSION: The technical advantages offered by robotics could help to standardize minimally invasive D2 lymphadenectomy and enable surgeons to perform this procedure routinely. Despite the scarcity of long-term data on survival, immediate oncological measures (lymph node yield and margin status) are encouraging. Further studies investigating the long-term oncological outcomes are required.

[Robot-assisted gastrectomy for cancer. German version]. / Roboterassistierte Magenresektion beim Karzinom.

BACKGROUND: Laparoscopic gastrectomy for cancer is commonly considered a challenging procedure. The technical drawbacks of laparoscopy have been addressed by robotic technology, which can facilitate demanding reconstructions and fine dissection. These features confer potential advantages in the execution of lymphadenectomy. OBJECTIVES: Here, we illustrate our technique of robotic gastrectomy and discuss advantages and drawbacks by reviewing the current literature. MATERIALS AND METHODS: We describe our technique for robot-assisted distal and total gastrectomy for cancer and assess the current literature dealing with short-term outcomes, immediate oncologic measures, and long-term oncologic outcomes of robot-assisted gastrectomy, in comparison with conventional laparoscopic and open surgery. RESULTS: The robotic procedure seems to be as safe and effective as conventional gastrectomy for gastric cancer, with a longer operative time and decreased blood loss in comparison with laparoscopic gastrectomy. CONCLUSION: The technical advantages offered by robotics could help to standardize minimally invasive D2 lymphadenectomy and enable surgeons to perform this procedure routinely. Despite the scarcity of long-termdata on survival, immediate oncological measures (lymph node yield and margin status) are encouraging. Further studies investigating the long-term oncological outcomes are required.

Gallbladder neoplasm: a single institution experience according to the standard current management.

AIM: The aim of this paper was to determine if an aggressive surgical approach, with an increase in R0 resections, has resulted in improved survival for patients with gallbladder cancer. Gallbladder cancer is a silent disease, despite the efforts, the prognosis remains dismal. Consensus among surgeons regarding the indications for the extent of resection, lymph node dissection, port site resection, bile duct management has not been reached. METHODS: A retrospective review of all patients with gallbladder cancer admitted during 12 years period was conducted. Sixteen patients were identified. Cases were divided into 2 cohorts surgical treated group (STG, N.=10) and non surgical treated group (NSTG, N.=6). RESULTS: In NSTG the disease was metastatic (stage IV): liver (33.3%), peritoneum (50%), liver and peritoneum (16.7%). In STG 13 procedures were performed, 6 liver resection (2 en bloc resection, 2 bisegmentectomy, 2 wedge resection) 7 cholecystectomies. 6 R1, 7 R0 resections. All the liver resections were R0. 0% mortality, 30.7% of morbidity, all the complications were managed conservatively. Length of stay was 10 days for the STG, and 5 days for the NSTG. The median overall survival was 10 months (Std Error 2.381 CI 5.333-14.667), while in the STG 16 months (Std Error 6.275 CI 3.701-28.299) and in the NSTG was 7 months (Std Error 2.381 CI 5.337-14.667) CONCLUSION: Whenever is possible radical resection with free margin (R0) must be achieved, being the only chance to treat efficiently.

Endogenous stem and precursor cells for demyelinating diseases: an alternative for transplantation?

Remyelination can be very effective in human. However, this process ultimately fails in multiple sclerosis (MS). In this paper, we discuss the possibility of stimulating endogenous oligodendrocyte precursors to participate in remyelination in experimental models (rat and primate Callithrix jacchus) of MS through thyroid hormone (TH) administration. TH is in fact known to be a key signal in brain development, oligodendrocyte development and myelin protein gene expression regulation.

[Peristomal laparocele: particular indications for the use of prosthetic materials]. / Il laparocele peristomale: una indicazione particolare all'utilizzazione di materiali protesici.

The authors report the case of a female patient suffering from colic neoplasm and a vast peristomal laparocele, the long-term outcome of a rectal amputation that the patient underwent at a young age. After colic resection, a vast area of surgical mesh in dacron was modelled and positioned in a retromuscular scat, thus allowing the hernia pathology to be resolved relatively simply, owing to its particular location-in correspondence with a preternatural anus-until not long ago this would have represented an absolute contraindication to the use of prosthetic materials. A precise surgical approach, marked by a scrupulous respect for aseptic conditions, is essential in these circumstances owing to the persistent risk of septic complications.