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EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-320713


Background & Aims: COVID-19 posed a major worldwide threat to population health as well as to patients with comorbidities, but its impact on patients with cirrhosis and hepatocellular carcinoma is currently poorly understood. This study aimed at evaluating the effects of COVID-19 outbreak both on the clinical outcome of these patients and on their follow-up. Methods: We conducted a phone survey off all patients living in Lombardy (the region with the highest incidence of Covid-19 infections in our country) included in our database and treated for hepatocellular carcinoma from January 2017 to April 2020. Results: We analyzed the database concerning 187 patients submitted to surgical treatment for HCC: 35 patients died before the pandemic. Therefore, we obtained a complete answer to the questionnaire from 131 patients while in other 7 cases we gained information by a family member because the patient had died in the meanwhile;14 cases were unreachable (9%). We identified 7 cases of Covid-19 among the 138 patients (5%): 5 confirmed and 2 probables. One patient died for COVID-19 pneumonia. During the lockdown period (March-April 2020), we registered 7 deaths: 1 patient for Covid-19 pneumonia, 2 patients for diffuse HCC recurrence and the remnant 4 for other causes. (crude death rate: 46.4). In the same period of 2018, we registered a crude death rate of 25.6 while in the 2019 a crude death rate of 10. Conclusions: irrespective of a low rate of Covid infections in a group of frailty patients, we observed a higher rate of mortality due to other causes: the reduced access to health services due to the disruption of the normal activities and the forced reassurance of sick patients could be the primary causes of this increase.Funding Statement: None.Declaration of Interests: All authors declare that they have no conflicts of interest or financial ties to disclose. Ethics Approval Statement: This retrospective study protocol was approved by our Institutional Review Board and waived the requirement for informed consent. Research involving human participants and/or animals Institutional review research board approval was granted by ASST Fatebenefratelli Sacco, and appropriate good clinical and research practices were followed.

BMC Surg ; 21(1): 180, 2021 Apr 06.
Article in English | MEDLINE | ID: covidwho-1169960


BACKGROUND: COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. METHODS: We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. RESULTS: Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. CONCLUSIONS: Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

COVID-19 , Cholecystitis, Acute , Disease Outbreaks , COVID-19/epidemiology , COVID-19/surgery , Cholecystitis, Acute/surgery , Cholecystostomy , Hospitals , Humans , Italy/epidemiology , Retrospective Studies , Treatment Outcome
J Laparoendosc Adv Surg Tech A ; 31(3): 266-272, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-720927


Background: COVID-19 pandemic rendered the surgical approach as well as the surgical indication very complex due to the outstanding consumption of public health system' resources, especially in the intensive care subdivision. A multidisciplinary team-based strategy is necessary to adapt guidelines and medical practices to the actual situation. The aim of this study is to evaluate the changes in the therapeutic algorithm in a small group of patients with hepatocellular carcinoma (HCC) enlisted for surgery during the COVID-19 outbreak. Materials and Methods: A multidisciplinary strategy has been adopted to allocate HCC patients to a treatment that permitted to reduce the risk of complications and the hospital stay, thus preventing contamination by the virus. Nasopharyngeal swab and a chest radiograph were performed in all patients within 48 hours before the surgical procedure: in the suspected cases with negative COVID tests, we prudently postponed surgery and repeated the diagnostic tests after 15 days. Results: During the emergency state, 11 HCC patients were treated (8 laparoscopic ablations and 3 hepatic resections). We reported only 1 postoperative complication (hemothorax) and 1 death during the follow-up for COVID pneumonia. Comparing our performances with those in the same time frame in the past 4 years, we treated a similar number of HCC patients, obtaining a decrease in operative timing (P = .0409) and hospital stay (P = .0412) (Fig. 2b) with similar rates of immediate postoperative complications, without ICU admissions. Conclusions: An adapted algorithm for the treatment of HCC to COVID outbreak permitted to manage safely these patients by identifying those most at risk of evolution of the neoplastic disease.

COVID-19/epidemiology , Carcinoma, Hepatocellular/surgery , Disease Management , Guideline Adherence , Hepatectomy/methods , Laparoscopy/methods , Liver Neoplasms/surgery , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/epidemiology , Comorbidity , Female , Humans , Length of Stay , Liver Neoplasms/epidemiology , Male , Middle Aged , Operative Time , Pandemics , SARS-CoV-2