Robotic vs open gastrectomy for gastric cancer: A propensity score-matched analysis on short- and long-term outcomes.

BACKGROUND: The aim of this study was compare short- and long-term outcomes between robotic (RG) and standard open gastrectomy (OG). METHODS: This is a single-center propensity score-matched study including patients who underwent RG or OG for gastric cancer between 2008 and 2018. RESULTS: In total, 191 patients could be included for analysis. Of 60 RG patients, 49 could be matched. After matching, significant differences in baseline characteristics were no longer present. Operative time was significantly longer (451 min, IQR: 392-513) in the RG group than in the OG (262 min, IQR: 225-330) (P < .0001). No significant differences in postoperative complications between RG (n = 15, 30.6%) and OG (n = 15, 30.6%) were seen (P = 1.000). Overall survival was comparable between the groups. CONCLUSIONS: RG is feasible and safe. With regard to long-term oncologic outcomes, survivals in the RG group were similar to those in OG group.

[Pinch-off syndrome]. / La sindrome di pinch-off.

Totally implantable central venous access devices, or ports, are commonly used for those patients which require long-term or continuum intravenous infusion therapy. We report a case of a rare complication related to them, called pinch-off syndrome, arising by the chronic compression of the central venous catheter between the clavicle and the first rib, with consequent mechanic obstruction of the catheter and eventual complete transection and embolization of a distal fragment of it. A chest radiograph, eventually with the injection of contrast through the catheter, is require when pain and/or swelling in the chest or shoulder at the side go the port occur at the time of infusion plus malfunction of it. The therapy of pinch-off syndrome is removal of the fractured or with embolism catheter and replacement of a new one more laterally to the previous approach.

[Gallbladder injury]. / A proposito di un trauma della colecisti.

The Authors report on a rare case of blunt traumatic injury of the gallbladder. A careful clinical examination, an abdominal ultrasonography and a contrast material-enhanced computed tomography have a primary importance for a correct diagnosis. Laparoscopic surgery has an important diagnostic and, in selected cases, therapeutic role. In all traumatic gallbladder ruptures, after an accurate search of eventual associated injuries of other abdominal organs, cholecystectomy is considered the treatment of choice.

[Mesenteric fibromatosis]. / La fibromatosi mesenterica.

Mesenteric fibromatosis is a rare benign mesenteric tumour, characterised by infiltrative growth and high rates of recurrence. Histological examination is the only diagnostic procedure capable of ruling out a malignant mesenteric neoplasm. It is not always possible to perform a radical removal of the tumour mass because it may have infiltrated important anatomical structures. In the present study the Authors report two cases of mesenteric fibromatosis and analyse the main clinical-diagnostic, therapeutic and prognostic problems posed by these tumours.

Pancreatic metastases: observations of three cases and review of the literature.

BACKGROUND: The aim of the study is to analyze pancreatic metastases and their clinical, radiological, therapeutic and prognostic features. METHODS: Three cases of pancreatic metastases observed and a world literature review of 333 cases were recorded. RESULTS: Pancreatic metastases are due more frequently to renal cell carcinoma; they are usually metachronous and characterized by a long period of time between the resection of the primary tumor and their detection. The differential diagnosis with other pancreatic masses is difficult, but an accurate anamnesis, some peculiar findings of imaging techniques and percutaneous fine needle aspiration could allow preoperative diagnosis. Pancreatic resections are the treatment of choice allowing the better palliation and improving survival. 150/234 pancreatic metastases underwent pancreatic resections (resectability index = 64.1%); 88/132 patients are alive with a mean follow-up of 27.1 months; of the 44 dead patients the mean survival time was 21.3 months. Among pancreatic metastases the primary tumor with better prognosis is renal cell carcinoma. CONCLUSION: Pancreatic metastases are rare; their preoperative diagnosis is difficult but useful and possible. Surgical resection is suggested because the patient still may have a prolonged survival.

Usefulness of the ultrasonically activated shears in total thyroidectomy.

Surgical technique of total thyroidectomy is nowadays well known. Technology could determine some improvement of this kind of surgery. Two groups of patients that underwent total thyroidectomy were compared retrospectively. In group 1 we described 105 total thyroidectomies performed with ultrasonically activated shears; in group 2, 76 performed with conventional methods of haemostasis. Comparing the two groups for several parameters, it results that in the total thyroidectomies performed with ultrasonically actived shears, operative time is shorter of 24 minutes compared with conventional method (81 vs 105 minutes), the mean amount of intraoperative blood loss is smaller (70 ml vs 125 ml), the postoperative pain is less, the cosmetic result is better (length of incision 6 cm vs 10 cm) and the costs is not more expensive. Complications of thyroid surgery are similar between the two methods. The use of ultrasonically actived shears in total thyroidectomy is safe (no increase of complications) and useful because it reduces operative time, improves the recovery of the patient (less pain, better cosmetic results) and, finally, is not more expensive than conventional method of haemostasis.

["Forgotten" goiter: clinical case and review of the literature]. / Gozzo "dimenticato": caso clinico e revisione della letteratura.

"Forgotten" goitre is an extremely rare disease. It is a mediastinic thyroid mass found after total thyroidectomy. In this paper we report a case of "forgotten" goitre and review the various diagnostic and therapeutic problems posed by the condition. A number of possible solutions that can be implemented for this disease are identified.