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BackgroundLaparoscopic right hemicolectomy is a commonly performed procedure. Little is known on how to perform the enterotomy closure after stapled side-to-side intracorporeal anastomosis.MethodA multicentric case-controlled study has been designed to compare different ways to fashion enterotomy closure: double layer versus single layer, sewn versus stapled, and robotic versus laparoscopic approach. Furthermore, additional characteristics including sutures’ materials, interrupted versus running suture and the presence of deep corner suture has been investigated.ResultsWe collected data for 1092 patients who underwent right hemicolectomy at ten centers. We analyzed 176 robotic against 916 laparoscopic anastomosis: no significant differences were found in terms of bleedings (p = 0.455) and anastomotic leak (p = 0.405). We collected data from 126 laparoscopic sewn single-layer versus 641 laparoscopic sewn double-layer anastomosis: a significant reduction was recorded in terms of leaks in double-layer group (p = 0.02). About double-layer characteristics, we found a significant reduction of bleedings (p = 0.008) and leaks (p = 0.017) with a running suture; similarly, a reduction of bleedings (p = 0.001) and leaks (p = 0.005) was observed with the usage of deep corner closure. The presence of a barbed suture thread seemed to significantly reduce both bleedings (p = 0.001) and leaks (p = 0.001). We found no significant differences in terms of bleedings (p = 0.245) and anastomotic leak (p = 0.660) comparing sewn versus stapled anastomosis.ConclusionsFashioning a stapled ileocolic intracorporeal anastomosis, we can recommend the adoption of a double-layer enterotomy closure using a running barbed suture in the first layer. Totally, stapled closure and robotic assistance have to be considered a non-inferior alternative.

Purpose Anorectal, sexual, and urinary dysfunction are common issues after rectal cancer surgery, although seldom explored. The primary aim of this study was to investigate postoperative anorectal functional results. Methods Patients with mid/low-rectal cancer treated with transanal TME (TaTME) with primary anastomosis with/without diverting stoma between 2015 and 2020 were reviewed and selected if they had a minimum follow-up of 6 months (from the primary procedure or stoma reversal). Patients were interviewed using validated questionnaires and the primary outcome was bowel function based on Low Anterior Resection Syndrome (LARS) scores. Statistical analyses were performed to identify clinical/operative variables correlated with worse outcomes. A random forest (RF) algorithm was computed to classify patients at a greater risk of minor/major LARS. Results Ninety-seven patients were selected out of 154 TaTME performed. Overall, 88.7% of the patients had a protective stoma and 25.8% reported major LARS at mean follow-up of 19.0 months. Statistical analyses documented that age, operative time, and interval to stoma reversal correlated with LARS outcomes. The RF analysis disclosed worse LARS symptoms in patients with longer operative time (> 295 min) and stoma reversal interval (> 5.6 months). If the interval ranged between 3 and 5.6 months, older patients (> 65 years) reported worse outcomes. Finally, no statistical difference was documented when comparing the rate of minor/major LARS in the first 27 cases versus others. Conclusion One-quarter of the patients developed major LARS after TaTME. An algorithm based on clinical/operative variables, such as age, operative time, and time to stoma reversal, was developed to identify categories at risk for LARS symptoms.

This study aimed to determine changes in body composition among patients undergoing surgery for colorectal cancer, treated with the NutriCatt protocol. All patients undergoing surgery for colorectal cancer were enrolled and treated with the NutriCatt protocol at the Fondazione Policlinico “A. Gemelli” – IRCCS in Rome. This protocol consisted of an implementation of the nutritional items included in the ERAS protocol. At pre-hospitalization anthropometrical, demographical, body composition by bioimpedance analysis and clinical data were collected and each patient was given a personalized diet. At hospital admission - the day before the surgical intervention-body composition analysis was repeated. The Student's t-test for paired data was used to assess statistical differences. 315 patients (56.7% of male) were enrolled between January 2016 and December 2018. At hospital admission Free Fat Mass (FFM) and Muscular Mass did not change compared to pre-hospitalization measurements (FFM% 74.0±8.9 to 74.3±8.7, p=0.21; MM% 34.9±7.3 to 34.6±7.3; p=0.78), while there was an amelioration of Phase Angle (PA) (5.27±0.92 to 5.42±0.91; p=0.0001), Standardized Phase Angle (SPA) (0.1±1.1 to 0.4±1.2; p=0.0002) and Body Cell Mass Index (BCMI) (9.3±1.8 to 9.8±1.8; p=0.01). The NutriCatt protocol, which was shown to reduce the length of hospital stay, the post-surgical complications and the hospitalization costs, is able to improve PA, SPA and BCMI before surgical intervention. Larger studies are required to find the optimal strategies to prepare oncological patients to surgery, which often represents only the first step of their therapeutical program.

This study aimed to determine changes in nutritional status and their impact on clinical outcomes in elderly patients undergoing surgery for colorectal cancer (CRC), treated with the NutriCattä protocol. All patients undergoing surgery for CRC at the Fondazione Policlinico “A. Gemelli” – IRCCS were treated with the NutriCattä protocol, which consists of an implementation of the ERASä protocol with a nutritional prehabilitation. Bioimpedance analysis (BIA) was performed at prehospitalization (preH), hospital admission, and discharge. All data are expressed as mean±standard deviation and the Student's t-test for paired data was used to assess statistical differences. Between January 2016 and December 2019, 324 patients were enrolled, 100 of which over 75 years and 224 under 75 years (mean age ± SD respectively 67.8±11.9, 80.9±4.3, 61.9±9.2). In patients over 75 years the BIA-derived Phase Angle showed an improvement between preH and admission (4.65±0.79 vs 4.95±0.85, p<0.00001), a reduction during hospitalization (4.95±0.85 vs 4.75±0.9; p=0.0001) returning to the preH levels at discharge (4.75±0.9 vs 4.65±0.79; p=0.68). The mean postoperative hospital stay (POS) was not different between over 75 years and under 75 years patients (5.5±3.1 and 5.0±3.5 days, p=0.21, respectively). NutriCattä protocol was effective in improving nutritional status before surgery for CRC in patients over 75 years, obtaining the same POS as that of under 75 years patients, thus confirming the importance of a nutritional prehabilitation to prepare fragile subjects for major abdominal surgery.

Background The aim of the present study was to investigate whether microarray gene expression analysis can be used to predict lymph node status in gastric cancer. Methods Twenty-nine patients undergoing gastrectomy for cancer were enrolled and subdivided according to the pathologic nodal involvement of their disease (N+ vs N0). Molecular profiling was performed by cDNA microarray on tumor tissue and healthy mucosa. Data were processed to identify differently expressed genes. Selected genes were categorized with gene ontology. Results Compared to healthy gastric mucosa, 52 genes were differently expressed in N+ patients, and 50 genes in N0 patients. Forty-five genes were similarly regulated in N+ and N0 patients, whereas 12 genes were differently expressed between N+ and N0 patients. Seven genes were exclusively expressed in N+ patients: Egr-1 was upregulated; Claudin-18, AKR1C2, Cathepsin E, CA II, TFF 1, and progastricsin were downregulated. Five genes were exclusively expressed in N0 patients: Complement C5 receptor 1, PLA2/VII, and MMP- 9 were upregulated; MAO-A and ID-4 were downregulated. Conclusions Microarray analysis could be a valuable tool to identify genes associated with lymph node metastasis in gastric cancer. This technique could improve the selection of patients with locally advanced disease who are candidates for extended lymph node dissection, multimodal treatment options, or alternative therapeutic strategies.

The XENON1T experiment at the Laboratori Nazionali del Gran Sasso (LNGS) is the first WIMP dark matter detector operating with a liquid xenon target mass above the ton-scale. Out of its 3.2 t liquid xenon inventory, 2.0 t constitute the active target of the dual-phase time projection chamber. The scintillation and ionization signals from particle interactions are detected with low-background photomultipliers. This article describes the XENON1T instrument and its subsystems as well as strategies to achieve an unprecedented low background level. First results on the detector response and the performance of the subsystems are also presented.

Background Although complete mesocolic excision (CME) is supposed to be associated with a higher lymph node (LN) yield, decreased local recurrence, and survival improvement, its implementation currently is debated because the evidence level of these data is rather low and still not supported by randomized controlled trials. Method This is a multicenter, randomized, superiority trial (NCT04871399). The 3-year disease-free survival (DFS) was the primary end point of the study. The secondary end points were safety (duration of operation, perioperative complications, hospital length of stay), oncologic outcomes (number of LNs retrieved, 3- and 5-year overall survival, 5-year DFS), and surgery quality (specimen length, area and integrity rate of mesentery, length of ileocolic and middle-colic vessels). The trial design required the LN yield to be higher in the CME group at interim analysis. Results Interim data analysis is presented in this report. The study enrolled 258 patients in nine referral centers. The number of LNs retrieved was significantly higher after CME (25 vs. 20; p = 0.012). No differences were observed with respect to intra- or post-operative complications, postoperative mortality, or duration of surgery. The hospital stay was even shorter after CME ( p = 0.039). Quality of surgery indicators were higher in the CME arm of the study. Survival data still were not available. Conclusions Interim data show that CME for right colon cancer in referral centers is safe and feasible and does not increase perioperative complications. The study documented with evidence that quality of surgery and LN yield are higher after CME, and this is essential for continuation of patient recruitment and implementation of an optimal comparison. Trial registration The trial was registered at ClinicalTrials.gov with the code NCT04871399 and with the acronym CoME-In trial.

The XENON1T dark matter experiment aims to detect weakly interacting massive particles (WIMPs) through low-energy interactions with xenon atoms. To detect such a rare event necessitates the use of radiopure materials to minimize the number of background events within the expected WIMP signal region. In this paper we report the results of an extensive material radioassay campaign for the XENON1T experiment. Using gamma-ray spectroscopy and mass spectrometry techniques, systematic measurements of trace radioactive impurities in over one hundred samples within a wide range of materials were performed. The measured activities allowed for stringent selection and placement of materials during the detector construction phase and provided the input for XENON1T detection sensitivity estimates through Monte Carlo simulations.