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Rocco Bellantone

Publications and source records attributed to Rocco Bellantone.

At least 19 recordsLinked to original sources
PubMed2007

Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma.

Functional lateral neck dissection requires a large incision providing adequate exposure of the surgical field. We evaluated the feasibility of minimally invasive video-assisted functional lateral neck dissection (VALNED) in patients with papillary thyroid carcinoma (PTC). Low-risk PTC patients with lateral neck metastases <2 cm, in absence of any evidence of great vessels involvement, were considered eligible. After accomplishing total thyroidectomy and central neck clearance, dissection was performed under endoscopic vision by using a technique very similar to conventional surgery through the single 4-cm skin incision used for thyroidectomy. Two patients were selected: 1 underwent bilateral and 1 unilateral VALNED. The mean number of the removed nodes was 25 per side. Both patients experienced transient postoperative hypocalcemia. No other complication occurred. No evidence of residual or recurrent disease was found at follow-up. VALNED is feasible, and the results are encouraging. For definitive conclusions, larger series and comparative studies are necessary.

Adenocarcinoma, Papillary↗
PubMed2006

Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia.

BACKGROUND: We evaluated the reliability of intact parathyroid hormone (iPTH) levels 4 hours after thyroidectomy (4h-iPTH) as a predictor of hypocalcemia in a large series of patients. METHODS: A prospective experimental design involving 523 consecutive patients between September 1, 2004, and June 30, 2005, was employed. The specificity, sensitivity, and overall accuracy of 4h-iPTH in predicting post-thyroidectomy hypocalcemia and symptoms were determined. RESULTS: A total of 199 patients developed hypocalcemia (serum calcium concentrations <8.0 mg/dl). Five patients still were receiving vitamin D/oral calcium at 6 months after the operation. Seventy-three patients experienced mild symptoms. The 4h-iPTH levels were reduced in hypocalcemic patients (28.8 +/- 15.3 vs 11.2 +/- 11.6 pg/ml) (P < .001). The 4h-iPTH levels were within the normal range (10 to 65 pg/ml) in 360 patients (290 normocalcemic) and subnormal in 163 patients (129 hypocalcemic, of whom 62 were symptomatic). The accuracy of 4h-iPTH levels <10 pg/ml in predicting post-thyroidectomy hypocalcemia and symptoms was 80.1% and 78.6%, respectively. False-negative results were observed in 70 hypocalcemic patients (13.4%), 11 of whom were symptomatic (2.1%). CONCLUSIONS: Subnormal 4h-iPTH levels alone did not accurately predict clinically relevant postoperative hypocalcemia. The optimal cut-off level and its integration with preoperative and postoperative serum calcium concentrations should be reconsidered.

Adolescent↗
PubMed2006

Role of laparoscopy in the management of adrenal malignancies.

BACKGROUND AND OBJECTIVES: The role of laparoscopic approach for the treatment of malignant adrenal diseases is still controversial. The aim of this study was to verify the results of laparoscopic adrenalectomy (LA) in the management of adrenal malignancies. METHODS: The medical records of all the patients who underwent laparoscopic procedures for adrenal diseases and in whom malignancy was demonstrated at final histology were reviewed. RESULTS: Nine patients were included (three malignant pheochromocytomas, four adrenocortical carcinomas, and two adrenal metastases). At a mean follow-up of 23.0 months, all but two patients were alive. One patient died for metastatic disease and the other one for unrelated causes. One patient operated on for an adrenocortical carcinoma developed a pelvic recurrence. One patient operated on for a malignant pheochromocytoma developed multiple intra-abdominal recurrences. No other case of recurrence was observed. CONCLUSIONS: The results of this study demonstrate that LA can have a role also in case of adrenal malignancies. Conversion to open surgery is mandatory in case of local invasion and when the dissection cannot be as accurate as in conventional operations. A preliminary laparoscopic exploration can be planned in case of suspected malignant lesions to confirm the diagnosis and to evaluate their operability.

Abdominal Neoplasms↗
PubMed2006

Video-assisted thyroidectomy: report of a 7-year experience in Rome.

BACKGROUND AND AIMS: We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-year period. MATERIALS AND METHODS: VAT is a gasless procedure performed under endoscopic vision through a single 1.5-2.0 cm skin incision. The eligibility criteria are thyroid nodules < or =35 mm, thyroid volume <30 ml, and no previous conventional neck surgery. Small, low-risk papillary thyroid carcinomas (PTC) were considered eligible. RESULTS: There were 521 VATs attempted. Conversion was necessary six times (difficult dissection in one case, large nodule size in three, and gross lymph node metastases in two). Thyroid lobectomy was successfully accomplished in 113 cases, total thyroidectomy in 398, and completion thyroidectomy in 14. In 66 patients, the central neck nodes were removed through the same access. Pathology showed benign diseases in 313 cases, PTC in 187, and medullary microcarcinoma in 1. Postoperative complications included 9 transient recurrent nerve palsies, 73 transient hypocalcemias, 3 definitive hypoparathyroidisms, 1 postoperative haematoma, and 2 wound infections. The cosmetic result was excellent. In patients with PTC, no evidence of recurrent disease was shown. CONCLUSIONS: The indications for VAT are still limited. Nonetheless, in selected patients, it seems a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.

Adolescent↗
PubMed2006

Video-assisted thyroidectomy: report on the experience of a single center in more than four hundred cases.

BACKGROUND: We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-year period and discuss the results obtained. METHODS: Video-assisted thyroidectomy is a gasless procedure performed under endoscopic vision through a single 1.5-2.0-cm skin incision, using a technique very similar to conventional surgery. Eligibility criteria were these: thyroid nodules < 35 mm; thyroid volume < 30 ml; no previous conventional neck surgery. Small, low-risk, papillary thyroid carcinomas (PTC) were considered eligible. RESULTS: A total of 473 VATs were attempted on 459 patients. Locoregional anesthesia was used in 15 patients. Conversion was necessary in 6 (difficult dissection in 1 case, large nodule size in 3, gross lymph node metastases in 2). Thyroid lobectomy was successfully performed in 110 cases, total thyroidectomy in 343, and completion thyroidectomy in 14. In 66 patients with carcinoma, central neck nodes were removed through the same access. Concomitant parathyroidectomy was performed in 14 patients. Pathology showed benign disease in 277 cases, PTC in 175, and medullary microcarcinoma in 1. Postoperative complications included 8 transient recurrent nerve palsies, 64 transient hypocalcemias, 3 definitive hypocalcemias, 1 postoperative hematoma, and 2 wound infections. Postoperative pain was minimal and the cosmetic result excellent. In patients with PTC no evidence of recurrent or residual disease was shown. CONCLUSIONS: Indications for VAT are still limited (20% of patients who require thyroidectomy). Nonetheless, in selected patients, it seems a valid option for thyroidectomy and it could be considered even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.

Adolescent↗
PubMed2006

Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries.

BACKGROUND: We performed a prospective analysis on voice and swallowing alterations following total thyroidectomy (TT), in the absence of recurrent nerve injury. METHODS: Patients aged 21 to 65 years undergoing TT, in the absence of laryngeal/pulmonary disease, previous neck surgery, or malignant diseases, were subjected to videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) tests preoperatively and 3 months postoperatively. Voice impairment scores (VIS) and swallowing impairment scores (SIS) were obtained preoperatively, and at 1 week, 1 month, and 3 months postoperatively. RESULTS: Among the 127 selected patients, 39 completed the postoperative evaluation. No recurrent nerve injury was observed during the postoperative VSL in any of the patients. Preoperative and postoperative AVA and MPT scores did not differ significantly. The mean postoperative VIS was significantly higher than the preoperative VIS at 1 week and 1 month after TT (13.7 and 9.6 vs 4.4, respectively; P < .05) but not 3 months after TT (6.7). The mean SIS was higher than the preoperative SIS at 1 week, 1 month, and 3 months after TT (10.3, 6.0, and 2.8 vs 0.5, respectively; P < .05). CONCLUSIONS: Physicians should inform patients that transient voice and swallowing symptoms may occur following total thyroidectomy, and our data suggest mild symptoms may occur in the majority of operated patients.

Adult↗
PubMed2005

Prevention and treatment of cancer cachexia: new insights into an old problem.

Cancer cachexia (CC) is a multifactorial paraneoplastic syndrome characterized by anorexia, body weight loss, loss of adipose tissue and skeletal muscle, accounting for at least 20% of deaths in neoplastic patients. CC significantly impairs quality of life and response to anti-neoplastic therapies, increasing morbidity and mortality of cancer patients. Muscle wasting is the most important phenotypic feature of CC and the principal cause of function impairment, fatigue and respiratory complications, mainly related to a hyperactivation of muscle proteolytic pathways. Most therapeutic strategies to CC have proven to be only partially effective . The inhibition of catabolic processes in muscle has been attempted pharmacologically with encouraging results in animal models. However, data in the clinical setting are still scanty and contradictory. Stimulation of muscle anabolism could represent a promising and valid therapeutic alternative for cancer-related muscle wasting. This goal may be currently achieved with the conventional, short-acting and adverse side effect-rich anabolic steroids. Insulin-like growth factor-1 (IGF-1) plays a critical role in muscle homeostasis, hypertrophy and regeneration. IGF-1 overexpression at the muscular level by gene therapy reverses muscle hypotrophy secondary to catabolic conditions and induces muscle hypertrophy increasing muscle mass and strength. This allows the speculation that this approach could also prove effective in modulating cancer-induced muscle wasting, while avoiding the potentially hazardous side effects of systemic IGF-1 administration. The present review will focus on the potential biochemical and molecular targets of CC therapy, and will define the rationale for a novel, gene therapy-based approach.

Cachexia↗
PubMed2005

Safety of video-assisted thyroidectomy versus conventional surgery.

BACKGROUND: Thyroid gland manipulation, surgical stress response, and postoperative outcome in cases of video-assisted thyroidectomy (VAT) and conventional thyroidectomy were compared to verify the safety of VAT. METHODS: Twenty consenting patients were randomly assigned to undergo VAT or conventional thyroidectomy. Serum thyroglobulin levels were monitored as indicators of thyroid manipulation, and C-reactive protein and white blood cell count were monitored to assess surgical stress response. Thyroid capsule integrity and the presence of spilled cells in the thyroid bed were verified. RESULTS: No significant differences were found in the indicators of thyroid gland manipulation and surgical stress response between groups. No thyroid capsules ruptured, and no spilled thyroid cells were found. Patients who had VAT experienced less pain, required fewer analgesics, and were more satisfied with the cosmetic result and the surgical outcome. CONCLUSIONS: VAT is as safe as conventional thyroidectomy and is characterized by a less painful postoperative course and by better cosmetic results and postoperative outcome.

Adult↗
PubMed2004

Video-assisted thyroidectomy under local anesthesia.

One theoretical limit of video-assisted thyroidectomy (VAT) was the supposed necessity of general anesthesia. Herein we describe a technique for VAT performed under locoregional anesthesia. Eligibility criteria were small thyroid nodules (<2 cm) in small or normal thyroid glands (thyroid volume < or =20 mL), no previous neck surgery or irradiation, and patient motivation for local anesthesia. VAT using locoregional anesthesia was performed under a superficial cervical block. During the procedure, the patients were completely awake and able to speak with members of the surgical team. Intraoperative and postoperative pain, as evaluated by a visual analogue scale, was usually negligible. No complications occurred. Mean postoperative stay was 26 hours. All of the patients were completely satisfied with the cosmetic result, the procedure, and the surgical outcome. VAT is also feasible and safe under local anesthesia. We are optimistic about the future of this approach, which opens a new frontier for minimally invasive procedures in thyroid surgery.

Anesthesia, Local↗
PubMed2004

Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement.

BACKGROUND: We prospectively evaluated the possibility to make an early prediction of postthyroidectomy hypocalcemia by postoperative intact parathyroid hormone (iPTH) measurements. METHODS: Fifty-three consecutive patients who underwent bilateral thyroid resection were included; iPTH was measured preoperatively, at the end of the surgical procedure, and at 2, 4, 6, 24, and 48 hours after the operation. Patients who had hypocalcemia (serum total calcium, <8.0 mg/dL) were compared with normocalcemic patients. RESULTS: Sixteen patients experienced hypocalcemia. Six patients experienced symptoms. No significant difference was found between hypocalcemic and normocalcemic patients concerning demographic, pathologic, and preoperative laboratory data, surgical procedure, and intraoperative findings. Postoperative iPTH levels were reduced in hypocalcemic patients at the end of the procedure and at 2, 4, 6, 24, and 48 hours after the operation ( P < .001). IPTH levels below the normal range (<10 pg/mL) at 4 and 6 hours after the operation correctly predicted postoperative hypocalcemia and symptoms in all but 1 patient with a self-limiting, asymptomatic hypocalcemia (serum calcium concentration, 7.8 mg/dL) (specificity, 100%; sensitivity, 94%; overall accuracy, 98%). CONCLUSIONS: One single iPTH measurement reliably can predict, early after thyroidectomy, which patients are prone to clinically relevant postoperative hypocalcemia and necessitate supplementation treatment and which patients are eligible for a safe early discharge.

Adult↗
PubMed2004

Predictive factors for recurrence after thyroid lobectomy for unilateral non-toxic goiter in an endemic area: results of a multivariate analysis.

BACKGROUND: The aim of the study was to identify the factors that are predictive of recurrence after thyroid lobectomy for unilateral non-toxic thyroid goiter in an endemic region through a multivariate analysis. METHODS: Two hundred sixty-eight consecutive patients who underwent thyroid lobectomy and who were evaluated by the same endocrinologist were included. Univariate and multivariate analysis analyzed the relationship between sex, age, preoperative thyroid-stimulating hormone, duration of disease, duration of levothyroxine (LT4) preoperative therapy, cytologic results, histologic results, resected thyroid weight, numbers and diameters of thyroid nodules, morphologic alterations of the remnant lobe, follow-up length, postoperative LT4 therapy, ultrasonographic evidence of recurrence, and reoperation. RESULTS: The incidence of recurrence was 33.9% (91/268 patients) after a mean follow-up time of 79.9 months (range, 12-251 months), female sex ( P = .016), multiple nodules ( P = .017), and lack of postoperative LT4 therapy ( P = .0009) were predictive factors of recurrence. Reoperation was performed in 20 patients (7.4%); factors that were predictive of reoperation were the presence of multiple nodules ( P = .008), resected thyroid weight ( P = .00006), and lack of postoperative hormonal therapy ( P = .0005). CONCLUSIONS: Thyroid lobectomy for unilateral non-toxic goiter, when combined with suppressive or substitutive thyroxin therapy, resulted in a low rate of recurrence and reoperation in an endemic area.

Adult↗
PubMed2004

Management of cystic or predominantly cystic thyroid nodules: the role of ultrasound-guided fine-needle aspiration biopsy.

OBJECTIVE: Conventional fine-needle aspiration biopsy (FNAB) for cystic thyroid nodules (CTNs) has a high rate of nondiagnostic and false-negative results. Ultrasound-guided FNAB (UG-FNAB) permits direct sampling of the wall and/or the solid portion of CTNs, increasing the possibility of a representative sample. In this study we evaluated the role of UG-FNAB in CTNs management. METHODS: Five-hundred-seventy-five UG-FNAB of CTNs were performed. Thyroidectomy was carried out in 119 of these cases. The medical records of these 119 patients were reviewed and form the basis of this report. RESULTS: The nondiagnostic smear rate was 9.2%. Cytological diagnosis was benign nodule in 42 cases, predominantly follicular lesion in 50 cases, and suspicious or malignant lesion in 16 cases. The final pathology revealed a benign nodule in 98 cases (82.4%) and a carcinoma in 21 (17.6%). The overall accuracy of UG-FNAB was 88.0%. No significant differences were found in age, sex, lesion size, or echographic pattern (p = NS) comparing patients with benign CTNs to patients with malignant CTNs. CONCLUSION: UG-FNAB has a low rate of nondiagnostic smears and a high overall accuracy in CTNs. All CTNs should undergo UG-FNAB to select patients for surgery, since the malignancy rate is not negligible and no clinical parameter can reliably predict it.

Biopsy, Fine-Needle↗
PubMed2004

Therapy of muscle wasting in cancer: what is the future?

PURPOSE OF REVIEW: The aim of the present review is to provide insights into the future therapeutic approaches to cancer-related muscle wasting that flow from the progressive knowledge of mechanisms regulating muscle mass in health and disease. RECENT FINDINGS: Cancer cachexia is a severely debilitating and life-threatening paraneoplastic syndrome accounting for approximately 20% of cancer deaths. The prominent clinical feature of cancer cachexia is the progressive loss of muscle mass, which is substantially not reversible with any of the currently available nutritional, metabolic or pharmacological approaches. Cancer cachexia has long been considered a late event in the natural history of cancer patients, thus condemning them to merely palliative interventions. The accumulating evidence that the metabolic and molecular derangements ultimately leading to muscle wasting are operating early after tumour onset, even when weight loss is minimal or absent, is strengthening the view that cancer cachexia should be considered an early phenomenon. SUMMARY: Currently, despite scientific and economic efforts, the therapy of cancer-related muscle wasting has a poor success rate. Present knowledge of the intracellular mechanisms involved in muscle homeoastasis is prompting continuous research aimed at developing more effective and selective therapeutic tools for the prevention and treatment of muscle loss in cancer.

Cachexia↗
PubMed2002

Total thyroidectomy for management of benign thyroid disease: review of 526 cases.

Total thyroidectomy is not frequently performed in cases of benign disease because of the associated risk of postoperative hypoparathyroidism and recurrent laryngeal nerve (RLN) damage. We chose a series of patients who had undergone total thyroidectomy (TT) for benign thyroid tumors to evaluate the safety of this approach and its role in the treatment of nonmalignant lesions of the thyroid. We considered only patients with a minimum follow-up of 24 months. Records of 526 patients who underwent TT were carefully reviewed, assessing for perioperative complications and late sequelae. The mean age was 44 +/- 15.7 years; 109 patients (20.7%) were male and 417 (79.3%) were female. Altogether, 65 patients (12.3%) were operated on for toxic goiter, 429 (81.6%) for bilateral nodular goiter, and 32 (6.1%) for thyroiditis. Postoperative hemorrhage requiring reoperation occurred in 8 cases (1.5%). The incidences of permanent RLN palsy (considered as a percentage of the nerves at risk) and permanent hypocalcemia were 0.4% and 3.4%, respectively. A trend toward a decrease in the complication rate was observed during the last 5 years. There were no disease recurrences during a mean follow-up of 44 months. The results of our series show that TT can be performed safely in patients, with a low incidence of lifetime disabilities. TT has the advantage of reducing/avoiding the risk of disease recurrence and reoperation and should therefore be considered a valuable option for treating benign thyroid diseases.

Adult↗
PubMed2002

Minimally invasive video-assisted thyroidectomy: multiinstitutional experience.

Minimally invasive video-assisted thyroidectomy (MIVAT) was described in 1998. In this study we collected the experience of four third-level referral centers that adopted this technique. A total of 336 patients (279 females, 57 males) were selected for MIVAT. Selection criteria were thyroid volume <15 ml, nodules not exceeding 3.5 cm of diameter, and an absence of thyroiditis, previous neck surgery, or previous irradiation. The procedure, totally gasless, is carried out through a 15 mm central incision above the sternal notch. Dissection is performed under endoscopic vision using conventional and endoscopic instruments. The mean operating time was 69.4 +/- 30.6 minutes for lobectomy (range 20-150 minutes) and 87.4 +/- 43.5 minutes for total thyroidectomy (range 30-220 minutes). The mean postoperative stay was 1.9 +/- 0.8 days. Postoperative complications were 7 transient and 1 definitive recurrent nerve palsies and 11 cases of hypoparathyroidism (9 transient, 2 definitive). Conversion to open surgery was necessary in 15 patients (4.5%). This study confirms in a large number of cases the safety and feasibility of MIVAT, even in different surgical settings where similar results were achieved. The complication rate was not different from that of standard thyroidectomy. Although the operating time appears longer than with conventional procedures, the learning curve demonstrates a sharp decrease with increasing experience and the introduction of new technologies. The number of patients eligible for this approach remains low, thereby limiting its use, but it should be considered a valid option in selected surgical centers, offering some advantages to patients in terms of cosmetic results and postoperative distress.

Adolescent↗
PubMed2002

Video-assisted vs conventional thyroid lobectomy: a randomized trial.

HYPOTHESIS: Video-assisted thyroid lobectomy improves the cosmetic outcome of the cutaneous scar and reduces postoperative pain. PARTICIPANTS: Patients admitted to the Division of Endocrine Surgery of the Università Cattolica del Sacro Cuore, Rome, Italy, between March 1999 and December 2000 who were candidates for thyroid lobectomy because of a single, small (< or = 3 cm) thyroid nodule were considered eligible. Of the 62 patients who were randomized, 31 underwent conventional thyroid lobectomy (COS group), and 31 underwent video-assisted surgery without carbon dioxide neck insufflation (VAS group), a new technique created by the authors. RESULTS: The cosmetic outcome was evaluated by scoring patients' satisfaction with their scars. Satisfaction was higher in the VAS group (mean +/- SD, 9.2 +/- 0.5) than the COS group (mean +/- SD, 5.8 +/- 0.7) (P<.001). Postoperative pain in the first and second days after surgery was lower in the VAS group (mean +/- SD, 1.8 +/- 0.2 and 1.2 +/- 0.1, respectively) than in the COS group (mean +/- SD, 6.2 +/- 0.2 and 5.8 +/- 0.2, respectively) (P<.001). There were no significant differences in complications (eg, bleeding, wound infection, permanent recurrent nerve palsy). Postoperative hospital stay was lower in the VAS group (mean +/- SD, 1.1 +/- 0.1 days) than in the COS group (mean +/- SD, 2.2 +/- 0.2 days) (P<.05). CONCLUSION: Video-assisted thyroid lobectomy is a valid alternative to conventional surgery in patients with single, small nodular thyroid lesions.

Cicatrix↗
PubMed2002

Video-assisted thyroidectomy.

OBJECTIVE: In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this paper, we report on the entire series of patients who underwent VAT and discuss the results obtained. METHODS: Seventy-three patients were selected for VAT. Eligibility criteria were: thyroid nodules </=35 mm in maximum diameter; estimated thyroid volume within normal range or slightly enlarged; small, low-risk papillary carcinomas; no previous neck surgery or irradiation and no thyroiditis. The VAT procedure was totally gasless. It was performed under endoscopic vision through a single 1.5 to 2.0-cm skin incision, using a technique very similar to conventional surgery. RESULTS: Eighty-one VATs were attempted on 73 patients. Forty-five lobectomies, 24 total thyroidectomies and eight completion thyroidectomies were successfully performed. Mean operative time was 82 minutes for lobectomy, 100 minutes for total thyroidectomy and 77 minutes for completion thyroidectomy. The conversion rate was 4.9%. Postoperative complications included two transient recurrent nerve palsies, five transient symptomatic postoperative hypocalcaemias and one wound infection. The cosmetic result was considered excellent by most of the patients. CONCLUSION: VAT is a feasible and and safe procedure that allows for excellent cosmetic results. In selected cases, it can be a valid option for the surgical treatment of thyroid diseases.

Adult↗