Publications by authors named "Federico Cappellacci"

: Radiofrequency ablation (RFA) has gained recognition as a minimally invasive alternative to surgery for managing symptomatic benign thyroid nodules. However, predicting RFA efficacy remains challenging, especially in identifying patients who may require multiple treatment sessions. The aim of the present study is to identify predictors of suboptimal volume reduction (SVR), defined as failure to achieve a volume reduction greater than 5% between 6 and 12 months after procedure and persistence of symptoms.

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Post-Traumatic Stress Disorder (PTSD) is a highly debilitating psychiatric disorder, which develops in a subset of trauma-exposed individuals. Patients with PTSD fail to extinguish fear responses to no-longer dangerous stimuli and develop enduring experiences of fear and anxiety. To advance the understanding of PTSD neurobiology, longitudinal and comprehensive clinical and molecular data are needed.

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Splenic rupture is one of the most frequent trauma-related injuries in the general population. While splenic injury is uncommon in pregnant patients, trauma is the leading non-obstetric cause of maternal death and is associated with significant maternal and fetal morbidity and mortality. The most frequent and life-threatening cause of trauma in this population is road traffic accidents.

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Postoperative neck hematoma is an infrequent but potentially fatal complication following thyroidectomy. The main aim of this study was to evaluate the impact of direct oral anticoagulants (DOACs) on the occurrence of this complication. Patients who underwent thyroidectomy between January 2020 and December 2022 in nine high-volume thyroid surgery centers in Europe were retrospectively evaluated.

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In robotic surgery, surgical planning and surgical navigation represent two crucial elements, allowing surgeons to maximize surgical outcomes while minimizing the risk of complications. In this context, an emerging imaging technology, namely augmented reality (AR), can represent a powerful tool to create an integration of preoperative 3D models into the live intraoperative view, providing an interactive visual interface rather than a simple operative field. In this way, surgeons can be guided by preoperative imaging during the operation.

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: The management of lymph node metastases of the central neck compartment (CNC) in differentiated thyroid carcinoma is debated. The intraoperative measurement of thyroglobulin (Tg) has gained attention in accurately detecting metastases, reducing unnecessary CNC dissections. : A total of 37 patients underwent surgery.

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Thyroidectomy is a common procedure in endocrine surgery, frequently performed to treat benign and malignant thyroid conditions. Recurrent laryngeal nerve (RLN) injury, a major complication, underscores the necessity for meticulous nerve dissection during surgery. Intraoperative neuromonitoring (IONM) has emerged as a valuable adjunct to visual identification in RLN preservation.

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Article Synopsis
  • * Out of 357 patients, lobectomies made up 73.9% of thyroid surgeries in 2023, with lobectomy patients typically presenting with larger nodules and indeterminate cytology compared to those opting for total thyroidectomy (TT).
  • * The findings indicate that while TT patients experienced higher lymph node metastasis, the recurrence rates were similar between TT and lobectomy patients, suggesting lobectomy as a safe and effective option that aligns with more conservative surgical practices.
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  • * Out of 3868 patients, a significant percentage were classified as overweight (34.5%) or obese (19.6%), with the majority diagnosed with papillary thyroid carcinoma (93.6%).
  • * Results indicate that overweight and obese patients with papillary thyroid carcinoma have a higher likelihood of AHS, bilateral and multifocal tumours, and larger metastatic nodules; BMI is an independent risk factor regardless of gender, especially in younger patients.
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Introduction: Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature.

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Background: Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence.

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Indeterminate thyroid nodules (ITNs) are characterized by an expected malignancy ranging from 5% to 30%, with most patients undergoing a diagnostic, rather than therapeutic, operation. The aim of our study was to compare the approach to ITNs across different regions of the world. In this retrospective, multicentric, international study, according to the WHO classification, we identified the South East Asian Region (SEAR), the Americas Region (AMR), the Eastern Mediterranean Region (EMR), the Europe Region (EUR), and the Western Pacific Region (WPR).

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Background: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.

Methods: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021.

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The outbreak of the SARS-COVID-2 pandemic (COVID-19) had a significant effect on the organisation of healthcare systems. Surgical units saw a significant reduction in the volume of surgical procedures performed, with lengthening waiting lists as a consequence. We assessed the surgical activity in relation to breast cancer that took place at the University Hospital of Cagliari, Italy, from February 2018 to March 2022.

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Introduction: Superobesity (SO) is defined as a BMI > 50 Kg/m, and represents the extreme severity of the disease, resulting in a challenge for the surgeons.

Methods: In this retrospective study we aimed to compare the outcomes of SO patients compared to morbidly obese (MO) patients.

Results: We included in this study 154 MO patients, with a median preoperative BMI of 40.

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Article Synopsis
  • The ChoCO-W study aimed to examine the effects of COVID-19 on the clinical presentation and outcomes of acute cholecystitis, particularly focusing on the rise of gangrenous cases during the pandemic.
  • Over 2,800 patients from 42 countries were enrolled, with a notable 6.9% testing positive for COVID-19, revealing a significantly higher prevalence of preexisting conditions and more severe outcomes in this group compared to those without the virus.
  • Patients with COVID-19 experienced higher postoperative complications (32.2% vs. 11.7%), longer hospital stays (13.21 days vs. 6.51 days), increased mortality rates (13.4% vs. 1.7
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Background: A growing number of patients taking antiplatelet drugs, mainly low-dose acetylsalicylic acid (ASA) (75-150 mg/day), for primary or secondary prevention of thrombotic events, are encountered in every field of surgery. While the bleeding risk due to the continuation of these medications during the perioperative period has been adequately investigated in several surgical specialties, in thyroid surgery it still needs to be clarified. The main aim of this study was to assess the occurrence of cervical haematoma in patients receiving low-dose acetylsalicylic acid, specifically ASA 100 mg/day, during the perioperative period of thyroidectomy.

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Hashimoto's thyroiditis is the most common cause of hypothyroidism in the iodine-sufficient areas of the world. Differentiated thyroid cancer is the most common thyroid cancer subtype, accounting for more than 95% of cases, and it is considered a tumor with a good prognosis, although a certain number of patients experience a poor clinical outcome. Hashimoto's thyroiditis has been found to coexist with differentiated thyroid cancer in surgical specimens, but the relationship between these two entities has not yet been clarified.

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Background: In thyroid surgery, achieving accurate haemostasis is fundamental in order to avoid the occurrence of complications. Energy-based devices are currently extensively utilized in this field of surgery. This study aims to compare Harmonic Focus and Thunderbeat Open Fine Jaw with regard to surgical outcomes and complications.

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There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim of this study was to investigate this topic. Patients undergoing a thyroidectomy for thyroid nodular disease with an indeterminate cytology in four high-volume thyroid surgery centres in Italy, between January 2017 and December 2020, were retrospectively analysed.

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  • Hypoparathyroidism is a common issue after total thyroidectomy, but there’s no immediate method to predict which patients will have permanent hypoparathyroidism post-surgery.
  • A study of 426 patients categorized them based on their intact parathyroid hormone (iPTH) levels on the first day after surgery, finding significant differences in permanent hypoparathyroidism rates between groups.
  • An iPTH level below 4.6 pg/mL on the first postoperative day accurately indicates a high risk of permanent hypoparathyroidism, with high sensitivity and specificity values, and no patients with levels above 6.5 pg/mL developed this condition.
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Preoperative localisation of pathological glands in patients with primary hyperparathyroidism (PHP) is the mainstay for mini-invasive parathyroidectomy. Nevertheless, a not negligible number of patients presents discordant or negative neck ultrasound (US) and Tc-Sestamibi (MIBI) scan. The aim of this study was to assess if a mini-invasive approach is feasible in this kind of patients.

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Aim: Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy. The aim of the present study was to investigate the risk factors of this complication.

Material And Methods: Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 were retrospectively analysed.

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Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. In the last few decades, the introduction of Rapid Intraoperative Parathyroid Hormone (ioPTH) monitoring has allowed to ensurance of the excision of all hyperfunctioning parathyroid tissues, reducing the risks of persistent and recurrent PHPT. However, the use of ioPTH is still debated among endocrine surgeons.

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Aim: Parathyroid carcinoma (PC) represents a rare cause of primary hyperparathyroidism (PHPT). In this paper, among patients who underwent surgery for PHPT, we compared those with benign parathyroid disease with those affected by PC in terms of demographic and preoperative biochemical features. Moreover, we singularly described all 10 cases of PC treated at our Institution (including a case that occurred in a patient with tertiary hyperparathyroidism) and a brief review of the literature.

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