Francesco Barberini

Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.

Sentinel lymph node biopsy is fundamental in the staging of primary cutaneous melanoma (PCL), but reported lymphoscintigraphic patterns are very heterogeneous. In this systematic review, we evaluated the role of the popliteal station in below-knee PCL. A systematic search of literature through was conducted on the electronic databases PubMed, SCOPUS, and Web of Science (WOS) to identify eligible studies. A total of 22 studies (n=5673 patients) were included. During the analysis of the included articles, it was not possible to classify patients into the 3 Menes popliteal drainage pattern, obtained by lymphoscintigraphy. The analysis of lymphatic drainage in patients undergoing lymphoscintigraphy for melanoma of the lower extremities below the knee was reported in 5637 patients and the type of lymphatic popliteal drainage was reported only in 5.64% (320 patients). The rate of popliteal lymph nodes melanoma metastases was 1.49%: they were located exclusively at the popliteal level in 0.60%, at the popliteal and inguinal levels in 0.39%, at the popliteal and iliac level in 0.02%, and at the groin level in 0.48%. In conclusion, the most common lymphoscintigraphic pattern is represented by popliteal nodes in-transit or interval nodes, so metastases from below-knee melanomas commonly transit through popliteal nodes stations and arrive to inguinal nodes stations. The popliteal nodes are the primary station in about 5.64% of cases. Larger studies are needed to corroborate these findings.

Synchronous primary lung cancers (SPLCs) may pose a radiologic-pathologic and therapeutic dilemma in according to recent WHO classification. Two cases of surgically treated SPLCs are reported. In the first case two nodules were detected by Computed Tomography (CT) in the upper right lobe. The patient underwent lobectomy and histological diagnosis was adenocarcinoma and squamous cell carcinoma. The second patient presented at CT one nodule in the upper left lobe and another nodule in the upper right lobe. Sternotomic access was chosen for bilateral removal of the lesions. The diagnosis was sarcomatoid carcinoma and large cell neuroendocrine adenocarcinoma. The criteria of Martini and Melamed are inadequate for the diagnosis of SPLCs. The use of TTF-1 (thyroid transcription factor-1) is necessary to establish the diagnosis of SPLC in patients with adenocarcinoma of other sites. Bronchioloalveolar carcinomas must be excluded because of their multicentricity. When histology of two tumors found in the same lobe is identical and histotype is adenocarcinoma, large cell carcinoma or sarcomatoid carcinoma, the diagnosis of SPLCs must be excluded and those lesions must be considered as metastatic disease. The prognosis and treatment of SPLCs are discussed after critical review of the literature.