Italian Society Research Articles

Standards for the Implementation, Analysis, Interpretation, and Reporting of 24-hour Ambulatory Blood Pressure Monitoring Recommendations of the Italian Society of Hypertension.

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is recognized as a reference tool for accurately diagnosing hypertension. Until a few years ago, this technique was restricted to use by specialists. Recently, however, due to the need for wider availability and thanks to technological innovation, simplification of analysis processes, and increasing recognition of the importance of this tool for the diagnosis of hypertension, ABPM is now also being used in non-specialist settings. In such settings, ABPM is used with a two-pronged approach: (i) independently by a general practitioner with the possibility of specialist supervision for particular and complex cases; (ii) in the non-medical setting (community pharmacies, home care services, etc.) where the healthcare provider is trained in the proper use of the technique, with the understanding a physician must be responsible for the final clinical reporting. Unfortunately, due to the increasingly wide diffusion of ABPM, there has been considerable confusion about management roles and responsibilities in recent years. To clarify competencies and roles and standardize the processes related to the technique's implementation and proper management, experts of the Blood Pressure Monitoring Working Group of the Italian Society of Hypertension have drafted this document with the aim of providing a quick and easy reference guide for training healthcare professionals in the field.

Promoting peace in the healthcare sector. What obstacles to overcome?

Modern military strategies, armaments and technologies imply that every war today has a deleterious impact on all determinants of health, with direct and indirect effects that cause physical, mental and social suffering of the exposed population, that extends far beyond the duration of the conflict. The promotion of peace and the prevention of war is therefore clearly one of the professional tasks of health professionals, at least as much as the prevention of other public health risks. Nevertheless, peace promotion and anti-war activities are struggling to take off and spread in the health sector. The article examines two possible factors that stand as obstacles between the realisation of the evil of war, shared by all, and the actual commitment to disarmament and peace, practised by a few. The first of these obstacles is the divergence of views on the methods to choose to prevent conflict. Nonviolence and disarmament or military deterrence? The hypothesis discussed is that the deterrence theory still enjoys a certain credibility even in the medical scientific world although it is far from being an evidence-based strategy. The second obstacle examined is the fear of professionals and their associations of being accused of 'playing politics'. Since war is always a public health catastrophe, when health professionals oppose war, they are only doing their job. However, it is undoubtedly true that preventing war also involves political choices, but this is the case in every other area of public health, which without the use of political and regulatory instruments could not fulfil its task. Lastly, a concrete example of an intervention to promote peace is presented, promoted by several Italian scientific societies in the health field who have succeeded in drawing up a joint declaration in favour of peace and against war, open for subscription also by other scientific societies, journals, associations and foundations in the health sector.

Italian Cardiological Guidelines (COCIS) for Competitive Sport Eligibility in athletes with heart disease: update 2024.

Nearly 35 years after its initial publication in 1989, the Italian Society of Sports Cardiology and the Italian Federation of Sports Medicine (FMSI), in collaboration with other leading Italian Cardiological Scientific Associations (ANCE - National Association of Outpatient Cardiology, ANMCO - National Association of Inpatient Cardiology, SIC - Italian Society of Cardiology), proudly present the 2023 version of the Cardiological Guidelines for Competitive Sports Eligibility. This publication is an update of the previous guidelines, offering a comprehensive and detailed guide for the participation of athletes with heart disease in sports. This edition incorporates the latest advances in cardiology and sports medicine, providing current information and recommendations. It addresses various topics, including the details of the pre-participation screening in Italy and recommendations for sports eligibility and disqualification in competitive athletes with various heart conditions. This revised version of the Cardiological Guidelines for Competitive Sports Eligibility, recorded in the Italian Guidelines Registry of the Italian Minister of Health, stands as a crucial resource for sports medicine professionals, cardiologists, and healthcare providers, marked by its completeness, reliability, and scientific thoroughness. It is an indispensable tool for those involved in the care, management and eligibility process of competitive athletes with heart conditions.

Hypercholesterolemia and laboratory reports: joint document from the Italian Society of Cardiology (SIC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Lab Medicine (SIBioC)

Dyslipidemia is one of the most important risk factors for the development of atherosclerotic disease and its control, through well-proven therapies, allows an optimal risk management over time. LDL-cholesterol targets are well defined by international guidelines and based on individual cardiovascular risk. As guidelines evolve, also laboratory reports need to do the same, including lipid reference values by cardiovascular risk classes, to avoid misunderstandings and inappropriate lipid-lowering therapy withdrawal. The aim of the present joint document from the Italian Society of Cardiology (SIC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Lab Medicine (SIBioC) is to analyze the importance of cardiovascular risk estimation, therapeutical targets, and crucial elements about dyslipidemia in laboratory tests, as well as to suggest a shared proposal for the report of lipid profile parameters to be applied to all clinical scenarios of our daily practice.

The impact of colectomy and restorative procedure on pouch function after ileo-pouch-anal anastomosis in ulcerative colitis. The icon fun study on behalf of the Italian Society of Colon and Rectal Surgery (SICCR) Inflammatory Bowel Diseases committee

BackgroundAvailable guidelines lack in indications on surgical standard in Ulcerative Colitis (UC) AimsTo determine the role of surgical strategies of colectomy and proctectomy with pouch-anal-anastomosis (IPAA) on functional outcomes in a nationwide population multicenter study. The secondary aims consisted of perioperative outcomes and complications. MethodsData on 379 patients who underwent total abdominal colectomy and proctectomy with ileo-pouch-anal-anastomosis (IPAA) with or without diverting ileostomy were retrospectively collected in a red cap multicenter-database searching for variables that could impact on pouch outcomes as cuffitis, pouchitis, anastomotic stenosis, pouch stenosis, failure or pathological Low-Anterior-Resection-Syndrome (LARS) score. ResultsMesocolic dissection sealing vessels at major trunks and from medial to lateral are associated with better outcomes. Laparoscopy is associated with lower rate of cuffitis over time (p = 0.028). Mesentery lengthening is associated with higher pouchitis rate (p = 0.015) and earlier failure (p < 0.0001). Hand-sewn IPAA results in early anastomotic stenosis (p = 0.00011). The Transanal-Transection and Single-Stapling Anastomosis (TTSS) showed to be protective against pouchitis. Extended dissection of adhesions correlates with lower rate of pouchitis-episodes (p = 0.0057). ConclusionsThe study highlights advantages of laparoscopy. New techniques such as TTSS promise further improvements. Mesentery lengthening correlates with high risk of pouch-failure and pouchitis, hand-sewn anastomosis increased risk of stenosis.

Enabling Efficient Verification in a DApp: the Case of Copyright Management

The Interested Party Information (IPI) system uniquely identifies the rights holders worldwide, making it possible to know for each subject and at any time which rights are protected, by whom and for which territories. Currently, this service is provided in a centralized way but, in 2021, Italian Society of Authors and Editors (SIAE) deployed a blockchain-based solution to completely decentralize this database to a) provide greater guarantees to the rights holders as well as to end users and b) make a first tangible step in the path towards an all in-chain solution decentralizing a relevant component of the current architecture. Such solution relied on early versions of Algorand smart contracts, delegating in many practical scenarios, some off-chain verification to trusted third parties. In the meanwhile, the Algorand technology developed new tools, allowing us to design new techniques to reduce some of the trust assumptions of the original solution and enhance at the same time its efficiency. In this paper, we present the evolution of the solutions we designed to issue new on-chain non-conflicting rights representations, namely representations that are consistent with the ones already available on-chain. Our solution relies on smart contracts that have been implemented to run our experiments to prove a) the feasibility of the proposed approach, b) the scalability of the proposed solutions and c) the sustainability in terms of costs.

Allergic rhinitis management: a survey on Italian primary care pediatricians.

Background. Allergic rhinitis (AR) is a widespread condition. The Italian Society of Pediatric Allergology and Immunology (SIAIP) promoted an initiative to update the knowledge on AR in children and adolescents. The present survey directly addressed primary care pediatricians, thus reflecting the real-world management of AR in children and adolescents. The aim was to investigate common practice in managing AR children. Methods. A panel of experts drafted a series of questions concerning the practical management of children with AR in clinical practice. The questionnaire was administered to a large sample of primary care pediatricians (864). Results. 864 primary care pediatricians participated to the survey. Each pediatrician on average follows 94 children with AR; globally 81,231 children. More than 70% of participants follow ARIA guidelines. Accordingly, 42% of children have mild AR and 58% moderate/severe. Asthma, conjunctivitis and adenoid hypertrophy are the most common comorbidity. Most pediatricians autonomously follow their patients. The intensity of treatment (use of medication) is directly proportional to the symptom severity. Intranasal corticosteroids are the most common medication used followed by oral antihistamines and nasal lavages (with hypertonic or isotonic solution). Up to 20% of participants prescribe the fixed association topical corticosteroids plus antihistamine. Conclusions. The present survey demonstrated that Italian primary care pediatricians accomplish ARIA guidelines and adapt treatment on the basis of the intensity of symptoms. Corticosteroids and antihistamines are the most common prescribed medications. Nasal lavages are also popular.

Palliative care in patients with hepatocellular carcinoma: Results from a survey among hepatologists and palliative care physicians

Background: Delays and limitations of palliative care in patients with liver transplantation-ineligible end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines. Aim: To assess physicians’ attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists. Design: Members of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant-ineligible end-stage hepatocellular carcinoma. Participants: Physician members of the of the two associations, representing several hospitals and services in the country. Results: Ninety-seven hepatologists and 70 palliative care physicians completed the survey: >80% regularly follow 1–19 patients; 58% of hepatologists collaborate with palliative care physicians in the management of patients, 55% of palliative care physicians take care of patients without the aid of hepatologists. Management of cirrhosis differed significantly between the two groups in terms of prescription of albumin, esophagogastroduodenoscopy, anti-viral treatment, anticoagulation, indication to paracentesis and management of encephalopathy. Full-dose acetaminophen is widely used among hepatologists, while opioids are commonly used by both categories, at full dosage, regardless of liver function. Conclusions: This survey highlights significant differences in the approach to patients with liver transplantation-ineligible end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.

Management of analgosedation during noninvasive respiratory support: an expert Delphi consensus document developed by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

BackgroundDiscomfort can be the cause of noninvasive respiratory support (NRS) failure in up to 50% of treated patients. Several studies have shown how analgosedation during NRS can reduce the rate of delirium, endotracheal intubation, and hospital length of stay in patients with acute respiratory failure. The purpose of this project was to explore consensus on which medications are currently available as analgosedatives during NRS, which types of patients may benefit from analgosedation while on NRS, and which clinical settings might be appropriate for the implementation of analgosedation during NRS.MethodsThe Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) selected a panel of experts and asked them to define key aspects of the use of analgesics and sedatives during NRS treatment. The methodology applied is in line with the principles of the modified Delphi and RAND-UCLA methods. The experts developed statements and supportive rationales which were then subjected to blind votes for consensus.ResultsThe use of an analgosedation strategy in adult patients with acute respiratory failure of different origins may be useful where there is a need to manage discomfort. This strategy should be considered after careful assessment of other potential factors associated with respiratory failure or inappropriate noninvasive respiratory support settings, which may, in turn, be responsible for NRS failure. Several drugs can be used, each of them specifically targeted to the main component of discomfort to treat. In addition, analgosedation during NRS treatment should always be combined with close cardiorespiratory monitoring in an appropriate clinical setting.ConclusionsThe use of analgosedation during NRS has been studied in several clinical trials. However, its successful application relies on a thorough understanding of the pharmacological aspects of the sedative drugs used, the clinical conditions for which NRS is applied, and a careful selection of the appropriate clinical setting.

ABSTRACTS OF THE 34th ANNUAL MEETING OF THE ITALIAN SOCIETY OF URO-ONCOLOGY (SIUrO)

ABSTRACTS OF THE 34th ANNUAL MEETING OF THE ITALIAN SOCIETY OF URO-ONCOLOGY (SIUrO)

2024 National Congress of the Italian Society of Hypertension (SIIA).

2024 National Congress of the Italian Society of Hypertension (SIIA).

Nutritional assessment and medical dietary therapy for management of obesity in patients with non-dialysis chronic kidney disease: a practical guide for endocrinologist, nutritionists and nephrologists. A consensus statement from the Italian society of endocrinology (SIE), working group of the club nutrition-hormones and metabolism; the Italian society of nutraceuticals (SINut), club ketodiets and nutraceuticals "KetoNut-SINut"; and the Italian society of nephrology

Chronic kidney disease (CKD) is a serious health concern with an estimated prevalence of about 13.4% worldwide. It is cause and consequence of various comorbidities, including cardiovascular diseases. In parallel, common pathological conditions closely related to ageing and unhealthy dietary habits increase the risk of CKD development and progression, including type 2 diabetes and obesity. Among these, obesity is either independent risk factor for new onset kidney disease or accelerates the rate of decline of kidney function by multiple mechanisms. Therefore, the role of diets aimed at attaining weight loss in patients with obesity is clearly essential to prevent CKD as to slow disease progression. Various dietary approaches have been licensed for the medical dietary therapy in CKD, including low-protein diet and Mediterranean diet. Interestingly, emerging evidence also support the use of low-carbohydrate/ketogenic diet (LCD/KD) in these patients. More specifically, LCD/KDs may efficiently promote weight loss, improve metabolic parameters, and reduce inflammation and oxidative stress, resulting in a dietary strategy that act globally in managing collateral conditions that are directly and indirectly related to the kidney function. This consensus statement from the Italian Society of Endocrinology (SIE), working group of the Club Nutrition - Hormones and Metabolism; the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut"; and the Italian Society of Nephrology (SIN) is intended to be a guide for Endocrinologist, Nutritionists and Nephrologist who deal with the management of patients with obesity with non-dialysis CKD providing a practical guidance on assessing nutritional status and prescribing the optimal diet in order to best manage obesity to prevent CKD and its progression to dialysis.

Surface Reconstruction from SLAM-Based Point Clouds: Results from the Datasets of the 2023 SIFET Benchmark

The rapid technological development that geomatics has been experiencing in recent years is leading to increasing ease, productivity and reliability of three-dimensional surveys, with portable laser scanner systems based on Simultaneous Localization and Mapping (SLAM) technology, gradually replacing traditional techniques in certain applications. Although the performance of such systems in terms of point cloud accuracy and noise level has been deeply investigated in the literature, there are fewer works about the evaluation of their use for surface reconstruction, cartographic production, and as-built Building Information Model (BIM) creation. The objective of this study is to assess the suitability of SLAM devices for surface modeling in an urban/architectural environment. To this end, analyses are carried out on the datasets acquired by three commercial portable laser scanners in the context of a benchmark organized in 2023 by the Italian Society of Photogrammetry and Topography (SIFET). In addition to the conventional point cloud assessment, we propose a comparison between the reconstructed mesh and a ground-truth model, employing a model-to-model methodology. The outcomes are promising, with the average distance between models ranging from 0.2 to 1.4 cm. However, the surfaces modeled from the terrestrial laser scanning point cloud show a level of detail that is still unmatched by SLAM systems.

The motivations for a women's series

The sources often speak of the world of women in an indirect, cross-cutting way, since over the centuries women have played social, legal, economic and cultural roles that are not always evident. Only in a few cases can gender studies boast of archives and libraries of exclusively female provenance: even with reference to recent periods, their number is small, either because of conservative conduct anchored in outdated historiographical hierarchies or as a result of women's lesser aptitude for documenting their existence and their role in society, expressing a difficulty in considering themselves as agent subjects in history. It is precisely on this side that the organization of the cycle Profiles of Women among Papers and Books was oriented, with which the aim was to illustrate to a wide audience the lives of some female figures and institutions that represent, or have represented, at several levels’ Italian society and culture through the cognitive lens of their papers and books.

The Minimal assessment Protocol for Cerebral Stroke 2020 (PMIC2020): a multicenter feasibility study in post-stroke inpatient rehabilitation.

In 2008, a Working Group of the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the first minimum protocol for assessing stroke patients (PMIC) to define functional needs and outcomes. The recent PMIC revision (PMIC2020) introduces a document for all rehabilitation settings, incorporating updated measurement tools. The aim of this study was to investigate the PMIC2020 feasibility and administration time (AT) in post-stroke inpatients and to examine the influence of demographic and clinical variables on AT. Multicenter prospective observational study. Eight Italian rehabilitation centers for post-acute inpatients. Adult patients consecutively admitted to rehabilitation after ischemic/hemorrhagic stroke, reporting the first event or recurrence, with a modified Barthel Index (mBI)<75 points, without cognitive impairment and clinical instability. PMIC2020 was administered at admission (T0) and discharge (T1), recording AT of each section/ tool. A feasibility questionnaire was administered to assessors. Univariate and multivariate analyses were conducted to investigate the effect of demographics and clinical variables on AT. One hundred fifty-one subjects were enrolled at T0 and 139 at T1; the mean±SD AT (seconds) was 1634±401 at T0 and 1087±360 at T1 (P<0.001). National Institute of Health-Stroke Scale and Mini-Mental State Examination required the highest AT. All but two scales had significantly lower AT at T1 (P<0.05). Severe disability (as measured by mBI) was associated with higher AT than either complete or minimal/absent disability. The feasibility questionnaire showed good PMIC2020 appraisal by assessors without relevant critical issues. PMIC2020 was feasible in post-acute inpatient rehabilitation settings. No relevant critical issue was raised by users. Even though more comprehensive than PMIC, PMIC2020 required only slightly more AT (27 minutes at T0 and 18 minutes at T1, on average); more AT was needed to assess patients with severe disability. The study has immediate transferability for the National Health Service, as PMIC2020 can be routinely implemented in clinical practice and research to assess stroke patients' needs and outcomes. The updated measures allow more immediate comparisons with international data on stroke rehabilitation. Future research should investigate the PMIC2020 feasibility in other rehabilitation settings and its relevance in predicting stroke rehabilitation needs and outcomes.

Risk perceptions of Italian paediatricians for the impact of climate change on children’s health

BackgroundsThis study delves into the risk perceptions of Italian pediatricians concerning climate change's impact on children's health. Given children's heightened vulnerability to climate-related health risks, comprehending these perceptions is crucial. A review of pertinent literature establishes the framework, emphasizing six key factors influencing children's susceptibility to climate-related health hazards.MethodsMethodologically, the study utilized a survey tool developed collaboratively with the Italian Society of Pediatrics (SIP), garnering responses from a representative sample of Italian pediatricians.ResultsFindings indicate a high level of awareness among respondents regarding climate change and its health implications, with a majority attributing it primarily to human activity. Pediatricians recognize various current and anticipated health impacts of climate change, notably concerning illnesses linked to outdoor air quality. Despite acknowledging their role in addressing climate-related health concerns, respondents also cite barriers to engagement, including time constraints and knowledge gaps. However, they express interest in resources like professional training and policy statements to bolster their capacity for effective communication and advocacy.ConclusionsComparisons with prior studies highlight the consistency of findings across diverse contexts and underscore the significance of integrating climate and environmental health education into medical training. Overall, this study sheds light on pediatricians' perspectives in tackling the convergence of climate change and children's health, pinpointing avenues for enhancing their involvement in climate advocacy and mitigation efforts.

Delirium Incidence and Predictors in SARS-CoV-2 Vaccinated Residents in Long-Term Care Facilities (LTCF): Insights from the GeroCovid Vax Study

ObjectiveSARS-CoV-2 vaccination can bring an important benefit for older people in terms of reduction of mortality and hospitalization; however, reports of rare adverse effects like altered consciousness and delirium among this demographic have raised concerns. This study aimed to assess delirium incidence post-SARS-CoV-2 vaccination and its predictors in older residents across 60 Italian long-term care facilities (LTCFs). DesignThis is a prospective cohort study considering data from GeroCovid Vax, a multicenter cohort study jointly performed by the Italian Society of Gerontology and Geriatrics (SIGG) (Florence, Italy) and the Italian National Institute of Health (Istituto Superiore di Sanità—ISS, Rome, Italy), and sponsored by the Italian Medicines Agency (Agenzia Italiana del Farmaco—AIFA). Setting and ParticipantsGeroCovid Vax enrolled LTCFs residents aged ≥60 who received at least 1 anti–SARS-CoV-2 vaccine dose. MethodsBaseline data covered sociodemographic details, chronic diseases, medications, nutritional status, cognitive and functional assessments, mobility, and frailty. Delirium was assessed post-first, second, and booster vaccine doses using DSM-5 criteria. Data analysis involved descriptive statistics, multivariate logistic regression, and network analysis. ResultsA total of 2521 participants (mean age 83.10 ± 9.21 years, 70.7% female) were analyzed. Delirium incidence post-first, second, and booster doses was 3.5%, 1.6%, and 1.5%, respectively. Age, preexisting cognitive disorders, and frailty were significant predictors of delirium, with odds ratios (ORs) of 1.70 (95% CI, 1.08–2.77), 2.05 (95% CI, 1.40–2.97), and 1.77 (95% CI, 1.25–2.52), respectively. Prior use of antipsychotics (OR, 1.75; 95% CI, 1.22–2.51) and antidepressants (OR, 1.77; 95% CI, 1.25–2.52) correlated significantly with delirium. Network analysis indicated a strong association between anorexia and delirium. Conclusion and ImplicationsPost-vaccination delirium is infrequent and decreases with subsequent doses. Timely assessments for frailty and cognitive impairment could aid in stratifying delirium risk among LTCF residents, facilitating enhanced prevention measures and close monitoring for delirium indicators.

Inter-societal Delphi Consensus on the topical nasal treatments in Italy.

Topical nasal therapy is widely used in clinical practice by different specialists. However, it is multifaceted and still controversial. Namely, there is no consensus about the many aspects, and there needs to be specific guidelines. Four independent experts involved 14 Italian scientific societies (concerning ENT, allergy, and pediatrics areas) to participate in generating an Intersocietal Delphi Consensus on this matter. Three iterative rounds collected experts (4 in the first round, 20 in the second round, and 45 in the third round) designed by the scientific societies based on their clinical expertise and documented scientific value. Thirty-four statements were discussed and voted on. At the second round, all statements accomplished a very high consensus grade (>95%). At the third round, many statements reached a high or very high grade of consensus (>70%). However, some statements did not obtain sufficient agreement. Consequently, there is a need to implement knowledge about this issue through educational initiatives and new studies conducted with a robust methodology. In conclusion, topical nasal therapy deserves adequate knowledge as it is widespread and fruitful in managing upper respiratory diseases.

Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology

The Italian Society of Nephrology has tasked its Working Group on Physical Exercise with developing a consensus statement document on physical activity and exercise in patients with chronic kidney disease (CKD). This paper consists of 16 points that were discussed, and approved using the mini-Delphi method by 15 members of the working group. Each statement is based on a comprehensive review of the literature, clinical experience, and expert opinions. Overall, the statements affirm that regular physical activity and exercise training offer numerous benefits to CKD patients, including improved physical function, enhanced cardiometabolic and neuromuscular function, cognitive benefits, and an overall improvement in quality of life. Furthermore, exercise may provide nephroprotection and reduce mortality. These advantages are observed across all CKD stages, whether on conservative therapy or kidney replacement therapy (hemodialysis or peritoneal dialysis), and in kidney transplant recipients. Moreover, when physical activity and exercise training are implemented with appropriate precautions, they are safe in CKD patients. Gradual physical activity and customized exercise programs should be tailored to the patient's exercise tolerance, potentially enhancing compliance. Clinicians are encouraged to use a series of questionnaires and tests to assess the patient's level of physical activity and performance. However, exercise and physical activity are poorly implemented in clinical practice due to many barriers related to patients and healthcare staff. Overcoming these barriers requires the proactive role of the nephrologists, who should actively incorporate exercise training and promote physical activity within routine care plans. Adopting a multidisciplinary team approach, which includes nephrologists, nurses, exercise professionals, and dietitians, is crucial for providing comprehensive rehabilitation for CKD patients. Integrating new technologies and remote check ups could further enhance the effectiveness of these interventions.Graphical abstract

403. ROBOTIC-ASSISTED IVOR LEWIS ESOPHAGECTOMY COMPARED TO CONVENTIONAL MINIMALLY INVASIVE ESOPHAGECTOMY: RESULTS FROM SEVEN HIGH VOLUME ITALIAN CENTERS

Abstract Background Over the past decade, minimally invasive esophagectomy has gained increasing attention, supported by numerous trials and retrospective series highlighting its advantages over the traditional open approach. In addition to the conventional minimally invasive surgery (CMIE), robotic assisted minimally invasive esophagectomy (RAMIE) has gained global popularity, due to its advantages in terms of 3D visualization and instrument stability. Methods This is a collaborative study involving seven high-volume Italian centers affiliated with the Italian Society for the Study of Esophageal Diseases (SISME). Patients who underwent Ivor Lewis esophagectomy for esophageal cancer between January 2015 and July 2022 were identified from seven institutional databases and divided in two groups according to the thoracic approach: CMIE versus RAMIE. Results We identified 316 patients in CMIE and 123 in RAMIE group. Operative time was significantly longer for RAMIE procedures (p&amp;lt;0.001). A borderline significant reduction in overall complication rate was observed (48% vs 59% in CMIE group, p=0.045), however there were no differences in severe (p=0.3) and pulmonary (p=0.13) complications rate. 90-day mortality (CMIE 3.2% vs RAMIE 0.8%, p=0.15) and readmission rate (CMIE 9.5% vs RAMIE 7.3%, p=0.47) were comparable. R0 rate was 94.9% in CMIE vs 92.7% in RAMIE (p=0.4). The most performed anastomosis was circular stapled anastomosis. Anastomotic leak rate was 13.9% for CMIE and 12.2% for RAMIE (p=0.6). Conclusion Minimally invasive Ivor Lewis esophagectomy has reached adequate surgical and oncological results with both conventional and robotic technique. Nowadays there is no clear superiority of one anastomotic technique.