Teresa Perra
Università di Sassari, Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Graduate Student
I was born in Cagliari (Italy) on 12th September, 1992.
I graduated in Medicine and Surgery at University of Cagliari (Italy) on 20th February, 2018.
I graduated in General Surgery at University of Sassari (Italy) on 14th November, 2023.
General Surgeon at Azienda Ospedaliero Universitaria di Sassari, Italy
ORCID ID: https://orcid.org/0000-0001-7032-1289
I graduated in Medicine and Surgery at University of Cagliari (Italy) on 20th February, 2018.
I graduated in General Surgery at University of Sassari (Italy) on 14th November, 2023.
General Surgeon at Azienda Ospedaliero Universitaria di Sassari, Italy
ORCID ID: https://orcid.org/0000-0001-7032-1289
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Papers by Teresa Perra
Abstract: In this article, the authors focus their attention on the issue related to the right to health and its application in the field of surgery during the COVID-19 pandemic. Each of them explores the questions underlying the topic in accordance to their competences. The health emergency poses numerous challenges and moving in this scenario is not easy for health professionals. In order to understand how the health emergency can be managed without sacrificing individuals’ right to health, it is essential to analyse the recommendations developed in the specific sector of surgery. Finally, the authors underline the importance of the scientific research that becomes the beacon that illuminates the road ahead in the middle of the COVID-19 pandemic.
Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them.
Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training.
Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.
Findings: Of eligible patients awaiting surgery, 2003 (10•0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0•6% non-operation rate (26 of 4521), moderate lockdowns with a 5•5% rate (201 of 3646; adjusted hazard ratio [HR] 0•81, 95% CI 0•77-0•84; p<0•0001), and full lockdowns with a 15•0% rate (1775 of 11 827; HR 0•51, 0•50-0•53; p<0•0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0•84, 95% CI 0•80-0•88; p<0•001), and full lockdowns (0•57, 0•54-0•60; p<0•001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9•1%] of 4521 in light restrictions, 317 [10•4%] of 3646 in moderate lockdowns, 2001 [23•8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays.
Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and longterm investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Dear Colleagues,
Pancreatic surgery (PS) is one of the most technically challenging kinds of surgery. Several surgical techniques and different anastomosis for the reconstruction of the digestive system have been performed over the years. PS has been adapted to treat different pancreatic diseases (e.g. cancer, acute or chronic pancreatitis, cysts). Various factors influence cancer recurrance, morbidity and mortality after PS, as scientific literature shows. The most common and clinically relevant complications are related to pancreaticojejunal anastomosis. The choice between neoadjuvant therapy and upfront surgery is dibated, in particular in case of vascular reconstruction. Resectability criteria, absolute and relative contraindications to PS are re-evaluated in the light of new scientific evidence. There are still many unanswered questions and further studies are needed to better manage and treat surgical patients with pancreatic disease. The scope of this Special Issue is to provide an overview of the global advancement of surgical research and clinical practice in the field of PS. Therefore, researchers in the field of PS are encouraged to share their experiences and discuss surgical approaches, submitting an original article or review to this Special Issue.
Guest editors:
Dr. Teresa Perra
Prof. Dr. Alberto Porcu
A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".
Deadline for manuscript submissions: 20 July 2022.
Design: REDcap online-based survey of hospital capacity.
Setting: UK secondary and tertiary hospitals providing head and neck cancer surgery.
Participants: One representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution.
Main outcome measures: The principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de-escalated surgery and therapeutic migration to non-surgical primary modality.
Results: Data were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy-based treatment instead of surgery, and 12% have received de-escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre-pandemic level) compared with the first wave (62%) despite the time to prepare.
Conclusions: Some hospitals are overwhelmed by COVID-19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately redirected away from the hospitals most constrained by their burden of COVID-19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients.
Abstract: In this article, the authors focus their attention on the issue related to the right to health and its application in the field of surgery during the COVID-19 pandemic. Each of them explores the questions underlying the topic in accordance to their competences. The health emergency poses numerous challenges and moving in this scenario is not easy for health professionals. In order to understand how the health emergency can be managed without sacrificing individuals’ right to health, it is essential to analyse the recommendations developed in the specific sector of surgery. Finally, the authors underline the importance of the scientific research that becomes the beacon that illuminates the road ahead in the middle of the COVID-19 pandemic.
Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them.
Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training.
Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.
Findings: Of eligible patients awaiting surgery, 2003 (10•0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0•6% non-operation rate (26 of 4521), moderate lockdowns with a 5•5% rate (201 of 3646; adjusted hazard ratio [HR] 0•81, 95% CI 0•77-0•84; p<0•0001), and full lockdowns with a 15•0% rate (1775 of 11 827; HR 0•51, 0•50-0•53; p<0•0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0•84, 95% CI 0•80-0•88; p<0•001), and full lockdowns (0•57, 0•54-0•60; p<0•001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9•1%] of 4521 in light restrictions, 317 [10•4%] of 3646 in moderate lockdowns, 2001 [23•8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays.
Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and longterm investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Dear Colleagues,
Pancreatic surgery (PS) is one of the most technically challenging kinds of surgery. Several surgical techniques and different anastomosis for the reconstruction of the digestive system have been performed over the years. PS has been adapted to treat different pancreatic diseases (e.g. cancer, acute or chronic pancreatitis, cysts). Various factors influence cancer recurrance, morbidity and mortality after PS, as scientific literature shows. The most common and clinically relevant complications are related to pancreaticojejunal anastomosis. The choice between neoadjuvant therapy and upfront surgery is dibated, in particular in case of vascular reconstruction. Resectability criteria, absolute and relative contraindications to PS are re-evaluated in the light of new scientific evidence. There are still many unanswered questions and further studies are needed to better manage and treat surgical patients with pancreatic disease. The scope of this Special Issue is to provide an overview of the global advancement of surgical research and clinical practice in the field of PS. Therefore, researchers in the field of PS are encouraged to share their experiences and discuss surgical approaches, submitting an original article or review to this Special Issue.
Guest editors:
Dr. Teresa Perra
Prof. Dr. Alberto Porcu
A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".
Deadline for manuscript submissions: 20 July 2022.
Design: REDcap online-based survey of hospital capacity.
Setting: UK secondary and tertiary hospitals providing head and neck cancer surgery.
Participants: One representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution.
Main outcome measures: The principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de-escalated surgery and therapeutic migration to non-surgical primary modality.
Results: Data were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy-based treatment instead of surgery, and 12% have received de-escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre-pandemic level) compared with the first wave (62%) despite the time to prepare.
Conclusions: Some hospitals are overwhelmed by COVID-19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately redirected away from the hospitals most constrained by their burden of COVID-19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients.
Organizan y Auspician: Ministerio de Salud Pública de la República de Cuba, Organización Mundial de la Salud/Organización Panamericana de la Salud, Consejo Nacional de Sociedades Científicas de la Salud de Cuba, Escuela Nacional de Salud Pública de Cuba, Academia de Ciencias de Cuba, Sindicato Nacional de Trabajadores de la Salud, Cámara de Comercio de la República de Cuba, Ministerio de Relaciones Exteriores, Ministerio de Comercio Exterior y la Inversión Extranjera, Ministerio de Turismo, Universidad de Ciencias Médicas de La Habana, Sociedad Cubana de Salud Pública, Sociedad Cubana de Higiene y Epidemiología, Sociedad Cubana de Informática Médica, Sociedad Cubana de Geriatría y Gerontología, Sociedad Cubana de Educadores en Ciencias de la Salud, Sociedad Cubana de Medicina Familiar, Organización Superior de Dirección Empresarial BioCubaFarma,
Palacio de Convenciones de La Habana, Unión de Universidades de América Latina,
Alianza de Sociedades de Salud Pública para Las Américas, Fondo de Población de las Naciones Unidas (UNFPA) Cuba.
Nell’ambito della IV Convención Internacional “Cuba-Salud 2022”, tenutasi dal 17 al 21 ottobre 2022, nel Palacio de Convenciones de La Habana, Cuba, si è svolto l'Encuentro Internacional “Sistemas y Servicios de Salud”, Simposio Determinantes Sociales de la Salud y Políticas Públicas;
Ponentes: Livio Perra e Teresa Perra;
Titolo ponencia: “La tutela del derecho a la salud en cirugía en Italia: los desafíos de la pandemia de COVID-19”,
Viernes 21, h. 12:50, SESIÓN DE LA MAÑANA, SALA 13.
Il Programa Científico è disponibile al seguente link: https://convencionsalud.sld.cu/index.php/convencionsalud22/2022/pages/view/programa Si veda: p. 93.
Flash-Talks of selected posters
Flash Talk: The impact of sarcopenia on the risk of postoperative pancreatic fistula after pancreatoduodenectomy (ID 279 | P76)
Teresa Perra, Alberto Porcu
FRIDAY, FEB 11, 2022 h 12:35 Poster Lounge 8
Poster presentations
The impact of sarcopenia on the risk of postoperative pancreatic fistula after pancreatoduodenectomy (P76 | ID 279)
Teresa Perra, Alberto Porcu
Mercoledì 1 dicembre 2021 Ore 17:30
Titoli interventi:
Livio Perra, I diritti della natura
Teresa Perra, Chirurgia generale durante la pandemia di COVID-19
Valentina Talu (DADU): Verso la costruzione di città autism-friendly
Antonio Brunetti (Dip. Scienze CC.FF.MM.NN.): Una nuova visione sulla metallurgia nuragica
Vanessa Lozano (Dip. Agraria): Utilizzo della Citizen Science per migliorare le conoscenze sulla distribuzione di specie invasive
Matteo Garau (Dip. Agraria): Scelte etiche per la Salute del Suolo: valorizzazione delle filiere agro-alimentari per un’agricoltura eco-sostenibile
Livio Perra (DISSUF): Il genocidio culturale
Teresa Perra (Dip. Sc. Mediche Chirurgiche e Sperim.): I progressi della chirurgia oncologica
Beatrice Groppa (studentessa DISSUF): “Le Orecchie a cotoletta”: divagazione sul pipistrello sardo
Programma disponibile al seguente link: https://www.uniss.it/node/13667
Talk:
Teresa Perra, La chirurgia oncologica;
Vanessa Lozano, Le specie aliene invasive;
Livio Perra, I diritti della natura.
Sassari, 24/09/2021 h. 16:30 – 17:00
Spazio ScienzArena, atrio del Palazzo dell’Università degli Studi di Sassari
Brevi talk divulgativi da parte dei partecipanti a FameLab 2021.
Talk:
1. Le piante aliene di Vanessa;
2. Nicola e l'apprendimento da fenomeni;
3. Lucia e i suoi studi sulla fatica;
4. Livio e i diritti della natura;
5. La fisiologia del sorriso di Francesca;
6. Luigi e la ricerca in pandemia;
7. Teresa e la chirurgia oncologica.
Sassari, 23/09/2021 h. 19:30 - 21:30