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1. Radical Resection in Entero-Pancreatic Neuroendocrine Tumors: Recurrence-Free Survival Rate and Definition of a Risk Score for Recurrence

Author

Merola, E, Pascher, A, Rinke, A, Bartsch, D K, Zerbi, A, Nappo, G, Carnaghi, C, Ciola, M, McNamara, M G, Zandee, W, Bertani, E, Marcucci, S, Modica, R, Grützmann, R, Fazio, N, de Herder, W, Valle, J W, Gress, T M, Fave, G Delle, de Pretis, G, Perren, A, Wiedenmann, B, Pavel, M E, Internal Medicine, Merola, E., Pascher, A., Rinke, A., Bartsch, D. K., Zerbi, A., Nappo, G., Carnaghi, C., Ciola, M., Mcnamara, M. G., Zandee, W., Bertani, E., Marcucci, S., Modica, R., Gruetzmann, R., Fazio, N., de Herder, W., Valle, J. W., Gress, T. M., Fave, G. Delle, de Pretis, G., Perren, A., Wiedenmann, B., and Pavel, M. E.

Subjects
Pancreatic Neoplasms, Survival Rate, Neuroendocrine Tumors, Oncology, Risk Factors, Humans, Surgery, Neoplasm Recurrence, Local, 610 Medizin und Gesundheit, Prognosis, 570 Biowissenschaften, Biologie, Retrospective Studies
Abstract

BACKGROUND: Surgery with radical intent is the only potentially curative option for entero-pancreatic neuroendocrine tumors (EP-NETs) but many patients develop recurrence even after many years. The subset of patients at high risk of disease recurrence has not been clearly defined to date.OBJECTIVE: The aim of this retrospective study was to define, in a series of completely resected EP-NETs, the recurrence-free survival (RFS) rate and a risk score for disease recurrence.PATIENTS AND METHODS: This was a multicenter retrospective analysis of sporadic pancreatic NETs (PanNETs) or small intestine NETs (SiNETs) [G1/G2] that underwent R0/R1 surgery (years 2000-2016) with at least a 24-month follow-up. Survival analysis was performed using the Kaplan-Meier method and risk factor analysis was performed using the Cox regression model.RESULTS: Overall, 441 patients (224 PanNETs and 217 SiNETs) were included, with a median Ki67 of 2% in tumor tissue and 8.2% stage IV disease. Median RFS was 101 months (5-year rate 67.9%). The derived prognostic score defined by multivariable analysis included prognostic parameters, such as TNM stage, lymph node ratio, margin status, and grading. The score distinguished three risk categories with a significantly different RFS (p < 0.01).CONCLUSIONS: Approximately 30% of patients with EP-NETs recurred within 5 years after radical surgery. Risk factors for recurrence were disease stage, lymph node ratio, margin status, and grading. The definition of risk categories may help in selecting patients who might benefit from adjuvant treatments and more intensive follow-up programs.

Published
2022

2. ASO Visual Abstract

Author

Merola, E, Pascher, A, Rinke, A, Bartsch, D K, Zerbi, A, Nappo, G, Carnaghi, C, Ciola, M, McNamara, M G, Zandee, W, Bertani, E, Marcucci, S, Modica, R, Grützmann, R, Fazio, N, de Herder, W, Valle, J W, Gress, T M, Delle Fave, G, de Pretis, G, Perren, A, Wiedenmann, B, Pavel, M E, Internal Medicine, Merola, E., Pascher, A., Rinke, A., Bartsch, D. K., Zerbi, A., Nappo, G., Carnaghi, C., Ciola, M., Mcnamara, M. G., Zandee, W., Bertani, E., Marcucci, S., Modica, R., Gruetzmann, R., Fazio, N., de Herder, W., Valle, J. W., Gress, T. M., Delle Fave, G., de Pretis, G., Perren, A., Wiedenmann, B., and Pavel, M. E.

Subjects
Pancreatic Neoplasms, Survival Rate, Neuroendocrine Tumors, Oncology, Risk Factors, 570 Life sciences, biology, Humans, Surgery, Neoplasm Recurrence, Local, 610 Medicine & health, Prognosis, Disease-Free Survival, Retrospective Studies
Published
2022

3. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author

Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., and De Peppo V.

Abstract

Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods: This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results: 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p<0.001). Conclusion: Curative approaches may guarantee long-term survival in case of recurrence.

Published
2021

4. The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Author

Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, Conticchio, M, Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D. P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., Grazi G. L., Valle R. D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M. G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., Conticchio M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, Conticchio, M, Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D. P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., Grazi G. L., Valle R. D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M. G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., and Conticchio M.

Abstract

Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41–71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921–1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295–0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.

Published
2021

5. The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Author

Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D'Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., Troci, A., Delvecchio, A., Floridi, A., Bernasconi, D. P., Fumagalli, L., Chiarelli, M., Memeo, R., Crespi, M., Zanus, G., Zimmitti, G., Antonucci, A., Zago, M., Frena, A., Griseri, G., Tarchi, P., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Grazi, G. L., Valle, R. D., Giuliante, F., Aldrighetti, L., Romano, F., Torzilli, G., Costa, G., Ciulli, C., Giani, A., Ratti, F., Bellobono, M., Cremaschi, E., Valsecchi, M. G., De Peppo, V., Calabrese, F., Desario, G., Lazzari, G., Cucchetti, A., Cosola, D., Percivale, A., Ciola, M., Montuori, M., Frassani, S., Manzoni, A., Salvador, L., Pennacchi, L., Corleone, P., Conticchio, M., Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D'Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., Troci, A., Delvecchio, A., Floridi, A., Bernasconi, D. P., Fumagalli, L., Chiarelli, M., Memeo, R., Crespi, M., Zanus, G., Zimmitti, G., Antonucci, A., Zago, M., Frena, A., Griseri, G., Tarchi, P., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Grazi, G. L., Valle, R. D., Giuliante, F., Aldrighetti, L., Romano, F., Torzilli, G., Costa, G., Ciulli, C., Giani, A., Ratti, F., Bellobono, M., Cremaschi, E., Valsecchi, M. G., De Peppo, V., Calabrese, F., Desario, G., Lazzari, G., Cucchetti, A., Cosola, D., Percivale, A., Ciola, M., Montuori, M., Frassani, S., Manzoni, A., Salvador, L., Pennacchi, L., Corleone, P., Conticchio, M., Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D.P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G.L., Ruzzenente A., Jovine E., Maestri M., Grazi G.L., Valle R.D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M.G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., Conticchio M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, and Conticchio, M

Subjects
Laparoscopic surgery, medicine.medical_specialty, endocrine system, Carcinoma, Hepatocellular, Disease-free survival, Hepatocellular carcinoma, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, 030230 surgery, NO, Liver surgery, Overall survival, Postoperative ascites, Postoperative complications, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Ascites, Risk of mortality, Medicine, Hepatectomy, Humans, Survival analysis, LS7_4, Retrospective Studies, business.industry, Proportional hazards model, Carcinoma, Liver Neoplasms, Gastroenterology, Hepatocellular, medicine.disease, Surgery, Postoperative complication, Postoperative ascite, Neoplasm Recurrence, Local, 030220 oncology & carcinogenesis, Ascite, medicine.symptom, Neoplasm Recurrence, Local, business, Complication, Varices, Human
Abstract

Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41–71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921–1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295–0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.

Published
2021

6. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

Author

Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Carissimi, F, Perri, P, Iaria, M, Dominioni, T, Zanello, M, Conci, S, Molfino, S, Labarba, G, Ferrari, C, Germani, P, Patauner, S, Pinotti, E, Lodo, E, Garatti, M, Sciannamea, I, Troci, A, Conticchio, M, Floridi, A, Chiarelli, M, Fumagalli, L, Memeo, R, Crespi, M, Antonucci, A, Zimmitti, G, Zanus, G, Zago, M, Frena, A, Tarchi, P, Griseri, G, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, Ciulli, C, Giani, A, Costa, G, Ratti, F, Bellobono, M, Calabrese, F, Cremaschi, E, De Peppo, V, Cucchetti, A, Lazzari, G, Percivale, A, Ciola, M, Sega, V, Frassani, S, Del Vecchio, A, Pennacchi, L, Corleone, P, Cosola, D, Salvador, L, Montuori, M, Famularo S., Donadon M., Cipriani F., Ardito F., Carissimi F., Perri P., Iaria M., Dominioni T., Zanello M., Conci S., Molfino S., LaBarba G., Ferrari C., Germani P., Patauner S., Pinotti E., Lodo E., Garatti M., Sciannamea I., Troci A., Conticchio M., Floridi A., Chiarelli M., Fumagalli L., Memeo R., Crespi M., Antonucci A., Zimmitti G., Zanus G., Zago M., Frena A., Tarchi P., Griseri G., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., DallaValle R., Grazi G. L., Giuliante F., Aldrighetti L., Torzilli G., Romano F., Bernasconi D. P., Ciulli C., Giani A., Costa G., Ratti F., Bellobono M., Calabrese F., Cremaschi E., De Peppo V., Cucchetti A., Lazzari G., Percivale A., Ciola M., Sega V., Frassani S., Del Vecchio A., Pennacchi L., Corleone P., Cosola D., Salvador L., Montuori M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Carissimi, F, Perri, P, Iaria, M, Dominioni, T, Zanello, M, Conci, S, Molfino, S, Labarba, G, Ferrari, C, Germani, P, Patauner, S, Pinotti, E, Lodo, E, Garatti, M, Sciannamea, I, Troci, A, Conticchio, M, Floridi, A, Chiarelli, M, Fumagalli, L, Memeo, R, Crespi, M, Antonucci, A, Zimmitti, G, Zanus, G, Zago, M, Frena, A, Tarchi, P, Griseri, G, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, Ciulli, C, Giani, A, Costa, G, Ratti, F, Bellobono, M, Calabrese, F, Cremaschi, E, De Peppo, V, Cucchetti, A, Lazzari, G, Percivale, A, Ciola, M, Sega, V, Frassani, S, Del Vecchio, A, Pennacchi, L, Corleone, P, Cosola, D, Salvador, L, Montuori, M, Famularo S., Donadon M., Cipriani F., Ardito F., Carissimi F., Perri P., Iaria M., Dominioni T., Zanello M., Conci S., Molfino S., LaBarba G., Ferrari C., Germani P., Patauner S., Pinotti E., Lodo E., Garatti M., Sciannamea I., Troci A., Conticchio M., Floridi A., Chiarelli M., Fumagalli L., Memeo R., Crespi M., Antonucci A., Zimmitti G., Zanus G., Zago M., Frena A., Tarchi P., Griseri G., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., DallaValle R., Grazi G. L., Giuliante F., Aldrighetti L., Torzilli G., Romano F., Bernasconi D. P., Ciulli C., Giani A., Costa G., Ratti F., Bellobono M., Calabrese F., Cremaschi E., De Peppo V., Cucchetti A., Lazzari G., Percivale A., Ciola M., Sega V., Frassani S., Del Vecchio A., Pennacchi L., Corleone P., Cosola D., Salvador L., and Montuori M.

Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020

7. Performance of comprehensive complication index and clavien‐dindo complication scoring system in liver surgery for hepatocellular carcinoma

Author

Giani, A, Cipriani, F, Famularo, S, Donadon, M, Bernasconi, D, Ardito, F, Fazio, F, Nicolini, D, Perri, P, Giuffrida, M, Pontarolo, N, Zanello, M, Lai, Q, Conci, S, Molfino, S, Germani, P, Pinotti, E, Romano, M, La Barba, G, Ferrari, C, Patauner, S, Manzoni, A, Sciannamea, I, Fumagalli, L, Troci, A, Ferraro, V, Floridi, A, Memeo, R, Crespi, M, Chiarelli, M, Antonucci, A, Zimmitti, G, Frena, A, Percivale, A, Ercolani, G, Zanus, G, Zago, M, Tarchi, P, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Valle, R, Grazi, G, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Gianotti, L, Romano, F, Ciulli, C, Braga, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, De Peppo, V, Cremaschi, E, Calabrese, F, Laureiro, Z, Lazzari, G, Cosola, D, Montuori, M, Salvador, L, Cucchetti, A, Franceschi, A, Ciola, M, Sega, V, Calcagno, P, Pennacchi, L, Tedeschi, M, Giani A., Cipriani F., Famularo S., Donadon M., Bernasconi D. P., Ardito F., Fazio F., Nicolini D., Perri P., Giuffrida M., Pontarolo N., Zanello M., Lai Q., Conci S., Molfino S., Germani P., Pinotti E., Romano M., La Barba G., Ferrari C., Patauner S., Manzoni A., Sciannamea I., Fumagalli L., Troci A., Ferraro V., Floridi A., Memeo R., Crespi M., Chiarelli M., Antonucci A., Zimmitti G., Frena A., Percivale A., Ercolani G., Zanus G., Zago M., Tarchi P., Baiocchi G. L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Valle R. D., Grazi G. L., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Gianotti L., Romano F., Ciulli C., Braga M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., De Peppo V., Cremaschi E., Calabrese F., Laureiro Z. L., Lazzari G., Cosola D., Montuori M., Salvador L., Cucchetti A., Franceschi A., Ciola M., Sega V., Calcagno P., Pennacchi L., Tedeschi M., Giani, A, Cipriani, F, Famularo, S, Donadon, M, Bernasconi, D, Ardito, F, Fazio, F, Nicolini, D, Perri, P, Giuffrida, M, Pontarolo, N, Zanello, M, Lai, Q, Conci, S, Molfino, S, Germani, P, Pinotti, E, Romano, M, La Barba, G, Ferrari, C, Patauner, S, Manzoni, A, Sciannamea, I, Fumagalli, L, Troci, A, Ferraro, V, Floridi, A, Memeo, R, Crespi, M, Chiarelli, M, Antonucci, A, Zimmitti, G, Frena, A, Percivale, A, Ercolani, G, Zanus, G, Zago, M, Tarchi, P, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Valle, R, Grazi, G, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Gianotti, L, Romano, F, Ciulli, C, Braga, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, De Peppo, V, Cremaschi, E, Calabrese, F, Laureiro, Z, Lazzari, G, Cosola, D, Montuori, M, Salvador, L, Cucchetti, A, Franceschi, A, Ciola, M, Sega, V, Calcagno, P, Pennacchi, L, Tedeschi, M, Giani A., Cipriani F., Famularo S., Donadon M., Bernasconi D. P., Ardito F., Fazio F., Nicolini D., Perri P., Giuffrida M., Pontarolo N., Zanello M., Lai Q., Conci S., Molfino S., Germani P., Pinotti E., Romano M., La Barba G., Ferrari C., Patauner S., Manzoni A., Sciannamea I., Fumagalli L., Troci A., Ferraro V., Floridi A., Memeo R., Crespi M., Chiarelli M., Antonucci A., Zimmitti G., Frena A., Percivale A., Ercolani G., Zanus G., Zago M., Tarchi P., Baiocchi G. L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Valle R. D., Grazi G. L., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Gianotti L., Romano F., Ciulli C., Braga M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., De Peppo V., Cremaschi E., Calabrese F., Laureiro Z. L., Lazzari G., Cosola D., Montuori M., Salvador L., Cucchetti A., Franceschi A., Ciola M., Sega V., Calcagno P., Pennacchi L., and Tedeschi M.

Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien‐Dindo complication (CDC) scale to predict excessive length of hospital stay (e‐LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi‐institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e‐LOS were fitted to compare predictive performance. E‐LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020

8. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

Author

Famularo, S., Donadon, M., Cipriani, Fabrizio, Ardito, Francesco, Carissimi, F., Perri, Pierluigi, Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, Anna Maria, Zimmitti, Giuseppe, Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, Marta, Dallavalle, R., Grazi, G. L., Giuliante, Felice, Aldrighetti, L., Torzilli, Guido, Romano, Federica, Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, Giovanni, Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, Arianna, Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., Montuori, M., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Ardito, Francesco, Carissimi, Francesca, Perri, Pasquale, Iaria, Maurizio, Dominioni, Tommaso, Zanello, Matteo, Conci, Simone, Molfino, Sarah, LaBarba, Giuliano, Ferrari, Cecilia, Germani, Paola, Patauner, Stefan, Pinotti, Enrico, Lodo, Enrico, Garatti, Marco, Sciannamea, Ivano, Troci, Albert, Conticchio, Maria, Floridi, Antonio, Chiarelli, Marco, Fumagalli, Luca, Memeo, Riccardo, Crespi, Michele, Antonucci, Adelmo, Zimmitti, Giuseppe, Zanus, Giacomo, Zago, Mauro, Frena, Antonio, Tarchi, Paola, Griseri, Guido, Ercolani, Giorgio, Baiocchi, Gian Luca, Ruzzenente, Andrea, Jovine, Elio, Maestri, Marcello, DallaValle, Raffaele, Grazi, Gian Luca, Giuliante, Felice, Aldrighetti, Luca, Torzilli, Guido, Romano, Fabrizio, Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Carissimi, F., Perri, P., Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, A., Zimmitti, G., Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Dallavalle, R., Grazi, G. L., Giuliante, F., Aldrighetti, L., Torzilli, G., Romano, F., Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, G., Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, A., Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., and Montuori, M.

Subjects
Male, Cirrhosis, Outcome Assessment, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Datasets as Topic, HERCOLES, Hepatocarcinoma recurrence, Liver surgery, Redo surgery, Outcome Assessment, Health Care, Ascites, Registries, Laparoscopy, education.field_of_study, medicine.diagnostic_test, Liver Neoplasms, Middle Aged, Italy, Local, Radiological weapon, Female, medicine.symptom, Reoperation, medicine.medical_specialty, Carcinoma, Hepatocellular, Population, NO, Internal medicine, medicine, Hepatectomy, Humans, education, LS7_4, Aged, business.industry, Carcinoma, Hepatocellular, Perioperative, Hepatology, medicine.disease, Surgery, Health Care, Neoplasm Recurrence, Neoplasm Recurrence, Local, business
Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power. Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020

10. Performance of comprehensive complication index and clavien‐dindo complication scoring system in liver surgery for hepatocellular carcinoma

Author

Giani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., Ferrari, C., Patauner, S., Manzoni, A., Sciannamea, I., Fumagalli, L., Troci, A., Ferraro, V., Floridi, A., Memeo, R., Crespi, M., Chiarelli, M., Antonucci, A., Zimmitti, G., Frena, A., Percivale, A., Ercolani, G., Zanus, G., Zago, M., Tarchi, P., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Vivarelli, M., Ferrero, A., Giuliante, F., Torzilli, G., Aldrighetti, L., Gianotti, L., Romano, F., Ciulli, C., Braga, M., Ratti, F., Costa, G., Razionale, F., Russolillo, N., Marinelli, L., De Peppo, V., Cremaschi, E., Calabrese, F., Laureiro, Z. L., Lazzari, G., Cosola, D., Montuori, M., Salvador, L., Cucchetti, A., Franceschi, A., Ciola, M., Sega, V., Calcagno, P., Pennacchi, L., Tedeschi, M., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., Manzoni A., Antonucci A., Zimmitti G. (ORCID:0000-0003-4925-4012), Maestri M., Vivarelli M. (ORCID:0000-0002-8746-9324), Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Romano F., Razionale F., Lazzari G., Giani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., Ferrari, C., Patauner, S., Manzoni, A., Sciannamea, I., Fumagalli, L., Troci, A., Ferraro, V., Floridi, A., Memeo, R., Crespi, M., Chiarelli, M., Antonucci, A., Zimmitti, G., Frena, A., Percivale, A., Ercolani, G., Zanus, G., Zago, M., Tarchi, P., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Vivarelli, M., Ferrero, A., Giuliante, F., Torzilli, G., Aldrighetti, L., Gianotti, L., Romano, F., Ciulli, C., Braga, M., Ratti, F., Costa, G., Razionale, F., Russolillo, N., Marinelli, L., De Peppo, V., Cremaschi, E., Calabrese, F., Laureiro, Z. L., Lazzari, G., Cosola, D., Montuori, M., Salvador, L., Cucchetti, A., Franceschi, A., Ciola, M., Sega, V., Calcagno, P., Pennacchi, L., Tedeschi, M., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., Manzoni A., Antonucci A., Zimmitti G. (ORCID:0000-0003-4925-4012), Maestri M., Vivarelli M. (ORCID:0000-0002-8746-9324), Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Romano F., Razionale F., and Lazzari G.

Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien‐Dindo complication (CDC) scale to predict excessive length of hospital stay (e‐LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi‐institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e‐LOS were fitted to compare predictive performance. E‐LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020

11. Surgical treatment for liver metastases from colorectal carcinoma: results of 228 patients

Author

Nicoli, N., Casaril, A., Mangiante, G., Ciola, M., Hilal, M. A., and Marchiori, L.

Subjects
Adult, Male, Risk Assessment, Cohort Studies, Sex Factors, Antineoplastic Combined Chemotherapy Protocols, Hepatectomy, Humans, Infusions, Intra-Arterial, Hospital Mortality, Aged, Neoplasm Staging, Retrospective Studies, Aged, 80 and over, Liver Neoplasms, Age Factors, colorectal liver metastases, liver resection, radiofrequency thermal ablation, Middle Aged, Survival Analysis, radiofrequency thermal ablation, colorectal liver metastases, Chemotherapy, Adjuvant, liver resection, Catheter Ablation, Female, Colorectal Neoplasms, Follow-Up Studies
Abstract

Liver metastases are a very common event. Multiple choices of therapies can be used. The aim of this paper is to analyze results and methods of a single institution series of 228 consecutive patients with colorectal liver metastases.228 consecutive patients underwent hepatic resection for colorectal liver metastases. From different periods intraoperative ultrasound, intraoperative histological examination, locoregional intra-arterial chemotherapy, and radiofrequency thermal ablation were introduced.Operative mortality was 0.9%. Mean follow-up was 29.5 months. Overall survival was 16% and 9% at 5 and 10 years. 5-year survival was 23% and 6% for patients with single and multiple metastases respectively. For patients with extrahepatic metastatic single lesion 5-year survival was 15%. From the start of intraoperative ultrasound use, 5-year survival was 9% and 27% for patients with multiple and single metastases. Five-year survival for re-resected patients was 13%. Overall survival at 1 and 3 years was 90% and 58% in patients treated with HAI and systemic chemotherapy (disease-free 70% and 47%) and 94% and 12% in patients treated with systemic chemotherapy alone after radical resection (disease-free 53% and 0%).Aggressive approach, re-resections, intraoperative ultrasound staging, intra-arterial chemotherapy and radiofrequency thermal ablation are justified in multimodal therapeutic strategy of colorectal metastases and seem to improve patients' survival.

Published
2004

15. Performance of comprehensive complication index and clavien‐dindo complication scoring system in liver surgery for hepatocellular carcinoma

Author

Valentina Sega, Francesca Ratti, Daniele Nicolini, Giorgio Ercolani, Michele Crespi, Matteo Donadon, Valerio De Peppo, Nadia Russolillo, Antonio Floridi, Matteo Zanello, Luca Pennacchi, Marcello Maestri, Mauro Montuori, Ivano Sciannamea, Cristina Ciulli, Mario Giuffrida, Mauro Zago, A. Frena, Felice Giuliante, Albert Troci, Luca Fumagalli, Valentina Ferraro, Giovanni Lazzari, Marco Chiarelli, Sarah Molfino, Simone Famularo, Andrea Ruzzenente, Alessandro Cucchetti, Giuseppe Zimmitti, Raffaele Dalla Valle, Davide Paolo Bernasconi, Paola Tarchi, Maurizio Romano, Massimo Rossi, Alessandro Giani, Luca Gianotti, Luca Salvador, Enrico Pinotti, Davide Cosola, Fabrizio Romano, Marco Braga, Luca Aldrighetti, Giuliano La Barba, Federico Fazio, Gian Luca Baiocchi, Alessandro Ferrero, Elena Cremaschi, Francesco Razionale, Federica Cipriani, Guido Torzilli, A. Antonucci, Alberto Manzoni, Cecilia Ferrari, Pasquale Perri, Stefan Patauner, Laura Marinelli, Francesco Ardito, Gian Luca Grazi, Simone Conci, Paola Germani, Nicholas Pontarolo, Giacomo Zanus, Quirino Lai, Michele Ciola, Guido Costa, Marco Vivarelli, Zoe Larghi Laureiro, Elio Jovine, Francesco Calabrese, Andrea Percivale, Riccardo Memeo, Michele Tedeschi, Pietro Calcagno, Angelo Franceschi, Giani A., Cipriani F., Famularo S., Donadon M., Bernasconi D.P., Ardito F., Fazio F., Nicolini D., Perri P., Giuffrida M., Pontarolo N., Zanello M., Lai Q., Conci S., Molfino S., Germani P., Pinotti E., Romano M., La Barba G., Ferrari C., Patauner S., Manzoni A., Sciannamea I., Fumagalli L., Troci A., Ferraro V., Floridi A., Memeo R., Crespi M., Chiarelli M., Antonucci A., Zimmitti G., Frena A., Percivale A., Ercolani G., Zanus G., Zago M., Tarchi P., Baiocchi G.L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Valle R.D., Grazi G.L., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Gianotti L., Romano F., Ciulli C., Braga M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., De Peppo V., Cremaschi E., Calabrese F., Laureiro Z.L., Lazzari G., Cosola D., Montuori M., Salvador L., Cucchetti A., Franceschi A., Ciola M., Sega V., Calcagno P., Pennacchi L., Tedeschi M., Giani, A, Cipriani, F, Famularo, S, Donadon, M, Bernasconi, D, Ardito, F, Fazio, F, Nicolini, D, Perri, P, Giuffrida, M, Pontarolo, N, Zanello, M, Lai, Q, Conci, S, Molfino, S, Germani, P, Pinotti, E, Romano, M, La Barba, G, Ferrari, C, Patauner, S, Manzoni, A, Sciannamea, I, Fumagalli, L, Troci, A, Ferraro, V, Floridi, A, Memeo, R, Crespi, M, Chiarelli, M, Antonucci, A, Zimmitti, G, Frena, A, Percivale, A, Ercolani, G, Zanus, G, Zago, M, Tarchi, P, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Valle, R, Grazi, G, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Gianotti, L, Romano, F, Ciulli, C, Braga, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, De Peppo, V, Cremaschi, E, Calabrese, F, Laureiro, Z, Lazzari, G, Cosola, D, Montuori, M, Salvador, L, Cucchetti, A, Franceschi, A, Ciola, M, Sega, V, Calcagno, P, Pennacchi, L, Tedeschi, M, Giani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., Ferrari, C., Patauner, S., Manzoni, A., Sciannamea, I., Fumagalli, L., Troci, A., Ferraro, V., Floridi, A., Memeo, R., Crespi, M., Chiarelli, M., Antonucci, A., Zimmitti, G., Frena, A., Percivale, A., Ercolani, G., Zanus, G., Zago, M., Tarchi, P., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Vivarelli, M., Ferrero, A., Giuliante, F., Torzilli, G., Aldrighetti, L., Gianotti, L., Romano, F., Ciulli, C., Braga, M., Ratti, F., Costa, G., Razionale, F., Russolillo, N., Marinelli, L., De Peppo, V., Cremaschi, E., Calabrese, F., Laureiro, Z. L., Lazzari, G., Cosola, D., Montuori, M., Salvador, L., Cucchetti, A., Franceschi, A., Ciola, M., Sega, V., Calcagno, P., Pennacchi, L., and Tedeschi, M.

Subjects
Liver surgery, Cancer Research, medicine.medical_specialty, Percentile, Clavien-Dindo Classification, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Performance, Logistic regression, lcsh:RC254-282, Article, NO, Clavien‐Dindo classification, Comprehensive complication index, Length of stay, Morbidity, 03 medical and health sciences, 0302 clinical medicine, Clavien-Dindo classification, Medicine, Derivation, LS7_4, business.industry, Odds ratio, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Surgery, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Complication
Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201, 7.438) for CCI and 5.507 (4.152, 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896, 4.115) for CCI and 2.439 (1.666, 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020

16. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author

Simone Famularo, Matteo Donadon, Federica Cipriani, Davide P. Bernasconi, Giuliano LaBarba, Tommaso Dominioni, Maurizio Iaria, Sarah Molfino, Simone Conci, Cecilia Ferrari, Marco Garatti, Antonella Delvecchio, Albert Troci, Stefan Patauner, Silvia Frassani, Maurizio Cosimelli, Giacomo Zanus, Felice Giuliante, Elio Jovine, Maria G. Valsecchi, GianLuca Grazi, Adelmo Antonucci, Antonio Frena, Michele Crespi, Riccardo Memeo, Giuseppe Zimmitti, Guido Griseri, Andrea Ruzzenente, Gianluca Baiocchi, Raffaele DallaValle, Marcello Maestri, Giorgio Ercolani, Luca Aldrighetti, Guido Torzilli, Fabrizio Romano, Cristina Ciulli, Alessandro Giani, Francesca Carissimi, Guido Costa, Francesca Ratti, Alessandro Cucchetti, Francesco Calabrese, Elena Cremaschi, Giovanni Lazzari, Angelo Franceschi, Valentina Sega, Maria Conticchio, Luca Pennacchi, Michele Ciola, Ivano Sciannamea, Valerio De Peppo, Famularo S., Donadon M., Cipriani F., Bernasconi D.P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M.G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Bernasconi, Davide P, Labarba, Giuliano, Dominioni, Tommaso, Iaria, Maurizio, Molfino, Sarah, Conci, Simone, Ferrari, Cecilia, Garatti, Marco, Delvecchio, Antonella, Troci, Albert, Patauner, Stefan, Frassani, Silvia, Cosimelli, Maurizio, Zanus, Giacomo, Giuliante, Felice, Jovine, Elio, Valsecchi, Maria G, Grazi, Gianluca, Antonucci, Adelmo, Frena, Antonio, Crespi, Michele, Memeo, Riccardo, Zimmitti, Giuseppe, Griseri, Guido, Ruzzenente, Andrea, Baiocchi, Gianluca, Dallavalle, Raffaele, Maestri, Marcello, Ercolani, Giorgio, Aldrighetti, Luca, Torzilli, Guido, and Romano, Fabrizio

Subjects
Sorafenib, medicine.medical_specialty, recurrence, Carcinoma, Hepatocellular, Tumor burden, 030230 surgery, liver, Gastroenterology, NO, 03 medical and health sciences, 0302 clinical medicine, hepatectomy, Retrospective Studie, Internal medicine, Humans, Medicine, Chemoembolization, Therapeutic, Liver surgery, Retrospective Studies, LS7_4, Hepatology, business.industry, Palliative Care, Liver Neoplasms, hepatocellular carcinoma, medicine.disease, Recurrent Hepatocellular Carcinoma, multicentric, Treatment Outcome, Time to recurrence, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Liver function, Neoplasm Recurrence, Local, business, medicine.drug, Human
Abstract

Background Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p Conclusion Curative approaches may guarantee long-term survival in case of recurrence.

Published
2021

17. Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma.

Author

Giani A, Cipriani F, Famularo S, Donadon M, Bernasconi DP, Ardito F, Fazio F, Nicolini D, Perri P, Giuffrida M, Pontarolo N, Zanello M, Lai Q, Conci S, Molfino S, Germani P, Pinotti E, Romano M, La Barba G, Ferrari C, Patauner S, Manzoni A, Sciannamea I, Fumagalli L, Troci A, Ferraro V, Floridi A, Memeo R, Crespi M, Chiarelli M, Antonucci A, Zimmitti G, Frena A, Percivale A, Ercolani G, Zanus G, Zago M, Tarchi P, Baiocchi GL, Ruzzenente A, Rossi M, Jovine E, Maestri M, Dalla Valle R, Grazi G, Vivarelli M, Ferrero A, Giuliante F, Torzilli G, Aldrighetti L, Gianotti L, Romano F, Ciulli C, Braga M, Ratti F, Costa G, Razionale F, Russolillo N, Marinelli L, De Peppo V, Cremaschi E, Calabrese F, Larghi Laureiro Z, Lazzari G, Cosola D, Montuori M, Salvador L, Cucchetti A, Franceschi A, Ciola M, Sega V, Calcagno P, Pennacchi L, and Tedeschi M

Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma., Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication., Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set., Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020
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18. Clinical complexity and hospital admissions in the December holiday period.

Author

Lenti MV, Klersy C, Brera AS, Musella V, Benedetti I, Padovini L, Ciola M, Croce G, Ballesio A, Gorgone MF, Bertolino G, Di Sabatino A, and Corazza GR

Subjects
Age Factors, Aged, Aged, 80 and over, Area Under Curve, Case-Control Studies, Female, Hospital Mortality, Humans, Length of Stay, Longitudinal Studies, Male, Middle Aged, Odds Ratio, Poverty, Prospective Studies, ROC Curve, Risk Factors, Seasons, Hospitalization statistics & numerical data
Abstract

Background: Christmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period., Methods: This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed., Results: Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10-3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality., Conclusions: Patients hospitalized during the December holiday period had worse health outcomes, and this could be attributable to the grater CC, especially related to socioeconomic (social deprivation, low income) and behavioral factors (inappropriate diet). The evaluation of all CC components could potentially represent a useful tool for a more rational resource allocation over this time of the year., Competing Interests: The authors have declared that no competing interests exist.

Published
2020
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20. Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk Factors.

Author

Valerio L, Ambaglio C, Barone M, Ciola M, Konstantinides SV, Mahmoudpour SH, Picchi C, Pieresca C, Trinchero A, and Barco S

Abstract

Background  It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently associated with a lower risk of recurrence in all patients, or represents a marker of the presence and severity of provoking factors for venous thromboembolism (VTE). Methods  We investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent VTE, including proximal DVT and PE. Results  A total of 205 (24.7%) patients presented with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03-0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28-1.78]). Conclusions  The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer.

Published
2019
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