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52. Pathways sustaining HDV activity act independently from the size of HBV resevoir and are fueled by an abundant expression of HBsAg from integrated HBV-DNA

Author

Salpini, R., D'Anna, S., Piermatteo, L., Teti, E., Di Lorenzo, A., Brancaccio, G., Torre, G., Malagnino, V., Iannetta, M., Ceccherini-Silberstein, F., Pasquazzi, C., Cillo, U., Vitale, A., Gringeri, E., Magrofuoco, M., Pacenti, M., Baiocchi, L., Francioso, S., Lenci, I., Geretti, A.M., Abate, M.L., Olivero, A., Gaeta, G.B., Sarmati, L., Rizzetto, M., Caviglia, G.P., and Svicher, V.

Published
2024
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58. Laparoscopic liver resection of hepatocellular carcinoma located in unfavorable segments: a propensity score-matched analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry

Author

Levi Sandri, G, Ettorre, G, Aldrighetti, L, Cillo, U, Dalla Valle, R, Guglielmi, A, Mazzaferro, V, Ferrero, A, Di Benedetto, F, Gruttadauria, S, De Carlis, L, Vennarecci, G, Antonucci, A, Belli, G, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Colledan, M, Coratti, A, Ferla, F, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Iaria, M, Jovine, E, Magistri, P, Maida, P, Mezzatesta, P, Russolillo, N, Navarra, G, Parisi, A, Pinna, A, Ratti, F, Rossi, G, Ruzzenente, A, Santambrogio, R, Scotti, A, Sgroi, G, Slim, A, Torzilli, G, Vincenti, L, Virdis, M, Zamboni, F, Levi Sandri G. B., Ettorre G. M., Aldrighetti L., Cillo U., Dalla Valle R., Guglielmi A., Mazzaferro V., Ferrero A., Di Benedetto F., Gruttadauria S., De Carlis L., Vennarecci G., Antonucci A., Belli G., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Colledan M., Coratti A., Ferla F., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Iaria M., Jovine E., Magistri P., Maida P., Mezzatesta P., Russolillo N., Navarra G., Parisi A., Pinna A. D., Ratti F., Rossi G. E., Ruzzenente A., Santambrogio R., Scotti A., Sgroi G., Slim A., Torzilli G., Vincenti L., Virdis M., Zamboni F., Levi Sandri, G, Ettorre, G, Aldrighetti, L, Cillo, U, Dalla Valle, R, Guglielmi, A, Mazzaferro, V, Ferrero, A, Di Benedetto, F, Gruttadauria, S, De Carlis, L, Vennarecci, G, Antonucci, A, Belli, G, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Colledan, M, Coratti, A, Ferla, F, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Iaria, M, Jovine, E, Magistri, P, Maida, P, Mezzatesta, P, Russolillo, N, Navarra, G, Parisi, A, Pinna, A, Ratti, F, Rossi, G, Ruzzenente, A, Santambrogio, R, Scotti, A, Sgroi, G, Slim, A, Torzilli, G, Vincenti, L, Virdis, M, Zamboni, F, Levi Sandri G. B., Ettorre G. M., Aldrighetti L., Cillo U., Dalla Valle R., Guglielmi A., Mazzaferro V., Ferrero A., Di Benedetto F., Gruttadauria S., De Carlis L., Vennarecci G., Antonucci A., Belli G., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Colledan M., Coratti A., Ferla F., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Iaria M., Jovine E., Magistri P., Maida P., Mezzatesta P., Russolillo N., Navarra G., Parisi A., Pinna A. D., Ratti F., Rossi G. E., Ruzzenente A., Santambrogio R., Scotti A., Sgroi G., Slim A., Torzilli G., Vincenti L., Virdis M., and Zamboni F.

Abstract

Objective: Laparoscopic liver resection (LLR) for Hepatocellular Carcinoma (HCC) is one of the most important indications for the minimally invasive approach. Our study aims to analyze the experience of the Italian Group of Minimally Invasive Liver Surgery with laparoscopic surgical treatment of HCC, with a focus on tumor location and how it affects morbidity and mortality. Methods: 38 centers participated in this study; 372 cases of LLR for HCC were prospectively enrolled. Patients were divided into two groups according to the HCC nodule location. Group 1 favorable location and group 2 unfavorable location. Perioperative outcomes were compared between the two groups before and after a propensity score match (PS) 1:1. Results: Before PS in group 2 surgical time was longer; conversion rate was higher; postoperative transfusion and comprehensive complication index were also higher. PS was performed with a cohort of 298 patients (from 18 centers), with 66 and 232 patients with HCC in unfavorable and favorable locations, respectively. After PS matching, 62 patients from group 1 and group 2 each were compared. Operative and postoperative course were similar in patients with HCC in favorable and unfavorable LLR locations. Surgical margins were found to be identical before and after PS. Conclusions: These results show that LLR in patients with HCC can be safely performed in all segments because of the extensive experience of all surgeons from multiple centers in performing traditional open liver surgery as well as laparoscopic surgery.

Published
2019

59. A national mandatory-split liver policy: A report from the Italian experience

Author

Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A, Cillo, U, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., Cillo U., Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A, Cillo, U, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., and Cillo U.

Abstract

To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially “splittable” donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P =.009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P =.045]). The pediatric (4.5% vs 2.5% [P =.398]) and adult (9.7% to 5.2% [P <.001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P =.035) and recipient weight >20 kg (HR = 5.113, P =.048) in LLS, and ischemic time >8 hours (HR = 2.475, P =.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.

Published
2019

61. Targeted therapies for extrahepatic cholangiocarcinoma: preclinical and clinical development and prospects for the clinic

Author

Cadamuro, M, Lasagni, A, Lamarca, A, Fouassier, L, Guido, M, Sarcognato, S, Gringeri, E, Cillo, U, Strazzabosco, M, Marin, J, Banales, J, Fabris, L, Marin, JJG, Banales, JM, Cadamuro, M, Lasagni, A, Lamarca, A, Fouassier, L, Guido, M, Sarcognato, S, Gringeri, E, Cillo, U, Strazzabosco, M, Marin, J, Banales, J, Fabris, L, Marin, JJG, and Banales, JM

Abstract

Introduction: Until recently, cholangiocarcinoma (CCA) was a largely overlooked disease, and among CCAs, extrahepatic CCA (eCCA) was even more neglected. Despite the growing impact of molecularly targeted therapies and immunotherapy, prognosis of eCCA is dismal. Therefore, unraveling the complex molecular landscape of eCCA has become an urgent need. Deep phenotyping studies have revealed that eCCA is a heterogeneous tumor, harboring specific alterations categorizable into four classes, ‘Mesenchymal’, ‘Proliferation’, ‘Immune’, ‘Metabolic’. Molecular alterations convey the activation of several pro-oncogenic pathways, where either actionable drivers or outcome predictors can be identified. Areas covered: We offer insights on perturbed pathways, molecular profiling, and actionable targets in eCCA and present a perspective on the potential stepping-stones to future progress. A systematic literature search in PubMed/ClinicalTrials.gov websites was performed by authors from different disciplines according to their specific topic knowledge to identify the newest and most relevant advances in precision medicine of eCCA. Expert opinion: eCCA is a distinct entity with unique features in terms of molecular classes, oncogenic drivers, and tumor microenvironment. Since more prevalent mutations are currently undruggable, and immunotherapy can be offered only to a minority of patients, international collaborations are instrumental to improve the understanding of the molecular underpins of this disease.

Published
2021

62. Liver resection for perihilar cholangiocarcinoma: Impact of biliary drainage failure on postoperative outcome. Results of an Italian multicenter study

Author

Giuliante, Felice, Ardito, Francesco, Aldrighetti, L., Ferrero, A., Pinna, A. D., De Carlis, L., Cillo, U., Jovine, E., Portolani, N., Gruttadauria, S., Mazzaferro, V., Massani, M., Rosso, Edoardo, Ettorre, G. M., Ratti, F., Guglielmi, A., Cescon, M., Colasanti, M., Di Sandro, S., Gringeri, E., Russolillo, N., Ruzzenente, A., Sposito, C., Zanello, M., Zimmitti, Giuseppe, Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Rosso E., Zimmitti G. (ORCID:0000-0003-4925-4012), Giuliante, Felice, Ardito, Francesco, Aldrighetti, L., Ferrero, A., Pinna, A. D., De Carlis, L., Cillo, U., Jovine, E., Portolani, N., Gruttadauria, S., Mazzaferro, V., Massani, M., Rosso, Edoardo, Ettorre, G. M., Ratti, F., Guglielmi, A., Cescon, M., Colasanti, M., Di Sandro, S., Gringeri, E., Russolillo, N., Ruzzenente, A., Sposito, C., Zanello, M., Zimmitti, Giuseppe, Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Rosso E., and Zimmitti G. (ORCID:0000-0003-4925-4012)

Abstract

Background: Preoperative biliary drainage may be essential to reduce the risk of postoperative liver failure after hepatectomy for perihilar cholangiocarcinoma. However, infectious complications related to preoperative biliary drainage may increase the risk of postoperative mortality. The strategy and optimal drainage method continues to be controversial. Methods: This is a retrospective multicenter study including patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2000 and 2016 at 14 Italian referral hepatobiliary centers. The primary end point was to evaluate independent predictors for postoperative outcome in patients undergoing liver resection for perihilar cholangiocarcinoma after preoperative biliary drainage. Results: Of the 639 enrolled patients, 441 (69.0%) underwent preoperative biliary drainage. Postoperative mortality was 8.9% (12.5% after right-side hepatectomy versus 5.7% after left-side hepatectomy; P = .003). Of the patients, 40.5% underwent preoperative biliary drainage at the first admitting hospital, before evaluation at referral centers. Use of percutaneous preoperative biliary drainage was significantly more frequent at referral centers than at community hospitals where endoscopic preoperative biliary drainage was the most frequent type. The overall failure rate after preoperative biliary drainage was 43.3%, significantly higher at community hospitals than that at referral centers (52.7% v 36.9%; P = .002). Failure of the first preoperative biliary drainage was one of the strongest predictors for postoperative complications after right-side and left-side hepatectomies and for mortality after right-side hepatectomy. Type of preoperative biliary drainage (percutaneous versus endoscopic) was not associated with significantly different risk of mortality. Conclusion: Failure of preoperative biliary drainage was significantly more frequent at community hospitals and it was an independent predictor for postoperative outcome. Ce

Published
2021

74. Worse Graft Survival in HCV-Infected Transplanted Females Receiving a Male Donor Graft. The Liver Match Study.: Abstract# O-164

Author

Romagnoli, R., Rossi, M., Gerunda, G. E., Pinna, A. D., Agnes, S., Spada, M., Colledan, M., Tisone, G., De Carlis, L., Baccarani, U., Ettorre, G. M., Cillo, U., Calise, F., Caccamo, L., Cuomo, O., Lupo, L., Corradini, S., Zamboni, F, Marianelli, T., Risaliti, A., Patrono, D., Petri, S. Li, Tagliabue, F., Mangoni, J. M.E., Antonelli, B., Sposito, C., Gringeri, E., Rompianesi, G., Sforza, D., Cucchetti, A., Miglioresi, L., Donataccio, M., Gelli, M., Gavrila, C., Nardi, A., and Angelico, M.

Published
2012

78. OC.05.3 ENDOTHELIAL DAMAGE IN THE PORTAL VEIN OF PATIENTS WITH CIRRHOSIS

Author

Shalaby, S., primary, Simioni, P., additional, Campello, E., additional, Gavasso, S., additional, Gringeri, E., additional, D'Amico, F., additional, Cillo, U., additional, Barbiero, G., additional, Battistel, M., additional, Bizzaro, D., additional, Cardin, R., additional, Zanetto, A., additional, Ferrarese, A., additional, Becchetti, C., additional, Pellone, M., additional, Gambato, M., additional, Germani, G., additional, Russo, F.P., additional, Burra, P., additional, and Senzolo, M., additional

Published
2020
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80. Italian practical clinical guidelines on cholangiocarcinoma: Part II, treatment

Author

Alvaro, D., Hassan, C., Cardinale, V., Carpino, G., Fabris, L., Gringeri, E., Granata, V., Mutignani, M., Morement, H., Giuliante, F., Guglielmi, A., Ridola, L., Tonini, G., Marzioni, M., Grazi, G., Guido, M., Di Giulio, E., Pantano, F., Venere, R., Bragazzi, M. C., Biancanello, F., Faccioli, J., Giannetti, A., Cintolo, M., Di Giunta, M., Gambato, M., Lasagni, A., Izzo, F., Avallone, A., Banales, J., Rossi, M., Catalano, C., Laghi, A., D'Amati, G., and Mancino, M. G.

Subjects
surgery, distal cholangiocarcinoma, intrahepatic cholangiocarcinoma, liver transplantation, locoregional treatments, perihilar cholangiocarcinoma, target therapies
Published
2020

81. Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery

Author

Aldrighetti, L., Boggi, U., Falconi, M., Giuliante, F., Cipriani, F., Ratti, F., Torzilli, G., Abu Hilal, M., Andrianello, S., Anselmo, A., Ardito, F., Gian, L. B., Banchini, F., Barabino, M., Barberis, A., Bassi, C., Batignani, G., Battiston, C., Belli, A., Berti, S., Bianco, P., Brolese, A., Brozzetti, S., Butturini, G., Calise, F., Carabott, K., Capretti, G., Casadei, R., Cescon, M., Cesaretti, M., Cillo, U., Cinardi, N., Colledan, M., Coppola, A., Cotsoglou, C., Crippa, S., Bona, E. D., Valle, R. D., De Angelis, M., De Carlis, L., Di Benedetto, F., Di Sebastiano, P., Dova, L., Ercolani, G., Esposito, A., Giuseppe, M. E., Fabris, A., Ferrero, A., Frena, A., Frigerio, I., Gianotti, L., Giuliani, A., Grazi, G., Gringeri, E., Griseri, G., Gruttadauria, S., Guglielmi, A., Izzo, F., Jovine, E., Lanza, E., Malleo, G., Manzini, L., Massani, M., Mazzaferro, V., Memeo, R., Minni, F., Morelli, L., Nappo, G., Nardo, B., Orlando, F., Partelli, S., Patriti, A., Patrone, R., Percivale, A., Piccolo, G., Ravaioli, M., Reggiani, P., Risaliti, M., Rocca, A., Romagnoli, R., Romano, F., Russolillo, N., Ruzzenente, A., Saladino, E., Salvia, R., Santambrogio, R., Tarchi, P., Troci, A., Troisi, R., Urbani, L., Veneroni, L., Vennarecci, G., Vigano, L., Viola, M., Vistoli, F., Vivarelli, M., Zanello, M., Zanus, G., Zerbi, A., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Aldrighetti, L., Boggi, U., Falconi, M., Giuliante, F., Cipriani, F., Ratti, F., Torzilli, G., Abu Hilal, M., Andrianello, S., Anselmo, A., Ardito, F., Gian, L. B., Banchini, F., Barabino, M., Barberis, A., Bassi, C., Batignani, G., Battiston, C., Belli, A., Berti, S., Bianco, P., Brolese, A., Brozzetti, S., Butturini, G., Calise, F., Carabott, K., Capretti, G., Casadei, R., Cescon, M., Cesaretti, M., Cillo, U., Cinardi, N., Colledan, M., Coppola, A., Cotsoglou, C., Crippa, S., Bona, E. D., Valle, R. D., De Angelis, M., De Carlis, L., Di Benedetto, F., Di Sebastiano, P., Dova, L., Ercolani, G., Esposito, A., Giuseppe, M. E., Fabris, A., Ferrero, A., Frena, A., Frigerio, I., Gianotti, L., Giuliani, A., Grazi, G., Gringeri, E., Griseri, G., Gruttadauria, S., Guglielmi, A., Izzo, F., Jovine, E., Lanza, E., Malleo, G., Manzini, L., Massani, M., Mazzaferro, V., Memeo, R., Minni, F., Morelli, L., Nappo, G., Nardo, B., Orlando, F., Partelli, S., Patriti, A., Patrone, R., Percivale, A., Piccolo, G., Ravaioli, M., Reggiani, P., Risaliti, M., Rocca, A., Romagnoli, R., Romano, F., Russolillo, N., Ruzzenente, A., Saladino, E., Salvia, R., Santambrogio, R., Tarchi, P., Troci, A., Troisi, R., Urbani, L., Veneroni, L., Vennarecci, G., Vigano, L., Viola, M., Vistoli, F., Vivarelli, M., Zanello, M., Zanus, G., Zerbi, A., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable.

Published
2020

82. Multicentre evaluation of case volume in minimally invasive hepatectomy

Author

Vigano, L., Cimino, M., Aldrighetti, L., Ferrero, A., Cillo, U., Guglielmi, A., Ettorre, G. M., Giuliante, Felice, Dalla Valle, R., Mazzaferro, V., Jovine, E., De Carlis, L., Calise, F., Torzilli, Guido, Ratti, F., Gringeri, E., Russolillo, N., Levi Sandri, G. B., Ardito, Francesco, Boggi, U., Gruttadauria, S., Di Benedetto, F., Rossi, G. E., Berti, S., Ceccarelli, G., Vincenti, L., Belli, G., Zamboni, F., Coratti, A., Mezzatesta, P., Santambrogio, R., Navarra, G., Giuliani, A., Pinna, A. D., Parisi, Carmelo Maria Antonio, Colledan, M., Slim, A., Antonucci, Anna Maria, Grazi, G. L., Frena, A., Sgroi, G., Brolese, A., Morelli, Lorenzo, Floridi, A., Patriti, A., Veneroni, L., Boni, L., Maida, P., Griseri, G., Filauro, M., Guerriero, S., Tisone, G., Romito, R., Tedeschi, U., Zimmitti, Giuseppe, Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Ardito F. (ORCID:0000-0003-1596-2862), Parisi A., Antonucci A., Morelli L. (ORCID:0000-0003-0475-2712), Zimmitti G. (ORCID:0000-0003-4925-4012), Vigano, L., Cimino, M., Aldrighetti, L., Ferrero, A., Cillo, U., Guglielmi, A., Ettorre, G. M., Giuliante, Felice, Dalla Valle, R., Mazzaferro, V., Jovine, E., De Carlis, L., Calise, F., Torzilli, Guido, Ratti, F., Gringeri, E., Russolillo, N., Levi Sandri, G. B., Ardito, Francesco, Boggi, U., Gruttadauria, S., Di Benedetto, F., Rossi, G. E., Berti, S., Ceccarelli, G., Vincenti, L., Belli, G., Zamboni, F., Coratti, A., Mezzatesta, P., Santambrogio, R., Navarra, G., Giuliani, A., Pinna, A. D., Parisi, Carmelo Maria Antonio, Colledan, M., Slim, A., Antonucci, Anna Maria, Grazi, G. L., Frena, A., Sgroi, G., Brolese, A., Morelli, Lorenzo, Floridi, A., Patriti, A., Veneroni, L., Boni, L., Maida, P., Griseri, G., Filauro, M., Guerriero, S., Tisone, G., Romito, R., Tedeschi, U., Zimmitti, Giuseppe, Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Ardito F. (ORCID:0000-0003-1596-2862), Parisi A., Antonucci A., Morelli L. (ORCID:0000-0003-0475-2712), and Zimmitti G. (ORCID:0000-0003-4925-4012)

Abstract

Background: Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known. Methods: Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month). Results: A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent). Conclusion: A volume–outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.

Published
2020

83. Risk-adjusted benchmarks in laparoscopic liver surgery in a national cohort

Author

Russolillo, N., Aldrighetti, L., Cillo, U., Guglielmi, A., Ettorre, G. M., Giuliante, F., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Jovine, E., Ferrero, A., Ratti, F., Lo Tesoriere, R., Gringeri, E., Ruzzenente, A., Levi Sandri, G. B., Ardito, F., Virdis, M., Iaria, M., Ferla, F., Lombardi, R., Di Benedetto, F., Gruttadauria, S., Boggi, U., Torzilli, G., Rossi, E., Vincenti, L., Berti, S., Ceccarelli, G., Belli, G., Zamboni, F., Calise, F., Coratti, A., Santambrogio, R., Brolese, A., Navarra, G., Mezzatesta, P., Zimmitti, G., Ravaioli, M., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Lombardi R., Torzilli G., Zimmitti G. (ORCID:0000-0003-4925-4012), Russolillo, N., Aldrighetti, L., Cillo, U., Guglielmi, A., Ettorre, G. M., Giuliante, F., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Jovine, E., Ferrero, A., Ratti, F., Lo Tesoriere, R., Gringeri, E., Ruzzenente, A., Levi Sandri, G. B., Ardito, F., Virdis, M., Iaria, M., Ferla, F., Lombardi, R., Di Benedetto, F., Gruttadauria, S., Boggi, U., Torzilli, G., Rossi, E., Vincenti, L., Berti, S., Ceccarelli, G., Belli, G., Zamboni, F., Calise, F., Coratti, A., Santambrogio, R., Brolese, A., Navarra, G., Mezzatesta, P., Zimmitti, G., Ravaioli, M., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Lombardi R., Torzilli G., and Zimmitti G. (ORCID:0000-0003-4925-4012)

Abstract

Background: This study aimed to assess the best achievable outcomes in laparoscopic liver resection (LLR) after risk adjustment based on surgical technical difficulty using a national registry. Methods: LLRs registered in the Italian Group of Minimally Invasive Liver Surgery registry from November 2014 to March 2018 were considered. Benchmarks were calculated according to the Achievable Benchmark of Care (ABCTM). LLRs at each centre were divided into three clusters (groups I, II and III) based on the Kawaguchi classification. ABCs for overall and major morbidity were calculated in each cluster. Multivariable analysis was used to identify independent risk factors for overall and major morbidity. Significant variables were used in further risk adjustment. Results: A total of 1752 of 2263 patients fulfilled the inclusion criteria: 1096 (62·6 per cent) in group I, 435 (24·8 per cent) in group II and 221 (12·6 per cent) in group III. The ABCs for overall morbidity (7·8, 14·2 and 26·4 per cent for grades I, II and II respectively) and major morbidity (1·4, 2·2 and 5·7 per cent) increased with the difficulty of LLR. Multivariable analysis showed an increased risk of overall morbidity associated with multiple LLRs (odds ratio (OR) 1·35), simultaneous intestinal resection (OR 3·76) and cirrhosis (OR 1·83), and an increased risk of major morbidity with intestinal resection (OR 4·61). ABCs for overall and major morbidity were 14·4 and 3·2 per cent respectively for multiple LLRs, 30 and 11·1 per cent for intestinal resection, and 14·9 and 4·8 per cent for cirrhosis. Conclusion: Overall morbidity benchmarks for LLR ranged from 7·8 to 26·4 per cent, and those for major morbidity from 1·4 to 5·7 per cent, depending on complexity. Benchmark values should be adjusted according to multiple LLRs or simultaneous intestinal resection and cirrhosis.

Published
2020

84. Preliminary Analysis of the Impact of COVID-19 Outbreak on Italian Liver Transplant Programs.

Author

Agnes, Salvatore, Andorno, E, Avolio, Alfonso Wolfango, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, De Ville De Goyet, J, Di Benedetto, F, Ettorre, Gm, Gringeri, E, Gruttadauria, S, Lupo, Lg, Mazzaferro, V, Regalia, E, Romagnoli, R, Rossi, Ge, Rossi, M, Spada, M, Tisone, G, Vennarecci, G, Vivarelli, M, Zamboni, F, Boggi, U., Agnes S (ORCID:0000-0002-3341-4221), Avolio AW (ORCID:0000-0003-2491-7625), Agnes, Salvatore, Andorno, E, Avolio, Alfonso Wolfango, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, De Ville De Goyet, J, Di Benedetto, F, Ettorre, Gm, Gringeri, E, Gruttadauria, S, Lupo, Lg, Mazzaferro, V, Regalia, E, Romagnoli, R, Rossi, Ge, Rossi, M, Spada, M, Tisone, G, Vennarecci, G, Vivarelli, M, Zamboni, F, Boggi, U., Agnes S (ORCID:0000-0002-3341-4221), and Avolio AW (ORCID:0000-0003-2491-7625)

Abstract

Liver Transplant Programs in Italy have faced a sequela of management and clinical decisionmaking problems due to the high incidence in some regions of the country of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The Italian Society for Organ Transplantation (SITO) and the Board of Liver Transplant Program Directors issued a survey to assess the initial impact of this pandemic event on the routine activity of 22 Italian Liver Transplant Programs. One hundred percent of participants completed the survey within a few days. The analysis is presented dividing the centers in two macro-areas: north-central Italy and south-central Italy. The reason for this is that the two areas had a different incidence of the infection and because they have distinctive rates of cadaveric donation. Overall, all centers remained open although a reduction in the activity was noted. Transplant Programs reduced their outpatient activity both in terms of pre-transplant evaluation (68% of the centers) and transplant recipient follow-up (100%); a reduction in transplant activity was observed in the first two weeks of March only in the north-central macro area (23 LTs vs 39 in 2018 and 60 in 2019); overall, SARS-CoV-2 infection was registered for 24 liver transplant recipients and 37 health care providers in liver transplant units. In the perspective of the increasing magnitude of the epidemic, more data will be required to define appropriate strategies for the increasingly complex management of liver transplant patients.

Published
2020

89. Multicentre evaluation of case volume in minimally invasive hepatectomy

Author

Viganò, L, primary, Cimino, M, additional, Aldrighetti, L, additional, Ferrero, A, additional, Cillo, U, additional, Guglielmi, A, additional, Ettorre, G M, additional, Giuliante, F, additional, Dalla Valle, R, additional, Mazzaferro, V, additional, Jovine, E, additional, De Carlis, L, additional, Calise, F, additional, Torzilli, G, additional, Ratti, F, additional, Gringeri, E, additional, Russolillo, N, additional, Levi Sandri, G B, additional, Ardito, F, additional, Boggi, U, additional, Gruttadauria, S, additional, Di Benedetto, F, additional, Rossi, G E, additional, Berti, S, additional, Ceccarelli, G, additional, Vincenti, L, additional, Belli, G, additional, Zamboni, F, additional, Coratti, A, additional, Mezzatesta, P, additional, Santambrogio, R, additional, Navarra, G, additional, Giuliani, A, additional, Pinna, A D, additional, Parisi, A, additional, Colledan, M, additional, Slim, A, additional, Antonucci, A, additional, Grazi, G L, additional, Frena, A, additional, Sgroi, G, additional, Brolese, A, additional, Morelli, L, additional, Floridi, A, additional, Patriti, A, additional, Veneroni, L, additional, Boni, L, additional, Maida, P, additional, Griseri, G, additional, Filauro, M, additional, Guerriero, S, additional, Tisone, G, additional, Romito, R, additional, Tedeschi, U, additional, and Zimmitti, G, additional

Published
2019
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92. Surgery for cholangiocarcinoma

Author

Cillo, U., Fondevila, C., Donadon, M., Gringeri, E., Mocchegiani, F., Schlitt, H.J. (Hans), IJzermans, J.N.M. (Jan), Vivarelli, M., Zieniewicz, K., Damink, S., Groot Koerkamp, B. (Bas), Cillo, U., Fondevila, C., Donadon, M., Gringeri, E., Mocchegiani, F., Schlitt, H.J. (Hans), IJzermans, J.N.M. (Jan), Vivarelli, M., Zieniewicz, K., Damink, S., and Groot Koerkamp, B. (Bas)

Published
2019
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93. Surgery for cholangiocarcinoma

Author

Cillo, U, Fondevila, C, Donadon, M, Gringeri, E, Mocchegiani, F, Schlitt, HJ, IJzermans, J.N.M., Vivarelli, M, Zieniewicz, K, Damink, S, Groot Koerkamp, B, Cillo, U, Fondevila, C, Donadon, M, Gringeri, E, Mocchegiani, F, Schlitt, HJ, IJzermans, J.N.M., Vivarelli, M, Zieniewicz, K, Damink, S, and Groot Koerkamp, B

Published
2019

94. Laparoscopic liver resection of hepatocellular carcinoma located in unfavorable segments: a propensity score-matched analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry

Author

Levi Sandri, G. B., Ettorre, G. M., Aldrighetti, L., Cillo, U., Dalla Valle, R., Guglielmi, A., Mazzaferro, V., Ferrero, A., Di Benedetto, F., Gruttadauria, S., De Carlis, L., Vennarecci, G., Antonucci, Anna Maria, Belli, G., Berti, S., Boggi, U., Bonsignore, P., Brolese, A., Calise, F., Ceccarelli, G., Colledan, M., Coratti, A., Ferla, F., Floridi, A., Frena, A., Giuliani, Antonio, Giuliante, Felice, Grazi, G. L., Gringeri, E., Griseri, G., Iaria, M., Jovine, E., Magistri, P., Maida, P., Mezzatesta, P., Russolillo, N., Navarra, G., Parisi, Carmelo Maria Antonio, Pinna, A. D., Ratti, F., Rossi, G. E., Ruzzenente, A., Santambrogio, R., Scotti, A., Sgroi, G., Slim, A., Torzilli, Guido, Vincenti, L., Virdis, M., Zamboni, F., Antonucci A., Giuliani A. (ORCID:0000-0002-0773-2162), Giuliante F. (ORCID:0000-0001-9517-8220), Parisi A., Torzilli G., Levi Sandri, G. B., Ettorre, G. M., Aldrighetti, L., Cillo, U., Dalla Valle, R., Guglielmi, A., Mazzaferro, V., Ferrero, A., Di Benedetto, F., Gruttadauria, S., De Carlis, L., Vennarecci, G., Antonucci, Anna Maria, Belli, G., Berti, S., Boggi, U., Bonsignore, P., Brolese, A., Calise, F., Ceccarelli, G., Colledan, M., Coratti, A., Ferla, F., Floridi, A., Frena, A., Giuliani, Antonio, Giuliante, Felice, Grazi, G. L., Gringeri, E., Griseri, G., Iaria, M., Jovine, E., Magistri, P., Maida, P., Mezzatesta, P., Russolillo, N., Navarra, G., Parisi, Carmelo Maria Antonio, Pinna, A. D., Ratti, F., Rossi, G. E., Ruzzenente, A., Santambrogio, R., Scotti, A., Sgroi, G., Slim, A., Torzilli, Guido, Vincenti, L., Virdis, M., Zamboni, F., Antonucci A., Giuliani A. (ORCID:0000-0002-0773-2162), Giuliante F. (ORCID:0000-0001-9517-8220), Parisi A., and Torzilli G.

Abstract

Objective: Laparoscopic liver resection (LLR) for Hepatocellular Carcinoma (HCC) is one of the most important indications for the minimally invasive approach. Our study aims to analyze the experience of the Italian Group of Minimally Invasive Liver Surgery with laparoscopic surgical treatment of HCC, with a focus on tumor location and how it affects morbidity and mortality. Methods: 38 centers participated in this study; 372 cases of LLR for HCC were prospectively enrolled. Patients were divided into two groups according to the HCC nodule location. Group 1 favorable location and group 2 unfavorable location. Perioperative outcomes were compared between the two groups before and after a propensity score match (PS) 1:1. Results: Before PS in group 2 surgical time was longer; conversion rate was higher; postoperative transfusion and comprehensive complication index were also higher. PS was performed with a cohort of 298 patients (from 18 centers), with 66 and 232 patients with HCC in unfavorable and favorable locations, respectively. After PS matching, 62 patients from group 1 and group 2 each were compared. Operative and postoperative course were similar in patients with HCC in favorable and unfavorable LLR locations. Surgical margins were found to be identical before and after PS. Conclusions: These results show that LLR in patients with HCC can be safely performed in all segments because of the extensive experience of all surgeons from multiple centers in performing traditional open liver surgery as well as laparoscopic surgery.

Published
2019

99. Portal endothelial damage in cirrhosis

Author

Shalaby, S., primary, Campello, E., additional, Gavasso, S., additional, Gringeri, E., additional, D’Amico, F., additional, Cillo, U., additional, Barbiero, G., additional, Battistel, M., additional, Zanetto, A., additional, Ferrarese, A., additional, Becchetti, C., additional, Pellone, M., additional, Ruzzarin, A., additional, Gambato, M., additional, Germani, G., additional, Russo, F.P., additional, Burra, P., additional, Simioni, P., additional, and Senzolo, M., additional

Published
2019
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