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1. The Effect of a Liver Transplant Program on the Outcomes of Resectable Hepatocellular Carcinoma: A Nationwide Multicenter Analysis

Author

Serenari, M., Lenzi, J., Cucchetti, A., Cipriani, F., Donadon, M., Ardito, Francesco, Fazio, F., Nicolini, D., Iaria, M., Famularo, S., Perri, P., Ansaloni, L., Zanello, M., Lai, Q., Conci, S., Molfino, S., Ferrari, C., Germani, P., Zago, M., Romano, M., Zimmitti, G., Antonucci, A., Fumagalli, L., Troci, A., Ferraro, V., Memeo, R., Crespi, M., Chiarelli, M., Ercolani, G., Hilal, M. A., Zanus, G., Pinotti, E., Tarchi, P., Griseri, G., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Grazi, G. L., Romano, F., Dalla Valle, R., Ravaioli, M., Vivarelli, M., Ferrero, A., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Cescon, M., Gorgone, M., Ratti, F., Costa, G., Razionale, Francesco, Russolillo, N., Marinelli, Luca, Giuffrida, M., Scotti, M., Garancini, M., De Peppo, V., De Stefano, F., Laureiro, Z. L., Marchitelli, I., Franceschi, A., Cosola, D., Corleone, P., Montuori, M., Salvador, L., Manzoni, Annamaria, La Barba, G., Calcagno, P., Pennacchi, L., Conticchio, M., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Razionale F., Marinelli L., Manzoni A., Serenari, M., Lenzi, J., Cucchetti, A., Cipriani, F., Donadon, M., Ardito, Francesco, Fazio, F., Nicolini, D., Iaria, M., Famularo, S., Perri, P., Ansaloni, L., Zanello, M., Lai, Q., Conci, S., Molfino, S., Ferrari, C., Germani, P., Zago, M., Romano, M., Zimmitti, G., Antonucci, A., Fumagalli, L., Troci, A., Ferraro, V., Memeo, R., Crespi, M., Chiarelli, M., Ercolani, G., Hilal, M. A., Zanus, G., Pinotti, E., Tarchi, P., Griseri, G., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Grazi, G. L., Romano, F., Dalla Valle, R., Ravaioli, M., Vivarelli, M., Ferrero, A., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Cescon, M., Gorgone, M., Ratti, F., Costa, G., Razionale, Francesco, Russolillo, N., Marinelli, Luca, Giuffrida, M., Scotti, M., Garancini, M., De Peppo, V., De Stefano, F., Laureiro, Z. L., Marchitelli, I., Franceschi, A., Cosola, D., Corleone, P., Montuori, M., Salvador, L., Manzoni, Annamaria, La Barba, G., Calcagno, P., Pennacchi, L., Conticchio, M., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Razionale F., Marinelli L., and Manzoni A.

Abstract

Objective: To evaluate the effect of a liver transplantation (LT) program on the outcomes of resectable hepatocellular carcinoma (HCC). Background: Surgical treatment of HCC includes both hepatic resection (HR) and LT. However, the presence of cirrhosis and the possibility of recurrence make the management of this disease complex and probably different according to the presence of a LT program. Methods: Patients undergoing HR for HCC between January 2005 and December 2019 were identified from a national database of HCC. The main study outcomes were major surgical complications according to the Comprehensive Complication Index, posthepatectomy liver failure (PHLF), 90-day mortality, overall survival, and disease-free survival. Secondary outcomes were salvage liver transplantation (SLT) and postrecurrence survival. Results: A total of 3202 patients were included from 25 hospitals over the study period. Three of 25 (12%) had an LT program. The presence of an LT program within a center was associated with a reduced probability of PHLF (odds ratio=0.38) but not with overall survival and disease-free survival. There was an increased probability of SLT when HR was performed in a transplant hospital (odds ratio=12.05). Among transplant-eligible patients, those who underwent LT had a significantly longer postrecurrence survival. Conclusions: This study showed that the presence of a LT program was associated with decreased PHLF rates and an increased probability to receive SLT in case of recurrence.

Published
2023

2. Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study

Author

Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated. Methods: Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed. Results: In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128–596) vs. 250 (SD 100–400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group. Conclusion: The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.

Published
2023

3. Survival benefit of adequate lymphadenectomy in patients undergoing liver resection for clinically node-negative intrahepatic cholangiocarcinoma

Author

Sposito, C., Ratti, F., Cucchetti, A., Ardito, Francesco, Ruzzenente, A., Di Sandro, S., Maspero, M., Ercolani, G., Di Benedetto, F., Guglielmi, A., Giuliante, Felice, Aldrighetti, L., Mazzaferro, V., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Sposito, C., Ratti, F., Cucchetti, A., Ardito, Francesco, Ruzzenente, A., Di Sandro, S., Maspero, M., Ercolani, G., Di Benedetto, F., Guglielmi, A., Giuliante, Felice, Aldrighetti, L., Mazzaferro, V., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background & Aims: Lymph-nodal status is an important predictor of survival in intrahepatic cholangiocarcinoma (iCCA), but the need to perform lymphadenectomy in patients with clinically node-negative (cN0) iCCA is still under debate. The aim of this study was to determine whether adequate lymphadenectomy improves long-term outcomes in patients undergoing liver resection for cN0 iCCA. Methods: We performed a retrospective cohort study on consecutive patients who underwent radical liver resection for cN0 iCCA at five tertiary referral centers. A propensity score based on preoperative data was calculated and used to generate stabilized inverse probability of treatment weight (IPTW). Overall and recurrence-free survival of patients undergoing adequate (≥6 retrieved lymph nodes) vs. inadequate lymphadenectomy were compared. Interactions between adequacy of lymphadenectomy and clinical variables of interest were explored through Cox IPTW regression. Results: The study includes 706 patients who underwent curative surgery for cN0 iCCA. Four-hundred and seventeen (59.1%) received adequate lymphadenectomy. After a median follow-up of 33 months (IQR 18-77), median overall survival was 39 months (IQR 23-109) and median recurrence-free survival was 23 months (IQR 8-74). After stratification according to nodal status at final pathology, node-positive patients had longer overall survival (28 vs. 23 months; hazard ratio 1.82; 95% CI 1.14-2.90; p = 0.023) and disease-free survival (13 vs. 9 months; hazard ratio 1.35; 95% CI 1.14-1.59; p = 0.008) after adequate lymphadenectomy. Adequate lymphadenectomy significantly improved survival outcomes in patients without chronic liver disease, and in patients with less-advanced tumors (solitary tumors, tumor size <5 cm, carbohydrate antigen 19-9 <200 U/ml). Conclusions: Adequate lymphadenectomy provided better survival outcomes for patients with cN0 iCCA who were found to be node-positive at pathology, supporting the routine use of

Published
2023

4. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study

Author

Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Objective: To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR). Background: There is limited published data to date on the best achievable outcomes after L-LR. Methods: This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs. Results: There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively. Conclusions: This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.

Published
2023

5. Short and long-term outcomes after minimally invasive liver resection for single small hepatocellular carcinoma: An analysis of 714 patients from the IGoMILS (Italian group of minimally invasive liver surgery) registry

Author

Giuliante, Felice, Ratti, F., Panettieri, Elena, Mazzaferro, V., Guglielmi, A., Ettorre, G. M., Gruttadauria, S., Di Benedetto, F., Cillo, U., De Carlis, L., Dalla Valle, R., Ferrero, A., Santambrogio, R., Ardito, Francesco, Aldrighetti, L., Giuliante F. (ORCID:0000-0001-9517-8220), Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante, Felice, Ratti, F., Panettieri, Elena, Mazzaferro, V., Guglielmi, A., Ettorre, G. M., Gruttadauria, S., Di Benedetto, F., Cillo, U., De Carlis, L., Dalla Valle, R., Ferrero, A., Santambrogio, R., Ardito, Francesco, Aldrighetti, L., Giuliante F. (ORCID:0000-0001-9517-8220), Panettieri E., and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Widespread use of minimally invasive liver surgery (MILS) contributed to the reduction of surgical risk of liver resection for hepatocellular carcinoma (HCC). Aim of this study was to analyze outcomes of MILS for single ≤3 cm HCC. Methods: Patients who underwent MILS for single ≤3 cm HCC (November 2014 - December 2019) were identified from the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) Registry. Results: Of 714 patients included, 641 (93.0%) were Child-Pugh A; 65.7% were limited resections and 2.2% major resections, with a conversion rate of 5.2%. Ninety-day mortality rate was 0.3%. Overall morbidity rate was 22.4% (3.8% major complications). Mean postoperative stay was 5 days. Robotic resection showed longer operative time (p = 0.004) and a higher overall morbidity rate (p < 0.001), with similar major complications (p = 0.431). Child-Pugh B patients showed worse mortality (p = 0.017) and overall morbidity (p = 0.021), and longer postoperative stay (p = 0.005). Five-year overall survival was 79.5%; cirrhosis, satellite micronodules, and microvascular invasion were independently associated with survival. Conclusions: MILS for ≤3 cm HCC was associated with low morbidity and mortality rates, showing high safety, and supporting the increasing indications for surgical resection in these patients.

Published
2023

6. Machine Learning Predictive Model to Guide Treatment Allocation for Recurrent Hepatocellular Carcinoma After Surgery

Author

Famularo, S., Donadon, M., Cipriani, F., Fazio, F., Ardito, Francesco, Iaria, M., Perri, P., Conci, S., Dominioni, T., Lai, Q., La Barba, G., Patauner, S., Molfino, S., Germani, P., Zimmitti, G., Pinotti, E., Zanello, M., Fumagalli, L., Ferrari, C., Romano, M., Delvecchio, A., Valsecchi, M. G., Antonucci, A., Piscaglia, F., Farinati, F., Kawaguchi, Y., Hasegawa, K., Memeo, R., Zanus, G., Griseri, G., Chiarelli, M., Jovine, E., Zago, M., Abu Hilal, M., Tarchi, P., Baiocchi, G. L., Frena, A., Ercolani, G., Rossi, M., Maestri, M., Ruzzenente, A., Grazi, G. L., Dalla Valle, R., Romano, F., Giuliante, Felice, Ferrero, A., Aldrighetti, L., Bernasconi, D. P., Torzilli, G., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Famularo, S., Donadon, M., Cipriani, F., Fazio, F., Ardito, Francesco, Iaria, M., Perri, P., Conci, S., Dominioni, T., Lai, Q., La Barba, G., Patauner, S., Molfino, S., Germani, P., Zimmitti, G., Pinotti, E., Zanello, M., Fumagalli, L., Ferrari, C., Romano, M., Delvecchio, A., Valsecchi, M. G., Antonucci, A., Piscaglia, F., Farinati, F., Kawaguchi, Y., Hasegawa, K., Memeo, R., Zanus, G., Griseri, G., Chiarelli, M., Jovine, E., Zago, M., Abu Hilal, M., Tarchi, P., Baiocchi, G. L., Frena, A., Ercolani, G., Rossi, M., Maestri, M., Ruzzenente, A., Grazi, G. L., Dalla Valle, R., Romano, F., Giuliante, Felice, Ferrero, A., Aldrighetti, L., Bernasconi, D. P., Torzilli, G., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Importance: Clear indications on how to select retreatments for recurrent hepatocellular carcinoma (HCC) are still lacking. Objective: To create a machine learning predictive model of survival after HCC recurrence to allocate patients to their best potential treatment. Design, Setting, and Participants: Real-life data were obtained from an Italian registry of hepatocellular carcinoma between January 2008 and December 2019 after a median (IQR) follow-up of 27 (12-51) months. External validation was made on data derived by another Italian cohort and a Japanese cohort. Patients who experienced a recurrent HCC after a first surgical approach were included. Patients were profiled, and factors predicting survival after recurrence under different treatments that acted also as treatment effect modifiers were assessed. The model was then fitted individually to identify the best potential treatment. Analysis took place between January and April 2021. Exposures: Patients were enrolled if treated by reoperative hepatectomy or thermoablation, chemoembolization, or sorafenib. Main Outcomes and Measures: Survival after recurrence was the end point. Results: A total of 701 patients with recurrent HCC were enrolled (mean [SD] age, 71 [9] years; 151 [21.5%] female). Of those, 293 patients (41.8%) received reoperative hepatectomy or thermoablation, 188 (26.8%) received sorafenib, and 220 (31.4%) received chemoembolization. Treatment, age, cirrhosis, number, size, and lobar localization of the recurrent nodules, extrahepatic spread, and time to recurrence were all treatment effect modifiers and survival after recurrence predictors. The area under the receiver operating characteristic curve of the predictive model was 78.5% (95% CI, 71.7%-85.3%) at 5 years after recurrence. According to the model, 611 patients (87.2%) would have benefited from reoperative hepatectomy or thermoablation, 37 (5.2%) from sorafenib, and 53 (7.6%) from chemoembolization in terms of potential survival after re

Published
2023

7. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8: An international multicenter propensity-score matched study

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

Published
2023

8. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

Author

Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., Vizzielli G., Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., and Vizzielli G.

Abstract

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March–April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients’ management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons’ personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon–patient/family communication. From the Italian surgeons’ perspective, COVID-related measures will continue to influence

Published
2023

9. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) – Part II - Solid lesions

Author

Pompili, Maurizio, Ardito, Francesco, Brunetti, E., Cabibbo, G., Calliada, F., Cillo, U., de Sio, I., Golfieri, R., Grova, M., Gruttadauria, S., Guido, M., Iavarone, M., Manciulli, T., Pagano, D., Pettinari, I., Santopaolo, Francesco, Soresi, M., Colli, A., Pompili M. (ORCID:0000-0001-6699-7980), Ardito F. (ORCID:0000-0003-1596-2862), Santopaolo F., Pompili, Maurizio, Ardito, Francesco, Brunetti, E., Cabibbo, G., Calliada, F., Cillo, U., de Sio, I., Golfieri, R., Grova, M., Gruttadauria, S., Guido, M., Iavarone, M., Manciulli, T., Pagano, D., Pettinari, I., Santopaolo, Francesco, Soresi, M., Colli, A., Pompili M. (ORCID:0000-0001-6699-7980), Ardito F. (ORCID:0000-0003-1596-2862), and Santopaolo F.

Abstract

Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic hepatic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the second part of the guideline, concerning the diagnosis and clinical management of hemangioma, focal nodular hyperplasia, and hepatocellular adenoma.

Published
2022

10. Survival by Number and Sites of Resections of Recurrence after First Curative Resection of Colorectal Liver Metastases

Author

Panettieri, Elena, Kim, B. J., Kawaguchi, Y., Ardito, Francesco, Mele, C., De Rose, Agostino Maria, Vellone, Maria, Chun, Y. S., Tzeng, C. W. D., Aloia, T. A., Giuliante, Felice, Vauthey, J. N., Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), De Rose A. M., Vellone M. (ORCID:0000-0002-7628-4092), Giuliante F. (ORCID:0000-0001-9517-8220), Panettieri, Elena, Kim, B. J., Kawaguchi, Y., Ardito, Francesco, Mele, C., De Rose, Agostino Maria, Vellone, Maria, Chun, Y. S., Tzeng, C. W. D., Aloia, T. A., Giuliante, Felice, Vauthey, J. N., Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), De Rose A. M., Vellone M. (ORCID:0000-0002-7628-4092), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background Recurrence after curative hepatectomy for colorectal liver metastases (CRLM) is common. We sought to determine if number and sites of resections of recurrence after hepatectomy for CRLM impact survival. Methods The study included patients who underwent resection of recurrence following complete curative-intent resection of CRLM during 1998-2016 at two academic medical centers in Houston, USA, and Rome, Italy. The survival impacts of number and sites of resections of recurrence were evaluated. Patients with synchronous extrahepatic disease at curative CRLM resection were excluded. Results Among 2163 patients who underwent curative hepatectomy, 1456 (67.3%) developed a recurrence. Four hundred seventy-eight patients underwent one (322/478; 67.4%) or two or more (156/478; 32.6%) resections of recurrence. The 5-year overall survival (OS) rate was higher in patients with resected than unresected recurrence (70.2% vs. 24.0%; p < 0.001). In patients who underwent only one resection of recurrence, the 5-year OS rate differed by location (lung, 81.6%; liver, 64.3%; other, 54.1%). In patients who underwent two or more resections of recurrence, the 5-year OS rate was similar for liver-only resection (87.5%) and resection of liver and other sites (66.1%) (p = 0.223) and for liver-only resection and other-sites-only resection (80.7%) (p = 0.258); 5-year OS rate by site of first resection of recurrence did not differ between liver (78.5%) and lung (81.8%) (p = 0.502) but was worse for other sites (61.1%) than for lung (p = 0.045). Conclusion When recurrence after initial CRLM resection is resectable, the ability to undergo resection was associated with improved survival and can be considered as an option regardless of the number of recurrence and resection. Sites of resection of recurrence impact survival and should be considered.

Published
2022

11. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

12. The Impact of KRAS Mutational Status on Long-Term Survival following Liver Resection for Hilar Cholangiocarcinoma

Author

Ardito, Francesco, Razionale, Francesco, Campisi, Andrea, Carlino, Angela, Vellone, Maria, Vani, S., Larocca, Luigi Maria, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Razionale F., Campisi A., Carlino A., Vellone M. (ORCID:0000-0002-7628-4092), Larocca L. M. (ORCID:0000-0003-1739-4758), Giuliante F. (ORCID:0000-0001-9517-8220), Ardito, Francesco, Razionale, Francesco, Campisi, Andrea, Carlino, Angela, Vellone, Maria, Vani, S., Larocca, Luigi Maria, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Razionale F., Campisi A., Carlino A., Vellone M. (ORCID:0000-0002-7628-4092), Larocca L. M. (ORCID:0000-0003-1739-4758), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

KRAS mutation is reportedly associated with poor prognosis in patients with different cancer types. However, mutational data on hilar cholangiocarcinoma are few and controversial. The aim of this study was to evaluate the rate of KRAS mutations in a single-center homogeneous population resected for hilar cholangiocarcinoma and the subsequent impact on prognosis. KRAS mutation status was evaluated in 54 patients undergoing major hepatectomy combined with resection of the main biliary confluence and regional lymphadenectomy for hilar cholangiocarcinoma between 2001 and 2019. Among these 54 patients, 12 (22.2%) had a KRAS mutation. KRAS mutation was not related with pathologic characteristics of the tumor. Five-year overall survival (OS) in patients with KRAS mutation was significantly lower than that observed in patients with KRAS wild type (0 vs. 49.2%, respectively; p = 0.003). In the multivariable analysis; independent predictors of poor OS were KRAS mutation (HR = 5.384; p = 0.003) and lymph node metastases (HR = 2.805; p = 0.023). The results of our study suggested that KRAS mutation in hilar cholangiocarcinoma was not rarely observed. KRAS mutation was an independent strong predictor of poor OS. KRAS mutation analysis should be included in the routine pathologic evaluation of resected hilar cholangiocarcinoma in order to better stratify prognosis

Published
2022

13. Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Author

Arizza, G., Russolillo, N., Ferrero, A., Syn, N. L., Cipriani, F., Aghayan, D., Marino, M. V., Memeo, R., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Yong, C. C., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Monden, K., Wakabayashi, G., Cherqui, D., Troisi, R. I., Yin, M., Giuliante, Felice, Geller, D., Sugioka, A., Edwin, B., Cheung, T. -T., Long, T. C. D., Hilal, M. A., Fuks, D., Chen, K. -H., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Chan, C. -Y., Prieto, M., Meurs, J., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Labadie, K. P., Kato, Y., Kojima, M., Fretland, A. A., Ghotbi, J., Coelho, F. F., Kruger, J. A. P., Lopez-Lopez, V., Magistri, P., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Pascual, F., Suhool, A., Nghia, P. P., Lim, C., Liu, Q., Kadam, P., Dalla Valle, B., Lai, E. C., Conticchio, M., Giustizieri, U., Citterio, D., Chen, Z., Yu, S., Ardito, Francesco, Vani, S., Dogeas, E., Siow, T. F., Mocchegianni, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Arizza, G., Russolillo, N., Ferrero, A., Syn, N. L., Cipriani, F., Aghayan, D., Marino, M. V., Memeo, R., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Yong, C. C., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Monden, K., Wakabayashi, G., Cherqui, D., Troisi, R. I., Yin, M., Giuliante, Felice, Geller, D., Sugioka, A., Edwin, B., Cheung, T. -T., Long, T. C. D., Hilal, M. A., Fuks, D., Chen, K. -H., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Chan, C. -Y., Prieto, M., Meurs, J., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Labadie, K. P., Kato, Y., Kojima, M., Fretland, A. A., Ghotbi, J., Coelho, F. F., Kruger, J. A. P., Lopez-Lopez, V., Magistri, P., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Pascual, F., Suhool, A., Nghia, P. P., Lim, C., Liu, Q., Kadam, P., Dalla Valle, B., Lai, E. C., Conticchio, M., Giustizieri, U., Citterio, D., Chen, Z., Yu, S., Ardito, Francesco, Vani, S., Dogeas, E., Siow, T. F., Mocchegianni, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Tumor size (TS) represents a critical parameter in the risk assessment of laparoscopic liver resections (LLR). Moreover, TS has been rarely related to the extent of liver resection. The aim of this study was to study the relationship between tumor size and difficulty of laparoscopic left lateral sectionectomy (L-LLS). Methods: The impact of TS cutoffs was investigated by stratifying tumor size at each 10 mm-interval. The optimal cutoffs were chosen taking into consideration the number of endpoints which show a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors. Results: A total of 1910 L-LLS were included. Overall, open conversion and intraoperative blood transfusion were 3.1 and 3.3%, respectively. The major morbidity rate was 2.7% and 90-days mortality 0.6%. Three optimal TS cutoffs were identified: 40-, 70-, and 100-mm. All the selected cutoffs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle maneuver. Moreover, 70- and 100-mm cutoffs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z = 3.90, P <.001), operative time (Z = 3.84, P <.001), blood loss (Z = 6.50, P <.001), intraoperative blood transfusion rate (Z = 5.15, P <.001), Pringle maneuver use (Z = 6.48, P <.001), major morbidity(Z = 2.17, P =.030) and 30-days readmission (Z = 1.99, P =.047) was registered as the size increased. Conclusion: L-LLS for tumors of increasing size was associated with poorer intraoperative and early postoperative outcomes suggesting increasing difficulty of the procedure. We determined three optimal TS cutoffs (40-, 70- and 100-mm) to accurately stratify surgical difficulty after L-LLS.

Published
2022

14. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) – Part I – Cystic lesions

Author

Pompili, Maurizio, Ardito, Francesco, Brunetti, E., Cabibbo, G., Calliada, F., Cillo, U., de Sio, I., Golfieri, R., Grova, M., Gruttadauria, S., Guido, M., Iavarone, M., Manciulli, T., Pagano, D., Pettinari, I., Santopaolo, Francesco, Soresi, M., Colli, A., Pompili M. (ORCID:0000-0001-6699-7980), Ardito F. (ORCID:0000-0003-1596-2862), Santopaolo F., Pompili, Maurizio, Ardito, Francesco, Brunetti, E., Cabibbo, G., Calliada, F., Cillo, U., de Sio, I., Golfieri, R., Grova, M., Gruttadauria, S., Guido, M., Iavarone, M., Manciulli, T., Pagano, D., Pettinari, I., Santopaolo, Francesco, Soresi, M., Colli, A., Pompili M. (ORCID:0000-0001-6699-7980), Ardito F. (ORCID:0000-0003-1596-2862), and Santopaolo F.

Abstract

Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.

Published
2022

15. Solitary fibrous tumor of the liver with Doege-Potter syndrome: An exceptional finding. Discovering the role of blood glucose levels and insulin growth factor II

Author

Taliente, Francesco, De Rose, Agostino Maria, Ardito, Francesco, Giuliante, Felice, Taliente F., De Rose A. M., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Taliente, Francesco, De Rose, Agostino Maria, Ardito, Francesco, Giuliante, Felice, Taliente F., De Rose A. M., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

N/A

Published
2022

16. The Tumor Microenvironment Drives Intrahepatic Cholangiocarcinoma Progression

Author

Mancarella, S., Serino, G., Coletta, S., Armentano, R., Dituri, F., Ardito, F., Ruzzenente, A., Fabregat, I., Giannelli, G., Ardito F. (ORCID:0000-0003-1596-2862), Mancarella, S., Serino, G., Coletta, S., Armentano, R., Dituri, F., Ardito, F., Ruzzenente, A., Fabregat, I., Giannelli, G., and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Intrahepatic cholangiocarcinoma (iCCA) is a highly aggressive cancer with limited therapeutic options and short overall survival. iCCA is characterized by a strong desmoplastic reaction in the surrounding ecosystem that likely affects tumoral progression. Overexpression of the Notch pathway is implicated in iCCA development and progression. Our aim was to investigate the effectiveness of Crenigacestat, a selective inhibitor of NOTCH1 signaling, against the cross-talk between cancer cells and the surrounding ecosystem in an in vivo HuCCT1-xenograft model. In the present study, a transcriptomic analysis approach, validated by Western blotting and qRT-PCR on iCCA tumor masses treated with Crenigacestat, was used to study the molecular pathways responsive to drug treatment. Our results indicate that Crenigacestat significantly inhibited NOTCH1 and HES1, whereas tumor progression was not affected. In addition, the drug triggered a strong immune response and blocked neovascularization in the tumor ecosystem of the HuCCT1-xenograft model without affecting the occurrence of fibrotic reactions. Therefore, although these data need further investigation, our observations confirm that Crenigacestat selectively targets NOTCH1 and that the desmoplastic response in iCCA likely plays a key role in both drug effectiveness and tumor progression.

Published
2022

17. Pancreatico-Jejunostomy On Isolated Loop After Pancreatico-Duodenectomy: Is It Worthwhile?

Author

Clemente, Gennaro, De Rose, Agostino Maria, Panettieri, Elena, Ardito, Francesco, Murazio, Marino, Nuzzo, Gennaro, Giuliante, Felice, Clemente G. (ORCID:0000-0002-8329-5582), De Rose A. M., Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), Murazio M. (ORCID:0000-0003-4863-0434), Nuzzo G., Giuliante F. (ORCID:0000-0001-9517-8220), Clemente, Gennaro, De Rose, Agostino Maria, Panettieri, Elena, Ardito, Francesco, Murazio, Marino, Nuzzo, Gennaro, Giuliante, Felice, Clemente G. (ORCID:0000-0002-8329-5582), De Rose A. M., Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), Murazio M. (ORCID:0000-0003-4863-0434), Nuzzo G., and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background: Postoperative morbidity remains a significant problem after pancreatico-duodenectomy. The management of pancreatic stump continues to be a challenge, and many technical solutions have been developed over the years. In this study, we report the results obtained with the use of an isolated loop for pancreatico-jejunostomy in patients with soft pancreas and small pancreatic duct diameter. Methods: Clinical data of patients submitted to pancreatico-duodenectomy in a period of sixteen years (2005–2020) were extracted from a prospective database. Patients with soft pancreas, main duct diameter < 2 mm and reconstruction by pancreatico-jejunostomy on single loop or isolated loop were selected. Primary end-point was the incidence of clinically relevant fistulas in the two groups of patients. Secondary endpoint was the length of postoperative hospital stay. A propensity score matching analysis was used for the statistics. Results: Two hundred and twenty-one patients with the above characteristics were found in the database. One hundred and twelve of these received a single-loop reconstruction and 109 an isolated loop reconstruction. Incidence of clinically relevant fistulas was higher in the first group (41% vs 27%; p = 0.023). Postoperative hospital stay was significantly shorter in the second group (21 days vs 15; p < 0.001). These results were confirmed at the propensity score matching. Conclusion: In patients with soft pancreatic texture and small main duct diameter, pancreatico-jejunostomy on isolated loop is associated with a lower incidence of clinically relevant fistulas than after classic reconstruction. The duration of postoperative hospital stay was significantly reduced, with consequent reduction of cost.

Published
2022

18. The largest western experience on salvage hepatectomy for recurrent hepatocellular carcinoma: propensity score-matched analysis on behalf of He.RC.O.Le.Study Group

Author

Iaria, M., Bianchi, G., Fazio, F., Ardito, Francesco, Perri, P., Pontarolo, N., Conci, S., Donadon, M., Zanello, M., Lai, Q., Famularo, S., Molfino, S., Sciannamea, I., Fumagalli, L., Germani, P., Floridi, A., Ferrari, C., Zimmitti, Giuseppe, Troci, A., Zago, M., Ferraro, V., Cipriani, F., Patauner, S., La Barba, G., Romano, M., Zanus, G., Ercolani, G., Frena, A., Aldrighetti, L., Memeo, R., Pinotti, E., Crespi, M., Hilal, M. A., Griseri, G., Tarchi, P., Chiarelli, M., Antonucci, A., Baiocchi, G. L., Romano, F., Rossi, M., Jovine, E., Torzilli, G., Ruzzenente, A., Maestri, M., Grazi, G. L., Giuliante, Felice, Ferrero, A., Dalla Valle, R., Giuffrida, M., Russolillo, N., Razionale, Francesco, De Peppo, V., Tomasoni, M., Marchitelli, I., Costa, G., Laureiro, Z. L., Scotti, M., Calcagno, P., Cosola, D., Franceschi, A., Manzoni, A., Pennacchi, L., Montuori, M., Conticchio, M., Ratti, F., Notte, F., Cucchetti, A., Salvador, L., Corleone, P., Garancini, M., Ciulli, C., Ardito F. (ORCID:0000-0003-1596-2862), Zimmitti G. (ORCID:0000-0003-4925-4012), Giuliante F. (ORCID:0000-0001-9517-8220), Razionale F., Iaria, M., Bianchi, G., Fazio, F., Ardito, Francesco, Perri, P., Pontarolo, N., Conci, S., Donadon, M., Zanello, M., Lai, Q., Famularo, S., Molfino, S., Sciannamea, I., Fumagalli, L., Germani, P., Floridi, A., Ferrari, C., Zimmitti, Giuseppe, Troci, A., Zago, M., Ferraro, V., Cipriani, F., Patauner, S., La Barba, G., Romano, M., Zanus, G., Ercolani, G., Frena, A., Aldrighetti, L., Memeo, R., Pinotti, E., Crespi, M., Hilal, M. A., Griseri, G., Tarchi, P., Chiarelli, M., Antonucci, A., Baiocchi, G. L., Romano, F., Rossi, M., Jovine, E., Torzilli, G., Ruzzenente, A., Maestri, M., Grazi, G. L., Giuliante, Felice, Ferrero, A., Dalla Valle, R., Giuffrida, M., Russolillo, N., Razionale, Francesco, De Peppo, V., Tomasoni, M., Marchitelli, I., Costa, G., Laureiro, Z. L., Scotti, M., Calcagno, P., Cosola, D., Franceschi, A., Manzoni, A., Pennacchi, L., Montuori, M., Conticchio, M., Ratti, F., Notte, F., Cucchetti, A., Salvador, L., Corleone, P., Garancini, M., Ciulli, C., Ardito F. (ORCID:0000-0003-1596-2862), Zimmitti G. (ORCID:0000-0003-4925-4012), Giuliante F. (ORCID:0000-0001-9517-8220), and Razionale F.

Abstract

Background: We aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments. Methods: Data were collected from the Hepatocarcinoma Recurrence on the Liver Study Group (He.RC.O.Le.S.) Italian Registry. After 1:1 propensity score-matched analysis (PSM), two groups were compared: the PH group (patients submitted to resection for a first HCC) and the SH group (patients resected for intrahepatic rHCC after previous HCC-related treatments). Results: 2689 patients were enrolled. PH included 2339 patients, SH 350. After PSM, 263 patients were selected in each group with major resected nodule median size, intraoperative blood loss and minimally invasive approach significantly lower in the SH group. Long-term outcomes were compared, with no difference in OS and DFS. Univariate and multivariate analyses revealed only microvascular invasion as an independent prognostic factor for OS. Conclusion: SH proved to be equivalent to PH in terms of safety, feasibility and long-term outcomes, consistent with data gathered from East Asia. In the awaiting of reliable treatment-allocating algorithms for rHCC, SH appears to be a suitable alternative in patients fit for surgery, regardless of the previous therapeutic modality implemented.

Published
2022

19. Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

Author

Famularo, S., Russolillo, N., Donadon, M., Cipriani, F., Ardito, Francesco, Perri, P., Giani, A., De Stefano, F., Lai, Q., Molfino, S., Zanello, M., Iaria, M., La Barba, G., Pinotti, E., Germani, P., Conci, S., Ferrari, C., Fumagalli, L., Romano, M., Antonucci, A., Zimmitti, Giuseppe, Troci, A., Floridi, A., Ferraro, V., Patauner, S., Frena, A., Memeo, R., Crespi, M., Hilal, M. A., Zanus, G., Chiarelli, M., Percivale, A., Ruzzenente, A., Tarchi, P., Zago, M., Ercolani, G., Dalla Valle, R., Jovine, E., Baiocchi, G. L., Rossi, M., Maestri, M., Romano, F., Grazi, G. L., Giuliante, Felice, Aldrighetti, L., Ferrero, A., Torzilli, G., Costa, G., Milana, F., Fazio, F., Ratti, F., Razionale, Francesco, De Peppo, V., Carissimi, F., Paolo Graziano, G. M., Laurerio, Z. L., Giuffrida, M., Cucchetti, A., Montuori, M., Cosola, D., Corleone, P., Lazzari, G., Franceschi, A., Calcagno, P., Salvador, L., Manzoni, A., Pennacchi, L., Libia, A., Notte, F., Bernasconi, D. P., Mori, S., Gaudesi, D., Ardito F. (ORCID:0000-0003-1596-2862), Zimmitti G. (ORCID:0000-0003-4925-4012), Giuliante F. (ORCID:0000-0001-9517-8220), Razionale F., Famularo, S., Russolillo, N., Donadon, M., Cipriani, F., Ardito, Francesco, Perri, P., Giani, A., De Stefano, F., Lai, Q., Molfino, S., Zanello, M., Iaria, M., La Barba, G., Pinotti, E., Germani, P., Conci, S., Ferrari, C., Fumagalli, L., Romano, M., Antonucci, A., Zimmitti, Giuseppe, Troci, A., Floridi, A., Ferraro, V., Patauner, S., Frena, A., Memeo, R., Crespi, M., Hilal, M. A., Zanus, G., Chiarelli, M., Percivale, A., Ruzzenente, A., Tarchi, P., Zago, M., Ercolani, G., Dalla Valle, R., Jovine, E., Baiocchi, G. L., Rossi, M., Maestri, M., Romano, F., Grazi, G. L., Giuliante, Felice, Aldrighetti, L., Ferrero, A., Torzilli, G., Costa, G., Milana, F., Fazio, F., Ratti, F., Razionale, Francesco, De Peppo, V., Carissimi, F., Paolo Graziano, G. M., Laurerio, Z. L., Giuffrida, M., Cucchetti, A., Montuori, M., Cosola, D., Corleone, P., Lazzari, G., Franceschi, A., Calcagno, P., Salvador, L., Manzoni, A., Pennacchi, L., Libia, A., Notte, F., Bernasconi, D. P., Mori, S., Gaudesi, D., Ardito F. (ORCID:0000-0003-1596-2862), Zimmitti G. (ORCID:0000-0003-4925-4012), Giuliante F. (ORCID:0000-0001-9517-8220), and Razionale F.

Abstract

Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined. Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3). Results: A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups). Conclusion: We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.

Published
2022

20. Preoperative Assessment of Skeletal Muscle Mass and Muscle Quality Using Computed Tomography: Incidence of Sarcopenia in Patients with Intrahepatic Cholangiocarcinoma Selected for Liver Resection

Author

Ardito, Francesco, Coppola, A., Rinninella, Emanuele, Razionale, Francesco, Pulcini, Gabriele, Carano, Davide, Cintoni, M., Mele, Maria Cristina, Barbaro, Brunella, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Rinninella E. (ORCID:0000-0002-9165-2367), Razionale F., Pulcini G., Carano D., Mele M. C. (ORCID:0000-0003-0153-5819), Barbaro B. (ORCID:0000-0002-9638-543X), Giuliante F. (ORCID:0000-0001-9517-8220), Ardito, Francesco, Coppola, A., Rinninella, Emanuele, Razionale, Francesco, Pulcini, Gabriele, Carano, Davide, Cintoni, M., Mele, Maria Cristina, Barbaro, Brunella, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Rinninella E. (ORCID:0000-0002-9165-2367), Razionale F., Pulcini G., Carano D., Mele M. C. (ORCID:0000-0003-0153-5819), Barbaro B. (ORCID:0000-0002-9638-543X), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background: Sarcopenia is considered a predictor of poor postoperative and long-term results following liver resection for intrahepatic cholangiocarcinoma (ICC). The aim of our study was to assess the incidence of sarcopenia in patients resected for ICC and its relation to preoperative clinical factors. Methods: Patients resected for ICC in our unit, with available preoperative CT scans within one month before operation, were enrolled in the study. Skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) were assessed for each patient. Results: Thirty patients matched all inclusion criteria. Low SMI values were documented in 15 patients (50.0%), and low SMD values were documented in 10 patients (33.3%). SMI was significantly greater in males (p < 0.001). In patients who were underweight, the incidence of low SMI was significantly higher than that of high SMI (p = 0.031). In patients who were overweight/obese, the incidence of high SMI was significantly higher than that of low SMI (p = 0.003) and the incidence of low SMD was significantly higher than that of high SMD (p = 0.038). In the univariate analysis, no preoperative factors (clinical and tumor-related factors), in particular BMI, were found to be independent predictors of low SMI. Conclusions: The incidence of sarcopenia was 50.0% in patients selected for liver resection for ICC and was not related to the preoperative clinical factors. A multidisciplinary evaluation of the nutritional status is fundamental before liver resection in patients.

Published
2022

21. Outcomes comparison of Pancreato-Gastrostomy and Isolated Jejunal Loop Pancreato-Jejunostomy following Pancreato-Duodenectomy in patients with soft pancreas and at moderate-high risk for POPF: a retrospective multicenter experience-based analysis

Author

Zimmitti, Giuseppe, Coppola, A., Ardito, Francesco, Meniconi, R., Ettorre, G. M., Rosso, Edoardo, Manzoni, A., Colasanti, M., Clemente, Gennaro, Murazio, Marino, Giuliante, Felice, Zimmitti G. (ORCID:0000-0003-4925-4012), Ardito F. (ORCID:0000-0003-1596-2862), Rosso E., Clemente G. (ORCID:0000-0002-8329-5582), Murazio M. (ORCID:0000-0003-4863-0434), Giuliante F. (ORCID:0000-0001-9517-8220), Zimmitti, Giuseppe, Coppola, A., Ardito, Francesco, Meniconi, R., Ettorre, G. M., Rosso, Edoardo, Manzoni, A., Colasanti, M., Clemente, Gennaro, Murazio, Marino, Giuliante, Felice, Zimmitti G. (ORCID:0000-0003-4925-4012), Ardito F. (ORCID:0000-0003-1596-2862), Rosso E., Clemente G. (ORCID:0000-0002-8329-5582), Murazio M. (ORCID:0000-0003-4863-0434), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Following pancreatoduodenectomy (PD), the modality of pancreato-enteric continuity restoration may impact on postoperative pancreatic fistula (POPF) risk. The aim of this study is to compare, among patients with soft pancreas and at moderate/high risk for POPF, the outcomes of PD with Pancreato-Gastrostomy (PG), versus Isolated Jejunal Loop Pancreato-Jejunostomy (IJL-PJ). 193 patients with a Callery Fistula Risk Score (C-FRS) ≥ 3 operated at 3 HPB Units, two performing PG and one IJL-PJ as their preferred anastomotic technique following PD (2009–2019) were included in this study (PG = 123, IJL-PJ = 70). Primary outcomes were POPF, clinically relevant (cr-)postoperative pancreatic hemorrhage (cr-PPH), delayed gastric emptying (cr-DGE), and postoperative major complications and mortality. POPF, cr-PPH, and cr-DGE occurred in 21.8%, 17.6%, and 11.4% of patients, and did not differ significantly between PG (26%, 19.5%, and 10.6%, respectively) and IJL-PJ (17.1%, 14.3%, and 12.9%, respectively; all p > 0.05) patients. Major (Dindo ≥ 3) complication and mortality rates were 26.4% and 3.3%, respectively, and did not differ significantly between PG (29.3% and 3.8%) and IJL-PJ (21.4% and 2.9) patients (p > 0.05). A faster surgical drain and nasogastric tube removal matched a significantly shorter hospitalization among IJL-PJ patients (median LOS: 18 days versus 25 days among PG patients, p < 0.001). In conclusion, IJL-PJ and PG, when performed by surgeons specialized with the concerned anastomotic technique in patients with soft pancreas and moderate/high risk for POPF, have similar results in terms of perioperative mortality and postoperative complications both overall and specific for PD.

Published
2021

22. ESTRO ACROP guidelines for the delineation of lymph nodal areas in upper gastrointestinal malignancies

Author

Valentini, Vincenzo, Cellini, Francesco, Riddell, A., Brunner, T. B., Roeder, F., Giuliante, Felice, Alfieri, Sergio, Manfredi, Riccardo, Ardito, Francesco, Fiorillo, Claudio, Porziella, Venanzio, Morganti, Alessio Giuseppe, Haustermans, K., Margaritora, Stefano, De Bari, B., Matzinger, O., Gkika, E., Belka, C., Allum, W., Verheij, M., Valentini V. (ORCID:0000-0003-4637-6487), Cellini F. (ORCID:0000-0002-2145-2300), Giuliante F. (ORCID:0000-0001-9517-8220), Alfieri S. (ORCID:0000-0002-0404-724X), Manfredi R. (ORCID:0000-0002-4972-9500), Ardito F. (ORCID:0000-0003-1596-2862), Fiorillo C. (ORCID:0000-0001-7681-3567), Porziella V. (ORCID:0000-0001-6000-3172), Morganti A. G., Margaritora S. (ORCID:0000-0002-9796-760X), Valentini, Vincenzo, Cellini, Francesco, Riddell, A., Brunner, T. B., Roeder, F., Giuliante, Felice, Alfieri, Sergio, Manfredi, Riccardo, Ardito, Francesco, Fiorillo, Claudio, Porziella, Venanzio, Morganti, Alessio Giuseppe, Haustermans, K., Margaritora, Stefano, De Bari, B., Matzinger, O., Gkika, E., Belka, C., Allum, W., Verheij, M., Valentini V. (ORCID:0000-0003-4637-6487), Cellini F. (ORCID:0000-0002-2145-2300), Giuliante F. (ORCID:0000-0001-9517-8220), Alfieri S. (ORCID:0000-0002-0404-724X), Manfredi R. (ORCID:0000-0002-4972-9500), Ardito F. (ORCID:0000-0003-1596-2862), Fiorillo C. (ORCID:0000-0001-7681-3567), Porziella V. (ORCID:0000-0001-6000-3172), Morganti A. G., and Margaritora S. (ORCID:0000-0002-9796-760X)

Abstract

The European SocieTy for Radiation and Oncology -Advisory Committee on Radiation Oncology Practice (ESTRO-ACROP) endorsed a project to provide guidelines (GL) for the identification and delineation of clinically negative lymph-nodal stations (LNs) involved in upper gastrointestinal clinical scenarios. The presented GL is focused on preoperative (or definitive) setting. The project aim is to improve the consistency of clinical target volume (CTV) delineation by providing: a description of the anatomical boundaries of the LNs; a radiological computed tomography-based atlas depicting the LNs areas; a free, web-based, interactive example case for independent training of radiation oncologists on LNs delineation according to the presented GL, by both qualitative and quantitative analysis (through the FALCON EduCase platform). This project was carried out with the intention to facilitate and improve uniformity of future upper gastrointestinal guidelines on nodal CTV delineation. We report methodology and results from the collaboration of a working group panel selected by the ESTRO-ACROP.

Published
2021

23. Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry

Author

Giuliante, F., Vigano, L., De Rose, A. M., Mirza, D. F., Lapointe, R., Kaiser, G., Barroso, E., Ferrero, A., Isoniemi, H., Lopez-Ben, S., Popescu, I., Ouellet, J. -F., Hubert, C., Regimbeau, J. -M., Lin, J. -K., Skipenko, O. G., Ardito, F., Adam, R., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Giuliante, F., Vigano, L., De Rose, A. M., Mirza, D. F., Lapointe, R., Kaiser, G., Barroso, E., Ferrero, A., Isoniemi, H., Lopez-Ben, S., Popescu, I., Ouellet, J. -F., Hubert, C., Regimbeau, J. -M., Lin, J. -K., Skipenko, O. G., Ardito, F., Adam, R., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach. Methods: Patients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis. Results: Overall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003). Conclusion: In patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standa

Published
2021

24. Conversion Therapy With Encorafenib and Cetuximab for Chemo-Refractory BRAF V600E-Mutated Liver-Limited Colorectal Cancer Metastasis: The First Case Report

Author

Calegari, M. A., Stefano, B. D., Basso, M., Carbone, C., Camarda, F., Ribelli, M., Anghelone, A., Vivolo, R., Bensi, M., Martini, M., Pozzo, C., Vellone, M., Ardito, F., Salvatore, L., Giuliante, F., Tortora, G., Calegari M. A., Basso M., Camarda F., Anghelone A., Vivolo R., Bensi M., Martini M. (ORCID:0000-0002-6260-6310), Pozzo C., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Salvatore L., Giuliante F. (ORCID:0000-0001-9517-8220), Tortora G. (ORCID:0000-0002-1378-4962), Calegari, M. A., Stefano, B. D., Basso, M., Carbone, C., Camarda, F., Ribelli, M., Anghelone, A., Vivolo, R., Bensi, M., Martini, M., Pozzo, C., Vellone, M., Ardito, F., Salvatore, L., Giuliante, F., Tortora, G., Calegari M. A., Basso M., Camarda F., Anghelone A., Vivolo R., Bensi M., Martini M. (ORCID:0000-0002-6260-6310), Pozzo C., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Salvatore L., Giuliante F. (ORCID:0000-0001-9517-8220), and Tortora G. (ORCID:0000-0002-1378-4962)

Abstract

• Standard chemotherapy plus surgery yields to unsatisfying results in BRAF-mutated colorectal liver metastases (CLM). Combination of targeted agents (encorafenib, a BRAF inhibitor, and cetuximab, an anti-EGFR) is the new standard of care for BRAF V600E-mutated mCRC refractory to a first-line standard chemotherapy. Up to now no evidence is available concerning the activity of this novel treatment as conversion therapy in CLM setting. • Our case provides evidence, for the first time to our knowledge, of the activity of encorafenib plus cetuximab as conversion regimen for BRAF V600E-mutated CLM. Additional observations in this case report concern mechanisms underlying rapid occurrence of acquired resistance and the role of CEA serum levels as biomarker to monitor treatment activity and occurrence of resistance, allowing to optimize the timing of surgery. • Further evidence on the role of doublet targeted regimen (encorafenib plus cetuximab) as conversion treatment in the setting of BRAF-mutant CLM is warranted.

Published
2021

25. Splenic artery transposition for hepatic arterial reconstruction in a locally advanced pancreatic cancer: A case report and literature review

Author

Tinelli, Giovanni, Montanari, Francesca, Sica, Simona, Razionale, Francesco, Ardito, Francesco, Minelli, Fabrizio, De Nigris, Francesca, Tshomba, Yamume, Giuliante, Felice, Tinelli G. (ORCID:0000-0002-2212-3226), Montanari F., Sica S., Razionale F., Ardito F. (ORCID:0000-0003-1596-2862), Minelli F., de Nigris F., Tshomba Y. (ORCID:0000-0001-7304-7553), Giuliante F. (ORCID:0000-0001-9517-8220), Tinelli, Giovanni, Montanari, Francesca, Sica, Simona, Razionale, Francesco, Ardito, Francesco, Minelli, Fabrizio, De Nigris, Francesca, Tshomba, Yamume, Giuliante, Felice, Tinelli G. (ORCID:0000-0002-2212-3226), Montanari F., Sica S., Razionale F., Ardito F. (ORCID:0000-0003-1596-2862), Minelli F., de Nigris F., Tshomba Y. (ORCID:0000-0001-7304-7553), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

OBJECTIVE: During pancreatic surgery for malignancies, hepatic revascularization is needed in case of en bloc resection with hepatic artery involvement. In these cases, the use of the splenic artery is described in the literature, including transposition and interposition techniques. PATIENTS AND METHODS: We report the case of pancreatic cancer resection with involvement of the right hepatic artery, anomalous arising from the superior mesenteric artery, and hepatic revascularization with splenic artery reconstruction. A literature review to analyze the use of splenic artery in hepatic revascularization during pancreatic cancer surgery was performed. RESULTS: A 61-year-old man with a 55-mm hypovascular tumor in the pancreatic head, in wide contact with the right hepatic artery, underwent total pancreatectomy and splenectomy. Right hepatic artery was resected, and the distal part of the splenic artery was transposed to the right hepatic artery with a termino-terminal anastomosis. Histopathological examination revealed R0 resection. CONCLUSIONS: Hepatic revascularization with splenic artery should be considered in patients suitable to extend resectability in pancreatic cancer surgery. A multidisciplinary approach and careful pre-operative planning are essential.

Published
2021

26. Hepatectomy for Metabolic Associated Fatty Liver Disease (MAFLD) related HCC: Propensity case-matched analysis with viral- and alcohol-related HCC

Author

Conci, S., Cipriani, F., Donadon, M., Marchitelli, I., Ardito, Francesco, Famularo, S., Perri, P., Iaria, M., Ansaloni, L., Zanello, M., La Barba, G., Patauner, S., Pinotti, E., Molfino, S., Germani, P., Romano, M., Sciannamea, I., Ferrari, C., Manzoni, A., Troci, A., Fumagalli, L., Delvecchio, A., Floridi, A., Memeo, R., Chiarelli, M., Crespi, M., Zimmitti, G., Griseri, G., Antonucci, A., Zanus, G., Tarchi, P., Baiocchi, G. L., Zago, M., Frena, A., Ercolani, G., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Romano, F., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Ruzzenente, A., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Conci, S., Cipriani, F., Donadon, M., Marchitelli, I., Ardito, Francesco, Famularo, S., Perri, P., Iaria, M., Ansaloni, L., Zanello, M., La Barba, G., Patauner, S., Pinotti, E., Molfino, S., Germani, P., Romano, M., Sciannamea, I., Ferrari, C., Manzoni, A., Troci, A., Fumagalli, L., Delvecchio, A., Floridi, A., Memeo, R., Chiarelli, M., Crespi, M., Zimmitti, G., Griseri, G., Antonucci, A., Zanus, G., Tarchi, P., Baiocchi, G. L., Zago, M., Frena, A., Ercolani, G., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Romano, F., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Ruzzenente, A., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background and aims: We investigated the clinical impact of the newly defined metabolic-associated fatty liver disease (MAFLD) in patients undergoing hepatectomy for HCC (MAFLD-HCC) comparing the characteristics and outcomes of patients with MAFLD-HCC to viral- and alcoholic-related HCC (HCV-HCC, HBV-HCC, A-HCC). Methods: A retrospective analysis of patients included in the He.RC.O.Le.S. Group registry was performed. The characteristics, short- and long-term outcomes of 1315 patients included were compared according to the study group before and after an exact propensity score match (PSM). Results: Among the whole study population, 264 (20.1%) had MAFLD-HCC, 205 (15.6%) had HBV-HCC, 671 (51.0%) had HCV-HCC and 175 (13.3%) had A-HCC. MAFLD-HCC patients had higher BMI (p < 0.001), Charlson Comorbidities Index (p < 0.001), size of tumour (p < 0.001), and presence of cirrhosis (p < 0.001). After PSM, the 90-day mortality and severe morbidity rates were 5.9% and 7.1% in MAFLD-HCC, 2.3% and 7.1% in HBV-HCC, 3.5% and 11.7% in HCV-HCC, and 1.2% and 8.2% in A-HCC (p = 0.061 and p = 0.447, respectively). The 5-year OS and RFS rates were 54.4% and 37.1% in MAFLD-HCC, 64.9% and 32.2% in HBV-HCC, 53.4% and 24.7% in HCV-HCC and 62.0% and 37.8% in A-HCC (p = 0.345 and p = 0.389, respectively). Cirrhosis, multiple tumours, size and satellitosis seems to be the independent predictors of OS. Conclusion: Hepatectomy for MAFLD-HCC seems to have a higher but acceptable operative risk. However, long-term outcomes seems to be related to clinical and pathological factors rather than aetiological risk factors.

Published
2021

27. Incidence and predictors of textbook outcome after simultaneous liver and rectal surgeries for Stage IV rectal cancer

Author

Russolillo, N., Gentile, V., Ratti, F., Ardito, Francesco, Serenari, M., Lombardi, R., Jovine, E., Cescon, M., Giuliante, Felice, Aldrighetti, L., Ferrero, A., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Russolillo, N., Gentile, V., Ratti, F., Ardito, Francesco, Serenari, M., Lombardi, R., Jovine, E., Cescon, M., Giuliante, Felice, Aldrighetti, L., Ferrero, A., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Aim: Textbook outcome (TO) is a new surgical quality measure that combines structure, process and surgical outcomes into a single element. Our study aimed to determine the incidence of TO after simultaneous rectal and liver surgery and to use the achievement of TO as a tool to identify the best candidates for these complex procedures. Methods: In total, 256 patients who underwent simultaneous liver and rectal surgery for Stage IV rectal cancer between January 2004 and August 2019 at five tertiary centres were enrolled. TO was defined as a lack of complication, prolonged length of stay, readmission and death. Results: Mortality rate at 90 days and major morbidity rate were 2.3% and 15.6%, respectively. An overall TO was achieved in 59% of the patients, which is associated with significantly improved overall (median TO 86.3 months vs. no TO 37.4 months) and disease-free (median TO 70.6 months vs. no TO 24.9 months) survival. On multivariate analysis the presence of multi-comorbidities (OR 3.073) was associated with a reduced likelihood of achieving TO. Left lateral sectionectomy/limited resection was a protective factor (OR 0.416). Conclusion: TO was achieved in six of 10 patients undergoing simultaneous resections for rectal cancer and liver metastases. Achieving a TO is strongly associated with improved long-term survival. The best candidates for these procedures were patients without multiple comorbidities and those treated with left lateral sectionectomy/limited resection.

Published
2021

28. Liver metastasectomy for metastatic breast cancer patients: A single institution retrospective analysis

Author

Orlandi, Armando, Pontolillo, Letizia, Mele, Caterina, Pasqualoni, Mariangela, Pannunzio, Sergio, Cannizzaro, Maria Chiara, Cutigni, Claudia, Palazzo, A., Garufi, Giovanna, Vellone, Maria, Ardito, Francesco, Franceschini, Gianluca, Sanchez, A. M., Cassano, Alessandra, Giuliante, Felice, Bria, Emilio, Tortora, Giampaolo, Orlandi A. (ORCID:0000-0001-5253-4678), Pontolillo L., Mele C., Pasqualoni M., Pannunzio S., Cannizzaro M. C., Cutigni C., Garufi G., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Franceschini G. (ORCID:0000-0002-2950-3395), Cassano A. (ORCID:0000-0002-3311-7163), Giuliante F. (ORCID:0000-0001-9517-8220), Bria E. (ORCID:0000-0002-2333-704X), Tortora G. (ORCID:0000-0002-1378-4962), Orlandi, Armando, Pontolillo, Letizia, Mele, Caterina, Pasqualoni, Mariangela, Pannunzio, Sergio, Cannizzaro, Maria Chiara, Cutigni, Claudia, Palazzo, A., Garufi, Giovanna, Vellone, Maria, Ardito, Francesco, Franceschini, Gianluca, Sanchez, A. M., Cassano, Alessandra, Giuliante, Felice, Bria, Emilio, Tortora, Giampaolo, Orlandi A. (ORCID:0000-0001-5253-4678), Pontolillo L., Mele C., Pasqualoni M., Pannunzio S., Cannizzaro M. C., Cutigni C., Garufi G., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Franceschini G. (ORCID:0000-0002-2950-3395), Cassano A. (ORCID:0000-0002-3311-7163), Giuliante F. (ORCID:0000-0001-9517-8220), Bria E. (ORCID:0000-0002-2333-704X), and Tortora G. (ORCID:0000-0002-1378-4962)

Abstract

The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients who had undergone an LM after a multidisciplinary Tumor Board discussion at the Hepatobiliary Surgery Unit of Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS in Rome, between January 1994 and December 2019 was conducted. The primary endpoint was overall survival (OS) after a MBC-LM; the secondary endpoint was the disease-free interval (DFI) after surgery. Forty-nine MBC patients underwent LM, but clinical data were only available for 22 patients. After a median follow-up of 71 months, median OS and DFI were 67 months (95% CI 45–103) and 15 months (95% CI 11–46), respectively. At univariate analysis, the presence of a negative resection margin (R0) was the only factor that statistically significantly influenced OS (78 months versus 16 months; HR 0.083, p < 0.0001) and DFI (16 months versus 5 months; HR 0.17, p = 0.0058). A LM for MBC might represent a therapeutic option for selected patients. The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option.

Published
2021

29. 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

30. Aggressive recurrences determine oncologic outcomes after resection of liver metastases from primary right colon cancer: Results of a case-control study

Author

Zimmitti, Giuseppe, Panettieri, Elena, Ardito, Francesco, Mele, Caterina, Maria, V., Rosso, Edoardo, Nuzzo, Gennaro, Giuliante, Felice, Zimmitti G. (ORCID:0000-0003-4925-4012), Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), Mele C., Rosso E., Nuzzo G., Giuliante F. (ORCID:0000-0001-9517-8220), Zimmitti, Giuseppe, Panettieri, Elena, Ardito, Francesco, Mele, Caterina, Maria, V., Rosso, Edoardo, Nuzzo, Gennaro, Giuliante, Felice, Zimmitti G. (ORCID:0000-0003-4925-4012), Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), Mele C., Rosso E., Nuzzo G., and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background: Despite recent studies suggest that, among patients operated on for colorectal liver metastases (CLM), the primary tumor location may impact on postoperative survivals, results are still contrasting. Objective: evaluating survivals (overall (OS) and (DFS)) following liver resection of CLM from Right colon Cancer (RcC-CLM) versus Left colon Cancer (LcC-CLM), among patients undergoing preoperative chemotherapy (pCHT), identifying survival predictors, and investigating impact of recurrent disease pattern and management on survival. Methods: Among 727 patients operated for CLM(1989–2016), after excluding patients with primary transverse colon/rectum tumor and patients not receving pCHT, 297 patients were identified. Among them, 81 with RcC-CLM were matched 1:1 with LcC-CLM, according to CLM number and diameter, disease-free interval between primary tumor and CLM diagnosis, primary tumor N-status, and the presence of extrahepatic disease. Results: Overall, 66.7% of patients had multiple CLM, 21% had CLM>5 cm, 82.7% had DFI<12 months, 67.9% had N+ primary tumor, and 11.1% had extrahepatic disease at time of hepatectomy. RcC-CLM patients were similar to LcC-CLM in terms of demographic, clinical, perioperative, and pathologic characteristics. Patients operated for RcC-CLM, compared to LcC-CLM, had significantly shorter 5y-DFS(18% versus 39%) and 5y-OS(38% vs 65%). At multivariate analysis, being operated for RcC-CLM, compared to LcC-CLM, was the strongest predictor of recurrence (Hazard Ratio:2.265,p < .001) and death (HR:2.234,p = .001). Among 107 patients experiencing recurrent disease, curative recurrence resection was associated with higher 5y-OS(64% vs 17%; p < .001). However, recurrence resection was less frequently feasible among RcC-CLM(26%) patients, compared to LcC-CLM(44%,p = .05). Conclusions: resection of RcC-CLM, compared to LcC-CLM, is associated with worse survivals, probably related to a different pattern of recurrence precluding rec

Published
2021

31. 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., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., D'Acapito F., Zimmitti G. (ORCID:0000-0003-4925-4012), Antonucci A., Maestri M., Giuliante F. (ORCID:0000-0001-9517-8220), Romano F., Torzilli G., Lazzari G., Manzoni A., 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., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., D'Acapito F., Zimmitti G. (ORCID:0000-0003-4925-4012), Antonucci A., Maestri M., Giuliante F. (ORCID:0000-0001-9517-8220), Romano F., Torzilli G., Lazzari G., and Manzoni A.

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

32. Liver metastasectomy for metastatic breast cancer patients: A single institution retrospective analysis

Author

Orlandi, Armando, Pontolillo, Letizia, Mele, Caterina, Pasqualoni, Mariangela, Pannunzio, Sergio, Cannizzaro, Maria Chiara, Cutigni, Claudia, Palazzo, A., Garufi, Giovanna, Vellone, Maria, Ardito, Francesco, Franceschini, Gianluca, Sanchez, A. M., Cassano, Alessandra, Giuliante, Felice, Bria, Emilio, Tortora, Giampaolo, Orlandi A. (ORCID:0000-0001-5253-4678), Pontolillo L., Mele C., Pasqualoni M., Pannunzio S., Cannizzaro M. C., Cutigni C., Garufi G., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Franceschini G. (ORCID:0000-0002-2950-3395), Cassano A. (ORCID:0000-0002-3311-7163), Giuliante F. (ORCID:0000-0001-9517-8220), Bria E. (ORCID:0000-0002-2333-704X), Tortora G. (ORCID:0000-0002-1378-4962), Orlandi, Armando, Pontolillo, Letizia, Mele, Caterina, Pasqualoni, Mariangela, Pannunzio, Sergio, Cannizzaro, Maria Chiara, Cutigni, Claudia, Palazzo, A., Garufi, Giovanna, Vellone, Maria, Ardito, Francesco, Franceschini, Gianluca, Sanchez, A. M., Cassano, Alessandra, Giuliante, Felice, Bria, Emilio, Tortora, Giampaolo, Orlandi A. (ORCID:0000-0001-5253-4678), Pontolillo L., Mele C., Pasqualoni M., Pannunzio S., Cannizzaro M. C., Cutigni C., Garufi G., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Franceschini G. (ORCID:0000-0002-2950-3395), Cassano A. (ORCID:0000-0002-3311-7163), Giuliante F. (ORCID:0000-0001-9517-8220), Bria E. (ORCID:0000-0002-2333-704X), and Tortora G. (ORCID:0000-0002-1378-4962)

Abstract

The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients who had undergone an LM after a multidisciplinary Tumor Board discussion at the Hepatobiliary Surgery Unit of Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS in Rome, between January 1994 and December 2019 was conducted. The primary endpoint was overall survival (OS) after a MBC-LM; the secondary endpoint was the disease-free interval (DFI) after surgery. Forty-nine MBC patients underwent LM, but clinical data were only available for 22 patients. After a median follow-up of 71 months, median OS and DFI were 67 months (95% CI 45–103) and 15 months (95% CI 11–46), respectively. At univariate analysis, the presence of a negative resection margin (R0) was the only factor that statistically significantly influenced OS (78 months versus 16 months; HR 0.083, p < 0.0001) and DFI (16 months versus 5 months; HR 0.17, p = 0.0058). A LM for MBC might represent a therapeutic option for selected patients. The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option.

Published
2021

34. The role of minimally invasive liver surgery to treat hepatic benign disease

Author

Ardito, Francesco, Ardito F. (ORCID:0000-0003-1596-2862), Ardito, Francesco, and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Benign liver disease is extremely frequent and often asymptomatic. During the recent years, the widespread use of radiological imaging, in particular the use of abdominal ultrasound, has significantly increased the incidence of benign liver lesions incidental diagnosis (1-3). Incidental diagnosis of a benign liver lesion by abdominal ultrasound usually occurs in asymptomatic patients or in patients with other symptoms not related with the presence of the hepatic benign nodule.

Published
2020

35. Laparoscopic left hepatectomy for primary intrahepatic lithiasis: surgical technique

Author

Ardito, Francesco, Mele, C., Vellone, Maria, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Vellone M. (ORCID:0000-0002-7628-4092), Giuliante F. (ORCID:0000-0001-9517-8220), Ardito, Francesco, Mele, C., Vellone, Maria, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Vellone M. (ORCID:0000-0002-7628-4092), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Primary intrahepatic lithiasis (PIHL) is defined by the presence of stones that generates in the liver at the level of cystic dilatations of the intrahepatic biliary tree. When PIHL is unilateral and limited to a single hemiliver or segment, liver resection may be considered the treatment of choice, because it removes the stones together with the atrophic parenchyma with anomalous bile duct dilations and strictures, that are associated with the risk of developing cholangiocarcinoma. PIHL can represent a valid indication for the minimally invasive approach. Localized PIHL is particularly prevalent in the left lateral segment. Left hepatectomy by minimally invasive approach may be considered as a standardized procedure and an excellent choice to treat the disease, resulting in better operative results than that reported after open procedure.

Published
2020

37. The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol

Author

Ardito, Francesco, Lai, Q., Rinninella, Emanuele, Mimmo, A., Vellone, Maria, Panettieri, Elena, Adducci, Enrica, Cintoni, M., Mele, Maria Cristina, Gasbarrini, Antonio, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Rinninella E. (ORCID:0000-0002-9165-2367), Vellone M. (ORCID:0000-0002-7628-4092), Panettieri E., Adducci E. (ORCID:0000-0002-8977-762X), Mele M. C. (ORCID:0000-0003-0153-5819), Gasbarrini A. (ORCID:0000-0002-7278-4823), Giuliante F. (ORCID:0000-0001-9517-8220), Ardito, Francesco, Lai, Q., Rinninella, Emanuele, Mimmo, A., Vellone, Maria, Panettieri, Elena, Adducci, Enrica, Cintoni, M., Mele, Maria Cristina, Gasbarrini, Antonio, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Rinninella E. (ORCID:0000-0002-9165-2367), Vellone M. (ORCID:0000-0002-7628-4092), Panettieri E., Adducci E. (ORCID:0000-0002-8977-762X), Mele M. C. (ORCID:0000-0003-0153-5819), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background: Malnutrition in liver surgery is correlated with higher postoperative complications and longer length of hospital stay (LOHS), the same items that ERAS programs try to optimize. However, to date, standardized dietary protocols have not been defined within ERAS programs. Aim of this study was to evaluate the impact on LOHS and postoperative complications, of a personalized nutritional protocol (NutriCatt) with diet and oral branched-chain amino acid (BCAA) supplementation, adopted within the ERAS program. Methods: 1960 consecutive liver resections were performed from January 2000 to September 2018. Exclusion criteria: perihilar cholangiocarcinoma, simultaneous colorectal and liver resections. Four groups for analysis: resections before 2009 (1st period); from 2009 to 2016 (2nd period, including laparoscopic resections); between 2016 and September 2017 (ERAS); after September 2017 (ERAS + NutriCatt). Results: LOHS declined (p < 0.0001), from a median of 10 days (1st period) to 8, 7 and 6 in 2nd period, ERAS and ERAS + NutriCatt groups, respectively. At multivariable analysis for risk of LOHS > 8 days, the 2nd period, ERAS and ERAS + NutriCatt groups showed a protective effect. These results were confirmed for both minor and major resections. LOHS was significantly lower in ERAS + Nutricatt group than in ERAS group, without increasing risk of postoperative complications, although the rate of laparoscopic resections was similar in these two groups and complexity of liver resections was significantly higher in the last period. Conclusions: Adoption of a personalized nutritional protocol with BCAA supplementation within the ERAS program for liver resections was a safe and effective approach that may impact on reducing the LOHS.

Published
2020

38. 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

39. 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

40. Laparoscopic Liver Resection of Segment 7 for Hepatocellular Carcinoma with an Ultrasound-Guided Trans-Parenchymal Approach to Segmental Pedicle

Author

Giuliante, Felice, Ardito, Francesco, Vellone, Maria, Mele, Caterina, Panettieri, Elena, Bellobono, M., De Rose, A. M., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Vellone M. (ORCID:0000-0002-7628-4092), Mele C., Panettieri E., Giuliante, Felice, Ardito, Francesco, Vellone, Maria, Mele, Caterina, Panettieri, Elena, Bellobono, M., De Rose, A. M., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Vellone M. (ORCID:0000-0002-7628-4092), Mele C., and Panettieri E.

Abstract

No abstract available

Published
2020

41. 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., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., Antonucci A., Zimmitti G. (ORCID:0000-0003-4925-4012), Maestri M., Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Romano F., Lazzari G., Del Vecchio A., 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., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., Antonucci A., Zimmitti G. (ORCID:0000-0003-4925-4012), Maestri M., Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Romano F., Lazzari G., and Del Vecchio A.

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

42. Elective Surgery in the COVID-19 Era: A Screening Algorithm and Related Concerns

Author

Taliente, Francesco, Mascagni, Pietro, Santullo, F, Ardito, Francesco, Pacelli, Fabio, Taliente F, Mascagni P, Ardito F (ORCID:0000-0003-1596-2862), Pacelli F. (ORCID:0000-0002-2013-6525), Taliente, Francesco, Mascagni, Pietro, Santullo, F, Ardito, Francesco, Pacelli, Fabio, Taliente F, Mascagni P, Ardito F (ORCID:0000-0003-1596-2862), and Pacelli F. (ORCID:0000-0002-2013-6525)

Abstract

No abstract available

Published
2020

43. Letter to the Editor: EUS-FNA for Lymph Nodes Staging in Cholangiocarcinoma: Should It Become Standard of Care?

Author

Larghi, A., Rimbas, M., Ardito, F., Rizzatti, G., Giuliante, F., Larghi A., Ardito F. (ORCID:0000-0003-1596-2862), Rizzatti G. (ORCID:0000-0003-1876-7587), Giuliante F. (ORCID:0000-0001-9517-8220), Larghi, A., Rimbas, M., Ardito, F., Rizzatti, G., Giuliante, F., Larghi A., Ardito F. (ORCID:0000-0003-1596-2862), Rizzatti G. (ORCID:0000-0003-1876-7587), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

No abstract available

Published
2020

44. The Impact of Hospital Volume on Failure to Rescue after Liver Resection for Hepatocellular Carcinoma: Analysis from the HE.RC.O.LE.S. Italian Registry

Author

Ardito, Francesco, Famularo, S., Aldrighetti, L., Grazi, G. L., Dallavalle, R., Maestri, Marta, Jovine, E., Ruzzenente, A., Baiocchi, G. L., Ercolani, G., Griseri, G., Frena, A., Zanus, G., Zimmitti, Giuseppe, Antonucci, Anna Maria, Crespi, M., Memeo, R., Romano, Federica, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Maestri M., Zimmitti G. (ORCID:0000-0003-4925-4012), Antonucci A., Romano F., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito, Francesco, Famularo, S., Aldrighetti, L., Grazi, G. L., Dallavalle, R., Maestri, Marta, Jovine, E., Ruzzenente, A., Baiocchi, G. L., Ercolani, G., Griseri, G., Frena, A., Zanus, G., Zimmitti, Giuseppe, Antonucci, Anna Maria, Crespi, M., Memeo, R., Romano, Federica, Giuliante, Felice, Ardito F. (ORCID:0000-0003-1596-2862), Maestri M., Zimmitti G. (ORCID:0000-0003-4925-4012), Antonucci A., Romano F., and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

OBJECTIVE: The aim of this study was to evaluate correlation between centers' volume and incidence of failure to rescue (FTR) following liver resection for hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: FTR, defined as the probability of postoperative death among patients with major complication, has been proposed to assess quality of care during hospitalization. Perioperative management is challenging in cirrhotic patients and the ability to recognize and treat a complication may be fundamental to rescue patients from the risk of death. METHODS: Patients undergoing liver resection for HCC between 2008 and 2018 in 18 Centers enrolled in the He.Rc.O.Le.S. Italian register. Early results included major complications (Clavien ≥3), 90-day mortality, and FTR and were analyzed according to center's volume. RESULTS: Among 1935 included patients, major complication rate was 9.4% (8.6%, 12.3%, and 7.0% for low-, intermediate- and high-volume centers, respectively, P = 0.001). Ninety-day mortality rate was 2.6% (3.7%, 4.2% and 0.9% for low-, intermediate- and high-volume centers, respectively, P < 0.001). FTR was significantly higher at low- and intermediate-volume centers (28.6% and 26.5%, respectively) than at high-volume centers (6.1%, P = 0.002). Independent predictors for major complications were American Society of Anesthesiologists (ASA) >2, portal hypertension, intraoperative blood transfusions, and center's volume. Independent predictors for 90-day mortality were ASA >2, Child-Pugh score B, BCLC stage B-C, and center's volume. Center's volume and BCLC stage were strongly associated with FTR. CONCLUSIONS: Risk of major complications and mortality was related with comorbidities, cirrhosis severity, and complexity of surgery. These factors were not correlated with FTR. Center's volume was the only independent predictor related with severe complications, mortality, and FTR.

Published
2020

45. The impact of multidisciplinary team management on outcome of hepatic resection in liver-limited colorectal metastases

Author

Basso, M., Corallo, S., Calegari, M. A., Zurlo, I. V., Ardito, F., Vellone, M., Marchesani, S., Orlandi, A., Dadduzio, V., Fuca, G., Di Dio, C., Mele, C., Barbaro, B., Strippoli, A., Coppola, A., Cassano, A., Bria, E., Barone, C. A., Giuliante, F., Basso M., Calegari M. A., Zurlo I. V., Ardito F. (ORCID:0000-0003-1596-2862), Vellone M. (ORCID:0000-0002-7628-4092), Orlandi A. (ORCID:0000-0001-5253-4678), Dadduzio V., Mele C., Barbaro B. (ORCID:0000-0002-9638-543X), Strippoli A., Cassano A. (ORCID:0000-0002-3311-7163), Bria E. (ORCID:0000-0002-2333-704X), Barone C. A., Giuliante F. (ORCID:0000-0001-9517-8220), Basso, M., Corallo, S., Calegari, M. A., Zurlo, I. V., Ardito, F., Vellone, M., Marchesani, S., Orlandi, A., Dadduzio, V., Fuca, G., Di Dio, C., Mele, C., Barbaro, B., Strippoli, A., Coppola, A., Cassano, A., Bria, E., Barone, C. A., Giuliante, F., Basso M., Calegari M. A., Zurlo I. V., Ardito F. (ORCID:0000-0003-1596-2862), Vellone M. (ORCID:0000-0002-7628-4092), Orlandi A. (ORCID:0000-0001-5253-4678), Dadduzio V., Mele C., Barbaro B. (ORCID:0000-0002-9638-543X), Strippoli A., Cassano A. (ORCID:0000-0002-3311-7163), Bria E. (ORCID:0000-0002-2333-704X), Barone C. A., and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Hepatic resection is the gold standard treatment for patients affected by liver-limited colorectal metastases. Reports addressing the impact of multidisciplinary team (MDT) evaluation on survival are controversial. The aim of this study was to evaluate the benefit of MDT management in these patients in our Institution experience. The objective of the analysis was to compare survivals of patients managed within our MDT (MDT cohort) to those of patients referred to surgery from other hospitals without MDT discussion (non-MDT cohort). Of the 523 patients, 229 were included in the MDT cohort and 294 in the non-MDT cohort. No difference between the two groups was found in terms of median overall survival (52.5 vs 53.6 months; HR 1.13; 95% CI, 0.88–1.45; p = 0.344). In the MDT cohort there was a higher number of metastases (4.5 vs 2.7; p < 0.0001). The median duration of chemotherapy was lower in MDT patients (8 vs 10 cycles; p < 0.001). Post-operative morbidity was lower in the MDT cohort (6.2 vs 21.5%; p < 0.001). One hundred and ninety-seven patients in each group were matched by propensity score and no significant difference was observed between the two groups in terms of OS and DFS. Our study does not demonstrate a survival benefit from MDT management, but it allows surgery to patients with a more advanced disease. MDT assessment reduces the median duration of chemotherapy and post-operative morbidities.

Published
2020

46. 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

47. 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

48. Type of response to conversion chemotherapy strongly impacts survival after hepatectomy for initially unresectable colorectal liver metastases

Author

Zimmitti, G., Panettieri, Elena, Ardito, Francesco, Rosso, E., Mele, C., Nuzzo, G., Giuliante, Felice, Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Zimmitti, G., Panettieri, Elena, Ardito, Francesco, Rosso, E., Mele, C., Nuzzo, G., Giuliante, Felice, Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background: Hepatectomy for initially unresectable colorectal liver metastases (IU-CLM) is considered at high risk due to the extensive preoperative chemotherapy (CHT) and complex surgical procedures required, and its results are questioned due to frequent and early post-operative recurrence. We aim to compare patients with initially resectable CLM (IR-CLM) and IU-CLM and identify prognostic factors among IU-CLM patients. Methods: A total of 81 patients with IU-CLM, undergoing hepatectomy following conversion CHT, were compared to 526 IR-CLM patients. Predictors of overall (OS) and disease-free survival (DFS) were identified for IU-CLM patients. Results: Patients resected for IU-CLM, compared to IR-CLM, had more and larger CLM and more frequently underwent prolonged CHT and major/extended hepatectomy (P < 0.001 for all comparisons). Such characteristics paralleled higher rates of overall and major (Clavien-Dindo ≥3) complications, longer median post-operative length of stay and lower 5-year survival rates (P < 0.001 for all comparisons) among IU-CLM patients compared to IR-CLM, with similar mortality (1.2% and nil for IU-CLM and IR-CLM, respectively). Among IU-CLM patients, 62 with partial response to CHT (versus tumour stability according to the Response Evaluation Criteria in Solid Tumors criteria) had better DFS (hazard ratio 2.76, P = 0.001) and OS (hazard ratio 2.83, P = 0.002), and their 5-year survival rates (DFS 19.8%, OS 46.7%) approached those of IR-CLM patients (DFS 31%, OS 59%, P > 0.05 for both comparisons). Conclusion: Resection of IU-CLM has acceptable perioperative results. Tumour responsiveness to conversion CHT improves IU-CLM patient selection for hepatectomy.

Published
2020

49. Ultra-late recurrence of gastrointestinal stromal tumour: case report and literature review

Author

Grossi, U., Ardito, F., Petracca Ciavarella, L., Goglia, M., Giuliante, F., Ardito F. (ORCID:0000-0003-1596-2862), Petracca Ciavarella L., Giuliante F. (ORCID:0000-0001-9517-8220), Grossi, U., Ardito, F., Petracca Ciavarella, L., Goglia, M., Giuliante, F., Ardito F. (ORCID:0000-0003-1596-2862), Petracca Ciavarella L., and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

No abstract available

Published
2019

50. Critical analysis of major and ancillary features of LI-RADS v2018 in the differentiation of small (< 2 cm) hepatocellular carcinoma from dysplastic nodules with gadobenate dimeglumine-enhanced magnetic resonance imaging

Author

De Gaetano, Anna Maria, Catalano, M., Pompili, Maurizio, Marinp, M. G., Rodriguez Carnero, P., Gulli, C., Infante, A., Iezzi, Roberto, Ponziani, Francesca Romana, Cerrito, Lucia, Marrone, Giuseppe, Giuliante, Felice, Ardito, Francesco, Rapaccini, Gian Ludovico, Vecchio, Fabio Maria, Giraldi, Luca, Manfredi, Riccardo, De Gaetano A. M. (ORCID:0000-0002-7493-9462), Pompili M. (ORCID:0000-0001-6699-7980), Iezzi R. (ORCID:0000-0002-2791-481X), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cerrito L., Marrone G., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Rapaccini G. L. (ORCID:0000-0002-6467-857X), Vecchio F. M. (ORCID:0000-0002-9197-2264), Giraldi L., Manfredi R. (ORCID:0000-0002-4972-9500), De Gaetano, Anna Maria, Catalano, M., Pompili, Maurizio, Marinp, M. G., Rodriguez Carnero, P., Gulli, C., Infante, A., Iezzi, Roberto, Ponziani, Francesca Romana, Cerrito, Lucia, Marrone, Giuseppe, Giuliante, Felice, Ardito, Francesco, Rapaccini, Gian Ludovico, Vecchio, Fabio Maria, Giraldi, Luca, Manfredi, Riccardo, De Gaetano A. M. (ORCID:0000-0002-7493-9462), Pompili M. (ORCID:0000-0001-6699-7980), Iezzi R. (ORCID:0000-0002-2791-481X), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cerrito L., Marrone G., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Rapaccini G. L. (ORCID:0000-0002-6467-857X), Vecchio F. M. (ORCID:0000-0002-9197-2264), Giraldi L., and Manfredi R. (ORCID:0000-0002-4972-9500)

Abstract

OBJECTIVE: To evaluate the performance of major features, ancillary features, and categories of Liver Imaging Reporting and Data System (LI-RADS) version 2018 at magnetic resonance (MR) imaging in the differentiation of small hepatocellular carcinoma (HCC) from dysplastic nodules (DNs). PATIENTS AND METHODS: This retrospective study included cirrhotic patients with pathologically proven untreated HCCs and DNs (< 2 cm) and liver MR imaging performed with gadobenate dimeglumine contrast agent within 3 months before pathological analysis, between 2015 and 2018. 37 patients with 43 observations (17 HCCs and 26 DNs) met the inclusion criteria. Two radiologists assessed major and ancillary imaging features for each liver observation and assigned a LI-RADS v2018 category in consensus. Estimates of diagnostic performance of major features, ancillary features, and LI-RADS categories were assessed based on their sensitivity, specificity, positive (PPV), and negative predictive values (NPV). RESULTS: Major features (nonrim arterial phase hyperenhancement, nonperipheral "washout", and enhancing "capsule") had a sensitivity of 94.1%, 88.2%, and 41.2%, and a specificity of 57.7%, 42.3%, and 88.5% for HCC, respectively. Ancillary features (hepatobiliary phase hypointensity, mild-moderate T2 hyperintensity, restricted diffusion, and fat in the lesion more than adjacent liver) had a sensitivity of 94.1%, 64.7%, 58.8%, and 11.8%, and a specificity of 26.9%, 61.5%, 65.4%, and 76.9% for HCC, respectively. The LR-5 category (determined by using major features only vs. the combination of major and ancillary features) had a sensitivity of 88.2% at both evaluations and a specificity of 76.9% and 80.8% for HCC, respectively. The combination of LR-4, LR-5 categories (determined by using major features only vs. the combination of major and ancillary features) had a sensitivity of 94.1% at both interpretations and a specificity of 65.4% and 26.9% for HCC, respectively. The use of ancillary

Published
2019

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