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2. Dynamic surgical anatomy using 3D reconstruction technology in complex hepato-biliary surgery with vascular involvement. Results from an international multicentric survey

Author

Cotsoglou, C, Granieri, S, Bassetto, S, Bagnardi, V, Pugliese, R, Grazi, G, Guglielmi, A, Ruzzenente, A, Aldrighetti, L, Ratti, F, De Carlis, L, De Carlis, R, Centonze, L, De Angelis, N, Memeo, R, Delvecchio, A, Felli, E, Izzo, F, Belli, A, Patrone, R, Ettorre, G, Berardi, G, Di Benedetto, F, Di Sandro, S, Romano, F, Garancini, M, Scotti, M, Bianchi, G, Germini, A, Gjoni, E, Bonomi, A, Bruno, F, Paleino, S, Pugliese, G, Cotsoglou C., Granieri S., Bassetto S., Bagnardi V., Pugliese R., Grazi G. L., Guglielmi A., Ruzzenente A., Aldrighetti L., Ratti F., De Carlis L., De Carlis R., Centonze L., De Angelis N., Memeo R., Delvecchio A., Felli E., Izzo F., Belli A., Patrone R., Ettorre G. M., Berardi G., Di Benedetto F., Di Sandro S., Romano F., Garancini M., Scotti M. A., Bianchi G., Germini A., Gjoni E., Bonomi A., Bruno F., Paleino S., Pugliese G., Cotsoglou, C, Granieri, S, Bassetto, S, Bagnardi, V, Pugliese, R, Grazi, G, Guglielmi, A, Ruzzenente, A, Aldrighetti, L, Ratti, F, De Carlis, L, De Carlis, R, Centonze, L, De Angelis, N, Memeo, R, Delvecchio, A, Felli, E, Izzo, F, Belli, A, Patrone, R, Ettorre, G, Berardi, G, Di Benedetto, F, Di Sandro, S, Romano, F, Garancini, M, Scotti, M, Bianchi, G, Germini, A, Gjoni, E, Bonomi, A, Bruno, F, Paleino, S, Pugliese, G, Cotsoglou C., Granieri S., Bassetto S., Bagnardi V., Pugliese R., Grazi G. L., Guglielmi A., Ruzzenente A., Aldrighetti L., Ratti F., De Carlis L., De Carlis R., Centonze L., De Angelis N., Memeo R., Delvecchio A., Felli E., Izzo F., Belli A., Patrone R., Ettorre G. M., Berardi G., Di Benedetto F., Di Sandro S., Romano F., Garancini M., Scotti M. A., Bianchi G., Germini A., Gjoni E., Bonomi A., Bruno F., Paleino S., and Pugliese G.

Abstract

Introduction: Three-dimensional liver modeling can lead to substantial changes in choosing the type and extension of liver resection. This study aimed to explore whether 3D reconstruction helps to better understand the relationship between liver tumors and neighboring vascular structures compared to standard 2D CT scan images. Methods: Contrast-enhanced CT scan images of 11 patients suffering from primary and secondary hepatic tumors were selected. Twenty-three experienced HBP surgeons participated to the survey. A standardized questionnaire outlining 16 different vascular structures (items) having a potential relationship with the tumor was provided. Intraoperative and histopathological findings were used as the reference standard. The proper hypothesis was that 3D accuracy is greater than 2D. As a secondary endpoint, inter-raters’ agreement was explored. Results: The mean difference between 3D and 2D, was 2.6 points (SE: 0.40; 95 % CI: 1.7–3.5; p < 0.0001). After sensitivity analysis, the results favored 3D visualization as well (mean difference 1.7 points; SE: 0.32; 95 % CI: 1.0–2.5; p = 0.0004). The inter-raters’ agreement was moderate for both methods (2D: W = 0.45; 3D: W = 0.44). Conclusion: 3D reconstruction may give a significant contribution to better understanding liver vascular anatomy and the precise relationship between the tumor and the neighboring structures.

Published
2024

3. Robotic ALPPS for primary and metastatic liver tumours: short-term outcomes versus open approach

Author

Magistri, P, Guidetti, C, Catellani, B, Caracciolo, D, Odorizzi, R, Frassoni, S, Bagnardi, V, Guerrini, G, Di Sandro, S, Di Benedetto, F, Magistri P., Guidetti C., Catellani B., Caracciolo D., Odorizzi R., Frassoni S., Bagnardi V., Guerrini G. P., Di Sandro S., Di Benedetto F., Magistri, P, Guidetti, C, Catellani, B, Caracciolo, D, Odorizzi, R, Frassoni, S, Bagnardi, V, Guerrini, G, Di Sandro, S, Di Benedetto, F, Magistri P., Guidetti C., Catellani B., Caracciolo D., Odorizzi R., Frassoni S., Bagnardi V., Guerrini G. P., Di Sandro S., and Di Benedetto F.

Abstract

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is one of the strategies available for patients initially unresectable. High risk of peri-operative morbidity and mortality limited its application and diffusion. We aimed to analyse short-term outcomes of robotic ALPPS versus open approach, to assess safety and reproducibility of this technique. A retrospective analysis of prospectively maintained databases at University of Modena and Reggio Emilia on patients that underwent ALPPS between January 2015 and September 2022 was conducted. The main aim of the study was to evaluate safety and feasibility of robotic approach, either full robotic or only first-stage robotic, compared to a control group of patients who underwent open ALPPS in the same Institution. 23 patients were included. Nine patients received a full open ALPPS (O-ALPPS), 7 received a full robotic ALPPS (R-ALPPS), and 7 underwent a robotic approach for stage 1, followed by an open approach for stage 2 (R + O-ALPPS). PHLF grade B-C after stage 1 was 0% in all groups, rising to 58% in the R + O-ALPPS group after stage 2 and remaining 0% in the R-ALPPS group. 86% of R-ALPPS cases were discharged from the hospital between stages 1 and 2, and median total in-hospital stay and ICU stay favoured full robotic approach as well. This contemporary study represents the largest series of robotic ALPPS, showing potential advantages from full robotic ALPPS over open approach, resulting in reduced hospital stay and complications and lower incidence of 90-day mortality.

Published
2024

6. Portal vein thrombosis and liver transplantation: management, matching, and outcomes: a retrospective multicenter cohort study

Author

Di Benedetto, F, Magistri, P, Di Sandro, S, Boetto, R, Tandoi, F, Camagni, S, Lauterio, A, Pagano, D, Nicolini, D, Violi, P, Dondossola, D, Guglielmo, N, Cherchi, V, Lai, Q, Toti, L, Bongini, M, Frassoni, S, Bagnardi, V, Mazzaferro, V, Tisone, G, Rossi, M, Baccarani, U, Ettorre, G, Caccamo, L, Carraro, A, Vivarelli, M, Gruttadauria, S, De Carlis, L, Colledan, M, Romagnoli, R, Cillo, U, Di Benedetto, Fabrizio, Magistri, Paolo, Di Sandro, Stefano, Boetto, Riccardo, Tandoi, Francesco, Camagni, Stefania, Lauterio, Andrea, Pagano, Duilio, Nicolini, Daniele, Violi, Paola, Dondossola, Daniele, Guglielmo, Nicola, Cherchi, Vittorio, Lai, Quirino, Toti, Luca, Bongini, Marco, Frassoni, Samuele, Bagnardi, Vincenzo, Mazzaferro, Vincenzo, Tisone, Giuseppe, Rossi, Massimo, Baccarani, Umberto, Ettorre, Giuseppe Maria, Caccamo, Lucio, Carraro, Amedeo, Vivarelli, Marco, Gruttadauria, Salvatore, De Carlis, Luciano, Colledan, Michele, Romagnoli, Renato, Cillo, Umberto, Di Benedetto, F, Magistri, P, Di Sandro, S, Boetto, R, Tandoi, F, Camagni, S, Lauterio, A, Pagano, D, Nicolini, D, Violi, P, Dondossola, D, Guglielmo, N, Cherchi, V, Lai, Q, Toti, L, Bongini, M, Frassoni, S, Bagnardi, V, Mazzaferro, V, Tisone, G, Rossi, M, Baccarani, U, Ettorre, G, Caccamo, L, Carraro, A, Vivarelli, M, Gruttadauria, S, De Carlis, L, Colledan, M, Romagnoli, R, Cillo, U, Di Benedetto, Fabrizio, Magistri, Paolo, Di Sandro, Stefano, Boetto, Riccardo, Tandoi, Francesco, Camagni, Stefania, Lauterio, Andrea, Pagano, Duilio, Nicolini, Daniele, Violi, Paola, Dondossola, Daniele, Guglielmo, Nicola, Cherchi, Vittorio, Lai, Quirino, Toti, Luca, Bongini, Marco, Frassoni, Samuele, Bagnardi, Vincenzo, Mazzaferro, Vincenzo, Tisone, Giuseppe, Rossi, Massimo, Baccarani, Umberto, Ettorre, Giuseppe Maria, Caccamo, Lucio, Carraro, Amedeo, Vivarelli, Marco, Gruttadauria, Salvatore, De Carlis, Luciano, Colledan, Michele, Romagnoli, Renato, and Cillo, Umberto

Abstract

BACKGROUND AND AIMS: Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients. METHODS: Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant. RESULTS: Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT ( P <0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present. CONCLUSIONS: Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of spe

Published
2024

7. Integrating microalgae growth in biomethane plants: Process design, modelling, and cost evaluation

Author

Rossi, S, Carecci, D, Marazzi, F, Di Benedetto, F, Mezzanotte, V, Parati, K, Alberti, D, Geraci, I, Ficara, E, Rossi, S, Carecci, D, Marazzi, F, Di Benedetto, F, Mezzanotte, V, Parati, K, Alberti, D, Geraci, I, and Ficara, E

Abstract

The integration of microalgae cultivation in anaerobic digestion (AD) plants can take advantage of relevant nutrients (ammonium and ortho-phosphate) and CO2 loads. The proposed scheme of microalgae integration in existing biogas plants aims at producing approximately 250 ty(-1) of microalgal biomass, targeting the biostimulants market that is currently under rapid expansion. A full-scale biorefinery was designed to treat 50 kty(-1) of raw liquid digestate from AD and 0.45 kty(-1) of CO2 from biogas upgrading, and 0.40 kty(-1) of sugar-rich solid by-products from a local confectionery industry. An innovative three-stage cultivation process was designed, modelled, and verified, including: i) microalgae inoculation in tubular PBRs to select the desired algal strains, ii) microalgae cultivation in raceway ponds under greenhouses, and iii) heterotrophic microalgae cultivation in fermenters. A detailed economic assessment of the proposed biorefinery allowed to compute a biomass production cost of 2.8 +/- 0.3 kg DW-1, that is compatible with current downstream process costs to produce biostimulants, suggesting that the proposed nutrient recovery route is feasible from the technical and economic perspective. Based on the case study analysis, a discussion of process, bioproducts and policy barriers that currently hinder the development of microalgae-based biorefineries is presented.

Published
2024

8. Open vs minimally invasive liver surgery for gallbladder cancer, an Italian registry-based analysis

Author

Poletto, E., primary, Conci, S., additional, Ettorre, G.M., additional, Cillo, U., additional, Belli, A., additional, Giuliante, F., additional, Jovine, E., additional, Vennarecci, G., additional, Frena, A., additional, Ferrero, A., additional, Gruttadauria, S., additional, Ercolani, G., additional, Di Benedetto, F., additional, Brolese, A., additional, Dalla Valle, R., additional, Ettore Rossi, G., additional, Barabino, M., additional, Filauro, M., additional, Morelli, L., additional, Massani, M., additional, Vincenti, L., additional, Aldrighetti, L., additional, and Ruzzenente, A., additional

Published
2024
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9. Improving outcomes of in situ split liver transplantation in Italy over the last 25 years

Author

Lauterio, A, Cillo, U, Spada, M, Trapani, S, De Carlis, R, Bottino, G, Bernasconi, D, Scalamogna, C, Pinelli, D, Cintorino, D, D'Amico, F, Spagnoletti, G, Miggino, M, Romagnoli, R, Centonze, L, Caccamo, L, Baccarani, U, Carraro, A, Cescon, M, Vivarelli, M, Mazaferro, V, Ettorre, G, Rossi, M, Vennarecci, G, De Simone, P, Angelico, R, Agnes, S, Di Benedetto, F, Lupo, L, Zamboni, F, Zefelippo, A, Patrono, D, Diviacco, P, Laureiro, Z, Gringeri, E, Di Francesco, F, Lucianetti, A, Valsecchi, M, Gruttadauria, S, De Feo, T, Cardillo, M, De Carlis, L, Colledan, M, Andorno, E, Lauterio A., Cillo U., Spada M., Trapani S., De Carlis R., Bottino G., Bernasconi D., Scalamogna C., Pinelli D., Cintorino D., D'Amico F. E., Spagnoletti G., Miggino M., Romagnoli R., Centonze L., Caccamo L., Baccarani U., Carraro A., Cescon M., Vivarelli M., Mazaferro V., Ettorre G. M., Rossi M., Vennarecci G., De Simone P., Angelico R., Agnes S., Di Benedetto F., Lupo L. G., Zamboni F., Zefelippo A., Patrono D., Diviacco P., Laureiro Z. L., Gringeri E., Di Francesco F., Lucianetti A., Valsecchi M. G., Gruttadauria S., De Feo T., Cardillo M., De Carlis L., Colledan M., Andorno E., Lauterio, A, Cillo, U, Spada, M, Trapani, S, De Carlis, R, Bottino, G, Bernasconi, D, Scalamogna, C, Pinelli, D, Cintorino, D, D'Amico, F, Spagnoletti, G, Miggino, M, Romagnoli, R, Centonze, L, Caccamo, L, Baccarani, U, Carraro, A, Cescon, M, Vivarelli, M, Mazaferro, V, Ettorre, G, Rossi, M, Vennarecci, G, De Simone, P, Angelico, R, Agnes, S, Di Benedetto, F, Lupo, L, Zamboni, F, Zefelippo, A, Patrono, D, Diviacco, P, Laureiro, Z, Gringeri, E, Di Francesco, F, Lucianetti, A, Valsecchi, M, Gruttadauria, S, De Feo, T, Cardillo, M, De Carlis, L, Colledan, M, Andorno, E, Lauterio A., Cillo U., Spada M., Trapani S., De Carlis R., Bottino G., Bernasconi D., Scalamogna C., Pinelli D., Cintorino D., D'Amico F. E., Spagnoletti G., Miggino M., Romagnoli R., Centonze L., Caccamo L., Baccarani U., Carraro A., Cescon M., Vivarelli M., Mazaferro V., Ettorre G. M., Rossi M., Vennarecci G., De Simone P., Angelico R., Agnes S., Di Benedetto F., Lupo L. G., Zamboni F., Zefelippo A., Patrono D., Diviacco P., Laureiro Z. L., Gringeri E., Di Francesco F., Lucianetti A., Valsecchi M. G., Gruttadauria S., De Feo T., Cardillo M., De Carlis L., Colledan M., and Andorno E.

Abstract

Background & Aims: Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. Methods: The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993–2005, 2006–2014, and 2015–2019, which match changes in national allocation policies. Primary outcomes were patient and graft survival, and the relative impact of each study period. Results: SLT accounted for 8.9% of all liver transplants performed in Italy. A total of 1,715 in situ split liver grafts were included in the analysis: 868 left lateral segments (LLSs) and 847 extended right grafts (ERGs). A significant improvement in patient and graft survival (p <0.001) was observed with ERGs over the three periods. Predictors of graft survival were cold ischaemia time (CIT) <6 h (p = 0.009), UNOS status 2b (p <0.001), UNOS status 3 (p = 0.009), and transplant centre volumes: 25–50 cases vs. <25 cases (p = 0.003). Patient survival was significantly higher with LLS grafts in period 2 vs. period 1 (p = 0.008). No significant improvement in graft survival was seen over the three periods, where predictors of graft survival were CIT <6 h (p = 0.007), CIT <6 h vs. ≥10 h (p = 0.019), UNOS status 2b (p = 0.038), and UNOS status 3 (p = 0.009). Retransplantation was a risk factor in split liver graft recipients, with significantly worse graft and patient survival for both types of graft (p <0.001). Conclusions: Our analysis showed Italian SLT outcomes to have improved over the last 25 years. These results could help to dispel reservations regarding the use of this procedure. Impact and implications: Split liver transplant(ation) (SLT) is still considered a challenging procedure and is by no means widely accepted. This study included all

Published
2023

10. The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients

Author

Rendina, M, Barone, M, Lillo, C, Trapani, S, Masiero, L, Trerotoli, P, Puoti, F, Lupo, L, Tandoi, F, Agnes, S, Grieco, A, Andorno, E, Marenco, S, Giannini, E, Baccarani, U, Toniutto, P, Carraro, A, Colecchia, A, Cescon, M, Morelli, M, Cillo, U, Burra, P, Angeli, P, Colledan, M, Fagiuoli, S, De Carlis, L, Belli, L, De Simone, P, Carrai, P, Di Benedetto, F, De Maria, N, Ettorre, G, Giannelli, V, Gruttadauria, S, Volpes, R, Corsale, S, Mazzaferro, V, Bhoori, S, Romagnoli, R, Martini, S, Rossi, G, Caccamo, L, Donato, M, Rossi, M, Ginanni Corradini, S, Spada, M, Maggiore, G, Tisone, G, Lenci, I, Vennarecci, G, Tortora, R, Vivarelli, M, Svegliati Baroni, G, Zamboni, F, Mameli, L, Tafuri, S, Simone, S, Gesualdo, L, Cardillo, M, Di Leo, A, Rendina M., Barone M., Lillo C., Trapani S., Masiero L., Trerotoli P., Puoti F., Lupo L. G., Tandoi F., Agnes S., Grieco A., Andorno E., Marenco S., Giannini E. G., Baccarani U., Toniutto P., Carraro A., Colecchia A., Cescon M., Morelli M. C., Cillo U., Burra P., Angeli P., Colledan M., Fagiuoli S., De Carlis L., Belli L., De Simone P., Carrai P., Di Benedetto F., De Maria N., Ettorre G. M., Giannelli V., Gruttadauria S., Volpes R., Corsale S., Mazzaferro V., Bhoori S., Romagnoli R., Martini S., Rossi G., Caccamo L., Donato M. F., Rossi M., Ginanni Corradini S., Spada M., Maggiore G., Tisone G., Lenci I., Vennarecci G., Tortora R., Vivarelli M., Svegliati Baroni G., Zamboni F., Mameli L., Tafuri S., Simone S., Gesualdo L., Cardillo M., Di Leo A., Rendina, M, Barone, M, Lillo, C, Trapani, S, Masiero, L, Trerotoli, P, Puoti, F, Lupo, L, Tandoi, F, Agnes, S, Grieco, A, Andorno, E, Marenco, S, Giannini, E, Baccarani, U, Toniutto, P, Carraro, A, Colecchia, A, Cescon, M, Morelli, M, Cillo, U, Burra, P, Angeli, P, Colledan, M, Fagiuoli, S, De Carlis, L, Belli, L, De Simone, P, Carrai, P, Di Benedetto, F, De Maria, N, Ettorre, G, Giannelli, V, Gruttadauria, S, Volpes, R, Corsale, S, Mazzaferro, V, Bhoori, S, Romagnoli, R, Martini, S, Rossi, G, Caccamo, L, Donato, M, Rossi, M, Ginanni Corradini, S, Spada, M, Maggiore, G, Tisone, G, Lenci, I, Vennarecci, G, Tortora, R, Vivarelli, M, Svegliati Baroni, G, Zamboni, F, Mameli, L, Tafuri, S, Simone, S, Gesualdo, L, Cardillo, M, Di Leo, A, Rendina M., Barone M., Lillo C., Trapani S., Masiero L., Trerotoli P., Puoti F., Lupo L. G., Tandoi F., Agnes S., Grieco A., Andorno E., Marenco S., Giannini E. G., Baccarani U., Toniutto P., Carraro A., Colecchia A., Cescon M., Morelli M. C., Cillo U., Burra P., Angeli P., Colledan M., Fagiuoli S., De Carlis L., Belli L., De Simone P., Carrai P., Di Benedetto F., De Maria N., Ettorre G. M., Giannelli V., Gruttadauria S., Volpes R., Corsale S., Mazzaferro V., Bhoori S., Romagnoli R., Martini S., Rossi G., Caccamo L., Donato M. F., Rossi M., Ginanni Corradini S., Spada M., Maggiore G., Tisone G., Lenci I., Vennarecci G., Tortora R., Vivarelli M., Svegliati Baroni G., Zamboni F., Mameli L., Tafuri S., Simone S., Gesualdo L., Cardillo M., and Di Leo A.

Abstract

Introduction: The study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators. Methods: Case collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate. Results: Among the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP. Discussion: According to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different fr

Published
2023

11. Evolution of minimally invasive techniques and surgical outcomes of ALPPS in Italy: a comprehensive trend analysis over 10 years from a national prospective registry

Author

Serenari, M, Ratti, F, Guglielmo, N, Zanello, M, Mocchegiani, F, Lenzi, J, Colledan, M, Mazzaferro, V, Cillo, U, Ferrero, A, Cescon, M, Di Benedetto, F, Massani, M, Grazi, G, Valle, R, Vivarelli, M, Ettorre, G, Aldrighetti, L, Jovine, E, Serenari M., Ratti F., Guglielmo N., Zanello M., Mocchegiani F., Lenzi J., Colledan M., Mazzaferro V., Cillo U., Ferrero A., Cescon M., Di Benedetto F., Massani M., Grazi G., Valle R. D., Vivarelli M., Ettorre G. M., Aldrighetti L., Jovine E., Serenari, M, Ratti, F, Guglielmo, N, Zanello, M, Mocchegiani, F, Lenzi, J, Colledan, M, Mazzaferro, V, Cillo, U, Ferrero, A, Cescon, M, Di Benedetto, F, Massani, M, Grazi, G, Valle, R, Vivarelli, M, Ettorre, G, Aldrighetti, L, Jovine, E, Serenari M., Ratti F., Guglielmo N., Zanello M., Mocchegiani F., Lenzi J., Colledan M., Mazzaferro V., Cillo U., Ferrero A., Cescon M., Di Benedetto F., Massani M., Grazi G., Valle R. D., Vivarelli M., Ettorre G. M., Aldrighetti L., and Jovine E.

Abstract

Background: Since 2012, Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has encountered several modifications of its original technique. The primary endpoint of this study was to analyze the trend of ALPPS in Italy over a 10-year period. The secondary endpoint was to evaluate factors affecting the risk of morbidity/mortality/post-hepatectomy liver failure (PHLF). Methods: Data of patients submitted to ALPPS between 2012 and 2021 were identified from the ALPPS Italian Registry and evaluation of time trends was performed. Results: From 2012 to 2021, a total of 268 ALPPS were performed within 17 centers. The number of ALPPS divided by the total number of liver resections performed by each center slightly declined (APC = - 2.0%, p = 0.111). Minimally invasive (MI) approach significantly increased over the years (APC = + 49.5%, p = 0.002). According to multivariable analysis, MI completion of stage 1 was protective against 90-day mortality (OR = 0.05, p = 0.040) as well as enrollment within high-volume centers for liver surgery (OR = 0.32, p = 0.009). Use of interstage hepatobiliary scintigraphy (HBS) and biliary tumors were independent predictors of PHLF. Conclusions: This national study showed that use of ALPPS only slightly declined over the years with an increased use of MI techniques, leading to lower 90-day mortality. PHLF still remains an open issue.

Published
2023

12. Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

Author

Di Benedetto, F, Magistri, P, Di Sandro, S, Sposito, C, Oberkofler, C, Brandon, E, Samstein, B, Guidetti, C, Papageorgiou, A, Frassoni, S, Bagnardi, V, Clavien, P, Citterio, D, Kato, T, Petrowsky, H, Halazun, K, Mazzaferro, V, Di Benedetto F., Magistri P., Di Sandro S., Sposito C., Oberkofler C., Brandon E., Samstein B., Guidetti C., Papageorgiou A., Frassoni S., Bagnardi V., Clavien P. -A., Citterio D., Kato T., Petrowsky H., Halazun K. J., Mazzaferro V., Di Benedetto, F, Magistri, P, Di Sandro, S, Sposito, C, Oberkofler, C, Brandon, E, Samstein, B, Guidetti, C, Papageorgiou, A, Frassoni, S, Bagnardi, V, Clavien, P, Citterio, D, Kato, T, Petrowsky, H, Halazun, K, Mazzaferro, V, Di Benedetto F., Magistri P., Di Sandro S., Sposito C., Oberkofler C., Brandon E., Samstein B., Guidetti C., Papageorgiou A., Frassoni S., Bagnardi V., Clavien P. -A., Citterio D., Kato T., Petrowsky H., Halazun K. J., and Mazzaferro V.

Abstract

Importance: Long-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology, but sparse data have been published thus far. Objective: To analyze short- and long-term outcomes of robotic liver resection (RLR) for hepatocellular carcinoma (HCC) from Western high-volume centers to assess the safety, reproducibility, and oncologic efficacy of this technique. Design, Setting, and Participants: This cohort study evaluated the outcomes of patients receiving RLR vs open liver resection (OLR) for HCC between 2010 and 2020 in 5 high-volume centers. After 1:1 propensity score matching, a group of patients who underwent RLR was compared with a validation cohort of OLR patients from a high-volume center that did not perform RLR. Main Outcomes and Measures: A retrospective analysis was performed of prospectively maintained databases at 2 European and 2 US institutions of patients who underwent RLR for HCC between January 1, 2010, and September 30, 2020. The main outcomes were safety and feasibility of RLR for HCC and its oncologic outcomes compared with a European OLR validation cohort. A 2-sided P <.05 was considered significant. Results: The study included 398 patients (RLR group: 125 men, 33 women, median [IQR] age, 66 [58-71] years; OLR group: 315 men, 83 women; median [IQR] age, 70 [64-74] years), and 106 RLR patients were compared with 106 OLR patients after propensity score matching. The RLR patients had a significantly longer operative time (median [IQR], 295 [190-370] minutes vs 200 [165-255] minutes, including docking; P <.001) but a significantly shorter hospital length of stay (median [IQR], 4 [3-6] days vs 10 [7-13] days; P <.001) and a lower number of admissions to the intensive care unit (7 [6.6%] vs 21 [19.8%]; P =.002). Incidence of posthepatectomy liver failure was significantly lower in the RLR group (8 [7.5%] vs 30 [28.3%]; P =.001), with no cases of grade C failure. The 90-day overall survival rate was comparable bet

Published
2023

13. Improving Outcome of Selected Patients With Non-Resectable Hepatic Metastases From Colorectal Cancer With Liver Transplantation: A Prospective Parallel Trial (COLT trial)

Author

Sposito, C, Pietrantonio, F, Maspero, M, Di Benedetto, F, Vivarelli, M, Tisone, G, De Carlis, L, Romagnoli, R, Gruttadauria, S, Colledan, M, Agnes, S, Ettorre, G, Baccarani, U, Torzilli, G, Di Sandro, S, Pinelli, D, Caccamo, L, Sartore Bianchi, A, Spreafico, C, Torri, V, Mazzaferro, V, Sposito C., Pietrantonio F., Maspero M., Di Benedetto F., Vivarelli M., Tisone G., De Carlis L., Romagnoli R., Gruttadauria S., Colledan M., Agnes S., Ettorre G., Baccarani U., Torzilli G., Di Sandro S., Pinelli D., Caccamo L., Sartore Bianchi A., Spreafico C., Torri V., Mazzaferro V., Sposito, C, Pietrantonio, F, Maspero, M, Di Benedetto, F, Vivarelli, M, Tisone, G, De Carlis, L, Romagnoli, R, Gruttadauria, S, Colledan, M, Agnes, S, Ettorre, G, Baccarani, U, Torzilli, G, Di Sandro, S, Pinelli, D, Caccamo, L, Sartore Bianchi, A, Spreafico, C, Torri, V, Mazzaferro, V, Sposito C., Pietrantonio F., Maspero M., Di Benedetto F., Vivarelli M., Tisone G., De Carlis L., Romagnoli R., Gruttadauria S., Colledan M., Agnes S., Ettorre G., Baccarani U., Torzilli G., Di Sandro S., Pinelli D., Caccamo L., Sartore Bianchi A., Spreafico C., Torri V., and Mazzaferro V.

Abstract

Background: Patients with unresectable Colorectal Liver Metastases (CLM) receiving palliative chemotherapy have a 5-year overall survival (OS) of less than 30%. Liver transplantation (LT) can improve OS up to 60%-83% (SECA-I and SECA-II trials). The aim of the study is to assess the efficacy of LT in liver-only metastatic CRC compared with a matched cohort of patients included in a phase III trial on triplet chemotherapy + antiEGFR. Patients and Methods: The COLT trial is an investigator-driven, multicenter, non-randomized, open-label, controlled, prospective, parallel trial (ClinicalTrials.gov NCT03803436). Hyperselected patients with liver-limited unresectable CLM, RAS and BRAF wild-type and curatively removed primary colon cancer are included. The observed post-transplant outcomes will be prospectively compared 1:5 with those obtained in a matched cohort from the TRIPLETE trial (NCT03231722). Results: Primary endpoint is to compare the 3 and 5-years OS of patients enrolled in the COLT trial with COLT-eligible population enrolled in the TRIPLETE trial. An expected gain in OS of 40% at 5-years is predicted for the COLT population (the expected OS at 5-years in COLT vs. TRIPLETE is 70% vs. 30%). Secondary endpoints are to compare the 5-years disease-free survival and to assess the safety of LT (Dindo-Clavien Classification and the Comprehensive Complication Index). Conclusion: LT offers the longest OS reported in selected patients with CLM. Improving the selection strategies can give patients a 5-year OS similar to other indications for LT and a better outcome than those undergoing chemotherapy alone.

Published
2023

14. Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective

Author

Di Sandro, S, Sposito, C, Ravaioli, M, Lauterio, A, Magistri, P, Bongini, M, Odaldi, F, De Carlis, R, Botta, F, Centonze, L, Maroni, L, Citterio, D, Guidetti, C, Bagnardi, V, De Carlis, L, Cescon, M, Mazzaferro, V, Di Benedetto, F, Catellani, B, Piero Guerrini, G, Danieli, M, Frassoni, S, Virdis, M, Bhoori, S, Serenari, M, Laurenzi, A, Di Sandro S., Sposito C., Ravaioli M., Lauterio A., Magistri P., Bongini M., Odaldi F., De Carlis R., Botta F., Centonze L., Maroni L., Citterio D., Guidetti C., Bagnardi V., De Carlis L., Cescon M., Mazzaferro V., Di Benedetto F., Catellani B., Piero Guerrini G., Danieli M., Frassoni S., Virdis M., Bhoori S., Serenari M., Laurenzi A., Di Sandro, S, Sposito, C, Ravaioli, M, Lauterio, A, Magistri, P, Bongini, M, Odaldi, F, De Carlis, R, Botta, F, Centonze, L, Maroni, L, Citterio, D, Guidetti, C, Bagnardi, V, De Carlis, L, Cescon, M, Mazzaferro, V, Di Benedetto, F, Catellani, B, Piero Guerrini, G, Danieli, M, Frassoni, S, Virdis, M, Bhoori, S, Serenari, M, Laurenzi, A, Di Sandro S., Sposito C., Ravaioli M., Lauterio A., Magistri P., Bongini M., Odaldi F., De Carlis R., Botta F., Centonze L., Maroni L., Citterio D., Guidetti C., Bagnardi V., De Carlis L., Cescon M., Mazzaferro V., Di Benedetto F., Catellani B., Piero Guerrini G., Danieli M., Frassoni S., Virdis M., Bhoori S., Serenari M., and Laurenzi A.

Abstract

Background. Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome. Methods. We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective. Results. We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group (P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001). Conclusions. High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios.

Published
2023

16. Evolution of minimally invasive techniques and surgical outcomes of ALPPS in Italy: a comprehensive trend analysis over 10 years from a national prospective registry

Author

Serenari M., Ratti F., Guglielmo N., Zanello M., Mocchegiani F., Lenzi J., Colledan M., Mazzaferro V., Cillo U., Ferrero A., Cescon M., Di Benedetto F., Massani M., Grazi G., Valle R. D., Vivarelli M., Ettorre G. M., Aldrighetti L., Jovine E., Serenari, M, Ratti, F, Guglielmo, N, Zanello, M, Mocchegiani, F, Lenzi, J, Colledan, M, Mazzaferro, V, Cillo, U, Ferrero, A, Cescon, M, Di Benedetto, F, Massani, M, Grazi, G, Valle, R, Vivarelli, M, Ettorre, G, Aldrighetti, L, and Jovine, E

Subjects
Hepatectomy, Laparoscopy, ALPPS, Minimally invasive, Outcome
Abstract

Background: Since 2012, Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has encountered several modifications of its original technique. The primary endpoint of this study was to analyze the trend of ALPPS in Italy over a 10-year period. The secondary endpoint was to evaluate factors affecting the risk of morbidity/mortality/post-hepatectomy liver failure (PHLF). Methods: Data of patients submitted to ALPPS between 2012 and 2021 were identified from the ALPPS Italian Registry and evaluation of time trends was performed. Results: From 2012 to 2021, a total of 268 ALPPS were performed within 17 centers. The number of ALPPS divided by the total number of liver resections performed by each center slightly declined (APC = -2.0%, p = 0.111). Minimally invasive (MI) approach significantly increased over the years (APC = + 49.5%, p = 0.002). According to multivariable analysis, MI completion of stage 1 was protective against 90-day mortality (OR = 0.05, p = 0.040) as well as enrollment within high-volume centers for liver surgery (OR = 0.32, p = 0.009). Use of interstage hepatobiliary scintigraphy (HBS) and biliary tumors were independent predictors of PHLF. Conclusions: This national study showed that use of ALPPS only slightly declined over the years with an increased use of MI techniques, leading to lower 90-day mortality. PHLF still remains an open issue.

Published
2023

17. Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry

Author

Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Salvatore, G, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Salvatore G., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Salvatore, G, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Salvatore G., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., and Zimmitti G.

Abstract

Laparoscopic liver resection (LLR) for Hepatocellular carcinoma (HCC) is a safe procedure. Repeat surgery is more often required, and the role of minimally invasive liver surgery (MILS) is not yet clearly defined. The present study analyzes data compiled by the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) on LLR. To compare repeated LLR with the first LLR for HCC is the primary endpoint. The secondary endpoint was to evaluate the outcome of repeat LLR in the case of primary open versus primary MILS surgery. The data cohort is divided into two groups. Group 1: first liver resection and Group 2: Repeat LLR. To compare the two groups a 3:1 Propensity Score Matching is performed to analyze open versus MILS primary resection. Fifty-two centers were involved in the present study, and 1054 patients were enrolled. 80 patients underwent to a repeat LLR. The type of resection was different, with more major resections in the group 1 before matching the two groups. After propensity score matching 3:1, each group consisted of 222 and 74 patients. No difference between the two groups was observed. In the subgroup analysis, in 44 patients the first resection was performed by an open approach. The other 36 patients were resected with a MILS approach. We found no difference between these two subgroups of patients. The present study in repeat MILS for HCC using the IGoMILS Registry has observed the feasibility and safety of the MILS procedure.

Published
2022

18. Correction to: Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry (Updates in Surgery, (2021), 10.1007/s13304-021-01161-w)

Author

Levi Sandri G. B., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri G. B., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., and Zimmitti G.

Abstract

In the originally published article the co-author first name and last name was interchanged. The correct name is copied below Salvatore Gruttadauria The original article has been updated.

Published
2022

19. Temporal trends of waitlistings for liver transplantation in Italy: The ECALITA (Evolution of IndiCAtion in LIver transplantation in ITAly) registry study

Author

Manzia, T, Trapani, S, Nardi, A, Ricci, A, Lenci, I, Milana, M, Angelico, R, De Feo, T, Agnes, S, Andorno, E, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, Di Benedetto, F, Ettorre, G, Gruttadauria, S, Lupo, L, Mazzaferro, V, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Vennarecci, G, Vivarelli, M, Zamboni, F, Tisone, G, Cardillo, M, Angelico, M, Manzia T. M., Trapani S., Nardi A., Ricci A., Lenci I., Milana M., Angelico R., De Feo T. M., Agnes S., Andorno E., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., Di Benedetto F., Ettorre G. M., Gruttadauria S., Lupo L. G., Mazzaferro V., Romagnoli R., Rossi G., Rossi M., Spada M., Vennarecci G., Vivarelli M., Zamboni F., Tisone G., Cardillo M., Angelico M., Manzia, T, Trapani, S, Nardi, A, Ricci, A, Lenci, I, Milana, M, Angelico, R, De Feo, T, Agnes, S, Andorno, E, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, Di Benedetto, F, Ettorre, G, Gruttadauria, S, Lupo, L, Mazzaferro, V, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Vennarecci, G, Vivarelli, M, Zamboni, F, Tisone, G, Cardillo, M, Angelico, M, Manzia T. M., Trapani S., Nardi A., Ricci A., Lenci I., Milana M., Angelico R., De Feo T. M., Agnes S., Andorno E., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., Di Benedetto F., Ettorre G. M., Gruttadauria S., Lupo L. G., Mazzaferro V., Romagnoli R., Rossi G., Rossi M., Spada M., Vennarecci G., Vivarelli M., Zamboni F., Tisone G., Cardillo M., and Angelico M.

Abstract

Background: Over the last decades relevant epidemiological changes of liver diseases have occurred, together with greatly improved treatment opportunities. Aim: To investigate how the indications for elective adult liver transplantation and the underlying disease etiologies have evolved in Italy. Methods: We recruited from the National Transplant Registry a cohort comprising 17,317 adults patients waitlisted for primary liver transplantation from January-2004 to December-2020. Patients were divided into three Eras:1(2004–2011),2(2012–2014) and 3(2015–2020). Results: Waitlistings for cirrhosis decreased from 65.9% in Era 1 to 46.1% in Era 3, while those for HCC increased from 28.7% to 48.7%. Comparing Eras 1 and 3, waitlistings for HCV-related cirrhosis decreased from 35.9% to 12.1%, yet those for HCV-related HCC increased from 8.5% to 26.7%. Waitlistings for HBV-related cirrhosis remained almost unchanged (13.2% and 12.4%), while those for HBV-related HCC increased from 4.0% to 11.6%. ALD-related cirrhosis decreased from 16.9% to 12.9% while ALD-related HCC increased from 1.9% to 3.9%. Conclusions: A sharp increase in liver transplant waitlisting for HCC and a concomitant decrease of waitlisting for cirrhosis have occurred In Italy. Despite HCV infection has noticeably decreased, still remains the primary etiology of waitlisting for HCC, while ALD and HBV represent the main causes for cirrhosis.

Published
2022

20. How useful is the machine perfusion in liver transplantation? An answer from a national survey

Author

Scalera, I, De Carlis, R, Patrono, D, Gringeri, E, Olivieri, T, Pagano, D, Lai, Q, Rossi, M, Gruttadauria, S, Di Benedetto, F, Cillo, U, Romagnoli, R, Lupo, L, De Carlis, L, Scalera I., De Carlis R., Patrono D., Gringeri E., Olivieri T., Pagano D., Lai Q., Rossi M., Gruttadauria S., Di Benedetto F., Cillo U., Romagnoli R., Lupo L. G., De Carlis L., Scalera, I, De Carlis, R, Patrono, D, Gringeri, E, Olivieri, T, Pagano, D, Lai, Q, Rossi, M, Gruttadauria, S, Di Benedetto, F, Cillo, U, Romagnoli, R, Lupo, L, De Carlis, L, Scalera I., De Carlis R., Patrono D., Gringeri E., Olivieri T., Pagano D., Lai Q., Rossi M., Gruttadauria S., Di Benedetto F., Cillo U., Romagnoli R., Lupo L. G., and De Carlis L.

Abstract

Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27–24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard aft

Published
2022

21. Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group

Author

Conigliaro, R, Pigo, F, Bertani, H, Greco, S, Burti, C, Indriolo, A, Di Sario, A, Ortolani, A, Maroni, L, Tringali, A, Barbaro, F, Costamagna, G, Magarotto, A, Masci, E, Mutignani, M, Forti, E, Parodi, M, Assandri, L, Marrone, C, Fantin, A, Penagini, R, Cantu, P, Di Benedetto, F, Ravelli, P, Vivarelli, M, Agnes, S, Mazzaferro, V, De Carlis, L, Andorno, E, Cillo, U, Rossi, G, Conigliaro R., Pigo F., Bertani H., Greco S., Burti C., Indriolo A., Di Sario A., Ortolani A., Maroni L., Tringali A., Barbaro F., Costamagna G., Magarotto A., Masci E., Mutignani M., Forti E., Parodi M. C., Assandri L., Marrone C., Fantin A., Penagini R., Cantu P., Di Benedetto F., Ravelli P., Vivarelli M., Agnes S., Mazzaferro V., De Carlis L., Andorno E., Cillo U., Rossi G., Conigliaro, R, Pigo, F, Bertani, H, Greco, S, Burti, C, Indriolo, A, Di Sario, A, Ortolani, A, Maroni, L, Tringali, A, Barbaro, F, Costamagna, G, Magarotto, A, Masci, E, Mutignani, M, Forti, E, Parodi, M, Assandri, L, Marrone, C, Fantin, A, Penagini, R, Cantu, P, Di Benedetto, F, Ravelli, P, Vivarelli, M, Agnes, S, Mazzaferro, V, De Carlis, L, Andorno, E, Cillo, U, Rossi, G, Conigliaro R., Pigo F., Bertani H., Greco S., Burti C., Indriolo A., Di Sario A., Ortolani A., Maroni L., Tringali A., Barbaro F., Costamagna G., Magarotto A., Masci E., Mutignani M., Forti E., Parodi M. C., Assandri L., Marrone C., Fantin A., Penagini R., Cantu P., Di Benedetto F., Ravelli P., Vivarelli M., Agnes S., Mazzaferro V., De Carlis L., Andorno E., Cillo U., and Rossi G.

Abstract

Background and Study Aim: The traditional endoscopic therapy of anastomotic strictures (AS) after orthotopic liver transplantation (OLT) is multiple ERCPs with the insertion of an increasing number of plastic stents side-by-side. Fully covered self-expanding metal stents (cSEMS) could be a valuable option to decrease the number of procedures needed or non-responders to plastic stents. This study aims to retrospectively analyse the results of AS endoscopic treatment by cSEMS and to identify any factors associated with its success. Patients and Methods: Ninety-one patients (mean age 55.9 ± 7.6 SD; 73 males) from nine Italian transplantation centres, had a cSEMS positioned for post-OLT-AS between 2007 and 2017. Forty-nine (54%) patients were treated with cSEMS as a second-line treatment. Results: All the procedures were successfully performed without immediate complications. After ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis and 8 cholangitis). In 49 patients (54%), cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients) or radiological (1 patient) treatments to solve the AS. Lastly, seven patients underwent surgery. Multivariable stepwise logistic regression showed that cSEMS migration was the only factor associated with further treatments (OR 2.6, 95% CI 1.0–6.6; p value 0.03); cSEMS implantation before 12 months from OLT was associated with stent migration (OR 5.2, 95% CI 1.7–16.0; p value 0.004). Conclusions: cSEMS appears to be a safe tool to treat AS. cSEMS migration is the main limitation to its routinary implantation and needs to be prevented, probably with the use of new generation anti-migration stents.

Published
2022

22. Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Author

De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., Zamboni F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., and Zamboni F.

Abstract

Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]

Published
2022

23. Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections

Author

Cucchetti, A, Aldrighetti, L, Ratti, F, Ferrero, A, Guglielmi, A, Giuliante, F, Cillo, U, Mazzaferro, V, De Carlis, L, Ercolani, G, Ettorre, G, di Benedetto, F, Valle, R, Gruttadauria, S, Jovine, E, Boggi, U, Vincenti, L, Santambrogio, R, Giuliani, A, Torzilli, G, Zimmiti, G, Brolese, A, Belli, A, Ravaioli, M, Frena, A, Rossi, G, Grazi, G, Zamboni, F, Berti, S, Calise, F, Massani, M, Morelli, L, Filauro, M, Tisone, G, Coratti, A, Navarra, G, Romito, R, Ceccarelli, G, Belli, G, Griseri, G, Antonucci, A, Mezzatesta, P, Veneroni, L, Schiavo, M, Colledan, M, Parisi, A, Guerriero, S, Spada, M, Batignani, G, Sgroi, G, Floridi, P, Boni, L, Maida, P, Ribero, D, La Barba, G, Cucchetti A., Aldrighetti L., Ratti F., Ferrero A., Guglielmi A., Giuliante F., Cillo U., Mazzaferro V., De Carlis L., Ercolani G., Ettorre G. M., di Benedetto F., Valle R. D., Gruttadauria S., Jovine E., Boggi U., Vincenti L., Santambrogio R., Giuliani A., Torzilli G., Zimmiti G., Brolese A., Belli A., Ravaioli M., Frena A., Rossi G. E., Grazi G. L., Zamboni F., Berti S., Calise F., Massani M., Morelli L., Filauro M., Tisone G., Coratti A., Navarra G., Romito R., Ceccarelli G., Belli G., Griseri G., Antonucci A., Mezzatesta P., Veneroni L., Schiavo M., Colledan M., Parisi A., Guerriero S., Spada M., Batignani G., Sgroi G., Floridi P., Boni L., Maida P., Ribero D., La Barba G., Cucchetti, A, Aldrighetti, L, Ratti, F, Ferrero, A, Guglielmi, A, Giuliante, F, Cillo, U, Mazzaferro, V, De Carlis, L, Ercolani, G, Ettorre, G, di Benedetto, F, Valle, R, Gruttadauria, S, Jovine, E, Boggi, U, Vincenti, L, Santambrogio, R, Giuliani, A, Torzilli, G, Zimmiti, G, Brolese, A, Belli, A, Ravaioli, M, Frena, A, Rossi, G, Grazi, G, Zamboni, F, Berti, S, Calise, F, Massani, M, Morelli, L, Filauro, M, Tisone, G, Coratti, A, Navarra, G, Romito, R, Ceccarelli, G, Belli, G, Griseri, G, Antonucci, A, Mezzatesta, P, Veneroni, L, Schiavo, M, Colledan, M, Parisi, A, Guerriero, S, Spada, M, Batignani, G, Sgroi, G, Floridi, P, Boni, L, Maida, P, Ribero, D, La Barba, G, Cucchetti A., Aldrighetti L., Ratti F., Ferrero A., Guglielmi A., Giuliante F., Cillo U., Mazzaferro V., De Carlis L., Ercolani G., Ettorre G. M., di Benedetto F., Valle R. D., Gruttadauria S., Jovine E., Boggi U., Vincenti L., Santambrogio R., Giuliani A., Torzilli G., Zimmiti G., Brolese A., Belli A., Ravaioli M., Frena A., Rossi G. E., Grazi G. L., Zamboni F., Berti S., Calise F., Massani M., Morelli L., Filauro M., Tisone G., Coratti A., Navarra G., Romito R., Ceccarelli G., Belli G., Griseri G., Antonucci A., Mezzatesta P., Veneroni L., Schiavo M., Colledan M., Parisi A., Guerriero S., Spada M., Batignani G., Sgroi G., Floridi P., Boni L., Maida P., Ribero D., and La Barba G.

Abstract

Background/Purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. The purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR). Methods: Data from a prospective, multicenter database involving 4318 patients submitted to LLRs in 41 hospitals from an intention-to-treat approach (2014–2020) were used to analyze heterogeneity (I2) among centers and to develop a risk-adjustment model on outcome measures through multivariable mixed-effect models to account for confounding due to case-mix. Results: Involved hospitals operated on very different patients: the largest heterogeneity was observed for operating in the presence of previous abdominal surgery (I2:79.1%), in cirrhotic patients (I2:89.3%) suffering from hepatocellular carcinoma (I2:88.6%) or requiring associated intestinal resections (I2:82.8%) and in regard to technical complexity (I2 for the most complex LLRs: 84.1%). These aspects determined substantial or large heterogeneity in overall morbidity (I2:84.9%), in prolonged in-hospital stay (I2:86.9%) and in conversion rate (I2:73.4%). Major complication had medium heterogeneity (I2:46.5%). The heterogeneity of mortality was null. Risk-adjustment accounted for all of this variability and the final risk-standardized conversion rate was 8.9%, overall morbidity was 22.1%, major morbidity was 5.1% and prolonged in-hospital stay was 26.0%. There were no outliers among the 41 participating centers. An online tool was provided. Conclusions: A benchmark for LLRs including all eligible patients was provided, suggesting that surgeons can act accordingly in the interest of the patient, modifying their approach in relation to different indications and different experience, but finally providing the same quality of care.

Published
2022

24. Pure laparoscopic versus robotic liver resections: Multicentric propensity score-based analysis with stratification according to difficulty scores

Author

Cipriani, F, Fiorentini, G, Magistri, P, Fontani, A, Menonna, F, Annecchiarico, M, Lauterio, A, De Carlis, L, Coratti, A, Boggi, U, Ceccarelli, G, Di Benedetto, F, Aldrighetti, L, Cipriani F., Fiorentini G., Magistri P., Fontani A., Menonna F., Annecchiarico M., Lauterio A., De Carlis L., Coratti A., Boggi U., Ceccarelli G., Di Benedetto F., Aldrighetti L., Cipriani, F, Fiorentini, G, Magistri, P, Fontani, A, Menonna, F, Annecchiarico, M, Lauterio, A, De Carlis, L, Coratti, A, Boggi, U, Ceccarelli, G, Di Benedetto, F, Aldrighetti, L, Cipriani F., Fiorentini G., Magistri P., Fontani A., Menonna F., Annecchiarico M., Lauterio A., De Carlis L., Coratti A., Boggi U., Ceccarelli G., Di Benedetto F., and Aldrighetti L.

Abstract

Background: The benefits of pure laparoscopic and robot-assisted liver resections (LLR and RALR) are known in comparison to open surgery. The aim of the present retrospective comparative study is to investigate the role of RALR and LLR according to different levels of difficulty. Methods: The institutional databases of six high-volume hepatobiliary centers were retrospectively reviewed. The study population was divided in two groups: LLR and RALR. The procedures were stratified for difficulty levels accordingly to three classifications. A propensity score matching was implemented to mitigate selection bias. Short-term outcomes were the object of comparison. Results: Nine hundred and thirty-six LLR and 403 RALR were collected. RALR exhibited fewer cases of intraoperative blood loss, lower transfusion and conversion rates (especially for oncological radicality) than LLR in the setting of highly difficult operations, whereas LLR had lower postoperative morbidity and fewer low-grade complications. For intermediate and low-difficulty resections, the intraoperative advantages of RALR gradually decreased to nonsignificant results and LLR remained associated with lower postoperative morbidity. Conclusion: Robot-assisted liver resections do not show operative nor clinically significant benefits over LLR for low- and intermediate-difficulty resections. By reducing conversion rates, RALR can favour the operative feasibility of difficult resections possibly extending the indications of minimally invasive approaches for liver resection.

Published
2022

25. Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

Author

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

Abstract

Background: Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods: Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results: A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions: This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.

Published
2022

28. TIPS under-dilation strategy with new controlled expansion endoprosthesis: A hemodynamic and imaging confirmation of its feasibility

Author

Saltini, D., primary, Caporali, C., additional, Indulti, F., additional, Casari, F., additional, Prampolini, F., additional, Felaco, D., additional, Battinelli, G., additional, Bianchini, M., additional, Guasconi, T., additional, Cuffari, B., additional, Zanetto, A., additional, Olivieri, T., additional, Assirati, G., additional, Serra, V., additional, Catellani, B., additional, Guidetti, C., additional, Guerrini, G.P., additional, Ballarin, R., additional, Magistri, P., additional, De Maria, N., additional, Di Sandro, S., additional, Torricelli, P., additional, Girardis, M., additional, Villa, E., additional, Colecchia, A., additional, Di Benedetto, F., additional, and Schepis, F., additional

Published
2023
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29. Roadmap on thermoelectricity

Author

Artini, C, Pennelli, G, Graziosi, P, Li, Z, Neophytou, N, Melis, C, Colombo, L, Isotta, E, Lohani, K, Scardi, P, Castellero, A, Baricco, M, Palumbo, M, Casassa, S, Maschio, L, Pani, M, Latronico, G, Mele, P, Di Benedetto, F, Contento, G, De Riccardis, M, Fucci, R, Palazzo, B, Rizzo, A, Demontis, V, Prete, D, Isram, M, Rossella, F, Ferrario, A, Miozzo, A, Boldrini, S, Dimaggio, E, Franzini, M, Galliano, S, Barolo, C, Mardi, S, Reale, A, Lorenzi, B, Narducci, D, Trifiletti, V, Milita, S, Bellucci, A, Trucchi, D, Artini, Cristina, Pennelli, Giovanni, Graziosi, Patrizio, Li, Zhen, Neophytou, Neophytos, Melis, Claudio, Colombo, Luciano, Isotta, Eleonora, Lohani, Ketan, Scardi, Paolo, Castellero, Alberto, Baricco, Marcello, Palumbo, Mauro, Casassa, Silvia, Maschio, Lorenzo, Pani, Marcella, Latronico, Giovanna, Mele, Paolo, Di Benedetto, Francesca, Contento, Gaetano, De Riccardis, Maria Federica, Fucci, Raffaele, Palazzo, Barbara, Rizzo, Antonella, Demontis, Valeria, Prete, Domenic, Isram, Muhammad, Rossella, Francesco, Ferrario, Alberto, Miozzo, Alvise, Boldrini, Stefano, Dimaggio, Elisabetta, Franzini, Marcello, Galliano, Simone, Barolo, Claudia, Mardi, Saeed, Reale, Andrea, Lorenzi, Bruno, Narducci, Dario, Trifiletti, Vanira, Milita, Silvia, Bellucci, Alessandro, Trucchi, Daniele M, Artini, C, Pennelli, G, Graziosi, P, Li, Z, Neophytou, N, Melis, C, Colombo, L, Isotta, E, Lohani, K, Scardi, P, Castellero, A, Baricco, M, Palumbo, M, Casassa, S, Maschio, L, Pani, M, Latronico, G, Mele, P, Di Benedetto, F, Contento, G, De Riccardis, M, Fucci, R, Palazzo, B, Rizzo, A, Demontis, V, Prete, D, Isram, M, Rossella, F, Ferrario, A, Miozzo, A, Boldrini, S, Dimaggio, E, Franzini, M, Galliano, S, Barolo, C, Mardi, S, Reale, A, Lorenzi, B, Narducci, D, Trifiletti, V, Milita, S, Bellucci, A, Trucchi, D, Artini, Cristina, Pennelli, Giovanni, Graziosi, Patrizio, Li, Zhen, Neophytou, Neophytos, Melis, Claudio, Colombo, Luciano, Isotta, Eleonora, Lohani, Ketan, Scardi, Paolo, Castellero, Alberto, Baricco, Marcello, Palumbo, Mauro, Casassa, Silvia, Maschio, Lorenzo, Pani, Marcella, Latronico, Giovanna, Mele, Paolo, Di Benedetto, Francesca, Contento, Gaetano, De Riccardis, Maria Federica, Fucci, Raffaele, Palazzo, Barbara, Rizzo, Antonella, Demontis, Valeria, Prete, Domenic, Isram, Muhammad, Rossella, Francesco, Ferrario, Alberto, Miozzo, Alvise, Boldrini, Stefano, Dimaggio, Elisabetta, Franzini, Marcello, Galliano, Simone, Barolo, Claudia, Mardi, Saeed, Reale, Andrea, Lorenzi, Bruno, Narducci, Dario, Trifiletti, Vanira, Milita, Silvia, Bellucci, Alessandro, and Trucchi, Daniele M

Abstract

The increasing energy demand and the ever more pressing need for clean technologies of energy conversion pose one of the most urgent and complicated issues of our age. Thermoelectricity, namely the direct conversion of waste heat into electricity, is a promising technique based on a long-standing physical phenomenon, which still has not fully developed its potential, mainly due to the low efficiency of the process. In order to improve the thermoelectric performance, a huge effort is being made by physicists, materials scientists and engineers, with the primary aims of better understanding the fundamental issues ruling the improvement of the thermoelectric figure of merit, and finally building the most efficient thermoelectric devices. In this Roadmap an overview is given about the most recent experimental and computational results obtained within the Italian research community on the optimization of composition and morphology of some thermoelectric materials, as well as on the design of thermoelectric and hybrid thermoelectric/photovoltaic devices.

Published
2023

30. Prospective minimally invasive pancreatic resections from the IGOMIPS registry: a snapshot of daily practice in Italy on 1191 between 2019 and 2022

Author

Boggi, U., Donisi, G., Napoli, N., Partelli, S., Esposito, A., Ferrari, G., Butturini, G., Morelli, L., Abu Hilal, M., Viola, M., Di Benedetto, F., Troisi, R., Vivarelli, M., Jovine, E., Ferrero, A., Bracale, U., Alfieri, Sergio, Casadei, R., Ercolani, G., Moraldi, L., Molino, C., Dalla Valle, R., Ettorre, G., Memeo, R., Zanus, G., Belli, A., Gruttadauria, S., Brolese, A., Coratti, A., Garulli, G., Romagnoli, R., Massani, M., Borghi, F., Belli, G., Coppola, R., Falconi, M., Salvia, R., Zerbi, A., Kauffmann, E. F., Capretti, G., Genova, L., Matteo, P., Mazzola, M., Giardino, A., Palmieri, M., Manzoni, A., Barbieri, V., Ballarin, R., Rompianesi, G., Rossi, R., Mastrangelo, L., Langella, S., Ilardi, M., Menghi, Roberta, Ricci, C., Gardini, A., Campra, D., Crolla, E., Cecconi, S., Meniconi, R. L., Ferraro, V., Brizzolari, M., Izzo, F., Cintorino, D., Marcucci, S., Giuliani, G., Veneroni, L., Moro, F., Nistri, C., Caputo, D., Gianluca, B., Mazzaferro, V., Alfieri S. (ORCID:0000-0002-0404-724X), Menghi R., Boggi, U., Donisi, G., Napoli, N., Partelli, S., Esposito, A., Ferrari, G., Butturini, G., Morelli, L., Abu Hilal, M., Viola, M., Di Benedetto, F., Troisi, R., Vivarelli, M., Jovine, E., Ferrero, A., Bracale, U., Alfieri, Sergio, Casadei, R., Ercolani, G., Moraldi, L., Molino, C., Dalla Valle, R., Ettorre, G., Memeo, R., Zanus, G., Belli, A., Gruttadauria, S., Brolese, A., Coratti, A., Garulli, G., Romagnoli, R., Massani, M., Borghi, F., Belli, G., Coppola, R., Falconi, M., Salvia, R., Zerbi, A., Kauffmann, E. F., Capretti, G., Genova, L., Matteo, P., Mazzola, M., Giardino, A., Palmieri, M., Manzoni, A., Barbieri, V., Ballarin, R., Rompianesi, G., Rossi, R., Mastrangelo, L., Langella, S., Ilardi, M., Menghi, Roberta, Ricci, C., Gardini, A., Campra, D., Crolla, E., Cecconi, S., Meniconi, R. L., Ferraro, V., Brizzolari, M., Izzo, F., Cintorino, D., Marcucci, S., Giuliani, G., Veneroni, L., Moro, F., Nistri, C., Caputo, D., Gianluca, B., Mazzaferro, V., Alfieri S. (ORCID:0000-0002-0404-724X), and Menghi R.

Abstract

This retrospective analysis of the prospective IGOMIPS registry reports on 1191 minimally invasive pancreatic resections (MIPR) performed in Italy between 2019 and 2022, including 668 distal pancreatectomies (DP) (55.7%), 435 pancreatoduodenectomies (PD) (36.3%), 44 total pancreatectomies (3.7%), 36 tumor enucleations (3.0%), and 8 central pancreatectomies (0.7%). Spleen-preserving DP was performed in 109 patients (16.3%). Overall incidence of severe complications (Clavien-Dindo & GE; 3) was 17.6% with a 90-day mortality of 1.9%. This registry analysis provided some important information. First, robotic assistance was preferred for all MIPR but DP with splenectomy. Second, robotic assistance reduced conversion to open surgery and blood loss in comparison to laparoscopy. Robotic PD was also associated with lower incidence of severe postoperative complications and a trend toward lower mortality. Fourth, the annual cut-off of & GE; 20 MIPR and & GE; 20 MIPD improved selected outcome measures. Fifth, most MIPR were performed by a single surgeon. Sixth, only two-thirds of the centers performed spleen-preserving DP. Seventh, DP with splenectomy was associated with higher conversion rate when compared to spleen-preserving DP. Eighth, the use of pancreatojejunostomy was the prevalent reconstruction in PD. Ninth, final histology was similar for MIPR performed at high- and low-volume centers, but neoadjuvant chemotherapy was used more frequently at high-volume centers. Finally, this registry analysis raises important concerns about the reliability of R1 assessment underscoring the importance of standardized pathology of pancreatic specimens. In conclusion, MIPR can be safely implemented on a national scale. Further analyses are required to understand nuances of implementation of MIPR in Italy.

Published
2023

31. 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

32. 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

33. 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

34. 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

39. Robotic ALPPS for Primary and Metastatic Liver Tumors

Author

Magistri, P., primary, Guidetti, C., additional, Catellani, B., additional, Caracciolo, D., additional, Frassoni, S., additional, Bagnardi, V., additional, Guerrini, G.P., additional, Di Sandro, S., additional, and Di Benedetto, F., additional

Published
2023
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41. Hepatitis delta virus (hdv) replication through hbv integrants in hcc recurrence after liver transplantation.

Author

Di Marco, L., De Maria, N., Pivetti, A., Colecchia, A., Romanzi, A., Spallanzani, A., Guaraldi, G., Dolci, G., Ciusa, G., Di Benedetto, F., Magistri, P., Di Sandro, S., Degasperi, E., Anolli, M.P., Lampertico, P., Giosa, D., Lombardo, D., Raimondo, G., and Pollicino, T.

Abstract

A PWID man, HCV/HBV-HDV/HIV-infected, underwent liver transplantation (LT) for HCC in 2012 at the age of 52 years. HCC tissue showed high HDV-RNA (88,400 copies/cell), low total HBV-DNA (0.00001 c/c), and HBVcccDNA0.00008 c/c), without detectable HBV-RNA. High-throughput HBV integration sequencing (HBIS) identified 657 HBV integration sites.HBV integrants were predominantly represented by HBx gene sequences. After LT, Tacrolimus, Bictegravir/Emtricitabine/TAF, and anti-HBs immunoglobulin were administered, yielding HBsAg, HDV-RNA, and HCV-RNA negativity. In 2018, HBsAg reversion was observed with undetectable HBV-DNA and HDV-RNA >19,000 c/ml. In 2019, HDV-related hepatitis occurred. Intrahepatic HBcAg, HBsAgHBV DNA, HBVcccDNA, and HBV-RNA were undetectable. HDV RNA concentrations were very high in the liver (3,920,000 c/c) but low in the serum (214 IU/mL). CT scan (CTs) suspected an isolated HCC recurrence in the left adrenal gland, confirmed by adrenalectomy. Real-time PCR in the tumor from the adrenal gland revealed high levels of HDV RNA (5.5 c/c) but low levels of HBV DNA (0.00009 c/c) and HBVcccDNA (0.00001 c/c). HBV RNA was undetectable. HBIS identified 3497 HBV integrations, most of which included HBs gene sequences. After adrenalectomy, HBsAg and HDV-RNA became undetectable. Anti-HBs immunoglobulin was continued with Everolimus. In 2021, CTs showed two HCC nodules in the liver and one in the right adrenal gland. TACE was performed, and TKI therapy was started. In 2023, new HDV hepatitis occurred, with HDV-RNA>3,631,360 UI/ml and HBV-DNA <10UI/ml. For the progression of HCC, RFA on the right adrenal gland was performed, and Bulevirtide was started. After 3 months, HDV-RNA was 48,638 c/ml, and transaminases were normal. This case demonstrates HDV replication in extrahepatic HCC recurrence, despite low levels of HBVcccDNA. The decreased HDV RNA levels after RFA and BLV therapy suggest that HCC metastases may serve as HBsAg production sites following HBV integration. [ABSTRACT FROM AUTHOR]

Published
2024
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42. How useful is the machine perfusion in liver transplantation? An answer from a national survey

Author

Scalera, Irene, primary, De Carlis, R., additional, Patrono, D., additional, Gringeri, E., additional, Olivieri, T., additional, Pagano, D., additional, Lai, Q., additional, Rossi, M., additional, Gruttadauria, S., additional, Di Benedetto, F., additional, Cillo, U., additional, Romagnoli, R., additional, Lupo, L. G., additional, and De Carlis, L., additional

Published
2022
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43. Long-term maintenance of sustained virological response in liver transplant recipients treated for recurrent hepatitis C

Author

Ponziani, Francesca Romana, Viganò, Raffaella, Iemmolo, Rosa Maria, Donato, Maria Francesca, Rendina, Maria, Toniutto, Pierluigi, Pasulo, Luisa, Morelli, Maria Cristina, Burra, Patrizia, Miglioresi, Lucia, Merli, Manuela, Di Paolo, Daniele, Fagiuoli, Stefano, Gasbarrini, Antonio, Pompili, Maurizio, Belli, L., Gerunda, G.E., Marino, M., Montalti, R., Di Benedetto, F., De Ruvo, N., Rigamonti, C., Colombo, M., Rossi, G., Di Leo, A., Lupo, L., Memeo, V., Bringiotti, R., Zappimbulso, M., Bitetto, D., Vero, V., Colpani, M., Fornasiere, E., Pinna, A.D., Morelli, M.C., Bertuzzo, V., De Martin, E., Senzolo, M., Ettorre, G.M., Visco-Comandini, U., Antonucci, G., Angelico, M., Tisone, G., Giannelli, V., and Giusto, M.

Published
2014
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44. Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections

Author

Cucchetti, A., Aldrighetti, L., Ratti, F., Ferrero, A., Guglielmi, A., Giuliante, F., Cillo, U., Mazzaferro, V., De Carlis, L., Ercolani, G., Ettorre, G. M., di Benedetto, F., Valle, R. D., Gruttadauria, S., Jovine, E., Boggi, U., Vincenti, L., Santambrogio, R., Giuliani, A., Torzilli, G., Zimmiti, G., Brolese, A., Belli, A., Ravaioli, M., Frena, A., Rossi, G. E., Grazi, G. L., Zamboni, F., Berti, S., Calise, F., Massani, M., Morelli, L., Filauro, M., Tisone, G., Coratti, A., Navarra, G., Romito, R., Ceccarelli, G., Belli, G., Griseri, G., Antonucci, A., Mezzatesta, P., Veneroni, L., Schiavo, M., Colledan, M., Parisi, A., Guerriero, S., Spada, M., Batignani, G., Sgroi, G., Floridi, P., Boni, L., Maida, P., Ribero, D., La Barba, G., Cucchetti, A, Aldrighetti, L, Ratti, F, Ferrero, A, Guglielmi, A, Giuliante, F, Cillo, U, Mazzaferro, V, De Carlis, L, Ercolani, G, Ettorre, G, di Benedetto, F, Valle, R, Gruttadauria, S, Jovine, E, Boggi, U, Vincenti, L, Santambrogio, R, Giuliani, A, Torzilli, G, Zimmiti, G, Brolese, A, Belli, A, Ravaioli, M, Frena, A, Rossi, G, Grazi, G, Zamboni, F, Berti, S, Calise, F, Massani, M, Morelli, L, Filauro, M, Tisone, G, Coratti, A, Navarra, G, Romito, R, Ceccarelli, G, Belli, G, Griseri, G, Antonucci, A, Mezzatesta, P, Veneroni, L, Schiavo, M, Colledan, M, Parisi, A, Guerriero, S, Spada, M, Batignani, G, Sgroi, G, Floridi, P, Boni, L, Maida, P, Ribero, D, La Barba, G, Cucchetti, Alessandro, Aldrighetti, Luca, Ratti, Francesca, Ferrero, Alessandro, Guglielmi, Alfredo, Giuliante, Felice, Cillo, Umberto, Mazzaferro, Vincenzo, De Carlis, Luciano, and Ercolani, Giorgio

Subjects
Hepatology, mortality, morbidity, Liver Neoplasms, risk-adjustment, morbidity, laparoscopic liver resection, Length of Stay, mortality, Settore MED/18, Hepatectomy, Humans, Surgery, Laparoscopy, Prospective Studies, heterogeneity
Abstract

Background/Purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. The purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR). Methods: Data from a prospective, multicenter database involving 4318 patients submitted to LLRs in 41 hospitals from an intention-to-treat approach (2014–2020) were used to analyze heterogeneity (I2) among centers and to develop a risk-adjustment model on outcome measures through multivariable mixed-effect models to account for confounding due to case-mix. Results: Involved hospitals operated on very different patients: the largest heterogeneity was observed for operating in the presence of previous abdominal surgery (I2:79.1%), in cirrhotic patients (I2:89.3%) suffering from hepatocellular carcinoma (I2:88.6%) or requiring associated intestinal resections (I2:82.8%) and in regard to technical complexity (I2 for the most complex LLRs: 84.1%). These aspects determined substantial or large heterogeneity in overall morbidity (I2:84.9%), in prolonged in-hospital stay (I2:86.9%) and in conversion rate (I2:73.4%). Major complication had medium heterogeneity (I2:46.5%). The heterogeneity of mortality was null. Risk-adjustment accounted for all of this variability and the final risk-standardized conversion rate was 8.9%, overall morbidity was 22.1%, major morbidity was 5.1% and prolonged in-hospital stay was 26.0%. There were no outliers among the 41 participating centers. An online tool was provided. Conclusions: A benchmark for LLRs including all eligible patients was provided, suggesting that surgeons can act accordingly in the interest of the patient, modifying their approach in relation to different indications and different experience, but finally providing the same quality of care.

Published
2022

45. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., A. G. R., Wu, 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., Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, 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, F., 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, F., Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Efanov, Mikhail, Salimgereeva, Diana, Alikhanov, Ruslan, Wu, Andrew G R, Geller, David, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund Avdem, Sijberden, Jasper, Belli, Andrea, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Prieto, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Fondevila, Constantino, Rotellar, Fernando, Choi, Gi-Hong, Robless Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Herman, Paulo, Di Benedetto, Fabrizio, Kingham, T Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Cherqui, Daniel, Scatton, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Han, Ho-Seong, Abu Hilal, Mohammad, Soubrane, Olivier, Fuks, David, Aldrighetti, Luca, Edwin, Bjorn, and Goh, Brian K P

Subjects
hepatectomy, laparoscopy, liver resection, posterosuperior segments, risk score, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery, posterosuperior segment
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
2022

46. Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Author

De Carlis, R., Lauterio, A., Centonze, L., Buscemi, V., Schlegel, A., Muiesan, P., De Carlis, L., Carraro, A., Ghinolfi, D., De Simone, P., Ravaioli, M., Cescon, M., Dondossola, D., Bongini, M., Mazzaferro, V., Pagano, D., Gruttadauria, S., Gringeri, E., Cillo, U., Patrono, D., Romagnoli, R., Camagni, S., Colledan, M., Olivieri, T., Di Benedetto, F., Vennarecci, G., Baccarani, U., Lai, Q., Rossi, M., Manzia, T. M., Tisone, G., Vivarelli, M., Scalera, I., Lupo, L. G., Andorno, E., Meniconi, R. L., Ettorre, G. M., Avolio, A. W., Agnes, S., Pellegrino, R. A., Zamboni, F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, and Zamboni, F

Subjects
Warm ischemia, Hypothermic oxygenated perfusion, Ischemic-type biliary lesions, Liver preservation, Liver utilization, Graft Survival, Organ Preservation, Ischemic-type biliary lesion, Tissue Donors, Settore MED/18, Liver Transplantation, Perfusion, Humans, Surgery
Abstract

Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]

Published
2022

47. 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., K. K., Ng, 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., 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, F., 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, F., Vani, S., Dogeas, E., Siow, T. F., Mocchegianni, F., Ettorre, G. M., Colasanti, M., and Guzman, Y.

Subjects
difficulty, laparoscopic hepatectomy, laparoscopic liver, left lateral sectionectomy, size, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery
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

Published
2022

48. Correction to: Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry (Updates in Surgery, (2021), 10.1007/s13304-021-01161-w)

Author

Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., and Zimmitti G.

Abstract

In the originally published article the co-author first name and last name was interchanged. The correct name is copied below Salvatore Gruttadauria The original article has been updated.

Published
2021

49. The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology

Author

Rocca, A, Cipriani, F, Belli, G, Berti, S, Boggi, U, Bottino, V, Cillo, U, Cescon, M, Cimino, M, Corcione, F, De Carlis, L, Degiuli, M, De Paolis, P, De Rose, A, D'Ugo, D, Di Benedetto, F, Elmore, U, Ercolani, G, Ettorre, G, Ferrero, A, Filauro, M, Giuliante, F, Gruttadauria, S, Guglielmi, A, Izzo, F, Jovine, E, Laurenzi, A, Marchegiani, F, Marini, P, Massani, M, Mazzaferro, V, Mineccia, M, Minni, F, Muratore, A, Nicosia, S, Pellicci, R, Rosati, R, Russolillo, N, Spinelli, A, Spolverato, G, Torzilli, G, Vennarecci, G, Vigano, L, Vincenti, L, Delrio, P, Calise, F, Aldrighetti, L, Rocca A., Cipriani F., Belli G., Berti S., Boggi U., Bottino V., Cillo U., Cescon M., Cimino M., Corcione F., De Carlis L., Degiuli M., De Paolis P., De Rose A. M., D'Ugo D., Di Benedetto F., Elmore U., Ercolani G., Ettorre G. M., Ferrero A., Filauro M., Giuliante F., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Laurenzi A., Marchegiani F., Marini P., Massani M., Mazzaferro V., Mineccia M., Minni F., Muratore A., Nicosia S., Pellicci R., Rosati R., Russolillo N., Spinelli A., Spolverato G., Torzilli G., Vennarecci G., Vigano L., Vincenti L., Delrio P., Calise F., Aldrighetti L., Rocca, A, Cipriani, F, Belli, G, Berti, S, Boggi, U, Bottino, V, Cillo, U, Cescon, M, Cimino, M, Corcione, F, De Carlis, L, Degiuli, M, De Paolis, P, De Rose, A, D'Ugo, D, Di Benedetto, F, Elmore, U, Ercolani, G, Ettorre, G, Ferrero, A, Filauro, M, Giuliante, F, Gruttadauria, S, Guglielmi, A, Izzo, F, Jovine, E, Laurenzi, A, Marchegiani, F, Marini, P, Massani, M, Mazzaferro, V, Mineccia, M, Minni, F, Muratore, A, Nicosia, S, Pellicci, R, Rosati, R, Russolillo, N, Spinelli, A, Spolverato, G, Torzilli, G, Vennarecci, G, Vigano, L, Vincenti, L, Delrio, P, Calise, F, Aldrighetti, L, Rocca A., Cipriani F., Belli G., Berti S., Boggi U., Bottino V., Cillo U., Cescon M., Cimino M., Corcione F., De Carlis L., Degiuli M., De Paolis P., De Rose A. M., D'Ugo D., Di Benedetto F., Elmore U., Ercolani G., Ettorre G. M., Ferrero A., Filauro M., Giuliante F., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Laurenzi A., Marchegiani F., Marini P., Massani M., Mazzaferro V., Mineccia M., Minni F., Muratore A., Nicosia S., Pellicci R., Rosati R., Russolillo N., Spinelli A., Spolverato G., Torzilli G., Vennarecci G., Vigano L., Vincenti L., Delrio P., Calise F., and Aldrighetti L.

Abstract

At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15–25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients’ selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries.

Published
2021

50. International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria

Author

Degroote, H, Piñero, F, Costentin, C, Notarpaolo, A, Boin, I, Boudjema, K, Baccaro, C, Chagas, A, Bachellier, P, Ettorre, G, Poniachik, J, Muscari, F, Di Benedetto, F, Duque, S, Salame, E, Cillo, U, Gadano, A, Vanlemmens, C, Fagiuoli, S, Rubinstein, F, Burra, P, Cherqui, D, Silva, M, Van Vlierberghe, H, Duvoux, C, Degroote H, Piñero F, Costentin C, Notarpaolo A, Boin IF, Boudjema K, Baccaro C, Chagas AL, Bachellier P, Ettorre GM, Poniachik J, Muscari F, Di Benedetto F, Duque SH, Salame E, Cillo U, Gadano A, Vanlemmens C, Fagiuoli S, Rubinstein F, Burra P, Cherqui D, Silva M, Van Vlierberghe H, Duvoux C, Degroote, H, Piñero, F, Costentin, C, Notarpaolo, A, Boin, I, Boudjema, K, Baccaro, C, Chagas, A, Bachellier, P, Ettorre, G, Poniachik, J, Muscari, F, Di Benedetto, F, Duque, S, Salame, E, Cillo, U, Gadano, A, Vanlemmens, C, Fagiuoli, S, Rubinstein, F, Burra, P, Cherqui, D, Silva, M, Van Vlierberghe, H, Duvoux, C, Degroote H, Piñero F, Costentin C, Notarpaolo A, Boin IF, Boudjema K, Baccaro C, Chagas AL, Bachellier P, Ettorre GM, Poniachik J, Muscari F, Di Benedetto F, Duque SH, Salame E, Cillo U, Gadano A, Vanlemmens C, Fagiuoli S, Rubinstein F, Burra P, Cherqui D, Silva M, Van Vlierberghe H, and Duvoux C

Abstract

Background & Aims: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and ‘all-comers’. Methods: This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000–2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs. Results: From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8–55.8) and 38.2% (CI 25.4–52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p <0.0001]) and not significantly higher for the UCSF-DS group (SHR 1.60 [p = 0.32]), compared with patients remaining within Milan. The all-comers presented more frequent features of aggressive HCC and higher tumour burden at explant. Among the UCSF-DS group, an AFP value of ≤20 ng/ml at listing was associated with lower recurrence (SHR 2.01 [p = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP ≤20 ng/ml in all-comers. Conclusions: Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of ≤20 ng/ml might be a novel tool to optimise selection of candidates for LT. Clinical trial number: This study was r

Published
2021

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