Author: "Federica, Cipriani" - Searchworks@Jio Institute Digital Library Search Results

146 results on '"Federica, Cipriani"'

1. Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Author: Luigi Marano, Federica Marmorino, Isacco Desideri, Ludovico Carbone, Alessandro Rizzo, Viola Salvestrini, Franco Roviello, Saverio Cinieri, Vittorio Donato, Raffaele De Luca, NutriOnc Research Group, Silvia Sofia, Marco Milone, Benedetto Ielpo, Maria Teresa Mita, Silvia Ministrini, Mario Giuffrida, Roberta Tutino, Caterina Baldi, Giampaolo Perri, Anna Stella Lippolis, Chiara Marafante, Giusy Giannandrea, Marco Vito Marino, Letizia Laface, Salomone Di Saverio, Luca Aldrighetti, Nicola de’Angelis, Nick Salimian, Marco Caricato, Gianluca Pellino, Sara Vertaldi, Federica Cipriani, Gabriella Teresa Capolupo, Antonio Costanzo, Letizia Santandrea, Gaetano Gallo, Andrea Belli, Laura Mastrangelo, Fausto Rosa, Nicolò Pecorelli, Graziella Marino, Alessio Giordano, Nicola Cillara, Maria Lemma, Francesco Pata, Federico Cammillini, Gianmario Edoardo Poto, Giulia Grassi, Donato Francesco Altomare, Arcangelo Picciariello, Lorenzo Petagna, Luca Ippolito, Elio Treppiedi, Daniele Delogu, Abdallah Moukachar, Stefano Granieri, Giuseppe Cuticone, Osvaldo Carpineto Samorani, Daniela Rega, Leonardo Solaini, Stefano de Pascale, Francesca Ascari, Michele Manigrasso, Simona Badalucco, Salvatore Paiella, Sara Coppola, Roberta Iadarola, Giovanna Di Meo, Isacco Montroni, Fabio Vistoli, Valentina Ferraro, Edoardo Saladino, Federico Fazio, Roberta Rota, Francesco Orlando, Simone Famularo, Cinzia Bizzoca, Giorgio Dalmonte, Marco Inama, Luigi Verre, Leandro Siragusa, Casoni Pattacini Gianmaria, Michele Benedetti, Nicolò Tamini, Cristian Conti, Giorgio Ammerata, Serena Mantova, Vito Leonardo Pinto, Arianna Corvasce, Giorgio Micheletti, Teresa Perra, Marco Pellicciaro, Marco Materazzo, Michele Zuolo, Emanuele Doria, Antonio Brillantino, Luca Del Prete, Andrea Muratore, Claudio Luciani, Giulia Turri, Fabio Casciani, Giuliani Giuseppe, Graziana Barile, Oldrà Gaia, Valeria Restaino, Simona Deidda, Michele Ammendola, Andrea Fares Bucci, Patrizia Marsanic, Dario Cassetti, Luca Resca, Daniele Fusario, Eleonora Andreucci, Anna Michelotti, Brunella Amoruso, Isabella Franco, Laura Noto, Andrea Spallanzani, Raimondo Calogero Scalia, Teresa Del Giudice, Valeria Merz, Gianmarco Motta, Alessandro Parisi, Mikol Modesti, Antonella Argentiero, Debora Basile, Gianmarco Vannini, Carlotta Ottanelli, Salvatore Corallo, Eufemia Stefania Lutrino, Daniele Rossini, Federica Morano, Luigia Stefania Stucci, Costanza Winchler, Martina Catalano, Andrea Marini, Giuseppe Brisinda, Enrico Sammarco, Martina Carullo, Giandomenico Roviello, Mirko Barone, Maria Grazia Rodriquenz, Giuseppe Tirino, Alessia Amoruso, Anna Russo, Veronica Conca, Laura Orgiano, Sveva Macrini, Giulia Nazzicone, Maria Bensi, Martina Montesano, Emanuela Dell’Aquila, Andrea Sbrana, Beatrice Borelli, Lorenzo Fornaro, Lucrezia Raimondi, Valeria Zurlo, Mattia Garutti, Elena Ongaro, Arianna Pellegrino, Andrea lanese, Laura Bernardini, Alessandra Boccaccino, Patrizia Farina, Federica Buzzacchino, Angelica Petrillo, Ada Taravella, Vittorio Studiale, Paolo Ciracì, Giovanna Lovino, Dora Di Cosmo, Sabrina Montrone, Fabiana Gregucci, Luca Dominici, Alba Fiorentino, Filippo Carannante, Giambattista Siepe, Giampaolo Montesi, Manuele Roghi, Michele Aquilano, Andrea Romei, Ilaria Bonaparte, Roberta Grassi, Emma D’Ippolito, Giulio Frosini, Giuseppina De Marco, Gennaro Giovine, Chiara Mattioli, Ilaria Morelli, Victoria Lorenzetti, Matteo Mariotti, Carolina Orsatti, Vincenzo Troncone, Lorenzo Livi, Antonio Angrisani, Marco Banini, Teresa Di Pietro, Giuseppe Carlo Iorio, Iacopo Cavallo, Cecilia Cerbai, Valerio Nardone, Francesca De Felice, Consuelo Rosa, Giulia Stocchi, Sara Lucidi, Michele Ganovelli, Damiano Dei, Chiara Cascone, Anna Peru, Luisa Caprara, Lucia Angelini, Luca Visani, Giulio Francolini, Beatrice Bettazzi, Francesco Belia, Virginia Boccardi, Simone Serafini, Vincenzo Bottino, Luca Ferrario, Giuseppe Frazzetta, Felice Pirozzi, Gennaro Martines, Francesco Antonio Ciarleglio, Daniele Indiani, Giuliano Barugola, Luca Mazza, and Chiara Guarini
Subjects: clinical nutrition, cancer, malnutrition, nutritional assessment, survey, Nutrition. Foods and food supply, TX341-641
Abstract: Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.
Published: 2023
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2. Response to: 'Comment on Hepatectomy Versus Sorafenib in Advanced Nonmetastatic Hepatocellular Carcinoma'

Author: Simone Famularo, MD, Matteo Donadon, MD, PhD, Federica Cipriani, MD, Luca Aldrighetti, MD, PhD, Franco Trevisani, MD, and Guido Torzilli, MD, PhD, FACS
Subjects: Surgery, RD1-811
Published: 2023
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3. Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma

Author: Angelo Della Corte, Francesca Ratti, Lorenzo Monfardini, Paolo Marra, Simone Gusmini, Marco Salvioni, Massimo Venturini, Federica Cipriani, Luca Aldrighetti, and Francesco De Cobelli
Subjects: liver, oncology, microwave, ablation, laparoscopy, Medical technology, R855-855.5
Abstract: Background Based on patient and tumor characteristics, some authors favor laparoscopic microwave ablation (LMWA) over the percutaneous approach (PMWA) for treatment of hepatocellular carcinoma (HCC). We compared the two techniques in terms of technique efficacy, local tumor progression (LTP) and complication rates. Study design A retrospective comparative analysis was performed on 91 consecutive patients (102 HCC tumors) who underwent PMWA or LMWA between October 2014 and May 2019. Technique efficacy at one-month and LTP at follow-up were assessed by contrast-enhanced CT/MRI. Kaplan–Meier estimates and Cox regression were used to compare LTP-free survival (LTPFS). Results At baseline analysis, LMWA group showed higher frequency of multinodular disease (p
Published: 2020
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4. Simultaneous resection of colorectal cancer and synchronous liver metastases

Author: Jasper P. Sijberden, Giuseppe Zimmitti, Simone Conci, Nadia Russolillo, Michele Masetti, Federica Cipriani, Jacopo Lanari, Burak Görgec, Andrea Benedetti Cacciaguerra, Fernando Rotellar, Mathieu D’Hondt, Bjørn Edwin, Robert P. Sutcliffe, Ibrahim Dagher, Mikhail Efanov, Santi López-Ben, John N. Primrose, Felice Giuliante, Antonino Spinelli, Manish Chand, Salud Alvarez, Serena Langella, Simone Nicosia, Andrea Ruzzenente, Marco Vivarelli, Umberto Cillo, Luca Aldrighetti, Elio Jovine, Alessandro Ferrero, Alfredo Guglielmi, Marc G. Besselink, Mohammad Abu Hilal, Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, Radiology and Nuclear Medicine, CCA - Imaging and biomarkers, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
Subjects: Surgery, General Medicine
Abstract: BACKGROUND: The use of a simultaneous resection (SIMR) in patients with synchronous colorectal liver metastases (sCRLM) has increased over the past decades. However, it remains unclear when a SIMR is beneficial and when it should be avoided. The aim of this retrospective cohort study was therefore to compare the outcomes of a SIMR for sCRLM in different settings, and to assess which factors are independently associated with unfavorable outcomes.METHODS: To perform this retrospective cohort study, patients with sCRLM undergoing SIMR (2004-2019) were extracted from an international multicenter database, and their outcomes were compared after stratification according to the type of liver and colorectal resection performed. Factors associated with unfavorable outcomes were identified through multivariable logistic regression.RESULTS: Overall, 766 patients were included, encompassing colorectal resections combined with a major liver resection (n=122), minor liver resection in the anterolateral (n=407), or posterosuperior segments ('Technically major', n=237). Minor and technically major resections, compared to major resections, were more often combined with a rectal resection (29.2 and 36.7 vs. 20.5%, respectively, both P=0.003) and performed fully laparoscopic (22.9 and 23.2 vs. 6.6%, respectively, both P = 0.003). Major and technically major resections, compared to minor resections, were more often associated with intraoperative transfusions (42.9 and 38.8 vs. 20%, respectively, both P = 0.003) and unfavorable incidents (9.6 and 9.8 vs. 3.3%, respectively, both P≤0.063). Major resections were associated, compared to minor and technically major resections, with a higher overall morbidity rate (64.8 vs. 50.4 and 49.4%, respectively, both P≤0.024) and a longer length of stay (12 vs. 10 days, both P≤0.042). American Society of Anesthesiologists grades ≥3 [adjusted odds ratio (aOR): 1.671, P=0.015] and undergoing a major liver resection (aOR: 1.788, P=0.047) were independently associated with an increased risk of severe morbidity, while undergoing a left-sided colectomy was associated with a decreased risk (aOR: 0.574, P=0.013).CONCLUSIONS: SIMR should primarily be reserved for sCRLM patients in whom a minor or technically major liver resection would suffice and those requiring a left-sided colectomy. These findings should be confirmed by randomized studies comparing SIMR with staged resections.
Published: 2023

5. Retrospective Evaluation and Significance of Neutrophil-to-Lymphocyte Ratio Prior to and 1 month Following Microwave Ablation of Hepatocellular Carcinoma

Author: Angelo Della Corte, Claudio Sallemi, Francesca Ratti, Lorenzo Monfardini, Simone Gusmini, Federica Cipriani, Renato Pennella, Domenico Santangelo, Valentina Burgio, Andrea Casadei-Gardini, Luca Aldrighetti, Francesco De Cobelli, Della Corte, Angelo, Sallemi, Claudio, Ratti, Francesca, Monfardini, Lorenzo, Gusmini, Simone, Cipriani, Federica, Pennella, Renato, Santangelo, Domenico, Burgio, Valentina, Casadei-Gardini, Andrea, Aldrighetti, Luca, and De Cobelli, Francesco
Subjects: Inflammation, Hepatocellular carcinoma, Radiology, Nuclear Medicine and imaging, Adaptive immune response, Cardiology and Cardiovascular Medicine, Microwave, Thermal ablation, NLR
Abstract: Neutrophil-to-lymphocyte ratio (NLR) recently demonstrated predictive value for hepatocellular carcinoma (HCC) recurrence after thermal ablation. Microwave ablation (MWA) has been shown to induce changes in the immune landscape after HCC treatment. This study aims at identifying predictors of local tumor progression (LTP) and post-treatment NLR kinetics after MWA.Data from 108 consecutive patients who underwent percutaneous MWA of 119 HCCs with a 2450 Hz/100 W generator in two institutions from October 2014 to September 2021 were retrospectively reviewed. Forty-five HCCs (42 patients) met inclusion criteria for analysis (technique efficacy, pre- and post-treatment NLR availability, follow-up 6 months, absence of complications). NLR was analyzed prior to therapy and at 1-month follow-up; difference between the two time points was defined as ΔNLRAfter a median follow-up of 25 months, LTP occurred in 18 HCCs (40%) and 18 patients (42.9%). Multivariate competing risk regression comprising ΔNLRNLR increase after ablation was the only independent predictor of LTP, supporting the role of balance between systemic inflammation and immunity in recurrence after MWA. Ablation energy/tumor size predicted NLR increase, reinforcing the concept of immune ablation.III.
Published: 2022
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6. Sub‐classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes

Author: Edoardo Poletto, Paolo Magistri, Nicholas Syn, Ho-Seong Han, and Federica Cipriani
Subjects: Hepatology, Surgery
Published: 2023
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7. IFNα gene/cell therapy curbs colorectal cancer colonization of the liver by acting on the hepatic microenvironment

Author: Mario Catarinella, Andrea Monestiroli, Giulia Escobar, Amleto Fiocchi, Ngoc Lan Tran, Roberto Aiolfi, Paolo Marra, Antonio Esposito, Federica Cipriani, Luca Aldrighetti, Matteo Iannacone, Luigi Naldini, Luca G Guidotti, and Giovanni Sitia
Subjects: colorectal cancer, gene therapy, interferon‐alpha, liver metastases, tumor microenvironment, Medicine (General), R5-920, Genetics, QH426-470
Abstract: Abstract Colorectal cancer (CRC) metastatic dissemination to the liver is one of the most life‐threatening malignancies in humans and represents the leading cause of CRC‐related mortality. Herein, we adopted a gene transfer strategy into mouse hematopoietic stem/progenitor cells to generate immune‐competent mice in which TEMs—a subset of Tie2+ monocytes/macrophages found at peritumoral sites—express interferon‐alpha (IFNα), a pleiotropic cytokine with anti‐tumor effects. Utilizing this strategy in mouse models of CRC liver metastasis, we show that TEMs accumulate in the proximity of hepatic metastatic areas and that TEM‐mediated delivery of IFNα inhibits tumor growth when administered prior to metastasis challenge as well as on established hepatic lesions, improving overall survival. Further analyses unveiled that local delivery of IFNα does not inhibit homing but limits the early phases of hepatic CRC cell expansion by acting on the radio‐resistant hepatic microenvironment. TEM‐mediated IFNα expression was not associated with systemic side effects, hematopoietic toxicity, or inability to respond to a virus challenge. Along with the notion that TEMs were detected in the proximity of CRC metastases in human livers, these results raise the possibility to employ similar gene/cell therapies as tumor site‐specific drug‐delivery strategies in patients with CRC.
Published: 2016
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8. Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Author: Marano, Luigi, Marmorino, Federica, Desideri, Isacco, Carbone, Ludovico, Rizzo, Alessandro, Salvestrini, Viola, Roviello, Franco, Cinieri, Saverio, Donato, Vittorio, De Luca, Raffaele, Silvia, Sofia, Marco, Milone, Benedetto, Ielpo, Maria Teresa Mita, Silvia, Ministrini, Mario, Giuffrida, Roberta, Tutino, Caterina, Baldi, Giampaolo, Perri, Anna Stella Lippolis, Chiara, Marafante, Giusy, Giannandrea, Marco Vito Marino, Letizia, Laface, Salomone Di Saverio, Luca, Aldrighetti, Nicola, De'Angelis, Nick, Salimian, Marco, Caricato, Gianluca, Pellino, Sara, Vertaldi, Federica, Cipriani, Gabriella Teresa Capolupo, Antonio, Costanzo, Letizia, Santandrea, Gallo, Gaetano, Andrea, Belli, Laura, Mastrangelo, Fausto, Rosa, Nicolò, Pecorelli, Graziella, Marino, Alessio, Giordano, Nicola, Cillara, Maria, Lemma, Francesco, Pata, Federico, Cammillini, Gianmario Edoardo Poto, Giulia, Grassi, Donato Francesco Altomare, Arcangelo, Picciariello, Lorenzo, Petagna, Luca, Ippolito, Elio, Treppiedi, Daniele, Delogu, Abdallah, Moukachar, Stefano, Granieri, Giuseppe, Cuticone, Osvaldo Carpineto Samorani, Daniela, Rega, Leonardo, Solaini, Stefano de Pascale, Francesca, Ascari, Michele, Manigrasso, Simona, Badalucco, Salvatore, Paiella, Sara, Coppola, Roberta, Iadarola, Giovanna Di Meo, Isacco, Montroni, Fabio, Vistoli, Valentina, Ferraro, Edoardo, Saladino, Federico, Fazio, Roberta, Rota, Francesco, Orlando, Simone, Famularo, Cinzia, Bizzoca, Giorgio, Dalmonte, Marco, Inama, Luigi, Verre, Leandro, Siragusa, Casoni Pattacini Gianmaria, Michele, Benedetti, Nicolò, Tamini, Cristian, Conti, Giorgio, Ammerata, Serena, Mantova, Vito Leonardo Pinto, Arianna, Corvasce, Giorgio, Micheletti, Teresa, Perra, Marco, Pellicciaro, Marco, Materazzo, Michele, Zuolo, Emanuele, Doria, Antonio, Brillantino, Luca Del Prete, Andrea, Muratore, Claudio, Luciani, Giulia, Turri, Fabio, Casciani, Giuliani, Giuseppe, Graziana, Barile, Oldrà, Gaia, Valeria, Restaino, Simona, Deidda, Michele, Ammendola, Andrea Fares Bucci, Patrizia, Marsanic, Dario, Cassetti, Luca, Resca, Daniele, Fusario, Eleonora, Andreucci, Anna, Michelotti, Brunella, Amoruso, Isabella, Franco, Laura, Noto, Andrea, Spallanzani, Raimondo Calogero Scalia, Teresa Del Giudice, Valeria, Merz, Gianmarco, Motta, Alessandro, Parisi, Mikol, Modesti, Antonella, Argentiero, Debora, Basile, Gianmarco, Vannini, Carlotta, Ottanelli, Salvatore, Corallo, Eufemia Stefania Lutrino, Daniele, Rossini, Federica, Morano, Luigia Stefania Stucci, Costanza, Winchler, Martina, Catalano, Andrea, Marini, Giuseppe, Brisinda, Enrico, Sammarco, Martina, Carullo, Giandomenico, Roviello, Mirko, Barone, Maria Grazia Rodriquenz, Giuseppe, Tirino, Alessia, Amoruso, Anna, Russo, Veronica, Conca, Laura, Orgiano, Sveva, Macrini, Giulia, Nazzicone, Maria, Bensi, Martina, Montesano, Emanuela, Dell'Aquila, Andrea, Sbrana, Beatrice, Borelli, Lorenzo, Fornaro, Lucrezia, Raimondi, Valeria, Zurlo, Mattia, Garutti, Elena, Ongaro, Arianna, Pellegrino, Andrea, Lanese, Laura, Bernardini, Alessandra, Boccaccino, Patrizia, Farina, Federica, Buzzacchino, Angelica, Petrillo, Ada, Taravella, Vittorio, Studiale, Paolo, Ciracì, Giovanna, Lovino, Dora Di Cosmo, Sabrina, Montrone, Fabiana, Gregucci, Luca, Dominici, Alba, Fiorentino, Filippo, Carannante, Giambattista, Siepe, Giampaolo, Montesi, Manuele, Roghi, Michele, Aquilano, Andrea, Romei, Ilaria, Bonaparte, Roberta, Grassi, Emma, D'Ippolito, Giulio, Frosini, Giuseppina De Marco, Gennaro, Giovine, Chiara, Mattioli, Ilaria, Morelli, Victoria, Lorenzetti, Matteo, Mariotti, Carolina, Orsatti, Vincenzo, Troncone, Lorenzo, Livi, Antonio, Angrisani, Marco, Banini, Teresa Di Pietro, Giuseppe Carlo Iorio, Iacopo, Cavallo, Cecilia, Cerbai, Valerio, Nardone, Francesca De Felice, Consuelo, Rosa, Giulia, Stocchi, Sara, Lucidi, Michele, Ganovelli, Damiano, Dei, Chiara, Cascone, Anna, Peru, Luisa, Caprara, Lucia, Angelini, Luca, Visani, Giulio, Francolini, Beatrice, Bettazzi, Francesco, Belia, Virginia, Boccardi, Simone, Serafini, Vincenzo, Bottino, Luca, Ferrario, Giuseppe, Frazzetta, Felice, Pirozzi, Gennaro, Martines, Francesco Antonio Ciarleglio, Daniele, Indiani, Giuliano, Barugola, Luca, Mazza, and Chiara, Guarini
Subjects: nutritional assessment, clinical nutrition, cancer, malnutrition, survey
Published: 2023

9. 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: Jacob Ghotbi, Davit Aghayan, Åsmund Fretland, Bjørn Edwin, Nicholas L. Syn, Federica Cipriani, Mohammed Alzoubi, Chetana Lim, Olivier Scatton, Tran Cong duy Long, Paulo Herman, Fabricio Ferreira Coelho, Marco V. Marino, Vincenzo Mazzaferro, Adrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Alejandro Mejia, James O. Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung-Ngai Tang, Charing C.N. Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T. Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Franco Pascual, Daniel Cherqui, Xiao Liang, Alessandro Mazzotta, Go Wakabayashi, Mariano Giglio, Roberto I. Troisi, Ho-Seong Han, Tan-To Cheung, Atsushi Sugioka, Kuo-Hsin Chen, Rong Liu, Olivier Soubrane, David Fuks, Luca Aldrighetti, Mohammad Abu Hilal, Brian K.P. Goh, Mikel Gastaca, Juul Meurs, Celine De Meyere, Kit-Fai Lee, Kelvin K. Ng, Diana Salimgereeva, Ruslan Alikhanov, Lip-Seng Lee, Jae Young Jang, Yutaro Kato, Masayuki Kojima, Jaime Arthur Pirola Kruger, Victor Lopez-Lopez, Margarida Casellas I Robert, Roberto Montalti, Boram Lee, Mizelle D'Silva, Hao-Ping Wang, Mansour Saleh, Zewei Chen, Shian Yu, Simone Vani, Francesco Ardito, Ugo Giustizieri, Davide Citterio, Federico Mocchegiani, Marco Colasanti, Yoelimar Guzmán, Kevin P. Labadie, Maria Conticchio, Epameinondas Dogeas, Emanuele F. Kauffmann, Mario Giuffrida, Daniele Sommacale, Alexis Laurent, Paolo Magistri, Phan Phuoc Nghia, Kohei Mishima, Bernardo Dalla Valle, Felix Krenzien, Moritz Schmelzle, Prashant Kadam, Qu Liu, Eric C.H. Lai, Junhao Zheng, Tiing Foong Siow, and Fabio Forchino
Subjects: Robotic liver resections, Oncology, Laparoscopic liver resections, Major resections, Settore MED/18 - CHIRURGIA GENERALE, Surgery, General Medicine, Difficulty, Neoadjuvant chemotherapy
Published: 2023

10. Impact of body mass index on the difficulty and outcomes of laparoscopic left lateral sectionectomy

Author: Zewei Chen, Mengqiu Yin, Junhao Fu, Shian Yu, Nicholas L. Syn, Darren W. Chua, T. Peter Kingham, Wanguang Zhang, Tijs J. Hoogteijling, Davit L. Aghayan, Tiing Foong Siow, Olivier Scatton, Paulo Herman, Marco V. Marino, Vincenzo Mazzaferro, Adrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Safi Dokmak, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O. Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Eric C.H. Lai, Charing C.N. Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Qu Liu, Rong Liu, Alessandro Ferrero, Giuseppe Maria Ettorre, Federica Cipriani, Daniel Cherqui, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I. Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Ho-Seong Han, Tran Cong duy Long, David Fuks, Mohammad Abu Hilal, Luca Aldrighetti, Kuo-Hsin Chen, Bjørn Edwin, Brian K.P. Goh, Mikel Gastaca, Juul Meurs, Celine De Meyere, Kit-Fai Lee, Kelvin K. Ng, Diana Salimgereeva, Ruslan Alikhanov, Lip-Seng Lee, Jae-Young Jang, Masayuki Kojima, Jaime Arthur Pirola Kruger, Fabricio Ferreira Coelho, Victor Lopez-Lopez, Margarida Casellas I Robert, Roberto Montalti, Mariano Giglio, Mizelle D'Silva, Boram Lee, Hao-Ping Wang, Franco Pascual, Mansour Saleh, Simone Vani, Francesco Ardito, Ugo Giustizieri, Davide Citterio, Federico Mocchegiani, Giammauro Berardi, Marco Colasanti, Yoelimar Guzmán, Kevin P. Labadie, Maria Conticchio, Epameinondas Dogeas, Emanuele F. Kauffmann, Mario Giuffrida, Daniele Sommacale, Alexis Laurent, Paolo Magistri, Kohei Mishima, Moritz Schmelzle, Felix Krenzien, Prashant Kadam, Jacob Ghotbi, Åsmund Avdem Fretland, Fabio Forchino, Alessandro Mazzotta, Francois Cauchy, Chetana Lim, Bernardo Dalla Valle, Junhao Zheng, Phan Phuoc Nghia, and Graduate School
Subjects: Minimally-invasive liver, Oncology, Left lateral sectionectomy, Laparoscopic hepatectomy, Laparoscopic liver, Minimally-invasive hepatectomy, Surgery, General Medicine, Body mass index
Abstract: Introduction: Currently, the impact of body mass index (BMI) on the outcomes of laparoscopic liver resections (LLR) is poorly defined. This study attempts to evaluate the impact of BMI on the peri-operative outcomes following laparoscopic left lateral sectionectomy (L-LLS). Methods: A retrospective analysis of 2183 patients who underwent pure L-LLS at 59 international centers between 2004 and 2021 was performed. Associations between BMI and selected peri-operative outcomes were analyzed using restricted cubic splines. Results: A BMI of >27kg/m2 was associated with increased in blood loss (Mean difference (MD) 21 mls, 95% CI 5–36), open conversions (Relative risk (RR) 1.13, 95% CI 1.03–1.25), operative time (MD 11 min, 95% CI 6–16), use of Pringles maneuver (RR 1.15, 95% CI 1.06–1.26) and reductions in length of stay (MD -0.2 days, 95% CI -0.3 to −0.1). The magnitude of these differences increased with each unit increase in BMI. However, there was a “U” shaped association between BMI and morbidity with the highest complication rates observed in underweight and obese patients. Conclusion: Increasing BMI resulted in increasing difficulty of L-LLS. Consideration should be given to its incorporation in future difficulty scoring systems in laparoscopic liver resections.
Published: 2023

11. Robotic Approach for Lymphadenectomy in Biliary Tumours: The Missing Ring Between the Benefits of Laparoscopic and Reproducibility of Open Approach?

Author: Francesca Ratti, Federica Cipriani, Sara Ingallinella, Antonella Tudisco, Marco Catena, and Luca Aldrighetti
Subjects: Surgery
Abstract: This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumours and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches, and to compare the techniques within a weighted propensity score analysis.The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery.Overall, 25 robotic resections with LND (2021-2022) from a single centre constituted the study group (Rob Group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap Group) and 113 open (Open Group) procedures to address the primary endpoint. A "per-period" analysis was performed comparing the characteristics and outcomes of the Rob Group with the first 25 consecutive laparoscopic liver resections with associated LND (LapInit Group).Minimally invasive techniques performed equally well regarding the number of harvested nodes, blood transfusions, functional recovery, length of stay, and major morbidity and provided a short-term benefit to patients when compared with the open technique. A better performance of the robotic approach over laparoscopic approach (and both approaches over the open technique) was recorded for patients achieving LND with retrieval of6 nodes. The open approach reduced both the operative time and time for LND, and robotic surgery performed better than laparoscopic surgery.Minimally invasive techniques are excellent tools for the management of LND in patients with biliary tumours, showing feasibility, and oncological adequacy. Robotics could contribute to the large-scale diffusion of these procedures with a high profile of complexity.
Published: 2022

12. Long-term oncological outcomes after laparoscopic parenchyma-sparing redo liver resections for patients with metastatic colorectal cancer: a European multi-center study

Author: Francesca Ratti, Airazat M. Kazaryan, Leonid Barkhatov, Thomas Armstrong, Giulio Belli, Åsmund Avdem Fretland, Davit L. Aghayan, Roberto Troisi, Ibrahim Dagher, Luca Aldrighetti, Federica Cipriani, Vincenzo Scuderi, Bjørn Edwin, Mohammad Abu Hilal, Andrea Belli, Barkhatov, L., Aghayan, D. L., Scuderi, V., Cipriani, F., Fretland, A. A., Kazaryan, A. M., Ratti, F., Armstrong, T., Belli, A., Dagher, I., Belli, G., Aldrighetti, L., Hilal, M. A., Troisi, R. I., and Edwin, B.
Subjects: medicine.medical_specialty, Palliative treatment, Colorectal cancer, Liver resections, Internal medicine, Hepatectomy, Humans, Medicine, Retrospective Studies, Parenchyma-sparing liver resections, Rectal Neoplasms, business.industry, Liver Neoplasms, Significant difference, Margins of Excision, Hepatology, medicine.disease, Surgery, Colorectal liver metastases, Redo liver resections, Treatment Outcome, Multi center study, Colonic Neoplasms, Resection margin, Laparoscopy, Neoplasm Recurrence, Local, Colorectal Neoplasms, business, Laparoscopic liver surgery, Abdominal surgery
Abstract: Background Laparoscopic redo resections for colorectal metastases are poorly investigated. This study aims to explore long-term results after second, third, and fourth resections. Material and methods Prospectively updated databases of primary and redo laparoscopic liver resections in six European HPB centers were analyzed. Procedure-related overall survival after first, second, third, and fourth resections were evaluated. Furthermore, patients without liver recurrence after first liver resection were compared to those with one redo, two or three redo, and patients with palliative treatment for liver recurrence after first laparoscopic liver surgery. Survival was calculated both from the date of the first liver resection and from the date of the actual liver resection. In total, 837 laparoscopic primary and redo liver resections performed in 762 patients were included (630 primary, 172 first redo, 29 second redo, and 6 third redo). Patients were bunched into four groups: Group 1—without hepatic recurrence after primary liver resection (n = 441); Group 2—with liver recurrence who underwent only one laparoscopic redo resection (n = 154); Group 3—with liver recurrence who underwent two laparoscopic redo resections (n = 29); Group 4—with liver recurrence who have not been found suitable for redo resections (n = 138). Results No significant difference has been found between the groups in terms of baseline characteristics and surgical outcomes. Rate of positive resection margin was higher in the group with palliative recurrence (group 4). Five-year survival calculated from the first liver resection was 67%, 62%, 84%, and 7% for group 1, 2, 3, and 4, respectively. Procedure-specific 5-year overall survival was 50% after primary laparoscopic liver resection, 52% after the 1st reoperation, 52% after the 2nd, and 40% after the 3rd reoperation made laparoscopic. Conclusions Multiple redo recurrences can be performed laparoscopically with good long-term results. Liver recurrence does not aggravate prognosis as long as the patient is suitable for reoperation.
Published: 2021
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13. Laparoscopic Approach for the Treatment of Hepatocellular Carcinoma

Author: Federica Cipriani and Luca Aldrighetti
Published: 2022
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14. Intrahepatic cholangiocarcinoma as the new field of implementation of laparoscopic liver resection programs. A comparative propensity score-based analysis of open and laparoscopic liver resections

Author: Arab Rawashdeh, Federica Cipriani, Mohammed Abu Hilal, Francesca Ratti, Guido Fiorentini, Luca Aldrighetti, John N. Primrose, Ratti, F., Rawashdeh, A., Cipriani, F., Primrose, J., Fiorentini, G., Abu Hilal, M., and Aldrighetti, L.
Subjects: Male, medicine.medical_specialty, 030230 surgery, Liver resections, Disease-Free Survival, Resection, New technique, Cholangiocarcinoma, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Blood loss, Internal medicine, medicine, Humans, Minimally invasive, Propensity Score, Laparoscopy, Intrahepatic Cholangiocarcinoma, Intrahepatic cholangiocarcinoma, Postoperative Care, Intraoperative Care, Liver resection, medicine.diagnostic_test, business.industry, Margins of Excision, Middle Aged, Hepatology, Surgery, Treatment Outcome, Bile Duct Neoplasms, Liver, Propensity score matching, Female, 030211 gastroenterology & hepatology, business, Abdominal surgery
Abstract: Background: the aim of the present study is to analyze the outcomes of laparoscopic and open liver resections for (Intrahepatic CholangioCarcinoma) ICC in the modern era of laparoscopic liver surgery.Methods: patients undergoing laparoscopic and open liver resections for ICC in two European referral centers were included. Finally, 104 patients from the open group and 104 patients from the laparoscopic group were compared after propensity scores matching according to seven covariates representative of patients and disease characteristics. Indications to surgery and short- and long-term outcomes were compared.Results: operative time, number of retrieved nodes, rate, and depth of negative resection margins were comparable between the two groups. Blood loss was lower in the MILS (150 ± 100 mL, mean ± SD) compared with the Open group (350 ± 250 mL, p = 0.030). Postoperative complications occurred in 14.4% of patients in the MILS and in the 24% of patients in the Open group (p = 0.02). There were no significant differences in long-term outcomes between groups.Conclusions: our results confirm feasibility, safety, and oncological efficiency of the laparoscopic approach in the management of ICC. However, this surgery is often complex and should be only considered in centers with large experience in laparoscopic liver surgery.
Published: 2020
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15. Perihilar cholangiocarcinoma: are we ready to step towards minimally invasiveness?

Author: Luca Aldrighetti, Michele Paganelli, Francesca Ratti, Marco Catena, Federica Cipriani, Guido Fiorentini, Ratti, F., Fiorentini, G., Cipriani, F., Catena, M., Paganelli, M., and Aldrighetti, L.
Subjects: Adult, Male, medicine.medical_specialty, Operative Time, Blood Loss, Surgical, Exploratory phase, Anastomosis, New technique, Blood loss, Clinical endpoint, Humans, Medicine, Blood Transfusion, Perihilar Cholangiocarcinoma, Liver surgery, Propensity Score, Laparoscopy, Aged, Outcome benefit, Intraoperative Care, medicine.diagnostic_test, business.industry, Anastomosis, Surgical, Middle Aged, Surgery, Open group, Biliary Tract Surgical Procedures, Treatment Outcome, Bile Duct Neoplasms, Propensity score matching, Feasibility Studies, Female, Safety, Perihilar cholangiocarcinoma, business, Klatskin Tumor
Abstract: The primary endpoint of this study is to evaluate the feasibility and safety of the laparoscopic approach in selected types of PeriHilar Cholangiocarcinoma (PHC). Secondary endpoint is to evaluate the potential advantages of laparoscopic approach over the open counterpart. From 2018, an MILS program for PHC was undertaken in selected patients: 16 patients constituted the study group (out of 261 operated between 2004 and 2019) and was compared with a group of patients operated by open technique (control group) in the previous period through a propensity score matching with a 1:2 ratio. Intraoperative and postoperative outcomes were evaluated and compared, focusing on blood loss, length of surgery, conversion to open approach, and complications. Laparoscopic resections resulted in statistically significant longer procedures (360 vs 275min, p = 0.048). Conversion rate was 18.8%, being oncological concerns the most frequent reason for conversion (3/3 cases). A lower blood loss (380 vs 470, p = 0.048) and minor intraoperative blood transfusions (12.5% vs 21.9%, p = 0.032) were recorded in the study group. A number of retrieved nodes and rate of R0 resections were similar between the two groups. Patients in the MILS group had shorter length of stay (median 10) compared with open group (median 14), p = 0.048. The laparoscopic approach in PHC, so far maintained in an exploratory phase with the biliary-enteric anastomosis performed through the service incision, demonstrates adequate feasibility and safety standards when conducted in carefully selected patients and in centers with expertise.
Published: 2020
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16. Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis

Author: David Martínez-Cecilia, Fernando Rotellar, Federica Cipriani, D. Wicherts, Giammauro Berardi, Mohammad Abu Hilal, Panagiotis Lainas, Mathieu D'Hondt, Roberto Troisi, Ibrahim Dagher, Luca Aldrighetti, Bjørn Edwin, Leonid Barkhatov, Martinez-Cecilia, D., Wicherts, D. A., Cipriani, F., Berardi, G., Barkhatov, L., Lainas, P., D'Hondt, M., Rotellar, F., Dagher, I., Aldrighetti, L., Troisi, R. I., Edwin, B., and Abu Hilal, M.
Subjects: Male, Laparoscopic surgery, medicine.medical_specialty, Resection margin, medicine.medical_treatment, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Hepatectomy, Humans, Medicine, Prospective Studies, Propensity Score, Laparoscopy, Aged, Retrospective Studies, Open liver resection, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Liver Neoplasms, Margins of Excision, Middle Aged, Hepatology, Surgery, Colorectal liver metastases, Propensity score matching, Female, 030211 gastroenterology & hepatology, Colorectal Neoplasms, business, Abdominal surgery
Abstract: Background: There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce. Methods: Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts. Results: After PSM, 648 patients were comparable in each group. The incidence of positive margins (< 1mm) was similar in open and laparoscopic groups (17% vs 13%, p = 0,142). Margins < 1mm were associated with shorter RFS in open (12 vs 26months, p = 0.042) and in laparoscopic group (13 vs 23, p = 0,002). Margins < 1mm were associated with shorter OS in open (36 vs 57months, p = 0.027), but not in laparoscopic group (49 vs 60, p = 0,177). Subgroups with margins ≥ 1mm (1–4mm, 5–9mm, ≥ 10mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (p = 0.117), as well as similar OS in open (p = 0.295) or laparoscopic cohorts (p = 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (p < 0.001). Conclusions: Our study suggests that a positive resection margin (less than 1mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1mm do not seem to improve oncological results in open or laparoscopic surgery.
Published: 2020
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17. Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study

Author: Hao Ping Wang, Chee Chien Yong, Andrew G.R. Wu, Daniel Cherqui, Roberto I. Troisi, Federica Cipriani, Davit Aghayan, Marco V. Marino, Andrea Belli, Adrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Marco Vivarelli, Fabrizio Di Benedetto, Sung-Hoon Choi, Jae Hoon Lee, James O. Park, Mikel Gastaca, Constantino Fondevila, Mikhail Efanov, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung Ngai Tang, Charing C. Chong, Mathieu D’Hondt, Andrea Ruzzenente, Paolo Herman, T. Peter Kingham, Olivier Scatton, Rong Liu, Alessandro Ferrero, Giovanni Battista Levi Sandri, Olivier Soubrane, Alejandro Mejia, Santiago Lopez-Ben, Jasper Sijberden, Kazuteru Monden, Go Wakabayashi, Atsushi Sugioka, Tan-To Cheung, Tran Cong Duy Long, Bjorn Edwin, Ho-Seong Han, David Fuks, Luca Aldrighetti, Mohamed Abu Hilal, Brian K.P. Goh, Chung-Yip Chan, Nicholas Syn, Mikel Prieto, Henri Schotte, Celine De Meyere, Felix Krenzien, Moritz Schmelzle, Kit-Fai Lee, Diana Salimgereeva, Ruslan Alikhanov, Lip Seng Lee, Jae Young Jang, Kevin P. Labadie, Masayuki Kojima, Yutaro Kato, Asmund Avdem Fretland, Jacob Ghotbi, Fabricio Ferreira Coelho, Jaime Arthur Pirola Kruger, Victor Lopez-Lopez, Paolo Magistri, Bernardo Dalla Valle, Margarida Casellas I Robert, Kohei Mishima, Giuseppe Maria Ettorre, Federico Mocchegiani, Prashant Kadam, Franco Pascual, Mansour Saleh, Alessandro Mazzotta, Roberto Montalti, Mariano Giglio, Boram Lee, Mizelle D’Silva, Phan Phuoc Nghia, Chetana Lim, Qu Liu, Eric C. Lai, Wang, Hao Ping, Yong, Chee Chien, Wu, Andrew G R, Cherqui, Daniel, Troisi, Roberto I, Cipriani, Federica, Aghayan, Davit, Marino, Marco V, Belli, Andrea, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Vivarelli, Marco, Di Benedetto, Fabrizio, Choi, Sung-Hoon, Lee, Jae Hoon, Park, James O, Gastaca, Mikel, Fondevila, Constantino, Efanov, Mikhail, Rotellar, Fernando, Choi, Gi-Hong, Campos, Ricardo Roble, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Tang, Chung Ngai, Chong, Charing C, D'Hondt, Mathieu, Ruzzenente, Andrea, Herman, Paolo, Kingham, T Peter, Scatton, Olivier, Liu, Rong, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Soubrane, Olivier, Mejia, Alejandro, Lopez-Ben, Santiago, Sijberden, Jasper, Monden, Kazuteru, Wakabayashi, Go, Sugioka, Atsushi, Cheung, Tan-To, Long, Tran Cong Duy, Edwin, Bjorn, Han, Ho-Seong, Fuks, David, Aldrighetti, Luca, Abu Hilal, Mohamed, Goh, Brian K P, Wang, H. P., Yong, C. C., Wu, A. G. R., Cherqui, D., Troisi, R. I., Cipriani, F., Aghayan, D., Marino, M. V., Belli, A., 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., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Ferrero, A., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Sijberden, J., Monden, K., Wakabayashi, G., Sugioka, A., Cheung, T. -T., Long, T. C. D., Edwin, B., Han, H. -S., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Chan, C. -Y., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. S., Jang, J. Y., Labadie, K. P., Kojima, M., Kato, Y., Fretland, A. A., Ghotbi, J., Coelho, F. F., Pirola Kruger, J. A., Lopez-Lopez, V., Magistri, P., Valle, B. D., Casellas I Robert, M., Mishima, K., Ettorre, G. M., Mocchegiani, F., Kadam, P., Pascual, F., Saleh, M., Mazzotta, A., Montalti, R., Giglio, M., Lee, B., D'Silva, M., Nghia, P. P., Lim, C., Liu, Q., Lai, E. C., Graduate School, Surgery, and CCA - Cancer Treatment and Quality of Life
Subjects: Male, Operative Time, Length of Stay, Conversion to Open Surgery, Hepatectomy, Humans, Minimally Invasive Surgical Procedures, Postoperative Complications, Retrospective Studies, Treatment Outcome, Hypertension, Portal, Laparoscopy, Neoplasms, Hypertension, Surgery, Portal
Abstract: Background: Despite the rapid advances that minimally invasive liver resection has gained in recent decades, open conversion is still inevitable in some circumstances. In this study, we aimed to determine the risk factors for open conversion after minimally invasive left lateral sectionectomy, and its impact on perioperative outcomes. Methods: This is a post hoc analysis of 2,445 of 2,678 patients who underwent minimally invasive left lateral sectionectomy at 45 international centers between 2004 and 2020. Factors related to open conversion were analyzed via univariate and multivariate analyses. One-to-one propensity score matching was used to analyze outcomes after open conversion versus non-converted cases. Results: The open conversion rate was 69/2,445 (2.8%). On multivariate analyses, male gender (3.6% vs 1.8%, P = .011), presence of clinically significant portal hypertension (6.1% vs 2.6%, P = .009), and larger tumor size (50 mm vs 32 mm, P < .001) were identified as independent factors associated with open conversion. The most common reason for conversion was bleeding in 27/69 (39.1%) of cases. After propensity score matching (65 open conversion vs 65 completed via minimally invasive liver resection), the open conversion group was associated with increased operation time, blood transfusion rate, blood loss, and postoperative stay compared with cases completed via the minimally invasive approach. Conclusion: Male sex, portal hypertension, and larger tumor size were predictive factors of open conversion after minimally invasive left lateral sectionectomy. Open conversion was associated with inferior perioperative outcomes compared with non-converted cases.
Published: 2022

18. Conversion of Minimally Invasive Liver Resection for HCC in Advanced Cirrhosis: Clinical Impact and Role of Difficulty Scoring Systems

Author: Federica Cipriani, Francesca Ratti, Gianluca Fornoni, Rebecca Marino, Antonella Tudisco, Marco Catena, and Luca Aldrighetti
Subjects: Child B, Cancer Research, Oncology, cirrhosis, portal hypertension, laparoscopic liver resection, conversion, minimally invasive liver resection, difficulty score
Abstract: Background: Minimally invasive liver resections (MILRs) in cirrhosis are at risk of conversion since cirrhosis and complexity, which can be estimated by scoring systems, are both independent factors for. We aimed to investigate the consequence of conversion of MILR for hepatocellular carcinoma in advanced cirrhosis. Methods: After retrospective review, MILRs for HCC were divided into preserved liver function (Cohort-A) and advanced cirrhosis cohorts (Cohort-B). Completed and converted MILRs were compared (Compl-A vs. Conv-A and Compl-B vs. Conv-B); then, converted patients were compared (Conv-A vs. Conv-B) as whole cohorts and after stratification for MILR difficulty using Iwate criteria. Results: 637 MILRs were studied (474 Cohort-A, 163 Cohort-B). Conv-A MILRs had worse outcomes than Compl-A: more blood loss; higher incidence of transfusions, morbidity, grade 2 complications, ascites, liver failure and longer hospitalization. Conv-B MILRs exhibited the same worse perioperative outcomes than Compl-B and also higher incidence of grade 1 complications. Conv-A and Conv-B outcomes of low difficulty MILRs resulted in similar perioperative outcomes, whereas the comparison of more difficult converted MILRs (intermediate/advanced/expert) resulted in several worse perioperative outcomes for patients with advanced cirrhosis. However, Conv-A and Conv-B outcomes were not significantly different in the whole cohort where “advanced/expert” MILRs were 33.1% and 5.5% in Cohort A and B. Conclusions: Conversion in the setting of advanced cirrhosis can be associated with non-inferior outcomes compared to compensated cirrhosis, provided careful patient selection is applied (patients elected to low difficulty MILRs). Difficulty scoring systems may help in identifying the most appropriate candidates.
Published: 2023
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19. Machine Learning Predictive Model to Guide Treatment Allocation for Recurrent Hepatocellular Carcinoma After Surgery

Author: Simone, Famularo, Matteo, Donadon, Federica, Cipriani, Federico, Fazio, Francesco, Ardito, Maurizio, Iaria, Pasquale, Perri, Simone, Conci, Tommaso, Dominioni, Quirino, Lai, Giuliano, La Barba, Stefan, Patauner, Sarah, Molfino, Paola, Germani, Giuseppe, Zimmitti, Enrico, Pinotti, Matteo, Zanello, Luca, Fumagalli, Cecilia, Ferrari, Maurizio, Romano, Antonella, Delvecchio, Maria Grazia, Valsecchi, Adelmo, Antonucci, Fabio, Piscaglia, Fabio, Farinati, Yoshikuni, Kawaguchi, Kiyoshi, Hasegawa, Riccardo, Memeo, Giacomo, Zanus, Guido, Griseri, Marco, Chiarelli, Elio, Jovine, Mauro, Zago, Moh'd, Abu Hilal, Paola, Tarchi, Gian Luca, Baiocchi, Antonio, Frena, Giorgio, Ercolani, Massimo, Rossi, Marcello, Maestri, Andrea, Ruzzenente, Gian Luca, Grazi, Raffaele, Dalla Valle, Fabrizio, Romano, Felice, Giuliante, Alessandro, Ferrero, Luca, Aldrighetti, Davide P, Bernasconi, Guido, Torzilli, and Silvia, Mori
Subjects: Machine Learning, Liver resection, Recurrence, Settore MED/18 - CHIRURGIA GENERALE, Surgery, Hepatocellular Carcinoma
Abstract: ImportanceClear indications on how to select retreatments for recurrent hepatocellular carcinoma (HCC) are still lacking.ObjectiveTo create a machine learning predictive model of survival after HCC recurrence to allocate patients to their best potential treatment.Design, Setting, and ParticipantsReal-life data were obtained from an Italian registry of hepatocellular carcinoma between January 2008 and December 2019 after a median (IQR) follow-up of 27 (12-51) months. External validation was made on data derived by another Italian cohort and a Japanese cohort. Patients who experienced a recurrent HCC after a first surgical approach were included. Patients were profiled, and factors predicting survival after recurrence under different treatments that acted also as treatment effect modifiers were assessed. The model was then fitted individually to identify the best potential treatment. Analysis took place between January and April 2021.ExposuresPatients were enrolled if treated by reoperative hepatectomy or thermoablation, chemoembolization, or sorafenib.Main Outcomes and MeasuresSurvival after recurrence was the end point.ResultsA total of 701 patients with recurrent HCC were enrolled (mean [SD] age, 71 [9] years; 151 [21.5%] female). Of those, 293 patients (41.8%) received reoperative hepatectomy or thermoablation, 188 (26.8%) received sorafenib, and 220 (31.4%) received chemoembolization. Treatment, age, cirrhosis, number, size, and lobar localization of the recurrent nodules, extrahepatic spread, and time to recurrence were all treatment effect modifiers and survival after recurrence predictors. The area under the receiver operating characteristic curve of the predictive model was 78.5% (95% CI, 71.7%-85.3%) at 5 years after recurrence. According to the model, 611 patients (87.2%) would have benefited from reoperative hepatectomy or thermoablation, 37 (5.2%) from sorafenib, and 53 (7.6%) from chemoembolization in terms of potential survival after recurrence. Compared with patients for which the best potential treatment was reoperative hepatectomy or thermoablation, sorafenib and chemoembolization would be the best potential treatment for older patients (median [IQR] age, 78.5 [75.2-83.4] years, 77.02 [73.89-80.46] years, and 71.59 [64.76-76.06] years for sorafenib, chemoembolization, and reoperative hepatectomy or thermoablation, respectively), with a lower median (IQR) number of multiple recurrent nodules (1.00 [1.00-2.00] for sorafenib, 1.00 [1.00-2.00] for chemoembolization, and 2.00 [1.00-3.00] for reoperative hepatectomy or thermoablation). Extrahepatic recurrence was observed in 43.2% (n = 16) for sorafenib as the best potential treatment vs 14.6% (n = 89) for reoperative hepatectomy or thermoablation as the best potential treatment and 0% for chemoembolization as the best potential treatment. Those profiles were used to constitute a patient-tailored algorithm for the best potential treatment allocation.Conclusions and RelevanceThe herein presented algorithm should help in allocating patients with recurrent HCC to the best potential treatment according to their specific characteristics in a treatment hierarchy fashion.
Published: 2023
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20. Minimally-invasive Right Hepatectomy for Perihilar Cholangiocarcinoma

Author: Francesca, Ratti, Federica, Cipriani, Yongha, Lee, Rebecca, Marino, Marco, Catena, Luca, Aldrighetti, Ratti, Francesca, Cipriani, Federica, Lee, Yongha, Marino, Rebecca, Catena, Marco, and Aldrighetti, Luca
Subjects: Cholangiocarcinoma, righthepatectomy, Bile Ducts, Intrahepatic, Treatment Outcome, Bile Duct Neoplasms, perihilarcholangiocarcinoma, Hepatectomy, Humans, Reproducibility of Results, Surgery, Klatskin Tumor
Abstract: The magnification of images provided by minimally-invasive surgery (MIS) allows a very sharp and precise dissection of the hepatic hilum, allowing to overcome the technical complexity of surgery of perihilar cholangiocarcinoma (PHC). Recently, the feasibility and reproducibility of MIS for PHC are reported: within centers with adequate expertise and respecting the cornerstones of oncological adequacy, it provides short term advantages in a selected population of patients. The video reports the case of a patient with PHC involving the right biliary duct and requiring right hepatectomy with biliary confluence and segment 1 resection, with associated lymphadenectomy. Current evidences, together with feasibility and reproducibility of the technique shown in this video, appear promising and constitute a good prerequisite for the further implementation of this approach to improve patients outcome while following the principles of surgical oncology in hilar cholangiocarcinoma.
Published: 2022

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

Author: Simone Famularo, Nadia Russolillo, Matteo Donadon, Federica Cipriani, Francesco Ardito, Pasquale Perri, Alessandro Giani, Francesca De Stefano, Quirino Lai, Sarah Molfino, Matteo Zanello, Maurizio Iaria, Giuliano La Barba, Enrico Pinotti, Paola Germani, Simone Conci, Cecilia Ferrari, Luca Fumagalli, Maurizio Romano, Adelmo Antonucci, Giuseppe Zimmitti, Albert Troci, Antonio Floridi, Valentina Ferraro, Stefan Patauner, Antonio Frena, Riccardo Memeo, Michele Crespi, Mohammed A. Hilal, Giacomo Zanus, Marco Chiarelli, Andrea Percivale, Andrea Ruzzenente, Paola Tarchi, Mauro Zago, Giorgio Ercolani, Raffaele Dalla Valle, Elio Jovine, Gian Luca Baiocchi, Massimo Rossi, Marcello Maestri, Fabrizio Romano, Gian Luca Grazi, Felice Giuliante, Luca Aldrighetti, Alessandro Ferrero, Guido Torzilli, Guido Costa, Flavio Milana, Federico Fazio, Francesca Ratti, Francesco Razionale, Valerio De Peppo, Francesca Carissimi, Giorgio M. Paolo Graziano, Zoe Larghi Laurerio, Mario Giuffrida, Alessandro Cucchetti, Mauro Montuori, Davide Cosola, Pio Corleone, Giovanni Lazzari, Angelo Franceschi, Pietro Calcagno, Luca Salvador, Alberto Manzoni, Luca Pennacchi, Annarita Libia, Francesca Notte, Davide P. Bernasconi, Silvia Mori, Davide Gaudesi, Famularo, Simone, Russolillo, Nadia, Donadon, Matteo, Cipriani, Federica, Ardito, Francesco, Perri, Pasquale, Giani, Alessandro, De Stefano, Francesca, Lai, Quirino, Molfino, Sarah, Zanello, Matteo, Iaria, Maurizio, La Barba, Giuliano, Pinotti, Enrico, Germani, Paola, Conci, Simone, Ferrari, Cecilia, Fumagalli, Luca, Romano, Maurizio, Antonucci, Adelmo, Zimmitti, Giuseppe, Troci, Albert, Floridi, Antonio, Ferraro, Valentina, Patauner, Stefan, Frena, Antonio, Memeo, Riccardo, Crespi, Michele, Hilal, Mohammed A, Zanus, Giacomo, Chiarelli, Marco, Percivale, Andrea, Ruzzenente, Andrea, Tarchi, Paola, Zago, Mauro, Ercolani, Giorgio, Dalla Valle, Raffaele, Jovine, Elio, Baiocchi, Gian Luca, Rossi, Massimo, Maestri, Marcello, Romano, Fabrizio, Grazi, Gian Luca, Giuliante, Felice, Aldrighetti, Luca, Ferrero, Alessandro, and Torzilli, Guido
Subjects: Liver Cirrhosis, Carcinoma, Hepatocellular, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Carcinoma, Liver Neoplasms, Gastroenterology, Achievable Benchmark of Care, Hepatocellular, hepatocellular carcinoma, NO, Benchmarking, Postoperative Complications, Cirrhosis, Liver, best achievable results, Hepatectomy, Humans, cirrhotic patients, liver surgery, Liver Failure, LS7_4, Retrospective Studies
Abstract: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined.Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3).A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups).We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.
Published: 2022

22. Minimally invasive ver-sus open liver resection for hepatocellular carcinoma in the elderly: international multicentre propensity score-matched study

Author: Jasper P Sijberden, Federica Cipriani, Jacopo Lanari, Nadia Russolillo, Andrea Benedetti Cacciaguerra, Daniel Osei-Bordom, Simone Conci, Burak Görgec, John N Primrose, Bjørn Edwin, Santi López-Ben, Mathieu D’Hondt, Fernando Rotellar, Marc G Besselink, Ibrahim Dagher, Felice Giuliante, David Fuks, Renzo Rozzini, Andrea Ruzzenente, Robert P Sutcliffe, Marco Vivarelli, Alessandro Ferrero, Umberto Cillo, Luca A Aldrighetti, and Mohammad Abu Hilal
Subjects: Surgery
Published: 2022

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

Author: Paola Tarchi, Pasquale Perri, Gian Luca Grazi, Marcello Maestri, Maurizio Romano, Giorgio Ercolani, Gian Luca Baiocchi, Michele Crespi, Federica Cipriani, Luca Fumagalli, Guido Torzilli, Matteo Donadon, Cecilia Ferrari, Paola Germani, Ivano Sciannamea, Raffaele Dalla Valle, Antonio Floridi, Sarah Molfino, A. Frena, Ivan Marchitelli, Francesco Ardito, Simone Famularo, Elio Jovine, Fabrizio Romano, Andrea Ruzzenente, G. Griseri, Luca Ansaloni, Antonella Delvecchio, Simone Conci, Giuliano La Barba, Giacomo Zanus, A. Antonucci, M. Iaria, Marco Chiarelli, Luca Aldrighetti, Enrico Pinotti, Stefan Patauner, Matteo Zanello, Riccardo Memeo, Mauro Zago, Felice Giuliante, Alberto Manzoni, Giuseppe Zimmitti, Albert Troci, Conci, S., Cipriani, F., Donadon, M., Marchitelli, I., Ardito, F., Famularo, S., Perri, P., Iaria, M., Ansaloni, L., Zanello, M., La Barba, G., Patauner, S., Pinotti, E., Molfino, S., Germani, P., Romano, M., Sciannamea, I., Ferrari, C., Manzoni, A., Troci, A., Fumagalli, L., Delvecchio, A., Floridi, A., Memeo, R., Chiarelli, M., Crespi, M., Zimmitti, G., Griseri, G., Antonucci, A., Zanus, G., Tarchi, P., Baiocchi, G. L., Zago, M., Frena, A., Ercolani, G., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Romano, F., Giuliante, F., Torzilli, G., Aldrighetti, L., Ruzzenente, A., Conci S., Cipriani F., Donadon M., Marchitelli I., Ardito F., Famularo S., Perri P., Iaria M., Ansaloni L., Zanello M., La Barba G., Patauner S., Pinotti E., Molfino S., Germani P., Romano M., Sciannamea I., Ferrari C., Manzoni A., Troci A., Fumagalli L., Delvecchio A., Floridi A., Memeo R., Chiarelli M., Crespi M., Zimmitti G., Griseri G., Antonucci A., Zanus G., Tarchi P., Baiocchi G.L., Zago M., Frena A., Ercolani G., Jovine E., Maestri M., Valle R.D., Grazi G.L., Romano F., Giuliante F., Torzilli G., Aldrighetti L., and Ruzzenente A.
Subjects: Liver Cirrhosis, Male, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Disease, Comorbidity, Gastroenterology, Body Mass Index, Neoplasms, Multiple Primary, Non-alcoholic Fatty Liver Disease, Multiple Primary, Neoplasms, Chronic, Liver resection, Liver Diseases, Fatty liver, Liver Neoplasms, General Medicine, Middle Aged, Hepatitis B, Alcoholic, Metabolic syndrome, Hepatitis C, Tumor Burden, Survival Rate, Oncology, Metabolic associated fatty liver disease, Population study, Female, medicine.medical_specialty, Carcinoma, Hepatocellular, Disease-Free Survival, NO, Hepatitis B, Chronic, Hepatectomy, NAFLD, Internal medicine, medicine, Humans, Propensity Score, neoplasms, Pathological, Liver Diseases, Alcoholic, Aged, business.industry, Carcinoma, Hepatocellular, Hepatitis C, Chronic, medicine.disease, digestive system diseases, Propensity score matching, Surgery, business
Abstract: Background and aims: We investigated the clinical impact of the newly defined metabolic-associated fatty liver disease (MAFLD) in patients undergoing hepatectomy for HCC (MAFLD-HCC) comparing the characteristics and outcomes of patients with MAFLD-HCC to viral- and alcoholic-related HCC (HCV-HCC, HBV-HCC, A-HCC). Methods: A retrospective analysis of patients included in the He.RC.O.Le.S. Group registry was performed. The characteristics, short- and long-term outcomes of 1315 patients included were compared according to the study group before and after an exact propensity score match (PSM). Results: Among the whole study population, 264 (20.1%) had MAFLD-HCC, 205 (15.6%) had HBV-HCC, 671 (51.0%) had HCV-HCC and 175 (13.3%) had A-HCC. MAFLD-HCC patients had higher BMI (p < 0.001), Charlson Comorbidities Index (p < 0.001), size of tumour (p < 0.001), and presence of cirrhosis (p < 0.001). After PSM, the 90-day mortality and severe morbidity rates were 5.9% and 7.1% in MAFLD-HCC, 2.3% and 7.1% in HBV-HCC, 3.5% and 11.7% in HCV-HCC, and 1.2% and 8.2% in A-HCC (p = 0.061 and p = 0.447, respectively). The 5-year OS and RFS rates were 54.4% and 37.1% in MAFLD-HCC, 64.9% and 32.2% in HBV-HCC, 53.4% and 24.7% in HCV-HCC and 62.0% and 37.8% in A-HCC (p = 0.345 and p = 0.389, respectively). Cirrhosis, multiple tumours, size and satellitosis seems to be the independent predictors of OS. Conclusion: Hepatectomy for MAFLD-HCC seems to have a higher but acceptable operative risk. However, long-term outcomes seems to be related to clinical and pathological factors rather than aetiological risk factors.
Published: 2022

24. Indications, trends, and perioperative outcomes of minimally invasive and open liver surgery in non-obese and obese patients: An international multicentre propensity score matched retrospective cohort study of 9963 patients

Author: Giuseppe Zimmitti, Jasper P. Sijberden, Daniel Osei-Bordom, Nadia Russolillo, Davit Aghayan, Jacopo Lanari, Federica Cipriani, Santi López-Ben, Fernando Rotellar, David Fuks, Mathieu D'Hondt, John N. Primrose, Burak Görgec, Andrea Benedetti Cacciaguerra, Ravi Marudanayagam, Serena Langella, Marco Vivarelli, Andrea Ruzzenente, Marc G. Besselink, Adnan Alseidi, Mikhail Efanov, Felice Giuliante, Ibrahim Dagher, Elio Jovine, Fabrizio di Benedetto, Luca A. Aldrighetti, Umberto Cillo, Bjφrn Edwin, Alessandro Ferrero, Robert P. Sutcliffe, Mohammed Abu Hilal, Graduate School, Surgery, Radiology and Nuclear Medicine, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
Subjects: Open liver resection, Minimally invasive liver resection, Liver Neoplasms, Blood Loss, Surgical, General Medicine, Length of Stay, Laparoscopic liver resection, Overweight, Fatty liver, Cohort Studies, Postoperative Complications, Humans, Hepatectomy, Minimally Invasive Surgical Procedures, Surgery, Laparoscopy, Obesity, Propensity Score, Retrospective Studies
Abstract: Background: Despite the worldwide increase of both obesity and the use of minimally invasive liver surgery (MILS), evidence regarding the safety and eventual benefits of MILS in obese patients is scarce. The aim of this study was therefore to compare the outcomes of non-obese and obese patients (BMI 18.5-29.9 and BMI≥30, respectively) undergoing MILS and OLS, and to assess trends in MILS use among obese patients.Methods: In this retrospective cohort study, patients operated at 20 hospitals in eight countries (2009-2019) were included and the characteristics and outcomes of non-obese and obese patients were compared. Thereafter, the outcomes of MILS and OLS were compared in both groups after propensity-score matching (PSM). Changes in the adoption of MILS during the study period were investigated.Resuls: Overall, 9963 patients were included (MILS: n = 4687; OLS: n = 5276). Compared to non-obese patients (n = 7986), obese patients(n = 1977) were more often comorbid, less often received preoperative chemotherapy or had a history of previous hepatectomy, had longer operation durations and more intraoperative blood loss (IOBL), paralleling significantly higher rates of wound- and respiratory-related complications. After PSM, MILS, compared to OLS, was associated, among both non-obese and obese patients, with less IOBL (200 ml vs 320 ml, 200 ml vs 400 ml, respectively), lower rates of transfusions (6.6% vs 12.8%, 4.7% vs 14.7%), complications (26.1% vs 35%, 24.9% vs 34%), bile leaks(4% vs 7%, 1.8% vs 4.9%), liver failure (0.7% vs 2.3%, 0.2% vs 2.1%), and a shorter length of stay(5 vs 7 and 4 vs 7 days). A cautious implementation of MILS over time in obese patients (42.1%-53%, p < .001) was paralleled by stable severe morbidity (p = .433) and mortality (p = .423) rates, despite an accompanying gradual increase in surgical complexity.Conclusions: MILS is increasingly adopted and associated with perioperative benefits in both non-obese and obese patients.
Published: 2022

25. Surgery for hepatocellular carcinoma and intrahepatic cholangiocarcinoma: milestone changes in the last two decades potentially affecting current guidelines

Author: Federica Cipriani, Gianluca Fornoni, Margherita Rimini, Federica Pedica, Federica Invernizzi, Andrea Casadei-Gardini, Francesco De Cobelli, Massimo Colombo, and Luca Aldrighetti
Subjects: Oncology, Hepatology
Abstract: The aim of this review is to describe the relevance of minimally invasive liver resection (MILR) for the treatment of most common primary liver tumors. The uptake has been slow but steady, and thus MILR has become a well-established field of hepatobiliary surgery and is considered a landmark change of the past 30 years. There is evidence that the advantage of MILR regarding specific complications of liver surgery for HCC (reduced incidence of postoperative hepatic decompensation and ascites) can be a tool to potentially expand the indications to surgical treatment. Evidence for intrahepatic cholangiocarcinoma is early and exploratory; however, it is beginning to be documented that the fundamental principles of surgical oncology for this tumor can be respected while offering patients the advantages of minimal invasiveness.
Published: 2023
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26. Robo-Lap Approach for Anatomical Resections of Postero-Superior Liver Segments by Indocyanine Green Fluorescence: Intraoperative Navigation Based on Vascular Landmarks

Author: Francesca Ratti, Marco Catena, Gianluca Fornoni, Federica Cipriani, and Luca Aldrighetti
Subjects: Surgery
Published: 2023
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27. Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis

Author: Luca Aldrighetti, Santiago López-Ben, Nadia Russolillo, Andrea Ruzzenente, Burak Görgec, Alessandro Ferrero, Marco Vivarelli, Bjørn Edwin, David Fuks, Giuseppe Zimmitti, D'Hondt Mathieu, Umberto Cillo, Adnan Alseidi, Federico Mocchegiani, Felice Giuliante, Andrea Benedetti Cacciaguerra, Mohammed Abu Hilal, Marc G. Besselink, J. Lanari, Fernando Rotellar, Federica Cipriani, Benedetti Cacciaguerra, A., Gorgec, B., Lanari, J., Cipriani, F., Russolillo, N., Mocchegiani, F., Zimmitti, G., Alseidi, A., Ruzzenente, A., Edwin, B., D'Hondt, M., Besselink, M. G., Giuliante, F., Fuks, D., Rotellar, F., Lopez-Ben, S., Ferrero, A., Aldrighetti, L., Cillo, U., Vivarelli, M., Abu Hilal, M., Graduate School, Radiology and Nuclear Medicine, Surgery, and Amsterdam Gastroenterology Endocrinology Metabolism
Subjects: Liver Cirrhosis, laparoscopic liver resection, liver cirrhosis, major liver resection, open liver resection, surgical oncology, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Subgroup analysis, Chronic liver disease, medicine, Humans, Hepatectomy, Laparoscopy, Propensity Score, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Liver Neoplasms, Retrospective cohort study, Perioperative, Length of Stay, medicine.disease, Surgery, Treatment Outcome, Hepatocellular carcinoma, Propensity score matching, business
Abstract: Objective: Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients. Methods: Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009–2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long-term outcome after resection for hepatocellular carcinoma was analyzed. Results: Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss (P=.042), lower overall and severe complication (P&nbsp
Published: 2021

28. The Two-Step Treatment for Giant Hepatic Hemangiomas

Author: Diego Palumbo, Simone Gusmini, Luca Aldrighetti, Francesca Ratti, Massimo Venturini, Rebecca Marino, Giorgia Guazzarotti, Angelo Della Corte, Francesco De Cobelli, Federica Cipriani, Luigi Augello, Guido Fiorentini, Della Corte, A., Marino, R., Ratti, F., Palumbo, D., Guazzarotti, G., Gusmini, S., Augello, L., Cipriani, F., Fiorentini, G., Venturini, M., Aldrighetti, L., and De Cobelli, F.
Subjects: Laparoscopic surgery, medicine.medical_specialty, giant hepatic hemangioma, business.industry, medicine.medical_treatment, Giant hepatic hemangioma, Radiologic arterial embolization, Two step, General Medicine, Successful completion, laparoscopic surgery, Article, Group B, Surgery, Blood loss, Maximum diameter, Laparotomy, medicine, Medicine, radiologic arterial embolization, Embolization, business
Abstract: The aim of the present study is to analyze the feasibility and the impact of a two-step approach in the treatment of giant hemangiomas (GH) i.e., exceeding 10 cm in maximum diameter, consisting of transarterial embolization (TAE) followed by laparoscopic liver resection (LLR). Ten patients with 11 GH were treated with TAE and subsequent LLR between 2017 and 2020 (Group A). A matched cohort of 10 patients with GH treated with upfront LLR between 2014 and 2017 was identified for comparison (Group B). Data were analyzed regarding intraoperative and postoperative outcomes, including successful completion of LLR, morbidity, and mortality. Successful microparticle embolization of the GH-feeding arteries was performed in all patients in group A. In three cases a liquid embolic agent (Squid-18) was also injected to obtain complete embolization. No complications were observed after TAE. Successful surgery was performed after a mean time interval of 2.2 days from TAE without any case of conversion to laparotomy. Statistically significant differences between group A and group B were found in intraoperative blood loss (250 ± 200 vs. 400 ± 300 mL, p = 0.039), operative time (245 ± 60 vs. 420 ± 60 min, p = 0.027), and length of stay (5 ± 1 vs. 8 ± 2 days, p = 0.046). Our data suggest that two-step TAE + LLR might be a safe and effective option for surgical treatment of GH &gt, 10 cm.
Published: 2021

29. Laparoscopic liver resections at the gates of 2020: a stand-alone field of hepatobiliary surgery

Author: Francesca Ratti, Luca Aldrighetti, Federica Cipriani, Cipriani, Federica, Ratti, Francesca, and Aldrighetti, Luca
Subjects: medicine.medical_specialty, business.industry, General surgery, education, MEDLINE, Liver resections, Resection, Hepatobiliary surgery, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Medicine, 030211 gastroenterology & hepatology, business
Abstract: We read with interest the review entitled “Laparoscopic liver resection: the current status and the future” written by Dr. Xiujun Cai and published in Hepatobiliary Surgery and Nutrition (1). The author has to be commended for the excellent and updated excursus on the actual role and future perspectives of laparoscopic liver resections (LLR). The manuscript summarizes well the most acknowledged indications, procedures, techniques and concepts related to the learning process, and highlights the still ongoing issues and open debates on the topic. In this article, we aim to add few considerations and highlight some latest evidences to facilitate an even more comprehensive knowledge of the readers.
Published: 2020
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30. Pure laparoscopic versus open hemihepatectomy: a critical assessment and realistic expectations – a propensity score-based analysis of right and left hemihepatectomies from nine European tertiary referral centers

Author: Francesca Ratti, Brice Gayet, Panagiotis Lainas, Marc G. Besselink, Takayuki Kawai, Mathieu D'Hondt, Luca Aldrighetti, Mohammad Abu Hilal, Ibrahim Dagher, Federica Cipriani, Marcel J. van der Poel, Olivier Scatton, Morad Faoury, Mohammad Alzoubi, Giammauro Berardi, Bjørn Edwin, Roberto Troisi, Leonid Barkhatov, David Fuks, Cipriani, F., Alzoubi, M., Fuks, D., Ratti, F., Kawai, T., Berardi, G., Barkhatov, L., Lainas, P., Van der Poel, M., Faoury, M., Besselink, M. G., D'Hondt, M., Dagher, I., Edwin, B., Troisi, R. I., Scatton, O., Gayet, B., Aldrighetti, L., Abu Hilal, M., Graduate School, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, and Surgery
Subjects: Adult, Male, medicine.medical_specialty, Referral, Malignancy, Hemihepatectomy, Postoperative Complications, Blood loss, Ascites, medicine, Hepatectomy, Humans, Propensity Score, Laparoscopy, Aged, Aged, 80 and over, Right hepatectomy, Hepatology, medicine.diagnostic_test, business.industry, Liver Diseases, Laparoscopic major hepatectomy, Middle Aged, Laparoscopic liver resection, medicine.disease, Surgery, Europe, Propensity score matching, Female, Critical assessment, Left hepatectomy, medicine.symptom, Complication, business
Abstract: Introduction: A stronger evidence level is needed to confirm the benefits and limits of laparoscopic hemihepatectomies. Methods: Laparoscopic and open hemihepatectomies from nine European referral centers were compared after propensity score matching (right and left hemihepatectomies separately, and benign and malignant diseases sub-analyses). Results: Five hundred and forty-five laparoscopic hemihepatectomies were compared with 545 open. Laparoscopy was associated with reduced blood loss (P < 0.001), postoperative stay (P&nbsp
Published: 2020

31. Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma

Author: Francesco De Cobelli, Federica Cipriani, Lorenzo Monfardini, Francesca Ratti, Angelo Della Corte, Simone Gusmini, Massimo Venturini, Marco Salvioni, Luca Aldrighetti, Paolo Marra, Della Corte, A., Ratti, F., Monfardini, L., Marra, P., Gusmini, S., Salvioni, M., Venturini, M., Cipriani, F., Aldrighetti, L., and De Cobelli, F
Subjects: Ablation Techniques, Male, Cancer Research, medicine.medical_specialty, Percutaneous, Carcinoma, Hepatocellular, microwave, Physiology, medicine.medical_treatment, laparoscopy, liver, ablation, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Medical technology, Medicine, Humans, R855-855.5, Laparoscopy, Aged, Retrospective Studies, Radiofrequency Ablation, medicine.diagnostic_test, business.industry, Microwave ablation, Liver Neoplasms, Percutaneous approach, Ablation, medicine.disease, Progression-Free Survival, Treatment Outcome, Liver, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, oncology, Female, Radiology, business
Abstract: Background Based on patient and tumor characteristics, some authors favor laparoscopic microwave ablation (LMWA) over the percutaneous approach (PMWA) for treatment of hepatocellular carcinoma (HCC). We compared the two techniques in terms of technique efficacy, local tumor progression (LTP) and complication rates. Study design A retrospective comparative analysis was performed on 91 consecutive patients (102 HCC tumors) who underwent PMWA or LMWA between October 2014 and May 2019. Technique efficacy at one-month and LTP at follow-up were assessed by contrast-enhanced CT/MRI. Kaplan–Meier estimates and Cox regression were used to compare LTP-free survival (LTPFS). Results At baseline analysis, LMWA group showed higher frequency of multinodular disease (p
Published: 2020

32. Combining Laparoscopic Liver Partitioning and Simultaneous Portohepatic Venous Deprivation for Rapid Liver Hypertrophy

Author: Angelo Della Corte, Guido Fiorentini, Francesca Ratti, Federica Cipriani, Carla Canevari, Marco Catena, Simone Gusmini, Luigi Augello, Diego Palumbo, Giorgia Guazzarotti, Luca Aldrighetti, Francesco De Cobelli, Della Corte, Angelo, Fiorentini, Guido, Ratti, Francesca, Cipriani, Federica, Canevari, Carla, Catena, Marco, Gusmini, Simone, Augello, Luigi, Palumbo, Diego, Guazzarotti, Giorgia, Aldrighetti, Luca, and De Cobelli, Francesco
Subjects: Portal Vein, Liver Neoplasms, Humans, Radiology, Nuclear Medicine and imaging, Laparoscopy, Hypertrophy, Cardiology and Cardiovascular Medicine, Liver Failure
Abstract: Future liver remnant (FLR) volume is an important indicator of the risk of posthepatectomy liver failure (PHLF) and limits the feasibility of major hepatectomies. A case series of 5 patients treated with a novel approach is presented. Laparoscopic liver partitioning was combined with subsequent liver venous deprivation (embolization of both the portal and the hepatic veins). Baseline average FLR was 28.8%. All procedures were successfully performed without major complications. Mean 1-, 2- and 4-week hypertrophy of the FLR were 35%, 40.3%, and 46.4%, respectively. Four patients underwent planned surgery after a mean interval of 28 days. Of these, 2 patients achieved sufficient FLR volume and function after 2 weeks and underwent surgery before the 4-week volumetric analysis. One patient did not undergo surgery because of intraoperative diagnosis of peritoneal metastases. No cases of PHLF were observed at 5-day follow-up.
Published: 2021

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

Author: Antonino Spinelli, Gaya Spolverato, Ugo Elmore, S. Berti, Giorgio Ercolani, Nadia Russolillo, Ugo Boggi, L. Vincenti, Simone Nicosia, Andrea Laurenzi, Paolo De Paolis, Giuseppe Maria Ettorre, Agostino Maria De Rose, Luca Aldrighetti, Giovanni Vennarecci, Pierluigi Marini, Matteo Cescon, Michela Mineccia, Umberto Cillo, Francesco Marchegiani, Aldo Rocca, Francesco Minni, Luciano De Carlis, Alfredo Guglielmi, Paolo Delrio, Salvatore Gruttadauria, Riccardo Rosati, Francesco Izzo, Domenico D'Ugo, Vincenzo Bottino, Maurizio Degiuli, Giulio Belli, Fulvio Calise, Vincenzo Mazzaferro, Luca Viganò, Francesco Corcione, Fabrizio Di Benedetto, Riccardo Pellicci, Marco Filauro, Alessandro Ferrero, Andrea Muratore, Marco Massani, Federica Cipriani, Guido Torzilli, Matteo Cimino, Felice Giuliante, Elio Jovine, 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, Aldo, Cipriani, Federica, Belli, Giulio, Berti, Stefano, Boggi, Ugo, Bottino, Vincenzo, Cillo, Umberto, Cescon, Matteo, Cimino, Matteo, Corcione, Francesco, De Carlis, Luciano, Degiuli, Maurizio, De Paolis, Paolo, De Rose, Agostino Maria, D’Ugo, Domenico, Di Benedetto, Fabrizio, Elmore, Ugo, Ercolani, Giorgio, Ettorre, Giuseppe M., Ferrero, Alessandro, Filauro, Marco, Giuliante, Felice, Gruttadauria, Salvatore, Guglielmi, Alfredo, Izzo, Francesco, Jovine, Elio, Laurenzi, Andrea, Marchegiani, Francesco, Marini, Pierluigi, Massani, Marco, Mazzaferro, Vincenzo, Mineccia, Michela, Minni, Francesco, Muratore, Andrea, Nicosia, Simone, Pellicci, Riccardo, Rosati, Riccardo, Russolillo, Nadia, Spinelli, Antonino, Spolverato, Gaya, Torzilli, Guido, Vennarecci, Giovanni, Viganò, Luca, Vincenti, Leonardo, Delrio, Paolo, Calise, Fulvio, Aldrighetti, Luca, 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.
Subjects: Synchronous colorectal liver metastases, medicine.medical_specialty, Consensus, Colorectal cancer, Delphi method, Consensu, Colorectal Neoplasm, 030230 surgery, law.invention, Metastasis, Standard procedure, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Minimally invasive surgery, medicine, Hepatectomy, Humans, Italy, Colorectal Neoplasms, Liver Neoplasms, computer.programming_language, business.industry, General surgery, medicine.disease, Chemotherapy regimen, Surgery, Systematic review, 030220 oncology & carcinogenesis, business, computer, Delphi, Synchronous colorectal liver metastase, Human
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

34. Evolution of surgical treatment of colorectal liver metastases in the real world: Single center experience in 1212 cases

Author: Francesca Ratti, L. Aldrighetti, F. De Cobelli, Guido Fiorentini, Monica Ronzoni, Valentina Burgio, Federica Cipriani, A. Della Corte, Stefano Cascinu, Ratti, F., Cipriani, F., Fiorentini, G., Burgio, V., Ronzoni, M., Corte, A. D., Cascinu, S., De Cobelli, F., and Aldrighetti, L.
Subjects: trends, Cancer Research, medicine.medical_specialty, Multivariate analysis, laparoscopy, Context (language use), Disease, Single Center, lcsh:RC254-282, Article, 03 medical and health sciences, 0302 clinical medicine, Colorectal metastases, Multidisciplinary approach, colorectal metastases, Medicine, Laparoscopy, Surgical treatment, Outcome, Hepatology, medicine.diagnostic_test, business.industry, General surgery, Gastroenterology, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Oncology, 030220 oncology & carcinogenesis, outcome, 030211 gastroenterology & hepatology, Disease characteristics, Trends, business
Abstract: Background: In recent years, the treatment of colorectal liver metastases (CRLM) has undergone significant evolution thanks to technical improvements as well as oncological advances, which have been the subject of targeted studies aimed at understanding the details of this heterogeneous disease. The purpose of this study is to put together pieces of this complex scenario by providing an overview of the evolution that has occurred in the context of a single center within a multidisciplinary management approach. Methods: Between 2005 and 2020, 1212 resections for CRLM were performed at the Hepatobiliary Surgery Division of San Raffaele Hospital, Milan. The series was divided into three historical periods, which were compared in terms of disease characteristics and short- and long-term outcomes: Period 1, 2005–2009 (293 cases), Period 2, 2010–2014 (353 cases), Period 3, 2015–2020 (566 cases). The trends for surgical technical complexity, oncological burden of the disease, use of the laparoscopic approach and use of techniques for hepatic hypertrophy were analyzed year by year. Uni- and multivariate analyses were performed to identify factors associated with inclusion to a laparoscopic approach and with long-term prognosis. Results: The number of resections performed over the years progressively increased, with an increase in the number of cases with a high Clinical Risk Score and a high profile of technical complexity. The proportion of cases performed laparoscopically increased, but less rapidly compared to other malignant tumors. The risk of postoperative morbidity and mortality was similar in the three analyzed periods. Long-term survival, stratified by Clinical Risk Score, improved in Period 3, while overall survival remained unchanged. Conclusion: The cultural background, the maturation of technical expertise and the consolidation of the multidisciplinary team have resulted in safe expansion of the possibility to offer a curative opportunity to patients, while continuously implementing into clinical practice evidence provided by the literature.
Published: 2021

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

Author: Federica Cipriani, Andrea Coratti, Andrea Fontani, Francesca Menonna, Fabrizio Di Benedetto, Mario Annecchiarico, Luca Aldrighetti, Andrea Lauterio, Ugo Boggi, Guido Fiorentini, Luciano De Carlis, Graziano Ceccarelli, Paolo Magistri, 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
Subjects: medicine.medical_specialty, medicine.medical_treatment, laparoscopy, Liver resections, Resection, Conversion to open surgery, conversion to open surgery, hepatectomy, propensity score, robotic surgical procedures, Postoperative Complications, Blood loss, MED/18 - CHIRURGIA GENERALE, Medicine, Humans, Laparoscopy, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Open surgery, Liver Neoplasms, Robotics, Length of Stay, Surgery, Propensity score matching, Hepatectomy, business, robotic surgical procedure
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: 2021

36. First World Consensus Conference on Pancreas Transplantation: Part II - recommendations

Author: Jonathan A. Fridell, Gabriel C. Oniscu, Marcelo Perosa, Quirino Lai, Helmut Arbogast, Jean-Paul Squifflet, Paola Maffi, Axel Andres, Jose Oberholzer, Claudio Ricci, Eelco J.P. de Koning, Daniel Casanova, Osama Gaber, Stephen T. Bartlett, Giuseppe Orlando, Ugo Boggi, Peter Schenker, Giuseppe Maria Ettorre, Piero Marchetti, R. Paul Robertson, Jenny E. Gunton, Steven A. White, Sara Iacopi, Raja Kandaswamy, Robert Öllinger, Pablo Uva, Francesco Menichetti, Rainer W.G. Gruessner, Dixon B. Kaufman, Lainie Friedman Ross, Cinthia B. Drachenberg, Paolo Rigotti, Robert R. Redfield, José Davide, Joseph R. Scalea, Mario Miccoli, Fanny Buron, Chiara Terrenzio, Duck Jong Han, Vittorio Perrone, Henry Pleass, Laureano Fernandez Cruz, Hussein A. Khambalia, Walter Baronti, Lucrezia Furian, Thierry Berney, Donzilia Sousa Silva, Robert Langer, Emmanuel Morelon, Peter G. Stock, Niccolò Napoli, Peter J. Friend, Robert J. Stratta, Fabio Vistoli, Matthew Cooper, Massimo Cardillo, Shruti Mittal, Frantisek Saudek, Adamasco Cupisti, Federica Cipriani, Emanuele Federico Kauffmann, Lionel Badet, Monica Ortenzi, Massimo Rossi, Lorella Marselli, Christopher J.E. Watson, Enrico Benedetti, George W. Burke, Jon S. Odorico, Carlo Socci, Rossana Caldara, Julien Branchereau, Angelika C. Gruessner, Antonio Secchi, Flavia Neri, Takashi Kenmochi, Boggi, Ugo, Vistoli, Fabio, Andres, Axel, Arbogast, Helmut, Badet, Lionel, Baronti, Walter, Bartlett, Stephen T, Benedetti, Enrico, Branchereau, Julien, W Rd Burke, George, Buron, Fanny, Caldara, Rossana, Cardillo, Massimo, Casanova, Daniel, Cipriani, Federica, Cooper, Matthew, Cupisti, Adamasco, Davide, Josè, Drachenberg, Cinthia, de Koning, Eelco Jp, Ettorre, Giuseppe Maria, Fernandez Cruz, Laureano, Fridell, Jonathan, Friend, Peter J, Furian, Lucrezia, Gaber, Osama, Gruessner, Angelika C, Gruessner, Rainer W, Gunton, Jenny, Han, Duck Jong, Iacopi, Sara, Kauffmann, Emanuele Federico, Kaufman, Dixon, Kenmochi, Takashi, Khambalia, Hussein A, Lai, Quirino, Langer, Robert M, Maffi, Paola, Marselli, Lorella, Menichetti, Francesco, Miccoli, Mario, Mittal, Shruti, Morelon, Emmanuel, Napoli, Niccolò, Neri, Flavia, Oberholzer, Jose, Odorico, Jon, Öllinger, Robert, Oniscu, Gabriel, Orlando, Giuseppe, Ortenzi, Monica, Perosa, Marcelo, Perrone, Vittorio Grazio, Pleass, Henry, Redfield, Robert R, Ricci, Claudio, Rigotti, Paolo, Robertson, Paul R, Ross, Lainie, Rossi, Massimo, Saudek, Frantisek, Scalea, Joseph, Schenker, Peter, Secchi, Antonio, Socci, Carlo, Sousa Silva, Donzilia, Squifflet, Jean Paul, Stock, Peter, Stratta, Robert, Terrenzio, Chiara, Uva, Pablo, Watson, Christopher, White, Steven A, Marchetti, Piero, Kandaswamy, Raja, Berney, Thierry, Boggi, Ugo [0000-0002-7505-5896], Vistoli, Fabio [0000-0003-2115-4191], Andres, Axel [0000-0003-3329-0801], Arbogast, Helmut P [0000-0001-5410-8699], Badet, Lionel [0000-0002-9596-0279], Baronti, Walter [0000-0002-4532-3028], Bartlett, Stephen T [0000-0002-3980-2559], Benedetti, Enrico [0000-0003-1120-6058], Branchereau, Julien [0000-0002-8460-9352], Burke, George W [0000-0002-6888-2842], Buron, Fanny [0000-0003-0404-6746], Caldara, Rossana [0000-0001-7115-5681], Cardillo, Massimo [0000-0002-2776-2297], Casanova, Daniel [0000-0003-3863-5039], Cipriani, Federica [0000-0002-8651-5982], Cooper, Matthew [0000-0002-3438-9638], Cupisti, Adamasco [0000-0002-8995-936X], Davide, Josè [0000-0003-3174-2456], Drachenberg, Cinthia [0000-0002-3104-5661], de Koning, Eelco JP [0000-0002-1232-7022], Ettorre, Giuseppe Maria [0000-0002-7501-5472], Fernandez Cruz, Laureano [0000-0001-5652-1209], Fridell, Jonathan A [0000-0002-8708-1506], Friend, Peter J [0000-0003-0841-9685], Furian, Lucrezia [0000-0002-2264-7986], Gaber, Osama A [0000-0002-9444-3202], Gruessner, Angelika C [0000-0001-5961-5913], Gruessner, Rainer WG [0000-0002-2094-9817], Gunton, Jenny E [0000-0002-8127-9773], Han, Duck-Jong [0000-0002-0990-6824], Kauffmann, Emanuele Federico [0000-0001-7634-4844], Kaufman, Dixon [0000-0003-3615-0994], Kenmochi, Takashi [0000-0002-9090-8770], Khambalia, Hussein A [0000-0002-7553-3026], Lai, Quirino [0000-0003-1487-3235], Langer, Robert M [0000-0001-8349-1260], Maffi, Paola [0000-0001-5011-6499], Marselli, Lorella [0000-0002-6698-2962], Menichetti, Francesco [0000-0003-0824-7166], Miccoli, Mario [0000-0002-8632-6145], Mittal, Shruti [0000-0003-2390-5366], Morelon, Emmanuel [0000-0001-9928-1671], Napoli, Niccolò [0000-0003-2538-9158], Neri, Flavia [0000-0002-2677-8967], Oberholzer, Jose [0000-0002-1069-2501], Odorico, Jon S [0000-0003-1096-464X], Öllinger, Robert [0000-0002-4499-1673], Oniscu, Gabriel [0000-0003-1714-920X], Orlando, Giuseppe [0000-0002-6460-7974], Ortenzi, Monica [0000-0002-6508-6488], Perosa, Marcelo [0000-0002-8576-9761], Pleass, Henry [0000-0002-9814-0452], Redfield, Robert R [0000-0001-5986-3466], Ricci, Claudio [0000-0002-6638-4479], Rigotti, Paolo [0000-0002-8895-935X], Ross, Lainie F [0000-0002-7395-3000], Rossi, Massimo [0000-0001-5105-4656], Saudek, Frantisek [0000-0002-0448-4351], Scalea, Joseph R [0000-0001-8278-2859], Schenker, Peter [0000-0002-3607-6993], Secchi, Antonio [0000-0002-4208-5116], Socci, Carlo [0000-0002-3276-5556], Sousa Silva, Donzilia [0000-0002-7165-3581], Squifflet, Jean Paul [0000-0002-0467-7559], Stock, Peter G [0000-0002-5806-0167], Stratta, Robert J [0000-0001-7634-094X], Terrenzio, Chiara [0000-0002-0629-2134], Uva, Pablo [0000-0001-7317-3875], Watson, Christopher JE [0000-0002-0590-4901], Marchetti, Piero [0000-0003-4907-0635], Kandaswamy, Raja [0000-0003-4302-0119], Berney, Thierry [0000-0002-4230-9378], Apollo - University of Cambridge Repository, Boggi U., Vistoli F., Andres A., Arbogast H.P., Badet L., Baronti W., Bartlett S.T., Benedetti E., Branchereau J., Burke G.W., Buron F., Caldara R., Cardillo M., Casanova D., Cipriani F., Cooper M., Cupisti A., Davide J., Drachenberg C., de Koning E.J.P., Ettorre G.M., Fernandez Cruz L., Fridell J.A., Friend P.J., Furian L., Gaber O.A., Gruessner A.C., Gruessner R.W.G., Gunton J.E., Han D.-J., Iacopi S., Kauffmann E.F., Kaufman D., Kenmochi T., Khambalia H.A., Lai Q., Langer R.M., Maffi P., Marselli L., Menichetti F., Miccoli M., Mittal S., Morelon E., Napoli N., Neri F., Oberholzer J., Odorico J.S., Ollinger R., Oniscu G., Orlando G., Ortenzi M., Perosa M., Perrone V.G., Pleass H., Redfield R.R., Ricci C., Rigotti P., Paul Robertson R., Ross L.F., Rossi M., Saudek F., Scalea J.R., Schenker P., Secchi A., Socci C., Sousa Silva D., Squifflet J.P., Stock P.G., Stratta R.J., Terrenzio C., Uva P., Watson C.J.E., White S.A., Marchetti P., Kandaswamy R., and Berney T.
Subjects: medicine.medical_specialty, medicine.medical_treatment, Pancreas transplantation, clinical research/practice, Pancreas/simultaneous pancreas-kidney transplantation, Quality of life, Renal Dialysi, Renal Dialysis, Diabetes mellitus, medicine, Risk of mortality, Humans, Immunology and Allergy, survey, Pharmacology (medical), Survey, Intensive care medicine, Dialysis, Kidney transplantation, pancreas/simultaneous pancreas‐kidney transplantation, Transplantation, ddc:617, diabetes, pancreas/simultaneous pancreas-kidney transplantation, business.industry, Diabetes, Graft Survival, medicine.disease, Kidney Transplantation, Diabetes Mellitus, Type 1, surgical procedures, operative, diabete, Clinical research/practice, Quality of Life, Life expectancy, Special Articles, Original Article, Pancreas Transplantation, business, Human
Abstract: Funder: Fondazione Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/100007368, Funder: Tuscany Region, Italy; Id: http://dx.doi.org/10.13039/501100009888, Funder: Pisa University Hospital, Pisa, Italy, Funder: University of Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/501100007514, The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.
Published: 2021

37. The SMART-ALPPS Protocol: Strategy to Minimize ALPPS Risks by Targeting Invasiveness

Author: R. Quattromani, Marco Catena, Luca Aldrighetti, Francesca Ratti, Michele Paganelli, Federica Cipriani, Guido Fiorentini, Fiorentini, G., Ratti, F., Cipriani, F., Quattromani, R., Catena, M., Paganelli, M., and Aldrighetti, L.
Subjects: medicine.medical_specialty, medicine.medical_treatment, Abdominal cavity, 03 medical and health sciences, 0302 clinical medicine, medicine, Hepatectomy, Humans, Stage (cooking), Portography, Ligation, Invasive Procedure, Hepatology, medicine.diagnostic_test, business.industry, Portal Vein, Liver Neoplasms, Gastroenterology, Perioperative, Surgery, Liver Regeneration, medicine.anatomical_structure, Treatment Outcome, Oncology, Liver, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Liver function, business
Abstract: Background: The range of procedures with documented feasibility by laparoscopic approach is widening in the setting of liver resections. Many technical limits have been overcome in the attempt to reduce the biological impact of major procedures [1–8]. Similarly, associated liver partition and portal vein ligation for staged hepatectomy (ALPPS)—which could be assumed as the paradigm of maxi-invasiveness—has recently been proposed in a minimally invasive fashion to reduce the impact of this procedure [9–12]. Technical insights to perform laparoscopic ALPPS are provided. Methods: Perioperative and intraoperative tips for laparoscopic ALPPS are provided within a SMART (Strategy to Minimize ALPPS Risks by Targeting invasiveness) protocol. Stage 1: After volumetric and functional assessment, partial liver transection is performed, keeping intact both the hilum and the caval plane (to prevent adhesions), therefore avoiding portal ligation. No inert material is left inside the abdominal cavity at the end of procedure to keep the liver surfaces apart. Radiologic portography with portal vein embolization is scheduled on postoperative day (POD) 1. Liver volume (pre-PVE: 29%; post-PVE: 52%) and liver function measured through a Technetium-99 hepatobiliary scintigraphy [13] (pre-PVE: 2.15%/min/sqm; post-PVE: 3.67%/min/sqm) of the future remnant liver are reassessed within 10 days to verify whether size and function are adequate. Stage 2: After 2 weeks from the first stage, laparoscopic right hepatectomy is performed following an anterior approach. Results: No conversion to open was required. Operative time was 100 and 300 minutes for stage 1 and 2, respectively. Intraoperative blood loss was 50 and 300 ml for the two procedures. Postoperative course was uneventful; patient was discharged on POD 6 of the second operation. Conclusions: The implementation of a perioperative protocol to prevent the risk of liver failure by both assessing volume and function of FLR and targeting the invasiveness of the surgical procedure may allow to minimize and control risks of a maximally invasive procedure, such as ALPPS.
Published: 2021

38. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

Author: Dmitri, Nepogodiev, Joana Ff Simoes, Elizabeth, Li, Maria, Picciochi, James, C Glasbey, Glauco, Baiocchi, Ruth, Blanco-Colino, Daoud, Chaudhry, Ehab, Alameer, Kariem, El-Boghdadly, Funmilola, Wuraola, Dhruva, Ghosh, Rohan, R Gujjuri, Ewen, M Harrison, Herman, Lule, Haytham, Kaafarani, Mohammad, Khosravi, Irmgard, Kronberger, Sezai, Leventoğlu, Harvinder, Mann, Kenneth, A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin, Ntirenganya, Lisa, Norman, Oumaima, Outani, Riinu, Pius, Peter, Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei, Satoi, Catherine, Shaw, Aneel, Bhangu, Omar, M Omar, Waheed-Ul-Rahman, Ahmed, Leah, Argus, Alasdair, Ball, Edward, P Bywater, Amanpreet, Brar, Brett, E Dawson, Irani, Duran, Muhammed, Elhadi, Conor, S Jones, Sivesh, K Kamarajah, James, M Keatley, Samuel, Lawday, Ella, J Marson, Riinu, Ots, Irène, Santos, Elliott, H Taylor, Isobel, M Trout, Chris, Varghese, Mary, L Venn, William, Xu, Irida, Dajti, Arben, Gjata, Salah Eddine Oussama Kacimi, Luis, Boccalatte, Daniel, Cox, Philip, Townend, Felix, Aigner, Irmgard Elisabeth Kronberger, Elgun, Samadov, Amer, Alderazi, Kamral, Hossain, Greg, Padmore, Gabrielle van Ramshorst, Ismaïl, Lawani, Anis, Cerovac, Samir, Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad, Gohar, Mihail, Slavchev, Chukwuemeka, Nwegbu, Arnav, Agarwal, Janet, Martin, Joshua, Ng-Kamstra, Maricarmen, Olivos, Wenhui, Lou, Dong-Lin, Ren, Jose Andres Calvache, Carlos, J Perez Rivera, Ana Danic Hadzibegovic, Tomislav, Kopjar, Jakov, Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos, Gouvas, Jaroslav, Klat, René, Novysedlák, Nicolas, Amisi, Peter, Christensen, Alaa, El-Hussuna, Sylvia, Batista, Eddy, Lincango-Naranjo, Sameh, Emile, Danilo Alfonso Arévalo Sandoval, Hailu, Dhufera, Samuel, Hailu, Mengistu, G Mengesha, Joonas, H Kauppila, Alexis, P Arnaud, Zaza, Demetrashvili, Markus, Albertsmeier, Hans, Lederhuber, Markus, W Löffler, Daniel Kwesi Acquah, Bernard, Ofori, Stephen, Tabiri, Symeon, Metallidis, Georgios, Tsoulfas, Maria-Lorena, Aguilera-Arevalo, Gustavo, Recinos, Tamás, Mersich, Dániel, Wettstein, Gabriele, Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud, Mozafari, Ahmed, Hilmi, Helen, Mohan, Oded, Zmora, Gaetano, Gallo, Francesco, Pata, Gianluca, Pellino, Yuki, Fujimoto, Naoto, Kuroda, Mohamad, K Abou Chaar, Faris, Ayasra, Ildar, Fakhradiyev, Intisar Hisham Said Hamdun, Jang, Jin-Young, Mohammad, Jamal, Lina, Karout, Aiste, Gulla, Fanjandrainy, Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura, Martinez, María José Martínez, Alejandra, Nayen, Antonio Ramos-De la Medina, Jade, Nunez, Pueya Rashid Nashidengo, Rakesh, Shah, Ashish Lal Shrestha, Pascal, Jonker, Schelto, Kruijff, Milou, Noltes, Pieter, Steinkamp, Deborah, Wright, Lukman, Abdur-Rahman, Adesoji, Ademuyiwa, Adewale, Adisa, Babatunde, Osinaike, Justina, Seyi-Olajide, Omolara, Williams, Emmanuel, Williams, Sofija, Pejkova, Zainab Al Balushi, Raza, Sayyed, Mustafa Abo Mohsen, Sadi, A Abukhalaf, Moises, Cukier, Hugo, Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr, Major, José, Azevedo, Miguel, F Cunha, Ahmad, Zarour, Eduard-Alexandru, Bonci, Ionut, Negoi, Sergey, Efetov, Viktor, Kochetkov, Andrey, Litvin, Jc Allen Ingabire, Georges, Bucyibaruta, Ntirenganya, Faustin, Sosthene, Habumuremyi, Alphonsine, Imanishimwe, Haragirimana Jean de Dieu, Emmanuel, Munyaneza, Isaie, Ncogoza, Abdourahmane, Ndong, Dejan, Radenkovic, Min Hoe Chew, Frederick, Koh, James, Ngu, Arpád, Panyko, Uros, Bele, Jurij Aleš Košir, Hassan, Daoud, Ana Maria Minaya Bravo, Umesh, Jayarajah, Dakshitha, Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin, Rutegård, Malin, Sund, Michel, Adamina, Eleftherios, Gialamas, Karoline, Horisberger, Muhammad, Alshaar, Abel, Huang, Varut, Lohsiriwat, Shane, Charles, Haithem, Jlassi, Arda, Isik, Hervé Monka Lekuya, Slava, Kopetskyi, Hayder, Alsaadi, Sattar, Alshryda, Osaid, Alser, Brittany, Bankhead-Kendall, Kerry, Breen, Hassan, Mashbari, Fernando Bonilla Cal, Hamza, Al-Naggar, Mayaba, Maimbo, Dennis, Mazingi, Tom, Abbott, Melika, Akhbari, Ruth, Benson, Shivam, Bhanderi, Bruce, Biccard, Edward, Caruana, Sohini, Chakrabortee, Reema, Chapatwala, Ainhoa, Costas-Chavarri, Andreas, K Demetriades, Anant, Desai, Salomone Di Saverio, Thomas, Drake, John, Edwards, Jonathan, Evans, Marco, Fiore, Samuel, Ford, Christina, Fotopoulou, Alexander, Fowler, Kaori, Futaba, Ian, Ganly, Harelimana Grace James, Ewen, Griffiths, Alessandro, Gronchi, Peter, Hutchinson, Gabriella Yael Hyman, Joseph, Incorvia, Ritu, Jain, Michael, Jenkinson, Tabassum, Khan, Stephen Richard Knight, Angelos, Kolias, Søren, Kudsk-Iversen, Tsun Yu Kwan, Elaine, Leung, Julio, Mayol, Siobhan, Mckay, John, G Meara, Emily, Mills, Susan, Moug, Akshay, Patel, Roberto, Perinotti, Henry, E Rice, Keith, Roberts, Andrew, Schache, Richard, Shaw, Neil, Smart, Matthew, Stephens, Grant, D Stewart, Ella, Teasdale, Peter, Vaughan-Shaw, Raghavan, Vidya, Naomi, Wright, Natalie, Zimmelman, Ervis, Agastra, Dariel, Thereska, Sergio Martin Lucchini, Veronica, Laudani, Carina, Chwat, Ivana Ines Pedraza Salazar, Diana Alejandra Pantoja Pachajoa, Agustin, Duro, José Alfredo Calderón Arancibia, Giuliana, D'Aulerio, Nagendra, Dudi-Venkata, Natasha, Egoroff, Shebani, Farik, Natalie, Lott, Jana-Lee, Moss, Sarah, Rennie, Lorwai, Tan, Uyen Giao Vo, David, Watson, David, Watters, Tim, Bright, Paul, Hollington, Xuanyu, Zhou, Hidde, M Kroon, Anthony, Farfus, John, Barker, Eleanor, Watson, Sean, Stevens, Haider, Latif, Amanda Caroline Dawson, Alwin, Chuan, Vijayaragavan, Muralidharan, Enoch, Wong, Travis, Ackermann, Maurizio, Pacilli, Russell, Hodgson, Alexander, Heriot, Peter, Choong, Wendy, Brown, Surjit, Lidder, Justin, Yeung, Luke, Traeger, Guillermo, Regalo, Ralph, Gourlay, Sarit, Badiani, Cherry, Koh, Soni, Putnis, Fayza, Haider, Ashrarur Rahman Mitul, Niels, Komen, Bert, Dhondt, Serge, Cappeliez, Manon, Pigeolet, Martijn, Schoneveld, Jasper, Stijns, Wouter, Oosterlinck, Nicolas, Flamey, Cyrille, Kpangon, Mouhamed, Agbadebo, Sèmèvo Romaric Tobome, Aldo Vieira Barros, Samuel Aguiar Júnior, Heloisa Galvão do Amaral Campos, Jefferson, Gross, Felipe José Fernandez Coimbra, Luiz Paulo Kowalski, Fabiana, Makdissi, Suely, Nakagawa, Joao Pedreira Duprat Neto, Jose Guilherme Vartanian, Guilherme, Yazbek, Stenio, C Zequi, Ronald, Flumignan, Natalia, Jaworska, Angela, Dell, Harsha, Shanthanna, Abdollah, Behzadi, Carolyn, Nessim, Michelle, Mozel, Pascal, St-Germain, Crispin, Russell, Gary, Groot, Najib, Safieddine, Duminda, Wijeysundera, Antoine, Eskander, Sami, Chadi, Shawn, Mackenzie, Alana, Flexman, Fernando, Heredia, Julio, Villanueva, Sofia, Waissbluth, Roberto, Macchiavello, Mario, I Escudero, Tyare, Fuentes, Ximena, Mimica, Dinimo Bolivar Saenz, Lina, Caicedo, Juan Pablo Alzate, Joaquin, Luna, Nestor Fabian Pedraza Alonso, Camilo Ortiz Silva, Juliana, 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Juliana Sanchez, David Mauricio Solano Varela, Paula Torres Gomez, Marcial, Trillos, Ana María Vargas Patiño, Felipe, Vargas-Barato, Juan Pablo Villate Leon, María Alejandra Wagner Useche, Jesus, Acosta, Adriana, Almeciga, Luis Becerra Mendez, Rafael Jose Beltran, Ana, Bonilla, Miguel, Buitrago, Marino, Cabrera, Pedro Hernando Calderon Quiroz, Diego, Camacho-Nieto, Carlos Andrés Carvajal Fierro, Sergio Cervera Bonilla, Sandra, Diaz, Helena, Facundo, Jorge, Forero, Mauricio Garcia Mora, Karena Victoria Garcia Tirado, German Fabian Godoy Perez, Felipe, Gonzalez, Oscar, Guevara, Jairo Alonso Hernandez, David Ricardo Herrera Mora, Juan David Lalinde, Carlos, Lehmann, Eduardo Leon Llanos, Byron Eduardo Lopez De Mesa Lopez, Ivan, Mariño, Monica, Medina, Raúl Eduardo Pinilla Morales, Angela, Puerto, Andrea, Quintero-Ortíz, Juliana Rendón Hernández, Elio Fabio Sánchez Cortés, Alvaro Eduardo Sánchez Hernández, Raul, Suarez, Oscar, Suescun, Marco, Vanegas, Rodolfo, Varela, Jorge Luis Velez 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Baelum, Mark Bremholm Ellebaek, Signe Bremholm Ellebaek, Anders, Hogh, Maria, Acosta, Yancy, Acosta, Pedro, Baez, Luis Alfredo Betances, Luis Rodolfo Bonilla, Daniel, Cabreja, Wilton Cabrera Cruz, María Mabel Collado Expósito, Aldo, Crespo, Octavio, Cruz-Pineda, Claudio Samuel D'óleo García, Pedro, Díaz, Remberto, Escoto, Jatnna, Figueroa, Luis, Garcia, U Garcia-Dubus Rodriguez, Humberto, Gomez, Adrian, Grullon, Fatherin, Guerrero, Lillian, Guzman, Thelma Rocío Jiménez Mosquea, Engels, Lazala, Ariela, Lopez, Leeany Maletta Francisco, Jhomayri, Mercado, Herisardy, Munoz, Jeffrey, Paulino, Maricely Ambar Perez Fernandez, Rudeily, Reyes, Lilia Rosa Reyes Guilamo, Ruben, Rivas, Claudia Alejandra Rivas Torres, Ada, Rodríguez, Madelin Tamar Rosario Villa, Eleazar, Santana, Joel, Soto, Nassin, Tactuk, Cristina Kristel Tonos Sardiñas, Raul, Ubinas, Jose, Victoria, Aaron, Villegas, Ricardo, Acra-Tolari, Larissa, Beltran, Luis Fernand Betances, Alejandro, Blaubach, Denisse Idalia Campos Mejía, 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Maher, Hosain, Ahmed, Hossam, Hamza Hussein Aly Salama Aly, Mohamed, Ibrahim, Abdelrahman, Ibrahim, Nourhan, Ibrahim, Noha Mohamed Salah Ibrahim Moussa Hamouda, Monica, Iskander, Islam, Khalifa, Mostafa, Kotb, Nada, Mahmoud, Alaa Mahmoud Abo Shabana, Nora, Mamdouh, Maram, Metwalli, Khaled, Metwally, Mahmoud, Moghazy, Moustafa, Mohamed, Mohamed, Mourad, Esraa, Moustafa, Kamilia, Mubarek, Nour Eldin Nader, Ahmed, Nasser, Samaa, Omar, Mostafa Shehata Qatora, Mohamed, Ragab, Marawan, Ragal, Dina, Ramadan, Rana, Ramadan, Sara, Ramadan, John, Romany, Ahmed, Sabry, Yasmeen, Said, Sara, Salamah, Ahmed Mostafa Saleh, Mona Saleh Mesbah Mohamed Elkaffas, Alaa, Salem, Hashem, Salim, Ahmed, Samih, Ahmed Samir Abdelaal, Ahmed, Shaheen, Yassmeen Sharafeldin Mohammed, Abdelrahman, Shehata, Mohamed, Shemeis, Karim, Shenit, Mennatallah, Sheta, Asmaa, Soffar, Yousef, Tanas, Ahmed, Tarek, Nermin, Yehia, Omar Khaled Mohamed Eid, Ammar Yasser Abdulfattah, Ahmed, Elsaghir, Mohamed Fouad Elganainy, Omar Ibrahim Elsayed, Omar, Elmandouh, Omar, Hamam, Mostafa Ahmed Shehata, Areej, A Abdelaziz, Ahmed, M Abbas, Wael Abd El-Ghani, Hossam Aldein, S Abd Elazeem, Mustafa Abd Elsayed, Ahmed Yassien Abd-Elkariem, Shimaa, Abdalla, Mahmoud, Abdel-Aleem, Khaled, Abdelazeem, Mahmoud, Abdelfattah, Mohammed, Abdelhafez, Mohamed, M Abdelkarem, Ali, Abdelraouf, Lamess, Abdullaha, Hossam, Abubeih, Moaiad Eldin Ahmed, Nagm Eldin Abu Elnga Ahmed, Ahmed, Ahmed, Sarah Ahmed Saad, Sherif, Alaa, Ali, Alhussaini, Abdelrahman Ahmed Abdelrahman Ali, Ibrahim, Ali, Wagdi, Ali, Mohamed Ali Mohamed, Mohamed, Ashraf, Muhammad, Bassiouni, Mohamed, G El-Adawy, Mohammad, El-Sharkawi, Hussein, Elkhayat, Khaled, Elmaghraby, Shady, Elsdfy, Mohamed, Elsharkawy, Almoutaz, Eltayeb, Mohamed Esmat Mohamed, Esraa, Essam, Mahmoud, Fahd, Osama, Farouk, Rabea, Gadelkareem, Ahmed, Ghoneim, Mohammed Hamada Takrouney, Ahmed, Hamdan, Abd El-Rahman Hamed, Ahmad, Hasan, Mohamed Abdelghafor Hassanin, Islam, Hawal, Kerollos, Henes, Mohamed Omar Herdan, Helal, F Hetta, Omar, Ibrahem, Mostafa, Ibrahim, Islam, H Ibrahim, Mahmoud, Kamel, Mohamed, Khallaf, Shrouk, M Elghazaly, Abobakr, Mahfouz, Osman, Mahmoud, Wesam, Mahran, Doha, Mahrous, Abadeer, Marsis, Ayman, Mohamed, Aliae Mohamed Hussein, Amr Mohamed Sayed, Mahmoud, M Mohammed, Ahmed, Mokhtar, Fatma, A Monib, Ahmed, Nageeb, Mariam Albatoul Nageh, Mohammed, Nageh, Nehal Gamal Omar, Abdelrahman, Ragab, Abdelrahman, Ramadan, Abdallah Rashad Temerik, Aya, Sabry, Hadeer, Safwat, Omar, Salah, Ahmed Elhussiny Salah Mahmoud, Ahmed, Saleh, Mahmoud, Sallam, Ahmed, Samir, Reem, Sayad, Esraa, Sayed, Ahmed, S Sedik, Mohammed, Shahine, Antonios, Soliman, Wael, Soliman, Mohamed Gamal Taher, Randa, Wanees, Ebrahim Ahmed Yousof, Ahmed, Youssef, Omar Zein Elabedeen, Ahmed Emad Sayed Hassan, Shrouk Abdel Fattah, Ahmed, Abostate, Samar, Ali, Saad Ali Saad Salama, Mohamed, Allam, Ahmed, Alsadek, Ebrahim, Arafa, Ahmed, Barakat, Mohammed El Sherpiny, Gehad, Elbehairy, Mahmoud, Eleisawy, 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Brolo, Ana Lucia Lemus, Jennifer, Greenberg, Krisna Mishel Morales Chew, José Rodrigo Oliva, María Alejandra De León Lima, Ismar Lopez Muralles, Felipe, Solares, Gaby, Ajcip, Claudia, Anton, Jose, Cojulun, Mario-Andrés, Flores, Noriega, José, Carlos Adolfo Marroquín Paiz, Steffanía, Morales, Ramiro, Najera, Eduardo Quiñónez Lorenzana, Pablo, Rivera, Lesly, Rodas, Victor, Santos, Dianne, Sosa, Natalia, Ybarra, José David Pérez Cajti, Carlos, Régil, Walter, A Osorio, Rember Rosales Arriola, Luis-Fernando, Talé-Rosales, Danilo, Herrera, Servio Tulio Torres Rodríguez, Sergio Alejandro Villeda, Joshua, Anicetti, Andrea Michelle Lowey Medina, Javier, Ardebol, Kathia, Barillas, Francis De Leon, Salvador, Recinos, Miguel-Angel, Marroquin-Alpirez, Yessica, Yax, Sophie, Hon, Yuk Ho Liu, Alex Qinyang Liu, Shirley, Liu, Hei Tung Natalie Chiu, Chi Man Tom Chow, Victor, Hau, Ho Wai Ip, Brian, Mak, Chung Ying Mok, Dennis, Ng, Yin Yu Eva Siu, Kiu Fung Wong, Jingya Jane Pu, Yu-Xiong, Su, Kit Ying 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Santhosh Kumar Sampengere Annayappa, Tulika, Agrawal, Premkumar, Anandan, Aditya, Baindur, Manjunath, Bd, Savitha, C, S Anitha, G, Sandeep, Harigond, K Tejeswini, K, Venkatesh, Kesarla, Mallikarjuna, Manangi, B Hareesh, P, Jyothi K, R Ranjan, Athish, Shetty, Santhosh Shivashankar Chikkanayakanahalli, Tanvi, Sunil, Shreya, Syamala, Kavya, Tharanath, Aditya, Atal, Niranjana, Rajagopal, S Srinath, B, Vinod, Nk, L Thirumanikandan, P, Nitu, Mishra, Sushruta, Shrivastava, Rekha, Wadhwani, Reyaz, Ahmad, Zainab Ahmad Haq, Prateek, Behera, Ritika, Dhurwe, Rehan, Haq, Vaibhav, Jain, Anuj, Jain, Sunaina, Karna, Kameshwarachari, Pushpalatha, Sumit, Raj, John Ashutosh Santoshi, Pooja, Singh, Virendra, Verma, Vaishali, Waindeskar, Moorat Singh Yadav, Zaheda, Aziz, Koyel, Chakraborty, Preetam, Chappity, Gurudip, Das, Debajyoti, Datta, Saubhagya Kumar Jena, Madhabananda, Kar, Susanta, Khuntia, Pankaj, Kumar, Ravi, Kumar, Aswathi, Kv, Abhijeet, Mishra, Swastik, Mishra, Yash, Mittal, Dillip, Muduly, 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Matteo, Filardo, Marika Sharmayne Milani, Franco, Ragni, Andrea de Manzoni Garberini, Edoardo, Baldini, Diana, Carpaneto, Michele, Cauteruccio, Corrado, Ciatti, Luigi, Conti, Serena, Gattoni, Pietro, Maniscalco, Gerardo, Palmieri, Calogero Puma Pagliarello, Giuseppe, Caristo, Raffaele, Galleano, Michele, Malerba, Marcello, Calabrò, Francesca, Farnesi, Elia Giuseppe Lunghi, Andrea, Muratore, Nicoletta Sveva Pipitone Federico, Joel Reuben Abel, Lorenzo, Andreani, Darienzo, Antonio, Vittorio, Aprile, Riccardo, Balestri, Giacomo, Benettini, Stefano, Berrettini, Luca, Bruschini, Massimo, Chiarugi, Federico, Coccolini, Simone, Colangeli, Camilla, Cremonini, Lodovica Cristofani Mencacci, Iacopo, Dallan, Silvia De Santi, Gregorio Di Franco, Lorena Di Girolami, Giacomo, Fiacchini, Niccolò, Furbetta, Stylianos, Korasidis, Marco, Lucchi, Andrea, Morandi, Luca, Morelli, Serena, Musetti, Carlo Maria Neri, Matteo, Palmeri, Miriana, Picariello, Francesco, Porcelli, Marco, Puccini, Nicolo, Roffi, 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Lisi, Tommaso Maria Manzia, Lorenzo, Petagna, Bruno, Sensi, Giuseppe, Sica, Leandro, Siragusa, Giuseppe, Tisone, Marco, Assenza, Barbara, Binda, Massimo, Biondi, Gioia, Brachini, Placido, Bruzzaniti, Mauro, Casagrande, Flavia, Ciccarone, Pierfranco Maria Cicerchia, Bruno, Cirillo, Daniele, Crocetti, Giancarlo, D'Ambrosio, Vito, D'Andrea, Francesca De Felice, Giorgio De Toma, Carlo Della Rocca, Giulia, Duranti, Pietro, Familiari, Enrico, Fiori, Giovanni Battista Fonsi, Alessandro, Frati, Stefania La Rocca, Filippo La Torre, Pierfrancesco, Lapolla, Giovanni, Marruzzo, Simona, Meneghini, Andrea, Mingoli, Andrea, Picchetto, Antonella, Polimeni, Diego, Ribuffo, Maurizio, Salvati, Antonio, Santoro, Paolo, Sapienza, Luigi, Simonelli, Valentino, Valentini, Martina, Zambon, Giuseppa, Zancana, Emma, Zuppi, Simone, D'Annunzio, Cosimo De Nunzio, Silvia, Fiorelli, Mohsen, Ibrahim, Chiara, Loffredo, Domenico, Massullo, Cecilia, Menna, Rocco, Monica, Massimiliano, Pelli, Erino Angelo Rendina, Leonardo, Teodonio, Andrea, Tubaro, Giulio, Argenio, Giulio, Accarino, Accarino, Giancarlo, Antonio Nicola Giordano, Luca, Cardinali, Elisa, Sebastiani, Grazia, Travaglini, Erika, Andreatta, Emanuele Luigi Giuseppe Asti, Daniele, Bernardi, Luigi, Bonavina, Caterina, Froiio, Andrea, Lovece, Chiara, Copelli, Alfonso, Manfuso, Pasquale Di Maio, Marco, Giudice, Oreste, Iocca, Rosario, Cennamo, Tommaso, Cornali, Francesco Di Marzo, Cristian, Altana, Francesco, Bussu, Giampiero, Capobianco, Anna Giacomina Carta, Sandro, Ciccarello, Maria Laura Cossu, Pietrina, Cottu, Giacomo De Riu, Salvatore, Dessole, Francesco, Dessole, Salvatora, Dettori, Carlo, Doria, Alessandro, Fancellu, Claudio, F Feo, Giorgio Carlo Ginesu, Giuliana, Giuliani, Marco Giuseppe Iannuccelli, Massimo, Madonia, Roberto, Mancino, Olindo, Massarelli, Gianfranco, Meloni, Fabio, Milia, Andrea, Mulliri, Teresa, Perra, Marco, Petrillo, Antonio, Piras, Franco, Piredda, Francesco, Pisanu, Alberto, Porcu, Davide, Rizzo, Angelino, Sanna, Antonio Mario Scanu, Fabrizio, Scognamillo, Damiano, Soma, Anna Rita Tanca, Alessandro, Tedde, Matteo, Tedde, Luigi Angelo Vaira, Andrea Bartalini Cinughi de Pazzi, Osvaldo Carpineto Samorani, Daniele, Fusario, Luigi, Marano, Gaia, Oldrà, Anna Lisa Pesce, Stefania Angela Piccioni, Luca, Resca, Vincenzo, Ricchiuti, Franco, Roviello, Vinno, Savelli, Alberto, Abrate, Pierpaolo, Bordoni, Lorenzo, Bosio, Guglielmo, Clarizia, Francesco, Fleres, Marco, Franzini, Antonio, Fratto, Pierluigi, Giumelli, Alessandro, Grechi, Alessandro, Longhini, Fabrizio, Lorusso, Elisa, Scarnecchia, Federica, Scolari, Alessandro, Spolini, Vincenzo, Maiuri, Matteo, Papandrea, Arturo, Roncone, Lorenzo, Conti, Andrea, Rizzi, Marco, Rovagnati, Alberto, Brolese, Tommaso, Cai, Francesco Antonio Ciarleglio, Francesca, Dalprà, Gianni, Malossini, Liliana, Mereu, Irene, Tamanini, Saverio, Tateo, Giovanni, Viel, Enrico, Battistella, Paolo Boscolo Rizzo, Cristoforo, Fabbris, Marco, Massani, Giacomo, Spinato, Roberta, Tutino, Ugo, Grossi, Alessandro, Iacomino, Simone, Novello, Maurizio, Romano, Serena, Rossi, Giulio, Santoro, Giacomo, Zanus, Sokol, Trungu, Giada, Aizza, Gabriele, Bellio, Selene, Bogoni, Marina, Bortul, Biagio, Casagranda, Sara, Cortinovis, Nicolò de Manzini, Davide, Drigo, Paola, Germani, Manuela, Mastronardi, Lucia, Paiano, Silvia, Palmisano, Pier Luigi Filosso, Francesco, Guerrera, Matteo, Marro, Mauro, Rinaldi, Enrico, Ruffini, Stefano, Salizzoni, Laura, Bardelli, Mattia, Berselli, Giacomo, Borroni, Eugenio, Cocozza, Matteo, Desio, Bottazzoli, Elisa, Giuseppe, Ietto, Valentina, Iori, Domenico, Iovino, Lorenzo, Livraghi, Valentina, Marchionini, Stefano, Megna, Emma Amal Nahal, Mara, Palumbo, Valeria, Quintodei, Alessandra, Zullo, Lucrezia, D'Alimonte, Giovanni, Pirozzolo, Chiara, Vignotto, Tommaso, Campagnaro, Andrea, Caravati, Simone, Conci, Carlotta De Cristofaro, Gabriele, Gecchele, Tommaso, Giuliani, Jacopo, Graziosi, Alfredo, Guglielmi, Salvatore, Paiella, Corrado, Pedrazzani, Tommaso, Pollini, Simone, Rattizzato, Andrea, Ruzzenente, Roberto, Salvia, Giulia, Turri, Matilde, Bacchion, Giovanni, Butturini, Andrea, Casaril, Alessandro, Giardino, Harmony, Impellizzeri, Marco, Inama, Frigerio, Isabella, Gianluigi, Moretto, Marco De Zuanni, Enrica, Deiana, Mario, Guglielmo, Alessandro, Broglia, Claudia, Casarini, Caterina Costanza Zingaretti, Marta, Bonaldi, Giovanni, Cesana, Francesco, Mastriale, Stefano, Olmi, Matteo Uccelli Yasuyuki Fukami, Takuya, Saito, Tsuyoshi, Sano, Naoki, Hirai, Kazuyoshi, Hirota, Tetsuya, Kushikata, Tasuku, Oyama, Junichi, Saito, Katsuhiko, Ishibashi, Mizue, Kamiyama, Kyongsuk, Son, Kentaroh, Tarao, Takayuki, Yamada, Toshiya, Shiga, Chisaki, Aze, Yoshihiko, Deguchi, Hirotoshi, Hasegawa, Tatsuki, Hoshino, Yasushi, Innami, Hiroyuki, Inoue, Shingo, Ito, Takeshi, Nomura, Tomomi, Ogihara, Reina, Okada, Takashi, Ouchi, Yuri, Sekiya, Keikoku, Tachibana, Emi, Takano, Masae, Yamamoto, Shuko, Matsuda, Yuka, Matsuki, Kenji, Shigemi, Teruyuki, Hiraki, Yui, Inoue, Shosaburo, Jotaki, Tatsuro, Abe, Masatoshi, Eto, Junichi, Inokuchi, Eiji, Kashiwagi, Fumio, Kinoshita, Satoshi, Kobayashi, Ken, Lee, Takashi, Matsumoto, Keisuke, Monji, Hidekazu, Naganuma, Masaki, Shiota, Ario, Takeuchi, Shinju, Obara, Saori, Takatsuki, Saori, Tanaka, Koji, Iida, Kota, Kagawa, Shuichiro, Neshige, Tomohiro, Chaki, Naoyuki, Hirata, Satoshi, Kazuma, Motonobu, Kimizuka, Sho, Kumita, Noriaki, Nishihara, Sato, Satoshi, Atsushi, Sawada, Shunsuke, Tachibana, Michiaki, Yamakage, Yuta, Nakamura, Kozo, Sato, Tomoya, Irie, Tomoko, Irisawa, Eiki, Kanemaru, Yuko, Koga, Yoshihiko, Chiba, Jun, Makino, Shinnosuke, Ohama, Shinichiro, Okada, Kano, Teruaki, Tatsuya, Kida, Tomohide, Takei, Kazuhiro, Hanazaki, Hiroyuki, Kitagawa, Tsutomu, Namikawa, Toshiyuki, Mizota, Chikashi, Takeda, Shintaro, Yagi, Hiroshi, Imai, Makoto, Ishitobi, Manabu, Kato, Kouhei, Nishikawa, Takeshi, Sasaki, Hiroshi, Yonekura, Akihiro, Kanaya, Daisuke, Irimada, Haruka, Ishikawa, Kaiho, 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Mubaydeen, Husam, Sarayrah, Mohammad Abdel Elah, A Tarawneh, Mohammad Yousef Karasneh, Amany, Zurgan, Mohammad, Alassaf, Sayel, H Alzraikat, Justin, Z Amarin, Ahmed, Hijjawi, Haya, H Suradi, Louay, Y Zaghlol, Ahmad, Abdalah, Ghaida, Abdallah, Ammar Abu Tarieh, Tareq, Abu-Libdeh, Faisal, Abualteen, Murad Al Abdallah, Zakaria Al Bdour, Seif Al Dahabrh, Farah, Al-Kasaji, Zaid Al-Sheikh Ali, Mohammad, Al-Thaher, Tareq, Alnajjar, Mohannad, Alqedrh, Mohammad, Alsaleh, Mohammad, Alzaatreh, Ghandi, Amayreh, Yazeed, Ayasra, Ahmad, Eid, Ibrahim, Ghayada, Khaled Moh'd Ahmed Hasanein, Anas, Hassouneh, Raid, Hijazeen, Majedah, Hmeidan, Ahmed, Khaled, Barihan, Khasawneh, Omar, Kifayeh, Yasser, Lafi, Jasem, Seba, Qusai, Semrin, Fda, Sma, Mohammad, Theab, Haitham, Tumeh, Muna Aba Zaid, Alaa, Abazeed, Bader, Abbad, Osaid, Abbadi, Nizar, Abu-Ishkerih, Malk, Al-Osta, Reham, Al-Zyadat, Bashar Omar Falah Alawneh, Majd, Alhattab, Mohd Mujahed Alkurdieh, Ziad, Awwad, Mohammad, Hammouri, Hamzeh, Hussein, 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Fade, Alawneh, Motasem, Al-Latayfeh, Abdel-Ellah, Al-Shudifat, Abd Almonem Shaikh Ahmad, Abdelkarim, Abdeljalil, Haneen, Abdelrahman, Abdulmalek, Abdulmalek, Lina, Abedalqader, Laith Abu Abed, Omar Al Smadi, Salameh, Alarood, Mohammad, Allouzi, Maha, Almansour, Sari, Almi'Ani, Abdulhakim, Alsaiad, Khaled, Alshaikh, Farah, Androus, Mirna, Awbakh, Belal, Azzam, Hammam Bany Yasin, Maher, Daoud, Lujain, Dawod, Omar, Dawod, Reem, Elmusa, Saba, Fadli, Farah, Hammad, Majd, Hunaiti, Mahmoud, Muhtaseb, Rawan, Owaimer, Zaki, Qulaghassi, Saleh, Romman, Rawand, Saket, Said, Sharawi, Alaa, Tawalbeh, Mohammed, Al-Howthi, Laila, Ababneh, Roba, Ababneh, Faris Jamal Abu Za'nouneh, Sajedah Al Dhoun, Ahmad Al Khassawneh, Ahmed Al Sharie, Ayah Ahmad Al Shraideh, Tawfik, Al-Dabaa, Salsabeel, Al-Jarrah, Hothaifa, Al-Jarrah, Hadeel, Al-Othman, Zuhair, Alaradi, Qutaiba, Alshannaq, Rima, Alsulaiman, Motasem, Alzaqh, Yazan, Alzu'Bi, Ziad, Audat, Mohammad, Bahhour, Saja, Bdour, Roa, Khatatbeh, Fares, Marji, Tagleb, Mazahreh, Dina, Nail, Amjad, Nuseir, Asmaa, Rabab'Ah, Taher, Sawadi, Ghina, Zidan, Dima Abu Muhfouz, Abdullah, Nael, Ahmad, Qasim, Amar, Al-Jarrah, Faisal, Rawagah, Dima, Y Abu Ismail, Wedad, Al-Dolat, Mai, Alzoubi, Malak, Alzoubi, Mu'Taz, Alzu'Bi, Ruba, Asha, Ali, Guboug, Hasan, Hussein, Shireen, Rawashdeh, Mohammad, Sanwar, Adnan, Ababneh, Basil, Abu-Eisheh, Haneen Ahmad Alhami, Saif Aldeen Al Dwairi, Hana' Al Shurman, Zakaria Al Yahya, Hussam, Al-Atiyah, Hasan, Al-Balas, Anas, Aljaiuossi, Shatha, Alqawasmi, Sadeel, Alqudah, Mahmoud, Alshourman, Abdulsalam Bani Hamad, Anas Bany Issa, Raed, Ennab, Sara, Hamdoni, Zaid, Hijazi, Ali, Khafaja, Mohamed, Mraiyan, Riyad, Obeidat, Dina, Olaywah, Mohamad, Qudah, Mhamdd, Talal, Askar, Aidarov, Aisulu, Sarmenova, Almat, Kodasbaev, Orazbek, Sakhov, Shynar, Tanabayeva, Sultan, Amrayev, Berik, Dzhumabekov, Maulen, Malgazhdarov, Kanat, Tezekbaev, Yerlan, Kukubassov, Alima, Satanova, Michael, Mwachiro, Robert, Parker, Ian, Simel, Shamshuddin, 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Farah, Abojeila, Mohamed, Aliwa, Sana, Shagour, Ahmed, Altobal, Omar, Aljuroushi, Hadeel, Almadani, Hajer, Attia, Amal Sharif Eljali, Ayyah, Emran, Mabruka, Omar, Radhwan, Salim, Ashraf, Samer, Nayrouz Abdullah Abulshuwashi, Emadeddin T, M Ben Khalifa, Hdaya Abdalla, S Benabdalla, Hatem, Elnageh, Ali, Hammad, Duha Milad Abdullah, Marwa, Abusalem, Esraa Ben Esmael, Fatma, Benmasoud, Laila, Debri, Randa, Elmokhtar, Manal Ezeddin Kamel Sheta, Bushra Sayeh Mohamed Elhabashi, Balkees, Younis, Amna, Elmabrouk, Ahmed, Momen, Abdalrahem Essied Alzubi Alzoubi, Kusay, Ayad, Ameerah Mahdi Abraheem Hasan, Fawzie, Musrati, Malek, Abusannoga, Ans, Malek, Hatem, Ajaj, Eman, Abdulwahed, Mohammed, Aboubeirah, Aya, Alqurpaa, Entisar, Alshareea, Sarra, Aribi, Tomather, Aribi, Marwa, Biala, Reem, Ghamgh, Mohannned, Issa, Amani Hamid Lamari, Mohammed, Mufth, Omar Sudig Abboud, Muad Fathi Khalleefah Abu Hallalah, Saleh, Abumahara, Sarah, Aburima, Mohammed, Adrees, Abdurahman, Ahtash, Asmaa Al Shukri, Hind, 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Rakotoarisoa, Maharo, Ramifehiarivo, Solonirina Harinarindra Ranaivoson, Hajamihamina Marina Parfaite Randriantsoa, Narindra Njarasoa Mihaja Razafimanjato, Jeannie Ba Razafindrahita, Solofoarimanana, Solofoarimanana, Guillaume Odilon Tsiambanizafy, Rakotonaivo Mamisoa Judicaël, Corinne Eulalie Solo, Tojomamy Herinjaka Ralaizafindraibe, Fanonjomahasoa Safiry Andofenohasina, Hanta, Rasataharifetra, Vanona Barijaona Razafindraibe, Angelin Sablon Herinirina, Andre, Das, Thanga, Ganapathy, Yohesuwary, Gunarasa, Kalyani, Mariapan, Maathichsudhaar, Muniandy, Mohd Firdauss Osman, Mohd Azem Fathi Mohammad Azmi, Jien Yen Soh, Wan Zainira Wan Zain, Andee Dzulkarnaen Zakaria, Zaidi, Zakaria, Kheng Hooi Chan, Firdaus, Hayati, Syamim, Johan, Jin Jiun Mah, Ratha Krishnan Sriram, Sentilnathan, Subramaniam, Nur Shahirah Binti Muhammad Shahimi, Khairul Hazim Hamdan, Mohd Razali Ibrahim, Guhan, Muthkumaran, Ju Ann Tan, Mohana Raj Thanapal, Dayang Anita Abdul Aziz, Mae-Lynn, Bastion, Mohd Hairul Nizam 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Sainal, Mat Salleh Sarif, Richelle, Chua, Aini Fahriza Ibrahim, Abdul Rauf Bin Ahmad, Yii Ling Lau, Ka Yee Liew, Kandasami, Palayan, Hui Yu Wong, Jasiah, Zakaria, Nor Azimah Abd Aziz, Norazila Abdul Rahim, Noorneza Abdul Rahman, Bahiyah, Abdullah, Mohamed Faizal Bin Sikkandar, Fatin, Firman, Nik Mohd Hazleigh, Intan Kartika Kamarudin, Shahril, Khalid, Mohd Fairudz Mohd Miswan, Akmal Zulayla Mohd Zahid, Norasyikin, Mustafa, Kadhim, Obaid, Mohd Yusoff Bin Yahaya Yahaya, Ahmad Ramzi Yusoff, Predrag, Andrejevic, Jeremy Borg Myatt, Svetlana, Brincat, Clifford, Caruana, Kurt Lee Chircop, Francesca, Chircop, Daniel Mario Chircop, Charles, Cini, Viktoria, Czok, Melanie, Farrugia, Gabriella, Grima, Fatimah Mj Hassan Almukhariq, Esther, Muscat, Darryl, Pisani, Mohsin Hassan Khan Roshan, Nicholas, Schembri, Mohamed, Shoukry, Neville, Spiteri, Gilbert, Tanti, Ziad Aboharp Hasan, Alberto Bazan Soto, Cedillo Rodrìguez Jonathan Rubén, Gustavo Esteban Lugo Zamudio, David Gerardo Miranda Gómez, José 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Uros, Bumbasirevic, Zoran, Dzamic, Boris, Kajmaković, Bogomir, Milojevic, Nebojša, Prijović, Marko, Zivkovic, Aleksandar, Lazic, Nebojsa, Mitrovic, Dejan, Stevanovic, Marko, Buta, Ana, Cvetkovic, Igor, Djurisic, Merima, Goran, Zorka, Inic, Andjela, Ivezić, Nikola, Jeftic, Marko, Jevric, Vladimir, Jokic, Milan, Kocic, Zoran, Kozomara, Ivan, Markovic, Srdjan, Nikolic, Nada, Santrac, Nevena, Savković, Igor, Spurnic, Dobrica, Stevic, Dejan, Stojiljkovic, Jovana, Tripkovic, Nikola, Vucic, Milan, Zegarac, Tatjana, Dejanovic, Vladimir, Djukic, Srdjan, Marinković, Miljan, Milanovic, Nemanja, Pijanovic, Milena, Radosavljevic, Predrag, Savic, Dejan, Stojakov, Rastko, Živić, Sinisa, Ducic, Mikan, Lazovic, Jovana, Bojičić, Vladica, Cuk, Jovan, Juloski, Aleksandar, Karamarkovic, Marko, Kenic, Bojan, Kovacevic, Igor, Krdzic, Vladan, Milutinović, Vladimir, Djan, Velicko, Trajkovic, Dragana, Zivkovic, Aleksandar, Đermanović, Danica, Golijanin, Dejan, Lukic, Zoran, Radovanovic, Dragana, Radovanovic, 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Raquel Angulo Artal, Luis, Barbier, Guillermo, García-Operé, Marta, Jiménez-Jiménez, Héctor, Marín, Mikel, Oñate, Luis Antonio Pascua-Gómez, María Alexandra Pesántez Peralta, Ibabe Villalabeitia Ateca, Ladislao Cayetano Paniagua, Joan, Camí, Pablo, Collera, Martínez, David, Carlos Javier Gómez Díaz, Jordi Querolt Coll, M Dolors Rosines Cubells, Cristina Soto Montesinos, Guillermo, Triana, Marina, Xicola, Alfonso, Alias, Albert, Baduell, Mariano, Balaguer-Castro, María Pilar Camacho Carrasco, Marina Cámara Vallejo, Borja Campuzano Bitterling, Guillem, Claret, Francisco, J Cuesta-González, Alberto Di Somma, Joaquim Enseñat Nora, Neus, Fabregas, Ada Ferrer Fuertes, Abel, Ferrés, Cesar, Ginesta, Jose Juan Gonzalez Sanchez, Isabel, Gracia, Jhon Alexander Hoyos Castro, Montsant, Jornet-Gibert, Xavier, Morales, Alejandra, Mosteiro-Cadaval, Leire, Pedrosa, José Poblete Carrizo, Marina, Renau-Cerrillo, Luis Alberto Reyes Figueroa, Pedro Roldan Ramos, Jordi Rumià Arboix, Marta, Sabater-Martos, Josep, M Segur, Thomaz, E Topczewski, Jorge, Torales, Ramon, Torné, Pere, Torner, Ricard, Valero, Marian, Vives-Barquiel, Eulalia, Ballester, Alberto Basterra Rincon, Vitiello, Giulia, Belén Martin Arnau, Marta, Gil, Silvia, Martin, Monica, Serrano-Navidad, Mauricio Agüero Mariño, Núria Casanova Torrequebrada, Berta Fabregó Capdevila, Adrián López Campillo, Gemma, Mancebo, Ester, Miralpeix, Blanca, Montcusí, Marina, Munarriz, Ariadna, Salvadó, Josep, M Sole-Sedeno, Clara Téllez Marquès, Ana Centeno Álvarez, Ruth Lopez Gonzalez, Luisana Riba Combatti, Andrea Sanz Llorente, Miguel Bejarano Serrano, Blanca Capdevila Vilaró, Maria Coronas Soucheiron, Mario Cuesta Argos, Irene de Haro Jorge, Yaiza Galvañ Félix, Luis, García-Aparicio, Rebeca, Leal, Albert Malet Contreras, Irene, Martínez-Padilla, Clara, Massaguer, Ines Moraleda Gudayol, María Elena Muñoz Fernández, Paco, Parri, Cristina Pérez Costoya, Javier, Rojas-Ticona, Leopoldo Tapia Moral, Francisco, Vicario, Francesc Angles Crespo, David Bosch Garcia, Berta, Escudero, Carlos Garcia Cardona, Sergi, Bellmunt-Montoya, Javier de la Torre, Úrsula, Acosta, Iago Alvarez Saez, Eva Andreu Riobello, Fernando Ascanio Gosling, Jose, Bagan, Irene, Brana, Bartomeu, Caimari, Marta Cicuendez López Ocaña, Anna, Conesa, Alba de Pablo García-Cuenca, Natalija, Dediulia, Francesc, Duran-Valles, Jordi Giralt López de Sagredo, Maria Jose Gomez-Jurado, Ernesto, Guerra-Farfan, Juan Sebastian Guillén, María Guisasola Rabés, Viviana Andrea Hernández Angel, Maria Jurado Ruiz, Yuri, Loaiza, Manuel, Lopez, Susana, Manrique, Maria Dolores Mateo Arzo, Joan, Minguell-Monyart, Enric Miret Alomar, Sonia Monreal Clua, Víctor Morales Ariza, Clara Morales Comas, Judith, Murillo, Jose Maria Nieto Rodriguez, Elena Vilardell Ortiz, Jorge, Pamias, Montserrat Pascual Pascual Arellano, Remei Perera Sarri, Aleix Pons Bartroli, Nil, Prat, Alfredo Pueyo Ferrer, Rosa Pujol Pina, Jordi, Raurich-Leandro, Maria José Reche Padilla, Joaquín Rivero Déniz, Natalia, 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Alexia Victoria Paluso Montero, Natalia Pérez Romero, Adriana, Poch, Jaime Rodríguez de Alarcón, Adriana Ruano Campos, Rebeca Ruiz Roman, Patricia Saez Carlin, Cristina Sánchez Del Pueblo, Lidia Sotillo Valenzuela, Armando, Galvan, Miguel Ángel García Ureña, Enrique, González, Manuel Medina Pedrique, Alvaro Robin Valle de Lersundi, Carlos San Miguel, Juan, Aragón-Chamizo, Monica, Ballon, Jose, M Barrio, Beatriz Castro Catalan, Laura Cebolla Rojas, Renan Carlo Colombari, Miguel Cuende Diez, Paula Dujovne Lindenbaum, Oscar, Gil-de-Sagredo, Silvia Kayser Mata, Pablo Lozano Lominchar, Yeniffer Tatiana Moreno Salazar, Angela, Moreno-Gutierrez, Melanie, Morote, Uxue, Murgoitio, Nikolas Palma Caucig, Lucía Polanco Pujol, Alejandro, Prosperi, María Belén Ramírez Senent, Diego Fernando Ruiz Chiriboga, Mercedes, Sanz, Maria, Tudela, María Adrien Lara, Raquel, Alarza, Isabel Alonso Sebastian, Mariano Artés Caselles, Laura, Calles-Sastre, Marcos Casas Sánchez, Aritz Equisoain Azcona, Lucía, 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Barbara, Algar-Yañez, Gutiérrez, Bérénice, Olga De La Varga-Martínez, Paula, Fernandez-Valdes-Bango, Sandra Maria Gadin-Lopez, José María Martínez-Gómiz, Elena, Nieto-Moreno, Ana, Nieto-Moreno, Montserrat Ocampos Hernandez, Maria Laura Pelegrina-Lopez, Alicia Ruiz Escobar, Elena, Sáez-Ruiz, Beatriz, Vazquez-Rivero, Antonio, Lara, Belén Vielva Del Campo, Fernando Alcaide Matas, Simbad, Costas-Ochoa, José María García Pérez, Elizabeth, Marmol, Paula Troncoso Pereira, Maria Del Pilar Concejo Cutoli, Juan Ramón Gómez López, Juan Carlos Martín Del Olmo, Paloma Guillamot Ruano, Javier Páramo Zunzunegui, Antonio Albarracín Marín Blázquez, Alfonso, Aliaga-Sanchez, Marta María Arroyo Domingo, Miriam Artés Artés, Ana Isabel Avellaneda Camarena, Aida, Blaya, Emny Rochell Bobadilla Romero, Pedro Vicente Fernández-Fernández, Lorena Galindo Iñiguez, Víctor Javier García Porcel, Clara Giménez Francés, Antonio Javier Gomez Poveda, Rebeca Gonzalez Celdran, Francisco Miguel González Valverde, Laura 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López, Ruth Marquina González, Tania, Pastor, Adrián Recio Ayesa, Ana Paula Riverola Aso, Carballo, Rodríguez, Araceli, Rodrìguez, Maria Inmaculada Ruiz Montesinos, Patricia, Torres, Jose, Undabeitia, Ainara, Villafruela, Maria Barrionuevo Ramos, David, Blanco, Marta, Calderón, Eva Corral Rubio, Angel, Cuadrado-García, Daniela, Cubek, Ignacio, Fariña, Maria Fernandez LLorente, Natalia Flores Amador, Mariana García Virosta, Luis Garcia-Sancho Tellez, Adelina Gonzalez Martinez, María, Hernandez, Rubén Herreros Ruiz-Valdepeñas, Carmen Jimenez Sanchez, Eduardo Llamazares Cobo, María, López, Javier, López-Martin, Teresa Martínez Marivela, Luis Miguel Martinez Parra, Paloma Maté Mate, Paloma, Medrano, Manuel Moriche Carretero, Sara Núñez O'Sullivan, Manuel Ortega Oria de Rueda, María Begoña Pastor Nieto, Clara, Pérez, Antonio, L Picardo, Remedios Revilla Amores, Carmen Rodríguez Haro, Jose Alberto Rojo López, Fatima Sanchez Cabezudo Noguera, Cristina, Sanz, Daniel Serralta de Colsa, Cristina Valor Garcia, Marta Velasco Martinez, Iván Andújar Lara, Aranzazu, Calero-Lillo, Enrique, López-Ruiz, Alberto Díaz García, Alejandro Menéndez Moreno, Luis Eduardo Pérez-Sánchez, Ángela, Pascual, Miguel Adeba García, Marta Alonso Fernández, Javier Alvarez Gama, Roberto, Ballestero, Loreto Berjon De La Vega, Paola Calleja Hermosa, Mariana, Carrillo-Rivas, Alfonso, Casado, Andrea, Cerveró, Bonifacio Cimadevilla Calvo, Patricia Corriols Noval, Paloma de la Dehesa Cueto-Felgueroso, Miren Jasone Diez Zapirain, José Estevez Tesouro, José Antonio Fernández-Dívar Sánchez, Lucia Garcia Alcalde, Juan García Cardo, Tito García Moreno, Daniel, García-López, Belen Garcia-Montesinos Perea, Miren Gonzalez Benito, Rocio, Gonzalez-Aguado, Miguel Ángel Gordo Vega Gordo-Vega, Jose, Gutierrez-Banos, Jaime Jimeno Fraile, Yolanda Jubete Castañeda, Patricia Lopez Gomez, Antonia Jesús López López, David Mato Mañas, Carmelo, Morales-Angulo, Dieter, Morales-Garcia, Sara, Naranjo, Jose Luis Rabago, Jose Manuel Rabanal, Rocio Revuelta Zorrilla, Adriana Reyes Echeverría, Juan Carlos Rodríguez-Sanjuán, Juan Ramón Sanz, Isabel Simal Badiola, Guillermo, Tejón, Enrique Toledo Martínez, Raquel Varea Malo, Begoña, Fadrique, Tania, Funes, Elena González Revilla, Isaias, Alarcón, Daniel Aparicio Sánchez, Pablo Beltran Miranda, Carmen, Cepeda-Franco, María Josefa Cuevas López, Sandra, Dios-Barbeito, Virginia María Durán Muñoz-Cruzado, Carlos Gonzalez De Pedro, Rosa, M Jimenez-Rodriguez, Francisco, Manresa-Manresa, Gabriel, Marin, Cristobalina, Martin-Garcia, Sara, Martínez-Núñez, Juan Manuel Martos Martinez, Lucas, Mengíbar, Felipe Pareja Ciuro, Eduardo Perea Del Pozo, Veronica Pino Diaz, José, Pintor-Tortolero, Claudia, Quintero-Pérez, Maria Luisa Reyes Diaz, Mercedes Rubio Manzanares Dorado, Alejandro Sanchez Arteaga, Ana, Senent-Boza, Luis, Tallon-Aguilar, Jose, Tinoco-Gonzalez, Luis-Cristobal, Capitan-Morales, Juan Cintas Catena, Javier, Valdes-Hernandez, María Del Campo Lavilla, Alina López De Fernández, Miriam Abellan Lucas, Alba Diaz Padillo, Maria Gómez Romero, Linda Grace Puerto Tamayo, El Mostafa El Yaqine Er Raoudi, Melody García Domínguez, María Ángeles Gascón Domínguez, Marta González Pérez, Alba Hernáez Arzoz, Joana San Anton, Cristian, Ruminot, Hander Guillermo Acosta Diaz, Daniella, Laguado, Kristina, Aghababyan, Alba, Jr, Enrique, Artigues, Rocío, Belda, Miguel, Beltran, Jose Ignacio Blanes, Elena Campos Carot, Miriam, Cantos, Laura, Costa, Carolina Ferrer Gomez, José María Gallego Sánchez, Oscar, Gil-Albarova, Juan, Gilabert-Estellés, Emilio Lopez Alcina, Isabel López Sánchez, Severiano Marin Bertolin, Carolina, Martinez-Perez, Antonio Melero Abellán, Claudia Mulas Fernández, Beatriz, Novoa, Ruth, Nuñez, Pablo Renovell Ferrer, Guijarro-Jorge, Ricardo, Carolina Soledad Romero Garcia, Miguel Sanfeliu Giner, Silvia, M West, Enrique, Zapater, Ignacio, Miranda, Ana, Monís, Alejandro Roselló Añón, María José Sangüesa, Jorge Sanz Romera, Marcos, Adrianzén, Maria Barrios Carvajal, Mireia, Bauzá, Ana Benítez Riesco, Jose Antonio Carbonell Lopez, María-Carmen, Fernández-Moreno, Ricardo Gadea Mateo, Francisco, Garcia, Maris Luisa García-Pérez, Luisa Paola Garzon, Ana, Izquierdo, Maria Lapeña Rodríguez, Carlos, León-Espinoza, Fernando, Lopez, Rosa Martí Fernández, Sara Martínez Castro, Berta Monleón López, Isabel Mora Oliver, David, Moro-Valdezate, Ernesto Muñoz Sornosa, Sara Palomares Casasús, Leticia Pérez Santiago, Mara Albert Fort, Reyes, Balanzá, Lorena Bermell Marco, Carla Carratalá Pérez, Claudia Pilar Clemente Tomas, Marta, Córcoles, Jose Ángel Diez Ares, Carlos Domingo Del Pozo, Nuria Estellés Vidagany, Gonzalo, Garrigos, Mar Gimeno Gimeno Vicente, Blanca Alastrue Giner, Segundo, Gomez-Abril, Paloma, Gonzalez, Paula Gonzálvez Guardiola, Guillermo Sebastian Martínez Fernández, Charo Martínez García, Lucía, Martínez-Costa, Luz María Moratalla Charcos, Sergio Navarro Martínez, Carmen, Payá-Llorente, Álvaro Pérez Rubio, Nuria, Peris, Eduardo Picazo Pineda, Jordi Planelles Gómez, Francisco Ripoll Vidal, Andrea, Roca, Enrique, Salmerón-González, Raquel Segura Roselló, Ramon Trullenque Juan, Cristina Verdejo Gimeno, Jose Miguel Zaragozá García, Gema Zomeño Bravo, Marcos Bruna Esteban, Hanna, Cholewa, Milton de Jesus, Matteo, Frasson, Luis Oliver García, Héctor, J Aguado, Antonio Jose Alonso Villalba, Francisco, Ardura, Carmen Elena Badillo Bercebal, María Bedate Núnez, Alvarez-Ramos Begoña Aranzazu, Juan Beltrán de Heredia, Hugo, Bermejo, Juan Berrocal Cuadrado, Maria Bragado González, Juan, Bustamante-Munguira, Raul Calvo Gonzalez, Yolanda, Carrascal, Ana Belén Casas Marcos, María Carmen Cervera, Sergio Chávez Valladares, Ángel Cilleruelo Ramos, Susana, Cortes, Jesús, Crespo-Sanjuán, María, Cuaresma, Luis Antonio Cuellar Martin, Carlos Ferreras García, Alvaro, Fuentes-Martín, Abel, Ganso, Elena García García, Luis, Garcia-Florez, Virginia, Garcia-Virto, Juan, Gatón, Julio Alberto Gobernado Tejedor, Tania Gómez Sanz, Jose Ignacio González Martín, María Begoña Gregorio Crespo, Ana Herranz Arriero, Jose, Herreros, Marta Ibáñez Nieto, César, Infante, Carlos, Jezieniecki, Moises, Juarez, Gregorio de Jesus Labrador Hernandez, Ana Patricia Legido Morán, Ricardo León Fernández, Alejandro, Leon-Andrino, Almudena, Llorente, Maria Lopez Pais, Mauricio Loucel Bellino, Sergio, Martin, Miguel Angel Martin-Ferrero, Gonzalo Martinez Municio, Elvira Mateos Alvarez, José María Matilla, Luis María Merino Peñacoba, Mario, Montes-Manrique, Fernando Natal Álvarez, David, C Noriega, Henar Nuñez Del Barrio, Francisco Javier Ortiz de Solórzano Aurusa, Lucía, Pañeda, Victoria Pascual Escudero, Miguel Pascual Samaniego, Adela, Pereda, Marta Pérez Febles, Laura, Pesquera, Maria, Plata, Emma Puertas Ruiz, Mario, Rodriguez-Lopez, Alejandro Romero de Diego, Ana, Ruano, María Ruiz Soriano, Cristina Sánchez Torralvo, Silvia Santiago Maniega, Bárbara, Segura-Méndez, Clarisa Simon Perez, José, Soro-García, Paula Suárez Mansilla Suárez-Mansilla, Jeancarlos Trujillo Díaz, Mª Esther Valsero Herguedas, Andrea Vazquez Fernandez, Eduardo Velasco García, Ana, Zabalza, Álvaro Zamora Horcajada, Fernando Acebes García, Enrique Asensio Díaz, Martín, Bailón, Alejandro David Bueno Cañones, Alvaro Centeno Velasco, Ekta Choolani Bhojwani, Fernando Labarga Rodríguez, Sara, Mambrilla, Pablo, Marcos-Santos, Toledano, Miguel, David Pacheco Sánchez, Baltasar, Pérez-Saborido, Pilar, Pinto, Katherine, Plua, Javier Sanchez Gonzalez, Vicente, Simo, Rosalía Velasco López, Sandra Veleda Belanche, Fabiola Eugenia Michel Campos, Iciar Muñoz Lindez, Maria, Balluerca, Maite, Camuera, Pablo, Helguera, Imanol, Herrero, Patricia Paunero Vazquez, María, Sánchez-Rubio, Isami, Soeda, María Dolores Arribas Del Amo, Vicente Manuel Borrego Estella, Estefania, Casas, Néstor Castán Villanueva, Daniel Delfau Lafuente, Elena Delgado Blanco, María, Domingo, Ismael Gil Romea, Azucena, Gonzalo, Emilio Lagunas Lostao, Noelia Lete Aguirre, Yaiza Martinez Lahoz, Jesús Víctor Pérez-Tierra Ruiz, Maria Del Mar Soriano, Isabel Valero Lázaro, Esmeralda Carnicer Escusol, Guillermo Pola Bandres, Juan Luis Blas Laina, Beatriz, Cros, Patricio Andrés Freile Pazmiño, David, Garcia-Aguilera, Ana Mejía Casado, Ana, Nogués, Issa Talal El-Abur, Carlos, Yánez, Isabel Gascon Ferrer, Carlos, Gracia-Roche, Ursula María Jariod Ferrer, María Victoria Simón Sanz, Tomas, Uson, Waseem, Ahamed, Sumudu, Jayasinghe, Eranda, Karunadasa, Prathibha, Nelihela, Sujeewa Priyantha Bandara Thalgaspitiya, Dickson, Wickramarathna, Nagenthiram, Harivallavan, Pirashanthan, Nagarasa, Eranga, Perera, Kanapathipillai, Piratheep, Vithranage Srimantha Dewsiri Rodrigo, Meera, Thayalan, Rajendram, Thayaparren, Arulprashanth, Arulanantham, Kanishka De Silva, Gagana, Ganga, Anuja Nadeeshan Kumarasinghe, Mahanada, Udukala, Koculen, Vimaleswaran, Prashanthan, Yogarajah, Ravindri, Jayasinghe, Probhodana, Ranaweera, Mohamed, Rishard, Dharmabandhu, N Samarasekera, Sanjeewa, Seneviratne, Sivasuriya, Sivaganesh, Chamal, Fernando, Nishantha, Mendis, Balasingam, Balagobi, Balasupramaniam, Sathesan, Lanka, Dasanayake, Malitha, Patabendige, Wickramasooriya, Dj, Kugarajh, Ganeshapillai, Sathyamoorthy, Prasanna, Dileepa, Ediriweera, Sumudu, Kumarage, Asanka, Jayawardane, Athula, Kaluarachchi, Pituwala Liyanage Adithya Sirisena, Abubakr, Abubakr, Hozifa, Mohamed, Ismail, Mustafa, Mogahid, Sharfeldein, Samir, Ismail, Reem, Musa, Monira, Sarih, Mussab, Abaker, Eman Adam Abdalla, Mohamad, Abdelbagi, Alsafe, Adlan, Ahmed, Alnaeem, Safa, Atyah, Yasir, Awad, Rsheeda, Dawelbait, Mohamed El Hag, Ibrahim, Elbashir, Sami, Eldirdiri, Samwal, Eldirdiri, Mohammed Eltahier Abdalla Omer, Lana Abdalgadir Ahmed Mohamed, Hiba Hassan Rehmtallah Ahmed, Mohammed Balla Yousif Balla, Abdulmoiz, Aljafari, Abdulmalek, Aljafari, Elsagad, Mohamed, Abdulkader, Mohammad, Abdulkader, Shaar, Mohamed Nafea Shaar, Maab Hussein Yousif Elhafiz, Mohammed Husien Yosif Elhafiz, Abubakr Ali Mohammed Alhassan Humidan, Almigdad, Ali, Hisham, Eljack, Mohamedyasin, Elrashid, Manhal, Ahmed, Albrra, Alhag, Douaa, Ali, Mohammed Ahmed Babikir, Imad, Bakheit, Hytham K, S Hamid, Sami, Mohamed, Walid, Shaban, Nidhal, Siddig, Mohamed, Suliman, Rihab Yasir Abdelmagid, Abubaker, Yassin, Omer, Abbas, Eltahir, Abdelrahim, Muhammed, Ahmed, Mohamed, Elobaid, Adil, Hashim, Ali, Mohamed, Omer, Mohamed, Khalid, Osman, Abdallah, Yousif, Safaa, Abdulaal, Marwa, Elsadig, Mohammed, Hussain, Malaz Amir Ataalmanan, Doha Amir AtaAlmanan, Tebyan Amir AtaAlmanan, Alaa, Elgaili, Maria, Mohamed, Usra, Omara, Alkhansa, Osman, Amna, Osman, Safaa, Saad, Abdelkareem, Ahmed, Ali Adil Ali Karar, Aya, Alhassan, Mohanad, Alsidig, Mohamed, Eljack, Mohammed Ibrahim Mohammed Ali, Awad Kamal Awad Osman, Liena, Mohamed, Samah Ibrahim Omer Mohamed Osman Mohamed Osman, Altayeb, Mohammed, Ayman, Mohammed, Khadija, Muhmmed, Eltahir, Musa, Egbal Sahal Abdelmajed, Khalid Z M, Y Hamid, Omnia M, M Yousif, Mahmoud, Saleh, Osman, Bashir, Yassein, Elhussein, Omar, Madani, Eva, Angenete, Jennifer, Park, Lars, Gillberg, Monir, Jawad, Linas, Pieteris, Yousif, Saeed, Sergej, Safonov, Martin, Spångfors, Henrik, Andersson, Hans, Bahlmann, Karin Björnström Karlsson, Michelle, Chew, Lara, Daham, Lina De Geer, Helen, Didriksson, Gunilla, Gagnö, Carina, Jonsson, Anna, Oscarsson, Pamela, Buchwald, Mathilde, Delorme, Marie-Louise, Lydrup, Shahin, Mohseni, Arvid, Pourlotfi, Souheil, Reda, Kajsa, Anderin, Nina, Blomme, Josefin, Segelman, Malin, Simlund, Anders, Thorell, Fredrik, Wogensen, Daniel, Danielsson, Peter, Elbe, Rebecka, Hultgren, Boel, Hynning, Fredrik, Klevebro, Karin, Lind, Ebba, K Lindqvist, Carl, Montan, Ernesto, Sparrelid, Clara Svenberg Lind, Jeremy, Wales, Andreas, Älgå, Martin, Nordberg, Emil, Pieniowski, Ioannis, Gkekas, Niklas, Löfgren, Karolina, Niska, Robert, Zürner, Silvio, Däster, Otto, Kollmar, Savas, Soysal, Stephanie, Taha-Mehlitz, Athanasios, Tampakis, Dominik Valentin Flury, Marie, Heyne-Pietschmann, Gregor Jan Kocher, Ana, M Calinescu, Barbara, Wildhaber, Markus, Gass, Jürg, Metzger, Andreas, Scheiwiller, Lukas, Briner, Oliver, Dwidar, Steven, Grandjean, Pietro, Ricciardi, Alexandra, Calmels, Christodoulou, Michel, Morena, Antonilli, Dimitrios, Christoforidis, Alessandra, Cristaudi, Jacopo, Galafassi, Maria Luisa Gasparri, Francesco, Mongelli, Martino, Munini, Andrea, Papadia, Sotirios Georgios Popeskou, Alex, Alfieri, Thomas, Bächler, Matteo, Giardini, Christian, Gingert, Laura, Guglielmetti, Inna, Meyer, Tobias, Müller, Daniel, Schöni, Folco, Solimene, Frank, Weidner, Marco, Bueter, Daniel, Gero, Amelie, Müller, Carmen, Portenkirchner, Andreas, Thalheimer, Jeannette, Widmer, Ahmad, Hmaideh, Alaa, Kour, Saleem, Swaes, Omar, Alannaz, Ramez, Aljasem, Ezeddin, Dabbagh, M Wafa Hamoud Alhussein, Amr, Hamza, Mazen, Mohammad, Abd El-Fattah Mouhandes, Mohamad, Shareeda, Mohammad Nour Shashaa, Mousa, Sifat, Sheraa, Tahhan, Rahaf, Toutounji, Mohamed, Abdulrahman, Albaraa, Abdulsalam, Ziad Al Jarad, Hala, Alayyoubi, Dina, Alfarra, Ahmad, Alhamid, Mahmoud, Alnasser, Mulham, Gharib, Ruwaid, Gharib, Obaida, Kabel, Osama, Kherallah, Abdulqader, Klaho, Mohamed Shukri Najjar, Ahmad, Razouk, Joud, Shiekhoni, Wael, Alkhaleel, Amira, Almosa, Mohammad, Aloulou, Maen, Alzaeem, Khaled, Arnaout, Muhamad Zakaria Brimo Alsaman, Mohamad, Estanbouli, Hanadi, Hawa, Ahmad Nbrass Kabawi, Ghina, Maarawi, Yehia, Mashhadany, Sana Shaikh Torab, Waleed, Abd, Tayma Abd Alghafour, Hani, Abdalnour, Nazeeh Al Aktaa, Marwan Al Aliwy, M Maher Al Arje, Tasneem Al Najjar, Ahmad, Al-Mouakeh, Ahmad, Aldakhil, Aos, Alhamid, Hasan, Alhasan, Mohamad Shadi Alkarrash, Jumaa, Alkhamis, Sara, Alshekh, Ahmad Yamen Arnaout, Oula, Azizeh, Mohammed, Dalaleh, Aghyad, Danial, Zain, Douba, Raghad, Ghadri, Mohammad Maen Ghannam, Anas, Ghawi, Luma Haj Kassem, M Yasser Halwani, Shahed, Hamadieh, Mohammad, Hanino, Ala Aldeen Hasan, Haya, Jawish, Nasr Ullah Kabbani, Saadullah, Kabbany, Mohamad, Kadi, Lama, Kadoura, Ahmad Amir Kayali, Ammar, Kayyali, Aya, Kelzia, Amana, Kezze, Abdullah, Khalaf, Maymona, Khayata, Mohammad Nour Kitaz, Mohammad, Kour, Raghad, Makki, Ruqaya, Masri, Joseph, Masri, Noor, Masri, Muhammad, Mazketly, Shiar, Mustafa, Ezzeldin, Nashed, Yaman Qoudra Danial, Hasan, Raslan, Rima, Salem, Mohammed Asaad Salem, Thabet Sayed Bakir, Manaf, Sharabaji, Majd Sheikh Alganameh, Duaa Sheikh Kadro, Joudy, Shurbatji, Mohammad Noor Sultan, Dana, Sultan, Hala, Swied, Bakri Tarras Jarkas, Tayf, Toutounji, Fadi, Ward, Rama, Zazo, Aya, Zazo, Zainab, Zeino, Mohamed, Alaktaa, Wael, Alsado, Hala, Fares, Nouran, Hawa, Hamza, Ibrahim, Abdulmonem, Kawas, Mourad, Niazi, Bayan, Toutounji, Mohammad, Abdow, Mohamad, Ahmad, Tareq, Ahmad, Rawan Al Azhar, Hiba Al Hage Diab, Rahaf Al Mulke, Mohammad, Al-Jadaan, Ahmad, Alhussein, Zahra, Alnajem, Omar, Alneser, Bayan, Alsaid, Elias, Azar, Lubna, Bakr, Ammar, Hamza, Yara, Houdifa, Sami, Jomaa, Samer, Kefo, Hiba, Mardini, Alaa, Mohammad, Fadi, Rayya, Fatima, Razzouk, Mohannad, Saleh, Anwar, Shamandi, Ammar Youzkatli Alkhatib, Omar Abdul Salam, Dany, Ajami, Mohammad, Alhamid, Ahmad, Alkhaledi, Danny, Hadidi, Massa, Jabra, Mamdouh, Kallas, Antoine, Laktine, Joelle, Naem, Naya, Naoum, Ghena Mohammed Fawaz Ashour, Ahmad, Alhouri, Deema, Fallouh, Ahmad, N Mohammad, Ahmad, Rmman, Ali, Slitin, Christine, Tanos, Ibrahim, Wakim, Hanaa, Zahrawi, Majd, Abouassi, Layth, Abouassi, Ayham, Aboutrab, Basel, Ahmad, Ahmad Mustafa Ahmad, Aya, Ahmad, Afaf, Ahmad, Mohamad, Alabras, Mohammad, Albasheer, Ola, Alkasser, Mhd Khaled Alkasser, Ali, Alkhdor, Marah, Azkoul, Mohammad Karam Chaaban, Haya, Deeb, Basel, Jazieh, Basel, Kouz, Youssef, Kozah, Raied, Mohamad, Ammar, Mohammad, Mhd Zied Nasri, Mohammed Mouaz Shebani, Mohammed, Shwin, Alaa, Sommaq, Amal, Youssef, Tala Al Asadi, Suhad, Alkhateb, Rasha Khalil Alsayyad, Roula, Altom, Mhd Amin Alzabibi, Batoul, Bakkar, Hlma, Ismail, Salma Khadem Alsrouji, Sara, Melhem, Mohamad, Sankari, Mosa, Shibani, Noura, Shujaa, Ibrahim, Adham, Salma, Al-Houssami, Maram, Balouli, Yazan, Rahmeh, Simon, Yanni, Sally, Yousef, Aline, Ahmad, Marah, Ali, Abdulrahman, Almjersah, Aya, Almoustafa, Hiba, Dahhan, Bashar Haj Hassan, Alaa, Hamdan, Salah, Hammed, Rawan, Harfoush, Rama, Hasan, Natalie, Jarkas, Moufid, Mahfoud, Ahmed, Moussa, Alaa, Sulaiman, Siba, Suliman, Yu-Ning, Hu, Jun-Neng, Roan, Meng-Ta, Tsai, Yi-Chen, Wang, Thammawat, Parakonthun, Nicha, Srisuworanan, Voraboot, Taweerutchana, Somcharoen, Saeteng, Sophon, Siwachat, Apichat, Tantraworasin, Danielle, Dimsoy, Shane, Khan, Akash, Ramsaroop, Shivanand, Ramsubhagh, Karim, Ayed, Oussama, Baraket, Mohamed Hedi Ghalloussi, Abbassi, Imed, Nahla, Kechiche, Waad, Farhat, Ammar, Houssem, Erdal Birol Bostanci, Volkan, Oter, Erol, Pişkin, Cihangir, Akyol, Sibel, Demirel, Mehmet Ali Koç, Can, Konca, Özge, Yanık, Basak, Bolukbasi, Huseyin, Gobut, Emre, Gülçek, Kerim, Karabulut, Ramazan, Kozan, Farshad, Noori, Elif, Özeller, Can, Şahin, Ali, Yalcinkaya, Mesut, Yavaş, Aydın, Yavuz, Utku, Akgor, Omer, Cennet, Hilmi Anil Dincer, Murat, Gultekin, Nazlı, Orhan, Mustafa, Oruç, Serdar, Culcu, Lütfi, Doğan, Cemil, Yüksel, Alp, Yildiz, Aybala, Yildiz, Perihan, Ekmekçi, Baturay Kansu Kazbek, Ülkü Ceren Köksoy, Deniz Serim Korkmaz, Zeynep Şahan Çetinkaya, Elif Aybeniz Yildirim, Hakan, Yilmaz, Metin, Yığman, Nasuh Utku Dogan, Selen, Doğan, Mehmet, Sakinci, Ozgen, Isik, Murat, Şen, Tuncay, Yılmazlar, Utku, Özgen, Ugur, Sungurtekin, Yener, Aydin, Ilker, Ince, Ali Bilal Ulas, Hüseyin Cahit Yalçın, Mehmet, Kaplan, Tuğba, Kaplan, Elif Tugce Kaplan, Afag, Aghayeva, Bilgi, Baca, Inci, Sahin, Zumrud, Aliyeva, Akif Enes Arikan, Erman, Aytac, Onur, Dülgeroğlu, Volkan, Ozben, Cihan, Uras, Emre, Sivrikoz, Ismail Ahmet Bilgin, Bahadır, Bozkırlı, Güralp Onur Ceyhan, Ismail, Hamzaoglu, Halil, Kara, Tayfun, Karahasanoğlu, Olus, Api, Mehmet, Ceyhan, Aylin Pelin Cil, Telce Aysen Gurbuz, Cumhur, B Lent Urman, Ahmet, Akbas, Yunus Emre Aktimur, Yuksel, Altinel, Fikret, Calikoglu, Serdar, 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Almohanady, Marwa, Alodine, Nooraldin, Alqasemi, Basma, Alqudaimi, Ansam Mohammed Ghaleb Alrobaiee, Mohammed, Alsabri, Radfan, Alsalal, Ramzi, Alsayadi, Musaed, Alsayadi, Reem, Alshaipani, Ebrahim, Alsharabi, Nora, Atiah, Hadeel, Bajjah, Muhib, Esmael, Asma, Ghallab, Rana, Ghannam, Adwa'A, Hamid, Lina, Hashem, Sara, Saif, Shaima, Sayad, Nawras, Shaban, Amatallah Hadi Shamsan, Sarah, Shream, Amal, Shukri, Shahd, Zeid, Nabila, Abdullah, Abdulrahman Faisal Al-Garadi, Ahmed, M Ali Al-Radhi, Norhan, Naji, Shaima'A, Nasser, Areej Taha Al Anaib, Ebrahim, Abdurab, Fadhl Al Muhtadi, Amer, Al-Hebbah, Ahmed, Al-Madhrahi, Shehab, Al-Mahdi, Sakhr Abdulhakeem Al-Maswari, Ayman, Al-Oqabi, Zakarya Abdullah Al-Zaazaai, Karim, Al-Zazay, Ali, Alafif, Asem, Albzzaz, Lina, Alqalisi, Mohammed, Alrezami, Haneen, Alshargabi, Mokhtar, Alshargabi, Hossam, Ghanem, Kareem, Saeed, Rasheed, Shalabi, Fareed, Showqi, Miriam, Maimbo, Catherine, Mkandawire, Mulaya, Mubambe, Theresa, Nkole, Vanessa, Savopoulos, Patricia, Shinondo, Chabwera, Shumba, Penias, Tembo, Shelton, Chivanga, Ngqabutho, Dube, Handsome, Dube, Daniel, Dzinotyiwei, Ronald, Makanda, Moses, Mangena, Partson, Maphosa, Derek, Matsika, Proud, Mawere, Nkosikhona, Moyo, Assel, Moyo, Arnold, Muguwu, Simbarashe, Mungazi, Garikai, Mwale, Gamuchirai, Ndabvonga, Mambote Crispin Olivier Ntoto, Hardlife, Ranganai, Ernesto Sánchez Castillo, Oltah, Tshuma, Grace, Gwini, Vimbai Moyana Muguto, Gilbert, Moyo, Trust, Mushawarima, Tinashe, Shoko, Rorisang, Jamela, Marvellous, Machiri, Eric, Shumba, Antony, Chengahomwe, Yemurai, Bikwa, Maxwell, Chimhina, Jeremy, Marume, Kudzayi, Munanzvi, Precious G, T Mutambanengwe, Federico, Ferrari, Marco, Fontanella, Franco, Odicino, Romano, Vito, Nepogodiev D, Emanuele Cammarata, Sofia Campanella, Daniela Canzonieri, Adriana Cordova, Federico De Michele, Ettore Dinoto, Mara Franza, Leo Licari, Daniele Matta, Domenico Mirabella, Felice Pecoraro, Roberto Pirrello, Pierfrancesco Pugliese, Fernando Rosatti, Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Nepogodiev, D, Rosati, R, Surgery, Medicine and Pharmacy academic/administration, Basic (bio-) Medical Sciences, Surgical clinical sciences, Faculty of Medicine and Pharmacy, Gastroenterology, Medical Oncology, Clinical sciences, Breda, João, ARD - Amsterdam Reproduction and Development, Paediatric Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AGEM - Endocrinology, metabolism and nutrition, Graduate School, Tytgat Institute for Liver and Intestinal Research, Laura Alberici, Filippo Antonacci, Alessandro Arena, Angela Belvedere, Fabio Bernagozzi, Paolo Bernante, Pietro Bertoglio, Lorenzo Bianchi, Maria Bisulli, Barbara Bonfanti, Safia Boussedra, Jury Brandolini, Crescenzo Cacciapuoti, Stefano Cardelli, Riccardo Casadei, Matteo Cescon, Alessandro Cipolli, Riccardo Cipriani, Alfredo Conti, Luca Contu, Francesco Costa, Niccolo’ Daddi, Eugenia De Crescenzo, Pierandrea De Iaco, Alessandra De Palma, Massimo Del Gaudio, Anna Nunzia Della Gatta, Giampiero Dolci, Giulia Dondi, Matteo Droghetti, Sergio Nicola Forti Parri, Elena Garelli, Chiara Gelati, Giuliana Germinario, Federico A. Giorgini, Carlo Ingaldi, Elio Jovine, Kenji Kawamukai, Antonio Lanci Lanci, Raffaele Lombardi, Maria Elisa Lozano Miralles, Claudio Marchetti, Michele Masetti, Francesco Minni, Daniele Morezzi, Daniele Parlanti, Alice Pellegrini, Anna Myriam Perrone, Anna paola Pezzuto, Marco Pignatti, Gianluigi Pilu, Valentina Pinto, Gilberto Poggioli, Silvana Bernadetta Puglisi, Diego Raimondo, Matteo Ravaioli, Claudio Ricci, Sara Ricciardi, Francesco Ricotta, Roberta Rizzo, Angela Romano, Matteo Rottoli, Riccardo Schiavina, Renato Seracchioli, Matteo Serenari, Margherita Serra, Piergiorgio Solli, Gioia Sorbi, Mario Taffurelli, Marta Tanzanu, Achille Tarsitano, Marco Tesei, Gabriele Vago, Tommaso Violante, Simone Zanotti, Tommaso Frisoni, leonardo solaini, giorgio ercolani, Fruscio, R, Ornaghi, S, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Žundienė, Laura, Dulskas, Audrius, Kuliavas, Justas, Čekauskas, Albertas, Kielaitė-Gulla, Aistė, Poškus, Tomas, Strupas, Kęstutis, Želvys, Arūnas, COVIDSurg Collaborative, GlobalSurg Collaborative, Department of Surgery, HUS Abdominal Center, Simoes, Jff, Li, E, Picciochi, M, Glasbey, Jc, Baiocchi, G, Blanco-Colino, R, Chaudhry, D, Alameer, E, El-Boghdadly, K, Wuraola, F, Ghosh, D, Gujjuri, Rr, Harrison, Em, Lule, H, Kaafarani, H, Khosravi, M, Kronberger, I, Leventoglu, S, Mann, H, Mclean, Ka, Mengistu, Gm, Modolo, Mm, Ntirenganya, F, Norman, L, Outani, O, Pius, R, Pockney, P, Qureshi, Au, Roslani, Ac, Satoi, S, Shaw, C, Bhangu, A, Omar, Om, Ahmed, Wur, Argus, L, Ball, A, Bywater, Ep, Brar, A, Dawson, Be, Duran, I, Elhadi, M, Jones, C, Kamarajah, Sk, Keatley, Jm, Lawday, S, Marson, Ej, Ots, R, Santos, I, Taylor, Eh, Trout, Im, Varghese, C, Venn, Ml, Xu, W, Dajti, I, Gjata, A, Kacimi, Seo, Boccalatte, L, Cox, D, Townend, P, Aigner, F, Kronberger, Ie, Samadov, E, Alderazi, A, Hossain, K, Padmore, G, van Ramshorst, G, Lawani, I, Cerovac, A, Delibegovic, S, Gomes, Gma, Buarque, Il, Gohar, M, Slavchev, M, Nwegbu, C, Agarwal, A, Martin, J, Ng-Kamstra, J, Olivos, M, Lou, Wh, Ren, Dl, Calvache, Ja, Rivera, Cjp, Hadzibegovic, Ad, Kopjar, T, Mihanovic, J, Jimenez, Pma, Gouvas, N, Klat, J, Novysedlak, R, Amisi, N, Christensen, P, El-Hussuna, A, Batista, S, Lincango-Naranjo, E, Emile, S, Sandoval, Daa, Dhufera, H, Hailu, S, Mengesha, Mg, Kauppila, Jh, Arnaud, Ap, Demetrashvili, Z, Albertsmeier, M, Lederhuber, H, Loffler, Mw, Acquah, Dk, Ofori, B, Tabiri, S, Metallidis, S, Tsoulfas, G, Aguilera-Arevalo, Ml, Recinos, G, Mersich, T, Wettstein, D, Kembuan, G, Milan, Pb, Khosravi, Mh, Mozafari, M, Hilmi, A, Mohan, H, Zmora, O, Gallo, G, Pata, F, Pellino, G, Fujimoto, Y, Kuroda, N, Abou Chaar, Mk, Ayasra, F, Fakhradiyev, I, Hamdun, Ih, Jin-Young, J, Jamal, M, Karout, L, Gulla, A, Rasoaherinomenjanahary, F, Samison, Lh, Sanchez, Iid, Gonzalez, D, Martinez, L, Martinez, Mj, Nayen, A, and Ramos-De la Medina, A
Subjects: Male, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MULTICENTER, infectious diseases, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, Cirugía, 80 and over, Prospective Studies, Young adult, Child, Lung, Aged, 80 and over, COVID-19, delay, SARS-CoV-2, surgery, timing, SARS‐CoV‐2 infection, Operative, Child, Preschool, Pneumonia & Influenza, Infection, Cohort study, Human, medicine.medical_specialty, Clinical Sciences, Sars-cov-2, GlobalSurg Collaborative, Settore MED/28 - MALATTIE ODONTOSTOMATOLOGICHE, 03 medical and health sciences, Clinical Research, Biodefense, Correspondence, Humans, PULMONARY COMPLICATIONS, CRIANÇAS EM IDADE PRÉ-ESCOLAR, Aged, Science & Technology, Cirurgia, Prevention, Infant, Odds ratio, Pneumonia, Prospective Studie, Clinical research, Surgery, Human medicine, 610 Medizin und Gesundheit, 1109 Neurosciences, Internationality, Settore MED/29 - CHIRURGIA MAXILLOFACCIALE, Settore MED/18 - CHIRURGIA GENERALE, Adolescent, Adult, Cohort Studies, Female, Middle Aged, Surgical Procedures, Operative, Time, Young Adult, Practice Guidelines as Topic, gastroenterology, Medicine and Health Sciences, 030212 general & internal medicine, Prospective cohort study, Mortality rate, Covid19, Infectious Diseases, Patient Safety, medicine.symptom, 6.4 Surgery, Life Sciences & Biomedicine, 610 Medicine & health, COVID-19, SARS-CoV-2, delay, surgery, timing, Asymptomatic, NO, COVIDSurg Collaborative, Vaccine Related, All institutes and research themes of the Radboud University Medical Center, medicine, Mortalitat, ddc:610, Mortality, Preschool, LS7_4, Surgical Procedures, business.industry, Neurosciences, Evaluation of treatments and therapeutic interventions, 1103 Clinical Sciences, 3126 Surgery, anesthesiology, intensive care, radiology, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Anesthesiology and Pain Medicine, Emerging Infectious Diseases, Good Health and Well Being, Mortalidad, Cohort Studie, business
Abstract: Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay. ispartof: ANAESTHESIA vol:76 issue:6 pages:748-758 ispartof: location:England status: published
Published: 2021
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39. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author: Simone Famularo, Matteo Donadon, Federica Cipriani, Davide P. Bernasconi, Giuliano LaBarba, Tommaso Dominioni, Maurizio Iaria, Sarah Molfino, Simone Conci, Cecilia Ferrari, Marco Garatti, Antonella Delvecchio, Albert Troci, Stefan Patauner, Silvia Frassani, Maurizio Cosimelli, Giacomo Zanus, Felice Giuliante, Elio Jovine, Maria G. Valsecchi, GianLuca Grazi, Adelmo Antonucci, Antonio Frena, Michele Crespi, Riccardo Memeo, Giuseppe Zimmitti, Guido Griseri, Andrea Ruzzenente, Gianluca Baiocchi, Raffaele DallaValle, Marcello Maestri, Giorgio Ercolani, Luca Aldrighetti, Guido Torzilli, Fabrizio Romano, Cristina Ciulli, Alessandro Giani, Francesca Carissimi, Guido Costa, Francesca Ratti, Alessandro Cucchetti, Francesco Calabrese, Elena Cremaschi, Giovanni Lazzari, Angelo Franceschi, Valentina Sega, Maria Conticchio, Luca Pennacchi, Michele Ciola, Ivano Sciannamea, Valerio De Peppo, Famularo S., Donadon M., Cipriani F., Bernasconi D.P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M.G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Bernasconi, Davide P, Labarba, Giuliano, Dominioni, Tommaso, Iaria, Maurizio, Molfino, Sarah, Conci, Simone, Ferrari, Cecilia, Garatti, Marco, Delvecchio, Antonella, Troci, Albert, Patauner, Stefan, Frassani, Silvia, Cosimelli, Maurizio, Zanus, Giacomo, Giuliante, Felice, Jovine, Elio, Valsecchi, Maria G, Grazi, Gianluca, Antonucci, Adelmo, Frena, Antonio, Crespi, Michele, Memeo, Riccardo, Zimmitti, Giuseppe, Griseri, Guido, Ruzzenente, Andrea, Baiocchi, Gianluca, Dallavalle, Raffaele, Maestri, Marcello, Ercolani, Giorgio, Aldrighetti, Luca, Torzilli, Guido, and Romano, Fabrizio
Subjects: Sorafenib, medicine.medical_specialty, recurrence, Carcinoma, Hepatocellular, Tumor burden, 030230 surgery, liver, Gastroenterology, NO, 03 medical and health sciences, 0302 clinical medicine, hepatectomy, Retrospective Studie, Internal medicine, Humans, Medicine, Chemoembolization, Therapeutic, Liver surgery, Retrospective Studies, LS7_4, Hepatology, business.industry, Palliative Care, Liver Neoplasms, hepatocellular carcinoma, medicine.disease, Recurrent Hepatocellular Carcinoma, multicentric, Treatment Outcome, Time to recurrence, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Liver function, Neoplasm Recurrence, Local, business, medicine.drug, Human
Abstract: Background Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p Conclusion Curative approaches may guarantee long-term survival in case of recurrence.
Published: 2021

40. Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma

Author: Raffaella Reineke, Federica Cipriani, Guido Fiorentini, Luca Aldrighetti, Francesca Ratti, Cipriani, F., Ratti, F., Fiorentini, G., Reineke, R., and Aldrighetti, L.
Subjects: medicine.medical_specialty, Cholangiocarcinoma, Robotic Surgical Procedures, Overall survival, Medicine, Hepatectomy, Humans, Minimally Invasive Surgical Procedures, Laparoscopy, medicine.diagnostic_test, business.industry, Bile duct, Mortality rate, Klatskin hilar cholangiocarcinoma, Perioperative, Laparoscopic liver resection, Robotic liver resection, Surgery, Critical appraisal, medicine.anatomical_structure, Systematic review, Treatment Outcome, Bile Duct Neoplasms, Minimally-invasive liver resection, Invasive surgery, Robot-assisted liver resection, business, Klatskin Tumor
Abstract: Most surgeons have traditionally been reluctant toward minimally-invasive surgery for bile duct tumors. This study aimed to perform a systematic literature review on perioperative and oncologic results of pure laparoscopic and robotic curative-intent surgery for hilar cholangiocarcinoma. According to the PRISMA statement, a systematic review was conducted into Pubmed, EMBASE and Cochrane. A critical appraisal of study was performed according to the Joanna Briggs Institute tools. Nineteen studies (12 on pure laparoscopy and 7 on robotics) were included: 7 case reports, 9 case series, 3 case–control (193 patients). The pooled conversion, morbidity, biliary leak and mortality rates were 5.5%, 43%, 16.4% and 4%. The weighted mean of operative time, blood loss and postoperative stay were 388min, 446mL and 14days. For pure laparoscopy, the pooled R0 rate was 86%; overall survival and disease-free survival rates ranged from 85 to 100% and from 80 to 100% (median observation time 6–18months). For robotic surgeries, the pooled R0 rate was 69% and overall survival rates ranged from 90 to 100% (median observation time 5–15months). Case reports were overall of high quality, case series of moderate / high-quality, case–control studies ranged from low to high quality. In selected patients, minimally-invasive surgery for Klatskin tumors appears feasible, safe, satisfactory for perioperative outcomes and adequate for oncologic results. However, the results are based on few studies, limited in patient numbers and with allocation criteria more restrictive than open, reporting short follow-up and mainly with non-comparative design: evidence of higher quality is recommended.
Published: 2020

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

Author: Simone, Famularo, Matteo, Donadon, Federica, Cipriani, Francesco, Ardito, Maurizio, Iaria, Francesca, Carissimi, Pasquale, Perri, Tommaso, Dominioni, Matteo, Zanello, Simone, Conci, Sarah, Molfino, Fabrizio, D'Acapito, Paola, Germani, Cecilia, Ferrari, Stefan, Patauner, Enrico, Pinotti, Ivano, Sciannamea, Marco, Garatti, Enrico, Lodo, Albert, Troci, Antonella, Delvecchio, Antonio, Floridi, Davide Paolo, Bernasconi, Luca, Fumagalli, Marco, Chiarelli, Riccardo, Memeo, Michele, Crespi, Giacomo, Zanus, Giuseppe, Zimmitti, Adelmo, Antonucci, Mauro, Zago, Antonio, Frena, Guido, Griseri, Paola, Tarchi, Giorgio, Ercolani, Gian Luca, Baiocchi, Andrea, Ruzzenente, Elio, Jovine, Marcello, Maestri, GianLuca, Grazi, Raffaele Dalla, Valle, Felice, Giuliante, Luca, Aldrighetti, Fabrizio, Romano, and Guido, Torzilli
Subjects: Carcinoma, Hepatocellular, Postoperative Complications, Liver Neoplasms, Ascites, Hepatectomy, Humans, Neoplasm Recurrence, Local, Disease-Free Survival, Retrospective Studies
Abstract: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence.Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence.Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41-71) for those with POA (p0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352-2.129, p0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921-1.822, p0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921-1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295-0.668, p0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p0.001).The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.
Published: 2020

42. Have we really understood when the efforts of laparoscopic liver resection are justified?-a complexity-based appraisal of the differential benefit

Author: Francesca Ratti, Michele Paganelli, Guido Fiorentini, Luca Aldrighetti, Federica Cipriani, Marco Catena, Ratti, Francesca, Cipriani, Federica, Fiorentini, Guido, Catena, Marco, Paganelli, Michele, and Aldrighetti, Luca
Subjects: medicine.medical_specialty, Laparoscopic, business.industry, General surgery, medicine, Original Article, business, complexity, liver, outcomes, Differential (mathematics), Resection
Abstract: BACKGROUND: The implementation of minimally invasive liver resection surgery (MILS) programs starts from procedures with a low degree of technical difficulty. Data regarding the real short-term advantage of laparoscopy according to technical difficulty are still lacking. The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always justified. METHODS: Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity (low, intermediate and high difficulty) and to approach (MILS or open) and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups (Pair 1: Low-MILS and Low-Open, including 274 cases respectively; Pair 2: Int-MILS and Int-Open, including 237 patients respectively; Pair 3: High-MILS and High-Open, including 226 patients respectively). RESULTS: MILS approach resulted in a statistically significant lower blood loss, reduced morbidity, reduced and shorter time for functional recover and length of stay within all pairs. The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree, both in terms of blood loss (–250 and –200 mL respectively) and morbidity rate (–5.7% and –4.1% respectively). CONCLUSIONS: The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures. The commitment towards MILS approach should be therefore stronger in this setting, where the advantage of laparoscopy seems to be enhanced.
Published: 2020

43. Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres

Author: D.J. Lips, P M P Van den Tol, Amal Suhool, Gijs A. Patijn, Türkan Terkivatan, Burak Görgec, J. S. D. Mieog, Joost M. Klaase, M. Liem, Hendrik A. Marsman, Koop Bosscha, Rutger-Jan Swijnenburg, R S Fichtinger, Marc H.A. Bemelmans, Pieter J. Tanis, Michael F. Gerhards, Wouter K. G. Leclercq, Francesca Ratti, Marc G. Besselink, J. Hagendoorn, R.M. van Dam, Martijn W J Stommel, C L Nota, Ra’ed Al-jarrah, Vincent B. Nieuwenhuijs, Chc Dejong, Paul D. Gobardhan, Federica Cipriani, Luca Aldrighetti, Werner A. Draaisma, Bjørn Edwin, Maarten Vermaas, Åsmund Avdem Fretland, T. Armstrong, Quintus Molenaar, M. Abu Hilal, Geert Kazemier, Arjen M. Rijken, Andries E. Braat, G. D. Slooter, Pascal G. Doornebosch, M de Boer, Davit L. Aghayan, M.J. van der Poel, W W Te Riele, P.B. van den Boezem, J. A. B. van der Hoeven, Graduate School, Radiology and Nuclear Medicine, Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, Gorgec, B., Fichtinger, R. S., Ratti, F., Aghayan, D., Van Der Poel, M. J., Al-Jarrah, R., Armstrong, T., Cipriani, F., Fretland, A. A., Suhool, A., Bemelmans, M., Bosscha, K., Braat, A. E., De Boer, M. T., Dejong, C. H. C., Doornebosch, P. G., Draaisma, W. A., Gerhards, M. F., Gobardhan, P. D., Hagendoorn, J., Kazemier, G., Klaase, J., Leclercq, W. K. G., Liem, M. S., Lips, D. J., Marsman, H. A., Mieog, J. S. D., Molenaar, Q. I., Nieuwenhuijs, V. B., Nota, C. L., Patijn, G. A., Rijken, A. M., Slooter, G. D., Stommel, M. W. J., Swijnenburg, R. J., Tanis, P. J., Te Riele, W. W., Terkivatan, T., Van Den Tol, P. M. P., Van Den Boezem, P. B., Van Der Hoeven, J. A., Vermaas, M., Edwin, B., Aldrighetti, L., Van Dam, R. M., Abu Hilal, M., Besselink, M. G., RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Heelkunde (9), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Groningen Institute for Organ Transplantation (GIOT), and Value, Affordability and Sustainability (VALUE)
Subjects: Male, medicine.medical_specialty, Carcinoma, Hepatocellular, SURGERY, IMPACT, 030230 surgery, Liver resections, Resection, 03 medical and health sciences, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Risk groups, Postoperative Complications, Risk Factors, Medicine, Hepatectomy, Humans, Propensity Score, Aged, Netherlands, Retrospective Studies, RISK, business.industry, General surgery, Incidence, Liver Neoplasms, Middle Aged, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], METASTASES, HOSPITALS, 030220 oncology & carcinogenesis, DIFFICULTY, Female, Laparoscopy, business, Hospital stay, Hospitals, High-Volume, Cohort study, Follow-Up Studies
Abstract: Background Based on excellent outcomes from high-volume centres, laparoscopic liver resection is increasingly being adopted into nationwide practice which typically includes low-medium volume centres. It is unknown how the use and outcome of laparoscopic liver resection compare between high-volume centres and low-medium volume centres. This study aimed to compare use and outcome of laparoscopic liver resection in three leading European high-volume centres and nationwide practice in the Netherlands. Method An international, retrospective multicentre cohort study including data from three European high-volume centres (Oslo, Southampton and Milan) and all 20 centres in the Netherlands performing laparoscopic liver resection (low-medium volume practice) from January 2011 to December 2016. A high-volume centre is defined as a centre performing >50 laparoscopic liver resections per year. Patients were retrospectively stratified into low, moderate- and high-risk Southampton difficulty score groups. Results A total of 2425 patients were included (1540 high-volume; 885 low-medium volume). The median annual proportion of laparoscopic liver resection was 42.9 per cent in high-volume centres and 7.2 per cent in low-medium volume centres. Patients in the high-volume centres had a lower conversion rate (7.4 versus 13.1 per cent; P Conclusion High-volume expert centres had a sixfold higher use of laparoscopic liver resection, less conversions, and shorter hospital stay, as compared to a nationwide low-medium volume practice. Stratification into Southampton difficulty score risk groups identified some differences but largely outcomes appeared better for high-volume centres in each risk group.
Published: 2020

44. Pure laparoscopic right hepatectomy: A risk score for conversion for the paradigm of difficult laparoscopic liver resections. A single centre case series

Author: Francesca Ratti, Marco Catena, Guido Fiorentini, Michele Paganelli, Luca Aldrighetti, Federica Cipriani, Cipriani, F., Ratti, F., Fiorentini, G., Catena, M., Paganelli, M., and Aldrighetti, L.
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Specific risk, 030230 surgery, Inferior vena cava, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Medicine, Hepatectomy, Humans, Derivation, Risk factor, Aged, Aged, 80 and over, Framingham Risk Score, business.industry, Hazard ratio, Liver Neoplasms, Conversion, General Medicine, Laparoscopic liver resection, Middle Aged, Surgery, medicine.vein, 030220 oncology & carcinogenesis, Cohort, Risk score, Female, Laparoscopy, business, Laparoscopic right hepatectomy
Abstract: Background Converted laparoscopic hepatectomies are known to lose some advantages of the minimally-invasiveness, and factors are identified to predict patients at risk. Specific evidence for laparoscopic right hepatectomy is expected of usefulness in clinical practice, given its technical peculiarities. The purpose of the study was the identification of risk factors and the development of a risk score for conversion of laparoscopic right hepatectomy. Materials and Methods Laparoscopic right hepatectomy performed at a single hepatobiliary surgical center were analyzed. The cohort was split in half to obtain a derivation and a validation set. Risk factors for conversion were identified by uni- and multivariable analysis. A “conversion risk score” was built assigning each factor 1 point and comparing the score with the conversion status for each patient. The accuracy was assessed by the area-under-the-receiver–operator-characteristic-curve. Results Among 130 operations, 22 were converted (16.9%). Reasons were: 45.5% oncologic inadequacy, 31.8% bleeding, 9.1% adhesions, 9.1% biliostasis, 4.5% anaesthesiological problems. Independent risk factors for conversion were: previous laparoscopic liver surgery (Hazard Ratio 4.9, p 0.011), preoperative chemotherapy ( Hazard Ratio 6.2, p 0.031), malignant diagnosis (Hazard Ratio 3.3, p 0.037), closeness to hepatocaval confluence or inferior vena cava (Hazard Ratio 4.1, p 0.029), tumor volume (Hazard Ratio 2.9, p 0.024). Conversion rates correlated positively with the score, raising from 0 to 100% when the score increased from 0 to 5 (Spearman: p 0.032 in the derivation set, p 0.020 in the validation set). The risk of conversion showed a sharp increase passing from class 3 to 4, reaching a probability estimated between 60 and 71.4%. The score showed good accuracy (area-under-the-receiver–operator-characteristic-curve 0.82). Conclusion Specific risk factors for conversion are identified for laparoscopic right hepatectomy. This score may help in standardizing the choice of a pure laparoscopic or open approach for such challenging resections.
Published: 2020

45. Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study

Author: Tan To Cheung, Roberto Montalti, Mariano Cesare Giglio, Annamaria Ferrero, Gregory C. Wilson, Nadia Russolillo, Masayuki Yamamoto, Hironori Kaneko, Chung-Yip Chan, Vincenzo Mazzaferro, Federica Cipriani, Roberto Troisi, I. Simonelli, Luca Aldrighetti, Guido Torzilli, H.-S. Han, K. Igarashi, S. Ariizumi, Shoji Kubo, Zenichi Morise, Matteo Cimino, Brian K. P. Goh, Carlo Sposito, Giuseppe Maria Ettorre, Go Wakabayashi, Sayaka Tanaka, V. Panetta, Giammauro Berardi, Daniel A. Geller, A. Kanazawa, S. Kim, Y. Takeda, Troisi, R. I., Berardi, G., Morise, Z., Cipriani, F., Ariizumi, S., Sposito, C., Panetta, V., Simonelli, I., Kim, S., Goh, B. K. P., Kubo, S., Tanaka, S., Takeda, Y., Ettorre, G. M., Russolillo, N., Wilson, G. C., Cimino, M., Montalti, R., Giglio, M. C., Igarashi, K., Chan, C. -Y., Torzilli, G., Cheung, T. T., Mazzaferro, V., Kaneko, H., Ferrero, A., Geller, D. A., Han, H. -S., Kanazawa, A., Wakabayashi, G., Aldrighetti, L., and Yamamoto, M.
Subjects: Liver Cirrhosis, Male, Cirrhosis, Blood Loss, Surgical, Severity of Illness Index, 0302 clinical medicine, Retrospective Studie, Ascites, Laparoscopy, Aged, 80 and over, medicine.diagnostic_test, Liver Neoplasms, Middle Aged, Prognosis, Liver Neoplasm, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Portal hypertension, 030211 gastroenterology & hepatology, Female, Survival Analysi, medicine.symptom, Human, Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Prognosi, Liver Cirrhosi, Preoperative care, Disease-Free Survival, 03 medical and health sciences, Young Adult, Hypertension, Portal, medicine, Hepatectomy, Humans, Propensity Score, Survival rate, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Length of Stay, medicine.disease, Survival Analysis, Surgery, business
Abstract: Background Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child–Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child–Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child–Pugh B cirrhosis. Methods Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. Results Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child–Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P Conclusion Patients without preoperative portal hypertension and Child–Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
Published: 2020

46. A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017

Author: Yukihiro Okuda, Sira Ocaña, Javier Briceño, Mark Halls, Olivier Soubrane, Fernando Rotellar, Federica Cipriani, Irene Gomez-Luque, Ruben Ciria, Mohammed Abu Hilal, Roberto Troisi, Ciria, R, Gomez-Luque, I, Ocaña, S, Cipriani, F, Halls, M, Briceño, J, Okuda, Y, Troisi, Roberto, Rotellar, F, Soubrane, O, and Abu Hilal, M
Subjects: Liver surgery, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, 030230 surgery, Liver resections, Resection, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Surgical oncology, medicine, Long term outcomes, Hepatectomy, Humans, business.industry, General surgery, Liver Neoplasms, Length of Stay, Prognosis, medicine.disease, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Meta-analysis, Practice Guidelines as Topic, Laparoscopy, Surgery, business
Abstract: BACKGROUND: The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed. OBJECTIVE: The aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC). METHODS: To identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child-Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle-Ottawa Scale. RESULTS: From the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child-Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches. CONCLUSIONS: Laparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.
Published: 2018
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47. Perioperative and Long-Term Outcomes of Laparoscopic Versus Open Lymphadenectomy for Biliary Tumors: A Propensity-Score-Based, Case-Matched Analysis

Author: Federica Cipriani, Luca Aldrighetti, Michele Paganelli, Guido Fiorentini, Francesca Ratti, Marco Catena, Ratti, F, Fiorentini, G, Cipriani, F, Paganelli, M, Catena, M, and Aldrighetti, L
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, Surgical oncology, Open Resection, medicine, Humans, Prospective Studies, Gallbladder cancer, Perioperative Period, Propensity Score, Intrahepatic Cholangiocarcinoma, Retrospective Studies, business.industry, Perioperative, Middle Aged, medicine.disease, Surgery, Survival Rate, Dissection, Biliary Tract Neoplasms, Treatment Outcome, Oncology, Case-Control Studies, 030220 oncology & carcinogenesis, Propensity score matching, Lymph Node Excision, Female, Laparoscopy, 030211 gastroenterology & hepatology, Lymphadenectomy, business, Follow-Up Studies
Abstract: The purpose of this study was to compare patients undergoing MILS and open liver resections with associated lymphadenectomy for biliary tumors (intrahepatic cholangiocarcinoma and gallbladder cancer) in a case-matched analysis using propensity scores. A total of 104 consecutive patients underwent liver resection with associated locoregional lymphadenectomy by laparoscopic approach constituted the study group (MILS group). The MILS group was matched in a ratio of 1:2 with patients who had undergone open resection for primary biliary cancers (Open group). Short- and long-term outcomes were evaluated and compared, with specific focus on specific details of lymphadenectomy. Laparoscopic series resulted in a statistically significant lower blood loss (200 vs. 350, p = 0.03), minor intraoperative blood transfusions (3.2% vs. 7.9%, p = 0.04), and postoperative blood transfusions (10.5% vs. 15.8%), other than shorter length of stay (4 vs. 6 days, p = 0.04). Number of retrieved nodes was 8 versus 7 (p = not significant); particularly, percentage of patients who achieved the recommended AJCC cutoff of six lymph nodes harvested were 93.7% versus 85.8% (p = 0.05). Both overall and lymphadenectomy-related morbidity (bleeding, pancreatitis, lymphatic fistula, vascular, and biliary injuries) were lower in MILS group (respectively 16.3% and 3.2% vs. 22.1% and 5.3%, p = 0.03). Median disease-free survival was 33 versus 36 months and disease recurrence occurred in 45.3% versus 55.3% of patients in MILS and Open groups respectively. Laparoscopic approach for lymphadenectomy is a valid option in patients with biliary cancers, because it allows to maintain the advantages of minimally invasive approach, without compromising the accuracy and the outcomes of nodal dissection.
Published: 2018
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48. Effect of Previous Abdominal Surgery on Laparoscopic Liver Resection: Analysis of Feasibility and Risk Factors for Conversion

Author: Federica Cipriani, Michele Paganelli, Luca Aldrighetti, Francesca Ratti, Guido Fiorentini, Marco Catena, Cipriani, F, Ratti, F, Fiorentini, G, Catena, M, Paganelli, M, and Aldrighetti, L
Subjects: Adult, Male, Liver surgery, medicine.medical_specialty, Resection, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Abdomen, Outcome Assessment, Health Care, parasitic diseases, medicine, Hepatectomy, Humans, Laparoscopy, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Middle Aged, Conversion to Open Surgery, Surgery, Case-Control Studies, 030220 oncology & carcinogenesis, Feasibility Studies, Female, 030211 gastroenterology & hepatology, Patient Safety, business, Abdominal surgery
Abstract: Introduction: Previous abdominal surgery has traditionally been considered an additional element of difficulty to later laparoscopic procedures. The aim of the study is to analyze the effect of previous surgery on the feasibility and safety of laparoscopic liver resection (LLR), and its role as a risk factor for conversion. Materials and Methods: After matching, 349 LLR in patients known for previous abdominal surgery (PS group) were compared with 349 LLR on patients with a virgin abdomen (NPS group). Subgroup analysis included 161 patients with previous upper abdominal surgery (UPS subgroup). Feasibility and safety were evaluated in terms of conversion rate, reasons for conversion and outcomes, and risk factors for conversion assessed via uni/multivariable analysis. Results: Conversion rate was 9.4%, and higher for PS patients compared with NPS patients (13.7% versus 5.1%, P=.021). Difficult adhesiolysis resulted the commonest reason for conversion in PS group (5.7%). However, operative time (P=.840), blood loss (P=.270), transfusion (P=.650), morbidity rate (P=.578), hospital stay (P=.780), and R1 rate (P=.130) were comparable between PS and NPS group. Subgroup analysis confirmed higher conversion rates for UPS patients (23%) compared with both NPS (P=.015) and PS patients (P=.041). Previous surgery emerged as independent risk factor for conversion (P=.033), alongside the postero-superior location and major hepatectomy. Conclusion: LLR are feasible in case of previous surgery and proved to be safe and maintain the benefits of LLR carried out in standard settings. However, a history of surgery should be considered a risk factor for conversion.
Published: 2018
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49. Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data

Author: Mohammad Abu Hilal, Baki Topal, Francesca Ratti, Meidai Kasai, Juan M. Sarmiento, Olivier Scatton, Ibrahim Dagher, John N. Primrose, Luca Aldrighetti, Ki-Hun Kim, Brice Gayet, Federica Cipriani, David Fuks, Takeo Nomi, Kasai, M, Cipriani, F, Gayet, B, Aldrighetti, L, Ratti, F, Sarmiento, Jm, Scatton, O, Kim, Kh, Dagher, I, Topal, B, Primrose, J, Nomi, T, Fuks, D, and Abu Hilal, M
Subjects: medicine.medical_specialty, Operative Time, Blood Loss, Surgical, MEDLINE, 030230 surgery, law.invention, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, law, medicine, Hepatectomy, Humans, Laparoscopy, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Mortality rate, Liver Neoplasms, Retrospective cohort study, Perioperative, Length of Stay, Surgery, 030220 oncology & carcinogenesis, Meta-analysis, business
Abstract: Background: The role of laparoscopy for major hepatectomies remains a matter of development to be further assessed. The purpose of this study is to compare the short-and long-term outcomes between laparoscopic and open major hepatectomies meta-analyzing individual patient data from published comparative studies. Methods: All retrospective studies comparing between laparoscopic and open major hepatectomies published until March 2017 were identified independently by 2 reviewers by searching in PubMed and Cochrane Central Register of Controlled Trials. Individual patient data were sought from all selected studies. Postoperative outcomes, including intraoperative blood loss, operative time, hospital stay, postoperative complications, mortality rates, and long-term survival were analyzed. Results: A total of 917 patients were divided into the laparoscopic (427) and open (490) groups from 8 selected studies. The hospital stay was significantly shorter, and the total morbidity was lower in the laparoscopic group. When classified by severity, the incidence of postoperative minor complications was lower; however, that of major complications was not significantly different. The operative time was longer in the laparoscopic group; however, intraoperative blood loss, perioperative mortality, and blood transfusions were comparable between the 2 groups. The overall survival in the patients with colorectal liver metastases and hepatocellular carcinoma was not significantly different between the 2 groups. Conclusion: Laparoscopic major hepatectomies offer some perioperative advantages, including fewer complications and shorter hospital stay, without increasing the blood loss volume and mortality. Whether these results can anticipate the outcomes in future randomized controlled trials has not been determined. (C) 2018 Elsevier Inc. All rights reserved.
Published: 2018
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50. ASO Author Reflections: The SMART-ALPPS Protocol—Strategy to Minimize ALPPS Risks by Targeting Invasiveness

Author: Luca Aldrighetti, Francesca Ratti, Guido Fiorentini, Federica Cipriani, Fiorentini, G., Ratti, F., Cipriani, F., and Aldrighetti, L.
Subjects: Protocol (science), medicine.medical_specialty, Oncology, Portal Vein, Surgical oncology, business.industry, medicine, Hepatectomy, Humans, Surgery, Medical physics, business
Published: 2021
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