931 results on '"Giuliante, F."'
Search Results
2. Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy
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Korenblik, R., Olij, B., Aldrighetti, L. A., Hilal, M. Abu, Ahle, M., Arslan, B., van Baardewijk, L. J., Baclija, I., Bent, C., Bertrand, C. L., Björnsson, B., de Boer, M. T., de Boer, S. W., Bokkers, R. P. H., Rinkes, I. H. M. Borel, Breitenstein, S., Bruijnen, R. C. G., Bruners, P., Büchler, M. W., Camacho, J. C., Cappelli, A., Carling, U., Chan, B. K. Y., Chang, D. H., choi, J., Font, J. Codina, Crawford, M., Croagh, D., Cugat, E., Davis, R., De Boo, D. W., De Cobelli, F., De Wispelaere, J. F., van Delden, O. M., Delle, M., Detry, O., Díaz-Nieto, R., Dili, A., Erdmann, J. I., Fisher, O., Fondevila, C., Fretland, Å., Borobia, F. Garcia, Gelabert, A., Gérard, L., Giuliante, F., Gobardhan, P. D., Gómez, F., Grünberger, T., Grünhagen, D. J., Guitart, J., Hagendoorn, J., Heil, J., Heise, D., Herrero, E., Hess, G. F., Hoffmann, M. H., Iezzi, R., Imani, F., Nguyen, J., Jovine, E., Kalff, J. C., Kazemier, G., Kingham, T. P., Kleeff, J., Kollmar, O., Leclercq, W. K. G., Ben, S. Lopez, Lucidi, V., MacDonald, A., Madoff, D. C., Manekeller, S., Martel, G., Mehrabi, A., Mehrzad, H., Meijerink, M. R., Menon, K., Metrakos, P., Meyer, C., Moelker, A., Modi, S., Montanari, N., Navines, J., Neumann, U. P., Peddu, P., Primrose, J. N., Qu, X., Raptis, D., Ratti, F., Ridouani, F., Rogan, C., Ronellenfitsch, U., Ryan, S., Sallemi, C., Moragues, J. Sampere, Sandström, P., Sarriá, L., Schnitzbauer, A., Serenari, M., Serrablo, A., Smits, M. L. J., Sparrelid, E., Spüntrup, E., Stavrou, G. A., Sutcliffe, R. P., Tancredi, I., Tasse, J. C., Udupa, V., Valenti, D., Fundora, Y., Vogl, T. J., Wang, X., White, S. A., Wohlgemuth, W. A., Yu, D., Zijlstra, I. A. J., Binkert, C. A., Bemelmans, M. H. A., van der Leij, C., Schadde, E., and van Dam, R. M.
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- 2022
- Full Text
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3. Heterogeneity of management practices surrounding operable gallbladder cancer – results of the OMEGA-S international HPB surgical survey
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Abe, T., Achalandabaso, M., Adham, M., Ahmet, A., Al-Sarireh, B., Albiol Quer, M., Alconchel, F., Alsammani, M., Alseidi, A., Anand, A., Anselmo, A., Antonakis, P., Arabadzhieva, E., de Aretxabala, X., Aroori, S., Ashley, S., Ausania, F., Banerjee, A., Barabino, M., Bartlett, A., Bartsch, F., Belli, A., Beristain-Hernandez, J., Berrevoet, F., Bhatti, A.B.H., Bhojwani, R., Bjornsson, B., Blaz, T., Byrne, M., Calvo, M.P., Castellanos, J., Castro, M.J., Cavallucci, D., Chang, D., Christodoulis, G., Ciacio, O., Clavien, P.A., Coker, A., Conde-Rodriguez, M., D'Amico, F.E., D'Hondt, M., Daams, F., Dasari, B.V.M., De Bellis, M., de Meijer, V.E., Dede, K., Deiro, G., Delgado, F.J.B., Desai, G., Di Gioia, A., Di Martino, M., Dixon, M., Dorovinis, P., Dumitrascu, T., Ebata, T., Eilard, M.S., Erdmann, J., Erkan, M., Famularo, S., Felli, E., Fergadi, M., Fernandez, G.B., Fox, A., Galodha, S., Galun, D., Ganandha, S., Garcia, R.J.R., Gemenetzis, G., Giannone, F., Gil, L., Giorgakis, E., Giovinazzo, F., Giuffrida, M., Giuliani, T., Giuliante, F., Gkekas, I., Goel, M., Goh, B.K., Gomes, A., Gruenberger, T., Guevara, O., Gulla, A., Gupta, A., Gupta, R., Hakeem, A.R., Hamid, H.K.S., Heinrich, S., Helton, S., Hernandez-Alejandro, R., Heumann, A., Higuchi, R., Hughes, D., Inarejos, B.C., Ivanecz, A., Iwao, Y., Iype, S., Jaen, I., Jie, M.J., Jones, R., Kacirek, K., Kalayarasan, R., Kaldarov, A., Kaman, L., Kanhere, H., Kapoor, V.K., Karanicolas, P., Karayiannakis, A., Kausar, A., Khan, Z.A., Kim, D.-S., Klose, J., Knowles, B., Koh, P.S., Kolodziejczyk, P., Komorowski, A.L., Koong, J.K., Kozyrin, I., Krishna, A., Kron, P., Kumar, N., van Laarhoven, S., Lakhey, P.J., Lanari, J., Laurenzi, A., Leow, V.M., Limbu, Y., Liu, Y.-B., Lob, S., Lolis, E., Lopez-Lopez, V., Lozano, R.C., Lundgren, L., Machairas, N., Magouliotis, D., Mahamid, A., Malde, D., Malek, A., Malik, H., Malleo, G., Marino, M.V., Mayo, S.C., Mazzola, M., Memeo, R., Menon, K., Menzulin, R., Mohan, R., Morgul, H., Moris, D., Mulita, F., Muttillo, E.M., Nahm, C., Nandasena, M., Nashidengo, P.R., Nickkholgh, A., Nikov, A., Noel, C., O'Reilly, D., O'Rourke, T., Ohtsuka, M., Omoshoro-Jones, J.A.O., Pandanaboyana, S., Pararas, N., Patel, R., Patkar, S., Peng, J.S., Perfecto, A., Perinel, J., Perivoliotis, K., Perra, T., Phan, M.T., Piccolo, G., Porcu, A., Primavesi, F., Primrose, J., Pueyo-Periz, E., Radenkovic, D., Rammohan, A., Rowcroft, A., Sakata, J., Saladino, E., Schena, C.A., Scholer, A., Schwarz, C., Serrano, P., Silva, M., Soreide, K., Sparrelid, E., Stattner, S., Sturesson, C., Sugiura, T., Sumo, M., Sutcliffe, R., Teh, C., Teo, J.Y., Tepetes, K., Thapa, P.B., Thepbunchonchai, A., Torres, J.B.P., Torres, O.J.M., Torzili, G., Tovikkai, C., Troncoso, A., Tsoulfas, G., Tuzuher, A., Tzimas, G., Umar, G.I., Urbani, L., Vanagas, T., Varga, Velayutham, V., Vigano, L., Wakai, T., Yang, Z., Yip, V., Zacharoulis, D., Zakharov, E.A., Zimmitti, G., Balakrishnan, Anita, Jah, Asif, Lesurtel, Mickael, Andersson, Bodil, Gibbs, Paul, Harper, Simon J.F., Huguet, Emmanuel L., Kosmoliaptsis, Vasilis, Liau, Siong S., Praseedom, Raaj K., Ramia, Jose M., Branes, Alejandro, Lendoire, Javier, Maithel, Shishir, and Serrablo, Alejandro
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- 2022
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4. Open vs minimally invasive liver surgery for gallbladder cancer, an Italian registry-based analysis
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Poletto, E., primary, Conci, S., additional, Ettorre, G.M., additional, Cillo, U., additional, Belli, A., additional, Giuliante, F., additional, Jovine, E., additional, Vennarecci, G., additional, Frena, A., additional, Ferrero, A., additional, Gruttadauria, S., additional, Ercolani, G., additional, Di Benedetto, F., additional, Brolese, A., additional, Dalla Valle, R., additional, Ettore Rossi, G., additional, Barabino, M., additional, Filauro, M., additional, Morelli, L., additional, Massani, M., additional, Vincenti, L., additional, Aldrighetti, L., additional, and Ruzzenente, A., additional
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- 2024
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5. Neoadjuvant FOLFOXIRI for colorectal liver metastases: insights from a multi- institutional study
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Panettieri, E., primary, De Rose, A.M., additional, Lendoire, M., additional, Ayabe, R., additional, Nakao, Y., additional, Maki, H., additional, Ardito, F., additional, Adam, R., additional, Vauthey, J.N., additional, and Giuliante, F., additional
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- 2024
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6. Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study
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Rystedt, Jenny M.L., Kleeff, Jörg, Salvia, Roberto, Besselink, Mark G., Prasad, Raj, Lesurtel, Mickael, Sturesson, Christian, Abu Hilal, M., Aljaiuossi, A., Antonucci, A., Ardito, F., Ausania, F., Bernon, M., Berrevoet, F., Björnsson, B., Bonsing, B.A., Boonstra, E.A., Bracke, B., Brusadin, R., Burda, L., Caraballo, M., Casellas-Robert, M., Çoker, A., Davide, J., De Gelder, A., De Rose, A.M., Djokic, M., Dudek, K., Ekmekçigil, E., Filauro, M., Fülöp, A., Gallagher, T., Gastaca, M., Gefen, R., Giuliante, F., Habibeh, H., Halle-Smith, J., Haraldsdottir, K.H., Hartman, V., Hauer, A., Hemmingsson, O., Hoskovec, D., Isaksson, B., Jonas, E., Khalaileh, A., Klug, R., Krige, J., Lignier, D., Lindemann, J., López-López, V., Lucidi, V., Mabrut, J.-Y., Månsson, C., Mieog, S., Mirza, D.F., Oldhafer, K.J., Omoshoro-Jones, J.A.O., Ortega-Torrecilla, N., Otto, W., Panaro, F., Pando, E., Paterna-López, S., Pekmezci, S., Pesce, A., Porte, R.J., Poves, I., Prieto Calvo, M., Primavesi, F., Puleo, S., Recordare, A., Rizell, M., Roberts, K., Robles-Campos, R., Sanchiz-Cardenas, E., Sandström, P., Saribeyoglu, K., Schauer, M., Schreuder, M., Siriwardena, A.K., Smith, M.D., Sousa Silva, D., Sparrelid, E., Stättner, S., Stavrou, G.A., Straka, M., Strömberg, C., Sutcliffe, R.P., Szijártó, A., Taflin, H., Trotovšek, B., van Gulik, T., Wallach, N., and Zieniewicz, K.
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- 2019
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7. The Effect of a Liver Transplant Program on the Outcomes of Resectable Hepatocellular Carcinoma: A Nationwide Multicenter Analysis
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Serenari, M, Lenzi, J, Cucchetti, A, Cipriani, F, Donadon, M, Ardito, F, Fazio, F, Nicolini, D, Iaria, M, Famularo, S, Perri, P, Ansaloni, L, Zanello, M, Lai, Q, Conci, S, Molfino, S, Ferrari, C, Germani, P, Zago, M, Romano, M, Zimmitti, G, Antonucci, A, Fumagalli, L, Troci, A, Ferraro, V, Memeo, R, Crespi, M, Chiarelli, M, Ercolani, G, Hilal, M, Zanus, G, Pinotti, E, Tarchi, P, Griseri, G, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Grazi, G, Romano, F, Dalla Valle, R, Ravaioli, M, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Cescon, M, Gorgone, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, Giuffrida, M, Scotti, M, Garancini, M, De Peppo, V, De Stefano, F, Laureiro, Z, Marchitelli, I, Franceschi, A, Cosola, D, Corleone, P, Montuori, M, Salvador, L, Manzoni, A, La Barba, G, Calcagno, P, Pennacchi, L, Conticchio, M, Serenari M., Lenzi J., Cucchetti A., Cipriani F., Donadon M., Ardito F., Fazio F., Nicolini D., Iaria M., Famularo S., Perri P., Ansaloni L., Zanello M., Lai Q., Conci S., Molfino S., Ferrari C., Germani P., Zago M., Romano M., Zimmitti G., Antonucci A., Fumagalli L., Troci A., Ferraro V., Memeo R., Crespi M., Chiarelli M., Ercolani G., Hilal M. A., Zanus G., Pinotti E., Tarchi P., Griseri G., Baiocchi G. L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Grazi G. L., Romano F., Dalla Valle R., Ravaioli M., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Cescon M., Gorgone M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., Giuffrida M., Scotti M., Garancini M., De Peppo V., De Stefano F., Laureiro Z. L., Marchitelli I., Franceschi A., Cosola D., Corleone P., Montuori M., Salvador L., Manzoni A., La Barba G., Calcagno P., Pennacchi L., Conticchio M., Serenari, M, Lenzi, J, Cucchetti, A, Cipriani, F, Donadon, M, Ardito, F, Fazio, F, Nicolini, D, Iaria, M, Famularo, S, Perri, P, Ansaloni, L, Zanello, M, Lai, Q, Conci, S, Molfino, S, Ferrari, C, Germani, P, Zago, M, Romano, M, Zimmitti, G, Antonucci, A, Fumagalli, L, Troci, A, Ferraro, V, Memeo, R, Crespi, M, Chiarelli, M, Ercolani, G, Hilal, M, Zanus, G, Pinotti, E, Tarchi, P, Griseri, G, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Grazi, G, Romano, F, Dalla Valle, R, Ravaioli, M, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Cescon, M, Gorgone, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, Giuffrida, M, Scotti, M, Garancini, M, De Peppo, V, De Stefano, F, Laureiro, Z, Marchitelli, I, Franceschi, A, Cosola, D, Corleone, P, Montuori, M, Salvador, L, Manzoni, A, La Barba, G, Calcagno, P, Pennacchi, L, Conticchio, M, Serenari M., Lenzi J., Cucchetti A., Cipriani F., Donadon M., Ardito F., Fazio F., Nicolini D., Iaria M., Famularo S., Perri P., Ansaloni L., Zanello M., Lai Q., Conci S., Molfino S., Ferrari C., Germani P., Zago M., Romano M., Zimmitti G., Antonucci A., Fumagalli L., Troci A., Ferraro V., Memeo R., Crespi M., Chiarelli M., Ercolani G., Hilal M. A., Zanus G., Pinotti E., Tarchi P., Griseri G., Baiocchi G. L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Grazi G. L., Romano F., Dalla Valle R., Ravaioli M., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Cescon M., Gorgone M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., Giuffrida M., Scotti M., Garancini M., De Peppo V., De Stefano F., Laureiro Z. L., Marchitelli I., Franceschi A., Cosola D., Corleone P., Montuori M., Salvador L., Manzoni A., La Barba G., Calcagno P., Pennacchi L., and Conticchio M.
- Abstract
Objective: To evaluate the effect of a liver transplantation (LT) program on the outcomes of resectable hepatocellular carcinoma (HCC). Background: Surgical treatment of HCC includes both hepatic resection (HR) and LT. However, the presence of cirrhosis and the possibility of recurrence make the management of this disease complex and probably different according to the presence of a LT program. Methods: Patients undergoing HR for HCC between January 2005 and December 2019 were identified from a national database of HCC. The main study outcomes were major surgical complications according to the Comprehensive Complication Index, posthepatectomy liver failure (PHLF), 90-day mortality, overall survival, and disease-free survival. Secondary outcomes were salvage liver transplantation (SLT) and postrecurrence survival. Results: A total of 3202 patients were included from 25 hospitals over the study period. Three of 25 (12%) had an LT program. The presence of an LT program within a center was associated with a reduced probability of PHLF (odds ratio=0.38) but not with overall survival and disease-free survival. There was an increased probability of SLT when HR was performed in a transplant hospital (odds ratio=12.05). Among transplant-eligible patients, those who underwent LT had a significantly longer postrecurrence survival. Conclusions: This study showed that the presence of a LT program was associated with decreased PHLF rates and an increased probability to receive SLT in case of recurrence.
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- 2023
8. Survival benefit of second line therapies for recurrent hepatocellular carcinoma: repeated hepatectomy, thermoablation and second-line transplant referral in a real life national scenario
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Famularo, S, Cillo, U, Lauterio, A, Donadon, M, Vitale, A, Serenari, M, Cipriani, F, Fazio, F, Giuffrida, M, Ardito, F, Dominioni, T, Garancini, M, Lai, Q, Nicolini, D, Molfino, S, Perri, P, Pinotti, E, Conci, S, Ferrari, C, Zanello, M, Patauner, S, Zimmitti, G, Germani, P, Chiarelli, M, Romano, M, De Angelis, M, La Barba, G, Troci, A, Ferraro, V, Izzo, F, Antonucci, A, Belli, A, Memeo, R, Crespi, M, Ercolani, G, Boccia, L, Zanus, G, Tarchi, P, Hilal, M, Frena, A, Jovine, E, Griseri, G, Ruzzenente, A, Zago, M, Grazi, G, Baiocchi, G, Vivarelli, M, Rossi, M, Romano, F, Maestri, M, Giuliante, F, Valle, R, Ferrero, A, Aldrighetti, L, De Carlis, L, Cescon, M, Torzilli, G, Milana, F, Bertacco, A, De Carlis, R, Ratti, F, Russolillo, N, Iaria, M, Razionale, F, Tartaglia, G, Ciulli, C, Carissimi, F, Laureiro, Z, Marinelli, L, Depeppo, V, Montuori, M, Marchitelli, I, Franceschi, A, Notte, F, Manzoni, A, Cosola, D, Corleone, P, Fumagalli, L, Salvador, L, Mantovani, G, Cucchetti, A, Cammarata, F, Conticchio, M, Patrone, R, Bernasconi, D, Famularo S., Cillo U., Lauterio A., Donadon M., Vitale A., Serenari M., Cipriani F., Fazio F., Giuffrida M., Ardito F., Dominioni T., Garancini M., Lai Q., Nicolini D., Molfino S., Perri P., Pinotti E., Conci S., Ferrari C., Zanello M., Patauner S., Zimmitti G., Germani P., Chiarelli M., Romano M., De Angelis M., La Barba G., Troci A., Ferraro V., Izzo F., Antonucci A., Belli A., Memeo R., Crespi M., Ercolani G., Boccia L., Zanus G., Tarchi P., Hilal M. A., Frena A., Jovine E., Griseri G., Ruzzenente A., Zago M., Grazi G., Baiocchi G. L., Vivarelli M., Rossi M., Romano F., Maestri M., Giuliante F., Valle R. D., Ferrero A., Aldrighetti L., De Carlis L., Cescon M., Torzilli G., Milana F., Bertacco A., De Carlis R., Ratti F., Russolillo N., Iaria M., Razionale F., Tartaglia G., Ciulli C., Carissimi F., Laureiro Z. L., Marinelli L., DePeppo V., Montuori M., Marchitelli I., Franceschi A., Notte F., Manzoni A., Cosola D., Corleone P., Fumagalli L., Salvador L., Mantovani G., Cucchetti A., Cammarata F., Conticchio M., Patrone R., Bernasconi D. P., Famularo, S, Cillo, U, Lauterio, A, Donadon, M, Vitale, A, Serenari, M, Cipriani, F, Fazio, F, Giuffrida, M, Ardito, F, Dominioni, T, Garancini, M, Lai, Q, Nicolini, D, Molfino, S, Perri, P, Pinotti, E, Conci, S, Ferrari, C, Zanello, M, Patauner, S, Zimmitti, G, Germani, P, Chiarelli, M, Romano, M, De Angelis, M, La Barba, G, Troci, A, Ferraro, V, Izzo, F, Antonucci, A, Belli, A, Memeo, R, Crespi, M, Ercolani, G, Boccia, L, Zanus, G, Tarchi, P, Hilal, M, Frena, A, Jovine, E, Griseri, G, Ruzzenente, A, Zago, M, Grazi, G, Baiocchi, G, Vivarelli, M, Rossi, M, Romano, F, Maestri, M, Giuliante, F, Valle, R, Ferrero, A, Aldrighetti, L, De Carlis, L, Cescon, M, Torzilli, G, Milana, F, Bertacco, A, De Carlis, R, Ratti, F, Russolillo, N, Iaria, M, Razionale, F, Tartaglia, G, Ciulli, C, Carissimi, F, Laureiro, Z, Marinelli, L, Depeppo, V, Montuori, M, Marchitelli, I, Franceschi, A, Notte, F, Manzoni, A, Cosola, D, Corleone, P, Fumagalli, L, Salvador, L, Mantovani, G, Cucchetti, A, Cammarata, F, Conticchio, M, Patrone, R, Bernasconi, D, Famularo S., Cillo U., Lauterio A., Donadon M., Vitale A., Serenari M., Cipriani F., Fazio F., Giuffrida M., Ardito F., Dominioni T., Garancini M., Lai Q., Nicolini D., Molfino S., Perri P., Pinotti E., Conci S., Ferrari C., Zanello M., Patauner S., Zimmitti G., Germani P., Chiarelli M., Romano M., De Angelis M., La Barba G., Troci A., Ferraro V., Izzo F., Antonucci A., Belli A., Memeo R., Crespi M., Ercolani G., Boccia L., Zanus G., Tarchi P., Hilal M. A., Frena A., Jovine E., Griseri G., Ruzzenente A., Zago M., Grazi G., Baiocchi G. L., Vivarelli M., Rossi M., Romano F., Maestri M., Giuliante F., Valle R. D., Ferrero A., Aldrighetti L., De Carlis L., Cescon M., Torzilli G., Milana F., Bertacco A., De Carlis R., Ratti F., Russolillo N., Iaria M., Razionale F., Tartaglia G., Ciulli C., Carissimi F., Laureiro Z. L., Marinelli L., DePeppo V., Montuori M., Marchitelli I., Franceschi A., Notte F., Manzoni A., Cosola D., Corleone P., Fumagalli L., Salvador L., Mantovani G., Cucchetti A., Cammarata F., Conticchio M., Patrone R., and Bernasconi D. P.
- Abstract
Background: Despite second-line transplant(SLT) for recurrent hepatocellular carcinoma(rHCC) leads to the longest survival after recurrence(SAR), its real applicability has never been reported. The aim was to compare the SAR of SLT versus repeated hepatectomy and thermoablation(CUR group). Methods: Patients were enrolled from the Italian register HE.RC.O.LE.S. between 2008 and 2021. Two groups were created: CUR versus SLT. A propensity score matching (PSM) was run to balance the groups. Results: 743 patients were enrolled, CUR = 611 and SLT = 132. Median age at recurrence was 71(IQR 6575) years old and 60(IQR 53-64, p < 0.001) for CUR and SLT respectively. After PSM, median SAR for CUR was 43 months(95%CI = 37 – 93) and not reached for SLT(p < 0.001). SLT patients gained a survival benefit of 9.4 months if compared with CUR. MilanCriteria(MC)-In patients were 82.7% of the CUR group. SLT(HR 0.386, 95%CI = 0.23 – 0.63, p < 0.001) and the MELD score(HR 1.169, 95%CI = 1.07 – 1.27, p < 0.001) were the only predictors of mortality. In case of MC-Out, the only predictor of mortality was the number of nodules at recurrence(HR 1.45, 95%CI= 1.09 – 1.93, p = 0.011). Conclusion: It emerged an important transplant under referral in favour of repeated hepatectomy or thermoablation. In patients with MC-Out relapse, the benefit of SLT over CUR was not observed.
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- 2023
9. Development and validation of a comprehensive model to predict complications after hepatectomy.
- Author
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GASPARI, R., ARDITO, F., PAFUNDI, P. C., AVOLIO, A. W., ACETO, P., ADDUCCI, E., PALLOCCHI, M., PARENTE, E., SOLLAZZI, L., ANTONELLI, M., and GIULIANTE, F.
- Abstract
OBJECTIVE: Despite advances in perioperative care, hepatectomy remains associated with morbidity rates of up to 40%. Currently, available nomograms for predicting severe post-hepatectomy complications do not include early postoperative data. This retrospective observational study aimed to determine whether the parameters routinely measured in patients admitted to the Intensive Care Unit (ICU) after hepatectomy could represent risk factors for severe morbidity and to propose a nomogram scoring system to predict severe postoperative complications. PATIENTS AND METHODS: 411 adult patients who underwent elective hepatectomy at a high-volume tertiary care center for hepatic surgery from December 2016 to June 2022 were enrolled. The primary outcome was the assessment of predictors of 30-day severe postoperative complications following hepatectomy, defined as Clavien-Dindo grade 3a or higher. As a secondary outcome, we aimed to develop an easy-to-use scoring system to estimate the risk of severe postoperative complications. RESULTS: Severe complications occurred in 78 patients (19%). The final model included body mass index, preoperative bilirubin level, and ICU data (i.e., pH, lactate clearance, arterial lactate concentration 12 hours after ICU admission, need for packed red blood cell transfusions, and length of stay). Notably, the latter three variables were proven to be independent predictors of the outcomes. The model showed an overall good fit (C-index=0.754, corrected Dxy=0.692). A calibration plot using bootstrap internal validity resampling confirmed the stability of the model (mean absolute error=0.017, root mean square error of approximation=0.00051). CONCLUSIONS: We developed an accurate and practical scoring system based on preoperative and early postoperative data to predict poor outcomes after hepatectomy. Further external validation on larger series could lead to the integration of such a tool in the routine clinical practice to support patients' management and early warning during ICU stay. [ABSTRACT FROM AUTHOR]
- Published
- 2024
10. Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry
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Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Salvatore, G, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Salvatore G., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Salvatore, G, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Salvatore G., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., and Zimmitti G.
- Abstract
Laparoscopic liver resection (LLR) for Hepatocellular carcinoma (HCC) is a safe procedure. Repeat surgery is more often required, and the role of minimally invasive liver surgery (MILS) is not yet clearly defined. The present study analyzes data compiled by the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) on LLR. To compare repeated LLR with the first LLR for HCC is the primary endpoint. The secondary endpoint was to evaluate the outcome of repeat LLR in the case of primary open versus primary MILS surgery. The data cohort is divided into two groups. Group 1: first liver resection and Group 2: Repeat LLR. To compare the two groups a 3:1 Propensity Score Matching is performed to analyze open versus MILS primary resection. Fifty-two centers were involved in the present study, and 1054 patients were enrolled. 80 patients underwent to a repeat LLR. The type of resection was different, with more major resections in the group 1 before matching the two groups. After propensity score matching 3:1, each group consisted of 222 and 74 patients. No difference between the two groups was observed. In the subgroup analysis, in 44 patients the first resection was performed by an open approach. The other 36 patients were resected with a MILS approach. We found no difference between these two subgroups of patients. The present study in repeat MILS for HCC using the IGoMILS Registry has observed the feasibility and safety of the MILS procedure.
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- 2022
11. The largest western experience on salvage hepatectomy for recurrent hepatocellular carcinoma: propensity score-matched analysis on behalf of He.RC.O.Le.Study Group
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Iaria, M, Bianchi, G, Fazio, F, Ardito, F, Perri, P, Pontarolo, N, Conci, S, Donadon, M, Zanello, M, Lai, Q, Famularo, S, Molfino, S, Sciannamea, I, Fumagalli, L, Germani, P, Floridi, A, Ferrari, C, Zimmitti, G, Troci, A, Zago, M, Ferraro, V, Cipriani, F, Patauner, S, La Barba, G, Romano, M, Zanus, G, Ercolani, G, Frena, A, Aldrighetti, L, Memeo, R, Pinotti, E, Crespi, M, Hilal, M, Griseri, G, Tarchi, P, Chiarelli, M, Antonucci, A, Baiocchi, G, Romano, F, Rossi, M, Jovine, E, Torzilli, G, Ruzzenente, A, Maestri, M, Grazi, G, Giuliante, F, Ferrero, A, Dalla Valle, R, Giuffrida, M, Russolillo, N, Razionale, F, De Peppo, V, Tomasoni, M, Marchitelli, I, Costa, G, Laureiro, Z, Scotti, M, Calcagno, P, Cosola, D, Franceschi, A, Manzoni, A, Pennacchi, L, Montuori, M, Conticchio, M, Ratti, F, Notte, F, Cucchetti, A, Salvador, L, Corleone, P, Garancini, M, Ciulli, C, Iaria M., Bianchi G., Fazio F., Ardito F., Perri P., Pontarolo N., Conci S., Donadon M., Zanello M., Lai Q., Famularo S., Molfino S., Sciannamea I., Fumagalli L., Germani P., Floridi A., Ferrari C., Zimmitti G., Troci A., Zago M., Ferraro V., Cipriani F., Patauner S., La Barba G., Romano M., Zanus G., Ercolani G., Frena A., Aldrighetti L., Memeo R., Pinotti E., Crespi M., Hilal M. A., Griseri G., Tarchi P., Chiarelli M., Antonucci A., Baiocchi G. L., Romano F., Rossi M., Jovine E., Torzilli G., Ruzzenente A., Maestri M., Grazi G. L., Giuliante F., Ferrero A., Dalla Valle R., Giuffrida M., Russolillo N., Razionale F., De Peppo V., Tomasoni M., Marchitelli I., Costa G., Laureiro Z. L., Scotti M., Calcagno P., Cosola D., Franceschi A., Manzoni A., Pennacchi L., Montuori M., Conticchio M., Ratti F., Notte F., Cucchetti A., Salvador L., Corleone P., Garancini M., Ciulli C., Iaria, M, Bianchi, G, Fazio, F, Ardito, F, Perri, P, Pontarolo, N, Conci, S, Donadon, M, Zanello, M, Lai, Q, Famularo, S, Molfino, S, Sciannamea, I, Fumagalli, L, Germani, P, Floridi, A, Ferrari, C, Zimmitti, G, Troci, A, Zago, M, Ferraro, V, Cipriani, F, Patauner, S, La Barba, G, Romano, M, Zanus, G, Ercolani, G, Frena, A, Aldrighetti, L, Memeo, R, Pinotti, E, Crespi, M, Hilal, M, Griseri, G, Tarchi, P, Chiarelli, M, Antonucci, A, Baiocchi, G, Romano, F, Rossi, M, Jovine, E, Torzilli, G, Ruzzenente, A, Maestri, M, Grazi, G, Giuliante, F, Ferrero, A, Dalla Valle, R, Giuffrida, M, Russolillo, N, Razionale, F, De Peppo, V, Tomasoni, M, Marchitelli, I, Costa, G, Laureiro, Z, Scotti, M, Calcagno, P, Cosola, D, Franceschi, A, Manzoni, A, Pennacchi, L, Montuori, M, Conticchio, M, Ratti, F, Notte, F, Cucchetti, A, Salvador, L, Corleone, P, Garancini, M, Ciulli, C, Iaria M., Bianchi G., Fazio F., Ardito F., Perri P., Pontarolo N., Conci S., Donadon M., Zanello M., Lai Q., Famularo S., Molfino S., Sciannamea I., Fumagalli L., Germani P., Floridi A., Ferrari C., Zimmitti G., Troci A., Zago M., Ferraro V., Cipriani F., Patauner S., La Barba G., Romano M., Zanus G., Ercolani G., Frena A., Aldrighetti L., Memeo R., Pinotti E., Crespi M., Hilal M. A., Griseri G., Tarchi P., Chiarelli M., Antonucci A., Baiocchi G. L., Romano F., Rossi M., Jovine E., Torzilli G., Ruzzenente A., Maestri M., Grazi G. L., Giuliante F., Ferrero A., Dalla Valle R., Giuffrida M., Russolillo N., Razionale F., De Peppo V., Tomasoni M., Marchitelli I., Costa G., Laureiro Z. L., Scotti M., Calcagno P., Cosola D., Franceschi A., Manzoni A., Pennacchi L., Montuori M., Conticchio M., Ratti F., Notte F., Cucchetti A., Salvador L., Corleone P., Garancini M., and Ciulli C.
- Abstract
Background: We aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments. Methods: Data were collected from the Hepatocarcinoma Recurrence on the Liver Study Group (He.RC.O.Le.S.) Italian Registry. After 1:1 propensity score-matched analysis (PSM), two groups were compared: the PH group (patients submitted to resection for a first HCC) and the SH group (patients resected for intrahepatic rHCC after previous HCC-related treatments). Results: 2689 patients were enrolled. PH included 2339 patients, SH 350. After PSM, 263 patients were selected in each group with major resected nodule median size, intraoperative blood loss and minimally invasive approach significantly lower in the SH group. Long-term outcomes were compared, with no difference in OS and DFS. Univariate and multivariate analyses revealed only microvascular invasion as an independent prognostic factor for OS. Conclusion: SH proved to be equivalent to PH in terms of safety, feasibility and long-term outcomes, consistent with data gathered from East Asia. In the awaiting of reliable treatment-allocating algorithms for rHCC, SH appears to be a suitable alternative in patients fit for surgery, regardless of the previous therapeutic modality implemented.
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- 2022
12. Hepatectomy for Metabolic Associated Fatty Liver Disease (MAFLD) related HCC: Propensity case-matched analysis with viral- and alcohol-related HCC
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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, Zago, M, Frena, A, Ercolani, G, Jovine, E, Maestri, M, Valle, R, Grazi, G, 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., 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, Zago, M, Frena, A, Ercolani, G, Jovine, E, Maestri, M, Valle, R, Grazi, G, 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.
- 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.
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- 2022
13. Correction to: Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry (Updates in Surgery, (2021), 10.1007/s13304-021-01161-w)
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Levi Sandri G. B., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri G. B., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., and Zimmitti G.
- Abstract
In the originally published article the co-author first name and last name was interchanged. The correct name is copied below Salvatore Gruttadauria The original article has been updated.
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- 2022
14. Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections
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Cucchetti, A, Aldrighetti, L, Ratti, F, Ferrero, A, Guglielmi, A, Giuliante, F, Cillo, U, Mazzaferro, V, De Carlis, L, Ercolani, G, Ettorre, G, di Benedetto, F, Valle, R, Gruttadauria, S, Jovine, E, Boggi, U, Vincenti, L, Santambrogio, R, Giuliani, A, Torzilli, G, Zimmiti, G, Brolese, A, Belli, A, Ravaioli, M, Frena, A, Rossi, G, Grazi, G, Zamboni, F, Berti, S, Calise, F, Massani, M, Morelli, L, Filauro, M, Tisone, G, Coratti, A, Navarra, G, Romito, R, Ceccarelli, G, Belli, G, Griseri, G, Antonucci, A, Mezzatesta, P, Veneroni, L, Schiavo, M, Colledan, M, Parisi, A, Guerriero, S, Spada, M, Batignani, G, Sgroi, G, Floridi, P, Boni, L, Maida, P, Ribero, D, La Barba, G, Cucchetti A., Aldrighetti L., Ratti F., Ferrero A., Guglielmi A., Giuliante F., Cillo U., Mazzaferro V., De Carlis L., Ercolani G., Ettorre G. M., di Benedetto F., Valle R. D., Gruttadauria S., Jovine E., Boggi U., Vincenti L., Santambrogio R., Giuliani A., Torzilli G., Zimmiti G., Brolese A., Belli A., Ravaioli M., Frena A., Rossi G. E., Grazi G. L., Zamboni F., Berti S., Calise F., Massani M., Morelli L., Filauro M., Tisone G., Coratti A., Navarra G., Romito R., Ceccarelli G., Belli G., Griseri G., Antonucci A., Mezzatesta P., Veneroni L., Schiavo M., Colledan M., Parisi A., Guerriero S., Spada M., Batignani G., Sgroi G., Floridi P., Boni L., Maida P., Ribero D., La Barba G., Cucchetti, A, Aldrighetti, L, Ratti, F, Ferrero, A, Guglielmi, A, Giuliante, F, Cillo, U, Mazzaferro, V, De Carlis, L, Ercolani, G, Ettorre, G, di Benedetto, F, Valle, R, Gruttadauria, S, Jovine, E, Boggi, U, Vincenti, L, Santambrogio, R, Giuliani, A, Torzilli, G, Zimmiti, G, Brolese, A, Belli, A, Ravaioli, M, Frena, A, Rossi, G, Grazi, G, Zamboni, F, Berti, S, Calise, F, Massani, M, Morelli, L, Filauro, M, Tisone, G, Coratti, A, Navarra, G, Romito, R, Ceccarelli, G, Belli, G, Griseri, G, Antonucci, A, Mezzatesta, P, Veneroni, L, Schiavo, M, Colledan, M, Parisi, A, Guerriero, S, Spada, M, Batignani, G, Sgroi, G, Floridi, P, Boni, L, Maida, P, Ribero, D, La Barba, G, Cucchetti A., Aldrighetti L., Ratti F., Ferrero A., Guglielmi A., Giuliante F., Cillo U., Mazzaferro V., De Carlis L., Ercolani G., Ettorre G. M., di Benedetto F., Valle R. D., Gruttadauria S., Jovine E., Boggi U., Vincenti L., Santambrogio R., Giuliani A., Torzilli G., Zimmiti G., Brolese A., Belli A., Ravaioli M., Frena A., Rossi G. E., Grazi G. L., Zamboni F., Berti S., Calise F., Massani M., Morelli L., Filauro M., Tisone G., Coratti A., Navarra G., Romito R., Ceccarelli G., Belli G., Griseri G., Antonucci A., Mezzatesta P., Veneroni L., Schiavo M., Colledan M., Parisi A., Guerriero S., Spada M., Batignani G., Sgroi G., Floridi P., Boni L., Maida P., Ribero D., and La Barba G.
- Abstract
Background/Purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. The purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR). Methods: Data from a prospective, multicenter database involving 4318 patients submitted to LLRs in 41 hospitals from an intention-to-treat approach (2014–2020) were used to analyze heterogeneity (I2) among centers and to develop a risk-adjustment model on outcome measures through multivariable mixed-effect models to account for confounding due to case-mix. Results: Involved hospitals operated on very different patients: the largest heterogeneity was observed for operating in the presence of previous abdominal surgery (I2:79.1%), in cirrhotic patients (I2:89.3%) suffering from hepatocellular carcinoma (I2:88.6%) or requiring associated intestinal resections (I2:82.8%) and in regard to technical complexity (I2 for the most complex LLRs: 84.1%). These aspects determined substantial or large heterogeneity in overall morbidity (I2:84.9%), in prolonged in-hospital stay (I2:86.9%) and in conversion rate (I2:73.4%). Major complication had medium heterogeneity (I2:46.5%). The heterogeneity of mortality was null. Risk-adjustment accounted for all of this variability and the final risk-standardized conversion rate was 8.9%, overall morbidity was 22.1%, major morbidity was 5.1% and prolonged in-hospital stay was 26.0%. There were no outliers among the 41 participating centers. An online tool was provided. Conclusions: A benchmark for LLRs including all eligible patients was provided, suggesting that surgeons can act accordingly in the interest of the patient, modifying their approach in relation to different indications and different experience, but finally providing the same quality of care.
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- 2022
15. Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study
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Ruzzenente, A, Ciangherotti, A, Aldrighetti, L, Ettorre, G, De Carlis, L, Ferrero, A, Dalla Valle, R, Tisone, G, Guglielmi, A, Ratti, F, Gringeri, E, Russolillo, N, Campagnaro, T, Conci, S, Sandri, G, Ardito, F, Boggi, U, Gruttadauria, S, Vigano, L, Di Benedetto, F, Rossi, G, Berti, S, Ceccarelli, G, Vincenti, L, Cillo, U, Giuliante, F, Mazzaferro, V, Jovine, E, Calise, F, Belli, G, Zamboni, F, Coratti, A, Mezzatesta, P, Santambrogio, R, Navarra, G, Giuliani, A, Ferla, F, Pinna, A, Parisi, A, Colledan, M, Slim, A, Antonucci, A, Grazi, G, Frena, A, Sgroi, G, Brolese, A, Morelli, L, Floridi, A, Patriti, A, Veneroni, L, Boni, L, Maida, P, Griseri, G, Filauro, M, Guerriero, S, Romito, R, Tedeschi, U, Zimmitti, G, Ruzzenente A., Ciangherotti A., Aldrighetti L., Ettorre G. M., De Carlis L., Ferrero A., Dalla Valle R., Tisone G., Guglielmi A., Ratti F., Gringeri E., Russolillo N., Campagnaro T., Conci S., Sandri G. B. L., Ardito F., Boggi U., Gruttadauria S., Vigano L., Di Benedetto F., Rossi G. E., Berti S., Ceccarelli G., Vincenti L., Cillo U., Giuliante F., Mazzaferro V., Jovine E., Calise F., Belli G., Zamboni F., Coratti A., Mezzatesta P., Santambrogio R., Navarra G., Giuliani A., Ferla F., Pinna A. D., Parisi A., Colledan M., Slim A., Antonucci A., Grazi G. L., Frena A., Sgroi G., Brolese A., Morelli L., Floridi A., Patriti A., Veneroni L., Boni L., Maida P., Griseri G., Filauro M., Guerriero S., Romito R., Tedeschi U., Zimmitti G., Ruzzenente, A, Ciangherotti, A, Aldrighetti, L, Ettorre, G, De Carlis, L, Ferrero, A, Dalla Valle, R, Tisone, G, Guglielmi, A, Ratti, F, Gringeri, E, Russolillo, N, Campagnaro, T, Conci, S, Sandri, G, Ardito, F, Boggi, U, Gruttadauria, S, Vigano, L, Di Benedetto, F, Rossi, G, Berti, S, Ceccarelli, G, Vincenti, L, Cillo, U, Giuliante, F, Mazzaferro, V, Jovine, E, Calise, F, Belli, G, Zamboni, F, Coratti, A, Mezzatesta, P, Santambrogio, R, Navarra, G, Giuliani, A, Ferla, F, Pinna, A, Parisi, A, Colledan, M, Slim, A, Antonucci, A, Grazi, G, Frena, A, Sgroi, G, Brolese, A, Morelli, L, Floridi, A, Patriti, A, Veneroni, L, Boni, L, Maida, P, Griseri, G, Filauro, M, Guerriero, S, Romito, R, Tedeschi, U, Zimmitti, G, Ruzzenente A., Ciangherotti A., Aldrighetti L., Ettorre G. M., De Carlis L., Ferrero A., Dalla Valle R., Tisone G., Guglielmi A., Ratti F., Gringeri E., Russolillo N., Campagnaro T., Conci S., Sandri G. B. L., Ardito F., Boggi U., Gruttadauria S., Vigano L., Di Benedetto F., Rossi G. E., Berti S., Ceccarelli G., Vincenti L., Cillo U., Giuliante F., Mazzaferro V., Jovine E., Calise F., Belli G., Zamboni F., Coratti A., Mezzatesta P., Santambrogio R., Navarra G., Giuliani A., Ferla F., Pinna A. D., Parisi A., Colledan M., Slim A., Antonucci A., Grazi G. L., Frena A., Sgroi G., Brolese A., Morelli L., Floridi A., Patriti A., Veneroni L., Boni L., Maida P., Griseri G., Filauro M., Guerriero S., Romito R., Tedeschi U., and Zimmitti G.
- Abstract
Background: Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods: Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results: A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions: This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.
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- 2022
16. Detection of hepatocellular carcinoma's microvascular invasion at the preoperative CT scan: Artificial intelligence meets radiomics
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Famularo, S., primary, Donadon, M., additional, Penzo, C., additional, Bortolotto, M., additional, Maino, C., additional, Marescaux, J., additional, Diana, M., additional, Romano, F., additional, Giuliante, F., additional, Ardito, F., additional, Grazi, G.L., additional, Bernasconi, D., additional, and Torzilli, G., additional
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- 2023
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17. The Effect of a Liver Transplant Program on the Outcomes of Resectable Hepatocellular Carcinoma: A Nationwide Multicenter Analysis
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Serenari, M., Lenzi, J., Cucchetti, A., Cipriani, F., Donadon, M., Ardito, Francesco, Fazio, F., Nicolini, D., Iaria, M., Famularo, S., Perri, P., Ansaloni, L., Zanello, M., Lai, Q., Conci, S., Molfino, S., Ferrari, C., Germani, P., Zago, M., Romano, M., Zimmitti, G., Antonucci, A., Fumagalli, L., Troci, A., Ferraro, V., Memeo, R., Crespi, M., Chiarelli, M., Ercolani, G., Hilal, M. A., Zanus, G., Pinotti, E., Tarchi, P., Griseri, G., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Grazi, G. L., Romano, F., Dalla Valle, R., Ravaioli, M., Vivarelli, M., Ferrero, A., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Cescon, M., Gorgone, M., Ratti, F., Costa, G., Razionale, Francesco, Russolillo, N., Marinelli, Luca, Giuffrida, M., Scotti, M., Garancini, M., De Peppo, V., De Stefano, F., Laureiro, Z. L., Marchitelli, I., Franceschi, A., Cosola, D., Corleone, P., Montuori, M., Salvador, L., Manzoni, Annamaria, La Barba, G., Calcagno, P., Pennacchi, L., Conticchio, M., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Razionale F., Marinelli L., Manzoni A., Serenari, M., Lenzi, J., Cucchetti, A., Cipriani, F., Donadon, M., Ardito, Francesco, Fazio, F., Nicolini, D., Iaria, M., Famularo, S., Perri, P., Ansaloni, L., Zanello, M., Lai, Q., Conci, S., Molfino, S., Ferrari, C., Germani, P., Zago, M., Romano, M., Zimmitti, G., Antonucci, A., Fumagalli, L., Troci, A., Ferraro, V., Memeo, R., Crespi, M., Chiarelli, M., Ercolani, G., Hilal, M. A., Zanus, G., Pinotti, E., Tarchi, P., Griseri, G., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Grazi, G. L., Romano, F., Dalla Valle, R., Ravaioli, M., Vivarelli, M., Ferrero, A., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Cescon, M., Gorgone, M., Ratti, F., Costa, G., Razionale, Francesco, Russolillo, N., Marinelli, Luca, Giuffrida, M., Scotti, M., Garancini, M., De Peppo, V., De Stefano, F., Laureiro, Z. L., Marchitelli, I., Franceschi, A., Cosola, D., Corleone, P., Montuori, M., Salvador, L., Manzoni, Annamaria, La Barba, G., Calcagno, P., Pennacchi, L., Conticchio, M., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Razionale F., Marinelli L., and Manzoni A.
- Abstract
Objective: To evaluate the effect of a liver transplantation (LT) program on the outcomes of resectable hepatocellular carcinoma (HCC). Background: Surgical treatment of HCC includes both hepatic resection (HR) and LT. However, the presence of cirrhosis and the possibility of recurrence make the management of this disease complex and probably different according to the presence of a LT program. Methods: Patients undergoing HR for HCC between January 2005 and December 2019 were identified from a national database of HCC. The main study outcomes were major surgical complications according to the Comprehensive Complication Index, posthepatectomy liver failure (PHLF), 90-day mortality, overall survival, and disease-free survival. Secondary outcomes were salvage liver transplantation (SLT) and postrecurrence survival. Results: A total of 3202 patients were included from 25 hospitals over the study period. Three of 25 (12%) had an LT program. The presence of an LT program within a center was associated with a reduced probability of PHLF (odds ratio=0.38) but not with overall survival and disease-free survival. There was an increased probability of SLT when HR was performed in a transplant hospital (odds ratio=12.05). Among transplant-eligible patients, those who underwent LT had a significantly longer postrecurrence survival. Conclusions: This study showed that the presence of a LT program was associated with decreased PHLF rates and an increased probability to receive SLT in case of recurrence.
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- 2023
18. 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
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Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)
- Abstract
Background: Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated. Methods: Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed. Results: In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128–596) vs. 250 (SD 100–400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group. Conclusion: The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.
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- 2023
19. Survival benefit of adequate lymphadenectomy in patients undergoing liver resection for clinically node-negative intrahepatic cholangiocarcinoma
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Sposito, C., Ratti, F., Cucchetti, A., Ardito, Francesco, Ruzzenente, A., Di Sandro, S., Maspero, M., Ercolani, G., Di Benedetto, F., Guglielmi, A., Giuliante, Felice, Aldrighetti, L., Mazzaferro, V., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Sposito, C., Ratti, F., Cucchetti, A., Ardito, Francesco, Ruzzenente, A., Di Sandro, S., Maspero, M., Ercolani, G., Di Benedetto, F., Guglielmi, A., Giuliante, Felice, Aldrighetti, L., Mazzaferro, V., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)
- Abstract
Background & Aims: Lymph-nodal status is an important predictor of survival in intrahepatic cholangiocarcinoma (iCCA), but the need to perform lymphadenectomy in patients with clinically node-negative (cN0) iCCA is still under debate. The aim of this study was to determine whether adequate lymphadenectomy improves long-term outcomes in patients undergoing liver resection for cN0 iCCA. Methods: We performed a retrospective cohort study on consecutive patients who underwent radical liver resection for cN0 iCCA at five tertiary referral centers. A propensity score based on preoperative data was calculated and used to generate stabilized inverse probability of treatment weight (IPTW). Overall and recurrence-free survival of patients undergoing adequate (≥6 retrieved lymph nodes) vs. inadequate lymphadenectomy were compared. Interactions between adequacy of lymphadenectomy and clinical variables of interest were explored through Cox IPTW regression. Results: The study includes 706 patients who underwent curative surgery for cN0 iCCA. Four-hundred and seventeen (59.1%) received adequate lymphadenectomy. After a median follow-up of 33 months (IQR 18-77), median overall survival was 39 months (IQR 23-109) and median recurrence-free survival was 23 months (IQR 8-74). After stratification according to nodal status at final pathology, node-positive patients had longer overall survival (28 vs. 23 months; hazard ratio 1.82; 95% CI 1.14-2.90; p = 0.023) and disease-free survival (13 vs. 9 months; hazard ratio 1.35; 95% CI 1.14-1.59; p = 0.008) after adequate lymphadenectomy. Adequate lymphadenectomy significantly improved survival outcomes in patients without chronic liver disease, and in patients with less-advanced tumors (solitary tumors, tumor size <5 cm, carbohydrate antigen 19-9 <200 U/ml). Conclusions: Adequate lymphadenectomy provided better survival outcomes for patients with cN0 iCCA who were found to be node-positive at pathology, supporting the routine use of
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- 2023
20. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study
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Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)
- Abstract
Objective: To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR). Background: There is limited published data to date on the best achievable outcomes after L-LR. Methods: This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs. Results: There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively. Conclusions: This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.
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- 2023
21. Short and long-term outcomes after minimally invasive liver resection for single small hepatocellular carcinoma: An analysis of 714 patients from the IGoMILS (Italian group of minimally invasive liver surgery) registry
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Giuliante, Felice, Ratti, F., Panettieri, Elena, Mazzaferro, V., Guglielmi, A., Ettorre, G. M., Gruttadauria, S., Di Benedetto, F., Cillo, U., De Carlis, L., Dalla Valle, R., Ferrero, A., Santambrogio, R., Ardito, Francesco, Aldrighetti, L., Giuliante F. (ORCID:0000-0001-9517-8220), Panettieri E., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante, Felice, Ratti, F., Panettieri, Elena, Mazzaferro, V., Guglielmi, A., Ettorre, G. M., Gruttadauria, S., Di Benedetto, F., Cillo, U., De Carlis, L., Dalla Valle, R., Ferrero, A., Santambrogio, R., Ardito, Francesco, Aldrighetti, L., Giuliante F. (ORCID:0000-0001-9517-8220), Panettieri E., and Ardito F. (ORCID:0000-0003-1596-2862)
- Abstract
Background: Widespread use of minimally invasive liver surgery (MILS) contributed to the reduction of surgical risk of liver resection for hepatocellular carcinoma (HCC). Aim of this study was to analyze outcomes of MILS for single ≤3 cm HCC. Methods: Patients who underwent MILS for single ≤3 cm HCC (November 2014 - December 2019) were identified from the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) Registry. Results: Of 714 patients included, 641 (93.0%) were Child-Pugh A; 65.7% were limited resections and 2.2% major resections, with a conversion rate of 5.2%. Ninety-day mortality rate was 0.3%. Overall morbidity rate was 22.4% (3.8% major complications). Mean postoperative stay was 5 days. Robotic resection showed longer operative time (p = 0.004) and a higher overall morbidity rate (p < 0.001), with similar major complications (p = 0.431). Child-Pugh B patients showed worse mortality (p = 0.017) and overall morbidity (p = 0.021), and longer postoperative stay (p = 0.005). Five-year overall survival was 79.5%; cirrhosis, satellite micronodules, and microvascular invasion were independently associated with survival. Conclusions: MILS for ≤3 cm HCC was associated with low morbidity and mortality rates, showing high safety, and supporting the increasing indications for surgical resection in these patients.
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- 2023
22. Machine Learning Predictive Model to Guide Treatment Allocation for Recurrent Hepatocellular Carcinoma After Surgery
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Famularo, S., Donadon, M., Cipriani, F., Fazio, F., Ardito, Francesco, Iaria, M., Perri, P., Conci, S., Dominioni, T., Lai, Q., La Barba, G., Patauner, S., Molfino, S., Germani, P., Zimmitti, G., Pinotti, E., Zanello, M., Fumagalli, L., Ferrari, C., Romano, M., Delvecchio, A., Valsecchi, M. G., Antonucci, A., Piscaglia, F., Farinati, F., Kawaguchi, Y., Hasegawa, K., Memeo, R., Zanus, G., Griseri, G., Chiarelli, M., Jovine, E., Zago, M., Abu Hilal, M., Tarchi, P., Baiocchi, G. L., Frena, A., Ercolani, G., Rossi, M., Maestri, M., Ruzzenente, A., Grazi, G. L., Dalla Valle, R., Romano, F., Giuliante, Felice, Ferrero, A., Aldrighetti, L., Bernasconi, D. P., Torzilli, G., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Famularo, S., Donadon, M., Cipriani, F., Fazio, F., Ardito, Francesco, Iaria, M., Perri, P., Conci, S., Dominioni, T., Lai, Q., La Barba, G., Patauner, S., Molfino, S., Germani, P., Zimmitti, G., Pinotti, E., Zanello, M., Fumagalli, L., Ferrari, C., Romano, M., Delvecchio, A., Valsecchi, M. G., Antonucci, A., Piscaglia, F., Farinati, F., Kawaguchi, Y., Hasegawa, K., Memeo, R., Zanus, G., Griseri, G., Chiarelli, M., Jovine, E., Zago, M., Abu Hilal, M., Tarchi, P., Baiocchi, G. L., Frena, A., Ercolani, G., Rossi, M., Maestri, M., Ruzzenente, A., Grazi, G. L., Dalla Valle, R., Romano, F., Giuliante, Felice, Ferrero, A., Aldrighetti, L., Bernasconi, D. P., Torzilli, G., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)
- Abstract
Importance: Clear indications on how to select retreatments for recurrent hepatocellular carcinoma (HCC) are still lacking. Objective: To create a machine learning predictive model of survival after HCC recurrence to allocate patients to their best potential treatment. Design, Setting, and Participants: Real-life data were obtained from an Italian registry of hepatocellular carcinoma between January 2008 and December 2019 after a median (IQR) follow-up of 27 (12-51) months. External validation was made on data derived by another Italian cohort and a Japanese cohort. Patients who experienced a recurrent HCC after a first surgical approach were included. Patients were profiled, and factors predicting survival after recurrence under different treatments that acted also as treatment effect modifiers were assessed. The model was then fitted individually to identify the best potential treatment. Analysis took place between January and April 2021. Exposures: Patients were enrolled if treated by reoperative hepatectomy or thermoablation, chemoembolization, or sorafenib. Main Outcomes and Measures: Survival after recurrence was the end point. Results: A total of 701 patients with recurrent HCC were enrolled (mean [SD] age, 71 [9] years; 151 [21.5%] female). Of those, 293 patients (41.8%) received reoperative hepatectomy or thermoablation, 188 (26.8%) received sorafenib, and 220 (31.4%) received chemoembolization. Treatment, age, cirrhosis, number, size, and lobar localization of the recurrent nodules, extrahepatic spread, and time to recurrence were all treatment effect modifiers and survival after recurrence predictors. The area under the receiver operating characteristic curve of the predictive model was 78.5% (95% CI, 71.7%-85.3%) at 5 years after recurrence. According to the model, 611 patients (87.2%) would have benefited from reoperative hepatectomy or thermoablation, 37 (5.2%) from sorafenib, and 53 (7.6%) from chemoembolization in terms of potential survival after re
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- 2023
23. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma
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Lai, Quirino, De Matthaeis, Nicoletta, Finotti, Michele, Galati, Giovanni, Marrone, Giuseppe, Melandro, Fabio, Morisco, Filomena, Nicolini, Daniele, Pravisani, Riccardo, Giannini, Edoardo G, Aglitti, A, Aliberti, C, Baccarani, U, Bhoori, S, Borzio, M, Brancaccio, G, Burra, P, Cabibbo, G, Casadei Gardini, A, Carrai, P, Cillo, U, Conti, F, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, Di Costanzi, Gg, Di Sandro, S, Foschi, Fg, Fucilli, F, Gambato, M, Gasbarrini, Antonio, Giuliante, Felice, Ghinolfi, D, Grieco, Antonio, Gruttaduria, S, Guarino, M, Kostandini, A, Iavarone, M, Lenci, I, Levi Sandri, Gb, Losito, F, Lupo, Lg, Manzia, Tm, Mazzocato, S, Mescoli, C, Miele, Luca, Muley, M, Persico, M, Plaz Torres, Mc, Pompili, Maurizio, Ponziani, Francesca Romana, Rapaccini, Gian Ludovico, Rendina, M, Renzulli, M, Rossi, Marco, Rreka, E, Russo, Fp, Sacco, R, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Trevisani, F, Viganò, L, Viganò, M, Villa, E, Vincenzi, V, Violi, P, Vitale, A, Gasbarrini, A (ORCID:0000-0002-7278-4823), Giuliante, F (ORCID:0000-0001-9517-8220), Grieco, A (ORCID:0000-0002-0544-8993), Miele, L (ORCID:0000-0003-3464-0068), Pompili, M (ORCID:0000-0001-6699-7980), Ponziani, FR (ORCID:0000-0002-5924-6238), Rapaccini, GL (ORCID:0000-0002-6467-857X), Rossi, M (ORCID:0000-0002-4539-5670), Lai, Quirino, De Matthaeis, Nicoletta, Finotti, Michele, Galati, Giovanni, Marrone, Giuseppe, Melandro, Fabio, Morisco, Filomena, Nicolini, Daniele, Pravisani, Riccardo, Giannini, Edoardo G, Aglitti, A, Aliberti, C, Baccarani, U, Bhoori, S, Borzio, M, Brancaccio, G, Burra, P, Cabibbo, G, Casadei Gardini, A, Carrai, P, Cillo, U, Conti, F, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, Di Costanzi, Gg, Di Sandro, S, Foschi, Fg, Fucilli, F, Gambato, M, Gasbarrini, Antonio, Giuliante, Felice, Ghinolfi, D, Grieco, Antonio, Gruttaduria, S, Guarino, M, Kostandini, A, Iavarone, M, Lenci, I, Levi Sandri, Gb, Losito, F, Lupo, Lg, Manzia, Tm, Mazzocato, S, Mescoli, C, Miele, Luca, Muley, M, Persico, M, Plaz Torres, Mc, Pompili, Maurizio, Ponziani, Francesca Romana, Rapaccini, Gian Ludovico, Rendina, M, Renzulli, M, Rossi, Marco, Rreka, E, Russo, Fp, Sacco, R, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Trevisani, F, Viganò, L, Viganò, M, Villa, E, Vincenzi, V, Violi, P, Vitale, A, Gasbarrini, A (ORCID:0000-0002-7278-4823), Giuliante, F (ORCID:0000-0001-9517-8220), Grieco, A (ORCID:0000-0002-0544-8993), Miele, L (ORCID:0000-0003-3464-0068), Pompili, M (ORCID:0000-0001-6699-7980), Ponziani, FR (ORCID:0000-0002-5924-6238), Rapaccini, GL (ORCID:0000-0002-6467-857X), and Rossi, M (ORCID:0000-0002-4539-5670)
- Abstract
Aim To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment. Methods A systematic literature search was performed using PubMed and Cochrane Central Register of Controlled Trials Databases. Two HCC clinical settings were explored: (i) incidence, and (ii) death after any HCC treatment. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the pooled data between patients who received or did not receive APT. Results A total of 20 studies were identified, of whom 15 focused on HCC incidence, including 2,685,009 patients, and five on post-treatment death, including 3281 patients. APT was associated with an overall reduced risk of HCC incidence (OR: 0.63; 95%CI = 0.51-0.79; p < 0.001) as well as of post-treatment mortality (OR: 0.54; 95%CI = 0.35-0.83; p = 0.006). Conclusions Current data suggest that APT correlated with higher HCC incidence and poor overall survival following tumour treatment.
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- 2023
24. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8: An international multicenter propensity-score matched study
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Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)
- Abstract
Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.
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- 2023
25. MINIMALLY-INVASIVE CYTOREDUCTION IN RECURRENT ENDOMETRIAL CANCER: LAPAROSCOPIC AND UNIPORTAL VIDEO-ASSISTED THORACOSCOPIC SURGERY (VATS) COMBINED APPROACH: EP1301
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Bizzarri, N, Meacci, E, Giuliante, F, Ghirardi, V, Scambia, G, and Fagotti, A
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- 2019
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26. 299 Precision oncology in surgery: patient selection for operable recurrent hepatic ovarian cancer
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Gallotta, V, Conte, C, D’Indinosante, M, Capoluongo, E, Angelo, M, De Rose Maria, A, Ardito, F, Giuliante, F, Di Giorgio, A, Zannoni, GF, Margreiter, C, Scambia, G, and Ferrandina, G
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- 2019
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27. Preoperative Detection of Hepatocellular Carcinoma’s Microvascular Invasion on CT-scan by Artificial-intelligence and Radiomics Analyses
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Famularo, S., primary, Donadon, M., additional, Penzo, C., additional, Bortolotto, M., additional, Marescaux, J., additional, Diana, M., additional, Romano, F., additional, Giuliante, F., additional, Ardito, F., additional, Grazi, G.L., additional, and Torzilli, G., additional
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- 2023
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28. CT-based Radiomics of Mass-forming Intrahepatic Cholangiocarcinoma and its Peritumoral Tissue Improve the Prediction of Survival after Surgery
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Vigano, L., primary, Langella, S., additional, Conci, S., additional, Serenari, M., additional, Ercolani, G., additional, Giuliante, F., additional, Cescon, M., additional, Guglielmi, A., additional, Ferrero, A., additional, Torzilli, G., additional, and Ieva, F., additional
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- 2023
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29. Single Large Hepatocellular Carcinoma > 5 cm with Surgical Indication: Is it Mandatory a Major Hepatectomy? A Propensity-score Weighted Analysis
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Garancini, M., primary, Ferrero, A., additional, De Carlis, L., additional, Grazi, G.L., additional, Giuliante, F., additional, Cillo, U., additional, Cescon, M., additional, Valle, R. Dalla, additional, Vivarelli, M., additional, Torzilli, G., additional, Aldrighetti, L., additional, Romano, Fabrizio, additional, Donadon, Matteo, additional, Cipriani, Federica, additional, Serenari, Matteo, additional, Ardito, Francesco, additional, Lauterio, Andrea, additional, Vitale, Alessandro, additional, Fazio, Federico, additional, Nicolini, Daniele, additional, Perri, Pasquale, additional, Iaria, Giuseppe, additional, Famularo, Simone, additional, Dominioni, Tommaso, additional, Zanello, Matteo, additional, Lai, Quirino, additional, Conci, Simone, additional, Molfino, Sarah, additional, Ferrari, Cecilia, additional, Germani, Paola, additional, Scotti, Mauro Alessandro, additional, Zago, Mauro, additional, Zimmitti, Giuseppe, additional, La Barba Maurizio Romano, Giuliano, additional, Sciannamea, Ivano, additional, Fumagalli, Luca, additional, Troci, Albert, additional, Ferraro, Valentina, additional, Memeo, Riccardo, additional, Crespi, Michele, additional, Chiarelli, Marco, additional, Antonucci, Adelmo, additional, Zanus, Giacomo, additional, Ercolani, Giorgio, additional, Hilal, Moh’d Abu, additional, Pinotti, Enrico, additional, Tarchi, Paola, additional, Griseri, Guido, additional, Baiocchi, Gian Luca, additional, Ruzzenente, Andrea, additional, Rossi, Massimo, additional, Jovine, Elio, additional, and Maestri, Marcello, additional
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- 2023
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30. Stratifying the Risk in Liver Surgery: Performance in an Italian Cohort of 3280 Liver Resection for HCC
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Costa, G., primary, Donadon, M.D., additional, Cipriani, F., additional, Serenari, M., additional, Ardito, F., additional, Fazio, F., additional, Ferrero, A., additional, Giuliante, F., additional, Cescon, M., additional, Aldrighetti, L., additional, and Torzilli, G., additional
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- 2023
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31. Trends in Surgical Indications and Perioperative Outcomes of Laparoscopic and Open Resections for Benign Liver Tumors
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Sijberden, J., primary, Aldrighetti, L.A., additional, Besselink, M.G., additional, Cillo, U., additional, Primrose, J.N., additional, Sutcliffe, R.P., additional, Edwin, B., additional, Jovine, E., additional, Ruzzenente, A., additional, Giuliante, F., additional, and Hilal, M. Abu, additional
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- 2023
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32. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma
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Lai, Q., De Matthaeis, N., Finotti, M., Galati, G., Marrone, G., Melandro, F., Morisco, F., Nicolini, D., Pravisani, R., Giannini, E. G., Aglitti, A., Aliberti, C., Baccarani, U., Bhoori, S., Borzio, M., Brancaccio, G., Burra, P., Cabibbo, G., Casadei Gardini, A., Carrai, P., Cillo, U., Conti, F., Cucchetti, A., D'Ambrosio, R., Dell'Unto, C., Di Costanzo, G. G., Di Sandro, S., Foschi, F. G., Fucilli, F., Gambato, M., Gasbarrini, A., Giuliante, F., Ghinolfi, D., Grieco, A., Gruttaduria, S., Guarino, M., Kostandini, A., Iavarone, M., Lenci, I., Levi Sandri, G. B., Losito, F., Lupo, L. G., Manzia, T. M., Mazzocato, S., Mescoli, C., Miele, L., Muley, M., Persico, M., Plaz Torres, M. C., Pompili, M., Ponziani, F. R., Rapaccini, G. L., Rendina, M., Renzulli, M., Rossi, M., Rreka, E., Russo, F. P., Sacco, R., Sangiovanni, A., Sessa, A., Simonetti, N., Sposito, C., Tortora, R., Trevisani, F., Vigano, L., Vigano, M., Villa, E., Vincenzi, V., Violi, P., and Vitale, A.
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clopidogrel ,aspirin ,Clinical Biochemistry ,incidence ,occurrence ,survival ,General Medicine ,Biochemistry ,Settore MED/18 - Abstract
To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment.A systematic literature search was performed using PubMed and Cochrane Central Register of Controlled Trials Databases. Two HCC clinical settings were explored: (i) incidence, and (ii) death after any HCC treatment. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the pooled data between patients who received or did not receive APT.A total of 20 studies were identified, of whom 15 focused on HCC incidence, including 2,685,009 patients, and five on post-treatment death, including 3281 patients. APT was associated with an overall reduced risk of HCC incidence (OR: 0.63; 95%CI = 0.51-0.79; p 0.001) as well as of post-treatment mortality (OR: 0.54; 95%CI = 0.35-0.83; p = 0.006).Current data suggest that APT correlated with higher HCC incidence and poor overall survival following tumour treatment.
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- 2023
33. Hepatolithiasis-associated cholangiocarcinoma: Results from a multi-institutional national database on a case series of 23 patients
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Guglielmi, A., Ruzzenente, A., Valdegamberi, A., Bagante, F., Conci, S., Pinna, A.D., Ercolani, G., Giuliante, F., Capussotti, L., Aldrighetti, L., and Iacono, C.
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- 2014
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34. Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections
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Cucchetti, A., Aldrighetti, L., Ratti, F., Ferrero, A., Guglielmi, A., Giuliante, F., Cillo, U., Mazzaferro, V., De Carlis, L., Ercolani, G., Ettorre, G. M., di Benedetto, F., Valle, R. D., Gruttadauria, S., Jovine, E., Boggi, U., Vincenti, L., Santambrogio, R., Giuliani, A., Torzilli, G., Zimmiti, G., Brolese, A., Belli, A., Ravaioli, M., Frena, A., Rossi, G. E., Grazi, G. L., Zamboni, F., Berti, S., Calise, F., Massani, M., Morelli, L., Filauro, M., Tisone, G., Coratti, A., Navarra, G., Romito, R., Ceccarelli, G., Belli, G., Griseri, G., Antonucci, A., Mezzatesta, P., Veneroni, L., Schiavo, M., Colledan, M., Parisi, A., Guerriero, S., Spada, M., Batignani, G., Sgroi, G., Floridi, P., Boni, L., Maida, P., Ribero, D., La Barba, G., Cucchetti, A, Aldrighetti, L, Ratti, F, Ferrero, A, Guglielmi, A, Giuliante, F, Cillo, U, Mazzaferro, V, De Carlis, L, Ercolani, G, Ettorre, G, di Benedetto, F, Valle, R, Gruttadauria, S, Jovine, E, Boggi, U, Vincenti, L, Santambrogio, R, Giuliani, A, Torzilli, G, Zimmiti, G, Brolese, A, Belli, A, Ravaioli, M, Frena, A, Rossi, G, Grazi, G, Zamboni, F, Berti, S, Calise, F, Massani, M, Morelli, L, Filauro, M, Tisone, G, Coratti, A, Navarra, G, Romito, R, Ceccarelli, G, Belli, G, Griseri, G, Antonucci, A, Mezzatesta, P, Veneroni, L, Schiavo, M, Colledan, M, Parisi, A, Guerriero, S, Spada, M, Batignani, G, Sgroi, G, Floridi, P, Boni, L, Maida, P, Ribero, D, La Barba, G, Cucchetti, Alessandro, Aldrighetti, Luca, Ratti, Francesca, Ferrero, Alessandro, Guglielmi, Alfredo, Giuliante, Felice, Cillo, Umberto, Mazzaferro, Vincenzo, De Carlis, Luciano, and Ercolani, Giorgio
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Hepatology ,mortality, morbidity ,Liver Neoplasms ,risk-adjustment ,morbidity ,laparoscopic liver resection ,Length of Stay ,mortality ,Settore MED/18 ,Hepatectomy ,Humans ,Surgery ,Laparoscopy ,Prospective Studies ,heterogeneity - Abstract
Background/Purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. The purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR). Methods: Data from a prospective, multicenter database involving 4318 patients submitted to LLRs in 41 hospitals from an intention-to-treat approach (2014–2020) were used to analyze heterogeneity (I2) among centers and to develop a risk-adjustment model on outcome measures through multivariable mixed-effect models to account for confounding due to case-mix. Results: Involved hospitals operated on very different patients: the largest heterogeneity was observed for operating in the presence of previous abdominal surgery (I2:79.1%), in cirrhotic patients (I2:89.3%) suffering from hepatocellular carcinoma (I2:88.6%) or requiring associated intestinal resections (I2:82.8%) and in regard to technical complexity (I2 for the most complex LLRs: 84.1%). These aspects determined substantial or large heterogeneity in overall morbidity (I2:84.9%), in prolonged in-hospital stay (I2:86.9%) and in conversion rate (I2:73.4%). Major complication had medium heterogeneity (I2:46.5%). The heterogeneity of mortality was null. Risk-adjustment accounted for all of this variability and the final risk-standardized conversion rate was 8.9%, overall morbidity was 22.1%, major morbidity was 5.1% and prolonged in-hospital stay was 26.0%. There were no outliers among the 41 participating centers. An online tool was provided. Conclusions: A benchmark for LLRs including all eligible patients was provided, suggesting that surgeons can act accordingly in the interest of the patient, modifying their approach in relation to different indications and different experience, but finally providing the same quality of care.
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- 2022
35. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?
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Choi S. H., Chen K. -H., Syn N. L., Cipriani F., Cheung T. -T., Chiow A. K. H., Choi G. -H., Siow T. -F., Sucandy I., Marino M. V., Gastaca M., Chong C. C., Lee J. H., Ivanecz A., Mazzaferro V., Lopez-Ben S., Fondevila C., Rotellar F., Campos R. R., Efanov M., Kingham T. P., Sutcliffe R. P., Troisi R. I., Pratschke J., Wang X., D'Hondt M., Yong C. C., Levi Sandri G. B., Tang C. N., Ruzzenente A., Cherqui D., Ferrero A., Wakabayashi G., Scatton O., Aghayan D., Edwin B., Coelho F. F., Giuliante F., Liu R., Sijberden J., Abu Hilal M., Sugioka A., Long T. C. D., Fuks D., Aldrighetti L., Han H. -S., Goh B. K. P., Kang I., Jang J. Y., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Kadam P., Montalti R., Giglio M., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Prieto M., Lim C., Nghia P. P., Kojima M., Kato Y., Forchino F., Herman P., Kruger J. A. P., Saleh M., Pascual F., Dalla Valle B., Lopez-Lopez V., Casellas-Robert M., Giustizieri U., Citterio D., Mishima K., Fretland A. A., Ghotbi J., Ettorre G. M., Colasanti M., Guzman Y., Ardito F., Vani S., Wang H. -P., Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, F., Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, F., Vani, S., Wang, H. -P., Choi, Sung Hoon, Chen, Kuo-Hsin, Syn, Nicholas L, Cipriani, Federica, Cheung, Tan-To, Chiow, Adrian K H, Choi, Gi-Hong, Siow, Tiing-Foong, Sucandy, Iswanto, Marino, Marco V, Gastaca, Mikel, Chong, Charing C, Lee, Jae Hoon, Ivanecz, Arpad, Mazzaferro, Vincenzo, Lopez-Ben, Santiago, Fondevila, Constantino, Rotellar, Fernando, Campos, Ricardo Roble, Efanov, Mikhail, Kingham, T Peter, Sutcliffe, Robert P, Troisi, Roberto I, Pratschke, Johann, Wang, Xiaoying, D'Hondt, Mathieu, Yong, Chee Chien, Levi Sandri, Giovanni Battista, Tang, Chung Ngai, Ruzzenente, Andrea, Cherqui, Daniel, Ferrero, Alessandro, Wakabayashi, Go, Scatton, Olivier, Aghayan, Davit, Edwin, Bjørn, Coelho, Fabricio Ferreira, Giuliante, Felice, Liu, Rong, Sijberden, Jasper, Abu Hilal, Mohammad, Sugioka, Atsushi, Long, Tran Cong Duy, Fuks, David, Aldrighetti, Luca, Han, Ho-Seong, and Goh, Brian K P
- Subjects
Carcinoma, Hepatocellular ,Laparoscopic liver ,Settore MED/18 - CHIRURGIA GENERALE ,Operative Time ,Liver Neoplasms ,Carcinoma ,Hepatocellular ,Difficulty score ,Length of Stay ,Iwate ,Laparoscopic hepatectomy ,Right posterior sectionectomy ,Treatment Outcome ,Postoperative Complications ,Humans ,Hepatectomy ,Surgery ,Laparoscopy ,Retrospective Studies - Abstract
Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.
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- 2022
36. Correction to: Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry (Updates in Surgery, (2021), 10.1007/s13304-021-01161-w)
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Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Gruttadauria, S, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri G. B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Gruttadauria S., Di Benedetto F., Ferrero A., Ettorre G. M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G. L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., and Zimmitti G.
- Abstract
In the originally published article the co-author first name and last name was interchanged. The correct name is copied below Salvatore Gruttadauria The original article has been updated.
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- 2021
37. Overview of prognostic systems for hepatocellular carcinoma and ITA.LI.CA external validation of MESH and CNLC classifications
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Vitale, A, Farinati, F, Finotti, M, Di Renzo, C, Brancaccio, G, Piscaglia, F, Cabibbo, G, Caturelli, E, Missale, G, Marra, F, Sacco, R, Giannini, E, Trevisani, F, Cillo, U, Bhoori, S, Borzio, M, Burra, P, Casadei Gardini, A, Carrai, P, Conti, F, Cozzolongo, R, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, De Matthaeis, N, Di Costanzo, G, Di Sandro, S, Famularo, S, Foschi, F, Fucilli, F, Galati, G, Gambato, M, Gasbarrini, A, Giuliante, F, Ghinolfi, D, Grieco, A, Gruttadauria, S, Guarino, M, Iavarone, M, Kostandini, A, Lai, Q, Lenci, I, Levi Sandri, G, Losito, F, Lupo, L, Marasco, G, Manzia, T, Mazzocato, S, Masarone, M, Melandro, F, Mescoli, C, Miele, L, Morisco, F, Muley, M, Nicolini, D, Pagano, D, Persico, M, Pompili, M, Ponziani, F, Pravisani, R, Rapaccini, G, Rendina, M, Renzulli, M, Romano, F, Rossi, M, Rreka, E, Russo, F, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Vigano, L, Vigano, M, Villa, E, Vincenzi, V, Violi, P, Azzaroli, F, Brunetto, M, Di Marco, A, Masotto, A, Mega, A, Nardone, G, Oliveri, F, Raimondo, G, Svegliati Baroni, G, Vidili, G, Zoli, M, Vitale A., Farinati F., Finotti M., Di Renzo C., Brancaccio G., Piscaglia F., Cabibbo G., Caturelli E., Missale G., Marra F., Sacco R., Giannini E. G., Trevisani F., Cillo U., Bhoori S., Borzio M., Burra P., Casadei Gardini A., Carrai P., Conti F., Cozzolongo R., Cucchetti A., D'ambrosio R., Dell'unto C., De Matthaeis N., Di Costanzo G. G., Di Sandro S., Famularo S., Foschi F. G., Fucilli F., Galati G., Gambato M., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttadauria S., Guarino M., Iavarone M., Kostandini A., Lai Q., Lenci I., Levi Sandri G. V., Losito F., Lupo L. G., Marasco G., Manzia T. M., Mazzocato S., Masarone M., Melandro F., Mescoli C., Miele L., Morisco F., Muley M., Nicolini D., Pagano D., Persico M., Pompili M., Ponziani F. R., Pravisani R., Rapaccini G. L., Rendina M., Renzulli M., Romano F., Rossi M., Rreka E., Russo F. P., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Vigano L., Vigano M., Villa E., Vincenzi V., Violi P., Azzaroli F., Brunetto M. R., Di Marco A., Masotto A., Mega A., Nardone G., Oliveri F., Raimondo G., Svegliati Baroni G., Vidili G., Zoli M., Vitale, A, Farinati, F, Finotti, M, Di Renzo, C, Brancaccio, G, Piscaglia, F, Cabibbo, G, Caturelli, E, Missale, G, Marra, F, Sacco, R, Giannini, E, Trevisani, F, Cillo, U, Bhoori, S, Borzio, M, Burra, P, Casadei Gardini, A, Carrai, P, Conti, F, Cozzolongo, R, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, De Matthaeis, N, Di Costanzo, G, Di Sandro, S, Famularo, S, Foschi, F, Fucilli, F, Galati, G, Gambato, M, Gasbarrini, A, Giuliante, F, Ghinolfi, D, Grieco, A, Gruttadauria, S, Guarino, M, Iavarone, M, Kostandini, A, Lai, Q, Lenci, I, Levi Sandri, G, Losito, F, Lupo, L, Marasco, G, Manzia, T, Mazzocato, S, Masarone, M, Melandro, F, Mescoli, C, Miele, L, Morisco, F, Muley, M, Nicolini, D, Pagano, D, Persico, M, Pompili, M, Ponziani, F, Pravisani, R, Rapaccini, G, Rendina, M, Renzulli, M, Romano, F, Rossi, M, Rreka, E, Russo, F, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Vigano, L, Vigano, M, Villa, E, Vincenzi, V, Violi, P, Azzaroli, F, Brunetto, M, Di Marco, A, Masotto, A, Mega, A, Nardone, G, Oliveri, F, Raimondo, G, Svegliati Baroni, G, Vidili, G, Zoli, M, Vitale A., Farinati F., Finotti M., Di Renzo C., Brancaccio G., Piscaglia F., Cabibbo G., Caturelli E., Missale G., Marra F., Sacco R., Giannini E. G., Trevisani F., Cillo U., Bhoori S., Borzio M., Burra P., Casadei Gardini A., Carrai P., Conti F., Cozzolongo R., Cucchetti A., D'ambrosio R., Dell'unto C., De Matthaeis N., Di Costanzo G. G., Di Sandro S., Famularo S., Foschi F. G., Fucilli F., Galati G., Gambato M., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttadauria S., Guarino M., Iavarone M., Kostandini A., Lai Q., Lenci I., Levi Sandri G. V., Losito F., Lupo L. G., Marasco G., Manzia T. M., Mazzocato S., Masarone M., Melandro F., Mescoli C., Miele L., Morisco F., Muley M., Nicolini D., Pagano D., Persico M., Pompili M., Ponziani F. R., Pravisani R., Rapaccini G. L., Rendina M., Renzulli M., Romano F., Rossi M., Rreka E., Russo F. P., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Vigano L., Vigano M., Villa E., Vincenzi V., Violi P., Azzaroli F., Brunetto M. R., Di Marco A., Masotto A., Mega A., Nardone G., Oliveri F., Raimondo G., Svegliati Baroni G., Vidili G., and Zoli M.
- Abstract
Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.
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- 2021
38. Effect of Diameter and Number of Hepatocellular Carcinomas on Survival After Resection, Transarterial Chemoembolization, and Ablation
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Kawaguchi, Y, Hasegawa, K, Hagiwara, Y, De Bellis, M, Famularo, S, Panettieri, E, Matsuyama, Y, Tateishi, R, Ichikawa, T, Kokudo, T, Izumi, N, Kubo, S, Sakamoto, M, Shiina, S, Takayama, T, Nakashima, O, Murakami, T, Vauthey, J, Giuliante, F, De Carlis, L, Romano, F, Ruzzenente, A, Guglielmi, A, Kudo, M, Kokudo, N, Kawaguchi Y., Hasegawa K., Hagiwara Y., De Bellis M., Famularo S., Panettieri E., Matsuyama Y., Tateishi R., Ichikawa T., Kokudo T., Izumi N., Kubo S., Sakamoto M., Shiina S., Takayama T., Nakashima O., Murakami T., Vauthey J. -N., Giuliante F., De Carlis L., Romano F., Ruzzenente A., Guglielmi A., Kudo M., Kokudo N., Kawaguchi, Y, Hasegawa, K, Hagiwara, Y, De Bellis, M, Famularo, S, Panettieri, E, Matsuyama, Y, Tateishi, R, Ichikawa, T, Kokudo, T, Izumi, N, Kubo, S, Sakamoto, M, Shiina, S, Takayama, T, Nakashima, O, Murakami, T, Vauthey, J, Giuliante, F, De Carlis, L, Romano, F, Ruzzenente, A, Guglielmi, A, Kudo, M, Kokudo, N, Kawaguchi Y., Hasegawa K., Hagiwara Y., De Bellis M., Famularo S., Panettieri E., Matsuyama Y., Tateishi R., Ichikawa T., Kokudo T., Izumi N., Kubo S., Sakamoto M., Shiina S., Takayama T., Nakashima O., Murakami T., Vauthey J. -N., Giuliante F., De Carlis L., Romano F., Ruzzenente A., Guglielmi A., Kudo M., and Kokudo N.
- Abstract
INTRODUCTION: Most studies predicting survival after resection, transarterial chemoembolization (TACE), and ablation analyzed diameter and number of hepatocellular carcinomas (HCCs) as dichotomous variables, resulting in an underestimation of risk variation. We aimed to develop and validate a new prognostic model for patients with HCC using largest diameter and number of HCCs as continuous variables. METHODS: The prognostic model was developed using data from patients undergoing resection, TACE, and ablation in 645 Japanese institutions. The model results were shown after balanced using the inverse probability of treatment-weighted analysis and were externally validated in an international multi-institution cohort. RESULTS: Of 77,268 patients, 43,904 patients, including 15,313 (34.9%) undergoing liver resection, 13,375 (30.5%) undergoing TACE, and 15,216 (34.7%) undergoing ablation, met the inclusion criteria. Our model (http://www.u-tokyo-hbp-transplant-surgery.jp/about/calculation.html) showed that the 5-year overall survival (OS) in patients with HCC undergoing these procedures decreased with progressive incremental increases in diameter and number of HCCs. For patients undergoing resection, the inverse probability of treatment-weighted-adjusted 5-year OS probabilities were 10%-20% higher compared with patients undergoing TACE for 1-6 HCC lesions <10 cm and were also 10%-20% higher compared with patients undergoing ablation when the HCC diameter was 2-3 cm. For patients undergoing resection and TACE, the model performed well in the external cohort. DISCUSSION: Our novel prognostic model performed well in predicting OS after resection and TACE for HCC and demonstrated that resection may have a survival benefit over TACE and ablation based on the diameter and number of HCCs.
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- 2021
39. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison
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Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., and De Peppo V.
- Abstract
Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods: This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results: 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p<0.001). Conclusion: Curative approaches may guarantee long-term survival in case of recurrence.
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- 2021
40. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy
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De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., Sommacale D., De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., and Sommacale D.
- Abstract
Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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- 2021
41. Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry
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Giuliante, F., Vigano, L., De Rose, A. M., Mirza, D. F., Lapointe, R., Kaiser, G., Barroso, E., Ferrero, A., Isoniemi, H., Lopez-Ben, S., Popescu, I., Ouellet, J. -F., Hubert, C., Regimbeau, J. -M., Lin, J. -K., Skipenko, O. G., Ardito, F., Adam, R., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Giuliante, F., Vigano, L., De Rose, A. M., Mirza, D. F., Lapointe, R., Kaiser, G., Barroso, E., Ferrero, A., Isoniemi, H., Lopez-Ben, S., Popescu, I., Ouellet, J. -F., Hubert, C., Regimbeau, J. -M., Lin, J. -K., Skipenko, O. G., Ardito, F., Adam, R., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)
- Abstract
Background: The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach. Methods: Patients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis. Results: Overall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003). Conclusion: In patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standa
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- 2021
42. Conversion Therapy With Encorafenib and Cetuximab for Chemo-Refractory BRAF V600E-Mutated Liver-Limited Colorectal Cancer Metastasis: The First Case Report
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Calegari, M. A., Stefano, B. D., Basso, M., Carbone, C., Camarda, F., Ribelli, M., Anghelone, A., Vivolo, R., Bensi, M., Martini, M., Pozzo, C., Vellone, M., Ardito, F., Salvatore, L., Giuliante, F., Tortora, G., Calegari M. A., Basso M., Camarda F., Anghelone A., Vivolo R., Bensi M., Martini M. (ORCID:0000-0002-6260-6310), Pozzo C., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Salvatore L., Giuliante F. (ORCID:0000-0001-9517-8220), Tortora G. (ORCID:0000-0002-1378-4962), Calegari, M. A., Stefano, B. D., Basso, M., Carbone, C., Camarda, F., Ribelli, M., Anghelone, A., Vivolo, R., Bensi, M., Martini, M., Pozzo, C., Vellone, M., Ardito, F., Salvatore, L., Giuliante, F., Tortora, G., Calegari M. A., Basso M., Camarda F., Anghelone A., Vivolo R., Bensi M., Martini M. (ORCID:0000-0002-6260-6310), Pozzo C., Vellone M. (ORCID:0000-0002-7628-4092), Ardito F. (ORCID:0000-0003-1596-2862), Salvatore L., Giuliante F. (ORCID:0000-0001-9517-8220), and Tortora G. (ORCID:0000-0002-1378-4962)
- Abstract
• Standard chemotherapy plus surgery yields to unsatisfying results in BRAF-mutated colorectal liver metastases (CLM). Combination of targeted agents (encorafenib, a BRAF inhibitor, and cetuximab, an anti-EGFR) is the new standard of care for BRAF V600E-mutated mCRC refractory to a first-line standard chemotherapy. Up to now no evidence is available concerning the activity of this novel treatment as conversion therapy in CLM setting. • Our case provides evidence, for the first time to our knowledge, of the activity of encorafenib plus cetuximab as conversion regimen for BRAF V600E-mutated CLM. Additional observations in this case report concern mechanisms underlying rapid occurrence of acquired resistance and the role of CEA serum levels as biomarker to monitor treatment activity and occurrence of resistance, allowing to optimize the timing of surgery. • Further evidence on the role of doublet targeted regimen (encorafenib plus cetuximab) as conversion treatment in the setting of BRAF-mutant CLM is warranted.
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- 2021
43. Liver resection for perihilar cholangiocarcinoma: Impact of biliary drainage failure on postoperative outcome. Results of an Italian multicenter study
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Giuliante, F, Ardito, F, Aldrighetti, L, Ferrero, A, Pinna, A, De Carlis, L, Cillo, U, Jovine, E, Portolani, N, Gruttadauria, S, Mazzaferro, V, Massani, M, Rosso, E, Ettorre, G, Ratti, F, Guglielmi, A, Cescon, M, Colasanti, M, Di Sandro, S, Gringeri, E, Russolillo, N, Ruzzenente, A, Sposito, C, Zanello, M, Zimmitti, G, Giuliante F., Ardito F., Aldrighetti L., Ferrero A., Pinna A. D., De Carlis L., Cillo U., Jovine E., Portolani N., Gruttadauria S., Mazzaferro V., Massani M., Rosso E., Ettorre G. M., Ratti F., Guglielmi A., Cescon M., Colasanti M., Di Sandro S., Gringeri E., Russolillo N., Ruzzenente A., Sposito C., Zanello M., Zimmitti G., Giuliante, F, Ardito, F, Aldrighetti, L, Ferrero, A, Pinna, A, De Carlis, L, Cillo, U, Jovine, E, Portolani, N, Gruttadauria, S, Mazzaferro, V, Massani, M, Rosso, E, Ettorre, G, Ratti, F, Guglielmi, A, Cescon, M, Colasanti, M, Di Sandro, S, Gringeri, E, Russolillo, N, Ruzzenente, A, Sposito, C, Zanello, M, Zimmitti, G, Giuliante F., Ardito F., Aldrighetti L., Ferrero A., Pinna A. D., De Carlis L., Cillo U., Jovine E., Portolani N., Gruttadauria S., Mazzaferro V., Massani M., Rosso E., Ettorre G. M., Ratti F., Guglielmi A., Cescon M., Colasanti M., Di Sandro S., Gringeri E., Russolillo N., Ruzzenente A., Sposito C., Zanello M., and Zimmitti G.
- Abstract
Background: Preoperative biliary drainage may be essential to reduce the risk of postoperative liver failure after hepatectomy for perihilar cholangiocarcinoma. However, infectious complications related to preoperative biliary drainage may increase the risk of postoperative mortality. The strategy and optimal drainage method continues to be controversial. Methods: This is a retrospective multicenter study including patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2000 and 2016 at 14 Italian referral hepatobiliary centers. The primary end point was to evaluate independent predictors for postoperative outcome in patients undergoing liver resection for perihilar cholangiocarcinoma after preoperative biliary drainage. Results: Of the 639 enrolled patients, 441 (69.0%) underwent preoperative biliary drainage. Postoperative mortality was 8.9% (12.5% after right-side hepatectomy versus 5.7% after left-side hepatectomy; P = .003). Of the patients, 40.5% underwent preoperative biliary drainage at the first admitting hospital, before evaluation at referral centers. Use of percutaneous preoperative biliary drainage was significantly more frequent at referral centers than at community hospitals where endoscopic preoperative biliary drainage was the most frequent type. The overall failure rate after preoperative biliary drainage was 43.3%, significantly higher at community hospitals than that at referral centers (52.7% v 36.9%; P = .002). Failure of the first preoperative biliary drainage was one of the strongest predictors for postoperative complications after right-side and left-side hepatectomies and for mortality after right-side hepatectomy. Type of preoperative biliary drainage (percutaneous versus endoscopic) was not associated with significantly different risk of mortality. Conclusion: Failure of preoperative biliary drainage was significantly more frequent at community hospitals and it was an independent predictor for postoperative outcome. Ce
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- 2021
44. The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology
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Rocca, A, Cipriani, F, Belli, G, Berti, S, Boggi, U, Bottino, V, Cillo, U, Cescon, M, Cimino, M, Corcione, F, De Carlis, L, Degiuli, M, De Paolis, P, De Rose, A, D'Ugo, D, Di Benedetto, F, Elmore, U, Ercolani, G, Ettorre, G, Ferrero, A, Filauro, M, Giuliante, F, Gruttadauria, S, Guglielmi, A, Izzo, F, Jovine, E, Laurenzi, A, Marchegiani, F, Marini, P, Massani, M, Mazzaferro, V, Mineccia, M, Minni, F, Muratore, A, Nicosia, S, Pellicci, R, Rosati, R, Russolillo, N, Spinelli, A, Spolverato, G, Torzilli, G, Vennarecci, G, Vigano, L, Vincenti, L, Delrio, P, Calise, F, Aldrighetti, L, Rocca A., Cipriani F., Belli G., Berti S., Boggi U., Bottino V., Cillo U., Cescon M., Cimino M., Corcione F., De Carlis L., Degiuli M., De Paolis P., De Rose A. M., D'Ugo D., Di Benedetto F., Elmore U., Ercolani G., Ettorre G. M., Ferrero A., Filauro M., Giuliante F., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Laurenzi A., Marchegiani F., Marini P., Massani M., Mazzaferro V., Mineccia M., Minni F., Muratore A., Nicosia S., Pellicci R., Rosati R., Russolillo N., Spinelli A., Spolverato G., Torzilli G., Vennarecci G., Vigano L., Vincenti L., Delrio P., Calise F., Aldrighetti L., Rocca, A, Cipriani, F, Belli, G, Berti, S, Boggi, U, Bottino, V, Cillo, U, Cescon, M, Cimino, M, Corcione, F, De Carlis, L, Degiuli, M, De Paolis, P, De Rose, A, D'Ugo, D, Di Benedetto, F, Elmore, U, Ercolani, G, Ettorre, G, Ferrero, A, Filauro, M, Giuliante, F, Gruttadauria, S, Guglielmi, A, Izzo, F, Jovine, E, Laurenzi, A, Marchegiani, F, Marini, P, Massani, M, Mazzaferro, V, Mineccia, M, Minni, F, Muratore, A, Nicosia, S, Pellicci, R, Rosati, R, Russolillo, N, Spinelli, A, Spolverato, G, Torzilli, G, Vennarecci, G, Vigano, L, Vincenti, L, Delrio, P, Calise, F, Aldrighetti, L, Rocca A., Cipriani F., Belli G., Berti S., Boggi U., Bottino V., Cillo U., Cescon M., Cimino M., Corcione F., De Carlis L., Degiuli M., De Paolis P., De Rose A. M., D'Ugo D., Di Benedetto F., Elmore U., Ercolani G., Ettorre G. M., Ferrero A., Filauro M., Giuliante F., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Laurenzi A., Marchegiani F., Marini P., Massani M., Mazzaferro V., Mineccia M., Minni F., Muratore A., Nicosia S., Pellicci R., Rosati R., Russolillo N., Spinelli A., Spolverato G., Torzilli G., Vennarecci G., Vigano L., Vincenti L., Delrio P., Calise F., and Aldrighetti L.
- Abstract
At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15–25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients’ selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries.
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- 2021
45. The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study
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Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, Conticchio, M, Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D. P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., Grazi G. L., Valle R. D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M. G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., Conticchio M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D'Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, D, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, G, Valle, R, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, M, De Peppo, V, Calabrese, F, Desario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P, Conticchio, M, Famularo S., Donadon M., Cipriani F., Ardito F., Iaria M., Carissimi F., Perri P., Dominioni T., Zanello M., Conci S., Molfino S., D'Acapito F., Germani P., Ferrari C., Patauner S., Pinotti E., Sciannamea I., Garatti M., Lodo E., Troci A., Delvecchio A., Floridi A., Bernasconi D. P., Fumagalli L., Chiarelli M., Memeo R., Crespi M., Zanus G., Zimmitti G., Antonucci A., Zago M., Frena A., Griseri G., Tarchi P., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., Grazi G. L., Valle R. D., Giuliante F., Aldrighetti L., Romano F., Torzilli G., Costa G., Ciulli C., Giani A., Ratti F., Bellobono M., Cremaschi E., Valsecchi M. G., De Peppo V., Calabrese F., DeSario G., Lazzari G., Cucchetti A., Cosola D., Percivale A., Ciola M., Montuori M., Frassani S., Manzoni A., Salvador L., Pennacchi L., Corleone P., and Conticchio M.
- Abstract
Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41–71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921–1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295–0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.
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- 2021
46. Preoperative predictors of liver decompensation after mini-invasive liver resection
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Sposito, C, Monteleone, M, Aldrighetti, L, Cillo, U, Dalla Valle, R, Guglielmi, A, Ettorre, G, Ferrero, A, Di Benedetto, F, Rossi, G, De Carlis, L, Giuliante, F, Mazzaferro, V, Sposito C., Monteleone M., Aldrighetti L., Cillo U., Dalla Valle R., Guglielmi A., Ettorre G. M., Ferrero A., Di Benedetto F., Rossi G. E., De Carlis L., Giuliante F., Mazzaferro V., Sposito, C, Monteleone, M, Aldrighetti, L, Cillo, U, Dalla Valle, R, Guglielmi, A, Ettorre, G, Ferrero, A, Di Benedetto, F, Rossi, G, De Carlis, L, Giuliante, F, Mazzaferro, V, Sposito C., Monteleone M., Aldrighetti L., Cillo U., Dalla Valle R., Guglielmi A., Ettorre G. M., Ferrero A., Di Benedetto F., Rossi G. E., De Carlis L., Giuliante F., and Mazzaferro V.
- Abstract
Background: Post-hepatectomy liver failure (PHLF) represents the most frequent complication after liver surgery, and the most common cause of morbidity and mortality. Aim of the study is to identify the predictors of PHLF after mini-invasive liver surgery in cirrhosis and chronic liver disease, and to develop a model for risk prediction. Methods: The present study is a multicentric prospective cohort study on 490 consecutive patients who underwent mini-invasive liver resection from the Italian Registry of Mini-invasive Liver Surgery (I go MILS). Retrospective additional biochemical and clinical data were collected. Results: On 490 patients (26.5% females), PHLF occurred in 89 patients (18.2%). The only independent predictors of PHLF were Albumin-Bilirubin (ALBI) score (OR 3.213; 95% CI 1.661–6.215; p <.0.0001) and presence of ascites (OR 3.320; 95% CI 1.468–7.508; p = 0.004). Classification and regression tree (CART) modeling led to the identification of three risk groups: PHLF occurred in 23/217 patients with ALBI grade 1 (10.6%, low risk group), in 54/254 patients with ALBI score 2 or 3 and absence of ascites (21.3%, intermediate risk group) and in 12/19 patients with ALBI score 2 or 3 and evidence of ascites (63.2%, high risk group), p < 0.0001. The three groups showed a corresponding increase in postoperative complications (20.0%, 27.5% and 66.7%), Comprehensive Complication Index (5.1 ± 11.1, 6.0 ± 10.9 and 18.8 ± 18.9) and hospital stay (6.0 ± 4.0, 6.0 ± 6.0 and 8.0 ± 5.0 days). Conclusion: The risk of PHLF can be stratified by determining two easily available preoperative factors: ALBI and ascites. This model of risk prediction offers an objective instrument for a correct clinical decision-making.
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- 2021
47. Gene expression profiling of pancreas neuroendocrine tumors with different ki67‐based grades
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Simbolo, M., Bilotta, M., Mafficini, A., Luchini, C., Furlan, D., Inzani, F., Petrone, G., Bonvissuto, D., Rosa, S. L., Schinzari, G., Bianchi, A., Rossi, E., Menghi, R., Giuliante, F., Boccia, S., Scarpa, A., Rindi, G., Inzani F., Petrone G., Bonvissuto D., Schinzari G. (ORCID:0000-0001-6105-7252), Menghi R., Giuliante F. (ORCID:0000-0001-9517-8220), Boccia S. (ORCID:0000-0002-1864-749X), Rindi G. (ORCID:0000-0003-2996-4404), Simbolo, M., Bilotta, M., Mafficini, A., Luchini, C., Furlan, D., Inzani, F., Petrone, G., Bonvissuto, D., Rosa, S. L., Schinzari, G., Bianchi, A., Rossi, E., Menghi, R., Giuliante, F., Boccia, S., Scarpa, A., Rindi, G., Inzani F., Petrone G., Bonvissuto D., Schinzari G. (ORCID:0000-0001-6105-7252), Menghi R., Giuliante F. (ORCID:0000-0001-9517-8220), Boccia S. (ORCID:0000-0002-1864-749X), and Rindi G. (ORCID:0000-0003-2996-4404)
- Abstract
Pancreatic neuroendocrine tumors (PanNETs) display variable aggressive behavior. A major predictor of survival is tumor grade based on the Ki67 proliferation index. As information on transcriptomic profiles of PanNETs with different tumor grades is limited, we investigated 29 PanNETs (17 G1, 7 G2, 5 G3) for their expression profiles, mutations in 16 PanNET relevant genes and LINE‐1 DNA methylation profiles. A total of 3050 genes were differentially expressed between tumors with different grades (p < 0.05): 1279 in G3 vs. G2; 2757 in G3 vs. G1; and 203 in G2 vs. G1. Mutational analysis showed 57 alterations in 11 genes, the most frequent being MEN1 (18/29), DAXX (7/29), ATRX (6/29) and MUTYH (5/29). The presence and type of mutations did not correlate with the specific expression profiles associated with different grades. LINE‐1 showed significantly lower methylation in G2/G3 versus G1 tumors (p = 0.007). The expression profiles of matched primaries and metastasis (nodal, hepatic and colorectal wall) of three cases confirmed the role of Ki67 in defining specific expression profiles, which clustered according to tumor grades, independently from anatomic location or patient of origin. Such data call for future exploration of the role of Ki67 in tumor progression, given its involvement in chromosomal stability.
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- 2021
48. The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study
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Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D'Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., Troci, A., Delvecchio, A., Floridi, A., Bernasconi, D. P., Fumagalli, L., Chiarelli, M., Memeo, R., Crespi, M., Zanus, G., Zimmitti, G., Antonucci, A., Zago, M., Frena, A., Griseri, G., Tarchi, P., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Grazi, G. L., Valle, R. D., Giuliante, F., Aldrighetti, L., Romano, F., Torzilli, G., Costa, G., Ciulli, C., Giani, A., Ratti, F., Bellobono, M., Cremaschi, E., Valsecchi, M. G., De Peppo, V., Calabrese, F., DeSario, G., Lazzari, G., Cucchetti, A., Cosola, D., Percivale, A., Ciola, M., Montuori, M., Frassani, S., Manzoni, A., Salvador, L., Pennacchi, L., Corleone, P., Conticchio, M., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., D'Acapito F., Zimmitti G. (ORCID:0000-0003-4925-4012), Antonucci A., Maestri M., Giuliante F. (ORCID:0000-0001-9517-8220), Romano F., Torzilli G., Lazzari G., Manzoni A., Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D'Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., Troci, A., Delvecchio, A., Floridi, A., Bernasconi, D. P., Fumagalli, L., Chiarelli, M., Memeo, R., Crespi, M., Zanus, G., Zimmitti, G., Antonucci, A., Zago, M., Frena, A., Griseri, G., Tarchi, P., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Grazi, G. L., Valle, R. D., Giuliante, F., Aldrighetti, L., Romano, F., Torzilli, G., Costa, G., Ciulli, C., Giani, A., Ratti, F., Bellobono, M., Cremaschi, E., Valsecchi, M. G., De Peppo, V., Calabrese, F., DeSario, G., Lazzari, G., Cucchetti, A., Cosola, D., Percivale, A., Ciola, M., Montuori, M., Frassani, S., Manzoni, A., Salvador, L., Pennacchi, L., Corleone, P., Conticchio, M., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., D'Acapito F., Zimmitti G. (ORCID:0000-0003-4925-4012), Antonucci A., Maestri M., Giuliante F. (ORCID:0000-0001-9517-8220), Romano F., Torzilli G., Lazzari G., and Manzoni A.
- Abstract
Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41–71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921–1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295–0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.
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- 2021
49. Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study
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Ruzzenente A., Ciangherotti A., Aldrighetti L., Ettorre G. M., De Carlis L., Ferrero A., Dalla Valle R., Tisone G., Guglielmi A., Ratti F., Gringeri E., Russolillo N., Campagnaro T., Conci S., Sandri G. B. L., Ardito F., Boggi U., Gruttadauria S., Vigano L., Di Benedetto F., Rossi G. E., Berti S., Ceccarelli G., Vincenti L., Cillo U., Giuliante F., Mazzaferro V., Jovine E., Calise F., Belli G., Zamboni F., Coratti A., Mezzatesta P., Santambrogio R., Navarra G., Giuliani A., Ferla F., Pinna A. D., Parisi A., Colledan M., Slim A., Antonucci A., Grazi G. L., Frena A., Sgroi G., Brolese A., Morelli L., Floridi A., Patriti A., Veneroni L., Boni L., Maida P., Griseri G., Filauro M., Guerriero S., Romito R., Tedeschi U., Zimmitti G., Ruzzenente, A., Ciangherotti, A., Aldrighetti, L., Ettorre, G. M., De Carlis, L., Ferrero, A., Dalla Valle, R., Tisone, G., Guglielmi, A., Ratti, F., Gringeri, E., Russolillo, N., Campagnaro, T., Conci, S., Sandri, G. B. L., Ardito, F., Boggi, U., Gruttadauria, S., Vigano, L., Di Benedetto, F., Rossi, G. E., Berti, S., Ceccarelli, G., Vincenti, L., Cillo, U., Giuliante, F., Mazzaferro, V., Jovine, E., Calise, F., Belli, G., Zamboni, F., Coratti, A., Mezzatesta, P., Santambrogio, R., Navarra, G., Giuliani, A., Ferla, F., Pinna, A. D., Parisi, A., Colledan, M., Slim, A., Antonucci, A., Grazi, G. L., Frena, A., Sgroi, G., Brolese, A., Morelli, L., Floridi, A., Patriti, A., Veneroni, L., Boni, L., Maida, P., Griseri, G., Filauro, M., Guerriero, S., Romito, R., Tedeschi, U., Zimmitti, G., Ruzzenente, A, Ciangherotti, A, Aldrighetti, L, Ettorre, G, De Carlis, L, Ferrero, A, Dalla Valle, R, Tisone, G, Guglielmi, A, Ratti, F, Gringeri, E, Russolillo, N, Campagnaro, T, Conci, S, Sandri, G, Ardito, F, Boggi, U, Gruttadauria, S, Vigano, L, Di Benedetto, F, Rossi, G, Berti, S, Ceccarelli, G, Vincenti, L, Cillo, U, Giuliante, F, Mazzaferro, V, Jovine, E, Calise, F, Belli, G, Zamboni, F, Coratti, A, Mezzatesta, P, Santambrogio, R, Navarra, G, Giuliani, A, Ferla, F, Pinna, A, Parisi, A, Colledan, M, Slim, A, Antonucci, A, Grazi, G, Frena, A, Sgroi, G, Brolese, A, Morelli, L, Floridi, A, Patriti, A, Veneroni, L, Boni, L, Maida, P, Griseri, G, Filauro, M, Guerriero, S, Romito, R, Tedeschi, U, and Zimmitti, G
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medicine.medical_specialty ,Carcinoma, Hepatocellular ,Settore MED/18 - CHIRURGIA GENERALE ,Article ,NO ,Cohort Studies ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Postoperative Complications ,Caudate lobe ,Open Resection ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Multi-institutional ,Prospective Studies ,Registries ,Propensity Score ,Contraindication ,Retrospective Studies ,LS7_4 ,Intrahepatic ,business.industry ,Carcinoma ,Liver Neoplasms ,Minimally invasive liver surgery ,Hepatocellular ,Perioperative ,Hepatology ,Length of Stay ,medicine.disease ,Surgery ,Settore MED/18 ,Bile Ducts, Intrahepatic ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Propensity score matching ,Feasibility Studies ,030211 gastroenterology & hepatology ,Laparoscopy ,Bile Ducts ,business ,Propensity score matched ,Abdominal surgery - Abstract
Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.
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- 2021
50. Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry
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Levi Sandri, G. B., Colasanti, M., Aldrighetti, L., Guglielmi, A., Cillo, U., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Salvatore, G., Di Benedetto, F., Ferrero, A., Ettorre, G. M., Antonucci, A., Batignani, G., Belli, G., Belli, A., Berti, S., Boggi, U., Bonsignore, P., Brolese, A., Calise, F., Ceccarelli, G., Cecconi, S., Colledan, M., Coratti, A., Ercolani, G., Ferla, F., Filauro, M., Floridi, A., Frena, A., Giuliani, A., Giuliante, F., Grazi, G. L., Gringeri, E., Griseri, G., Guerriero, S., Jovine, E., Magistri, P., Maida, P., Massani, M., Mezzatesta, P., Morelli, L., Russolillo, N., Navarra, G., Parisi, A., Patriti, A., Ravaioli, M., Ratti, F., Romito, R., Reggiani, P., Ruzzenente, A., Santambrogio, R., Berardi, G., Sgroi, G., Slim, A., Spada, M., Sposito, C., Tedeschi, U., Tisone, G., Torzilli, G., Veneroni, L., Vincenti, L., Zamboni, F., Zimmitti, G., Levi Sandri G.B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Salvatore G., Di Benedetto F., Ferrero A., Ettorre G.M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G.L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Salvatore, G, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri, G. B., Colasanti, M., Aldrighetti, L., Guglielmi, A., Cillo, U., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Salvatore, G., Di Benedetto, F., Ferrero, A., Ettorre, G. M., Antonucci, A., Batignani, G., Belli, G., Belli, A., Berti, S., Boggi, U., Bonsignore, P., Brolese, A., Calise, F., Ceccarelli, G., Cecconi, S., Colledan, M., Coratti, A., Ercolani, G., Ferla, F., Filauro, M., Floridi, A., Frena, A., Giuliani, A., Giuliante, F., Grazi, G. L., Gringeri, E., Griseri, G., Guerriero, S., Jovine, E., Magistri, P., Maida, P., Massani, M., Mezzatesta, P., Morelli, L., Russolillo, N., Navarra, G., Parisi, A., Patriti, A., Ravaioli, M., Ratti, F., Romito, R., Reggiani, P., Ruzzenente, A., Santambrogio, R., Berardi, G., Sgroi, G., Slim, A., Spada, M., Sposito, C., Tedeschi, U., Tisone, G., Torzilli, G., Veneroni, L., Vincenti, L., Zamboni, F., and Zimmitti, G.
- Subjects
Liver surgery ,Registrie ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Subgroup analysis ,IGoMILS ,Laparoscopic HCC ,Laparoscopic indications ,Laparoscopic liver resection ,Minimally invasive ,Recurrence ,Redo surgery ,Robotic ,NO ,Resection ,Postoperative Complications ,Retrospective Studie ,Clinical endpoint ,Medicine ,Humans ,Hepatectomy ,Registries ,Propensity Score ,LS7_4 ,Retrospective Studies ,business.industry ,Primary resection ,Carcinoma ,Liver Neoplasms ,Hepatocellular ,Length of Stay ,medicine.disease ,Surgery ,Settore MED/18 ,Hepatocellular carcinoma ,Cohort ,Propensity score matching ,Laparoscopy ,Postoperative Complication ,business ,Laparoscopic indication ,Human - Abstract
Laparoscopic liver resection (LLR) for Hepatocellular carcinoma (HCC) is a safe procedure. Repeat surgery is more often required, and the role of minimally invasive liver surgery (MILS) is not yet clearly defined. The present study analyzes data compiled by the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) on LLR. To compare repeated LLR with the first LLR for HCC is the primary endpoint. The secondary endpoint was to evaluate the outcome of repeat LLR in the case of primary open versus primary MILS surgery. The data cohort is divided into two groups. Group 1: first liver resection and Group 2: Repeat LLR. To compare the two groups a 3:1 Propensity Score Matching is performed to analyze open versus MILS primary resection. Fifty-two centers were involved in the present study, and 1054 patients were enrolled. 80 patients underwent to a repeat LLR. The type of resection was different, with more major resections in the group 1 before matching the two groups. After propensity score matching 3:1, each group consisted of 222 and 74 patients. No difference between the two groups was observed. In the subgroup analysis, in 44 patients the first resection was performed by an open approach. The other 36 patients were resected with a MILS approach. We found no difference between these two subgroups of patients. The present study in repeat MILS for HCC using the IGoMILS Registry has observed the feasibility and safety of the MILS procedure.
- Published
- 2021
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