Search

Your search keyword '"Zimmitti G"' showing total 13 results
Start Over Author "Zimmitti G" Topic humans
13 results on '"Zimmitti G"'

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

Author

Ruzzenente A., Ciangherotti A., Aldrighetti L., Ettorre G. 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

Subjects
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.

Published
2021

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

Author

Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D'Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., Troci, A., Delvecchio, A., Floridi, A., Bernasconi, D. P., Fumagalli, L., Chiarelli, M., Memeo, R., Crespi, M., Zanus, G., Zimmitti, G., Antonucci, A., Zago, M., Frena, A., Griseri, G., Tarchi, P., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Grazi, G. L., Valle, R. D., Giuliante, F., Aldrighetti, L., Romano, F., Torzilli, G., Costa, G., Ciulli, C., Giani, A., Ratti, F., Bellobono, M., Cremaschi, E., Valsecchi, M. G., De Peppo, V., Calabrese, F., Desario, G., Lazzari, G., Cucchetti, A., Cosola, D., Percivale, A., Ciola, M., Montuori, M., Frassani, S., Manzoni, A., Salvador, L., Pennacchi, L., Corleone, P., Conticchio, M., 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.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, and Conticchio, M

Subjects
Laparoscopic surgery, medicine.medical_specialty, endocrine system, Carcinoma, Hepatocellular, Disease-free survival, Hepatocellular carcinoma, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, 030230 surgery, NO, Liver surgery, Overall survival, Postoperative ascites, Postoperative complications, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Ascites, Risk of mortality, Medicine, Hepatectomy, Humans, Survival analysis, LS7_4, Retrospective Studies, business.industry, Proportional hazards model, Carcinoma, Liver Neoplasms, Gastroenterology, Hepatocellular, medicine.disease, Surgery, Postoperative complication, Postoperative ascite, Neoplasm Recurrence, Local, 030220 oncology & carcinogenesis, Ascite, medicine.symptom, Neoplasm Recurrence, Local, business, Complication, Varices, Human
Abstract

Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41–71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921–1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295–0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.

Published
2021

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

Author

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

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

Author

Iaria, M, Bianchi, G, Fazio, F, Ardito, 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, Ma, Griseri, G, Tarchi, P, Chiarelli, M, Antonucci, A, Baiocchi, Gl, Romano, F, Rossi, M, Jovine, E, Torzilli, G, Ruzzenente, A, Maestri, M, Grazi, Gl, Giuliante, F, Ferrero, A, Dalla Valle, R, Group, HE. RC. O. LE. S., HERCOLES GROUP Contributors: Mario Giuffrida, Nadia, Russolillo, Francesco, Razionale, DE PEPPO, Valerio, Matteo, Tomasoni, Ivan, Marchitelli, Guido, Costa, LARGHI LAUREIRO, Zoe, Mauro, Scotti, Pietro, Calcagno, Davide, Cosola, Angelo, Franceschi, Alberto, Manzoni, Luca, Pennacchi, Mauro, Montuori, Maria, Conticchio, Francesca, Ratti, Francesca, Notte, Alessandro, Cucchetti, Luca, Salvador, Pio, Corleone, Mattia, Garancini, and Cristina, Ciulli.

Subjects
long-term outcome, recurrence, Carcinoma, Hepatocellular, Hepatology, Liver resection, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Carcinoma, Liver Neoplasms, Gastroenterology, Hepatocellular, NO, Neoplasm Recurrence, Treatment Outcome, Local, Recurrent disease, Hepatectomy, Humans, HCC, Neoplasm Recurrence, Local, Liver surgery, Propensity Score, Retrospective Studies
Abstract

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.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).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.SH proved to be equivalent to PH in terms of safety, feasibility and long-term outcomes, consistent with data gathered from East Asia. In the awaiting of reliable treatment-allocating algorithms for rHCC, SH appears to be a suitable alternative in patients fit for surgery, regardless of the previous therapeutic modality implemented.

Published
2021

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

Author

Paola Tarchi, Pasquale Perri, Gian Luca Grazi, Marcello Maestri, Maurizio Romano, Giorgio Ercolani, Gian Luca Baiocchi, Michele Crespi, Federica Cipriani, Luca Fumagalli, Guido Torzilli, Matteo Donadon, Cecilia Ferrari, Paola Germani, Ivano Sciannamea, Raffaele Dalla Valle, Antonio Floridi, Sarah Molfino, A. Frena, Ivan Marchitelli, Francesco Ardito, Simone Famularo, Elio Jovine, Fabrizio Romano, Andrea Ruzzenente, G. Griseri, Luca Ansaloni, Antonella Delvecchio, Simone Conci, Giuliano La Barba, Giacomo Zanus, A. Antonucci, M. Iaria, Marco Chiarelli, Luca Aldrighetti, Enrico Pinotti, Stefan Patauner, Matteo Zanello, Riccardo Memeo, Mauro Zago, Felice Giuliante, Alberto Manzoni, Giuseppe Zimmitti, Albert Troci, Conci, S., Cipriani, F., Donadon, M., Marchitelli, I., Ardito, F., Famularo, S., Perri, P., Iaria, M., Ansaloni, L., Zanello, M., La Barba, G., Patauner, S., Pinotti, E., Molfino, S., Germani, P., Romano, M., Sciannamea, I., Ferrari, C., Manzoni, A., Troci, A., Fumagalli, L., Delvecchio, A., Floridi, A., Memeo, R., Chiarelli, M., Crespi, M., Zimmitti, G., Griseri, G., Antonucci, A., Zanus, G., Tarchi, P., Baiocchi, G. L., Zago, M., Frena, A., Ercolani, G., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Romano, F., Giuliante, F., Torzilli, G., Aldrighetti, L., Ruzzenente, A., Conci S., Cipriani F., Donadon M., Marchitelli I., Ardito F., Famularo S., Perri P., Iaria M., Ansaloni L., Zanello M., La Barba G., Patauner S., Pinotti E., Molfino S., Germani P., Romano M., Sciannamea I., Ferrari C., Manzoni A., Troci A., Fumagalli L., Delvecchio A., Floridi A., Memeo R., Chiarelli M., Crespi M., Zimmitti G., Griseri G., Antonucci A., Zanus G., Tarchi P., Baiocchi G.L., Zago M., Frena A., Ercolani G., Jovine E., Maestri M., Valle R.D., Grazi G.L., Romano F., Giuliante F., Torzilli G., Aldrighetti L., and Ruzzenente A.

Subjects
Liver Cirrhosis, Male, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Disease, Comorbidity, Gastroenterology, Body Mass Index, Neoplasms, Multiple Primary, Non-alcoholic Fatty Liver Disease, Multiple Primary, Neoplasms, Chronic, Liver resection, Liver Diseases, Fatty liver, Liver Neoplasms, General Medicine, Middle Aged, Hepatitis B, Alcoholic, Metabolic syndrome, Hepatitis C, Tumor Burden, Survival Rate, Oncology, Metabolic associated fatty liver disease, Population study, Female, medicine.medical_specialty, Carcinoma, Hepatocellular, Disease-Free Survival, NO, Hepatitis B, Chronic, Hepatectomy, NAFLD, Internal medicine, medicine, Humans, Propensity Score, neoplasms, Pathological, Liver Diseases, Alcoholic, Aged, business.industry, Carcinoma, Hepatocellular, Hepatitis C, Chronic, medicine.disease, digestive system diseases, Propensity score matching, Surgery, business
Abstract

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

Published
2022

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

Author

Salvatore Gruttadauria, Matteo Zanello, Matteo Cescon, Umberto Cillo, Edoardo Rosso, Nadia Russolillo, Alfredo Guglielmi, Andrea Ruzzenente, Felice Giuliante, Elio Jovine, Francesco Ardito, Alessandro Ferrero, Enrico Gringeri, Marco Massani, Stefano Di Sandro, Carlo Sposito, Luca Aldrighetti, Giuseppe Zimmitti, Vincenzo Mazzaferro, Giuseppe Maria Ettorre, Luciano De Carlis, Antonio Daniele Pinna, Nazario Portolani, Francesca Ratti, Marco Colasanti, 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.

Subjects
Male, Percutaneous, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, postoperative outcome, 030230 surgery, Postoperative Complications, 0302 clinical medicine, Risk Factors, Retrospective Studie, 80 and over, Risk of mortality, Clinical endpoint, Drainage, Referral and Consultation, Aged, 80 and over, medicine.diagnostic_test, Liver resection, Middle Aged, Treatment Outcome, Italy, 030220 oncology & carcinogenesis, Female, Human, Adult, medicine.medical_specialty, Preoperative care, 03 medical and health sciences, Preoperative Care, medicine, Humans, Hepatectomy, Bile Duct Neoplasm, Retrospective Studies, Aged, business.industry, Risk Factor, Retrospective cohort study, Endoscopy, biliary drainage, Surgery, Bile Duct Neoplasms, Postoperative Complication, business, perihilar cholangiocarcinoma, Liver Failure, Klatskin Tumor
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. Centers’ experience in preoperative biliary drainage management is crucial to reduce the risk of failure that is closely associated with postoperative morbidity and mortality.

Published
2021

7. Multicentre evaluation of case volume in minimally invasive hepatectomy

Author

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

Subjects
Aged, Female, Hepatectomy, Humans, Italy, Liver Neoplasms, Male, Minimally Invasive Surgical Procedures, Registries, Retrospective Studies, Treatment Outcome, Liver surgery, Hepatic resection, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Proposal, laparoscopy, Metastases, Liver resections, 0302 clinical medicine, minimally invasive liver surgery, case volume, Case volume, Laparascopic Liver Resection, minimally invasive hepatectomy, liver resections, 030220 oncology & carcinogenesis, high-volume centres, 030211 gastroenterology & hepatology, hepatectomy, laparoscopy, liver resections, Hepatocellular-Carcinome, medicine.medical_specialty, Outcomes, NO, 03 medical and health sciences, Hospital volume, medicine, minimally invasive, hepatectomy, LS7_4, business.industry, Retrospective cohort study, Laparascopic Liver Resection, Hepatocellular-Carcinome, Surgery, Outcomes, Metastases, Difficulty, Proposal, hepatectomy, Surgery, Severe morbidity, business, Difficulty
Abstract

Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known.Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month).A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent).A volume-outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.Los resultados quirúrgicos pueden estar relacionados con el volumen de casos del hospital, pero no se conoce la influencia en la cirugía mínimamente invasiva del hígado (minimally‐invasive liver surgery, MILS). MÉTODOS: Se incluyeron los pacientes registrados en el registro prospectivo del grupo italiano de MILS desde 2014 a 2018. Solo se consideraron centros con extensión de ≥ 12 meses y actividad estable de MILS durante el periodo de reclutamiento. El volumen de casos se definió como el número de MILS efectuado por mes.Se llevaron a cabo un total de 2.225 MILS en 46 centros, 9 de ellos con 2 MILS/mes (n = 1.376 pacientes) y 37 centros con ≤ 2 MILS/mes (n = 849). La proporción de resecciones de segmentos anterolaterales disminuyó con el volumen de casos, mientras que la proporción de hepatectomías mayores aumentó. Los resultados para ambos grupos fueron similares en las seccionectomías lateral izquierda y en las resecciones del segmento anterolateral. Las resecciones del segmento posterosuperior y las hepatectomías mayores presentaron tasas más altas de morbilidad global y morbilidad grave en centros que realizaban ≤ 2 MILS/mes que en los que realizaban 2 MILS/mes (resecciones del segmento posterosuperior, morbilidad global 30,4 versus 18,7%, morbilidad grave 9,9 versus 4,0%; hepatectomía izquierda, 46,2 versus 22,0%, 19,2 versus 5,5%; hepatectomía derecha, 41,7 versus 33,8%, 25,0 versus 14.9%). CONCLUSIÓN: Se observó una asociación volumen‐resultado para la resección hepática mínimamente invasiva. Las resecciones complejas y mayores se pueden manejar mejor en centros de gran volumen.

Published
2020

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

Author

Fabrizio Romano, Elio Jovine, Michele Crespi, Andrea Ruzzenente, Luca Aldrighetti, A. Antonucci, Francesco Ardito, Gian Luca Baiocchi, Simone Famularo, Raffaele DallaValle, A. Frena, Gian Luca Grazi, Riccardo Memeo, G. Griseri, Giacomo Zanus, Marcello Maestri, Giorgio Ercolani, Felice Giuliante, Giuseppe Zimmitti, Ardito, F, Famularo, S, Aldrighetti, L, Grazi, G, Dallavalle, R, Maestri, M, Jovine, E, Ruzzenente, A, Baiocchi, G, Ercolani, G, Griseri, G, Frena, A, Zanus, G, Zimmitti, G, Antonucci, A, Crespi, M, Memeo, R, Romano, F, Giuliante, F, Ardito, F., Famularo, S., Aldrighetti, L., Grazi, G. L., Dallavalle, R., Maestri, M., Jovine, E., Ruzzenente, A., Baiocchi, G. L., Ercolani, G., Griseri, G., Frena, A., Zanus, G., Zimmitti, G., Antonucci, A., Crespi, M., Memeo, R., Romano, F., Giuliante, F., Ardito F., Famularo S., Aldrighetti L., Grazi G.L., DallaValle R., Maestri M., Jovine E., Ruzzenente A., Baiocchi G.L., Ercolani G., Griseri G., Frena A., Zanus G., Zimmitti G., Antonucci A., Crespi M., Memeo R., Romano F., and Giuliante F.

Subjects
Male, Registrie, Cirrhosis, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Comorbidity, Postoperative Complications, 0302 clinical medicine, hospital volume, Risk Factors, 80 and over, Adult, Aged, Aged, 80 and over, Carcinoma, Hepatocellular, Female, Hepatectomy, Hospital Mortality, Humans, Italy, Liver Neoplasms, Middle Aged, Registries, Failure to Rescue, Health Care, Hospitals, High-Volume, Hospitals, Low-Volume, major complications, Mortality rate, hepatocellular carcinoma, liver resection, failure to rescue, center's volume, mortality, Hospitals, Liver Neoplasm, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Portal hypertension, 030211 gastroenterology & hepatology, Human, medicine.medical_specialty, High-Volume, NO, 03 medical and health sciences, Low-Volume, medicine, Carcinoma, Liver surgery, LS7_4, business.industry, Risk Factor, Hepatocellular, medicine.disease, BCLC Stage, Surgery, Health Care, Postoperative Complication, Complication, business
Abstract

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

Published
2020

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

Author

Nadia Russolillo, L. Vincenti, M. Iaria, R. Lo Tesoriere, Giulio Belli, R. Dalla Valle, Enrico Gringeri, Alberto Brolese, Roberto Santambrogio, Luca Aldrighetti, F. Di Benedetto, Fausto Zamboni, L. De Carlis, Giuseppe Zimmitti, Felice Giuliante, Vincenzo Mazzaferro, Elio Jovine, Graziano Ceccarelli, G.B. Levi Sandri, Alfredo Guglielmi, Fabio Ferla, P. Mezzatesta, Matteo Virdis, S. Berti, Fulvio Calise, Giuseppe Navarra, Salvatore Gruttadauria, Annamaria Ferrero, Francesco Ardito, Umberto Cillo, E. Rossi, A. Coratti, R. Lombardi, Francesca Ratti, Guido Torzilli, Ugo Boggi, Matteo Ravaioli, Andrea Ruzzenente, Giuseppe Maria Ettorre, Russolillo, N, Aldrighetti, L, Cillo, U, Guglielmi, A, Ettorre, G, Giuliante, F, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Jovine, E, Ferrero, A, Russolillo N., Aldrighetti L., Cillo U., Guglielmi A., Ettorre G.M., Giuliante F., Mazzaferro V., Dalla Valle R., De Carlis L., Jovine E., Ferrero A., Ratti F., Lo Tesoriere R., Gringeri E., Ruzzenente A., Levi Sandri G.B., Ardito F., Virdis M., Iaria M., Ferla F., Lombardi R., Di Benedetto F., Gruttadauria S., Boggi U., Torzilli G., Rossi E., Vincenti L., Berti S., Ceccarelli G., Belli G., Zamboni F., Calise F., Coratti A., Santambrogio R., Brolese A., Navarra G., Mezzatesta P., Zimmitti G., Ravaioli M., Russolillo, N., Aldrighetti, L., Cillo, U., Guglielmi, A., Ettorre, G. M., Giuliante, F., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Jovine, E., Ferrero, A., Ratti, F., Lo Tesoriere, R., Gringeri, E., Ruzzenente, A., Levi Sandri, G. B., Ardito, F., Virdis, M., Iaria, M., Ferla, F., Lombardi, R., Di Benedetto, F., Gruttadauria, S., Boggi, U., Torzilli, G., Rossi, E., Vincenti, L., Berti, S., Ceccarelli, G., Belli, G., Zamboni, F., Calise, F., Coratti, A., Santambrogio, R., Brolese, A., Navarra, G., Mezzatesta, P., Zimmitti, G., and Ravaioli, M.

Subjects
Liver surgery, Male, ACHIEVABLE BENCHMARKS, Cirrhosis, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, ESTABLISHING BENCHMARKS, CARE, COMPLICATIONS, PROPOSAL, 030230 surgery, 0302 clinical medicine, Postoperative Complications, Risk Factors, benchmarks, Registries, Laparoscopy, liver surgery, medicine.diagnostic_test, Bowel resection, Benchmarking, Treatment Outcome, Italy, liver resection, 030211 gastroenterology & hepatology, Female, medicine.medical_specialty, National cohort, Coronavirus, SARS-CoV-2COVID-19Pandemic, Obesity, Bariatric surgery, 03 medical and health sciences, Internal medicine, medicine, Hepatectomy, Humans, Obesity, Quality of Health Care, Bariatric surgery, major morbidity, business.industry, Minimally Invasive Liver Surgery, laparoscopic liver surgery, Odds ratio, Risk adjustment, medicine.disease, Coronavirus, benchmarks, laparoscopic, SARS-CoV-2COVID-19Pandemic, Surgery, business
Abstract

This study aimed to assess the best achievable outcomes in laparoscopic liver resection (LLR) after risk adjustment based on surgical technical difficulty using a national registry.LLRs registered in the Italian Group of Minimally Invasive Liver Surgery registry from November 2014 to March 2018 were considered. Benchmarks were calculated according to the Achievable Benchmark of Care (ABC™). LLRs at each centre were divided into three clusters (groups I, II and III) based on the Kawaguchi classification. ABCs for overall and major morbidity were calculated in each cluster. Multivariable analysis was used to identify independent risk factors for overall and major morbidity. Significant variables were used in further risk adjustment.A total of 1752 of 2263 patients fulfilled the inclusion criteria: 1096 (62·6 per cent) in group I, 435 (24·8 per cent) in group II and 221 (12·6 per cent) in group III. The ABCs for overall morbidity (7·8, 14·2 and 26·4 per cent for grades I, II and II respectively) and major morbidity (1·4, 2·2 and 5·7 per cent) increased with the difficulty of LLR. Multivariable analysis showed an increased risk of overall morbidity associated with multiple LLRs (odds ratio (OR) 1·35), simultaneous intestinal resection (OR 3·76) and cirrhosis (OR 1·83), and an increased risk of major morbidity with intestinal resection (OR 4·61). ABCs for overall and major morbidity were 14·4 and 3·2 per cent respectively for multiple LLRs, 30 and 11·1 per cent for intestinal resection, and 14·9 and 4·8 per cent for cirrhosis.Overall morbidity benchmarks for LLR ranged from 7·8 to 26·4 per cent, and those for major morbidity from 1·4 to 5·7 per cent, depending on complexity. Benchmark values should be adjusted according to multiple LLRs or simultaneous intestinal resection and cirrhosis.Este estudio tuvo como objetivo evaluar los mejores resultados que se pueden conseguir en la resección hepática laparoscópica (laparoscopic liver resection, LLR) después del ajuste por riesgos basado en la dificultad de la técnica quirúrgica utilizando un registro nacional. MÉTODOS: Se consideraron las LLRs incluidas en el Registro del Grupo Italiano de Cirugía Hepática Mínimamente Invasiva desde 11/2014 a 03/2018. Los resultados de referencia (benchmarks) se calcularon de acuerdo con el Achievable Benchmark of Care (ABC™). Las LLRs de cada uno de los centros se dividieron en 3 grupos (Grupo I, II y III) en base a la clasificación de Kawaguchi. Se calculó el ABC de la morbilidad global y de la morbilidad mayor para cada grupo. Se realizó un análisis multivariable para identificar los factores independientes de riesgos para la morbilidad global y morbilidad mayor. Se utilizaron variables significativas para realizar ajustes de riesgo adicionales.Un total de 1.752 pacientes de los 2.263 cumplían los criterios de inclusión, de los cuales 1.096 (62,6%) se incluyeron en el Grupo I, 435 (24,8%) en el Grupo II y 221 (12,6%) en el Grupo III. El ABC de la morbilidad global (7,8%, 14,2%, 26,4%) y de la morbilidad mayor (1,4%, 2,2%, 5,7%) aumentó del Grupo I al Grupo III. El análisis multivariable mostró un incremento del riesgo para la morbilidad global asociada con múltiples LLRs (razón de oportunidades, odds ratio, OR 1,349), resección intestinal simultánea (OR 3,760) y cirrosis (OR 1,825), y para la morbilidad mayor con la resección intestinal (OR 4,606). Los ABC de la morbilidad global y morbilidad mayor fueron 14,4% y 3,2% para las LLR múltiples, 30% y 11% para la resección intestinal, y 14,9% y 4,8% para la cirrosis, respectivamente. CONCLUSIÓN: Los resultados de referencia (benchmark) para la morbilidad global y morbilidad mayor en la LLR variaron entre un 8% y un 26% y entre un 1,4% y un 5,7%, dependiendo de la complejidad. Los valores de referencia deberían ajustarse de acuerdo con la práctica de LLRs múltiples o resección intestinal simultánea y cirrosis.

Published
2020

10. Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis

Author

Luca Aldrighetti, Santiago López-Ben, Nadia Russolillo, Andrea Ruzzenente, Burak Görgec, Alessandro Ferrero, Marco Vivarelli, Bjørn Edwin, David Fuks, Giuseppe Zimmitti, D'Hondt Mathieu, Umberto Cillo, Adnan Alseidi, Federico Mocchegiani, Felice Giuliante, Andrea Benedetti Cacciaguerra, Mohammed Abu Hilal, Marc G. Besselink, J. Lanari, Fernando Rotellar, Federica Cipriani, Benedetti Cacciaguerra, A., Gorgec, B., Lanari, J., Cipriani, F., Russolillo, N., Mocchegiani, F., Zimmitti, G., Alseidi, A., Ruzzenente, A., Edwin, B., D'Hondt, M., Besselink, M. G., Giuliante, F., Fuks, D., Rotellar, F., Lopez-Ben, S., Ferrero, A., Aldrighetti, L., Cillo, U., Vivarelli, M., Abu Hilal, M., Graduate School, Radiology and Nuclear Medicine, Surgery, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Liver Cirrhosis, laparoscopic liver resection, liver cirrhosis, major liver resection, open liver resection, surgical oncology, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Subgroup analysis, Chronic liver disease, medicine, Humans, Hepatectomy, Laparoscopy, Propensity Score, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Liver Neoplasms, Retrospective cohort study, Perioperative, Length of Stay, medicine.disease, Surgery, Treatment Outcome, Hepatocellular carcinoma, Propensity score matching, business
Abstract

Objective: Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients. Methods: Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009–2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long-term outcome after resection for hepatocellular carcinoma was analyzed. Results: Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss (P=.042), lower overall and severe complication (P&nbsp

Published
2021

11. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author

Simone Famularo, Matteo Donadon, Federica Cipriani, Davide P. Bernasconi, Giuliano LaBarba, Tommaso Dominioni, Maurizio Iaria, Sarah Molfino, Simone Conci, Cecilia Ferrari, Marco Garatti, Antonella Delvecchio, Albert Troci, Stefan Patauner, Silvia Frassani, Maurizio Cosimelli, Giacomo Zanus, Felice Giuliante, Elio Jovine, Maria G. Valsecchi, GianLuca Grazi, Adelmo Antonucci, Antonio Frena, Michele Crespi, Riccardo Memeo, Giuseppe Zimmitti, Guido Griseri, Andrea Ruzzenente, Gianluca Baiocchi, Raffaele DallaValle, Marcello Maestri, Giorgio Ercolani, Luca Aldrighetti, Guido Torzilli, Fabrizio Romano, Cristina Ciulli, Alessandro Giani, Francesca Carissimi, Guido Costa, Francesca Ratti, Alessandro Cucchetti, Francesco Calabrese, Elena Cremaschi, Giovanni Lazzari, Angelo Franceschi, Valentina Sega, Maria Conticchio, Luca Pennacchi, Michele Ciola, Ivano Sciannamea, Valerio De Peppo, Famularo S., Donadon M., Cipriani F., Bernasconi D.P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M.G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Bernasconi, Davide P, Labarba, Giuliano, Dominioni, Tommaso, Iaria, Maurizio, Molfino, Sarah, Conci, Simone, Ferrari, Cecilia, Garatti, Marco, Delvecchio, Antonella, Troci, Albert, Patauner, Stefan, Frassani, Silvia, Cosimelli, Maurizio, Zanus, Giacomo, Giuliante, Felice, Jovine, Elio, Valsecchi, Maria G, Grazi, Gianluca, Antonucci, Adelmo, Frena, Antonio, Crespi, Michele, Memeo, Riccardo, Zimmitti, Giuseppe, Griseri, Guido, Ruzzenente, Andrea, Baiocchi, Gianluca, Dallavalle, Raffaele, Maestri, Marcello, Ercolani, Giorgio, Aldrighetti, Luca, Torzilli, Guido, and Romano, Fabrizio

Subjects
Sorafenib, medicine.medical_specialty, recurrence, Carcinoma, Hepatocellular, Tumor burden, 030230 surgery, liver, Gastroenterology, NO, 03 medical and health sciences, 0302 clinical medicine, hepatectomy, Retrospective Studie, Internal medicine, Humans, Medicine, Chemoembolization, Therapeutic, Liver surgery, Retrospective Studies, LS7_4, Hepatology, business.industry, Palliative Care, Liver Neoplasms, hepatocellular carcinoma, medicine.disease, Recurrent Hepatocellular Carcinoma, multicentric, Treatment Outcome, Time to recurrence, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Liver function, Neoplasm Recurrence, Local, business, medicine.drug, Human
Abstract

Background Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p Conclusion Curative approaches may guarantee long-term survival in case of recurrence.

Published
2021

12. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

Author

Famularo, S., Donadon, M., Cipriani, Fabrizio, Ardito, Francesco, Carissimi, F., Perri, Pierluigi, Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, Anna Maria, Zimmitti, Giuseppe, Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, Marta, Dallavalle, R., Grazi, G. L., Giuliante, Felice, Aldrighetti, L., Torzilli, Guido, Romano, Federica, Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, Giovanni, Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, Arianna, Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., Montuori, M., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Ardito, Francesco, Carissimi, Francesca, Perri, Pasquale, Iaria, Maurizio, Dominioni, Tommaso, Zanello, Matteo, Conci, Simone, Molfino, Sarah, LaBarba, Giuliano, Ferrari, Cecilia, Germani, Paola, Patauner, Stefan, Pinotti, Enrico, Lodo, Enrico, Garatti, Marco, Sciannamea, Ivano, Troci, Albert, Conticchio, Maria, Floridi, Antonio, Chiarelli, Marco, Fumagalli, Luca, Memeo, Riccardo, Crespi, Michele, Antonucci, Adelmo, Zimmitti, Giuseppe, Zanus, Giacomo, Zago, Mauro, Frena, Antonio, Tarchi, Paola, Griseri, Guido, Ercolani, Giorgio, Baiocchi, Gian Luca, Ruzzenente, Andrea, Jovine, Elio, Maestri, Marcello, DallaValle, Raffaele, Grazi, Gian Luca, Giuliante, Felice, Aldrighetti, Luca, Torzilli, Guido, Romano, Fabrizio, Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Carissimi, F., Perri, P., Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, A., Zimmitti, G., Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Dallavalle, R., Grazi, G. L., Giuliante, F., Aldrighetti, L., Torzilli, G., Romano, F., Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, G., Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, A., Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., and Montuori, M.

Subjects
Male, Cirrhosis, Outcome Assessment, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Datasets as Topic, HERCOLES, Hepatocarcinoma recurrence, Liver surgery, Redo surgery, Outcome Assessment, Health Care, Ascites, Registries, Laparoscopy, education.field_of_study, medicine.diagnostic_test, Liver Neoplasms, Middle Aged, Italy, Local, Radiological weapon, Female, medicine.symptom, Reoperation, medicine.medical_specialty, Carcinoma, Hepatocellular, Population, NO, Internal medicine, medicine, Hepatectomy, Humans, education, LS7_4, Aged, business.industry, Carcinoma, Hepatocellular, Perioperative, Hepatology, medicine.disease, Surgery, Health Care, Neoplasm Recurrence, Neoplasm Recurrence, Local, business
Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power. Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020

13. Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

Author

Giuseppe Zimmitti, Nadia Russolillo, Adnan Alseidi, Alessandro Ferrero, Federico Mocchegiani, Felice Giuliante, Andrea Benedetti Cacciaguerra, Davit L. Aghayan, J. Lanari, Burak Görgec, Bjørn Edwin, David Fuks, Mathieu D'Hondt, Luca Aldrighetti, Mikhail Efanov, Marco Vivarelli, Mohammed Abu Hilal, Andrea Ruzzenente, Umberto Cillo, Fernando Rotellar, Marc G. Besselink, Federica Cipriani, Graduate School, Radiology and Nuclear Medicine, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gorgec, B., Benedetti Cacciaguerra, A., Lanari, J., Russolillo, N., Cipriani, F., Aghayan, D., Zimmitti, G., Efanov, M., Alseidi, A., Mocchegiani, F., Giuliante, F., Ruzzenente, A., Rotellar, F., Fuks, D., D'Hondt, M., Vivarelli, M., Edwin, B., Aldrighetti, L., Ferrero, A., Cillo, U., Besselink, M. G., and Abu Hilal, M.

Subjects
Male, Liver surgery, Neoplasm, Residual, Outcome Assessment, Databases, Factual, 030230 surgery, Cholangiocarcinoma, Postoperative Complications, 0302 clinical medicine, Single indicator, Interquartile range, Surveys and Questionnaires, Outcome Assessment, Health Care, Hospital Mortality, Intraoperative Complications, Laparoscopy, medicine.diagnostic_test, Incidence (epidemiology), Liver Neoplasms, Margins of Excision, Middle Aged, After discharge, Tumor Burden, Residual, 030220 oncology & carcinogenesis, Female, Gallbladder Neoplasms, Colorectal Neoplasms, Reoperation, medicine.medical_specialty, Carcinoma, Hepatocellular, Patient Readmission, Databases, 03 medical and health sciences, medicine, Hepatectomy, Humans, Propensity Score, Factual, Aged, business.industry, Carcinoma, Metastasectomy, Hepatocellular, Surgery, Health Care, Multicenter study, Neoplasm, business, Abdominal surgery
Abstract

Importance: Textbook outcome (TO) is a composite measure that captures the most desirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR). Objective: To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a large international multicenter database using a propensity-score matched analysis. Design, Setting, and Participants: Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated. Main Outcomes and Measures: Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications, readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin. Results: A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P 10 cm = OR, 0.550 [95% CI, 0.366-0.826]; P =.004) were associated with a worse TOLS rate. Conclusions and Relevance: In this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR..

Published
2021

Catalog

Books, media, physical & digital resources
See catalog results