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

Author

Serenari, M, Lenzi, J, Cucchetti, A, Cipriani, F, Donadon, M, Ardito, 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.

Published
2023

2. Survival benefit of second line therapies for recurrent hepatocellular carcinoma: repeated hepatectomy, thermoablation and second-line transplant referral in a real life national scenario

Author

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.

Published
2023

3. 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, 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.

Published
2022

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

Author

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

Abstract

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

Published
2023

5. 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, 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.

Published
2021

6. 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

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

Author

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, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, 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, Montuori, M, 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., Montuori M., 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, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, 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, Montuori, M, 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.

Abstract

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

Published
2020

8. Performance of comprehensive complication index and clavien‐dindo complication scoring system in liver surgery for hepatocellular carcinoma

Author

Giani, A, Cipriani, F, Famularo, S, Donadon, M, Bernasconi, D, Ardito, F, Fazio, F, Nicolini, D, Perri, P, Giuffrida, M, Pontarolo, N, Zanello, M, Lai, Q, Conci, S, Molfino, S, Germani, P, Pinotti, E, Romano, M, La Barba, G, Ferrari, C, Patauner, S, Manzoni, A, Sciannamea, I, Fumagalli, L, Troci, A, Ferraro, V, Floridi, A, Memeo, R, Crespi, M, Chiarelli, M, Antonucci, A, Zimmitti, G, Frena, A, Percivale, A, Ercolani, G, Zanus, G, Zago, M, Tarchi, P, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Valle, R, Grazi, G, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Gianotti, L, Romano, F, Ciulli, C, Braga, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, De Peppo, V, Cremaschi, E, Calabrese, F, Laureiro, Z, Lazzari, G, Cosola, D, Montuori, M, Salvador, L, Cucchetti, A, Franceschi, A, Ciola, M, Sega, V, Calcagno, P, Pennacchi, L, Tedeschi, M, Giani A., Cipriani F., Famularo S., Donadon M., Bernasconi D. P., Ardito F., Fazio F., Nicolini D., Perri P., Giuffrida M., Pontarolo N., Zanello M., Lai Q., Conci S., Molfino S., Germani P., Pinotti E., Romano M., La Barba G., Ferrari C., Patauner S., Manzoni A., Sciannamea I., Fumagalli L., Troci A., Ferraro V., Floridi A., Memeo R., Crespi M., Chiarelli M., Antonucci A., Zimmitti G., Frena A., Percivale A., Ercolani G., Zanus G., Zago M., Tarchi P., Baiocchi G. L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Valle R. D., Grazi G. L., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Gianotti L., Romano F., Ciulli C., Braga M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., De Peppo V., Cremaschi E., Calabrese F., Laureiro Z. L., Lazzari G., Cosola D., Montuori M., Salvador L., Cucchetti A., Franceschi A., Ciola M., Sega V., Calcagno P., Pennacchi L., Tedeschi M., Giani, A, Cipriani, F, Famularo, S, Donadon, M, Bernasconi, D, Ardito, F, Fazio, F, Nicolini, D, Perri, P, Giuffrida, M, Pontarolo, N, Zanello, M, Lai, Q, Conci, S, Molfino, S, Germani, P, Pinotti, E, Romano, M, La Barba, G, Ferrari, C, Patauner, S, Manzoni, A, Sciannamea, I, Fumagalli, L, Troci, A, Ferraro, V, Floridi, A, Memeo, R, Crespi, M, Chiarelli, M, Antonucci, A, Zimmitti, G, Frena, A, Percivale, A, Ercolani, G, Zanus, G, Zago, M, Tarchi, P, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Valle, R, Grazi, G, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Gianotti, L, Romano, F, Ciulli, C, Braga, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, De Peppo, V, Cremaschi, E, Calabrese, F, Laureiro, Z, Lazzari, G, Cosola, D, Montuori, M, Salvador, L, Cucchetti, A, Franceschi, A, Ciola, M, Sega, V, Calcagno, P, Pennacchi, L, Tedeschi, M, Giani A., Cipriani F., Famularo S., Donadon M., Bernasconi D. P., Ardito F., Fazio F., Nicolini D., Perri P., Giuffrida M., Pontarolo N., Zanello M., Lai Q., Conci S., Molfino S., Germani P., Pinotti E., Romano M., La Barba G., Ferrari C., Patauner S., Manzoni A., Sciannamea I., Fumagalli L., Troci A., Ferraro V., Floridi A., Memeo R., Crespi M., Chiarelli M., Antonucci A., Zimmitti G., Frena A., Percivale A., Ercolani G., Zanus G., Zago M., Tarchi P., Baiocchi G. L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Valle R. D., Grazi G. L., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Gianotti L., Romano F., Ciulli C., Braga M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., De Peppo V., Cremaschi E., Calabrese F., Laureiro Z. L., Lazzari G., Cosola D., Montuori M., Salvador L., Cucchetti A., Franceschi A., Ciola M., Sega V., Calcagno P., Pennacchi L., and Tedeschi M.

Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien‐Dindo complication (CDC) scale to predict excessive length of hospital stay (e‐LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi‐institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e‐LOS were fitted to compare predictive performance. E‐LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020

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

Author

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

Abstract

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

Published
2022

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

Author

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

Abstract

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

Published
2022

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

Author

Serenari, M., Lenzi, J., Cucchetti, A., Cipriani, F., Donadon, M., Ardito, Francesco, Fazio, F., Nicolini, D., Iaria, M., Famularo, S., Perri, P., Ansaloni, L., Zanello, M., Lai, Q., Conci, S., Molfino, S., Ferrari, C., Germani, P., Zago, M., Romano, M., Zimmitti, G., Antonucci, A., Fumagalli, L., Troci, A., Ferraro, V., Memeo, R., Crespi, M., Chiarelli, M., Ercolani, G., Hilal, M. A., Zanus, G., Pinotti, E., Tarchi, P., Griseri, G., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Grazi, G. L., Romano, F., Dalla Valle, R., Ravaioli, M., Vivarelli, M., Ferrero, A., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Cescon, M., Gorgone, M., Ratti, F., Costa, G., Razionale, Francesco, Russolillo, N., Marinelli, Luca, Giuffrida, M., Scotti, M., Garancini, M., De Peppo, V., De Stefano, F., Laureiro, Z. L., Marchitelli, I., Franceschi, A., Cosola, D., Corleone, P., Montuori, M., Salvador, L., Manzoni, Annamaria, La Barba, G., Calcagno, P., Pennacchi, L., Conticchio, M., Serenari, Matteo, Lenzi, Jacopo, Cucchetti, Alessandro, Cipriani, Federica, Donadon, Matteo, Ardito, Francesco, Fazio, Federico, Nicolini, Daniele, Iaria, Maurizio, Famularo, Simone, Perri, Pasquale, Ansaloni, Luca, Zanello, Matteo, Lai, Quirino, Conci, Simone, Molfino, Sarah, Ferrari, Cecilia, Germani, Paola, Zago, Mauro, Romano, Maurizio, Zimmitti, Giuseppe, Antonucci, Adelmo, Fumagalli, Luca, Troci, Albert, Ferraro, Valentina, Memeo, Riccardo, Crespi, Michele, Chiarelli, Marco, Ercolani, Giorgio, Hilal, Mohamed Abu, Zanus, Giacomo, Pinotti, Enrico, Tarchi, Paola, Griseri, Guido, Baiocchi, Gian Luca, Ruzzenente, Andrea, Rossi, Massimo, Jovine, Elio, Maestri, Marcello, Grazi, Gian Luca, Romano, Fabrizio, Dalla Valle, Raffaele, Ravaioli, Matteo, Vivarelli, Marco, Ferrero, Alessandro, Giuliante, Felice, Torzilli, Guido, Aldrighetti, Luca, and Cescon, Matteo

Subjects
hepatectomy, complications, liver transplantation, salvage, Settore MED/18 - CHIRURGIA GENERALE, Surgery, hepatocellular carcinoma, case-mix
Abstract

To evaluate the effect of a liver transplantation (LT) program on the outcomes of resectable hepatocellular carcinoma (HCC).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.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 (CCI), post-hepatectomy liver failure (PHLF), 90-day mortality, overall survival (OS), and disease-free survival (DFS). Secondary outcomes were salvage liver transplantation (SLT) and post-recurrence survival (PRS).A total of 3202 patients were included from 25 hospitals over the study period. Three out of 25 (12%) had a LT program. The presence of a LT program within a center was associated with a reduced probability of PHLF (OR=0.38) but not with OS and DFS. There was an increased probability of SLT when HR was performed in a transplant hospital (OR=12.05). Among transplant-eligible patients, those who underwent LT had a significantly longer PRS.This study showed that the presence of a LT program was associated with decreased PHLF rates and an increased probability to receive SLT in case of recurrence.

Published
2022

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

14. Performance of comprehensive complication index and clavien‐dindo complication scoring system in liver surgery for hepatocellular carcinoma

Author

Giani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., Ferrari, C., Patauner, S., Manzoni, A., Sciannamea, I., Fumagalli, L., Troci, A., Ferraro, V., Floridi, A., Memeo, R., Crespi, M., Chiarelli, M., Antonucci, A., Zimmitti, G., Frena, A., Percivale, A., Ercolani, G., Zanus, G., Zago, M., Tarchi, P., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Vivarelli, M., Ferrero, A., Giuliante, F., Torzilli, G., Aldrighetti, L., Gianotti, L., Romano, F., Ciulli, C., Braga, M., Ratti, F., Costa, G., Razionale, F., Russolillo, N., Marinelli, L., De Peppo, V., Cremaschi, E., Calabrese, F., Laureiro, Z. L., Lazzari, G., Cosola, D., Montuori, M., Salvador, L., Cucchetti, A., Franceschi, A., Ciola, M., Sega, V., Calcagno, P., Pennacchi, L., Tedeschi, M., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., Manzoni A., Antonucci A., Zimmitti G. (ORCID:0000-0003-4925-4012), Maestri M., Vivarelli M. (ORCID:0000-0002-8746-9324), Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Romano F., Razionale F., Lazzari G., Giani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., Ferrari, C., Patauner, S., Manzoni, A., Sciannamea, I., Fumagalli, L., Troci, A., Ferraro, V., Floridi, A., Memeo, R., Crespi, M., Chiarelli, M., Antonucci, A., Zimmitti, G., Frena, A., Percivale, A., Ercolani, G., Zanus, G., Zago, M., Tarchi, P., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Vivarelli, M., Ferrero, A., Giuliante, F., Torzilli, G., Aldrighetti, L., Gianotti, L., Romano, F., Ciulli, C., Braga, M., Ratti, F., Costa, G., Razionale, F., Russolillo, N., Marinelli, L., De Peppo, V., Cremaschi, E., Calabrese, F., Laureiro, Z. L., Lazzari, G., Cosola, D., Montuori, M., Salvador, L., Cucchetti, A., Franceschi, A., Ciola, M., Sega, V., Calcagno, P., Pennacchi, L., Tedeschi, M., Cipriani F., Ardito F. (ORCID:0000-0003-1596-2862), Perri P., Manzoni A., Antonucci A., Zimmitti G. (ORCID:0000-0003-4925-4012), Maestri M., Vivarelli M. (ORCID:0000-0002-8746-9324), Giuliante F. (ORCID:0000-0001-9517-8220), Torzilli G., Romano F., Razionale F., and Lazzari G.

Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien‐Dindo complication (CDC) scale to predict excessive length of hospital stay (e‐LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi‐institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e‐LOS were fitted to compare predictive performance. E‐LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020

15. Laparoscopic paracaval adenoma

Author

Tarchi, P., primary, Tarchi, P., additional, Lanzaro, A., additional, Pastoricchio, M., additional, Cosola, D., additional, and de Manzini, N., additional

Published
2020
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22. Performance of comprehensive complication index and clavien‐dindo complication scoring system in liver surgery for hepatocellular carcinoma

Author

Valentina Sega, Francesca Ratti, Daniele Nicolini, Giorgio Ercolani, Michele Crespi, Matteo Donadon, Valerio De Peppo, Nadia Russolillo, Antonio Floridi, Matteo Zanello, Luca Pennacchi, Marcello Maestri, Mauro Montuori, Ivano Sciannamea, Cristina Ciulli, Mario Giuffrida, Mauro Zago, A. Frena, Felice Giuliante, Albert Troci, Luca Fumagalli, Valentina Ferraro, Giovanni Lazzari, Marco Chiarelli, Sarah Molfino, Simone Famularo, Andrea Ruzzenente, Alessandro Cucchetti, Giuseppe Zimmitti, Raffaele Dalla Valle, Davide Paolo Bernasconi, Paola Tarchi, Maurizio Romano, Massimo Rossi, Alessandro Giani, Luca Gianotti, Luca Salvador, Enrico Pinotti, Davide Cosola, Fabrizio Romano, Marco Braga, Luca Aldrighetti, Giuliano La Barba, Federico Fazio, Gian Luca Baiocchi, Alessandro Ferrero, Elena Cremaschi, Francesco Razionale, Federica Cipriani, Guido Torzilli, A. Antonucci, Alberto Manzoni, Cecilia Ferrari, Pasquale Perri, Stefan Patauner, Laura Marinelli, Francesco Ardito, Gian Luca Grazi, Simone Conci, Paola Germani, Nicholas Pontarolo, Giacomo Zanus, Quirino Lai, Michele Ciola, Guido Costa, Marco Vivarelli, Zoe Larghi Laureiro, Elio Jovine, Francesco Calabrese, Andrea Percivale, Riccardo Memeo, Michele Tedeschi, Pietro Calcagno, Angelo Franceschi, Giani A., Cipriani F., Famularo S., Donadon M., Bernasconi D.P., Ardito F., Fazio F., Nicolini D., Perri P., Giuffrida M., Pontarolo N., Zanello M., Lai Q., Conci S., Molfino S., Germani P., Pinotti E., Romano M., La Barba G., Ferrari C., Patauner S., Manzoni A., Sciannamea I., Fumagalli L., Troci A., Ferraro V., Floridi A., Memeo R., Crespi M., Chiarelli M., Antonucci A., Zimmitti G., Frena A., Percivale A., Ercolani G., Zanus G., Zago M., Tarchi P., Baiocchi G.L., Ruzzenente A., Rossi M., Jovine E., Maestri M., Valle R.D., Grazi G.L., Vivarelli M., Ferrero A., Giuliante F., Torzilli G., Aldrighetti L., Gianotti L., Romano F., Ciulli C., Braga M., Ratti F., Costa G., Razionale F., Russolillo N., Marinelli L., De Peppo V., Cremaschi E., Calabrese F., Laureiro Z.L., Lazzari G., Cosola D., Montuori M., Salvador L., Cucchetti A., Franceschi A., Ciola M., Sega V., Calcagno P., Pennacchi L., Tedeschi M., Giani, A, Cipriani, F, Famularo, S, Donadon, M, Bernasconi, D, Ardito, F, Fazio, F, Nicolini, D, Perri, P, Giuffrida, M, Pontarolo, N, Zanello, M, Lai, Q, Conci, S, Molfino, S, Germani, P, Pinotti, E, Romano, M, La Barba, G, Ferrari, C, Patauner, S, Manzoni, A, Sciannamea, I, Fumagalli, L, Troci, A, Ferraro, V, Floridi, A, Memeo, R, Crespi, M, Chiarelli, M, Antonucci, A, Zimmitti, G, Frena, A, Percivale, A, Ercolani, G, Zanus, G, Zago, M, Tarchi, P, Baiocchi, G, Ruzzenente, A, Rossi, M, Jovine, E, Maestri, M, Valle, R, Grazi, G, Vivarelli, M, Ferrero, A, Giuliante, F, Torzilli, G, Aldrighetti, L, Gianotti, L, Romano, F, Ciulli, C, Braga, M, Ratti, F, Costa, G, Razionale, F, Russolillo, N, Marinelli, L, De Peppo, V, Cremaschi, E, Calabrese, F, Laureiro, Z, Lazzari, G, Cosola, D, Montuori, M, Salvador, L, Cucchetti, A, Franceschi, A, Ciola, M, Sega, V, Calcagno, P, Pennacchi, L, Tedeschi, M, Giani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., Ferrari, C., Patauner, S., Manzoni, A., Sciannamea, I., Fumagalli, L., Troci, A., Ferraro, V., Floridi, A., Memeo, R., Crespi, M., Chiarelli, M., Antonucci, A., Zimmitti, G., Frena, A., Percivale, A., Ercolani, G., Zanus, G., Zago, M., Tarchi, P., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Vivarelli, M., Ferrero, A., Giuliante, F., Torzilli, G., Aldrighetti, L., Gianotti, L., Romano, F., Ciulli, C., Braga, M., Ratti, F., Costa, G., Razionale, F., Russolillo, N., Marinelli, L., De Peppo, V., Cremaschi, E., Calabrese, F., Laureiro, Z. L., Lazzari, G., Cosola, D., Montuori, M., Salvador, L., Cucchetti, A., Franceschi, A., Ciola, M., Sega, V., Calcagno, P., Pennacchi, L., and Tedeschi, M.

Subjects
Liver surgery, Cancer Research, medicine.medical_specialty, Percentile, Clavien-Dindo Classification, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Performance, Logistic regression, lcsh:RC254-282, Article, NO, Clavien‐Dindo classification, Comprehensive complication index, Length of stay, Morbidity, 03 medical and health sciences, 0302 clinical medicine, Clavien-Dindo classification, Medicine, Derivation, LS7_4, business.industry, Odds ratio, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Surgery, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Complication
Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201, 7.438) for CCI and 5.507 (4.152, 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896, 4.115) for CCI and 2.439 (1.666, 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020

23. Is the ACS-NSQIP Risk Calculator Accurate in Predicting Adverse Postoperative Outcomes in the Emergency Setting? An Italian Single-center Preliminary Study

Author

Lucia Paiano, Annalisa Zucca, Nicolò de Manzini, Alan Biloslavo, Stefano Fracon, Giulio Del Zotto, Davide Cosola, Giovanni Scotton, Laura Bernardi, Susanna Terranova, Scotton, G., Del Zotto, G., Bernardi, L., Zucca, A., Terranova, S., Fracon, S., Paiano, L., Cosola, D., Biloslavo, A., and de Manzini, N.

Subjects
Adult, Male, medicine.medical_specialty, Original Scientific Report, Single Center, Risk Assessment, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine, Humans, emergency surgery, Aged, Retrospective Studies, Aged, 80 and over, risk calculator, Receiver operating characteristic, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, Vascular surgery, medicine.disease, Appendicitis, Italy, Brier score, Area Under Curve, 030220 oncology & carcinogenesis, Relative risk, Emergency medicine, Female, Surgery, business, Abdominal surgery
Abstract

Background The ACS-NSQIP surgical risk calculator (SRC) is an open-access online tool that estimates the chance for adverse postoperative outcomes. The risk is estimated based on 21 patient-related variables and customized for specific surgical procedures. The purpose of this monocentric retrospective study is to validate its predictive value in an Italian emergency setting. Methods From January to December 2018, 317 patients underwent surgical procedures for acute cholecystitis (n = 103), appendicitis (n = 83), gastrointestinal perforation (n = 45), and intestinal obstruction (n = 86). Patients’ personal risk was obtained and divided by the average risk to calculate a personal risk ratio (RR). Areas under the ROC curves (AUC) and Brier score were measured to assess both the discrimination and calibration of the predictive model. Results The AUC was 0.772 (95%CI 0.722–0.817, p p p p p p 1.24, RR > 1.52, and RR > 2.63 predicted the onset of serious complications (sensitivity = 60.47%, specificity = 64.07%; NPV = 81%), death (sensitivity = 82.76%, specificity = 62.85%; NPV = 97%), and discharge to nursing or rehab facility (sensitivity = 80.00%, specificity = 69.12%; NPV = 95%), respectively. Conclusions The calculator appears to be accurate in predicting adverse postoperative outcomes in our emergency setting. A RR cutoff provides a much more practical method to forecast the onset of a specific type of complication in a single patient.

Published
2020

24. Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry

Author

Jan Grosek, Laurents P. S. Stassen, Andrea Balla, Davide Cosola, Catalin Copaescu, Silvia Quaresima, Maurizio Castagnola, Giuseppe Navarra, Paolo De Paolis, Gonzalo P Martin-Martin, Andrea Picchetto, Ivano Dal Dosso, J. Kosir, Marcello Calabrò, Harmony Impellizzeri, Roland Chautems, Carlo Castoro, Mahdi Al-Taher, Gian Luca Baiocchi, Giancarlo D'Ambrosio, G. Moretto, Giovanni Maria Garbarino, Giorgio Bianchi, Giuseppe Spinoglio, Alessandro Franchello, Robert Juvan, Salvador Morales Conde, Carlos Marques Ferreira, Emilio Bertani, Marco Filauro, Nunzio Rosso, Antonio Pesce, Gabriele Anania, Andrea Spota, Lorenzo Casali, Ramon Vilallonga, Marc Olivier Sauvain, Christian Franzini, Orestis Ioannidis, Michele Diana, Eleftherios Gialamas, Alend Saadi, Eric Felli, Gaetano La Greca, Jacques Marescaux, Paola De Nardi, José F. Noguera, Alessio Rollo, Pietro Riva, Nicolò de Manzini, Marta Silvestri, Caterina Santi, Luciano Tartamella, Gregor Norčič, Alessandro Patané, Thomas Carus, Alessandro M. Paganini, Luigi Boni, Surgery, MUMC+: MA Heelkunde (9), MUMC+: MA AIOS Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, RS: SHE - R1 - Research (OvO), Spota, A., Al-Taher, M., Felli, E., Morales Conde, S., Dal Dosso, I., Moretto, G., Spinoglio, G., Baiocchi, G., Vilallonga, R., Impellizzeri, H., Martin-Martin, G. P., Casali, L., Franzini, C., Silvestri, M., de Manzini, N., Castagnola, M., Filauro, M., Cosola, D., Copaescu, C., Garbarino, G. M., Pesce, A., Calabro, M., de Nardi, P., Anania, G., Carus, T., Boni, L., Patane, A., Santi, C., Saadi, A., Rollo, A., Chautems, R., Noguera, J., Grosek, J., D'Ambrosio, G., Ferreira, C. M., Norcic, G., Navarra, G., Riva, P., Quaresima, S., Paganini, A., Rosso, N., De Paolis, P., Balla, A., Sauvain, M. O., Gialamas, E., Bianchi, G., La Greca, G., Castoro, C., Picchetto, A., Franchello, A., Tartamella, L., Juvan, R., Ioannidis, O., Kosir, J. A., Bertani, E., Stassen, L., Marescaux, J., and Diana, M.

Subjects
medicine.medical_specialty, Registry, RESECTION, INDOCYANINE GREEN, Subgroup analysis, Anastomotic Leak, Near-infrared fluorescence imaging, Anastomosis, Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Nearinfrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, NO, 03 medical and health sciences, COLORECTAL-SURGERY, ESOPHAGECTOMY, 0302 clinical medicine, LEAKAGE, Statistical significance, Internal medicine, medicine, Humans, Image-guided surgery, Registries, Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Nearinfrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry, COMPLICATIONS, CONSEQUENCES, business.industry, Incidence (epidemiology), Anastomosis, Surgical, Hepatology, CANCER, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry, Perfusion, Surgery, Computer-Assisted, 030220 oncology & carcinogenesis, RISK-FACTORS, fluorescence-guided surgery, image-guided surgery, near-infrared fluorescence imaging, registry, Fluorescence-guided surgery, 030211 gastroenterology & hepatology, Surgery, Radiology, ENHANCED REALITY, business, Abdominal surgery
Abstract

Background: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. Methods: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. Results: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013–0.89mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. Conclusion: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.

Published
2021

25. The Obesity-Related Gut Bacterial and Viral Dysbiosis Can Impact the Risk of Colon Cancer Development

Author

Serena Delbue, Manola Comar, Nicolò de Manzini, Pasquale Ferrante, Giuseppina Campisciano, Carolina Cason, Giuseppe Basile, Davide Cosola, Silvia Palmisano, Campisciano, G., de Manzini, N., Delbue, S., Cason, C., Cosola, D., Basile, G., Ferrante, P., Comar, M., and Palmisano, S.

Subjects
0301 basic medicine, Microbiology (medical), obesity, cancer pathogenesis, Colorectal cancer, microbiome, Merkel cell polyomavirus, Gut microbiota, Gut flora, dysbiotic microbiota, Cancer pathogenesi, Microbiology, Article, 03 medical and health sciences, 0302 clinical medicine, Cancer pathogenesis, Dysbiotic microbiota, Microbiome, Obesity, Virology, medicine, lcsh:QH301-705.5, gut microbiota, biology, Cancer, medicine.disease, biology.organism_classification, 030104 developmental biology, lcsh:Biology (General), 030220 oncology & carcinogenesis, Immunology, Dysbiosis, Oncovirus, Akkermansia muciniphila
Abstract

An incorrect food regimen from childhood is suggested to negatively impact the gut microbiome composition leading to obesity and perhaps to colon rectal cancer (CRC) in adults. In this study, we show that the obesity and cancer gut microbiota share a characteristic microbial profile with a high colonization by mucin degraders species, such as Hafnia alvei and Akkermansia muciniphila. In addition, the species Clostridium bolteae, a bacterium associated with insulin resistance, dyslipidemia, and inflammation, has been associated with the presence of oncogenic Human Polyomaviruses (HPyVs). Merkel cell Polyomavirus (MCPyV) and BK Polyomavirus (BKPyV) were the most frequently oncogenic viruses recovered in the gut of both obese and tumor patients. Considering the high seroprevalence of HPyVs in childhood, their association with specific bacterial species deserve to be further investigated. Data from the present study highlight the presence of a similar microbiome pattern in CRC and obese subjects, suggesting that obese microbiome may represent an opportunity for tumorigenic/driver bacteria and viruses to trigger cell transformation.

Published
2020

26. La Patologia Maligna del Retto e dell' Ano

Author

N. de Manzini, A. Turoldo, D. Cosola, N. de Manzini, A. Turoldo, D. Cosola, Davide F. D'Amico, de Manzini, N., Turoldo, A., and Cosola, D.

Subjects
Cancro del Retto, Cancro dell' Ano
Abstract

Cancro del retto: Prevenzione, diagnosi e cura. Tumore Cloacale Tumori dell' ano: Varietà anatomo-patologiche e trattamenti multimodali

Published
2018

27. Predictive value of preoperative albumin-bilirubin score and other risk factors for short-term outcomes after open pancreatoduodenectomy.

Author

Zavrtanik H, Cosola D, Badovinac D, Hadžialjević B, Horvat G, Plevel D, Bogoni S, Tarchi P, de Manzini N, and Tomažič A

Abstract

Background: Pancreatoduodenectomy represents a complex procedure involving extensive organ resection and multiple alimentary reconstructions. It is still associated with high morbidity, even in high-volume centres. Prediction tools including preoperative patient-related factors to preoperatively identify patients at high risk for postoperative complications could enable tailored perioperative management and improve patient outcomes., Aim: To evaluate the clinical significance of preoperative albumin-bilirubin score and other risk factors in relation to short-term postoperative outcomes in patients after open pancreatoduodenectomy., Methods: This retrospective study included all patients who underwent open pancreatic head resection (pylorus-preserving pancreatoduodenectomy or Whipple resection) for various pathologies during a five-year period (2017-2021) in a tertiary care setting at University Medical Centre Ljubljana, Slovenia and Cattinara Hospital, Trieste, Italy. Short-term postoperative outcomes, namely, postoperative complications, postoperative pancreatic fistula, reoperation, and mortality, were evaluated in association with albumin-bilirubin score and other risk factors. Multiple logistic regression models were built to identify risk factors associated with these short-term postoperative outcomes., Results: Data from 347 patients were collected. Postoperative complications, major postoperative complications, postoperative pancreatic fistula, reoperation, and mortality were observed in 52.7%, 22.2%, 23.9%, 21.3%, and 5.2% of patients, respectively. There was no statistically significant association between the albumin-bilirubin score and any of these short-term postoperative complications based on univariate analysis. When controlling for other predictor variables in a logistic regression model, soft pancreatic texture was statistically significantly associated with postoperative complications [odds ratio (OR): 2.09; 95% confidence interval (95%CI): 1.19-3.67]; male gender (OR: 2.12; 95%CI: 1.15-3.93), soft pancreatic texture (OR: 3.06; 95%CI: 1.56-5.97), and blood loss (OR: 1.07; 95%CI: 1.00-1.14) were statistically significantly associated with major postoperative complications; soft pancreatic texture was statistically significantly associated with the development of postoperative pancreatic fistula (OR: 5.11; 95%CI: 2.38-10.95); male gender (OR: 1.97; 95%CI: 1.01-3.83), soft pancreatic texture (OR: 2.95; 95%CI: 1.42-6.11), blood loss (OR: 1.08; 95%CI: 1.01-1.16), and resection due to duodenal carcinoma (OR: 6.58; 95%CI: 1.20-36.15) were statistically significantly associated with reoperation., Conclusion: The albumin-bilirubin score failed to predict short-term postoperative outcomes in patients undergoing pancreatoduodenectomy. However, other risk factors seem to influence postoperative outcomes, including male sex, soft pancreatic texture, blood loss, and resection due to duodenal carcinoma., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Published
2023
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28. Anastomosis Leak: Is There Still a Place for Indocyanine Green Fluorescence Imaging in Colon-Rectal Surgery? A Retrospective, Propensity Score-Matched Cohort Study.

Author

Losurdo P, Mis TC, Cosola D, Bonadio L, Giudici F, Casagranda B, Bortul M, and de Manzini N

Subjects
Anastomosis, Surgical adverse effects, Cohort Studies, Colon diagnostic imaging, Colon surgery, Humans, Intraoperative Care methods, Optical Imaging methods, Propensity Score, Retrospective Studies, Anastomotic Leak diagnostic imaging, Anastomotic Leak etiology, Anastomotic Leak prevention & control, Indocyanine Green
Abstract

Anastomotic leakage (AL) represents one of the most relevant complications of colorectal cancer surgery. The aim of this study was to evaluate the utility of intraoperative indocyanine green (ICG) fluorescence imaging in the prevention of AL during laparoscopic colorectal surgery. Methods. We retrospectively analyzed 272 patients who underwent rectal and left colon surgery, consecutively enrolled between 2015 and 2019. Due to the heterogeneity of our groups, a propensity score matching (PSM) was performed with a 1:1 PSM cohort. Results. AL occurred in 36 (13.2%) patients. One hundred seventy-seven (65%) of them underwent an intraoperatory ICG test (ICG-group), whereas 95 patients (35%) did not receive the intraoperatory ICG test (no-ICG group). AL occurred in 10.8% of ICG group patients and in 17.8% of no-ICG group patients ( P = 0.07). The ICG group registered significantly less type B and type C fistulas than the no-ICG group (57.9 vs 88.2%; P = .043). After PSM, the overall AL rate was less in the ICG group than the no-ICG group (9.3% vs 16%; P = 0.058), while type B and type C fistulas occurred in 5.48% in the ICG group vs 13.70% in the no-ICG group ( P = 0.09). Univariate analysis demonstrated a protective effect of intraoperative ICG imaging against AL occurrence (odds ratio (OR: 0.66)). Conclusions. Hypoperfusion is a well-recognized cause of AL. The ICG assessment of colic vascularization is a simple, inexpensive, and side effects free method, which can sensibly reduce both overall AL and type B and type C fistulas when routinely used.

Published
2022
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29. Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry.

Author

Spota A, Al-Taher M, Felli E, Morales Conde S, Dal Dosso I, Moretto G, Spinoglio G, Baiocchi G, Vilallonga R, Impellizzeri H, Martin-Martin GP, Casali L, Franzini C, Silvestri M, de Manzini N, Castagnola M, Filauro M, Cosola D, Copaescu C, Garbarino GM, Pesce A, Calabrò M, de Nardi P, Anania G, Carus T, Boni L, Patané A, Santi C, Saadi A, Rollo A, Chautems R, Noguera J, Grosek J, D'Ambrosio G, Ferreira CM, Norcic G, Navarra G, Riva P, Quaresima S, Paganini A, Rosso N, De Paolis P, Balla A, Sauvain MO, Gialamas E, Bianchi G, La Greca G, Castoro C, Picchetto A, Franchello A, Tartamella L, Juvan R, Ioannidis O, Kosir JA, Bertani E, Stassen L, Marescaux J, and Diana M

Subjects
Anastomosis, Surgical adverse effects, Anastomotic Leak epidemiology, Anastomotic Leak etiology, Humans, Perfusion, Registries, Indocyanine Green, Surgery, Computer-Assisted
Abstract

Background: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry., Methods: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications., Results: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not., Conclusion: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Published
2021
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30. Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma.

Author

Giani A, Cipriani F, Famularo S, Donadon M, Bernasconi DP, Ardito F, Fazio F, Nicolini D, Perri P, Giuffrida M, Pontarolo N, Zanello M, Lai Q, Conci S, Molfino S, Germani P, Pinotti E, Romano M, La Barba G, Ferrari C, Patauner S, Manzoni A, Sciannamea I, Fumagalli L, Troci A, Ferraro V, Floridi A, Memeo R, Crespi M, Chiarelli M, Antonucci A, Zimmitti G, Frena A, Percivale A, Ercolani G, Zanus G, Zago M, Tarchi P, Baiocchi GL, Ruzzenente A, Rossi M, Jovine E, Maestri M, Dalla Valle R, Grazi G, Vivarelli M, Ferrero A, Giuliante F, Torzilli G, Aldrighetti L, Gianotti L, Romano F, Ciulli C, Braga M, Ratti F, Costa G, Razionale F, Russolillo N, Marinelli L, De Peppo V, Cremaschi E, Calabrese F, Larghi Laureiro Z, Lazzari G, Cosola D, Montuori M, Salvador L, Cucchetti A, Franceschi A, Ciola M, Sega V, Calcagno P, Pennacchi L, and Tedeschi M

Abstract

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma., Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication., Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set., Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Published
2020
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31. Role of preoperative gut microbiota on colorectal anastomotic leakage: preliminary results.

Author

Palmisano S, Campisciano G, Iacuzzo C, Bonadio L, Zucca A, Cosola D, Comar M, and de Manzini N

Subjects
Adult, Aged, Aged, 80 and over, Colorectal Neoplasms therapy, Digestive System Surgical Procedures, Female, Healthy Volunteers, Humans, Male, Middle Aged, Neoadjuvant Therapy, Preoperative Period, Risk Factors, Young Adult, Anastomotic Leak etiology, Colorectal Neoplasms microbiology, Dysbiosis complications, Dysbiosis microbiology, Gastrointestinal Microbiome, Gastrointestinal Tract microbiology, Host Microbial Interactions physiology, Postoperative Complications etiology
Abstract

Background: The dysbiosis is defined as a disturbed symbiotic relationship between microbiota and the host and can cause a pro-inflammatory imbalance impairing the healing process at anastomotic level. The aim of this study is to detect, in fecal samples collected in the preoperative time, a peculiar microbiota composition that could predict the onset of colorectal anastomotic leakage., Materials and Methods: We compared gut microbiota of healthy patients (Group A) and patients with colorectal cancer eligible for surgery (Group B). Group B was divided into patients who developed anastomotic leak (Group BL) and patients who had uneventful recovery (Group BNL). Stool samples were collected before surgery and after neoadjuvant treatment., Results: We analyzed stool samples from 48 patients, 27 belonging to Group A and 21 to Group B. In Group B, five patients developed anastomotic leakage (Group BL). Compared to healthy subjects, Group B showed a moderate increase of Bacteroidetes and Proteobacteria, a moderate reduction of Firmicutes and Actinobacteria, and a statistically significant reduction of Faecalibacterium prausnitzii. Group BL patients showed an array of bacterial species which promoted dysbiosis, such as Acinetobacter lwoffii and Hafnia alvei. Group BNL patients showed that bacterial species like Faecalibacterium prausnitzii and Barnesiella intestinihominis have a protective function., Conclusions: The bacterial flora in subjects with colorectal cancer is statistically different compared to healthy patients. The presence of preoperative aggressive bacteria and the lack of protective strains has strengthened the hypothesis that a peculiar microbiota composition could represent a risk factor for the occurrence of anastomotic leakage.

Published
2020
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32. Is the ACS-NSQIP Risk Calculator Accurate in Predicting Adverse Postoperative Outcomes in the Emergency Setting? An Italian Single-center Preliminary Study.

Author

Scotton G, Del Zotto G, Bernardi L, Zucca A, Terranova S, Fracon S, Paiano L, Cosola D, Biloslavo A, and de Manzini N

Subjects
Adult, Aged, Aged, 80 and over, Area Under Curve, Female, Humans, Italy epidemiology, Male, Middle Aged, Retrospective Studies, Postoperative Complications epidemiology, Risk Assessment methods
Abstract

Background: The ACS-NSQIP surgical risk calculator (SRC) is an open-access online tool that estimates the chance for adverse postoperative outcomes. The risk is estimated based on 21 patient-related variables and customized for specific surgical procedures. The purpose of this monocentric retrospective study is to validate its predictive value in an Italian emergency setting., Methods: From January to December 2018, 317 patients underwent surgical procedures for acute cholecystitis (n = 103), appendicitis (n = 83), gastrointestinal perforation (n = 45), and intestinal obstruction (n = 86). Patients' personal risk was obtained and divided by the average risk to calculate a personal risk ratio (RR). Areas under the ROC curves (AUC) and Brier score were measured to assess both the discrimination and calibration of the predictive model., Results: The AUC was 0.772 (95%CI 0.722-0.817, p < 0.0001; Brier 0.161) for serious complications, 0.887 (95%CI 0.847-0.919, p < 0.0001; Brier 0.072) for death, and 0.887 (95%CI 0.847-0.919, p < 0.0001; Brier 0.106) for discharge to nursing or rehab facility. Pneumonia, cardiac complications, and surgical site infection presented an AUC of 0.794 (95%CI 0.746-0.838, p < 0.001; Brier 0.103), 0.836 (95%CI 0.790-0.875, p < 0.0001; Brier 0.081), and 0.729 (95%CI 0.676-0.777, p < 0.0001; Brier 0.131), respectively. A RR > 1.24, RR > 1.52, and RR > 2.63 predicted the onset of serious complications (sensitivity = 60.47%, specificity = 64.07%; NPV = 81%), death (sensitivity = 82.76%, specificity = 62.85%; NPV = 97%), and discharge to nursing or rehab facility (sensitivity = 80.00%, specificity = 69.12%; NPV = 95%), respectively., Conclusions: The calculator appears to be accurate in predicting adverse postoperative outcomes in our emergency setting. A RR cutoff provides a much more practical method to forecast the onset of a specific type of complication in a single patient.

Published
2020
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33. Indocyanine green-enhanced fluorangiography (ICGf) in laparoscopic extraperitoneal rectal cancer resection.

Author

Bonadio L, Iacuzzo C, Cosola D, Cipolat Mis T, Giudici F, Casagranda B, Biloslavo A, and de Manzini N

Subjects
Aged, Aged, 80 and over, Anastomotic Leak epidemiology, Cohort Studies, Elective Surgical Procedures methods, Female, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Retrospective Studies, Anastomotic Leak prevention & control, Endoscopy, Gastrointestinal methods, Fluorescein Angiography methods, Indocyanine Green, Laparoscopy methods, Postoperative Complications prevention & control, Rectal Neoplasms surgery, Rectum surgery, Surgery, Computer-Assisted methods
Abstract

Anastomotic leak (AL) is one of the worst complications of rectal anterior resection (RAR) and its incidence varies according to the anatomical site, increasing in lower anastomoses. Many etiological factors have been evaluated and most of these are related to bowel perfusion. Indocyanine green-enhanced fluorangiography (ICGf) has been proposed to help surgeons assess colonic perfusion with higher reliability than subjective clinical judgment. The aim of the study was to evaluate the efficacy of this tool in patients subjected to elective laparoscopic RAR for extraperitoneal rectal cancer. All the patients subjected to elective laparoscopic RAR for extraperitoneal rectal cancer between May 2015 and January 2017 were considered. In all of them, ICGf was performed to evaluate bowel perfusion. The control group included an equal number of patients subjected to the same procedure from January 2014 to April 2015, before the start of routine use of this tool at our institution. The endpoint of the study was to compare the incidence of AL between the two groups. A total of 33 patients were included in both groups. Relying on fluorescence intensity in the indocyanine green (ICG) group, we changed the level of resection in 6/33 patients (18.2%). An AL developed in 2/33 patients (6%) in the ICG group versus in 7/33 patients (21.2%) in the control group. The routine use of this technique may help surgeons in selecting the best level of proximal bowel resection during RAR.

Published
2020
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34. The Obesity-Related Gut Bacterial and Viral Dysbiosis Can Impact the Risk of Colon Cancer Development.

Author

Campisciano G, de Manzini N, Delbue S, Cason C, Cosola D, Basile G, Ferrante P, Comar M, and Palmisano S

Abstract

An incorrect food regimen from childhood is suggested to negatively impact the gut microbiome composition leading to obesity and perhaps to colon rectal cancer (CRC) in adults. In this study, we show that the obesity and cancer gut microbiota share a characteristic microbial profile with a high colonization by mucin degraders species, such as Hafnia alvei and Akkermansia muciniphila . In addition, the species Clostridium bolteae, a bacterium associated with insulin resistance, dyslipidemia, and inflammation, has been associated with the presence of oncogenic Human Polyomaviruses (HPyVs). Merkel cell Polyomavirus (MCPyV) and BK Polyomavirus (BKPyV) were the most frequently oncogenic viruses recovered in the gut of both obese and tumor patients. Considering the high seroprevalence of HPyVs in childhood, their association with specific bacterial species deserve to be further investigated. Data from the present study highlight the presence of a similar microbiome pattern in CRC and obese subjects, suggesting that obese microbiome may represent an opportunity for tumorigenic/driver bacteria and viruses to trigger cell transformation.

Published
2020
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35. Hepatectomy with or without the thoraco-abdominal approach: impact on perioperative outcome.

Author

Donadon M, Mimmo A, Cosola D, Terrone A, Procopio F, Del Fabbro D, Cimino M, Viganò L, and Torzilli G

Subjects
Aged, Blood Loss, Surgical prevention & control, Blood Transfusion, Databases, Factual, Female, Hepatectomy adverse effects, Hepatectomy mortality, Humans, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Operative Time, Postoperative Complications etiology, Postoperative Complications mortality, Propensity Score, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Hepatectomy methods, Liver Neoplasms surgery
Abstract

Background: Hepatectomy using the thoraco-abdominal approach (TAA) compared to the abdominal approach (AA) remains under debate. This study assessed the perioperative outcomes of patients operated with or without TAA., Methods: 1:1 propensity score-matched analysis was applied in 744 patients operated between 2007 and 2013, identifying 246 patients who underwent hepatectomy with TAA compared to 246 patients with AA. These groups were matched for demographics, liver disease, comorbidity, tumor features, and extent of resection. Rates of morbidity and mortality were the study endpoints., Results: The rates of morbidity or mortality were not different. With the TAA length of the operations (P = 0.002), length of the Pringle maneuver (P = 0.012), and rate of blood transfusions (P = 0.041) were significantly different. Hospital stay was similar. Independent significant prognostic factors for adverse perioperative outcome were: renal comorbidity (OR = 2.7; P = 0.001), extent of the resection (OR = 3.7; P = 0.001), and increased BILCHE score (OR = 2.4; P = 0.002)., Conclusions: Hepatectomy using the TAA was not associated with adverse perioperative outcome. The associations with length of operation, Pringle maneuver and blood transfusions may have reflected the complexity of the tumor presentation rather than the technical approach., (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Published
2018
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36. New Perspectives in the Treatment of Colorectal Metastases.

Author

Elias D, Viganò L, Orsi F, Scorsetti M, Comito T, Lerut J, Cosola D, and Torzilli G

Abstract

Background: In recent years, the management of metastatic colorectal cancer has become more aggressive and more multidisciplinary. New treatment options have been proposed in addition to the standard approach of resection of liver metastases and chemotherapy., Summary: Selected patients with synchronous limited peritoneal and liver disease (peritoneal cancer index <12 and <3 liver metastases) can be scheduled for aggressive treatment, including cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and liver resection. This approach has achieved survival benefits, even if the treatment is unlikely to be curative in most patients. Moreover, liver transplantation has been recently reconsidered for liver-only metastases, resulting in the de facto reinstatement of the chance of surgery for some unresectable patients. Even though indications for liver transplantation remain to be standardized, preliminary studies have reported extremely promising outcomes. Radio-embolization has proven to be an effective additional tool for the treatment of unresectable tumors, and its potential role in association with chemotherapy for resectable disease is currently being investigated. Stereotactic body radiation therapy is a safe, non-invasive, and effective therapeutic option for patients with inoperable oligometastatic disease. Thanks to recent technical progress, high radiation doses can now be delivered in fewer fractions with excellent local disease control and a low risk of radiation-induced liver injury. Finally, radiofrequency ablation (RFA) for colorectal metastases has become more effective, with results approaching those of surgical series. New interstitial treatments, such as microwave ablation and irreversible electroporation, could overcome some of the limitations of RFA, thereby further expanding indications and optimizing outcomes., Key Messages: Currently, a multidisciplinary approach to patients with colorectal liver metastases is mandatory. Aggressive surgical treatments should be integrated with all the available non-surgical options to maximize disease control and patient survival.

Published
2016
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37. Self-adhesive mesh for Lichtenstein inguinal hernia repair. Experience of a single center.

Author

Tarchi P, Cosola D, Germani P, Troian M, and De Manzini N

Subjects
Adult, Aged, Aged, 80 and over, Equipment Design, Female, Follow-Up Studies, Humans, Hypesthesia etiology, Male, Middle Aged, Operative Time, Pain Measurement, Quality of Life, Recurrence, Retrospective Studies, Risk Assessment, Treatment Outcome, Collagen, Hernia, Inguinal surgery, Herniorrhaphy adverse effects, Herniorrhaphy methods, Pain, Postoperative etiology, Polyesters, Surgical Mesh adverse effects
Abstract

Aim: Lichtenstein tension-free mesh repair is the most frequently performed procedure for inguinal hernioplasty. In the past surgery aimed to control recurrences. Nowadays it is important to avoid postoperative chronic pain and thus several studies have examined the potential role of meshes in causing postoperative pain. The purpose of this study was to retrospectively assess the early and long-term results after Lichtenstein tension-free repair using a self-adhesive mesh (Parietex ProgripTM - Covidien, Germany) in a single center., Methods: The study enrolled 211 patients, 199 males (94.3%) and 12 females (5.7%), mean age 62 years (28-90 years), between January 2008 and December 2011. Of these, 206 had primary inguinal hernias while 5 were recurrences following previous tension repair. Ten different general surgeons, including residents, performed Lichtenstein hernia repair using a 12 x 8-cm Parietex ProgripTM mesh. In 88.1% of patients no additional fixation was used, while in 11.9% a single 2-0 polypropylene stitch was placed on the pubic bone. A 1-10 visual analog scale (VAS) was used to assess postoperative pain, evaluating it at 1 week, 1 month and 12, 24 and 36 months. Local paresthesia was assessed at same intervals. Any pain sensation lasting longer than 3 months postoperatively, or requiring injection of analgesics was defined as chronic pain., Results: Mean operating time was 64.1 minutes (SD ± 21.14). There were no intraoperative complications. Early postoperative complications included hematoma-seroma (5.7% cases), superficial wound infection (1%), urinary retention (0.5%), and scrotal swelling (1%). The main follow-up period was 3 years, although patients operated between 2009 and 2011 underwent a shorter follow-up. At one-year follow-up, 17 patients reported groin discomfort, but did not require analgesics. Three patients reported moderate pain, requiring occasional use of oral analgesics, and 2 of these described a discontinuous pain mainly during movement. One patient reported severe pain requiring local injection of analgesics. At 2-year follow-up, 3 patients reported groin discomfort. Five of the 17 patients who reported discomfort at 1 year were lost to the 2-year follow-up. One patient kept reporting a high VAS score (6), though slightly reduced from the previously reported at 1-year follow-up. Recurrence was observed in 0.5% at 1 year and in 2.4% at 2 years. At 3 years only half of the patients (102) were still on follow-up. Of these, 1 reported mild discomfort and 3 developed hernia recurrence. Globally a decrease in pain and local discomfort was observed. No cases of seroma, testicular complications or mesh infection were reported at 1-, 2- and 3-year follow-up., Conclusion: Self-gripping mesh for inguinal hernia repair is a good and safe option, easy to handle and with a low incidence of chronic pain (<3%). A sutureless fixation seems to prevent the development of postoperative chronic pain, without increasing recurrence rates. Using a self-adhesive mesh also slightly reduce operating times, and costs are lower when compared to biological glue used to fix the mesh. In conclusion, our experience with the self-gripping mesh is limited but positive, randomized clinical trials are warranted to confirm our results.

Published
2014

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