Search

Your search keyword '"Valle R. D."' showing total 23 results
Start Over Author "Valle R. D."
23 results on '"Valle R. D."'

1. Single large hepatocellular carcinoma > 5 cm with surgical indication: is it mandatory a major hepatectomy? a propensity-score weighted analysis

Author

Garancini, M, Serenari, M, Famularo, S, Cipriani, F, Ardito, F, Russolillo, N, Conci, S, Nicolini, D, Perri, P, Zanello, M, Iaria, M, Lai, Q, Romano, M, La Barba, G, Molfino, S, Germani, P, Dominioni, T, Zimmiti, G, Conticchio, M, Fumagalli, L, Zago, M, Troci, A, Sciannamea, I, Ferrari, C, Scotti, M, Griseri, G, Antonucci, A, Crespi, M, Pinotti, E, Chiarelli, M, Memeo, R, Hilal, M, Maestri, M, Tarchi, P, Baiocchi, G, Ercolani, G, Zanus, G, Rossi, M, Valle, R, Jovine, E, Frena, A, Patauner, S, Grazi, G, Vivarelli, M, Ruzzenente, A, Ferrero, A, Giuliante, F, Aldrighetti, L, Torzilli, G, Cescon, M, Bernasconi, D, Romano, F, Milana, F, Bertacco, A, Ratti, F, Razionale, F, Cicerone, O, Fazio, F, Ciulli, C, Carissimi, F, Laureiro, Z, Marinelli, L, De Peppo, V, Montuori, M, Marchitelli, I, Franceschi, A, Manzoni, A, Cosola, D, Corleone, P, Salvador, L, Cucchetti, A, Pennacchi, L, Giuffrida, M, Fugazzola, P, Casella, A, Calcagno, P, Garancini M., Serenari M., Famularo S., Cipriani F., Ardito F., Russolillo N., Conci S., Nicolini D., Perri P., Zanello M., Iaria M., Lai Q., Romano M., La Barba G., Molfino S., Germani P., Dominioni T., Zimmiti G., Conticchio M., Fumagalli L., Zago M., Troci A., Sciannamea I., Ferrari C., Scotti M. A., Griseri G., Antonucci A., Crespi M., Pinotti E., Chiarelli M., Memeo R., Hilal M. A., Maestri M., Tarchi P., Baiocchi G., Ercolani G., Zanus G., Rossi M., Valle R. D., Jovine E., Frena A., Patauner S., Grazi G. L., Vivarelli M., Ruzzenente A., Ferrero A., Giuliante F., Aldrighetti L., Torzilli G., Cescon M., Bernasconi D., Romano F., Milana F., Bertacco A., Ratti F., Razionale F., Cicerone O., Fazio F., Ciulli C., Carissimi F., Laureiro Z. L., Marinelli L., De Peppo V., Montuori M., Marchitelli I., Franceschi A., Manzoni A., Cosola D., Corleone P., Salvador L., Cucchetti A., Pennacchi L., Giuffrida M., Fugazzola P., Casella A., Calcagno P., Garancini, M, Serenari, M, Famularo, S, Cipriani, F, Ardito, F, Russolillo, N, Conci, S, Nicolini, D, Perri, P, Zanello, M, Iaria, M, Lai, Q, Romano, M, La Barba, G, Molfino, S, Germani, P, Dominioni, T, Zimmiti, G, Conticchio, M, Fumagalli, L, Zago, M, Troci, A, Sciannamea, I, Ferrari, C, Scotti, M, Griseri, G, Antonucci, A, Crespi, M, Pinotti, E, Chiarelli, M, Memeo, R, Hilal, M, Maestri, M, Tarchi, P, Baiocchi, G, Ercolani, G, Zanus, G, Rossi, M, Valle, R, Jovine, E, Frena, A, Patauner, S, Grazi, G, Vivarelli, M, Ruzzenente, A, Ferrero, A, Giuliante, F, Aldrighetti, L, Torzilli, G, Cescon, M, Bernasconi, D, Romano, F, Milana, F, Bertacco, A, Ratti, F, Razionale, F, Cicerone, O, Fazio, F, Ciulli, C, Carissimi, F, Laureiro, Z, Marinelli, L, De Peppo, V, Montuori, M, Marchitelli, I, Franceschi, A, Manzoni, A, Cosola, D, Corleone, P, Salvador, L, Cucchetti, A, Pennacchi, L, Giuffrida, M, Fugazzola, P, Casella, A, Calcagno, P, Garancini M., Serenari M., Famularo S., Cipriani F., Ardito F., Russolillo N., Conci S., Nicolini D., Perri P., Zanello M., Iaria M., Lai Q., Romano M., La Barba G., Molfino S., Germani P., Dominioni T., Zimmiti G., Conticchio M., Fumagalli L., Zago M., Troci A., Sciannamea I., Ferrari C., Scotti M. A., Griseri G., Antonucci A., Crespi M., Pinotti E., Chiarelli M., Memeo R., Hilal M. A., Maestri M., Tarchi P., Baiocchi G., Ercolani G., Zanus G., Rossi M., Valle R. D., Jovine E., Frena A., Patauner S., Grazi G. L., Vivarelli M., Ruzzenente A., Ferrero A., Giuliante F., Aldrighetti L., Torzilli G., Cescon M., Bernasconi D., Romano F., Milana F., Bertacco A., Ratti F., Razionale F., Cicerone O., Fazio F., Ciulli C., Carissimi F., Laureiro Z. L., Marinelli L., De Peppo V., Montuori M., Marchitelli I., Franceschi A., Manzoni A., Cosola D., Corleone P., Salvador L., Cucchetti A., Pennacchi L., Giuffrida M., Fugazzola P., Casella A., and Calcagno P.

Abstract

Purpose: Single large hepatocellular carcinoma >5cm (SLHCC) traditionally requires a major liver resection. Minor resections are often performed with the goal to reduce morbidity and mortality. Aim of the study was to establish if a major resection should be considered the best treatment for SLHCC or a more limited resection should be preferred. Methods: A multicenter retrospective analysis of the HE.RC.O.LE.S. Group register was performed. All collected patients with surgically treated SLHCC were divided in 5 groups of treatment (major hepatectomy, sectorectomy, left lateral sectionectomy, segmentectomy, non-anatomical resection) and compared for baseline characteristics, short and long-term results. A propensity-score weighted analysis was performed. Results: 535 patients were enrolled in the study. Major resection was associated with significantly increased major complications compared to left lateral sectionanectomy, segmentectomy and non-anatomical resection (all p<0.05) and borderline significant increased major complications compared to sectorectomy (p=0.08). Left lateral sectionectomy showed better overall survival compared to major resection (p=0.02), while other groups of treatment resulted similar to major hepatectomy group for the same item. Absence of oncological benefit after major resection and similar outcomes among the 5 groups of treatment was confirmed even in the sub-population excluding patients with macrovascular invasion. Conclusion: Major resection was associated to increased major post-operative morbidity without long-term survival benefit; when technically feasible and oncologically adequate, minor resections should be preferred for the surgical treatment of SLHCC.

Published
2024

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. Regret affects the choice between neoadjuvant therapy and upfront surgery for potentially resectable pancreatic cancer

Author

Cucchetti, A., Djulbegovic, B., Crippa, S., Hozo, I., Sbrancia, M., Tsalatsanis, A., Binda, C., Fabbri, C., Salvia, R., Falconi, M., Ercolani, G., Alfieri, Sergio, Amato, A., Amisano, M., Anderloni, A., Maestri, A., Coluccio, C., Brandi, G., Casadei-Gardini, A., Cennamo, V., Crino, S. F., Valle, R. D., De Angelis, C., Di Battista, M., Di Maio, M., Di Marco, M., Di Matteo, F., Di Mitri, R., Ettorre, G. M., Facciorusso, A., Farina, G., Ferrari, G., Fornaro, L., Frigerio, I., Frisone, D., Fuccio, L., Gardini, A., Garufi, C., Giampieri, R., Grazi, G. L., Jovine, E., Kauffmann, E., Langella, S., Larghi, Alberto Leonardo, Manno, M., Marciano, E., Marzioni, M., Merighi, A., Mutignani, M., Nardo, B., Niger, M., Palmisano, V., Partelli, S., Pinto, C., Piras, E., Rapposelli, I. G., Reni, M., Ricci, C., Rimassa, L., Siena, S., Spada, Cristiano, Sperti, E., Spezzaferro, M., Sposito, C., Tamberi, S., Troisi, R., Veneroni, L., Vivarelli, M., Zerbi, A., Alfieri S. (ORCID:0000-0002-0404-724X), Larghi A., Spada C. (ORCID:0000-0002-5692-0960), Cucchetti, A., Djulbegovic, B., Crippa, S., Hozo, I., Sbrancia, M., Tsalatsanis, A., Binda, C., Fabbri, C., Salvia, R., Falconi, M., Ercolani, G., Alfieri, Sergio, Amato, A., Amisano, M., Anderloni, A., Maestri, A., Coluccio, C., Brandi, G., Casadei-Gardini, A., Cennamo, V., Crino, S. F., Valle, R. D., De Angelis, C., Di Battista, M., Di Maio, M., Di Marco, M., Di Matteo, F., Di Mitri, R., Ettorre, G. M., Facciorusso, A., Farina, G., Ferrari, G., Fornaro, L., Frigerio, I., Frisone, D., Fuccio, L., Gardini, A., Garufi, C., Giampieri, R., Grazi, G. L., Jovine, E., Kauffmann, E., Langella, S., Larghi, Alberto Leonardo, Manno, M., Marciano, E., Marzioni, M., Merighi, A., Mutignani, M., Nardo, B., Niger, M., Palmisano, V., Partelli, S., Pinto, C., Piras, E., Rapposelli, I. G., Reni, M., Ricci, C., Rimassa, L., Siena, S., Spada, Cristiano, Sperti, E., Spezzaferro, M., Sposito, C., Tamberi, S., Troisi, R., Veneroni, L., Vivarelli, M., Zerbi, A., Alfieri S. (ORCID:0000-0002-0404-724X), Larghi A., and Spada C. (ORCID:0000-0002-5692-0960)

Abstract

Background: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes to-ward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma.Methods: Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons). Respondents were asked to report their regret of omission and commission regarding neo-adjuvant chemotherapy on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied to analyze respondents' attitudes toward neo-adjuvant therapy.Results: The lowest regret of omission was elicited in the low-risk scenario, and the highest regret in the high-risk scenario (P < .001). The regret of the commission was diametrically opposite to the regret of omission (P < .001). The disease-specific threshold mortality at which upfront surgery is favored over the neoadjuvant therapy progressively decreased from the low-risk to the high-risk scenarios (P <=.001). The nonsurgeons working in or with lower surgical volume centers (P = .010) and surgeons (P = .018) accepted higher disease-specific mortality after upfront surgery, which resulted in the lower likelihood of adopting neoadjuvant therapy.Conclusion: Regret drives decision making in the management of pancreatic adenocarcinoma. Being a surgeon or a specialist working in surgical centers with lower patient volumes reduces the likelihood of recommending neoadjuvant therapy.(c) 2023 Elsevier Inc. All rights reserved.

Published
2023

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

Author

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

Abstract

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

Published
2023

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

Author

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

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

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

Published
2023

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

Author

Conci, S, Cipriani, F, Donadon, M, Marchitelli, I, Ardito, F, Famularo, S, Perri, P, Iaria, M, Ansaloni, L, Zanello, M, La Barba, G, Patauner, S, Pinotti, E, Molfino, S, Germani, P, Romano, M, Sciannamea, I, Ferrari, C, Manzoni, A, Troci, A, Fumagalli, L, Delvecchio, A, Floridi, A, Memeo, R, Chiarelli, M, Crespi, M, Zimmitti, G, Griseri, G, Antonucci, A, Zanus, G, Tarchi, P, Baiocchi, G, Zago, M, Frena, A, Ercolani, G, Jovine, E, Maestri, M, Valle, R, Grazi, G, Romano, F, Giuliante, F, Torzilli, G, Aldrighetti, L, Ruzzenente, A, Conci S., Cipriani F., Donadon M., Marchitelli I., Ardito F., Famularo S., Perri P., Iaria M., Ansaloni L., Zanello M., La Barba G., Patauner S., Pinotti E., Molfino S., Germani P., Romano M., Sciannamea I., Ferrari C., Manzoni A., Troci A., Fumagalli L., Delvecchio A., Floridi A., Memeo R., Chiarelli M., Crespi M., Zimmitti G., Griseri G., Antonucci A., Zanus G., Tarchi P., Baiocchi G. L., Zago M., Frena A., Ercolani G., Jovine E., Maestri M., Valle R. D., Grazi G. L., Romano F., Giuliante F., Torzilli G., Aldrighetti L., Ruzzenente A., Conci, S, Cipriani, F, Donadon, M, Marchitelli, I, Ardito, F, Famularo, S, Perri, P, Iaria, M, Ansaloni, L, Zanello, M, La Barba, G, Patauner, S, Pinotti, E, Molfino, S, Germani, P, Romano, M, Sciannamea, I, Ferrari, C, Manzoni, A, Troci, A, Fumagalli, L, Delvecchio, A, Floridi, A, Memeo, R, Chiarelli, M, Crespi, M, Zimmitti, G, Griseri, G, Antonucci, A, Zanus, G, Tarchi, P, Baiocchi, G, Zago, M, Frena, A, Ercolani, G, Jovine, E, Maestri, M, Valle, R, Grazi, G, Romano, F, Giuliante, F, Torzilli, G, Aldrighetti, L, Ruzzenente, A, Conci S., Cipriani F., Donadon M., Marchitelli I., Ardito F., Famularo S., Perri P., Iaria M., Ansaloni L., Zanello M., La Barba G., Patauner S., Pinotti E., Molfino S., Germani P., Romano M., Sciannamea I., Ferrari C., Manzoni A., Troci A., Fumagalli L., Delvecchio A., Floridi A., Memeo R., Chiarelli M., Crespi M., Zimmitti G., Griseri G., Antonucci A., Zanus G., Tarchi P., Baiocchi G. L., Zago M., Frena A., Ercolani G., Jovine E., Maestri M., Valle R. D., Grazi G. L., Romano F., Giuliante F., Torzilli G., Aldrighetti L., and Ruzzenente A.

Abstract

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

Published
2022

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

Author

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

Abstract

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

Published
2022

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

Author

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

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

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

Published
2022

9. 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

10. 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

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

Author

Conci, S., Cipriani, F., Donadon, M., Marchitelli, I., Ardito, Francesco, Famularo, S., Perri, P., Iaria, M., Ansaloni, L., Zanello, M., La Barba, G., Patauner, S., Pinotti, E., Molfino, S., Germani, P., Romano, M., Sciannamea, I., Ferrari, C., Manzoni, A., Troci, A., Fumagalli, L., Delvecchio, A., Floridi, A., Memeo, R., Chiarelli, M., Crespi, M., Zimmitti, G., Griseri, G., Antonucci, A., Zanus, G., Tarchi, P., Baiocchi, G. L., Zago, M., Frena, A., Ercolani, G., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Romano, F., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Ruzzenente, A., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Conci, S., Cipriani, F., Donadon, M., Marchitelli, I., Ardito, Francesco, Famularo, S., Perri, P., Iaria, M., Ansaloni, L., Zanello, M., La Barba, G., Patauner, S., Pinotti, E., Molfino, S., Germani, P., Romano, M., Sciannamea, I., Ferrari, C., Manzoni, A., Troci, A., Fumagalli, L., Delvecchio, A., Floridi, A., Memeo, R., Chiarelli, M., Crespi, M., Zimmitti, G., Griseri, G., Antonucci, A., Zanus, G., Tarchi, P., Baiocchi, G. L., Zago, M., Frena, A., Ercolani, G., Jovine, E., Maestri, M., Valle, R. D., Grazi, G. L., Romano, F., Giuliante, Felice, Torzilli, G., Aldrighetti, L., Ruzzenente, A., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

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

Published
2021

12. Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery

Author

Aldrighetti, L, Boggi, U, Falconi, M, Giuliante, F, Cipriani, F, Ratti, F, Torzilli, G, Abu Hilal, M, Andrianello, S, Anselmo, A, Ardito, F, Gian, L, Banchini, F, Barabino, M, Barberis, A, Bassi, C, Batignani, G, Battiston, C, Belli, A, Berti, S, Bianco, P, Brolese, A, Brozzetti, S, Butturini, G, Calise, F, Carabott, K, Capretti, G, Casadei, R, Cescon, M, Cesaretti, M, Cillo, U, Cinardi, N, Colledan, M, Coppola, A, Cotsoglou, C, Crippa, S, Bona, E, Valle, R, De Angelis, M, De Carlis, L, Di Benedetto, F, Di Sebastiano, P, Dova, L, Ercolani, G, Esposito, A, Giuseppe, M, Fabris, A, Ferrero, A, Frena, A, Frigerio, I, Gianotti, L, Giuliani, A, Grazi, G, Gringeri, E, Griseri, G, Gruttadauria, S, Guglielmi, A, Izzo, F, Jovine, E, Lanza, E, Malleo, G, Manzini, L, Massani, M, Mazzaferro, V, Memeo, R, Minni, F, Morelli, L, Nappo, G, Nardo, B, Orlando, F, Partelli, S, Patriti, A, Patrone, R, Percivale, A, Piccolo, G, Ravaioli, M, Reggiani, P, Risaliti, M, Rocca, A, Romagnoli, R, Romano, F, Russolillo, N, Ruzzenente, A, Saladino, E, Salvia, R, Santambrogio, R, Tarchi, P, Troci, A, Troisi, R, Urbani, L, Veneroni, L, Vennarecci, G, Vigano, L, Viola, M, Vistoli, F, Vivarelli, M, Zanello, M, Zanus, G, Zerbi, A, Aldrighetti L., Boggi U., Falconi M., Giuliante F., Cipriani F., Ratti F., Torzilli G., Abu Hilal M., Andrianello S., Anselmo A., Ardito F., Gian L. B., Banchini F., Barabino M., Barberis A., Bassi C., Batignani G., Battiston C., Belli A., Berti S., Bianco P., Brolese A., Brozzetti S., Butturini G., Calise F., Carabott K., Capretti G., Casadei R., Cescon M., Cesaretti M., Cillo U., Cinardi N., Colledan M., Coppola A., Cotsoglou C., Crippa S., Bona E. D., Valle R. D., De Angelis M., De Carlis L., Di Benedetto F., Di Sebastiano P., Dova L., Ercolani G., Esposito A., Giuseppe M. E., Fabris A., Ferrero A., Frena A., Frigerio I., Gianotti L., Giuliani A., Grazi G., Gringeri E., Griseri G., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Lanza E., Malleo G., Manzini L., Massani M., Mazzaferro V., Memeo R., Minni F., Morelli L., Nappo G., Nardo B., Orlando F., Partelli S., Patriti A., Patrone R., Percivale A., Piccolo G., Ravaioli M., Reggiani P., Risaliti M., Rocca A., Romagnoli R., Romano F., Russolillo N., Ruzzenente A., Saladino E., Salvia R., Santambrogio R., Tarchi P., Troci A., Troisi R., Urbani L., Veneroni L., Vennarecci G., Vigano L., Viola M., Vistoli F., Vivarelli M., Zanello M., Zanus G., Zerbi A., Aldrighetti, L, Boggi, U, Falconi, M, Giuliante, F, Cipriani, F, Ratti, F, Torzilli, G, Abu Hilal, M, Andrianello, S, Anselmo, A, Ardito, F, Gian, L, Banchini, F, Barabino, M, Barberis, A, Bassi, C, Batignani, G, Battiston, C, Belli, A, Berti, S, Bianco, P, Brolese, A, Brozzetti, S, Butturini, G, Calise, F, Carabott, K, Capretti, G, Casadei, R, Cescon, M, Cesaretti, M, Cillo, U, Cinardi, N, Colledan, M, Coppola, A, Cotsoglou, C, Crippa, S, Bona, E, Valle, R, De Angelis, M, De Carlis, L, Di Benedetto, F, Di Sebastiano, P, Dova, L, Ercolani, G, Esposito, A, Giuseppe, M, Fabris, A, Ferrero, A, Frena, A, Frigerio, I, Gianotti, L, Giuliani, A, Grazi, G, Gringeri, E, Griseri, G, Gruttadauria, S, Guglielmi, A, Izzo, F, Jovine, E, Lanza, E, Malleo, G, Manzini, L, Massani, M, Mazzaferro, V, Memeo, R, Minni, F, Morelli, L, Nappo, G, Nardo, B, Orlando, F, Partelli, S, Patriti, A, Patrone, R, Percivale, A, Piccolo, G, Ravaioli, M, Reggiani, P, Risaliti, M, Rocca, A, Romagnoli, R, Romano, F, Russolillo, N, Ruzzenente, A, Saladino, E, Salvia, R, Santambrogio, R, Tarchi, P, Troci, A, Troisi, R, Urbani, L, Veneroni, L, Vennarecci, G, Vigano, L, Viola, M, Vistoli, F, Vivarelli, M, Zanello, M, Zanus, G, Zerbi, A, Aldrighetti L., Boggi U., Falconi M., Giuliante F., Cipriani F., Ratti F., Torzilli G., Abu Hilal M., Andrianello S., Anselmo A., Ardito F., Gian L. B., Banchini F., Barabino M., Barberis A., Bassi C., Batignani G., Battiston C., Belli A., Berti S., Bianco P., Brolese A., Brozzetti S., Butturini G., Calise F., Carabott K., Capretti G., Casadei R., Cescon M., Cesaretti M., Cillo U., Cinardi N., Colledan M., Coppola A., Cotsoglou C., Crippa S., Bona E. D., Valle R. D., De Angelis M., De Carlis L., Di Benedetto F., Di Sebastiano P., Dova L., Ercolani G., Esposito A., Giuseppe M. E., Fabris A., Ferrero A., Frena A., Frigerio I., Gianotti L., Giuliani A., Grazi G., Gringeri E., Griseri G., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Lanza E., Malleo G., Manzini L., Massani M., Mazzaferro V., Memeo R., Minni F., Morelli L., Nappo G., Nardo B., Orlando F., Partelli S., Patriti A., Patrone R., Percivale A., Piccolo G., Ravaioli M., Reggiani P., Risaliti M., Rocca A., Romagnoli R., Romano F., Russolillo N., Ruzzenente A., Saladino E., Salvia R., Santambrogio R., Tarchi P., Troci A., Troisi R., Urbani L., Veneroni L., Vennarecci G., Vigano L., Viola M., Vistoli F., Vivarelli M., Zanello M., Zanus G., and Zerbi A.

Abstract

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable.

Published
2020

13. 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

14. Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery

Author

Aldrighetti, L., Boggi, U., Falconi, M., Giuliante, F., Cipriani, F., Ratti, F., Torzilli, G., Abu Hilal, M., Andrianello, S., Anselmo, A., Ardito, F., Gian, L. B., Banchini, F., Barabino, M., Barberis, A., Bassi, C., Batignani, G., Battiston, C., Belli, A., Berti, S., Bianco, P., Brolese, A., Brozzetti, S., Butturini, G., Calise, F., Carabott, K., Capretti, G., Casadei, R., Cescon, M., Cesaretti, M., Cillo, U., Cinardi, N., Colledan, M., Coppola, A., Cotsoglou, C., Crippa, S., Bona, E. D., Valle, R. D., De Angelis, M., De Carlis, L., Di Benedetto, F., Di Sebastiano, P., Dova, L., Ercolani, G., Esposito, A., Giuseppe, M. E., Fabris, A., Ferrero, A., Frena, A., Frigerio, I., Gianotti, L., Giuliani, A., Grazi, G., Gringeri, E., Griseri, G., Gruttadauria, S., Guglielmi, A., Izzo, F., Jovine, E., Lanza, E., Malleo, G., Manzini, L., Massani, M., Mazzaferro, V., Memeo, R., Minni, F., Morelli, L., Nappo, G., Nardo, B., Orlando, F., Partelli, S., Patriti, A., Patrone, R., Percivale, A., Piccolo, G., Ravaioli, M., Reggiani, P., Risaliti, M., Rocca, A., Romagnoli, R., Romano, F., Russolillo, N., Ruzzenente, A., Saladino, E., Salvia, R., Santambrogio, R., Tarchi, P., Troci, A., Troisi, R., Urbani, L., Veneroni, L., Vennarecci, G., Vigano, L., Viola, M., Vistoli, F., Vivarelli, M., Zanello, M., Zanus, G., Zerbi, A., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Aldrighetti, L., Boggi, U., Falconi, M., Giuliante, F., Cipriani, F., Ratti, F., Torzilli, G., Abu Hilal, M., Andrianello, S., Anselmo, A., Ardito, F., Gian, L. B., Banchini, F., Barabino, M., Barberis, A., Bassi, C., Batignani, G., Battiston, C., Belli, A., Berti, S., Bianco, P., Brolese, A., Brozzetti, S., Butturini, G., Calise, F., Carabott, K., Capretti, G., Casadei, R., Cescon, M., Cesaretti, M., Cillo, U., Cinardi, N., Colledan, M., Coppola, A., Cotsoglou, C., Crippa, S., Bona, E. D., Valle, R. D., De Angelis, M., De Carlis, L., Di Benedetto, F., Di Sebastiano, P., Dova, L., Ercolani, G., Esposito, A., Giuseppe, M. E., Fabris, A., Ferrero, A., Frena, A., Frigerio, I., Gianotti, L., Giuliani, A., Grazi, G., Gringeri, E., Griseri, G., Gruttadauria, S., Guglielmi, A., Izzo, F., Jovine, E., Lanza, E., Malleo, G., Manzini, L., Massani, M., Mazzaferro, V., Memeo, R., Minni, F., Morelli, L., Nappo, G., Nardo, B., Orlando, F., Partelli, S., Patriti, A., Patrone, R., Percivale, A., Piccolo, G., Ravaioli, M., Reggiani, P., Risaliti, M., Rocca, A., Romagnoli, R., Romano, F., Russolillo, N., Ruzzenente, A., Saladino, E., Salvia, R., Santambrogio, R., Tarchi, P., Troci, A., Troisi, R., Urbani, L., Veneroni, L., Vennarecci, G., Vigano, L., Viola, M., Vistoli, F., Vivarelli, M., Zanello, M., Zanus, G., Zerbi, A., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable.

Published
2020

15. 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

16. CLIN-IMMUNOTHERAPY/BIOLOGIC THERAPIES

Author

Pollack, I. F., primary, Jakacki, R. I., additional, Butterfield, L., additional, Okada, H., additional, Chiba, Y., additional, Hashimoto, N., additional, Kagawa, N., additional, Kinoshita, M., additional, Kijima, N., additional, Hirayama, R., additional, Oji, Y., additional, Tsuboi, A., additional, Oka, Y., additional, Sugiyama, H., additional, Yoshimine, T., additional, Valle, R. D., additional, Tejada, S., additional, Inoges, S., additional, Idoate, M. A., additional, de Cerio, A. L. D., additional, Espinos, J., additional, Aristu, J., additional, Gallego, J., additional, Calvo, J. P., additional, Bendandi, M., additional, Zhu, J., additional, Chen, C., additional, Ravelo, A., additional, Yu, E., additional, Dhanda, R., additional, Schnadig, I. D., additional, Zhang, L., additional, Fan, H., additional, Zhang, I., additional, Chen, X., additional, Wang, H., additional, Da Fonseca, A., additional, Badie, B., additional, Butterfield, L. H., additional, Hamilton, R. L., additional, Mintz, A. H., additional, Engh, J. A., additional, Drappatz, J., additional, Lively, M. O., additional, Chan, M. D., additional, Salazar, A. M., additional, Potter, D. M., additional, Shaw, E. G., additional, Lieberman, F. S., additional, Wei, J., additional, Kong, L.-Y., additional, Wang, F., additional, Xu, S., additional, Doucette, T. A., additional, Ferguson, S. D., additional, Yang, Y., additional, McEnery, K., additional, Jethwa, K., additional, Gjyshi, O., additional, Qiao, W., additional, Lang, F. F., additional, Rao, G., additional, Fuller, G. N., additional, Calin, G. A., additional, Heimberger, A. B., additional, Yang, S., additional, Archer, G. E., additional, Miao, H., additional, Cui, X., additional, Xie, W., additional, Snyder, D., additional, Pretorian, A. J., additional, Dechkovskaia, A., additional, Reap, E., additional, Perez, L. A. S., additional, Norberg, P., additional, Schmittling, R., additional, Mitchell, D. A., additional, Sampson, J. H., additional, Lang, F., additional, Calin, G., additional, Walker, D. G., additional, Crough, T., additional, Beagley, L., additional, Smith, C., additional, Jones, L., additional, Khanna, R., additional, Kanemura, Y., additional, Sumida, M., additional, Yoshioka, E., additional, Yamamoto, A., additional, Kanematsu, D., additional, Matsumoto, Y., additional, Fukusumi, H., additional, Takada, A., additional, Nonaka, M., additional, Nakajima, S., additional, Mori, K., additional, Goto, S., additional, Kamigaki, T., additional, Maekawa, R., additional, Shofuda, T., additional, Moriuchi, S., additional, Yamasaki, M., additional, Yeung, J. T., additional, Hamilton, R., additional, Jakacki, R., additional, Pollack, I., additional, Pellegatta, S., additional, Eoli, M., additional, Antozzi, C., additional, Frigerio, S., additional, Bruzzone, M. G., additional, Cuppini, L., additional, Nava, S., additional, Anghileri, E., additional, Cantini, G., additional, Prodi, E., additional, Ciusani, E., additional, Ferroli, P., additional, Saini, M., additional, Broggi, G., additional, Mantegazza, R., additional, Parati, E. A., additional, Finocchiaro, G., additional, Hegde, M., additional, Corder, A., additional, Chow, K. K., additional, Mukherjee, M., additional, Brawley, V. S., additional, Heslop, H. E., additional, Gottschalk, S., additional, Yvon, E., additional, Ahmed, N., additional, Gibo, D. M., additional, Debinski, W., additional, Bonomo, J., additional, Rossmeisl, J., additional, Robertson, J., additional, Dickinson, P., additional, Salacz, M. E., additional, Camarata, P. J., additional, Ots, M., additional, McIntire, J., additional, Lovick, D., additional, Archer, G., additional, Bigner, D., additional, Friedman, H., additional, Lally-Goss, D., additional, Perry, B., additional, Herndon, J., additional, McGehee, S., additional, McLendon, R., additional, Coleman, R. E., additional, Sampson, J., additional, Grada, Z., additional, Byrd, T., additional, Shaffer, D. R., additional, Ghazi, A., additional, Schonfeld, K., additional, Dotti, G., additional, Heslop, H., additional, Wels, W., additional, Baker, M. L., additional, Robbins, J. M., additional, Dickinson, P. J., additional, York, D., additional, Sturges, B. K., additional, Martin, B., additional, Higgins, R. J., additional, Bringas, J., additional, Bankiewicz, K., additional, Gruber, H. E., additional, Jolly, D. J., additional, Narayana, A., additional, Mathew, M., additional, Kannan, R., additional, Madden, K., additional, Golfinos, J., additional, Parker, E., additional, Ott, P., additional, Pavlick, A., additional, Bota, D. A., additional, Pretto, C., additional, Hantos, P., additional, Hofman, F. M., additional, Chen, T. C., additional, Carrillo, J. A., additional, Schijns, V. E., additional, Stathopoulos, A. A., additional, Prins, R. M., additional, Everson, R., additional, Soto, H., additional, Lisiero, D. N., additional, Young, E., additional, Liau, L. M., additional, Friedman, A., additional, Bigner, D. D., additional, Boczkowski, D., additional, Gururangan, S. G., additional, Grant, G., additional, Driscoll, T., additional, King, J., additional, Nair, S., additional, Fuchs, H., additional, Kurtzberg, J., additional, Shevtsov, M. A., additional, Pozdnyakov, A. V., additional, Kim, A. V., additional, Samochernych, K. A., additional, Guzhova, I. V., additional, Romanova, I. V., additional, Margulis, B. A., additional, and Khachatryan, W. A., additional

Published
2012
Full Text
View/download PDF

20. Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery

Author

Aldrighetti, aEmail Author, L., Boggi, U. b., Falconi, M. c., Giuliante, F. d., Cipriani, F. a., Ratti, Torzilli, G. e., Abu, Hilal, Andrianello, Anselmo, Ardito, Gian, L. B., Banchini, Barabino, Barberis, Bassi, Batignani, Battiston, Belli, Berti, Bianco, Brolese, Brozzetti, Butturini, Calise, Carabott, Capretti, Casadei, Cescon, Cesaretti, Cillo, Cinardi, Colledan, Coppola, Cotsoglou, Crippa, Bona, E. D., Valle, R. D., Angelis, De, Carlis, De, Benedetto, Di, Sebastiano, Di, Dova, Ercolani, Esposito, Giuseppe, M. E., Fabris, Ferrero, Frena, Frigerio, Gianotti, Giuliani, Grazi, Gringeri, Griseri, Gruttadauria, Guglielmi, Izzo, Jovine, Lanza, Malleo, Manzini, Massani, Mazzaferro, Memeo, Minni, Morelli, Nappo, Nardo, Orlando, Partelli, Patriti, Patrone, Percivale, Piccolo, Ravaioli, Reggiani, Risaliti, Rocca, A, Romagnoli, Romano, Russolillo, Ruzzenente, Saladino, Salvia, Santambrogio, Tarchi, Troci, Troisi, Urbani, Veneroni, Vennarecci, Vigano, Viola, Vistoli, Vivarelli, Zanello, Zanus, Zerbi, Italian Association of HepatoBilioPancreatic Surgeons-AICEP, Aldrighetti, L., Boggi, U., Falconi, M., Giuliante, F., Cipriani, F., Ratti, F., Torzilli, G., Abu Hilal, M., Andrianello, S., Anselmo, A., Ardito, F., Gian, L. B., Banchini, F., Barabino, M., Barberis, A., Bassi, C., Batignani, G., Battiston, C., Belli, A., Berti, S., Bianco, P., Brolese, A., Brozzetti, S., Butturini, G., Calise, F., Carabott, K., Capretti, G., Casadei, R., Cescon, M., Cesaretti, M., Cillo, U., Cinardi, N., Colledan, M., Coppola, A., Cotsoglou, C., Crippa, S., Bona, E. D., Valle, R. D., De Angelis, M., De Carlis, L., Di Benedetto, F., Di Sebastiano, P., Dova, L., Ercolani, G., Esposito, A., Giuseppe, M. E., Fabris, A., Ferrero, A., Frena, A., Frigerio, I., Gianotti, L., Giuliani, A., Grazi, G., Gringeri, E., Griseri, G., Gruttadauria, S., Guglielmi, A., Izzo, F., Jovine, E., Lanza, E., Malleo, G., Manzini, L., Massani, M., Mazzaferro, V., Memeo, R., Minni, F., Morelli, L., Nappo, G., Nardo, B., Orlando, F., Partelli, S., Patriti, A., Patrone, R., Percivale, A., Piccolo, G., Ravaioli, M., Reggiani, P., Risaliti, M., Rocca, A., Romagnoli, R., Romano, F., Russolillo, N., Ruzzenente, A., Saladino, E., Salvia, R., Santambrogio, R., Tarchi, P., Troci, A., Troisi, R., Urbani, L., Veneroni, L., Vennarecci, G., Vigano, L., Viola, M., Vistoli, F., Vivarelli, M., Zanello, M., Zanus, G., Zerbi, A., Aldrighetti L., Boggi U., Falconi M., Giuliante F., Cipriani F., Ratti F., Torzilli G., Abu Hilal M., Andrianello S., Anselmo A., Ardito F., Gian L.B., Banchini F., Barabino M., Barberis A., Bassi C., Batignani G., Battiston C., Belli A., Berti S., Bianco P., Brolese A., Brozzetti S., Butturini G., Calise F., Carabott K., Capretti G., Casadei R., Cescon M., Cesaretti M., Cillo U., Cinardi N., Colledan M., Coppola A., Cotsoglou C., Crippa S., Bona E.D., Valle R.D., De Angelis M., De Carlis L., Di Benedetto F., Di Sebastiano P., Dova L., Ercolani G., Esposito A., Giuseppe M.E., Fabris A., Ferrero A., Frena A., Frigerio I., Gianotti L., Giuliani A., Grazi G., Gringeri E., Griseri G., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Lanza E., Malleo G., Manzini L., Massani M., Mazzaferro V., Memeo R., Minni F., Morelli L., Nappo G., Nardo B., Orlando F., Partelli S., Patriti A., Patrone R., Percivale A., Piccolo G., Ravaioli M., Reggiani P., Risaliti M., Rocca A., Romagnoli R., Romano F., Russolillo N., Ruzzenente A., Saladino E., Salvia R., Santambrogio R., Tarchi P., Troci A., Troisi R., Urbani L., Veneroni L., Vennarecci G., Vigano L., Viola M., Vistoli F., Vivarelli M., Zanello M., Zanus G., and Zerbi A.

Subjects
Future studies, Settore MED/18 - CHIRURGIA GENERALE, Crisis management, Nationwide survey, 0302 clinical medicine, Pandemic, Pancrea, Medicine, Viral, Minimally invasive procedures, Liver Disease, Liver Diseases, COVID-19, Liver, Minimally invasive, Pancreas, Biliary Tract Diseases, Health Care Surveys, Humans, Italy, Pancreatic Diseases, Coronavirus Infections, Minimally Invasive Surgical Procedures, Pandemics, Pneumonia, Viral, 030220 oncology & carcinogenesis, Esophagus Resection, Original Article, 030211 gastroenterology & hepatology, Biliary Tract Disease, Human, Prioritization, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), NO, 03 medical and health sciences, High Volume Hospital, Centralization, LS7_4, Coronavirus Infection, business.industry, Minimally Invasive Surgical Procedure, Pneumonia, Surgery, Health Care Survey, Invasive surgery, Pancreatic Disease, business
Abstract

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable. Electronic supplementary material The online version of this article (10.1007/s13304-020-00815-5) contains supplementary material, which is available to authorized users.

Published
2020
Full Text
View/download PDF

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

Author

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

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

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

Published
2022

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. Octreotide in the treatment of lymphorrhea after renal transplantation: a preliminary experience.

Author

Capocasale E, Busi N, Valle RD, Mazzoni MP, Bignardi L, Maggiore U, Buzio C, and Sianesi M

Subjects
Adult, Body Mass Index, Cadaver, Humans, Injections, Subcutaneous, Lymphatic Diseases etiology, Middle Aged, Octreotide adverse effects, Postoperative Complications drug therapy, Retrospective Studies, Tissue Donors, Treatment Outcome, Kidney Transplantation adverse effects, Lymphatic Diseases drug therapy, Octreotide therapeutic use
Abstract

Background: Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that octreotide has beneficial effects to treat lymphorrhea after axillary node dissection and excision of lymphatic malformations. The aim of this study was to report preliminary experience about octreotide treatment in lymphorrea after kidney transplantation., Materials and Methods: This retrospective study included 20 recipients of cadaveric kidney allografts with posttransplant lymphorrhea including 10 treated with instillation of povidone iodate solution, and the other 10 with octreotide (0.1 mg three times a day subcutaneously). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay., Results: The average duration of lymphorrhea was 8.5 (+/-4.5) and 16.3 (+/-7.3) days for the octreotide versus the povidone groups, respectively (P = .001). No complications occurred among the octreotide group, while three lymphoceles grew among patients treated with povidone solution. No differences were observed for acute rejection episodes or renal function between the groups. No octreotide-related adverse events were noted., Conclusion: The mean length of lymphorrhea was lower with octreotide versus iodate povidone solution treatment. There was a shorter hospital stay and minor patient discomfort. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by octreotide administration.

Published
2006
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results