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Article ; Online: Irreversible electroporation for the management of pancreatic cancer: Current data and future directions.

Spiliopoulos, Stavros / Reppas, Lazaros / Filippiadis, Dimitrios / Delvecchio, Antonella / Conticchio, Maria / Memeo, Riccardo / Inchingolo, Riccardo

World journal of gastroenterology

2023 Volume 29, Issue 2, Page(s) 223–231

Abstract: Pancreatic cancer is currently the seventh leading cause of cancer death (4.5% of all cancer deaths) while 80%-90% of the patients suffer from unresectable disease at the time of diagnosis. Prognosis remains poor, with a mean survival up to 15 mo ... ...

Abstract	Pancreatic cancer is currently the seventh leading cause of cancer death (4.5% of all cancer deaths) while 80%-90% of the patients suffer from unresectable disease at the time of diagnosis. Prognosis remains poor, with a mean survival up to 15 mo following systemic chemotherapy. Loco-regional thermal ablative techniques are rarely implemented due to the increased risk of thermal injury to the adjacent structures, which can lead to severe adverse events. Irreversible electroporation, a promising novel non-thermal ablative modality, has been recently introduced in clinical practice for the management of inoperable pancreatic cancer as a safer and more effective loco-regional treatment option. Experimental and initial clinical data are optimistic. This review will focus on the basic principles of IRE technology, currently available data, and future directions.
MeSH term(s)	Humans ; Pancreatic Neoplasms/therapy ; Treatment Outcome ; Prognosis ; Electroporation/methods ; Pancreatic Neoplasms
Language	English
Publishing date	2023-01-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v29.i2.223
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Article ; Online: Detection and management of bile duct injury during cholecystectomy.

Marchegiani, Francesco / Conticchio, Maria / Zadoroznyj, Alizée / Inchingolo, Riccardo / Memeo, Riccardo / De'angelis, Nicola

Minerva surgery

2023 Volume 78, Issue 5, Page(s) 545–557

Abstract: Introduction: Cholecystectomy represents one of the most performed surgical procedures. Bile duct injuries (BDIs) are a dangerous complication of this intervention. With the advent of the laparoscopy, the rate of BDIs showed a growing trend that was ... ...

Abstract	Introduction: Cholecystectomy represents one of the most performed surgical procedures. Bile duct injuries (BDIs) are a dangerous complication of this intervention. With the advent of the laparoscopy, the rate of BDIs showed a growing trend that was partially justified by the learning curve of this technique. Evidence acquisition: A literature search was conducted on Embase, Medline, and Cochrane databases to identify studies published up to October 2022 that analyzed the intraoperative detection and management of BDIs diagnosed during cholecystectomy. Evidence synthesis: According to the literature, approximately 25% of BDIs is diagnosed during the laparoscopic cholecystectomy. In the clinical suspicion of BDI, an intraoperative cholangiography is performed to confirm it. Complimentary technology, such as near-infrared cholangiography, can be also adopted. Intraoperative ultrasound represents a useful tool to furtherly define the biliary and the vascular anatomy. The proper classification of the type of BDI allows to identify the correct treatment. When a good expertise in hepato-pancreato-biliary surgery is available, a direct repair is performed with good outcomes both in case of simple and complex lesions. When the local resources are limited or there is a lack of dedicated surgical experience, patient referral to a reference center shows better outcomes. In particular, complex vasculo-biliary injuries require a highly specialized treatment. The key elements to transfer the patients are a good documentation of the injury, a proper drainage of the abdomen, and an antibiotic therapy. Conclusions: BDI management requires a proper diagnostic process and prompt treatment to reduce the morbidity and mortality of this feared complication occurring during cholecystectomy.
Language	English
Publishing date	2023-03-08
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.23.09866-0
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Article ; Online: Standardization of robotic right liver mobilization.

Conticchio, Maria / Delvecchio, Antonella / Ferraro, Valentina / Stasi, Matteo / Casella, Annachiara / Filippo, Rosalinda / Tedeschi, Michele / Memeo, Riccardo

The international journal of medical robotics + computer assisted surgery : MRCAS

2023 Volume 19, Issue 6, Page(s) e2551

Abstract: Background: Since its introduction 2 decades ago, robotics has been increasingly used for resection of benign and malignant liver lesions. The robotic platform seems to preserve minimally invasive approach benefits, overcoming laparoscopy limitations. ... ...

Abstract	Background: Since its introduction 2 decades ago, robotics has been increasingly used for resection of benign and malignant liver lesions. The robotic platform seems to preserve minimally invasive approach benefits, overcoming laparoscopy limitations. Robotic right liver mobilisation represents a key step for many robotic resections from non-anatomical resections of posterosuperior segments to right hepatectomy. Methods: We present here a standardized technique of right hepatic lobe mobilisation including technical steps and videos. Robotic resection provide all benefits of minimally invasive approaches in terms of preserving abdominal wall, early alimentation, reduced respiratory stress, associated with more ergonomic conditions for surgeon. Results: We present our standardized and feasible right liver lobe mobilisation needed for posterosuperior resections to the right hepatectomy. Conclusions: The standardisation of right liver lobe represented our aim to provide a safe and reproducible initial step for many procedures to reduce the conversion rate and to improve the learning curve in young surgeons.
MeSH term(s)	Humans ; Liver Neoplasms/surgery ; Robotic Surgical Procedures/methods ; Robotics ; Hepatectomy/methods ; Laparoscopy/methods ; Reference Standards
Language	English
Publishing date	2023-07-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2151860-9
ISSN	1478-596X ; 1478-5951
ISSN (online)	1478-596X
ISSN	1478-5951
DOI	10.1002/rcs.2551
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Article: Awake robotic liver surgery: A case report.

Delvecchio, Antonella / Pavone, Gaetano / Conticchio, Maria / Piacente, Claudia / Varvara, Miriam / Ferraro, Valentina / Stasi, Matteo / Casella, Annachiara / Filippo, Rosalinda / Tedeschi, Michele / Pullano, Carmine / Inchingolo, Riccardo / Delmonte, Vito / Memeo, Riccardo

World journal of gastrointestinal surgery

2024 Volume 15, Issue 12, Page(s) 2954–2961

Abstract: Background: In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. ... ...

Abstract	Background: In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease. Case summary: A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal-epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful. Conclusion: Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Case Reports
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v15.i12.2954
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Article: Optimization of the future remnant liver: review of the current strategies in Europe.

Memeo, Riccardo / Conticchio, Maria / Deshayes, Emmanuel / Nadalin, Silvio / Herrero, Astrid / Guiu, Boris / Panaro, Fabrizio

Hepatobiliary surgery and nutrition

2021 Volume 10, Issue 3, Page(s) 350–363

Abstract: Liver resection still represent the treatment of choice for liver malignancies, but in some cases inadequate future remnant liver (FRL) can lead to post hepatectomy liver failure (PHLF) that still represents the most common cause of death after ... ...

Abstract	Liver resection still represent the treatment of choice for liver malignancies, but in some cases inadequate future remnant liver (FRL) can lead to post hepatectomy liver failure (PHLF) that still represents the most common cause of death after hepatectomy. Several strategies in recent era have been developed in order to generate a compensatory hypertrophy of the FRL, reducing the risk of post hepatectomy liver failure. Portal vein embolization, portal vein ligation, and ALLPS are the most popular techniques historically adopted up to now. The liver venous deprivation and the radio-embolization are the most recent promising techniques. Despite even more precise tools to calculate the relationship among volume and function, such as scintigraphy with
Language	English
Publishing date	2021-04-27
Publishing country	China (Republic : 1949- )
Document type	Journal Article ; Review
ZDB-ID	2812398-0
ISSN	2304-389X ; 2304-3881
ISSN (online)	2304-389X
ISSN	2304-3881
DOI	10.21037/hbsn-20-394
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Article: Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Case Report and Literature Review of 890 Patients Affected by Uncommon Primary Liver Tumor Presentation.

Conticchio, Maria / Maggialetti, Nicola / Rescigno, Marco / Brunese, Maria Chiara / Vaschetti, Roberto / Inchingolo, Riccardo / Calbi, Roberto / Ferraro, Valentina / Tedeschi, Michele / Fantozzi, Maria Rita / Avella, Pasquale / Calabrese, Angela / Memeo, Riccardo / Scardapane, Arnaldo

Journal of clinical medicine

2023 Volume 12, Issue 2

Abstract: Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47- ... ...

Abstract	Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47-year-old male patient admitted to the University Hospital of Bari with abdominal pain. Blood tests revealed the presence of an untreated hepatitis B virus infection (HBV), with normal liver function and without jaundice. Abdominal ultrasonography revealed a cirrhotic liver with a segmental dilatation of the third bile duct segment, confirmed by a CT scan and liver MRI, which also identified a heterologous mass. No other focal hepatic lesions were identified. A percutaneous ultrasound-guided needle biopsy was then performed, detecting a moderately differentiated HCC. Finally, the patient underwent a third hepatic segmentectomy, and the histopathological analysis confirmed the endobiliary localization of HCC. Subsequently, the patient experienced a nodular recurrence in the fourth hepatic segment, which was treated with ultrasound-guided percutaneous radiofrequency ablation (RFA). This case shows that HCC with BDTT can mimic different types of tumors. It also indicates the value of an early multidisciplinary patient assessment to obtain an accurate diagnosis of HCC with BDTT, which may have prognostic value that has not been recognized until now.
Language	English
Publishing date	2023-01-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12020423
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Article ; Online: Robotic emergency liver resection of ruptured hepatocellular carcinoma.

Conticchio, Maria / Delvecchio, Antonella / Ferraro, Valentina / Stasi, Matteo / Casella, Annachiara / Chetta, Nicola / De Marinis, Emma / Madaro, Andrea / Raele, Margherita / Filippo, Rosalinda / Ammendola, Michele / Tedeschi, Michele / dèAngelis, Nicola / Memeo, Riccardo

The international journal of medical robotics + computer assisted surgery : MRCAS

2023 Volume 19, Issue 5, Page(s) e2537

Abstract: Background: The spontaneous rupture of hepatocellular carcinoma (HCC) is a rare complication. The management of this complication needs a stepwise, multidisciplinary approach which considers first of all clinical conditions of the patient and also the ... ...

Abstract	Background: The spontaneous rupture of hepatocellular carcinoma (HCC) is a rare complication. The management of this complication needs a stepwise, multidisciplinary approach which considers first of all clinical conditions of the patient and also the possibility of the best curative treatment. Methods: We report our experience of an emergency robotic liver resection for a ruptured HCC in an elderly patient. Minimally invasive liver resection is currently recognised as a safe and feasible approach to the treatment of HCC in elderly patients. Results: Our patient presented haemodynamic stability, which allows us to perform a robotic resection of segment 3. To our knowledge, this is the first report of the application of a robotic platform in an emergency setting for liver resection. Conclusions: Rupture of HCC is an uncommon complication, burdened by a high rate of mortality. Its management still remains controversial. Treatment should be individualised taking into consideration the clinical status of the patient, tumour features and possibility of centre therapeutic strategy.
MeSH term(s)	Humans ; Aged ; Carcinoma, Hepatocellular/surgery ; Liver Neoplasms/surgery ; Robotic Surgical Procedures ; Hepatectomy ; Retrospective Studies
Language	English
Publishing date	2023-05-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2151860-9
ISSN	1478-596X ; 1478-5951
ISSN (online)	1478-596X
ISSN	1478-5951
DOI	10.1002/rcs.2537
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Article: Peri-operative score for elderly patients with resectable hepatocellular carcinoma.

World journal of hepatology

2024 Volume 15, Issue 12, Page(s) 1307–1314

Abstract: Background: Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains ...

Abstract	Background: Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality. Aim: To identify new perioperative risk factors that could be associated with higher 90- and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score. Methods: A multicentric, retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC; several independent variables correlated with death from all causes at 90 and 180 d were studied. The coefficients of Cox regression proportional-hazards model for six-month mortality were rounded to the nearest integer to assign risk factors' weights and derive the scoring algorithm. Results: Multivariate analysis found variables (American Society of Anesthesiology score, high rate of comorbidities, Mayo end stage liver disease score and size of biggest lesion) that had independent correlations with increased 90- and 180-d mortality. A clinical risk score was developed with survival profiles. Conclusion: This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573703-X
ISSN	1948-5182
ISSN	1948-5182
DOI	10.4254/wjh.v15.i12.1307
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Article ; Online: A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease.

Azoulay, Daniel / Feray, Cyrille / Lim, Chetana / Salloum, Chady / Conticchio, Maria / Cherqui, Daniel / Sa Cunha, Antonio / Adam, René / Vibert, Eric / Samuel, Didier / Allard, Marc Antoine / Golse, Nicolas

JHEP reports : innovation in hepatology

2022 Volume 4, Issue 4, Page(s) 100447

Abstract: Background & aims: The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation ( ... ...

Abstract	Background & aims: The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD. Methods: This is a systematic review on ALT using SFSGs in patients with CLD. The review was completed by updates obtained from the authors of the retained reports. Results: Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS Conclusions: Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results. Lay summary: At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed.
Language	English
Publishing date	2022-02-12
Publishing country	Netherlands
Document type	Journal Article
ISSN	2589-5559
ISSN (online)	2589-5559
DOI	10.1016/j.jhepr.2022.100447
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Article ; Online: Tumors located in the central column of the liver are associated with increased surgical difficulty and postoperative complications following open liver resection for colorectal metastases.

Azoulay, Daniel / Desterke, Christophe / Bhangui, Prashant / Salloum, Chady / Conticchio, Maria / Vibert, Eric / Cherqui, Daniel / Adam, René / Ichai, Philippe / Saliba, Faouzi / Elmaleh, Annie / Naili, Salima / Lim, Chetana / Feray, Cyrille

HPB : the official journal of the International Hepato Pancreato Biliary Association

2022 Volume 24, Issue 8, Page(s) 1376–1386

Abstract: Background: To assess the impact of difficult location (based on preoperative computed tomography) of liver metastases from colorectal cancer (LMCRC) on surgical difficulty, and occurrence of severe postoperative complications (POCs).: Methods: A ... ...

Abstract	Background: To assess the impact of difficult location (based on preoperative computed tomography) of liver metastases from colorectal cancer (LMCRC) on surgical difficulty, and occurrence of severe postoperative complications (POCs). Methods: A retrospective single-centre study of 911 consecutive patients with LMCRC who underwent hepatectomy by the open approach between 1998 and 2011, before implementation of laparoscopic surgery to obviate approach selection bias. LMCRC with at least one of the following four features on preoperative imaging: tumor invading the hepatocaval confluence or retro-hepatic inferior vena cava, centrally located (Segments 4,5,8) and >10 cm in diameter, abutting the supra-hilar area, or involving the paracaval portion or caudate process of Segment 1; were considered as topographically difficult (top-diff). Independent predictors of surgical difficulty assessed by number of blood units transfused, duration of ischemia, and number of sessions of pedicle clamping during surgery and of severe POCs were identified by multivariate analysis before, and after propensity score matching. Results: Top-diff tumor location independently predicted surgical difficulty. Severe POCs were associated with the tumor location [top-diff vs. topographically non difficult (non top-diff)], preoperative portal vein embolization, and variables related to surgical difficulty. Conclusion: LMCRC in difficult location independently predicts surgical difficulty and severe POCs.
MeSH term(s)	Colorectal Neoplasms/pathology ; Hepatectomy/adverse effects ; Hepatectomy/methods ; Humans ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Retrospective Studies ; Vena Cava, Inferior/surgery
Language	English
Publishing date	2022-03-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2022.03.006
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