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Article ; Online: Correction to: The LiTOS-Approach: Liver Partitioning and Total Venous Occlusion for Staged Hepatectomy.

Fiorentini, Guido / Ratti, Francesca / Aldrighetti, Luca

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2022 Volume 26, Issue 11, Page(s) 2416

Language	English
Publishing date	2022-09-21
Publishing country	United States
Document type	Published Erratum
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-022-05466-y
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The LiTOS-Approach: Liver Partitioning and Total Venous Occlusion for Staged Hepatectomy.

Fiorentini, Guido / Ratti, Francesca / Aldrighetti, Luca

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2022 Volume 26, Issue 10, Page(s) 2244–2247

MeSH term(s)	Hepatectomy ; Humans ; Ligation ; Liver/surgery ; Liver Neoplasms/surgery ; Portal Vein/surgery
Language	English
Publishing date	2022-07-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-022-05402-0
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma.

Cipriani, Federica / Ratti, Francesca / Fiorentini, Guido / Reineke, Raffaella / Aldrighetti, Luca

Updates in surgery

2021 Volume 73, Issue 2, Page(s) 359–377

Abstract: Most surgeons have traditionally been reluctant toward minimally-invasive surgery for bile duct tumors. This study aimed to perform a systematic literature review on perioperative and oncologic results of pure laparoscopic and robotic curative-intent ... ...

Abstract	Most surgeons have traditionally been reluctant toward minimally-invasive surgery for bile duct tumors. This study aimed to perform a systematic literature review on perioperative and oncologic results of pure laparoscopic and robotic curative-intent surgery for hilar cholangiocarcinoma. According to the PRISMA statement, a systematic review was conducted into Pubmed, EMBASE and Cochrane. A critical appraisal of study was performed according to the Joanna Briggs Institute tools. Nineteen studies (12 on pure laparoscopy and 7 on robotics) were included: 7 case reports, 9 case series, 3 case-control (193 patients). The pooled conversion, morbidity, biliary leak and mortality rates were 5.5%, 43%, 16.4% and 4%. The weighted mean of operative time, blood loss and postoperative stay were 388 min, 446 mL and 14 days. For pure laparoscopy, the pooled R0 rate was 86%; overall survival and disease-free survival rates ranged from 85 to 100% and from 80 to 100% (median observation time 6-18 months). For robotic surgeries, the pooled R0 rate was 69% and overall survival rates ranged from 90 to 100% (median observation time 5-15 months). Case reports were overall of high quality, case series of moderate / high-quality, case-control studies ranged from low to high quality. In selected patients, minimally-invasive surgery for Klatskin tumors appears feasible, safe, satisfactory for perioperative outcomes and adequate for oncologic results. However, the results are based on few studies, limited in patient numbers and with allocation criteria more restrictive than open, reporting short follow-up and mainly with non-comparative design: evidence of higher quality is recommended.
MeSH term(s)	Bile Duct Neoplasms/surgery ; Cholangiocarcinoma/surgery ; Hepatectomy ; Humans ; Klatskin Tumor/surgery ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Robotic Surgical Procedures ; Treatment Outcome
Language	English
Publishing date	2021-02-22
Publishing country	Italy
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-021-01006-6
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Zs.B 101: Show issues

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Article: Have we really understood when the efforts of laparoscopic liver resection are justified?-a complexity-based appraisal of the differential benefit.

Ratti, Francesca / Cipriani, Federica / Fiorentini, Guido / Catena, Marco / Paganelli, Michele / Aldrighetti, Luca

Hepatobiliary surgery and nutrition

2022 Volume 11, Issue 3, Page(s) 363–374

Abstract: Background: The implementation of minimally invasive liver resection surgery (MILS) programs starts from procedures with a low degree of technical difficulty. Data regarding the real short-term advantage of laparoscopy according to technical difficulty ... ...

Abstract	Background: The implementation of minimally invasive liver resection surgery (MILS) programs starts from procedures with a low degree of technical difficulty. Data regarding the real short-term advantage of laparoscopy according to technical difficulty are still lacking. The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always justified. Methods: Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity (low, intermediate and high difficulty) and to approach (MILS or open) and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups (Pair 1: Low-MILS and Low-Open, including 274 cases respectively; Pair 2: Int-MILS and Int-Open, including 237 patients respectively; Pair 3: High-MILS and High-Open, including 226 patients respectively). Results: MILS approach resulted in a statistically significant lower blood loss, reduced morbidity, reduced and shorter time for functional recover and length of stay within all pairs. The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree, both in terms of blood loss (-250 and -200 mL respectively) and morbidity rate (-5.7% and -4.1% respectively). Conclusions: The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures. The commitment towards MILS approach should be therefore stronger in this setting, where the advantage of laparoscopy seems to be enhanced.
Language	English
Publishing date	2022-05-31
Publishing country	China (Republic : 1949- )
Document type	Journal Article
ZDB-ID	2812398-0
ISSN	2304-389X ; 2304-3881
ISSN (online)	2304-389X
ISSN	2304-3881
DOI	10.21037/hbsn-20-562
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Article ; Online: ASO Visual Abstract: Outcomes of Neoadjuvant Chemotherapy for Invasive Intraductal Papillary Mucinous Neoplasm Compared with De Novo Pancreatic Adenocarcinoma.

Fogliati, Alessandro / Zironda, Andrea / Fiorentini, Guido / Adjei, Stella / Amro, Abdelrahman / Starlinger, Patrick P / Grotz, Travis E / Warner, Susanne G / Smoot, Rory L / Thiels, Cornelius A / Kendrick, Michael L / Cleary, Sean P / Truty, Mark J

Annals of surgical oncology

2024

Language	English
Publishing date	2024-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-024-15016-2
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Zs.A 4042: Show issues

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Article ; Online: Outcomes of Neoadjuvant Chemotherapy for Invasive Intraductal Papillary Mucinous Neoplasm Compared with de Novo Pancreatic Adenocarcinoma.

Annals of surgical oncology

2024 Volume 31, Issue 4, Page(s) 2632–2639

Abstract: Background: The management of invasive intraductal papillary mucinous cystic neoplasm (I-IPMN) does not differ from de novo pancreatic ductal adenocarcinoma (PDAC); however, I-IPMNs are debated to have better prognosis. Despite being managed similarly ... ...

Abstract	Background: The management of invasive intraductal papillary mucinous cystic neoplasm (I-IPMN) does not differ from de novo pancreatic ductal adenocarcinoma (PDAC); however, I-IPMNs are debated to have better prognosis. Despite being managed similarly to PDAC, no data are available on the response of I-IPMN to neoadjuvant chemotherapy. Methods: All patients undergoing pancreatic resection for a pancreatic adenocarcinoma from 2011 to 2022 were included. The PDAC and I-IPMN cohorts were compared to evaluate response to neoadjuvant therapy (NAT) and overall survival (OS). Results: This study included 1052 PDAC patients and 105 I-IPMN patients. NAT was performed in 25% of I-IPMN patients and 65% of PDAC patients. I-IPMN showed a similar pattern of pathological response to NAT compared with PDAC (p = 0.231). Furthermore, positron emission tomography (PET) response (71% vs. 61%; p = 0.447), CA19.9 normalization (85% vs. 76%, p = 0.290), and radiological response (32% vs. 37%, p = 0.628) were comparable between I-IPMN and PDAC. A significantly higher OS and disease-free survival (DFS) of I-IPMN was denoted by Kaplan-Meier analysis, with a p-value of < 0.001 in both plots. In a multivariate analysis, I-IPMN histology was independently associated with lower risk of recurrence and death. Conclusions: I-IPMN patients have a longer OS and DFS after surgical treatment when compared with PDAC patients. The more favorable oncologic outcome of I-IPMNs does not seem to be related to early detection, as I-IPMN histological subclass is independently associated with a lower risk of disease recurrence. Moreover, neoadjuvant effect on I-IPMN was non-inferior to PDAC in terms of pathological, CA19.9, PET, and radiological response and thus can be considered in selected patients.
MeSH term(s)	Humans ; Pancreatic Neoplasms/drug therapy ; Pancreatic Neoplasms/surgery ; Adenocarcinoma/pathology ; Neoadjuvant Therapy ; Pancreatic Intraductal Neoplasms ; Adenocarcinoma, Mucinous/drug therapy ; Adenocarcinoma, Mucinous/surgery ; Neoplasm Recurrence, Local/drug therapy ; Neoplasm Recurrence, Local/surgery ; Carcinoma, Pancreatic Ductal/drug therapy ; Carcinoma, Pancreatic Ductal/surgery ; Adenocarcinoma, Papillary/pathology ; Retrospective Studies
Language	English
Publishing date	2024-02-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-14875-5
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Zs.A 4042: Show issues

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Article ; Online: Implications of pregnancy on MCN of the pancreas: A multicentric case-control study.

Fogliati, Alessandro / Crippa, Stefano / Marchegiani, Giovanni / Belfiori, Giulio / Pea, Antonio / Graham, Rondell P / Fiorentini, Guido / Tomasoni, Giorgia / Aleotti, Francesca / Kendrick, Michael L / Salvia, Roberto / Falconi, Massimo / Truty, Mark J

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

2024

Abstract: Background: Mucinous cystic neoplasms (MCN) of the pancreas express estrogen and progesterone receptors. Several case reports describe MCN increasing in size during gestation. The aim of this study is to assess if pregnancy is a risk factor for ... ...

Abstract	Background: Mucinous cystic neoplasms (MCN) of the pancreas express estrogen and progesterone receptors. Several case reports describe MCN increasing in size during gestation. The aim of this study is to assess if pregnancy is a risk factor for malignant degeneration of MCN. Methods: All female patients who underwent pancreatic resection of a MCN between 2011 and 2021 were included. MCN resected or diagnosed within 12 months of gestation were defined perigestational. MCN with high grade dysplasia or an invasive component were classified in the high grade (HG) group. The primary outcome was defined as the correlation between exposure to gestation and peri-gestational MCN to development of HG-MCN. Results: The study includes 176 patients, 25 (14 %) forming the HG group, and 151 (86 %) forming the low grade (LG) group. LG and HG groups had a similar distribution of systemic contraceptives use (26 % vs. 16 %, p = 0.262), and perigestational MCN (7 % vs 16 %, p = 0.108). At univariate analysis cyst size ≥10 cm (OR 5.3, p < 0.001) was associated to HG degeneration. Peri gestational MCN positively correlated with cyst size (R = 0.18, p = 0.020). In the subgroup of 14 perigestational MCN patients 29 % had HG-MCN and 71 % experienced cyst growth during gestation with an average growth of 55.1 ± 18 mm. Conclusions: Perigestational MCN are associated to increased cyst diameter, and in the subset of patients affected by MCN during gestation a high rate of growth was observed. Patients with a MCN and pregnancy desire should undergo multidisciplinary counselling.
Language	English
Publishing date	2024-04-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2056680-3
ISSN	1424-3911 ; 1424-3903
ISSN (online)	1424-3911
ISSN	1424-3903
DOI	10.1016/j.pan.2024.04.009
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Zs.A 5553: Show issues

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Article ; Online: Pure laparoscopic right hepatectomy: A risk score for conversion for the paradigm of difficult laparoscopic liver resections. A single centre case series.

Cipriani, Federica / Ratti, Francesca / Fiorentini, Guido / Catena, Marco / Paganelli, Michele / Aldrighetti, Luca

International journal of surgery (London, England)

2020 Volume 82, Page(s) 108–115

Abstract: Background: Converted laparoscopic hepatectomies are known to lose some advantages of the minimally-invasiveness, and factors are identified to predict patients at risk. Specific evidence for laparoscopic right hepatectomy is expected of usefulness in ... ...

Abstract	Background: Converted laparoscopic hepatectomies are known to lose some advantages of the minimally-invasiveness, and factors are identified to predict patients at risk. Specific evidence for laparoscopic right hepatectomy is expected of usefulness in clinical practice, given its technical peculiarities. The purpose of the study was the identification of risk factors and the development of a risk score for conversion of laparoscopic right hepatectomy. Materials and methods: Laparoscopic right hepatectomy performed at a single hepatobiliary surgical center were analyzed. The cohort was split in half to obtain a derivation and a validation set. Risk factors for conversion were identified by uni- and multivariable analysis. A "conversion risk score" was built assigning each factor 1 point and comparing the score with the conversion status for each patient. The accuracy was assessed by the area-under-the-receiver-operator-characteristic-curve. Results: Among 130 operations, 22 were converted (16.9%). Reasons were: 45.5% oncologic inadequacy, 31.8% bleeding, 9.1% adhesions, 9.1% biliostasis, 4.5% anaesthesiological problems. Independent risk factors for conversion were: previous laparoscopic liver surgery (Hazard Ratio 4.9, p 0.011), preoperative chemotherapy ( Hazard Ratio 6.2, p 0.031), malignant diagnosis (Hazard Ratio 3.3, p 0.037), closeness to hepatocaval confluence or inferior vena cava (Hazard Ratio 4.1, p 0.029), tumor volume (Hazard Ratio 2.9, p 0.024). Conversion rates correlated positively with the score, raising from 0 to 100% when the score increased from 0 to 5 (Spearman: p 0.032 in the derivation set, p 0.020 in the validation set). The risk of conversion showed a sharp increase passing from class 3 to 4, reaching a probability estimated between 60 and 71.4%. The score showed good accuracy (area-under-the-receiver-operator-characteristic-curve 0.82). Conclusion: Specific risk factors for conversion are identified for laparoscopic right hepatectomy. This score may help in standardizing the choice of a pure laparoscopic or open approach for such challenging resections.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Hepatectomy/adverse effects ; Humans ; Laparoscopy/adverse effects ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Risk Factors
Language	English
Publishing date	2020-08-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2020.08.013
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Zs.A 6502: Show issues

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Article ; Online: Technical Outcomes of Porto-Mesenteric Venous Reconstruction in Pancreatic Resection Using Autologous Left Renal Vein Graft as Conduit.

Fogliati, Alessandro / Fiorentini, Guido / Alva-Ruiz, Roberto / Abdelrahman, Amro M / Zironda, Andrea / Lynch, Isaac T / Smoot, Rory L / Starlinger, Patrick P / Cleary, Sean P / Kendrick, Michael L / Truty, Mark J

Journal of the American College of Surgeons

2023 Volume 237, Issue 1, Page(s) 58–67

Abstract: Background: Portal or superior mesenteric vein (PV-SMV) resection and reconstruction is sometimes required during pancreatic tumor resection. In patients requiring segmental venous resection with interposition grafting, the left renal vein (LRV) is an ... ...

Abstract	Background: Portal or superior mesenteric vein (PV-SMV) resection and reconstruction is sometimes required during pancreatic tumor resection. In patients requiring segmental venous resection with interposition grafting, the left renal vein (LRV) is an accessible autologous solution. However, long-term patency outcomes of the LRV as an interposition conduit in this setting have not been analyzed. Study design: We conducted a retrospective analysis of patients undergoing pancreatic resection with PV-SMV reconstruction using LRV between 2002 and 2022. The primary outcome was PV-SMV patency at last follow-up, assessed with postoperative CT scans and analyzed using Kaplan-Meier survival methods that account for variation in follow-up duration. Development of any postoperative acute kidney injury within 7 days of surgery and morbidity were secondary outcomes. Results: The study cohort includes 65 patients who underwent LRV harvest; 60 (92%) ultimately underwent successful reconstruction with harvested LRV graft. Kaplan-Meier 2-year estimated patency rate of the LRV graft was 88%, with no cases of complete occlusion. Six (10%) patients experienced graft stenosis. Nine of 61 (15%) patients experienced grade II or III acute kidney injury, 6 of 9 returning to normal renal function before discharge. No difference in median serum creatinine was observed at baseline, 6 and 12 months from surgery. LRV remnant thrombosis was seen in 7 of 65 (11%) patients. Only 3 of 61 (5%) patients had persistent acute kidney injury caused by complications unrelated to LRV harvesting. Conclusions: Autologous LRV graft was a reliable conduit for segmental PV-SMV reconstruction, resulting in a high patency rate and marginal impact on renal function. LRV harvest is a safe and potentially ideal surgical option for PV-SMV reconstruction in pancreatic surgery.
MeSH term(s)	Humans ; Renal Veins/surgery ; Renal Veins/pathology ; Mesenteric Veins/surgery ; Pancreaticoduodenectomy/methods ; Retrospective Studies ; Treatment Outcome ; Portal Vein/surgery ; Pancreatic Neoplasms ; Kidney/surgery ; Kidney/physiology ; Kidney/pathology ; Acute Kidney Injury
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000744
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Article ; Online: Technical Insights on Laparoscopic Left and Right Hepatectomy for Perihilar Cholangiocarcinoma.

Ratti, Francesca / Fiorentini, Guido / Cipriani, Federica / Catena, Marco / Paganelli, Michele / Aldrighetti, Luca

Annals of surgical oncology

2020 Volume 27, Issue 13, Page(s) 5191–5192

MeSH term(s)	Bile Duct Neoplasms/surgery ; Bile Ducts, Intrahepatic/surgery ; Cholangiocarcinoma/surgery ; Hepatectomy ; Humans ; Klatskin Tumor/surgery ; Laparoscopy ; Treatment Outcome
Language	English
Publishing date	2020-05-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-020-08647-8
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