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  1. Article ; Online: Right-side fixation of the sigmoid colon causing internal herniation with closed-loop obstruction of both small and large bowel: a case report and review of the literature.

    Bertelli, G / Patauner, S / Gorgatti, T / Frena, A

    Journal of medical case reports

    2022  Volume 16, Issue 1, Page(s) 323

    Abstract: Background: Right-side fixation of the sigmoid colon is a rare anatomical variant associated with intestinal malrotation (Choi et al. in J Korean Surg Soc. 84(4):256-60, 2013). Differently from other forms of malrotation, this variant has not been ... ...

    Abstract Background: Right-side fixation of the sigmoid colon is a rare anatomical variant associated with intestinal malrotation (Choi et al. in J Korean Surg Soc. 84(4):256-60, 2013). Differently from other forms of malrotation, this variant has not been associated thus far with acute surgical conditions.
    Case presentation: In this report, we present a 65-year-old Caucasian patient admitted for bowel obstruction symptoms. Computed tomography scan revealed right-side fixation of the sigmoid colon extended to the subhepatic recess complicated by obstructed internal herniation of the ileum. In this patient, the sigmoid colon occupied a recess posterior to the ascending colon and right Toldt's fascia. Within this narrow anatomical space, an ileal loop was trapped causing internal herniation with resultant close-bowel obstruction of both ileum and sigmoid colon. The ileal loop was released surgically and the anatomical abnormality corrected.
    Conclusions: To our knowledge, this is the first case of right-side fixation of the sigmoid colon causing acute obstruction secondary to internal herniation of the small intestine. Early recognition and precise anatomical definition of such anatomical variants are essential to optimize their surgical approach.
    MeSH term(s) Aged ; Colon, Sigmoid/diagnostic imaging ; Colon, Sigmoid/surgery ; Hernia/complications ; Hernia/diagnostic imaging ; Humans ; Ileum ; Intestinal Obstruction/diagnostic imaging ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Intestine, Small/diagnostic imaging ; Intestine, Small/surgery
    Language English
    Publishing date 2022-08-30
    Publishing country England
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2269805-X
    ISSN 1752-1947 ; 1752-1947
    ISSN (online) 1752-1947
    ISSN 1752-1947
    DOI 10.1186/s13256-022-03529-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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

    Famularo, Simone / Cillo, Umberto / Lauterio, Andrea / Donadon, Matteo / Vitale, Alessandro / Serenari, Matteo / Cipriani, Federica / Fazio, Federico / Giuffrida, Mario / Ardito, Francesco / Dominioni, Tommaso / Garancini, Mattia / Lai, Quirino / Nicolini, Daniele / Molfino, Sarah / Perri, Pasquale / Pinotti, Enrico / Conci, Simone / Ferrari, Cecilia /
    Zanello, Matteo / Patauner, Stefan / Zimmitti, Giuseppe / Germani, Paola / Chiarelli, Marco / Romano, Maurizio / De Angelis, Michela / La Barba, Giuliano / Troci, Albert / Ferraro, Valentina / Izzo, Francesco / Antonucci, Adelmo / Belli, Andrea / Memeo, Riccardo / Crespi, Michele / Ercolani, Giorgio / Boccia, Luigi / Zanus, Giacomo / Tarchi, Paola / Hilal, Moh'd Abu / Frena, Antonio / Jovine, Elio / Griseri, Guido / Ruzzenente, Andrea / Zago, Mauro / Grazi, Gianluca / Baiocchi, Gian L / Vivarelli, Marco / Rossi, Massimo / Romano, Fabrizio / Maestri, Marcello / Giuliante, Felice / Valle, Raffaele D / Ferrero, Alessandro / Aldrighetti, Luca / De Carlis, Luciano / Cescon, Matteo / Torzilli, Guido

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

    2023  Volume 25, Issue 10, Page(s) 1223–1234

    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 ... ...

    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.
    MeSH term(s) Humans ; Carcinoma, Hepatocellular ; Hepatectomy/adverse effects ; Liver Neoplasms ; Liver Transplantation/adverse effects ; Retrospective Studies ; Neoplasm Recurrence, Local ; Salvage Therapy
    Language English
    Publishing date 2023-06-12
    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.2023.06.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Machine Learning Predictive Model to Guide Treatment Allocation for Recurrent Hepatocellular Carcinoma After Surgery.

    Famularo, Simone / Donadon, Matteo / Cipriani, Federica / Fazio, Federico / Ardito, Francesco / Iaria, Maurizio / Perri, Pasquale / Conci, Simone / Dominioni, Tommaso / Lai, Quirino / La Barba, Giuliano / Patauner, Stefan / Molfino, Sarah / Germani, Paola / Zimmitti, Giuseppe / Pinotti, Enrico / Zanello, Matteo / Fumagalli, Luca / Ferrari, Cecilia /
    Romano, Maurizio / Delvecchio, Antonella / Valsecchi, Maria Grazia / Antonucci, Adelmo / Piscaglia, Fabio / Farinati, Fabio / Kawaguchi, Yoshikuni / Hasegawa, Kiyoshi / Memeo, Riccardo / Zanus, Giacomo / Griseri, Guido / Chiarelli, Marco / Jovine, Elio / Zago, Mauro / Abu Hilal, Moh'd / Tarchi, Paola / Baiocchi, Gian Luca / Frena, Antonio / Ercolani, Giorgio / Rossi, Massimo / Maestri, Marcello / Ruzzenente, Andrea / Grazi, Gian Luca / Dalla Valle, Raffaele / Romano, Fabrizio / Giuliante, Felice / Ferrero, Alessandro / Aldrighetti, Luca / Bernasconi, Davide P / Torzilli, Guido

    JAMA surgery

    2022  Volume 158, Issue 2, Page(s) 192–202

    Abstract: Importance: Clear indications on how to select retreatments for recurrent hepatocellular carcinoma (HCC) are still lacking.: Objective: To create a machine learning predictive model of survival after HCC recurrence to allocate patients to their best ... ...

    Abstract Importance: Clear indications on how to select retreatments for recurrent hepatocellular carcinoma (HCC) are still lacking.
    Objective: To create a machine learning predictive model of survival after HCC recurrence to allocate patients to their best potential treatment.
    Design, setting, and participants: Real-life data were obtained from an Italian registry of hepatocellular carcinoma between January 2008 and December 2019 after a median (IQR) follow-up of 27 (12-51) months. External validation was made on data derived by another Italian cohort and a Japanese cohort. Patients who experienced a recurrent HCC after a first surgical approach were included. Patients were profiled, and factors predicting survival after recurrence under different treatments that acted also as treatment effect modifiers were assessed. The model was then fitted individually to identify the best potential treatment. Analysis took place between January and April 2021.
    Exposures: Patients were enrolled if treated by reoperative hepatectomy or thermoablation, chemoembolization, or sorafenib.
    Main outcomes and measures: Survival after recurrence was the end point.
    Results: A total of 701 patients with recurrent HCC were enrolled (mean [SD] age, 71 [9] years; 151 [21.5%] female). Of those, 293 patients (41.8%) received reoperative hepatectomy or thermoablation, 188 (26.8%) received sorafenib, and 220 (31.4%) received chemoembolization. Treatment, age, cirrhosis, number, size, and lobar localization of the recurrent nodules, extrahepatic spread, and time to recurrence were all treatment effect modifiers and survival after recurrence predictors. The area under the receiver operating characteristic curve of the predictive model was 78.5% (95% CI, 71.7%-85.3%) at 5 years after recurrence. According to the model, 611 patients (87.2%) would have benefited from reoperative hepatectomy or thermoablation, 37 (5.2%) from sorafenib, and 53 (7.6%) from chemoembolization in terms of potential survival after recurrence. Compared with patients for which the best potential treatment was reoperative hepatectomy or thermoablation, sorafenib and chemoembolization would be the best potential treatment for older patients (median [IQR] age, 78.5 [75.2-83.4] years, 77.02 [73.89-80.46] years, and 71.59 [64.76-76.06] years for sorafenib, chemoembolization, and reoperative hepatectomy or thermoablation, respectively), with a lower median (IQR) number of multiple recurrent nodules (1.00 [1.00-2.00] for sorafenib, 1.00 [1.00-2.00] for chemoembolization, and 2.00 [1.00-3.00] for reoperative hepatectomy or thermoablation). Extrahepatic recurrence was observed in 43.2% (n = 16) for sorafenib as the best potential treatment vs 14.6% (n = 89) for reoperative hepatectomy or thermoablation as the best potential treatment and 0% for chemoembolization as the best potential treatment. Those profiles were used to constitute a patient-tailored algorithm for the best potential treatment allocation.
    Conclusions and relevance: The herein presented algorithm should help in allocating patients with recurrent HCC to the best potential treatment according to their specific characteristics in a treatment hierarchy fashion.
    MeSH term(s) Humans ; Female ; Aged ; Male ; Carcinoma, Hepatocellular/surgery ; Carcinoma, Hepatocellular/pathology ; Sorafenib/therapeutic use ; Liver Neoplasms/surgery ; Liver Neoplasms/pathology ; Chemoembolization, Therapeutic ; Retrospective Studies ; Neoplasm Recurrence, Local/pathology ; Hepatectomy
    Chemical Substances Sorafenib (9ZOQ3TZI87)
    Language English
    Publishing date 2022-12-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2022.6697
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort.

    Famularo, Simone / Russolillo, Nadia / Donadon, Matteo / Cipriani, Federica / Ardito, Francesco / Perri, Pasquale / Giani, Alessandro / De Stefano, Francesca / Lai, Quirino / Molfino, Sarah / Zanello, Matteo / Iaria, Maurizio / La Barba, Giuliano / Pinotti, Enrico / Germani, Paola / Conci, Simone / Ferrari, Cecilia / Fumagalli, Luca / Romano, Maurizio /
    Antonucci, Adelmo / Zimmitti, Giuseppe / Troci, Albert / Floridi, Antonio / Ferraro, Valentina / Patauner, Stefan / Frena, Antonio / Memeo, Riccardo / Crespi, Michele / Hilal, Mohammed A / Zanus, Giacomo / Chiarelli, Marco / Percivale, Andrea / Ruzzenente, Andrea / Tarchi, Paola / Zago, Mauro / Ercolani, Giorgio / Dalla Valle, Raffaele / Jovine, Elio / Baiocchi, Gian Luca / Rossi, Massimo / Maestri, Marcello / Romano, Fabrizio / Grazi, Gian Luca / Giuliante, Felice / Aldrighetti, Luca / Ferrero, Alessandro / Torzilli, Guido

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

    2022  Volume 24, Issue 8, Page(s) 1365–1375

    Abstract: Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined.: Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care ( ...

    Abstract Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined.
    Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3).
    Results: A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups).
    Conclusion: We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.
    MeSH term(s) Benchmarking ; Carcinoma, Hepatocellular ; Hepatectomy/adverse effects ; Hepatectomy/methods ; Humans ; Liver Cirrhosis/complications ; Liver Cirrhosis/pathology ; Liver Cirrhosis/surgery ; Liver Failure/etiology ; Liver Neoplasms/complications ; Liver Neoplasms/surgery ; Postoperative Complications ; Retrospective Studies
    Language English
    Publishing date 2022-03-01
    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.2022.02.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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

    Iaria, Maurizio / Bianchi, Giorgio / Fazio, Federico / Ardito, Francesco / Perri, Pasquale / Pontarolo, Nicholas / Conci, Simone / Donadon, Matteo / Zanello, Matteo / Lai, Quirino / Famularo, Simone / Molfino, Sarah / Sciannamea, Ivano / Fumagalli, Luca / Germani, Paola / Floridi, Antonio / Ferrari, Cecilia / Zimmitti, Giuseppe / Troci, Albert /
    Zago, Mauro / Ferraro, Valentina / Cipriani, Federica / Patauner, Stefan / La Barba, Giuliano / Romano, Maurizio / Zanus, Giacomo / Ercolani, Giorgio / Frena, Antonio / Aldrighetti, Luca / Memeo, Riccardo / Pinotti, Enrico / Crespi, Michele / Hilal, Moh'd Abu / Griseri, Guido / Tarchi, Paola / Chiarelli, Marco / Antonucci, Adelmo / Baiocchi, Gian L / Romano, Fabrizio / Rossi, Massimo / Jovine, Elio / Torzilli, Guido / Ruzzenente, Andrea / Maestri, Marcello / Grazi, Gian L / Giuliante, Felice / Ferrero, Alessandro / Dalla Valle, Raffaele

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

    2022  Volume 24, Issue 8, Page(s) 1291–1304

    Abstract: Background: We aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments.: Methods! ...

    Abstract Background: We aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments.
    Methods: Data were collected from the Hepatocarcinoma Recurrence on the Liver Study Group (He.RC.O.Le.S.) Italian Registry. After 1:1 propensity score-matched analysis (PSM), two groups were compared: the PH group (patients submitted to resection for a first HCC) and the SH group (patients resected for intrahepatic rHCC after previous HCC-related treatments).
    Results: 2689 patients were enrolled. PH included 2339 patients, SH 350. After PSM, 263 patients were selected in each group with major resected nodule median size, intraoperative blood loss and minimally invasive approach significantly lower in the SH group. Long-term outcomes were compared, with no difference in OS and DFS. Univariate and multivariate analyses revealed only microvascular invasion as an independent prognostic factor for OS.
    Conclusion: SH proved to be equivalent to PH in terms of safety, feasibility and long-term outcomes, consistent with data gathered from East Asia. In the awaiting of reliable treatment-allocating algorithms for rHCC, SH appears to be a suitable alternative in patients fit for surgery, regardless of the previous therapeutic modality implemented.
    MeSH term(s) Carcinoma, Hepatocellular/pathology ; Hepatectomy/adverse effects ; Humans ; Liver Neoplasms/pathology ; Neoplasm Recurrence, Local/pathology ; Propensity Score ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-01-11
    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.2022.01.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison.

    Famularo, Simone / Donadon, Matteo / Cipriani, Federica / Bernasconi, Davide P / LaBarba, Giuliano / Dominioni, Tommaso / Iaria, Maurizio / Molfino, Sarah / Conci, Simone / Ferrari, Cecilia / Garatti, Marco / Delvecchio, Antonella / Troci, Albert / Patauner, Stefan / Frassani, Silvia / Cosimelli, Maurizio / Zanus, Giacomo / Giuliante, Felice / Jovine, Elio /
    Valsecchi, Maria G / Grazi, GianLuca / Antonucci, Adelmo / Frena, Antonio / Crespi, Michele / Memeo, Riccardo / Zimmitti, Giuseppe / Griseri, Guido / Ruzzenente, Andrea / Baiocchi, Gianluca / DallaValle, Raffaele / Maestri, Marcello / Ercolani, Giorgio / Aldrighetti, Luca / Torzilli, Guido / Romano, Fabrizio

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

    2020  Volume 23, Issue 6, Page(s) 889–898

    Abstract: Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments ...

    Abstract Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC.
    Methods: This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups.
    Results: 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14-2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22-2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54-0.69; p<0.001).
    Conclusion: Curative approaches may guarantee long-term survival in case of recurrence.
    MeSH term(s) Carcinoma, Hepatocellular/therapy ; Chemoembolization, Therapeutic ; Humans ; Liver Neoplasms/therapy ; Neoplasm Recurrence, Local/therapy ; Palliative Care ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2020-11-02
    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.2020.10.007
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  7. Article ; Online: The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study.

    Famularo, Simone / Donadon, Matteo / Cipriani, Federica / Ardito, Francesco / Iaria, Maurizio / Carissimi, Francesca / Perri, Pasquale / Dominioni, Tommaso / Zanello, Matteo / Conci, Simone / Molfino, Sarah / D'Acapito, Fabrizio / Germani, Paola / Ferrari, Cecilia / Patauner, Stefan / Pinotti, Enrico / Sciannamea, Ivano / Garatti, Marco / Lodo, Enrico /
    Troci, Albert / Delvecchio, Antonella / Floridi, Antonio / Bernasconi, Davide Paolo / Fumagalli, Luca / Chiarelli, Marco / Memeo, Riccardo / Crespi, Michele / Zanus, Giacomo / Zimmitti, Giuseppe / Antonucci, Adelmo / Zago, Mauro / Frena, Antonio / Griseri, Guido / Tarchi, Paola / Ercolani, Giorgio / Baiocchi, Gian Luca / Ruzzenente, Andrea / Jovine, Elio / Maestri, Marcello / Grazi, GianLuca / Valle, Raffaele Dalla / Giuliante, Felice / Aldrighetti, Luca / Romano, Fabrizio / Torzilli, Guido

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

    2021  Volume 25, Issue 11, Page(s) 2823–2834

    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- ... ...

    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.
    MeSH term(s) Ascites/epidemiology ; Ascites/etiology ; Carcinoma, Hepatocellular/surgery ; Disease-Free Survival ; Hepatectomy/adverse effects ; Humans ; Liver Neoplasms/surgery ; Neoplasm Recurrence, Local/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies
    Language English
    Publishing date 2021-03-09
    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/s11605-021-04952-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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

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

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2021  Volume 48, Issue 1, Page(s) 103–112

    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 ... ...

    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.
    MeSH term(s) Aged ; Body Mass Index ; Carcinoma, Hepatocellular/etiology ; Carcinoma, Hepatocellular/surgery ; Comorbidity ; Disease-Free Survival ; Female ; Hepatectomy ; Hepatitis B, Chronic/complications ; Hepatitis C, Chronic/complications ; Humans ; Liver Cirrhosis/complications ; Liver Diseases, Alcoholic/complications ; Liver Neoplasms/etiology ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Neoplasms, Multiple Primary/etiology ; Neoplasms, Multiple Primary/surgery ; Non-alcoholic Fatty Liver Disease/complications ; Propensity Score ; Survival Rate ; Tumor Burden
    Language English
    Publishing date 2021-07-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2021.07.015
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  9. Article ; Online: Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience.

    Famularo, Simone / Donadon, Matteo / Cipriani, Federica / Ardito, Francesco / Carissimi, Francesca / Perri, Pasquale / Iaria, Maurizio / Dominioni, Tommaso / Zanello, Matteo / Conci, Simone / Molfino, Sarah / LaBarba, Giuliano / Ferrari, Cecilia / Germani, Paola / Patauner, Stefan / Pinotti, Enrico / Lodo, Enrico / Garatti, Marco / Sciannamea, Ivano /
    Troci, Albert / Conticchio, Maria / Floridi, Antonio / Chiarelli, Marco / Fumagalli, Luca / Memeo, Riccardo / Crespi, Michele / Antonucci, Adelmo / Zimmitti, Giuseppe / Zanus, Giacomo / Zago, Mauro / Frena, Antonio / Tarchi, Paola / Griseri, Guido / Ercolani, Giorgio / Baiocchi, Gian Luca / Ruzzenente, Andrea / Jovine, Elio / Maestri, Marcello / DallaValle, Raffaele / Grazi, Gian Luca / Giuliante, Felice / Aldrighetti, Luca / Torzilli, Guido / Romano, Fabrizio

    Updates in surgery

    2020  Volume 72, Issue 2, Page(s) 399–411

    Abstract: Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on ... ...

    Abstract Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.
    MeSH term(s) Aged ; Carcinoma, Hepatocellular/epidemiology ; Carcinoma, Hepatocellular/surgery ; Datasets as Topic ; Female ; Hepatectomy/methods ; Hepatectomy/trends ; Humans ; Italy/epidemiology ; Laparoscopy/methods ; Laparoscopy/trends ; Liver Neoplasms/epidemiology ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Outcome Assessment, Health Care/methods ; Registries ; Reoperation
    Language English
    Publishing date 2020-03-13
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-020-00733-6
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  10. Article: Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma.

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

    Cancers

    2020  Volume 12, Issue 12

    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.: ... ...

    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.
    Language English
    Publishing date 2020-12-21
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers12123868
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