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Article ; Online: Novel Calculators for Risk Stratification in Hepatocellular Carcinoma: A Concise Review.

Pirisi, Mario / Leutner, Monica / Romito, Raffaele / Gaia, Silvia

2020 Volume 54, Issue 9, Page(s) 789–794

Abstract: Among clinicians, the users of medical calculators have expanded in recent years to an unprecedented number. The usefulness of some of these calculators is sometimes debatable, and experienced professionals may at times be right in avoiding their use; ... ...

Abstract	Among clinicians, the users of medical calculators have expanded in recent years to an unprecedented number. The usefulness of some of these calculators is sometimes debatable, and experienced professionals may at times be right in avoiding their use; however, many may simply be unaware of the very existence of medical calculators applicable to their field of interest. The authors felt that this latter scenario might possibly apply to hepatocellular carcinoma (HCC). Hence, the authors concisely reviewed 10 free online medical calculators proposed in the last 8 years, categorizing them on the basis of the purpose for which they were developed (risk of harboring or developing HCC, N=4; prognostication in established HCC, N=6). In addition, the authors tried to establish the success each calculator has had so far in the medical community, by 2 criteria: having been included in the more popular app of medical calculators and being highly cited in the scientific literature.
MeSH term(s)	Carcinoma, Hepatocellular/diagnosis ; Humans ; Liver Neoplasms/diagnosis ; Risk Assessment
Language	English
Publishing date	2020-08-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	448460-5
ISSN	1539-2031 ; 0192-0790
ISSN (online)	1539-2031
ISSN	0192-0790
DOI	10.1097/MCG.0000000000001406
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Article: Standard Versus Advanced Protective Measures in a COVID-Free Surgical Pathway.

Frosio, Fabio / Masserano, Riccardo / Colli, Fabio / Portigliotti, Luca / Maroso, Fabio / Nicolosi, Filadelfio Massimiliano / Soresini, Oscar / Romito, Raffaele

Cureus

2022 Volume 14, Issue 11, Page(s) e31227

Abstract: Introduction The importance of coronavirus disease (COVID)-free surgical pathways during the coronavirus disease 2019 (COVID-19) pandemic has been demonstrated. However, the extent of protective measures to be applied against severe acute respiratory ... ...

Abstract	Introduction The importance of coronavirus disease (COVID)-free surgical pathways during the coronavirus disease 2019 (COVID-19) pandemic has been demonstrated. However, the extent of protective measures to be applied against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), particularly before vaccines became available, remained unclear. Methods This retrospective study included all SARS-CoV-2-negative patients admitted to the COVID-free pathway of a regional abdominal surgery hub center in Northern Italy over 12 months, before the vaccination campaign. During the first seven months, basic protective measures against SARS-CoV-2 were adopted (surgical masks, swabs for symptomatic patients, and intra- or interhospital transfers), since patients were treated as effectively negative (standard management). During the last five months, advanced measures were implemented (enhanced personal protections and systematic control swabs), as patients were considered potentially positive (advanced management). The aim of this article was to compare SARS-CoV-2 incidence and surgical outcomes in these periods. Results A total of 283 and 194 patients were admitted under standard and advanced management, respectively; pre-admission data differed only in the rate of previous SARS-CoV-2 infection (2.5% versus 6.7%, p= 0.034). The SARS-CoV-2 incidence was 3.9% and 3.1% for standard and advanced periods, respectively (p = 0.835). Two internal outbreaks developed during the standard phase. The advanced protocol significantly increased the rate of patients re-tested for SARS-CoV-2 (83% versus 41.7%, p < 0.001) and allowed early detection of all infections, which remained sporadic. Surgical outcomes were similar. Conclusions Advanced management was instrumental in detecting positive patients early and preventing outbreaks, without affecting surgical results; accordingly, it stands as a reproducible model for future pandemic scenarios.
Language	English
Publishing date	2022-11-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.31227
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Article ; Online: Genistein and 17β-Estradiol Protect Hepatocytes from Fatty Degeneration by Mechanisms Involving Mitochondria, Inflammasome and Kinases Activation.

Farruggio, Serena / Cocomazzi, Grazia / Marotta, Patrizia / Romito, Raffaele / Surico, Daniela / Calamita, Giuseppe / Bellan, Mattia / Pirisi, Mario / Grossini, Elena

Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology

2020 Volume 54, Issue 3, Page(s) 401–416

Abstract: Background/aims: Oxidative stress and mitochondria dysfunction could be involved in the onset of non-alcoholic fatty liver disease (NAFLD) and in its progression to non-alcoholic steatohepatitis (NASH). Estrogens/phytoestrogens could counteract liver ... ...

Abstract	Background/aims: Oxidative stress and mitochondria dysfunction could be involved in the onset of non-alcoholic fatty liver disease (NAFLD) and in its progression to non-alcoholic steatohepatitis (NASH). Estrogens/phytoestrogens could counteract liver fat deposition with beneficial effects against NAFLD by unclear mechanisms. We aimed to analyze the protective effects elicited by genistein/estradiol in hepatocytes cultured in NAFLD-like medium on cell viability, triglycerides accumulation, mitochondrial function and oxidative stress and the role of NLRP3 inflammasome, toll like receptors 4 (TLR4), Akt and 5' AMP-activated protein kinase (AMPK)α1/2. Methods: Human primary hepatocytes/hepatoma cell line (Huh7.5 cells) were incubated with a 2 mM mixture of oleate/palmitate in presence/absence of genistein/17β-estradiol. In some experiments, Huh7.5 cells were exposed to various inhibitors of the above pathways and estrogenic receptors (ERs) and G protein-coupled estrogen receptor (GPER) blockers, before genistein/17β-estradiol. Cell viability, mitochondrial membrane potential, reactive oxygen species and triglycerides content were examined by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT), 5,51,6,61-tetrachloro-1,11,3,31 tetraethylbenzimidazolyl carbocyanine iodide (JC-1), 2,7-dichlorodihydrofluorescein diacetate (H2DCFDA) and the Triglyceride Colorimetric Assay. The expression/activation of kinases was analyzed by means of Western blot. Results: Genistein/17β-estradiol protected hepatocytes against NAFLD-like medium, by preventing the loss of cell viability and mitochondrial function, triglycerides accumulation and peroxidation. The blocking of kinases, ERs and GPER was able to reduce the above effects, which were potentiated by NLRP3 inflammasome. Conclusion: Our findings suggest novel mechanisms underlying the protective effects elicited by phytoestrogens/estrogens against NAFLD/NASH and open novel therapeutic perspectives in the management of NAFLD in postmenopausal women.
MeSH term(s)	Cell Line ; Cell Survival/drug effects ; Estradiol/pharmacology ; Genistein/pharmacology ; Hepatocytes/drug effects ; Hepatocytes/metabolism ; Humans ; Inflammasomes/metabolism ; Membrane Potential, Mitochondrial/drug effects ; Mitochondria/metabolism ; Non-alcoholic Fatty Liver Disease/metabolism ; Oxidative Stress/drug effects ; Phytoestrogens/pharmacology ; Protein Kinases/metabolism ; Proto-Oncogene Proteins c-akt/metabolism ; Reactive Oxygen Species/metabolism ; Receptors, Estrogen/antagonists & inhibitors ; Receptors, G-Protein-Coupled/antagonists & inhibitors ; Toll-Like Receptor 4/metabolism ; Triglycerides/metabolism
Chemical Substances	GPER1 protein, human ; Inflammasomes ; Phytoestrogens ; Reactive Oxygen Species ; Receptors, Estrogen ; Receptors, G-Protein-Coupled ; TLR4 protein, human ; Toll-Like Receptor 4 ; Triglycerides ; Estradiol (4TI98Z838E) ; Genistein (DH2M523P0H) ; Protein Kinases (EC 2.7.-) ; AMP-activated protein kinase kinase (EC 2.7.1.-) ; Proto-Oncogene Proteins c-akt (EC 2.7.11.1)
Language	English
Publishing date	2020-06-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1067572-3
ISSN	1421-9778 ; 1015-8987
ISSN (online)	1421-9778
ISSN	1015-8987
DOI	10.33594/000000227
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Article ; Online: A 28-Year-Old Woman with Ascites and Multiple Focal Spleen Lesions.

Pirovano, Alice / Matino, Erica / Zecca, Erika / Costanzo, Martina / Croce, Alessandro / Leutner, Monica / Romito, Raffaele / Pirisi, Mario

European journal of case reports in internal medicine

2019 Volume 6, Issue 5, Page(s) 1061

Abstract: Serous effusions complicating the course of lymphomas occur commonly in the pleural space but seldom in the peritoneum, where they most often present as chylous ascites with diagnostic cytology. Almost invariably, in these rare cases, the serum to ... ...

Abstract	Serous effusions complicating the course of lymphomas occur commonly in the pleural space but seldom in the peritoneum, where they most often present as chylous ascites with diagnostic cytology. Almost invariably, in these rare cases, the serum to ascites albumin gradient is low. We describe a 28-year-old woman with anasarca, ascites and a serum to ascites albumin gradient of 1.1 g/dl, consistent with portal hypertension. No tumour cells were detected in the ascitic fluid. However, a CT scan of the chest and abdomen disclosed liver and spleen enlargement and multiple enlarged retroperitoneal lymph nodes, suspicious for a lymphoproliferative disorder. Bone marrow aspiration and biopsy were not diagnostic, so a decision was made to proceed with a splenectomy despite the onset of low-grade disseminated intravascular coagulation. Surgery was uneventful. Diffuse large B cell lymphoma was diagnosed. A liver biopsy taken at the time of surgery demonstrated that the liver parenchyma was massively infiltrated by reactive T lymphocytes surrounding rare large CD20+ tumour cells. This infiltrate had likely led to increased portal pressure attended by ascites formation, which resolved completely after chemotherapy. The case emphasizes the rewards of pursuing a diagnosis supported by a high prior probability even in the presence of apparently discordant laboratory findings, as well as the importance of performing a diagnostic splenectomy in case of splenomegaly with unexplained focal lesions. Learning points: Lymphomas may present with serous effusion, which is usually chylous and with positive cytology when represented by ascites accumulation; non-chylous effusions can be due to altered lymphatic drainage, extrinsic compression of the portal vein by enlarged lymph nodes as well as massive infiltration of the liver by lymphoma.If the cause of splenomegaly is unclear, diagnostic splenectomy remains a viable option.The diagnosis of lymphoma should always be pursued, even if it requires apparently unwise surgery, since this type of cancer can be treated effectively only if thoroughly characterized pathologically and molecularly.
Language	English
Publishing date	2019-05-06
Publishing country	Italy
Document type	Journal Article
ISSN	2284-2594
ISSN (online)	2284-2594
DOI	10.12890/2019_001061
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Article: Exposure to Plasma From Non-alcoholic Fatty Liver Disease Patients Affects Hepatocyte Viability, Generates Mitochondrial Dysfunction, and Modulates Pathways Involved in Fat Accumulation and Inflammation.

Grossini, Elena / Garhwal, Divya Praveen / Calamita, Giuseppe / Romito, Raffaele / Rigamonti, Cristina / Minisini, Rosalba / Smirne, Carlo / Surico, Daniela / Bellan, Mattia / Pirisi, Mario

Frontiers in medicine

2021 Volume 8, Page(s) 693997

Abstract: Changes of lipidic storage, oxidative stress and mitochondrial dysfunction may be involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Although the knowledge of intracellular pathways has vastly expanded in recent years, the role ... ...

Abstract	Changes of lipidic storage, oxidative stress and mitochondrial dysfunction may be involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Although the knowledge of intracellular pathways has vastly expanded in recent years, the role and mechanisms of circulating triggering factor(s) are debated. Thus, we tested the hypothesis that factors circulating in the blood of NAFLD patients may influence processes underlying the disease. Huh7.5 cells/primary human hepatocytes were exposed to plasma from 12 NAFLD patients and 12 healthy subjects and specific assays were performed to examine viability, H
Language	English
Publishing date	2021-07-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2021.693997
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Article ; Online: Development of a prognostic score to predict response to Yttrium-90 radioembolization for hepatocellular carcinoma with portal vein invasion.

Spreafico, Carlo / Sposito, Carlo / Vaiani, Marta / Cascella, Tommaso / Bhoori, Sherrie / Morosi, Carlo / Lanocita, Rodolfo / Romito, Raffaele / Chiesa, Carlo / Maccauro, Marco / Marchianò, Alfonso / Mazzaferro, Vincenzo

Journal of hepatology

2018 Volume 68, Issue 4, Page(s) 724–732

Abstract: Background & aims: Yttrium-90 transarterial radioembolization (TARE) has shown promising efficacy in the treatment of patients with hepatocellular carcinoma (HCC), associated with portal vein tumor thrombus (PVTT). The aim of this study is to identify ... ...

Abstract	Background & aims: Yttrium-90 transarterial radioembolization (TARE) has shown promising efficacy in the treatment of patients with hepatocellular carcinoma (HCC), associated with portal vein tumor thrombus (PVTT). The aim of this study is to identify prognostic factors for survival in patients with HCC and PVTT undergoing TARE, and build a prognostic classification for these patients. Methods: This is a single center retrospective study conducted over six years (2010-2015), on consecutive patients undergoing TARE. Patients were included if they met the following criteria: presence of at least one measurable HCC, presence of PVTT not occluding the main portal trunk, absence of extrahepatic metastases, Child-Pugh score within B7, Eastern Cooperative Oncology Group performance status 0-1. Uni- and multivariable analysis was used to explore the variables that showed an independent relationship with survival. A prognostic score was then derived, and three prognostic categories were identified. Results: A total of 120 patients were included in the study. Median overall survival (OS) was 14.1 months (95% CI 10.7-17.5) and median progression-free survival (PFS) was 6.5 months (95% CI 3.8-9.2). The only variables independently correlated with OS were bilirubin, extension of PVTT and tumor burden. Three prognostic categories were identified: favourable prognosis (0 points), intermediate prognosis (2-3 points) and dismal prognosis (>3 points). Median OS in the three categories was 32.2 months, 14.9 months and 7.8 months respectively (p <0.0001). PFS (p = 0.045) and the risk of liver decompensation (p <0.0001) also significantly differed along the same prognostic categories. Conclusions: Radioembolization with Yttrium-90 is an effective therapy for patients with HCC and PVTT. The proposed prognostic stratification may help to better identify good candidates for the treatment, and those for whom TARE may be futile. Lay summary: Yttrium-90 transarterial radioembolization (TARE) is a microembolic procedure that minimizes alterations to hepatic arterial flow, and thus can be safely performed in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). In this study, we retrospectively evaluated the independent predictors of long-term outcomes in patients with HCC and PVTT treated with TARE. Bilirubin level, extension of PVTT and tumor burden were independently related to post-treatment survival: the combination of these factors allowed us to build a prognostic stratification that may help to better identify good candidates for the treatment, and those for whom TARE may be futile.
MeSH term(s)	Aged ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/therapy ; Embolization, Therapeutic/methods ; Female ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Portal Vein/pathology ; Prognosis ; Retrospective Studies ; Yttrium Radioisotopes/therapeutic use
Chemical Substances	Yttrium Radioisotopes ; Yttrium-90 (1K8M7UR6O1)
Language	English
Publishing date	2018-01-10
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	605953-3
ISSN	1600-0641 ; 0168-8278
ISSN (online)	1600-0641
ISSN	0168-8278
DOI	10.1016/j.jhep.2017.12.026
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Article ; Online: Intrahepatic flow redistribution in patients treated with radioembolization.

Spreafico, Carlo / Morosi, Carlo / Maccauro, Marco / Romito, Raffaele / Lanocita, Rodolfo / Civelli, Enrico M / Sposito, Carlo / Bhoori, Sherrie / Chiesa, Carlo / Frigerio, Laura F / Lorenzoni, Alice / Cascella, Tommaso / Marchianò, Alfonso / Mazzaferro, Vincenzo

Cardiovascular and interventional radiology

2015 Volume 38, Issue 2, Page(s) 322–328

Abstract: Introduction: In planning Yttrium-90 ((90)Y)-radioembolizations, strategy problems arise in tumours with multiple arterial supplies. We aim to demonstrate that tumours can be treated via one main feeding artery achieving flow redistribution by ... ...

Abstract	Introduction: In planning Yttrium-90 ((90)Y)-radioembolizations, strategy problems arise in tumours with multiple arterial supplies. We aim to demonstrate that tumours can be treated via one main feeding artery achieving flow redistribution by embolizing accessory vessels. Methods: One hundred (90)Y-radioembolizations were performed on 90 patients using glass microspheres. In 19 lesions/17 patients, accessory branches were found feeding a minor tumour portion and embolized. In all 17 patients, the assessment of the complete perfusion was obtained by angiography and single photon emission computerized tomography-computerized tomography (SPECT-CT). Dosimetry, toxicity, and tumor response rate of the patients treated after flow redistribution were compared with the 83 standard-treated patients. Seventeen lesions in 15 patients with flow redistribution were chosen as target lesions and evaluated according to mRECIST criteria. Results: In all patients, the complete tumor perfusion was assessed immediately before radioembolization by angiography in all patients and after the (90)Y-infusion by SPECT-CT in 15 of 17 patients. In the 15 assessable patients, the response rate in their 17 lesions was 3 CR, 8 PR, and 6 SD. Dosimetric and toxicity data, as well tumour response rate, were comparable with the 83 patients with regular vasculature. Conclusions: All embolization procedures were performed successfully with no complications, and the flow redistribution was obtained in all cases. Results in term of toxicity, median dose administered, and radiological response were comparable with standard radioembolizations. Our findings confirmed the intratumoral flow redistribution after embolizing the accessory arteries, which makes it possible to treat the tumour through its single main feeding artery.
MeSH term(s)	Brachytherapy/methods ; Female ; Humans ; Liver/blood supply ; Liver/diagnostic imaging ; Liver Neoplasms/blood supply ; Liver Neoplasms/radiotherapy ; Male ; Microspheres ; Multimodal Imaging ; Radiopharmaceuticals/therapeutic use ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed ; Yttrium Radioisotopes/therapeutic use
Chemical Substances	Radiopharmaceuticals ; Yttrium Radioisotopes
Language	English
Publishing date	2015-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	603082-8
ISSN	1432-086X ; 0342-7196 ; 0174-1551
ISSN (online)	1432-086X
ISSN	0342-7196 ; 0174-1551
DOI	10.1007/s00270-014-0921-2
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Article ; Online: REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer.

Boggi, Ugo / Kauffmann, Emanuele / Napoli, Niccolò / Barreto, S George / Besselink, Marc G / Fusai, Giuseppe K / Hackert, Thilo / Abu Hilal, Mohammad / Marchegiani, Giovanni / Salvia, Roberto / Shrikhande, Shailesh / Truty, Mark / Werner, Jens / Wolfgang, Christopher / Bannone, Elisa / Capretti, Giovanni / Cattelani, Alice / Coppola, Alessandro / Cucchetti, Alessandro /

De Sio, Davide / Di Dato, Armando / Di Meo, Giovanna / Fiorillo, Claudio / Gianfaldoni, Cesare / Ginesini, Michael / Hidalgo Salinas, Camila / Lai, Quirino / Miccoli, Mario / Montorsi, Roberto / Pagnanelli, Michele / Poli, Andrea / Ricci, Claudio / Sucameli, Francesco / Tamburrino, Domenico / Viti, Virginia / Addeo, Pietro F / Alfieri, Sergio / Bachellier, Philippe / Baiocchi, Gianluca / Balzano, Gianpaolo / Barbarello, Linda / Brolese, Alberto / Busquets, Juli / Butturini, Giovanni / Caniglia, Fabio / Caputo, Damiano / Casadei, Riccardo / Chunhua, Xi / Colangelo, Ettore / Coratti, Andrea / Costa, Francesca / Crafa, Francesco / Dalla Valle, Raffaele / De Carlis, Luciano / de Wilde, Roeland F / Del Chiaro, Marco / Di Benedetto, Fabrizio / Di Sebastiano, Pierluigi / Dokmak, Safi / Hogg, Melissa / Egorov, Vyacheslav I / Ercolani, Giorgio / Ettorre, Giuseppe Maria / Falconi, Massimo / Ferrari, Giovanni / Ferrero, Alessandro / Filauro, Marco / Giardino, Alessandro / Grazi, Gian Luca / Gruttaduaria, Salvatore / Izbicki, Jakob R / Jovine, Elio / Katz, Matthew / Keck, Tobias / Khatkov, Igor / Kiguchi, Gozo / Kooby, David / Lang, Hauke / Lombardo, Carlo / Malleo, Giuseppe / Massani, Marco / Mazzaferro, Vincenzo / Memeo, Riccardo / Miao, Yi / Mishima, Kohei / Molino, Carlo / Nagakawa, Yuichi / Nakamura, Masafumi / Nardo, Bruno / Panaro, Fabrizio / Pasquali, Claudio / Perrone, Vittorio / Rangelova, Elena / Riu, Long / Romagnoli, Renato / Romito, Raffaele / Rosso, Edoardo / Schulick, Richard / Siriwardena, Ajith / Spampinato, Marcello / Strobel, Oliver / Testini, Mario / Troisi, Roberto / Uzunoglo, Faik G / Valente, Roberto / Veneroni, Luigi / Zerbi, Alessandro / Vicente, Emilio / Vistoli, Fabio / Vivarelli, Marco / Wakabayashi, Go / Zanus, Giacomo / Zureikat, Amer / Zyromski, Nicholas J / Coppola, Roberto / D'Andrea, Vito / Davide, José / Dervenis, Christos / Frigerio, Isabella / Konlon, Kevin C / Michelassi, Fabrizio / Montorsi, Marco / Nealon, William / Portolani, Nazario / Sousa Silva, Donzília / Bozzi, Giuseppe / Ferrari, Viviana / Trivella, Maria G / Cameron, John / Clavien, Pierre-Alain / Asbun, Horacio J

Annals of surgery

2024

Abstract: Objective: The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).: Summary background ... ...

Abstract	Objective: The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Summary background data: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. Methods: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines. Results: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ). Conclusions: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.
Language	English
Publishing date	2024-02-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006248
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Article ; Online: Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: a phase 2 study.

Mazzaferro, Vincenzo / Sposito, Carlo / Bhoori, Sherrie / Romito, Raffaele / Chiesa, Carlo / Morosi, Carlo / Maccauro, Marco / Marchianò, Alfonso / Bongini, Marco / Lanocita, Rodolfo / Civelli, Enrico / Bombardieri, Emilio / Camerini, Tiziana / Spreafico, Carlo

Hepatology (Baltimore, Md.)

2013 Volume 57, Issue 5, Page(s) 1826–1837

Abstract: Unlabelled: Yttrium-90 radioembolization (Y90RE) is a novel approach to radiation therapy for hepatocellular carcinoma (HCC), never tested in phase 2 studies. Fifty-two patients with intermediate (n.17) to advanced (n.35) HCC were prospectively ... ...

Abstract	Unlabelled: Yttrium-90 radioembolization (Y90RE) is a novel approach to radiation therapy for hepatocellular carcinoma (HCC), never tested in phase 2 studies. Fifty-two patients with intermediate (n.17) to advanced (n.35) HCC were prospectively recruited to assess, as the primary endpoint, efficacy of Y90RE on time-to-progression (TTP). Secondary endpoints were tumor response, safety, and overall survival (OS). All patients were Eastern Cooperative Oncology Group (ECOG) score 0-1, Child-Pugh class A-B7. Y90RE treatments aimed at a lobar delivery of 120 Gy. Retrospective dosimetric correlations were conducted and related to response. Fifty-eight treatments were performed on 52 patients. The median follow-up was 36 months. The median TTP was 11 months with no significant difference between portal vein thrombosis (PVT) versus no PVT (7 versus 13 months). The median OS was 15 months (95% confidence interval [CI], 12-18 months) with a nonsignificant trend in favor of non-PVT versus PVT patients (18 versus 13 months). Five complete responses occurred (9.6%), and the 2 year-progression rate was 62%. Objective response was 40.4%, whereas the disease control rate (78.8%) significantly affected survival (responders versus nonresponders: 18.4% versus 9.1%; P = 0.009). Tumor response significantly correlated with absorbed dose in target lesions (r = 0.60, 95% CI, 0.41-0.74, P < 0.001) and a threshold of 500 Gy predicted response (area under the curve, 0.78). Mortality at 30-90 days was 0%-3.8%. Various grades of reduction in liver function occurred within 6 months in 36.5% of patients, with no differences among stages. On multivariate analysis, tumor response was the sole variable affecting TTP (P < 0.001) and the second affecting survival (after Child-Pugh class). Conclusion: Y90RE is an effective treatment in intermediate to advanced HCC, particularly in the case of PVT. Further prospective evaluations comparing Y90RE with conventional treatments are warranted.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/therapy ; Cohort Studies ; Embolization, Therapeutic/methods ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Retrospective Studies ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Yttrium Radioisotopes
Chemical Substances	Yttrium Radioisotopes
Language	English
Publishing date	2013-05
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604603-4
ISSN	1527-3350 ; 0270-9139
ISSN (online)	1527-3350
ISSN	0270-9139
DOI	10.1002/hep.26014
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Article: Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts.

Cozzi, Guido / Severini, Aldo / Civelli, Enrico / Milella, Marco / Pulvirenti, Andrea / Salvetti, Monica / Romito, Raffaele / Suman, Laura / Chiaraviglio, Francesca / Mazzaferro, Vincenzo

Cardiovascular and interventional radiology

2006 Volume 29, Issue 3, Page(s) 380–388

Abstract: Purpose: To assess the feasibility of percutaneous transhepatic biliary drainage (PTBD) for the treatment of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts, its efficacy in restoring the integrity of bile ducts, and ... ...

Abstract	Purpose: To assess the feasibility of percutaneous transhepatic biliary drainage (PTBD) for the treatment of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts, its efficacy in restoring the integrity of bile ducts, and technical procedures to reduce morbidity. Methods: Seventeen patients out of 936 undergoing PTBD over a 20-year period had a noncholestatic liver and were retrospectively reviewed. All patients underwent surgery for cancer and suffered a postsurgical biliary leak of 345 ml/day on average; 71% were in poor condition and required permanent nutritional support. An endoscopic approach failed or was excluded due to inaccessibility of the bile ducts. Results: Established biliary leaks and site of origin were diagnosed an average of 21 days (range 1-90 days) after surgery. In all cases percutaneous access to the biliary tree was achieved. An external (preleakage) drain was applied in 7 cases, 9 patients had an external-internal fistula bridging catheter, and 1 patient had a percutaneous hepatogastrostomy. Fistulas healed in an average of 31 days (range 3-118 days ) in 15 of 17 patients (88%) following PTBD. No major complications occurred after drainage. Post-PTBD cholangitis was observed in 6 of 17 patients (35%) and was related to biliary sludge formation occurring mostly when drainage lasted >30 days and was of the external-internal type. Median patient survival was 17.7 months and in all cases the repaired biliary leaks remained healed. Conclusions: PTBD is a feasible, effective, and safe procedure for the treatment of postsurgical biliary leaks. It is therefore a reliable alternative to surgical repair, which entails longer hospitalization and higher costs.
MeSH term(s)	Adult ; Aged ; Bile Ducts, Intrahepatic/diagnostic imaging ; Biliary Tract Diseases/surgery ; Cholangiography ; Drainage/methods ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/therapy ; Retrospective Studies ; Survival Analysis ; Treatment Outcome
Language	English
Publishing date	2006-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603082-8
ISSN	1432-086X ; 0174-1551 ; 0342-7196
ISSN (online)	1432-086X
ISSN	0174-1551 ; 0342-7196
DOI	10.1007/s00270-005-0102-4
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