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Article ; Online: The Role of Surgery in the Treatment of Bismuth-Corlette Type IV Perihilar Cholangiocarcinoma.

Alaimo, Laura / Bagante, Fabio / Ruzzenente, Andrea

2021 Volume 28, Issue 12, Page(s) 7730

MeSH term(s)	Bile Duct Neoplasms/surgery ; Bile Ducts, Intrahepatic ; Bismuth ; Cholangiocarcinoma/surgery ; Humans ; Klatskin Tumor/surgery
Chemical Substances	Bismuth (U015TT5I8H)
Language	English
Publishing date	2021-04-21
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-021-09980-2
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Article: A novel use of the comprehensive complication index in perihilar cholangiocarcinoma surgery.

Poletto, Edoardo / Conci, Simone / Campagnaro, Tommaso / De Bellis, Mario / Alaimo, Laura / Ruzzenente, Andrea

Hepatobiliary surgery and nutrition

2023 Volume 13, Issue 1, Page(s) 139–142

Language	English
Publishing date	2023-12-28
Publishing country	China (Republic : 1949- )
Document type	Editorial
ZDB-ID	2812398-0
ISSN	2304-389X ; 2304-3881
ISSN (online)	2304-389X
ISSN	2304-3881
DOI	10.21037/hbsn-23-585
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Article ; Online: Trends in hospital volume and operative mortality in hepato-biliary surgery in Veneto region, Italy.

Guglielmi, Alfredo / Tripepi, Marzia / Salmaso, Laura / Fedeli, Ugo / Ruzzenente, Andrea / Saia, Mario

Updates in surgery

2023 Volume 75, Issue 7, Page(s) 1949–1959

Abstract: Hepatobiliary resections are among the most complex and technically challenging surgical procedures. Even though robust evidence showed that complex surgical procedures such as hepatobiliary surgery have better short- and long-term outcomes and lower ... ...

Abstract	Hepatobiliary resections are among the most complex and technically challenging surgical procedures. Even though robust evidence showed that complex surgical procedures such as hepatobiliary surgery have better short- and long-term outcomes and lower mortality rate when performed in high-volume centers, the minimal criteria of centers that can perform hepatobiliary activity are not clearly defined. We conducted a retrospective population study of patients who underwent hepatobiliary surgery for malignant disease in a single Italian administrative region (Veneto) from 2010 to 2021 with the aim to investigate the hospitals annual surgical volume for hepatobiliary malignant diseases and the effect of hospital volume on in-hospital, 30- and 90-day postoperative mortality. The centralization process of hepatobiliary surgery in Veneto is rapidly increasing over the past 10 years (rate of performed in highly specialized centers increased from 62% in 2010 to 78% in 2021) and actually it is really established. The crude and adjusted (for age, sex, Charlson Index) mortality rate after hepatobiliary surgery resulted significantly lower in centers with high-volume activity compared to them with low-volume activity. In the Veneto region, the "Hub and Spoke" model led to a progressive centralization of liver and biliary cancer treatment. High surgical volume has been confirmed to be related to better outcomes in terms of mortality rate after hepatobiliary surgical procedures. Further studies are necessary to clearly define the minimal criteria and associated numerical cutoffs that can help define the characteristics of centers that can perform hepatobiliary activities.
MeSH term(s)	Humans ; Retrospective Studies ; Hospitals ; Biliary Tract Surgical Procedures ; Hospital Mortality ; Biliary Tract Neoplasms/surgery ; Italy/epidemiology ; Hospitals, High-Volume
Language	English
Publishing date	2023-07-03
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/s13304-023-01574-9
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Article ; Online: Perihilar cholangiocarcinoma: three-dimensional modelling algorithm to estimate tumour extension and bile duct resection margins.

Ruzzenente, Andrea / Alaimo, Laura / D'Onofrio, Mirko / Marchese, Andrea / Roman, Diletta / Conci, Simone / De Bellis, Mario / Pedrazzani, Corrado / Campagnaro, Tommaso / Guglielmi, Alfredo

The British journal of surgery

2024 Volume 111, Issue 1

MeSH term(s)	Humans ; Klatskin Tumor/surgery ; Margins of Excision ; Bile Ducts ; Bile Duct Neoplasms/surgery
Language	English
Publishing date	2024-01-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znad428
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Article ; Online: The Role of Three-Dimensional Modeling to Improve Comprehension of Liver Anatomy and Tumor Characteristics for Medical Students and Surgical Residents.

Alaimo, Laura / Marchese, Andrea / Vignola, Damiano / Roman, Diletta / Conci, Simone / De Bellis, Mario / Pedrazzani, Corrado / Campagnaro, Tommaso / Manzini, Gessica / Guglielmi, Alfredo / Ruzzenente, Andrea

Journal of surgical education

2024 Volume 81, Issue 4, Page(s) 597–606

Abstract: Objective: Studying liver anatomy can be challenging for medical students and surgical residents due to its complexity. Three-dimensional visualization technology (3DVT) allows for a clearer and more precise view of liver anatomy. We sought to assess ... ...

Abstract	Objective: Studying liver anatomy can be challenging for medical students and surgical residents due to its complexity. Three-dimensional visualization technology (3DVT) allows for a clearer and more precise view of liver anatomy. We sought to assess how 3DVT can assist students and surgical residents comprehend liver anatomy. Design: Data from 5 patients who underwent liver resection for malignancy at our institution between September 2020 and April 2022 were retrospectively reviewed and selected following consensus among the investigators. Participants were required to complete an online survey to investigate their understanding of tumor characteristics and vascular variations based on patients' computed tomography (CT) and 3DVT. Setting: The study was carried out at the General and Hepato-Biliary Surgery Department of the University of Verona. Participants: Among 32 participants, 13 (40.6%) were medical students, and 19 (59.4%) were surgical residents. Results: Among 5 patients with intrahepatic lesions, 4 patients (80.0%) had at least 1 vascular variation. Participants identified number and location of lesions more correctly when evaluating the 3DVT (84.6% and 80.9%, respectively) compared with CT scans (61.1% and 64.8%, respectively) (both p ≤ 0.001). The identification of any vascular variations was more challenging using the CT scans, with only 50.6% of correct answers compared with 3DVT (72.2%) (p < 0.001). Compared with CT scans, 3DVT led to a 23.5%, 16.1%, and 21.6% increase in the correct definition of number and location of lesions, and vascular variations, respectively. 3DVT allowed for a decrease of 50.8 seconds (95% CI 23.6-78.0) in the time needed to answer the questions. All participants agreed on the usefulness of 3DVT in hepatobiliary surgery. Conclusions: The 3DVT facilitated a more precise preoperative understanding of liver anatomy, tumor location and characteristics.
MeSH term(s)	Humans ; Retrospective Studies ; Internship and Residency ; Students, Medical ; Comprehension ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/surgery ; Imaging, Three-Dimensional/methods
Language	English
Publishing date	2024-02-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2023.12.018
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Article ; Online: Portal vein stenting in recurrent or locally advanced peri-hilar cholangiocarcinoma.

De Bellis, Mario / Contro, Alberto / Bianco, Andrea / Gasparini, Clizia / Tripepi, Marzia / La Raja, Matilde / Alaimo, Laura / Conci, Simone / Campagnaro, Tommaso / Guglielmi, Alfredo / Mansueto, Giancarlo / Ruzzenente, Andrea

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

2024 Volume 50, Issue 3, Page(s) 107984

Abstract: Background: Recurrent or locally advanced peri-hilar cholangiocarcinoma (PHCC) usually involves the portal vein (PV) leading to significant stenosis. With disease progression, clinical symptoms such as ascites, bleeding, and hepatic insufficiency are ... ...

Abstract	Background: Recurrent or locally advanced peri-hilar cholangiocarcinoma (PHCC) usually involves the portal vein (PV) leading to significant stenosis. With disease progression, clinical symptoms such as ascites, bleeding, and hepatic insufficiency are usually observed. Little is know about the benefit of PV stenting in relieving the symptoms associated to portal hypertension and allowing anticancer therapies. The aim of this study is to review our experience in PV stenting for PHCC patients. Methods: From 2014 to 2022, data from PHCC patients underwent PV stenting at Verona University Hospital, Italy, were reviewed. The indications were: gastrointestinal bleeding from esophagus-gastric varices, ascites not responsive to medical therapy, severe thrombocytopenia, liver insufficiency (hepatic jaundice, coagulopathy, and/or hyperammoniemia), or asymptomatic high-grade PV stenosis. Cavernous transformation and intrahepatic thrombosis in both sides of the liver were considered contraindication. Systematic anticoagulation therapy was not administered. Results: Technical success was achieved in all 16 (100 %) patients. The improvement of clinical symptoms were observed in 12 (75 %) patients. Anticancer therapy was administrated in 11 (69 %) patients. 2 (13 %) complications were observed: 1 biliary injury and 1 recurrent cholangitis that required a percutaneous trans-hepatic biliary drainage placement. Stent occlusion for tumor progression occurred in 1 patient and a re-stenting procedure was successfully performed. No case of thrombotic stent occlusion was observed during follow up. The 1-year stent patency was 86 % and the median patency period was 8 months (IQR, 4-12). Conclusion: PV stenting is a feasible and safe palliative treatment that improves clinical condition, allow anticancer therapies, and provide a better quality of life.
MeSH term(s)	Humans ; Klatskin Tumor/pathology ; Portal Vein/surgery ; Treatment Outcome ; Constriction, Pathologic/etiology ; Ascites/etiology ; Quality of Life ; Cholangiocarcinoma/surgery ; Cholangiocarcinoma/pathology ; Bile Ducts, Intrahepatic/surgery ; Bile Ducts, Intrahepatic/pathology ; Bile Duct Neoplasms/surgery ; Bile Duct Neoplasms/complications ; Stents/adverse effects ; Retrospective Studies
Language	English
Publishing date	2024-01-30
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.2024.107984
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The Relevance of Radial Margin Status in Perihilar Cholangiocarcinoma: A State-of-the-Art Narrative Review.

De Bellis, Mario / Mastrosimini, Maria Gaia / Capelli, Paola / Alaimo, Laura / Conci, Simone / Campagnaro, Tommaso / Pecori, Sara / Scarpa, Aldo / Guglielmi, Alfredo / Ruzzenente, Andrea

Digestive surgery

2024 Volume 41, Issue 2, Page(s) 92–102

Abstract: Background: Prognosis of perihilar cholangiocarcinoma (PHCC) is poor, and curative-intent resection is the most effective treatment associated with long-term survival. Surgery is technically demanding since it involves a major hepatectomy with en bloc ... ...

Abstract	Background: Prognosis of perihilar cholangiocarcinoma (PHCC) is poor, and curative-intent resection is the most effective treatment associated with long-term survival. Surgery is technically demanding since it involves a major hepatectomy with en bloc resection of the caudate lobe and extrahepatic bile duct. Furthermore, to achieve negative margins, it may be necessary to perform concomitant vascular resection or pancreatoduodenectomy. Despite this aggressive approach, recurrence is often observed, considering 5-year recurrence-free survival below 15% and 5-year overall survival that barely exceeds 40%. Summary: The literature reports that survival rates are better in patients with negative margins, and surprisingly, R0 resections range between 19% and 95%. This variability is probably due to different surgical strategies and the pathologist's expertise with specimens. In fact, a proper pathological examination of residual disease should take into consideration both the ductal and the radial margin (RM) status. Currently, detailed pathological reports are lacking, and there is a likelihood of misinterpreting residual disease status due to the missing of RM description and the utilization of various definitions for surgical margins. Key messages: The aim of PHCC surgery is to achieve negative margins including RM. More clarity in reporting on RM is needed to define true radical resection and consistent design of oncological studies for adjuvant treatments.
MeSH term(s)	Humans ; Klatskin Tumor/surgery ; Klatskin Tumor/pathology ; Margins of Excision ; Survival Analysis ; Retrospective Studies ; Hepatectomy ; Bile Duct Neoplasms/pathology ; Cholangiocarcinoma
Language	English
Publishing date	2024-03-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000535995
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Article ; Online: Dose-escalation strategy in refractory metastatic colorectal cancer: A change in terms of cost-effectiveness.

Giuliani, Jacopo / Fiorica, Francesco / Ponturo, Giovanni / Azzurro, Maurizio / Ruzzenente, Andrea / Bonetti, Andrea

Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners

2021 Volume 27, Issue 4, Page(s) 974–977

Abstract: The analysis was conducted to assess the pharmacological costs of regorafenib and trifluridine/tipiracil in the treatment of refractory metastatic colorectal cancer (mCRC). Pivotal phase III randomized controlled trials (RCTs) of regorafenib and ... ...

Abstract	The analysis was conducted to assess the pharmacological costs of regorafenib and trifluridine/tipiracil in the treatment of refractory metastatic colorectal cancer (mCRC). Pivotal phase III randomized controlled trials (RCTs) of regorafenib and trifluridine/tipiracil in the treatment of refractory mCRC were considered. We have also considered the ReDOS trial, in order to verify if the dose-escalation strategy (practice changing for regorafenib) could influences the results. Differences in OS (expressed in months) between the different arms were calculated and compared with the pharmacological costs (at the Pharmacy of our Hospital and expressed in euros (€)) needed to get one month of OS. Trifluridine/tipiracil resulted the less expensive, with 1167.50 €per month OS-gained. The ReDOS trial further reduce costs with 510.41 €per month OS-gained in favour of regorafenib with the escalation-dose strategy. Both regorafenib and trifluridine/tipiracil can be considered economically sustainable treatments for refractory mCRC, apparently with a lower cost of trifluridine/tipiracil. The adoption of a dose-escalation strategy (ReDOS trial) could reverse the situation making regorafenib more cost-effective than trifluridine/tipiracil.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/economics ; Colorectal Neoplasms/drug therapy ; Colorectal Neoplasms/economics ; Cost-Benefit Analysis/methods ; Dose-Response Relationship, Drug ; Drug Combinations ; Drug Costs/trends ; Humans ; Phenylurea Compounds/administration & dosage ; Phenylurea Compounds/economics ; Pyridines/administration & dosage ; Pyridines/economics ; Pyrrolidines/administration & dosage ; Pyrrolidines/economics ; Thymine/administration & dosage ; Thymine/economics ; Trifluridine/administration & dosage ; Trifluridine/economics
Chemical Substances	Drug Combinations ; Phenylurea Compounds ; Pyridines ; Pyrrolidines ; trifluridine tipiracil drug combination ; regorafenib (24T2A1DOYB) ; Thymine (QR26YLT7LT) ; Trifluridine (RMW9V5RW38)
Language	English
Publishing date	2021-02-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1330764-2
ISSN	1477-092X ; 1078-1552
ISSN (online)	1477-092X
ISSN	1078-1552
DOI	10.1177/1078155221992546
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Article: Surgical treatment of ductal biliary recurrence of poorly cohesive gastric cancer mimicking primary biliary tract cancer: a case report.

Poletto, Edoardo / Ruzzenente, Andrea / Turri, Giulia / Conci, Simone / Ammendola, Serena / Luchini, Claudio / Scarpa, Aldo / Guglielmi, Alfredo

Journal of surgical case reports

2022 Volume 2022, Issue 4, Page(s) rjac132

Abstract: Ductal biliary recurrence of cancers arising in other anatomical districts is a rare event, usually observed in the setting of disseminated disease; hence surgery is rarely a viable option. We present the case of a 56-year-old male who underwent subtotal ...

Abstract	Ductal biliary recurrence of cancers arising in other anatomical districts is a rare event, usually observed in the setting of disseminated disease; hence surgery is rarely a viable option. We present the case of a 56-year-old male who underwent subtotal gastric resection 7 years earlier for a poorly cohesive gastric cancer, presenting with obstructive jaundice. Magnetic resonance imaging and computed tomography scan suggested primary malignant obstruction of the main bile duct. Percutaneous transhepatic biliary drainage was performed to palliate jaundice and obtain biopsies; pathological examination suggested a ductal biliary recurrence of gastric carcinoma. Pancreaticoduodenectomy and bile duct resection were performed. Histology, immunohistochemistry and molecular profiling confirmed that the stenosis represented a gastric cancer metastasis. This is the first case of an isolated ductal biliary recurrence of gastric cancer amenable to surgical resection. This clinical case suggests that biliary obstructions in patients with previous oncological history require biliary biopsies to exclude a recurrent disease.
Language	English
Publishing date	2022-04-11
Publishing country	England
Document type	Case Reports
ZDB-ID	2580919-2
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjac132
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Article ; Online: A machine learning analysis of difficulty scoring systems for laparoscopic liver surgery.

Ruzzenente, Andrea / Bagante, Fabio / Poletto, Edoardo / Campagnaro, Tommaso / Conci, Simone / De Bellis, Mario / Pedrazzani, Corrado / Guglielmi, Alfredo

Surgical endoscopy

2022 Volume 36, Issue 12, Page(s) 8869–8880

Abstract: Introduction: In the last decade, several difficulty scoring systems (DSS) have been proposed to predict technical difficulty in laparoscopic liver resections (LLR). The present study aimed to investigate the ability of four DSS for LLR to predict ... ...

Abstract	Introduction: In the last decade, several difficulty scoring systems (DSS) have been proposed to predict technical difficulty in laparoscopic liver resections (LLR). The present study aimed to investigate the ability of four DSS for LLR to predict operative, short-term, and textbook outcomes. Methods: Patients who underwent LLR at a single tertiary referral center from January 2014 to June 2020 were included in the present study. Four DSS for LLR (Halls, Hasegawa, Kawaguchi, and Iwate) were investigated to test their ability to predict operative and postoperative complications. Machine learning algorithms were used to identify the most important DSS associated with operative and short-term outcomes. Results: A total of 346 patients were included in the analysis, 28 (8.1%) patients were converted to open surgery. A total of 13 patients (3.7%) had severe (Clavien-Dindo ≥ 3) complications; the incidence of prolonged length of stay (> 5 days) was 39.3% (n = 136). No patients died within 90 days after the surgery. According to Halls, Hasegawa, Kawaguchi, and Iwate scores, 65 (18.8%), 59 (17.1%), 57 (16.5%), and 112 (32.4%) patients underwent high difficulty LLR, respectively. In accordance with a random forest algorithm, the Kawaguchi DSS predicted prolonged length of stay, high blood loss, and conversions and was the best performing DSS in predicting postoperative outcomes. Iwate DSS was the most important variable associated with operative time, while Halls score was the most important DSS predicting textbook outcomes. No one of the DSS investigated was associated with the occurrence of complication. Conclusions: According to our results DDS are significantly related to surgical complexity and short-term outcomes, Kawaguchi and Iwate DSS showed the best performance in predicting operative outcomes, while Halls score was the most important variable in predicting textbook outcome. Interestingly, none of the DSS showed any correlation with or importance in predicting overall and severe postoperative complications.
MeSH term(s)	Humans ; Liver Neoplasms/surgery ; Length of Stay ; Retrospective Studies ; Hepatectomy/methods ; Laparoscopy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Machine Learning
Language	English
Publishing date	2022-05-23
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-022-09322-7
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