Publications by authors named "Aldrighetti L"
Background: Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.
View Article and Find Full Text PDFBackground: We sought to define textbook outcome in liver surgery (TOLS) for intrahepatic cholangiocarcinoma (ICC) by considering the implications of perioperative outcomes on overall survival (OS).
Methods: Using a multi-institutional database, TOLS for ICC was defined by employing novel machine learning (ML) models to identify perioperative factors most strongly predictive of OS ≥ 12 months. Subsequently, clinicopathologic factors associated with achieving TOLS were investigated.
Objective: We sought to develop a machine learning (ML) preoperative model to predict bile leak following hepatectomy for primary and secondary liver cancer.
Methods: An eXtreme Gradient Boosting (XGBoost) model was developed to predict post-hepatectomy bile leak using data from the ACS-NSQIP database. The model was externally validated using data from hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) multi-institutional databases.
Background: We sought to define whether and how hepatic ischemia/reperfusion (I/R) as manifested by perioperative aspartate aminotransferase (AST) and alanine aminotransaminase (ALT) levels impact long-term outcomes after curative-intent resection of hepatocellular carcinoma (HCC).
Patients And Methods: Intrasplenic injection of HCC cells was used to establish a murine model of HCC recurrence with versus without I/R injury. Patients who underwent curative resection for HCC were identified from a multi-institutional derivative cohort (DC) and separate external validation (VC) cohort.
Purpose: Personalized treatment schemes are being systematically applied to ensure best treatment outcome in oncologic patients. This is true also for personalized dosimetry in transarterial radioembolization (TARE) in hepatocellular carcinoma (HCC) patients. Precise and detailed volumetric and functional data derived from radiological and nuclear imaging methods are essential for personalized dosimetry.
View Article and Find Full Text PDFA European expert consensus surgical technique description for robotic hepatectomy.
Hepatobiliary Surg Nutr
December 2024
The robotic platform enables surgeons to operate with a similar level of freedom and control as in open surgery, while still providing the patient with the benefits of a minimally invasive approach. More centres continue to adopt robotic liver surgery however standardized training materials and consensus on the surgical technique are currently lacking. The availability of a standardized surgical protocol could benefit the further dissemination of the robotic approach while promoting safe and effective operating techniques.
View Article and Find Full Text PDFIntroduction: The TOPAZ-1 phase III trial showed a survival benefit with durvalumab plus gemcitabine and cisplatin in patients with advanced biliary tract cancer (BTC). To understand this combination's real-world efficacy and tolerability, we conducted a retrospective analysis of its first-line treatment outcomes.
Methods: We included patients with unresectable, locally advanced, or metastatic BTC treated with cisplatin, gemcitabine, plus durvalumab.
Background: The effect of "time to surgery (TTS)" on outcomes for curative-intent hepatectomy of hepatocellular carcinoma (HCC) remains debated. The interaction between tumor burden score (TBS) and TTS remains unclear. We sought to evaluate the effects of TBS and TTS on long-term HCC outcomes.
View Article and Find Full Text PDFBackground: The prognostic role of the fibrosis-4 (FIB-4) index relative to intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study sought to characterize the impact of the FIB-4 index and tumor burden score (TBS) on recurrence and overall survival (OS).
Methods: ICC patients undergoing hepatectomy (2000-2020) were identified using a multi-institutional database.
Article Synopsis
- - The study focused on evaluating the learning curves of two surgeons with different laparoscopic experiences performing robotic liver resections at San Raffaele Hospital, using cumulative sum (CUSUM) analysis on surgeries performed since February 2021.
- - Results indicated that both surgeons improved their operative times after performing a set number of cases, with the Pioneer Surgeon and New Generation Surgeon needing 15 and 10 low- to intermediate-complexity cases respectively, and 10 and 18 high-complexity cases.
- - The findings highlight that team collaboration significantly impacts the learning process, revealing that after 12 cases, a "team learning curve" was evident, showing the effectiveness of working together in surgical settings.
Intermediate hepatocellular carcinoma: new horizons and prospects for our patients.
Expert Rev Gastroenterol Hepatol
October 2024
Introduction: In recent years, significant progress has been made in treatment strategies for intermediate-stage hepatocellular carcinoma (HCC), which is a highly heterogeneous patient population requiring tailored therapies based on tumor characteristics.
Methods: We conducted a comprehensive review of treatment approaches for intermediate-stage HCC, highlighting the evolution of treatment options over time. While chemoembolization remains the standard therapy for many patients, it has advanced to include combinations with systemic therapies, known as combination therapy, which is becoming the new standard of care for this group.
Article Synopsis
- A study was conducted to develop a machine learning (ML) model that predicts early extra-hepatic recurrence (EEHR) in patients who had colorectal liver metastasis (CRLM) surgery from 2000 to 2020.
- The ML model, using eXtreme Gradient Boosting (XGBoost), successfully identified key factors influencing EEHR, achieving a c-index of 0.77, indicating good predictive power.
- An online risk calculator was created to assist clinicians in evaluating patients' risks of EEHR post-surgery, potentially aiding in better treatment decisions for CRLM patients.*
Background: Failure to rescue (FTR) is defined as the inability to prevent death after the development of a complication. FTR is a parameter in evaluating multidisciplinary postoperative complication management. The aim of this study was to evaluate FTR rates after major liver resection for perihilar cholangiocarcinoma (pCCA) and analyze factors associated with FTR.
View Article and Find Full Text PDFArticle Synopsis
- - Robotic surgery is gaining popularity in the surgical field, especially for liver resections, but its effectiveness near major blood vessels needs further investigation.
- - A study of 1030 patients categorized them into two groups (lesions in contact with major vessels vs. those free from) to compare surgical outcomes before and after adjusting for other variables.
- - Findings indicated that while the Pringle Manoeuvre was more frequently used in surgeries near major vessels, overall operative time, complication rates, and surgery success were similar between both groups, suggesting robotic surgery is safe even for challenging cases.
Article Synopsis
- The text talks about a medical study comparing two procedures for patients who have both bile duct and stomach blockages at the same time.
- In the study, 20 patients were treated, and it showed that one procedure (EUS-CDS) had more problems and shorter time without issues compared to the other procedure (EUS-HGS).
- The results suggest that EUS-CDS may not be as good as EUS-HGS for these patients because it can lead to more complications and less chance of staying healthy longer without issues.
Article Synopsis
- The study investigates how the length of time taken during liver surgeries affects the likelihood of postoperative complications in patients undergoing different types of liver resections.
- A total of 5,424 patients were analyzed from multiple centers between 2000 and 2022, focusing on procedures like right hemihepatectomy, technically major resection, and left lateral sectionectomy.
- Results show that patients in the longest operative time group had a significantly higher risk of complications, particularly in various surgical approaches like open, laparoscopic, and robotic surgeries.
Objective: We sought to identify patients at risk of "futile" surgery for intrahepatic cholangiocarcinoma using an artificial intelligence (AI)-based model based on preoperative variables.
Methods: Intrahepatic cholangiocarcinoma patients who underwent resection between 1990 and 2020 were identified from a multi-institutional database. Futility was defined either as mortality or recurrence within 12 months of surgery.
Article Synopsis
- This study compares outcomes of open liver resection (OLR), laparoscopic liver resection (LLR), and percutaneous thermal ablation (PTA) in elderly patients (≥70 years) with single hepatocellular carcinoma (HCC) ≤30 mm.
- A total of 239 patients were analyzed, revealing that PTA resulted in shorter hospital stays and less morbidity than OLR or LLR, but lower 5-year overall and disease-free survival rates.
- The findings suggest that while PTA is advantageous for specific HCC locations, surgical options (OLR and LLR) offer better long-term survival outcomes for elderly patients.
Background And Objectives: Among patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC.
Methods: Patients undergoing curative-intent liver surgery for ICC (1990-2020) were identified from a multi-institutional database.
Background: Cholangiocarcinoma (CCA) is a very difficult-to-treat cancer. Chemotherapies are little effective and response to immune checkpoint inhibitors is limited. Therefore, new therapeutic strategies need to be identified.
View Article and Find Full Text PDFArticle Synopsis
- A study was conducted to compare robotic minor liver resections (RMLR) with laparoscopic minor liver resections (LMLR) in patients undergoing surgery on the anterolateral liver segments.
- The analysis included over 10,000 patients and employed propensity score matching to balance the groups for accuracy in comparisons.
- Results indicated RMLR had benefits like less blood loss, lower major morbidity, and shorter hospital stays than LMLR, although the difference in 30-day readmission rates suggested RMLR may have some drawbacks.
Article Synopsis
- * Patients taking metformin had significantly shorter OS (HR 1.9) and PFS (HR 1.6) compared to those not using the medication, while no such differences were found in the Lenvatinib cohort.
- * The findings suggest a negative impact of metformin usage on patient outcomes specifically in the context of Atezolizumab plus Bevacizumab treatment for HCC, highlighting the need for
Purpose: We sought to develop an artificial intelligence (AI)-based model to predict early recurrence (ER) after curative-intent resection of neuroendocrine liver metastases (NELMs).
Methods: Patients with NELM who underwent resection were identified from a multi-institutional database. ER was defined as recurrence within 12 months of surgery.
Background: It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients. However, what type of procedures can benefit most from a laparoscopic approach has been investigated poorly thus far. The aim of this study is thus to define the extent of advantages of laparoscopic over open liver surgery for lesions in the anterolateral (AL) and posterosuperior (PS) segments.
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