Publications by authors named "Francesco Ardito"

Introduction: No instruments are available to predict preoperatively the risk of posthepatectomy liver failure (PHLF) in HCC patients. The aim was to predict the occurrence of PHLF preoperatively by radiomics and clinical data through machine-learning algorithms.

Materials And Methods: Clinical data and 3-phases CT scans were retrospectively collected among 13 Italian centres between 2008 and 2022.

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  • Cancer-associated fibroblasts (CAFs) contribute to the aggressive nature and treatment resistance of intrahepatic Cholangiocarcinoma (iCCA), prompting research into the effects of the Notch1 inhibitor Crenigacestat on this interaction.
  • Using both 2D and 3D in vitro models, along with a xenograft setup, the study found that CAFs enhance iCCA cell migration and growth, but Crenigacestat effectively inhibits this cross-talk and reduces tumor growth and fibrosis.
  • Overall, targeting the hCAF/iCCA interaction with Crenigacestat presents a promising approach to slowing cancer progression and altering critical cell cycle pathways.
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  • The study aims to develop a Preoperative Recurrence Score (PRS) to predict the risk of early recurrence in patients with perihilar cholangiocarcinoma (PCC) after surgery based on their preoperative imaging.
  • Researchers collected data from 215 patients and found significant tumor characteristics (like size and vascular involvement) correlated with recurrence-free survival, successfully validating the PRS model across multiple patient cohorts.
  • High PRS scores indicated a higher likelihood of recurrence, suggesting that surgery might not be beneficial for those patients, highlighting the need for careful consideration before proceeding to surgery.
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Background: In patients undergoing liver resection, postoperative complications remain high. We hypothesized that the incidence of postoperative complications after liver resection would be predicted well by liver resection complexity and nutritional status.

Methods: We retrospectively assessed patients undergoing liver resection at The University of Tokyo Hospital from 2011 to 2021.

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Purpose: Single large hepatocellular carcinoma >5cm (SLHCC) traditionally requires a major liver resection. Minor resections are often performed with the goal to reduce morbidity and mortality. Aim of the study was to establish if a major resection should be considered the best treatment for SLHCC or a more limited resection should be preferred.

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Background: Postoperative serum ALT levels are one of the most frequently used marker to detect liver tissue damage following liver resection. The aim of this study was to evaluate if minimally invasive liver surgery (MILS) may result in less hepatic injury than open hepatectomy by assessing the differences of postoperative ALT levels.

Methods: Patients who underwent MILS between 2009 and 2019 at our unit were included and compared with open liver resections.

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Introduction: Although the management of gynecological cancers recurrences may be challenging, due to the heterogeneity of recurrent disease, the aim of this work is to present a descriptive analysis of gynecological malignancies recurrences in our institution treated by robotic approach.

Materials And Methods: We performed a retrospective review and analysis of data of patients who underwent robotic surgery for recurrent gynecological malignancies at Catholic University of the Sacred Hearth, Rome, from January 2013 to January 2024.

Results: A total of 54 patients underwent successful robotic cytoreductive surgery.

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In patients with hepatocellular carcinoma (HCC), liver resection is potentially curative. Nevertheless, post-operative recurrence is common, occurring in up to 70% of patients. Factors traditionally recognized to predict recurrence and survival after liver resection for HCC include pathologic factors (i.

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Pancreatic ductal adenocarcinoma (PDAC) is a prognostically unfavorable malignancy that presents with distant metastases at the time of diagnosis in half of patients. Even if patients with metastatic PDAC have not been traditionally considered candidates for surgery, an increasing number of researchers have been investigating the efficacy of surgical treatment for patients with liver-only oligometastases from PDAC, showing promising results in extremely selected patients, mainly with metachronous metastases after perioperative chemotherapy. Nevertheless, a standardized definition of oligometastatic disease should be adopted and additional investigations focusing on the role of perioperative chemotherapy and tumor biology are warranted to reliably assess the role of resection for PDAC metastatic to the liver.

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Background: For many tumors, radiomics provided a relevant prognostic contribution. This study tested whether the computed tomography (CT)-based textural features of intrahepatic cholangiocarcinoma (ICC) and peritumoral tissue improve the prediction of survival after resection compared with the standard clinical indices.

Methods: All consecutive patients affected by ICC who underwent hepatectomy at six high-volume centers (2009-2019) were considered for the study.

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  • The 2022 Barcelona Clinic Liver Cancer algorithm advises against liver resection for patients with multiple small tumors (2 or 3 nodules, each ≤3 cm) in hepatocellular carcinoma.
  • This study retrospectively analyzed data from over 12,000 patients to compare survival outcomes among those undergoing liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE).
  • Results showed that LR had the highest survival rates at 1, 3, and 5 years (89.11%, 70.98%, 56.44% respectively) compared to PRFA and TACE, indicating that LR may offer better long-term outcomes in treating early multin
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Background: Economic impact of robotic liver surgery (RLS) is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology. Therefore, the aim of this study is to perform a time-driven activity-based costing (TD-ABC) comparing the costs of RLS, laparoscopic liver surgery (LLS) and open liver surgery (OLS) in the context of complex liver resections and to compare short term perioperative outcomes.

Methods: The institutional databases of two Italian high volume hepatobiliary centres were retrospectively reviewed from February 2021 to April 2022.

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  • The study analyzes how effective liver resection (LR) and liver transplantation (LT) are in treating hepatocellular carcinoma (HCC) by comparing multiple previous studies.
  • Findings show that LT offers better 5-year overall survival and disease-free survival rates compared to LR for HCC patients.
  • It concludes that while LT is generally superior, in cases of recurrence, LR can still be a viable option given the shortage of available organs for transplantation.
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Introduction: Microvascular invasion (MVI) is the main risk factor for overall mortality and recurrence after surgery for hepatocellular carcinoma (HCC).The aim was to train machine-learning models to predict MVI on preoperative CT scan.

Methods: 3-phases CT scans were retrospectively collected among 4 Italian centers.

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Intraoperative blood loss has an unfavorable impact on the outcome of patients undergoing liver surgery. Today, the use of devices capable of minimizing this risk with high technical performance becomes mandatory. Into this scenario fits the CUSA Clarity Ultrasonic Surgical Aspirator System.

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  • The study examines the effects of increasing laparoscopic liver surgery on patients with solid benign liver lesions (BLL) across multiple medical centers globally.
  • It analyzes patient outcomes over three time periods (2008-2019), noting a stable percentage of surgeries for benign conditions but an increase in laparoscopic procedures and a decrease in hospital stay length.
  • Despite no significant change in overall surgical success rates (TOLS), there was a notable improvement in a more stringent success measure (TOLS+) over time, indicating better perioperative outcomes for these patients.
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  • - The study developed the LC-CVS OPSA, an assessment tool that focuses on safety in laparoscopic cholecystectomy surgery, to improve surgical training and align with the American Board of Surgery's initiatives.
  • - Expert surgeons rated ten surgical videos on a "safe" vs. "unsafe" scale, identifying 238 unsafe instances across various tasks and noting significant variations in ratings among the surgeons.
  • - Analysis of feedback revealed key reasons for unsafe ratings, such as failure to achieve the critical view of safety, suboptimal techniques, and potential future complications, leading to modifications in assessment instructions to enhance reliability.
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  • A new 6-item objective assessment tool for laparoscopic cholecystectomy (LC-CVS OPSA) was created to evaluate trainees’ skills, focusing on critical safe practices during surgery.
  • The tool evaluates various aspects such as fundus retraction and visualization of important anatomical structures, with scoring categories ranging from "poor-unsafe" to "excellent-safe."
  • Testing with expert surgeons showed high inter-rater reliability for assessing performance, indicating the tool's effectiveness in evaluating surgical trainees and its potential for integration into training programs alongside AI developments.
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Standard imaging cannot assess the pathology details of intrahepatic cholangiocarcinoma (ICC). We investigated whether CT-based radiomics may improve the prediction of tumor characteristics. All consecutive patients undergoing liver resection for ICC (2009-2019) in six high-volume centers were evaluated for inclusion.

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Impact of timing of repair on outcomes of patients repaired with Hepp-Couinaud hepatico-jejunostomy (HC-HJ) after bile duct injury (BDI) during cholecystectomy remains debated. This is an observational retrospective study at a tertiary referral hepato-biliary center. HC-HJ was always performed in patients without sepsis or bile leak and with dilated bile ducts.

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  • A study aimed to compare survival rates after second-line transplant (SLT) versus repeated hepatectomy and thermoablation (CUR) for recurrent hepatocellular carcinoma (rHCC) was conducted using data from the Italian register HE.RC.O.LE.S. between 2008 and 2021.
  • Out of 743 patients, those who underwent CUR had a median survival after recurrence of 43 months, while SLT patients showed a longer survival benefit of 9.4 months, although exact numbers for SLT were not reached.
  • The results indicated that SLT is underutilized compared to CUR, especially in cases where patients do not meet the Milan Criteria; however, SLT did not demonstrate a survival
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Background: Widespread use of minimally invasive liver surgery (MILS) contributed to the reduction of surgical risk of liver resection for hepatocellular carcinoma (HCC). Aim of this study was to analyze outcomes of MILS for single ≤3 cm HCC.

Methods: Patients who underwent MILS for single ≤3 cm HCC (November 2014 - December 2019) were identified from the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) Registry.

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Background: Bile duct injury (BDI) following cholecystectomy is associated with malpractice litigation. Aim of this study was to evaluate risk factors for litigation in patients with BDI referred in a tertiary care center.

Methods: Patients treated for BDI between 1994 and 2016.

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