Publications by authors named "Giuseppe Zimmitti"
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.
Article 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.
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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- The study aimed to create global benchmark outcome indicators for laparoscopic right posterior sectionectomies (L-RPS/H67) to improve surgical standards.
- It analyzed data from 854 patients across 57 centers globally, establishing key performance benchmarks for low-risk cases based on specific outcome indicators.
- The findings set standard benchmarks for metrics like operation time and complication rates, serving as a reference for surgical auditing and improvement.
Article Synopsis
- 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
Article Synopsis
- Minimally invasive liver surgery has become more common over the last 30 years, especially for treating colorectal liver metastases, but the effects of neoadjuvant chemotherapy on surgical outcomes are not well understood.
- A study analyzed a large database of nearly 5,000 patients who underwent minimally invasive liver surgeries to compare outcomes between those who received neoadjuvant chemotherapy and those who did not.
- The results showed that neoadjuvant chemotherapy did not significantly affect the short-term surgical outcomes in patients undergoing these liver procedures.
Article Synopsis
- A study was conducted to compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) across various healthcare settings from 2009 to 2021.
- The results showed that RLS had better outcomes in terms of "textbook outcomes," lower blood loss, fewer complications, and shorter operative times compared to LLS after matching patient groups for bias.
- Despite the higher costs generally associated with robotic surgery, this study suggests that RLS may offer specific clinical advantages over LLS in minimally invasive liver procedures.
Background: The spleen plays a significant role in the clearance of circulating microorganisms. Sequelae of splenectomy, especially immunodeficiency, can have a deleterious effect on a patient's health and even lead to death. Hence, splenectomy should be avoided and spleen preservation during elective surgery has become a treatment goal.
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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.
Article Synopsis
- 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
Background: Laparoscopic right hemihepatectomy (L-RHH) is still considered a technically complex procedure, which should only be performed by experienced surgeons in specialized centers. Future liver remnant modulation (FLRM) strategies, including portal vein embolization (PVE), and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), might increase the surgical difficulty of L-RHH, due to the distortion of hepatic anatomy, periportal inflammation, and fibrosis. Therefore, this study aims to evaluate the safety and feasibility of L-RHH after FLRM, when compared with ex novo L-RHH.
View Article and Find Full Text PDFBackground: The use of a simultaneous resection (SIMR) in patients with synchronous colorectal liver metastases (sCRLM) has increased over the past decades. However, it remains unclear when a SIMR is beneficial and when it should be avoided. The aim of this retrospective cohort study was therefore to compare the outcomes of a SIMR for sCRLM in different settings, and to assess which factors are independently associated with unfavorable outcomes.
View Article and Find Full Text PDFBackground: The European registry for minimally invasive pancreatic surgery (E-MIPS) collects data on laparoscopic and robotic MIPS in low- and high-volume centers across Europe.
Methods: Analysis of the first year (2019) of the E-MIPS registry, including minimally invasive distal pancreatectomy (MIDP) and minimally invasive pancreatoduodenectomy (MIPD). Primary outcome was 90-day mortality.
Background: Consensus on the best surgical strategy for the management of synchronous colorectal liver metastases (sCRLM) has not been achieved. This study aimed to assess the attitudes of surgeons involved in the treatment of sCRLM.
Methods: Surveys designed for colorectal, hepato-pancreato-biliary (HPB), and general surgeons were disseminated through representative societies.
Article Synopsis
- Metabolic syndrome (MS) increases the risk of postoperative complications after liver resection for hepatocellular carcinoma (HCC), making careful patient selection essential.
- A study analyzed 1,087 patients from multiple centers to identify key factors associated with major morbidity, revealing that obesity, diabetes, ischemic heart disease, and other factors significantly increase risks.
- The resulting predictive model exhibited a 72.8% accuracy in assessing the likelihood of major complications, underscoring the importance of understanding individual patient characteristics for better surgical outcomes.
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.
Article Synopsis
- This study investigates the safety and effectiveness of minimally invasive liver surgery (MILS) in obese patients compared to non-obese patients, due to limited evidence on the topic.
- A total of 9,963 patients were analyzed from 20 hospitals across eight countries, revealing that obese patients faced more complications and longer surgeries than non-obese patients.
- The results indicated that MILS led to better outcomes than open liver surgery (OLS) for both groups, showing reduced blood loss, fewer complications, shorter hospital stays, and stable rates of severe morbidity and mortality over time as MILS use among obese patients increased.
Article Synopsis
- The study aimed to assess how a liver transplantation (LT) program impacts outcomes for patients with resectable hepatocellular carcinoma (HCC) undergoing surgery.
- It analyzed data from 3202 patients who had hepatic resection (HR) for HCC over a 14-year period, focusing on complications, survival rates, and the likelihood of receiving salvage liver transplantation (SLT).
- Findings revealed that centers with an LT program had lower rates of posthepatectomy liver failure and higher chances of SLT, but no significant difference in overall survival or disease-free survival rates compared to those without an LT program.
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.
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.
Objective: Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients.
Methods: Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009-2020).
Background: The anatomical structure around the pancreatic head is very complex and it is important to understand its precise anatomy and corresponding anatomical approach to safely perform minimally invasive pancreatoduodenectomy (MIPD). This consensus statement aimed to develop recommendations for elucidating the anatomy and surgical approaches to MIPD.
Methods: Studies identified via a comprehensive literature search were classified using the Scottish Intercollegiate Guidelines Network method.
Following pancreatoduodenectomy (PD), the modality of pancreato-enteric continuity restoration may impact on postoperative pancreatic fistula (POPF) risk. The aim of this study is to compare, among patients with soft pancreas and at moderate/high risk for POPF, the outcomes of PD with Pancreato-Gastrostomy (PG), versus Isolated Jejunal Loop Pancreato-Jejunostomy (IJL-PJ). 193 patients with a Callery Fistula Risk Score (C-FRS) ≥ 3 operated at 3 HPB Units, two performing PG and one IJL-PJ as their preferred anastomotic technique following PD (2009-2019) were included in this study (PG = 123, IJL-PJ = 70).
View Article and Find Full Text PDFBackground: Surgical views with high resolution and magnification have enabled us to recognize the precise anatomical structures that can be used as landmarks during minimally invasive distal pancreatectomy (MIDP). This study aimed to validate the usefulness of anatomy-based approaches for MIDP before and during the Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (February 24, 2021).
Methods: Twenty-five international MIDP experts developed clinical questions regarding surgical anatomy and approaches for MIDP.