Publications by authors named "Marcello di Martino"
Pre-operative evaluation of spontaneous portosystemic shunts as a predictor of post-hepatectomy liver failure in patients undergoing liver resection for hepatocellular carcinoma.
Eur J Surg Oncol
October 2024
Background: Post-hepatectomy liver failure (PHLF) can significantly compromise outcomes, especially in cirrhotic patients. The identification of accurate and non-invasive pre-operative predictors is of paramount importance to appropriately stratify patients according to their estimated risk and select the best treatment strategy.
Materials And Methods: Consecutive patients undergoing liver resection for HCC on cirrhosis between 1-2015 and 12-2020 at 10 international Institutions were enrolled and their pre-operative CT scans were evaluated for the presence of spontaneous portosystemic shunts (SPSS) to identify predictors of PHLF and develop a nomogram.
Background: Recent studies suggest that low-molecular-weight heparin (LMWH) may play a role in mitigating the severity of acute pancreatitis (AP). This systematic review and meta-analysis aims to synthesise existing evidence on the effectiveness and safety of LMWH in the treatment of moderately-severe and severe AP.
Methods: This systematic review and meta-analysis was conducted in accordance with the 2020 update of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.
Background: Indicators of surgical outcomes are designed to objectively evaluate surgical performance, enabling comparisons among surgeons and institutions. In recent years, there has been a surge in complex indicators of perioperative short-term and long-term outcomes. The aim of this narrative review is to provide an overview and a critical analysis of surgical outcomes indicators, with a special emphasis on hepato-pancreato-biliary (HPB) surgery.
View Article and Find Full Text PDFObjective: For patients with T1b gallbladder cancer or greater, an adequate lymphadenectomy should include at least 6 nodes. Studies comparing short- and long-term outcomes of the open approach with those of laparoscopy and robotic approaches are limited, with small sample sizes, and there are none comparing laparoscopic and robotic approaches. This study compared patients who underwent robotic, laparoscopic, and open resection of gallbladder cancer, evaluating short- and long-term outcomes.
View Article and Find Full Text PDFPurpose: Whether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume.
Methods: This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry "Piano Nazionale Esiti" (PNE) 2023 that included all liver procedures performed in 2022.
Background: There is lack of data on the association between socioeconomic factors, guidelines compliance and clinical outcomes among patients with acute biliary pancreatitis (ABP).
Methods: Post-hoc analysis of the international MANCTRA-1 registry evaluating the impact of regional disparities as indicated by the Human Development Index (HDI), and guideline compliance on ABP clinical outcomes. Multivariable logistic regression models were employed to identify prognostic factors associated with mortality and readmission.
A machine learning predictive model for recurrence of resected distal cholangiocarcinoma: Development and validation of predictive model using artificial intelligence.
Eur J Surg Oncol
July 2024
Introduction: Distal Cholangiocarcinoma (dCCA) represents a challenge in hepatobiliary oncology, that requires nuanced post-resection prognostic modeling. Conventional staging criteria may oversimplify dCCA complexities, prompting the exploration of novel prognostic factors and methodologies, including machine learning algorithms. This study aims to develop a machine learning predictive model for recurrence after resected dCCA.
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- The study surveyed general surgeons from April to May 2023 to understand their workload, academic involvement, and rest after on-call duty, receiving 1,046 responses with diverse representation, particularly from Europe and North America.
- Over 78% of respondents engaged in research activities, with European surgeons averaging more published studies yearly, while teaching participation was highest in North America and Africa.
- Results indicated significant disparities in on-call frequencies and post-shift days off, with only 35.1% of surgeons receiving a day off afterwards, influenced by factors like Human Development Index (HDI) and hospital capacity.
Article Synopsis
- The study aimed to identify risk factors linked to the failure of non-operative treatment in patients with certain types of diverticular abscesses, using a multicentre case-control approach.
- Among the 116 patients who experienced treatment failure (27.04%), significant predictors included the Hinchey classification IIb, smoking, and the presence of air bubbles within the abscess.
- The findings highlight the effectiveness of non-operative treatments but suggest that young smokers with IIb Hinchey diverticulitis need closer monitoring and that further research should focus on the role of image-guided drainage.
Background: A large proportion of patients with colorectal cancer (CRC) presents with synchronous colorectal liver metastases (sCRLM) at diagnosis. Surgical approaches for patients with sCRLM have evolved over the past decades. Simultaneous resection (SR) of CRC and sCRLM for selected patients has emerged as a safe and efficient alternative approach to traditional staged resections.
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- KRAS mutation negatively impacts survival outcomes for patients with colorectal liver metastases, with those having mutated KRAS showing significantly shorter overall and disease-free survival compared to those with wild-type KRAS.
- The study analyzed data from 593 patients to compare the effects of R0 (no cancer at margins) and R1 (cancer at margins) resections based on KRAS status, finding that R0 resections benefit wild-type patients but not those with KRAS mutations.
- In KRAS wild-type tumors, R0 resections were linked to longer survival, while in KRAS-mutated tumors, the resection margin did not influence outcomes, emphasizing the aggressive nature of KRAS-mutated cancers.
Percutaneous cholecystostomy (PC) is often preferred over early cholecystectomy (EC) for elderly patients presenting with acute cholecystitis (AC). However, there is a lack of solid data on this issue. Following the PRISMA guidelines, we searched the Medline and Web of Science databases for reports published before December 2022.
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- Combined hepatocholangiocarcinoma is a rare and aggressive type of cancer combining features of both hepatocellular carcinoma and intrahepatic cholangiocarcinoma, leading to a poor prognosis.
- A multicenter international study analyzed the surgery outcomes for patients with combined hepatocholangiocarcinoma and compared them with those having either hepatocellular carcinoma or intrahepatic cholangiocarcinoma from 2000 to 2021.
- The results showed significant differences in overall survival rates at 1, 3, and 5 years among the groups, with combined hepatocholangiocarcinoma having the lowest survival rates, while disease-free survival rates were similar across groups, suggesting that combined hepatochol
Article Synopsis
- There is ongoing debate about the effectiveness of surgery for non-colorectal non-neuroendocrine liver metastases (NCNNLM), despite an increase in liver resections for these cases.
- A preliminary international survey was conducted among surgeons to gather insights on current clinical practices and to assess the feasibility of an International Registry for NCNNLM, utilizing an online questionnaire that received responses from 141 surgeons across 27 countries.
- The survey revealed that a majority of participating surgeons work in general surgery units, with a high rate of multidisciplinary discussions for surgical indications, and noted that parenchymal-sparing resections are common, although significant post-operative complications were reported in some cases.
Factors affecting overall survival and disease-free survival after surgery for hepatocellular carcinoma: a nomogram-based prognostic model-a Western European multicenter study.
Updates Surg
January 2024
Few studies have assessed the clinical implications of the combination of different prognostic indicators for overall survival (OS) and disease-free survival (DFS) of resected hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic factors in HCC patients for OS and DFS outcomes and establish a nomogram-based prognostic model to predict the DFS of HCC. A multicenter, retrospective European study was conducted through the collection of data on 413 consecutive treated patients with a first diagnosis of HCC between January 2010 and December 2020.
View Article and Find Full Text PDFIntroduction: Endoscopic retrograde appendicitis therapy has been proposed as an alternative strategy for treating appendicitis, but debate exists on its role compared with conventional treatment.
Methods: This systematic review was performed on MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE. The last search was in April of 2023.
Importance: Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue.
Objective: To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP.
Design, Settings, And Participants: This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries.
Article Synopsis
- Surgical resection (SR) is a potential cure for hepatocellular carcinoma (HCC), but high recurrence rates pose a challenge, necessitating the development of better risk stratification tools for predicting recurrence.
- A new scoring system, called the Early Recurrence Score (ERS), was created from data of 2359 patients who underwent SR for HCC, evaluating factors like alpha-fetoprotein levels and tumor characteristics to forecast 2-year recurrence risk.
- The ERS effectively stratified patients into four risk categories with good accuracy and can help personalize surveillance and therapy plans post-surgery.
Objective: To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method.
Background: A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations.
Methods: The research questions were addressed in this bundle following the PICO criteria.
A core set of quality performance indicators for HPB procedures: a global consensus for hepatectomy, pancreatectomy, and complex biliary surgery.
HPB (Oxford)
August 2023
Article Synopsis
- A study was conducted to create a standardized set of quality performance indicators (QPI) for hepatopancreaticobiliary (HPB) surgical procedures worldwide.
- The research involved a thorough literature review and feedback from members of the International Hepatopancreaticobiliary Association (IHPBA) via a modified Delphi process.
- The finalized QPI consists of seven core indicators applicable to multiple HPB surgeries, along with additional specific indicators for procedures like pancreatectomy, hepatectomy, and cholecystectomy, which were approved by over 100 IHPBA members globally.*
Background: Use of antibiotics in selected cases of acute uncomplicated diverticulitis (AUD) has recently been questioned.
Objective: The aim of this study is to examine the safety and efficacy of treatment regimens without antibiotics compared with that of traditional treatments with antibiotics in selected patients with AUD.
Data Sources: PubMed, Medline, Embase, Web of Science, and the Cochrane Library.