Publications by authors named "Ratti F"
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.
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.
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- - 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.
Article 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 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
- 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: 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.
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- 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: Laparoscopic liver surgery is increasingly used for more challenging procedures. The aim of this study was to assess the feasibility and oncological safety of laparoscopic right hepatectomy for colorectal liver metastases after portal vein embolization.
Methods: This was an international retrospective multicentre study of patients with colorectal liver metastases who underwent open or laparoscopic right and extended right hepatectomy after portal vein embolization between 2004 and 2020.
Background: We sought to assess the impact of various perioperative factors on the risk of severe complications and post-surgical mortality using a novel maching learning technique.
Methods: Data on patients undergoing resection for HCC were obtained from an international, multi-institutional database between 2000 and 2020. Gradient boosted trees were utilized to construct predictive models.
Article Synopsis
- - This national survey aimed to assess the use of liver hypertrophy techniques in Italy, focusing on trends and differences among various medical centers.
- - In December 2022, 46 centers completed a detailed online questionnaire, revealing that hypertrophy techniques were used in 6.2% of liver resections, with PVE and ALPPS being the most common techniques employed.
- - The findings indicated that while these techniques play a crucial role in increasing resectability, there is substantial inconsistency in how centers define the need for them and the protocols used for patient allocation.
Background & Aims: Metabolic syndrome (MS) is a growing epidemic and a risk factor for the development of hepatocellular carcinoma (HCC). This study investigated the long-term outcomes of liver resection (LR) for HCC in patients with MS. Rates, timing, patterns, and treatment of recurrences were investigated, and cancer-specific survivals were assessed.
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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
- Minimally invasive liver surgery has become safer and more feasible over time, prompting this study to explore its effectiveness in elderly patients.
- The research analyzed data from 1070 robotic liver resections across nine European hospitals, focusing on 131 major liver resections and comparing outcomes between patients under and over 65 years old.
- Results show that while elderly patients had some increased complications, overall short-term outcomes for robotic major liver resection in this group were still satisfactory.
Article Synopsis
- The study investigates the risk factors and outcomes related to open conversion during minimally invasive liver resections (MILR), especially in minor hepatectomies, highlighting its association with inferior results.
- Analysis was conducted on data from over 10,500 patients who underwent laparoscopic or robotic liver resections from 2004 to 2020, identifying key independent predictors for open conversion.
- Results show that patients who required open conversion experienced longer recovery times, increased blood loss, higher complications, and elevated 90-day mortality rates compared to those who had successful minimally invasive surgeries.
Introduction: Incidental Gallbladder Cancer (IGBC) following cholecystectomy constitutes a significant portion of gallbladder cancer diagnoses. Re-exploration is advocated to optimize disease clearance and enhance survival rates. The consistent association of residual disease (RD) with inferior oncologic outcomes prompts a critical examination of re-resection's role as a modifying factor in the natural history of IGBC.
View Article and Find Full Text PDFObjective: We sought to develop Artificial Intelligence (AI) based models to predict non-transplantable recurrence (NTR) of hepatocellular carcinoma (HCC) following hepatic resection (HR).
Methods: HCC patients who underwent HR between 2000-2020 were identified from a multi-institutional database. NTR was defined as recurrence beyond Milan Criteria.
Purpose: Radiomics may aid in predicting prognosis in patients with colorectal liver metastases (CLM). Consistent data is available on CT, yet limited data is available on MRI. This study assesses the capability of MRI-derived radiomic features (RFs) to predict local tumor progression-free survival (LTPFS) in patients with CLMs treated with microwave ablation (MWA).
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- The study looked at how problems after surgery affect patients with liver cancer (HCC) based on a measure called the alpha-fetoprotein-tumor burden score (ATS).
- They found that patients with serious complications after surgery had a lower chance of being cancer-free after 2 years compared to those with fewer complications.
- Reducing these complications is important to help patients with certain types of liver cancer have better outcomes.
Technology have helped surgeons to increase MILS feasibility, so that currently liver surgery evolution is strongly based on technological advances and the same trend is expected even further soon. Aim of the present technical report is to provide insights regarding the possible interplay between 3D reconstructions based on augmented reality and intraoperative navigation by indocyanine green fluorescence. Augmented reality methods based on reconstructions created through artificial intelligence interact synergistically.
View Article and Find Full Text PDFBackground: The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed cell death ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer (BTC).
Objective: The present study investigated for the first time the impact on survival of adding durvalumab to cisplatin/gemcitabine compared with cisplatin/gemcitabine in a real-world setting.
Patients And Methods: The analyzed population included patients with unresectable, locally advanced, or metastatic BTC treated with durvalumab in combination with cisplatin/gemcitabine or with cisplatin/gemcitabine alone.