Publications by authors named "Simone Famularo"

Background: R0 resection is the standard for mass-forming cholangiocarcinoma (MFCCC). R1vasc resection (tumor-vessel detachment) yielded results comparable to R0 and superior to parenchymal-tumor exposure (R1par) for hepatocellular carcinoma and colorectal liver metastases. This study aims to clarify R1vasc outcomes for MFCCC.

View Article and Find Full Text PDF

Introduction: The open abdomen (OA) technique is nowadays a worldwide strategy both for trauma and emergency general surgery. Despite the attempt at conducting prospective studies, a high level of evidence is far from established. The aim of this study was to investigate if we overused this strategy and if it improved the postoperative course of our patients.

View Article and Find Full Text PDF

Background: Recent papers report significant survival gain after liver resection in BCLC-B and -C HCC patients. The results of minimally invasive liver surgery (MILS) in such patients have not been widely investigated so far.

Methods: Data regarding patients undergoing MILS or open liver resection (OLR) for HCC staged BCLC -B and -C were extracted from the HERCOLES database.

View Article and Find Full Text PDF

Background: Communicating vessels among hepatic veins in patients with tumors invading/compressing hepatic veins at their caval confluence facilitate new surgical solutions. Although their recognition by intraoperative ultrasound has been described, the possibility of preoperative detection still remains uncertain. We aimed to develop a model to predict their presence before surgery.

View Article and Find Full Text PDF

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 PDF

Background: Cystic echinococcosis (CE) is a significant public health issue, primarily affecting the liver. While several management strategies exist, there is a lack of predictive tools to guide surgical decisions for hepatic CE. This study aimed to develop predictive models to support surgical decision-making in hepatic CE, enhancing the precision of patient allocation to surgical or non-surgical management pathways.

View Article and Find Full Text PDF

Background: Identifying liver ischemia is crucial in liver surgery. This study aimed to develop a hemi-hepatic ischemia model for assessing liver ischemia using single snapshot imaging of optical properties (SSOP), a noninvasive optical imaging modality that provides real-time measurements of tissue oxygen saturation (StO2).

Materials And Methods: Twelve swine were randomly assigned to two groups: One undergoing total vascular inflow occlusion (TVIO) and the other undergoing hepatic artery occlusion (HAO).

View Article and Find Full Text PDF

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.

View Article and Find Full Text PDF

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.

View Article and Find Full Text PDF
Article Synopsis
  • Systemic inflammation plays a crucial role in intrahepatic cholangiocarcinoma (iCCA), and this study investigates the prognostic importance of inflammatory indexes like the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR).
  • A total of 101 iCCA patients were analyzed, revealing that higher NLR and lower LMR correlate with worse survival outcomes; those with high-risk profiles had significantly lower 5-year overall survival rates compared to low-risk patients.
  • Flow cytometry results showed distinct immune cell profiles, with high-risk patients having more CD4+ T-cells and fewer CD8+ T-cells, suggesting inflammatory indexes can serve as indicators for tumor microenvironment and prognosis
View Article and Find Full Text PDF
Article Synopsis
  • Metabolic syndrome (MS) is linked to hepatocellular carcinoma (HCC), prompting a study on the long-term outcomes of liver resections in MS patients.
  • Data from 813 patients over 20 years showed a median overall survival of 81.4 months, with a recurrence rate of 48.3%, often peaking at 6 and 24 months post-surgery.
  • The study concluded that while patients have favorable long-term outcomes, the timing and nature of recurrences—linked to tumor features and cirrhosis—play a crucial role in survival, highlighting the need for careful post-operative monitoring.
View Article and Find Full Text PDF
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
View Article and Find Full Text PDF

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.

View Article and Find Full Text PDF

Background: Preoperative nutritional status and body structure affect short-term prognosis in patients undergoing major oncologic surgery. Bioimpedance vectorial analysis (BIVA) is a reliable tool to assess body composition. Low BIVA-derived phase angle (PA) indicates a decline of cell membrane integrity and function.

View Article and Find Full Text PDF

Background: Previous studies showed that bacterial contamination of surgical drains was associated with higher morbidity and mortality following pancreaticoduodenectomy (PD). However, there is still no agreement on the routine use of fluid drainage cultures in the management of patients underwent PD. Therefore, we aimed to clarify the role of surgical drain bacterial contamination in predicting patients' postoperative course.

View Article and Find Full Text PDF

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 PDF

An ischemia-reperfusion injury (IRI) results from a prolonged ischemic insult followed by the restoration of blood perfusion, being a common cause of morbidity and mortality, especially in liver transplantation. At the maximum of the potential damage, IRI is characterized by 2 main phases. The first is the ischemic phase, where the hypoxia and vascular stasis induces cell damage and the accumulation of damage-associated molecular patterns and cytokines.

View Article and Find Full Text PDF

Liver resection is the first curative option for most hepatic primary and secondary malignancies. However, post-hepatectomy liver failure (PHLF) still represents a non-negligible postoperative complication, embodying the most frequent cause of hepatic-related mortality. In the absence of a specific treatment, the most effective way to deal with PHLF is its prevention through a careful preoperative assessment of future liver remnant (FLR) volume and function.

View Article and Find Full Text PDF

Introduction: Malnutrition and alteration of body composition are early features in pancreatic cancer and appear to be predictors of advanced stages and dismal overall survival. Whether specific patient characteristics measured at the preoperative bioimpedance analysis (BIA) could be associated with long-term outcomes following curative resection has not been yet described.

Methods: In a prospective multicenter study, all histologically proven resected pancreatic cancer patients were included in the analysis.

View Article and Find Full Text PDF