Publications by authors named "Tullio Piardi"
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
- 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.
Association between pancreatic adenocarcinoma risk and concentration of organochlorine pesticides in adipose tissue and urine: A targeted-screening analysis case-control study (PESTIPAC).
United European Gastroenterol J
September 2024
Background: Knowledge about environmental pancreatic adenocarcinoma (PA) risk factors, including pesticide exposure, remains limited. Organochlorine (OC) accumulates in adipose tissue and can help reflect long-term exposure.
Patients And Methods: Age and body mass index (BMI) of patients with PA were matched with those undergoing a surgery for a benign disease on age and BMI (1:1).
Since its first description in 1898, pancreaticoduodenectomy has constantly been improved, allowing increasingly more complex operations to be performed even with a minimally invasive approach: laparoscopic and, in recent years, robotic approach. In most cases, similarly to open surgery, parenchymal transection is performed after the creation of a retropancreatic tunnel to ensure adequate control of the mesenteric vessels before sectioning the parenchyma. Sometimes tunnelling can be very difficult even dangerous to achieve, due to conditions such as: vascular involvement by the neoplasm of superior mesenteric vein (SMV) or portal vein (PV); fibrosis secondary to acute pancreatitis (AP) or radiotherapy.
View Article and Find Full Text PDFArticle 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
- Hepatocellular carcinoma (HCC) has a poor prognosis, and this study examines the effectiveness of neoadjuvant transarterial chemoembolization (TACE) for large, resectable HCC tumors over 5 cm.
- In a retrospective analysis of 384 patients, TACE showed no significant impact on disease-free survival or overall survival when compared to surgery alone, even after adjusting for other variables.
- However, TACE may benefit specific patients, particularly those with very large tumors (≥10 cm), single tumors, or those needing portal vein embolization.
Article Synopsis
- 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.
Background: The Coronavirus 2019 (COVID-19) pandemic has favored the growth of telemedicine systems and in this context the idea of Metaverse was born and developed. A 3D reality in which people can interact with each other through digital reproductions of themselves. Metaverse has already been tested in numerous medical fields due to its ability to combine visual and auditory information with tactile sensations.
View Article and Find Full Text PDFBackground: Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality.
Aim: To identify new perioperative risk factors that could be associated with higher 90- and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score.
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 PDFBackground: Due to delayed diagnosis and a lower surgical indication rate, left-sided pancreatic ductal adenocarcinoma (PDAC) is often associated with a poor prognosis in comparison to pancreatic head tumors. Multi-visceral resections (MVR) associated with distal pancreatectomy could be proposed for patients presenting with locally infiltrating disease.
Methods: We retrospectively analyzed a multi-centric cohort of left-sided PDAC patients operated on from 2009 to 2020.
Objective: To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery.
Summary Background Data: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines.
Background: Eastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce. In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared.
View Article and Find Full Text PDFBackground: The impact of obesity on surgical outcomes in elderly patients candidate for liver surgery is still debated.
Aim: To evaluate the impact of high body mass index (BMI) on perioperative and oncological outcome in elderly patients (> 70 years old) treated with laparoscopic liver resection for hepatocellular carcinoma (HCC).
Methods: Retrospective multicenter study including 224 elderly patients (> 70 years old) operated by laparoscopy for HCC (196 with a BMI < 30 and 28 with BMI ≥ 30), observed from January 2009 to January 2019.
Background: Liver resection (LR) and radiofrequency ablation (RFA) are considered curative options for hepatocellular carcinoma (HCC). The aim of this study was to compare outcomes after LR and RFA in octogenarian patients with HCC.
Materials And Methods: This multicenter retrospective study included 102 elderly patients (> 80 years old) treated between January 2009 and January 2019, who underwent LR or RFA for HCC (65 and 37 with, respectively).
Background: Pancreatic ductal adenocarcinoma (PDAC) is the most common pancreatic neoplasm. Surgery is the factual curative option, but most patients present with advanced disease. In order to increase resectability, results of neoadjuvant chemotherapy (NAC) on metastatic disease were extrapolated to the neoadjuvant setting by many centers.
View Article and Find Full Text PDFLong-Term Outcomes of Perioperative Versus Neoadjuvant Chemotherapy for Resectable Colorectal Liver Metastases: An International Multicentre Propensity-Score Matched Analysis with Stratification by Contemporary Risk-Scoring.
Ann Surg Oncol
October 2022
Article Synopsis
- - The study explores the effectiveness of different chemotherapy approaches (neoadjuvant vs. perioperative) in patients with resectable colorectal liver metastases (CRLM) and assesses their long-term survival outcomes.
- - A total of 252 patients were retrospectively analyzed, showing that those who received perioperative chemotherapy had significantly better recurrence-free survival (RFS) and overall survival (OS) rates compared to those who only received neoadjuvant chemotherapy.
- - The results suggest that combining neoadjuvant and adjuvant chemotherapy (perioperative strategy) enhances survival outcomes, especially in patients who can handle postoperative chemotherapy following liver resection, regardless of their initial risk level.
(1) Background: colorectal liver metastases (CRLM) are the most common extra-lymphatic metastases in colorectal cancer; however, few patients are fit for curative surgery. Microwave ablation (MWA) showed promising outcomes in this cohort of patients. This systematic review and pooled analysis aimed to analyze the oncological results of MWA for CRLM.
View Article and Find Full Text PDFBackground: Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.
Aim: To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.
Background: Data on the management of elderly patients with extensive colorectal liver metastases (CRLM) are scarce and conflicting. This study assesses differences in management and long-term oncological outcomes between older and younger patients with CRLM and a high Tumour Burden Score (TBS).
Methods: International multicentre retrospective study on patients with CRLM and a category 3 TBS, submitted to liver resection.
Background: Surgical resection is a first-line curative option for hepatocellular carcinoma, but its role is still unclear in elderly patients. The aim of our study was to compare short- and long-term outcomes of laparoscopic and open liver resection in elderly patients with hepatocellular carcinoma.
Methods: The study included 665 consecutive hepatocellular carcinoma liver resection cases in patients with ≥70 years of age treated in eight European hospital centres.
Background: Laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) represented potential treatments for patients with a single hepatocellular carcinoma (HCC) smaller than 3 cm. As the aging population soared, our study aimed to examine the advantage/drawback balance for these treatments, which should be reassessed in elderly patients.
Methods: A multicentric retrospective study compared 184 elderly patients (aged >70 years) (86 patients underwent LLR and 98 had RFA) with single ≤3 cm HCC, observed from January 2009 to January 2019.
Article Synopsis
- Bile duct injury (BDI) is a serious complication following cholecystectomy, with incidences ranging from 0.4% to 1.5%, potentially leading to significant long-term health issues for patients.
- Early recognition of BDIs, whether during surgery or soon after, is crucial for effective treatment, as delayed diagnoses can complicate management and outcomes.
- The 2020 World Society of Emergency Surgery (WSES) guidelines provide evidence-based recommendations on preventing, diagnosing, and managing BDIs, covering risk reduction strategies, classification, intraoperative management, and postoperative care.