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Role of laparoscopic and robotic liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis

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Hepatoma Research 2020年第6期6卷 77-91页

作者： Alberto Brolese Marta Rigoni Alessandro Vitale Giovanni de Pretis Ivo Avancini CeciliaPravadelli Michela Frisinghelli Umberto Rozzanigo Giacomo Luppi francesco Dionisi Stefano Marcucci Giovanni Viel Paolo Beltempo Cristina Prezzi Marco Frisini Marco Brolese Giandomenico Nollo francesco a.ciarleglio Department of General Surgery&HPB Unit(Chief:Alberto Brolese MD)Azienda Provinciale per i Servizi Sanitari(APSS)Santa Chiara HospitalTrento 38122Italy IRCS-Innovation and Clinical Health Research-Bruno Kessler Foundation(FBK) Trento 38123Italy Department of Surgical Oncological&Gastroenterological SciencesPadua University HospitalPadua 35128Italy Department of Hepatology&Gastroenterology APSSTrento 38122Italy Department of Oncology Azienda Provinciale per i Servizi Sanitari(APSS)Trento 38122Italy Department of Radiology Azienda Provinciale per i Servizi Sanitari(APSS)Trento 38122Italy Proton therapy Unit Azienda Provinciale per i Servizi Sanitari(APSS)Trento 38122Italy Department of Industrial Engineering BIOtech LabUniversity of TrentoTrento 38122Italy School of Medicine Padua UniversityPadua 35128Italy

Aim:This study aimed to compare mini-invasive liver resection(MILR)(laparoscopic/robotic approach)and open liver resection(OLR)for hepatocellular carcinoma(HCC)in elderly patients with regard to clinical and oncological outcomes through a comprehensive systematic review.Methods:The MEDLINE and Cochrane Library electronic databases were systematically searched from 2009 to December 2019 to identify relevant English written studies comparing MILR and OLR.The main endpoints were Child-Pugh score,serum total bilirubin level,comorbidity,presence/absence of cirrhosis,minor/major resection,challenge segment approach,operative time,estimated intraoperative blood loss,liver failure rate,morbidity according to the Clavien-Dindo classification,length of hospital stay(LOS),postoperative mortality,number of lesions,tumor size,readmission rate,recurrence rate and survival at 1,3 and 5 years after operation.Meta-analyses provided pooled relative risks and mean differences for these outcomes.Cut-off for"elderly age"was set at 65 years old.Results:Eight studies that evaluated 3051 patients who underwent liver resection for HCC,with 950 undergoing MILR and 2101 OLR,were included after the screening process.Blood loss,morbidity,and LOS showed statistical significance in favor of MILR.In particular,with respect to OLR,MILR decreased on average blood loss by 161.43 mL(95%CI:250.24-72.61),risk of morbidity by 42%(P<0.01),LOS by 4 days(95%CI:7-2),postoperative mortality risk by 47%(although not significantly,P=0.06).Major resections were significantly more common in the OLR group(P<0.0001).Recurrence,although not significant(P=0.06),must also be emphasized.The two surgical approaches were comparable with regard to the other outcomes investigated.Conclusion:Meta-analyses confirmed the advantages of MILR in terms of short perioperative outcomes,where it may promote the extension of liver resection to HCC patients with borderline liver function.MILR may be considered an important treatment option with significant benefits in the elderly a

关键词： Hepatocellular carcinoma HCC mini-invasive liver resection laparoscopic liver surgery robotic liver surgery open liver surgery meta-analysis

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Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma:A case report and review of the literature

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World Journal of Gastroenterology 2020年第35期26卷 5375-5386页

作者： Teresa Marzia Rogger Andrea Michielan Sandro Sferrazza Cecilia Pravadelli Luisa Moser Flora Agugiaro Giovanni Vettori Sonia Seligmann Elettra Merola Marcello Maida francesco Antonio ciarleglio Alberto Brolese Giovanni de Pretis Department of Surgery Gastroenterology and Digestive Endoscopy UnitSanta Chiara HospitalTrento 38122Italy Gastroenterology and Endoscopy Unit S.Elia-Raimondi HospitalCaltanissettaCaltanissetta 93100Italy Department of Surgery Hepato-biliary Surgery UnitSanta Chiara HospitalTrento 38122Italy

BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events is low,ranging from 2.4%to 13.1%for RFA and from 2.6%to 7.5%for MWA.Gastrointestinal tract(GIT)injury is even more infrequent(0.11%),but usually requires surgery with an unfavourable prognosis.Due to its low incidence and the retrospective nature of the studies,the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics,comorbidities and treatment approaches.CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location.He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever.A subcutaneous abscess was diagnosed and treated by percutaneous drainage.A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall.The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulentabdominal collection. An over-the-scope clip (OTSC) was used to successfullyclose the defectCONCLUSIONThis is the first reported case of RFA-related GIT injury to have been successfullytreated with an OTSC, which highlights the role of this endoscopic treatment forthe management of this complication.

关键词： Gastrointestinal tract Radiofrequency ablation Hepatocellular carcinoma Complications Endoscopy Over-the-scope clip Case report

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Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatoceiluiar carcinoma

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World Journal of Gastroenterology 2005年第44期11卷 6920-6925页

作者： Umberto Cillo Alessandro Vitale Filippo Navaglia Daniela Basso Umberto Montin Marco Bassanello francesco D'Amico francesco Antonio ciarleglio Alberto Brolese Giacomo Zanus Vito De Pascale Mario Plebani Davide francesco D'Amico Clinica Chirurgica Ⅰ Dipartimento di Medicina di Laboratono Dipartimento Assistenziale di Chirurgia Generale ed Emergenze Chirurgiche Dipartimento di Medicina di Laboratorio Clinica Chirurgica I

AIM: To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma (HCC)eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria.METHODS: Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (1) histological assessment of tumor grade by means of percutaneous biopsies; (2) determination of AFP mRNA status in the blood; (3) patient's eligibility for radical therapies.RESULTS: At preoperative evaluation, 54% of the study group had a well-differentiated HCC, 42% had AFP mRNA in the blood, 40% had a tumor larger than 5 cm and 56% had more than one nodule. Surgery (resection or liver transplantation) was performed in 29 patients,while 21 had percutaneous ablation procedures. After a median follow-up of 28 mo, 12-, 24-, and 36-mo survival rates were 78%, 58%, and 51%, respectively. Surgical therapy, performance status and three tumor-related variables (AFP mRNA, HCC grade and gross vascular invasion) resulted as significant survival predictors at univariate analysis. Nodule size and number did not perform as significant prognosticators. Multivariate study selected only surgical therapy and a biologically early HCC profile (AFP mRNA negative and well-differentiated tumor without gross vascular invasion) as independent survival variables.CONCLUSION: The preoperative determination of tumor grade and blood AFP mRNA status may potentially refine the prognostic evaluation of HCC patients and improve the selection process for radical therapies.

关键词：血液检查肿瘤分级手术治疗肝细胞癌

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