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Hepatobiliary Surgery and Nutrition 2019年第2期8卷 151-152页

作者： giorgio ercolani Michele Cucchi Department of Medical and Surgical Sciences DIMECAlma Mater StudiorumUniversity of BolognaBolognaItaly General Surgery MorgagniPierantoni HospitalForlì(FC)Italy

When deciding for the optimal treatment to adopt in patients suffering from hepatocellular carcinoma(HCC),the surgical approach is commonly considered as the most curative option(1,2).The scarcity of donors for liver transplantation(LT)led surgeons to bridge patients until an eventual future transplant(salvage LT),opting in first instance and when feasible for hepatic resection(HR)also for those patients otherwise transplantable(2).In the study published by Pinna and colleagues in Annals of Surgery 2018,it was verified in what measure LT and HR can provide for HCC the same mortality expected in the general population,defining the so called"statistical cure"(3).

关键词： Surgery hepatocellular otherwise

Local recurrence rate as quality indicator in surgery for pancreatic cancer?

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 548-550页

作者： Carlo Alberto Pacilio Alessandro Cucchetti giorgio ercolani General and Oncologic Surgery Unit Morgagni-Pierantoni HospitalAUSL RomagnaVia Carlo Forlanini 3447121ForlìItaly Department of Medical and Surgical Sciences Alma Mater StudiorumUniversity of BolognaVia Massarenti 940138BolognaItaly

To the Editor: As we all know, even with the current advancements regarding novel chemotherapy regimens, patients affected by pancreatic cancer(PC) have an extremely dismal prognosis(5-year survival rate 12% for all stages in the National Cancer Institute SEER database). Among the patients undergoing surgical treatment, the prognosis is mostly affected by recurrence. PC after surgery has mainly four patterns of recurrence, isolated or variously associated with each other: local, lymph nodal, peritoneal or distant(liver, lung, other sites).

关键词： surgery prognosis cancer

Systematic review of surgical resection vs radiofrequency ablation for hepatocellular carcinoma

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World Journal of Gastroenterology 2013年第26期19卷 4106-4118页

作者： Alessandro Cucchetti Fabio Piscaglia Matteo Cescon giorgio ercolani Antonio Daniele Pinna General Surgery and Transplant Unit Department of General Surgery and Organ Transplantation Alma Mater Studiorum-University of Bologna Policlinico Sant'Orsola-Malpighi University of Bologna Division of Internal Medicine Department of Clinical Medicine S Orsola-Malpighi Hospital Alma Mater Studiorum-University of Bologna

Hepatocellular carcinoma (HCC) represents one of the most common neoplasms worldwide. Surgical resection and local ablative therapies represent the most frequent first lines therapies adopted when liver transplantation can not be offered or is not immediately accessible. Hepatic resection (HR) is currently considered the most curative strategy, but in the last decade local ablative therapies have started to obtain satisfactory results in term of efficacy and, of them, radiofrequency ablation (RFA) is considered the reference standard. An extensive literature review, from the year 2000, was performed, focusing on results coming from studies that directly compared HR and RFA. Qualities of the studies, characteristics of patients included, and patient survival and recurrence rates were analyzed. Except for three randomized controlled trials (RCT), most studies are affected by uncertain methodological approaches since surgical and ablated patients represent different populations as regards clinical and tumor features that are known to affect prognosis. Unfortunately, even the available RCTs report conflicting results. Until further evidences become available, it seems reasonable to offer RFA to very small HCC ( 2 cm and especially if > 3 cm, and/or in tumor locations in which ablation is not expected to be effective or safe, surgical removal is to be preferred.

关键词： Hepatocellular carcinoma Hepatic resection Surgical therapy Ablation techniques Survival Liver failure

Treatment options for recurrence of hepatocellular carcinoma after surgical resection: review of the literature and current recommendations for management

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Hepatoma Research 2020年第5期6卷 73-81页

作者： Francesco Pasini Matteo Serenari Alessandro Cucchetti giorgio ercolani Department of Medical and Surgical Sciences University of BolognaBologna 40138Italy Department of Surgery "Morgagni-Pierantoni"HospitalForlì47121Italy

The recurrence rate after primary resection for hepatocellular carcinoma(HCC)has been reported to be up to 80%.There is no consensus or guideline about the best treatment option for such recurrent HCC(rHCC).It is therefore of paramount importance to select patients for suitable treatment due to the high risk of associated morbidity and *** this paper,we review the literature on treatment for rHCC and propose a strategy based on the best evidence *** in rHCC,it is still possible to achieve cure and good survival rates through careful patient *** hepatectomy is recognized as a feasible and safe procedure even in cirrhotic patients and should be considered as the best option with curative intent when the patient is fit *** adoption of minimally-invasive liver surgery could have the potential to increase the number of candidate patients with rHCC for repeat resection in the next few *** transplantation offers longer disease-free survival compared to repeat resection,curing the underlying cirrhosis,but is not widely available due to organ *** surgery is not feasible,locoregional treatments such as radiofrequency ablation and transarterial chemoembolization have an important role for patients who cannot tolerate repeat hepatectomy and are not suitable for *** advanced cases,systemic therapy could be considered.

关键词： Recurrence hepatocellular carcinoma hepatic resection second resection

Gastric splenosis mimicking a gastrointestinal stromal tumor:A case report

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World Journal of Gastrointestinal Surgery 2020年第10期12卷 435-441页

作者： Claudio Isopi Giulia Vitali Federica Pieri Leonardo Solaini giorgio ercolani Department of Surgery Morgagni-Pierantoni HospitalForli 47121Italy Pathology Unit Morgagni-Pierantoni HospitalForli 47121Italy Department of Medical and Surgical Sciences University of BolognaBologna 47100Italy

BACKGROUND Mass lesions located in the wall of the stomach(and also of the bowel)are referred to as“intramural.”The differential diagnosis of such lesions can be challenging in some *** such,it may occur that an inconclusive fine needle aspiration(FNA)result give way to an unexpected diagnosis upon final surgical ***,we present a case of an intramural gastric nodule mimicking a gastric gastrointestinal stromal tumor(GIST).CASE SUMMARY A 47-year-old Caucasian woman,who had undergone splenectomy for trauma at the age of 16,underwent gastroscopy for long-lasting epigastric pain and *** revealed a 15 mm submucosal nodule bulging into the gastric lumen with smooth margins and normal overlying mucosa.A thoraco-abdominal computed tomography scan showed in the gastric fundus a rounded mass(30 mm in diameter)with an exophytic growth and intense enhancement after administration of intravenous *** ultrasound scan showed a hypoechoic nodule,and fine needle FNA was *** GIST was considered the most probable diagnosis,and surgical resection was proposed due to symptoms.A laparoscopic gastric wedge resection was *** postoperative course was uneventful,and the patient was discharged on the seventh postoperative *** final pathology report described a rounded encapsulated accumulation of lymphoid tissue of about 4 cm in diameter consistent with spleen parenchyma implanted during the previous *** Splenosis is a rare condition that should always be considered as a possible diagnosis in splenectomized patients who present with an intramural gastric nodule.

关键词： Splenosis Intramural gastric mass Gastric nodule Laparoscopic gastric surgery Gastrointestinal stromal tumor Case report

Liver grafts from hepatitis B surface antigen-positive donors: A review of the literature

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World Journal of Gastroenterology 2016年第35期22卷 8010-8016页

作者： Elisabetta Loggi Fabio Conti Alessandro Cucchetti giorgio ercolani Antonio Daniele Pinna Pietro Andreone Dipartimento di Scienze Mediche e Chirurgiche Università degli Studi di Bologna Centro di Ricerca per lo Studio delle Epatiti Università degli Studi di Bologna

The scarcity of available organs and the gap between supply and demand continue to be the main limitations of liver transplantation. To relieve the organ shortage, current transplant strategies have implemented extended criteria, which include the use of liver from patients with signs of past or present hepatitis B virus(HBV) infection. While the use of liver grafts from donors with evidence of past HBV infection is quite limited, some data have been collected regarding the feasibility of transplanting a liver graft from a hepatitis B surface antigen(HBs Ag) positive donor. The aim of the present work was to review the literature regarding liver transplants from HBs Ag-positive donors. A total of 17 studies were identified by a search in Medline. To date, HBs Ag positive grafts have preferentially been allocated to HBs Ag positive recipients. The large majority of these patients continue to be HBs Ag positive despite the use of immunoglobulin, and infection prevention can only be guaranteed by using antiviral prophylaxis. Although serological persistence is evident, no significant HBV-related disease has been observed, except in patients coinfected with delta virus. Consistently less data are available for HBs Ag negative recipients, although they are mostly promising. HBs Agpositive grafts could be an additional organ source for liver transplantation, provided that the risk of reinfection/reactivation is properly prevented.

关键词： Liver transplantation Hepatitis B Marginal grafts Hepatitis B positive graft Hepatitis B surface antigen positive donor

Solid serous cystadenoma of the pancreas:A rare tumor with challenging differential diagnosis

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 303-306页

作者： Luca Saragoni Carlo Alberto Pacilio Davide Cavaliere Francesco Limarzi Claudio Isopi giorgio ercolani Pathology Unit Morgagni-Pierantoni HospitalAUSL RomagnaVia Carlo Forlanini 3447121ForliItaly General and Oncologic Surgery Unit Morgagni-Pierantoni HospitalAUSL RomagnaVia Carlo Forlanini 3447121ForliItaly Department of Medical and Surgical Sciences Alma Mater StudiorumUniversity of BolognaVia Massarenti 940138BolognaItaly

To the Editor:Cystic tumors of the pancreas are rare,accounting for 1%-5%of exocrine pancreatic *** cystadenoma(SCA)was firstly described by Compagno and Oertel in 1978 as a benign glycogenrich neoplasm[1].In 1996 Perez-Ordonez et al.[2]reported the first case of a solid variant of SCA;since then,23 cases of this extremely uncommon tumor variant were reported.

关键词： pancreas adenoma diagnosis

Liver transplantation for hepatocellular carcinoma:Role of inflammatory and immunological state on recurrence and prognosis

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World Journal of Gastroenterology 2013年第48期19卷 9174-9182页

作者： Matteo Cescon Valentina Rosa Bertuzzo giorgio ercolani Matteo Ravaioli Federica Odaldi Antonio Daniele Pinna General Surgery and Transplant Unit Department of Medical and Surgical Sciences Alma Mater Studiorum-University of Bologna40138 Bologna Italy

Criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC)and post-LT indicators of prognosis are historically based on the measurement of the tumor ***,high throughput technologies have increased the prediction of recurrence,but these tools are not yet routinely *** interaction between HCC and the immune system has revealed an imbalance of lymphocyte phenotypes in the peritumoral tissue,and the increase of regulatory T cells with respect to cytotoxic lymphocytes has been linked to a higher rate of post-LT HCC ***,some inflammatory markers have shown good reliability in predicting cancer reappearance after surgery,as a result of either a systemic inflammatory response or a decreased capacity of the organism to control the tumor *** these markers,the neutrophil-tolymphocyte ratio appears to be the most promising and easily available serum parameter able to predict HCC recurrence after LT and following other types of treatment,although the exact mechanisms determining its elevation have not been ***-LT immunosuppression may impact on cancer control,and the exposure to high levels of calcineurin inhibitors or other immunusuppressants has recently emerged as a negative prognostic factor for HCC recurrence and patient *** the absence of prospective randomized trials,inhibitors of the mammalian target of rapamycin have been shown to be associated with lower rates of tumor recurrence compared to other immunosuppressors,suggesting their use especially in patients with HCC exceeding the conventional indication criteria for LT.

关键词： Liver transplantation Hepatocellular carcinoma Inflammation Immunosuppression Recurrence

Post reperfusion syndrome during liver transplantation:From pathophysiology to therapy and preventive strategies

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World Journal of Gastroenterology 2016年第4期22卷 1551-1569页

作者： Antonio Siniscalchi Lorenzo Gamberini Cristiana Laici Tommaso Bardi giorgio ercolani Laura Lorenzini Stefano Faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna40138 BolognaItaly Division of Surgery Alma Mater Studiorum University of Bologna40138 BolognaItaly

This review aims at evaluating the existing evidence regarding post reperfusion syndrome, providing a description of the pathophysiologic mechanisms involved and possible management and preventive strategies. A Pub Med search was conducted using the Me SH database, "Reperfusion" AND "liver transplantation" were the combined Me SH headings; EMBASE and the Cochrane library were also searched using the same terms. 52 relevant studies and one ongoing trial were found. The concept of post reperfusion syndrome has evolved through years to a multisystemic disorder. The implications of the main organ, recipient and procedure related factors in the genesis of this complex syndrome are discussed in the text as the novel pharmacologic and technical approaches to reduce its incidence. However the available evidence about risk factors, physiopathology and preventive measures is still confusing, the presence of two main definitions and the numerosity of possible confounding factors greatly complicates the interpretation of the studies.

关键词： Liver transplantation Reperfusion Ischemiareperfusioninjury Hemodynamics Drug therapy

The impact of extent of pancreatic and venous resection on survival for patients with pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 389-394页

作者： Matteo Serenari giorgio ercolani Alessandro Cucchetti Matteo Zanello Enrico Prosperi Guido Fallani Michele Masetti Raffaele Lombardi Matteo Cescon Elio Jovine Department of Medical and Surgical Sciences S.Orsola-Malpighi HospitalAlma Mater Studiorum-University of BolognaBolognaItaly Department of General Surgery Maggiore Hospital-Bologna Local Health DistrictBolognaItaly

Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgical therapy in this *** study aimed to investigate the impact of extent of pancreatic and venous resection on short-and long-term outcomes in patients with pancreatic adenocarcinoma(PDAC).Methods:This was a retrospective study from a prospectively maintained database of pancreatic resections for ***-and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy(TP)or pancreaticoduodenectomy(PD)with simultaneous portal vein(PV)and/or superior mesenteric vein(SMV)*** resections were carried out as tangential venous resection(TVR)or segmental venous resection(SVR).Patients were divided into 4 groups:(1)PD+TVR,(2)PD+SVR,(3)TP+TVR,(4)TP+***-and multivariate Cox regression analysis were performed to identify factors associated with ***:Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for *** them,25 were submitted to PD+TVR(25.3%),12 to PD+SVR(12.1%),23 to TP+TVR(23.2%),and 39 to TP+SVR(39.4%).Overall,major morbidity(Clavien-Dindo grade≥IIIA)was 26.3%.Thirty-and 90-day mortality were 3%and 11.1%,*** were no significant differences among groups in terms of short-term *** overall survival of patients submitted to PD+TVR was significantly higher than those to TP+SVR(29.5 vs 7.9 months,P=0.001).Multivariate analysis identified TP(HR=2.11;95%CI:1.31–3.44;P=0.002)and SVR(HR=2.01;95%CI:1.27–3.15;P=0.003)as the only independent prognostic factors for overall ***:Up-front TP associated to SVR was predictive of worse survival in borderline resectable *** treatments in high-risk surgical groups may improve such poor outcomes.

关键词： Pancreatic resection Vascular resection Pancreatic cancer surgery