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Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients

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World Journal of Gastroenterology 2012年第44期18卷 6398-6408页

作者： Alessandro Cucchetti matteo cescon Franco Trevisani Antonio Daniele Pinna General Surgery and Transplant Unit Department of General Surgery and Organ TransplantationAlma Mater StudiorumUniversity of Bologna40138 BolognaItaly Department of Clinical Medicine Semeiotica MedicaS.Orsola-Malpighi HospitalAlma Mater StudiorumUniversity of BolognaVia Massarenti 940138 BolognaItaly

Hepatocellular carcinoma(HCC) is one of the most frequent neoplasms worldwide and in most cases it is associated with liver *** resection is considered the most potentially curative therapy for HCC patients when liver transplantation is not an option or is not immediately *** review is aimed at investigating the current concepts that drive the surgical choice in the treatment of HCC in cirrhotic patients;Eastern and Western perspectives are *** extensive literature review of the last two decades was performed,on topics covering various aspects of hepatic *** post-operative and long-term outcome measures adopted were firstly analyzed in an attempt to define an optimal standardization useful for research *** need to avoid the development of post-hepatectomy liver failure represents the "conditio sine qua non" of surgical choice and the role of the current tools available for the assessment of liver function reserve were *** of hepatic resection in relationship with tumor burden were compared with those of available competing strategies,namely,radiofrequency ablation for early stages,and trans-arterial chemoembolization for intermediate and advanced ***,the choice for anatomical versus non-anatomical,as well as the role of laparoscopic approach,was *** literature review suggests that partial hepatectomy for HCC should be considered in the context of multi-disciplinary evaluation of cirrhotic *** research on HCC has moved,in recent years,from surgical therapy toward non-surgical approaches and most of the literature regarding topics debated in the present review is represented by observational studies,whereas very few well-designed randomized controlled trials are currently available;thus,no robust recommendations can be derived.

关键词： Hepatocellular carcinoma Hepatic resec-tion Surgical therapy Ablation techniques Transplan-tation Survival Liver failure

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

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

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

Liver transplantation for hepatic tumors:a systematic review

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World Journal of Gastroenterology 2014年第18期20卷 5345-5352页

作者： matteo Ravaioli Giorgio Ercolani Flavia Neri matteo cescon Giacomo Stacchini Massimo Del Gaudio Alessandro Cucchetti Antonio Daniele Pinna Department of General Surgery and Transplantation Sant’Orsola-Malpighi HospitalUniversity of Bologna40138 BolognaItaly

Improvements in the medical and pharmacological management of liver transplantation (LT) recipients have led to a better long-term outcome and extension of the indications for this procedure. Liver tumors are relevant to LT; however, the use of LT to treat malignancies remains a debated issue because the high risk of recurrence. In this review we considered LT for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), liver metastases (LM) and other rare tumors. We reviewed the literature, focusing on the past 10 years. The highly selected Milan criteria of LT for HCC (single nodule < 5 cm or up to 3 nodules < 3 cm) have been recently extended by a group from the University of S. Francisco (1 lesion < 6.5 cm or up to 3 lesions < 4.5 cm) with satisfying results in terms of recurrence-free survival and the “up-to-seven criteria”. Moreover, using these criteria, other transplant groups have recently developed downstaging protocols, including surgical or loco-regional treatments of HCC, which have increased the post-operative survival of recipients. CCA may be treated by LT in patients who cannot undergo liver resection because of underlying liver disease or for anatomical technical challenges. A well-defined protocol of chemoirradiation and staging laparotomy before LT has been developed by the Mayo Clinic, which has resulted in long term disease-free survival comparable to other indications. LT for LM has also been investigated by multicenter studies. It offers a real benefit for metastases from neuroendocrine tumors that are well differentiated and when a major extrahepatic resection is not required. If LT is an option in these selected cases, liver metastases from colorectal cancer is still a borderline indication because data concerning the disease-free survival are still lacking. Hepatoblastoma and hemangioendothelioma represent rare primary tumors for which LT is often the only possible and effective cure because

关键词： Liver transplantation Liver cancer Hepatocellular carcinoma Cholangiocarcinoma Neuroendocrine carcinoma Liver metastases Hepatoblastoma Hemangioendothelioma

Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: Is it necessary?

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World Journal of Gastroenterology 2010年第17期16卷 2146-2150页

作者： Marco Vivarelli matteo Zanello Chiara Zanfi Alessandro Cucchetti matteo Ravaioli Massimo Del Gaudio matteo cescon Augusto Lauro Eva Montanari Gian Luca Grazi Antonio Daniele Pinna Department of Surgery and Transplantation University of BolognaS.Orsola HospitalVia Massarenti 940138 BolognaItaly Institute of Forensic Medicine University of Bologna

AIM: To assess the safety and effectiveness of prophylaxis for venous thromboembolism (VTE) in a large population of patients with hepatocellular carcinoma (HCC) on ***: Two hundred and twenty nine consecutive cirrhotic patients with HCC who underwent hepatic resection were retrospectively evaluated to assess whether there was any difference in the incidence of thrombotic or hemorrhagic complications between those who received and those who did not receive prophylaxis with low-molecular weight *** and possible effects of the following parameters were investigated: age,sex,Child-Pugh and model for end-stage liver disease (MELD) score,platelet count,presence of esophageal varices,type of hepatic resection,duration of surgery,intraoperative transfusion of blood and fresh frozen plasma (FFP),body mass index,diabetes and previous cardiovascular ***: One hundred and fifty seven of 229 (68.5%) patients received antithromboembolic prophylaxis (group A) while the remaining 72 (31.5%) patients did not (group B).Patients in group B had higher Child-Pugh and MELD scores,lower platelet counts,a higher prevalence of esophageal varices and higher requirements for intraoperative transfusion of *** incidence of VTE and postoperative hemorrhage was 0.63% and 3.18% in group A and 1.38% and 1.38% in group B,respectively;these differences were not *** of the variables analyzed including prophylaxis proved to be risk factors for VTE,and only the presence of esophageal varices was associated with an increased risk of ***: Prophylaxis is safe in cirrhotic patients without esophageal varices;the real need for prophylaxis should be better assessed.

关键词： Hepatic surgery Hepatocellular carcinoma Liver cirrhosis Postoperative bleeding Postoperative thromboembolism Venous thromboembolism prophylaxis

Prognostic factors for hepatocellular carcinoma recurrence

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World Journal of Gastroenterology 2014年第20期20卷 5935-5950页

作者： Antonio Colecchia Ramona Schiumerini Alessandro Cucchetti matteo cescon Martina Taddia Giovanni Marasco Davide Festi Department of Gastrointestinal Diseases and Internal Medicine University of Bologna 40138 Bologna Italy Department of General Surgery and Transplants University of Bologna 40138 Bologna Italy

The recurrence of hepatocellular carcinoma,the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide,represents an important clinical problem,since it may occur after both surgical and medical *** recurrence rate involves 2 phases:an early phase and a late *** early phase usually occurs within 2 years after resection;it is mainly related to local invasion and intrahepatic metastases and,therefore,to the intrinsic biology of the *** the other hand,the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic *** recent studies have reported that early and late recurrences may have different risk factors,it is clinically important to recognize these factors in the individual patient as soon as *** aim of this review was,therefore,to identify predicting factors for the recurrence of hepatocellularcarcinoma,by means of invasive and non-invasive methods,according to the different therapeutic strategies *** particular the role of emerging techniques(e.g.,transient elastography)and biological features of hepatocellular carcinoma in predicting recurrence have been *** particular,invasive methods were differentiated from non-invasive ones for research purposes,taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.

关键词： Percutaneous ethanol injection Percutaneous radiofrequency ablation Transarterial chemoembolization Hepatic resection Orthotopic liver transplant Liver biopsy Liver stiffness measurement Hepatocellular carcinoma

Liver collision lesion:inflammatory hepatocellular adenoma within focal nodular hyperplasia

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Gastroenterology Report 2021年第4期9卷 374-376,I0003页

作者： matteo Renzulli Irene Pettinari Francesco Vasuri matteo Ravaioli Beniamino Corcioni Daniele Spinelli Giovanni Marasco matteo cescon Antonietta D’Errico Rita Golfieri Department of Radiology IRCCS Azienda Ospedaliero-Universitaria di BolognaVia Albertoni 15BolognaItalia Pathology Unit S.Orsola Malpighi University HospitalBolognaItaly General Surgery and Transplantation Unit Department of Medical and Surgical SciencesS.Orsola HospitalUniversity of BolognaBolognaItaly Department of Medical and Surgical Sciences S.Orsola HospitalUniversity of BolognaBolognaItaly

Introduction Focal nodular hyperplasia(FNH)and hepatocellular adenoma(HCA)are both benign nodular hepatocellular *** is the second-most common solid liver tumour,representing8%of all primary hepatic neoplasms[1].If the diagnosis of FNH is firmly established on the basis of imaging,and if the individual is asymptomatic,follow-up imaging is not required,and the patient can be ***,there is a poor association between FNH and symptoms;therefore,even in symptomatic cases,treatment is rarely indicated[2].

关键词：局灶性结节增生 neoplasms diagnosis 肝细胞

Two-stage hepatectomy with radioembolization for bilateral colorectal liver metastases:A case report

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World Journal of Hepatology 2021年第2期13卷 261-268页

作者： matteo Serenari Jacopo Neri Giovanni Marasco Cristina Larotonda Alberta Cappelli matteo Ravaioli Cristina Mosconi Rita Golfieri matteo cescon General Surgery and Transplant Unit IRCCSAzienda Ospedaliero-Universitaria di BolognaSant'Orsola-Malpighi HospitalBologna 40138Italy Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Department of Radiology IRCCSAzienda Ospedaliero-Universitaria di BolognaSant'Orsola-Malpighi HospitalBologna 40138Italy

BACKGROUND Two-stage hepatectomy(TSH)is a well-established surgical technique,used to treat bilateral colorectal liver metastases(CRLM)with a small future liver remnant(FLR).However,in classical TSH,drop-out is reported to be around 25%-40%,due to insufficient FLR increase or progression of ***-arterial radioembolization(TARE)has been described to control locally tumor growth of liver malignancies such as hepatocellular carcinoma,but it has been also reported to induce a certain degree of contralateral liver hypertrophy,even if at a lower rate compared to portal vein embolization or *** SUMMARY Herein we report the case of a 75-year-old female patient,where TSH and TARE were combined to treat bilateral *** to computed tomography(CT)-scan,the patient had a hepatic lesion in segment VI-VII and two other confluent lesions in segment ***,one-stage posterior right sectionectomy plus left lateral sectionectomy(LLS)was *** liver volumetry estimated a FLR of 38%(segments I-IV-V-VIII).However,due to a more than initially planned,extended right resection,simultaneous LLS was not performed and the patient underwent selective TARE to segments II-III after the first *** CT-scan performed after TARE showed a reduction of the treated lesion and a FLR increase of 55%.Carcinoembryonic antigen and CA 19.9 decreased *** three months later after the first surgery,LLS was performed and the patient was discharged without any postoperative *** According to this specific experience,TARE was used to induce liver hypertrophy and simultaneously control cancer progression in TSH settings for bilateral CRLM.

关键词： Trans-arterial Radioembolization Two-stage hepatectomy Colorectal liver metastases Selective internal radiation therapy Yttrium90 Case report