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Artificial intelligence in the diagnosis and management of colorectal cancer liver metastases

World Journal of Gastroenterology 2022年第1期28卷 108-122页

作者： Gianluca Rompianesi Francesca Pegoraro Carlo DL Ceresa roberto Montalti roberto ivan troisi Division of Hepato-Bilio-Pancreatic Minimally Invasive and Robotic SurgeryDepartment of Clinical Medicine and SurgeryFederico II University HospitalNaples 80125Italy Department of Hepato-Pancreato-Biliary Surgery Oxford University Hospitals NHS Foundation TrustOxford OX39ESUnited Kingdom Division of Hepato-Bilio-Pancreatic Minimally Invasive and Robotic SurgeryDepartment of Public HealthFederico II University HospitalNaples 80125Italy

Colorectal cancer(CRC)is the third most common malignancy worldwide,with approximately 50%of patients developing colorectal cancer liver metastasis(CRLM)during the follow-up *** of CRLM is best achieved via a multidisciplinary approach and the diagnostic and therapeutic decision-making process is *** order to optimize patients’survival and quality of life,there are several unsolved challenges which must be *** primarily include a timely diagnosis and the identification of reliable prognostic ***,to allow optimal treatment options,a precision-medicine,personalized approach is *** widespread digitalization of healthcare generates a vast amount of data and together with accessible high-performance computing,artificial intelligence(AI)technologies can be *** increasing diagnostic accuracy,reducing timings and costs,the application of AI could help mitigate the current shortcomings in CRLM *** this review we explore the available evidence of the possible role of AI in all phases of the CRLM natural *** analysis and convolutional neural networks(CNN)which combine computed tomography(CT)images with clinical data have been developed to predict CRLM development in CRC *** models have also proven themselves to perform similarly or better than expert radiologists in detecting CRLM on CT and magnetic resonance scans or identifying them from the noninvasive analysis of patients’exhaled *** application of AI and machine learning(ML)in diagnosing CRLM has also been extended to histopathological examination in order to rapidly and accurately identify CRLM tissue and its different histopathological growth *** and CNN have shown good accuracy in predicting response to chemotherapy,early local tumor progression after ablation treatment,and patient survival after surgical treatment or *** the initial enthusiasm and the accumulating evidence,AI technologies’role i

关键词： Colorectal cancer Liver metastases Artificial intelligence Machine learning Deep learning Neural networks Radiomics

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Role of neoadjuvant therapy for nonmetastatic pancreatic cancer:Current evidence and future perspectives

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 911-924页

作者： Gianluca Cassese Ho-Seong Han Yoo-Seok Yoon Jun Suh Lee Boram Lee Antonio Cubisino Fabrizio Panaro roberto ivan troisi Department of Clinical Medicine and Surgery Division of Minimally Invasive HPB Surgery and Transplantation ServiceFederico II University HospitalNaples 80131Italy Department of Surgery Seoul National University College of MedicineSeongnam 13620Gyeonggi-doSouth Korea Department of HPB Surgery and Transplantation Beaujon HospitalClichy 92110France Department of Digestive Surgery and Liver Transplantation CHU MontpellierMontpellier 34100France

Pancreatic adenocarcinoma(PDAC)is one of the most common and lethal human cancers *** followed by adjuvant chemotherapy offers the best chance of a long-term survival for patients with PDAC,although only approximately 20%of the patients have resectable tumors when *** chemotherapy(NACT)is recommended for borderline resectable pancreatic *** studies have investigated the role of NACT in treating resectable tumors based on the recent advances in PDAC biology,as NACT provides the potential benefit of selecting patients with favorable tumor biology and controls potential micro-metastases in high-risk patients with resectable *** such challenging cases,new potential tools,such as ct-DNA and molecular targeted therapy,are emerging as novel therapeutic options that may improve old *** review aims to summarize the current evidence regarding the role of NACT in treating non-metastatic pancreatic cancer while focusing on future perspectives in light of recent evidence.

关键词： Pancreatic cancer Pancreatic duct adenocarcinoma Neoadjuvant chemotherapy Borderline resectable Locally advanced pancreatic cancer

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Portal vein embolization failure:Current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection

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World Journal of Gastrointestinal Oncology 2022年第11期14卷 2088-2096页

作者： Gianluca Cassese Ho-Seong Han Boram Lee Jai Young Cho Hae Won Lee Boris Guiu Fabrizio Panaro roberto ivan troisi Clinical Medicine and Surgery Federico II UniversityNaples 80131Italy Department of Surgery Seoul National University College of MedicineSeongnam 13620South Korea Department of Surgery Seoul National University Bundang HospitalSeongnam 13620South Korea Department of Medical Imaging and Interventional Radiology St-Eloi University HospitalMontpellier 34295France Digestive Surgery and Transplantation CHU de MontpellierMontpellier 34295France

Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after *** degree of hypertrophy obtained after PVE is variable and depends on multiple *** to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical *** additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein *** aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.

关键词： Portal vein embolization Portal vein embolization failure Rescue associating liver partition and portal vein ligation Hepatic vein embolization Liver venous deprivation Segment 4 portal vein embolization

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Immunotherapy for hepatocellular carcinoma:A promising therapeutic option for advanced disease

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World Journal of Hepatology 2022年第10期14卷 1862-1874页

作者： Gianluca Cassese Ho-Seong Han Boram Lee Hae Won Lee Jai Young Cho Fabrizio Panaro roberto ivan troisi Department of Clinical Medicine and Surgery Division of Minimally Invasive and Robotic HPB SurgeryFederico II UniversityNaples 80131Italy Department of Surgery Seoul National University Bundang HospitalSeongnam 13620South Korea Department of Surgery Division of HBP Surgery and TransplantationMontpellier University Hospital-School of MedicineMontpellier 34000France

Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related deaths worldwide,and its incidence continues to *** improvements in both medical and surgical therapies,HCC remains associated with poor outcomes due to its high rates of recurrence and *** 50% of patients require systemic therapies that traditionally consist of tyrosine kinase ***,however,immune checkpoint inhibitors have revolutionized HCC management,providing new therapeutic *** these major advances,the different factors involved in poor clinical responses and molecular pathways leading to resistance following use of these therapies remain *** strategies,such as adoptive T cell transfer,vaccination,and virotherapy,are currently under *** of immunotherapies with other systemic or local treatments are also being investigated and may be the most promising opportunities for HCC *** aim of this review is to provide updated information on currently available immunotherapies for HCC as well as future perspectives.

关键词： Hepatocellular Carcinoma Immunotherapy Hepatocellular Carcinoma management Hepatocellular Carcinoma therapy Molecular targeted therapy

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Big size is not all, even better!

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Hepatobiliary Surgery and Nutrition 2019年第5期8卷 539-540页

作者： roberto ivan troisi Mariano Cesare Giglio roberto Montalti Department of Clinical Medicine and Surgery Federico II University of NaplesNaplesItaly Department of Liver and Small Bowel Transplantation Hepato-Biliary and Pancreatic SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhKingdom of Saudi Arabia Department of Public Health Federico II University of NaplesNaplesItaly

We read with interest the article entitled"Comprehensive Complication Index validates improved outcomes over time despiteincreased complexity in 3707 consecutive hepatectomies"by Cloydet al.(1).This article focused on... 详细信息

关键词： entitled consecutive despite

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Laparoscopic surgery for colorectal liver metastases:moving forward while keeping feet on the ground

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 107-109页

作者： Mariano Cesare Giglio roberto ivan troisi Division of HPB Minimally Invasive and Robotic SurgeryDepartment of Clinical Medicine and SurgeryFederico II University HospitalNaplesItaly

The laparoscopic approach to the surgical treatment of colorectal liver metastases(CRLMs)is supported nowadays by high evidence(1).In the hand of expert surgeons,patients undergoing laparoscopic liver surgery(LLS)for CLRMs benefit from a number of advantages,including a shorter postoperative in-hospital stay,less pain,fewer complications and a faster recovery(1).More importantly,all these profits are achieved while preserving the oncological outcomes,which are not-inferior to those achieved by open procedures(1).Recently published long-term results of randomized trials have shown similar patient survival after laparoscopic and open surgery for CRLM(2).

关键词： surgery colorectal faster

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Perioperative thromboprophylaxis in liver transplant patients

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World Journal of Gastroenterology 2018年第27期24卷 2931-2948页

作者： Lesley De Pietri roberto Montalti Daniele Nicolini roberto ivan troisi Federico Moccheggiani Marco Vivarelli Division of Anaesthesiology and Intensive Care Unit Department of General SurgeryAUSL Reggio Emilia-IRCCSReggio Emilia 42123Italy Hepatobiliary and Abdominal Transplantation Surgery Department of Experimental and Clinical MedicinePolytechnic University of MarcheAncona 60126Italy Department of General Hepatobiliary and Liver Transplantation SurgeryGhent University Hospital Medical SchoolGhent 185 3K3 9000Belgium

Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation(LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications(intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed in a setting of already unstable hemostasis. For this reason, the role of routine perioperative prophylactic anticoagulation is usually restricted. However, recent data have shown that the bleeding tendency of cirrhotic patients is not an expression of an acquired bleeding disorder but rather of coexisting factors(portal hypertension, hypervolemia and infections). Furthermore, in cirrhotic patients, the new paradigm of ‘‘rebalanced hemostasis' ' can easily tip towards hypercoagulability because of the recently described enhanced thrombin generation, procoagulant changes in fibrin structure and platelet hyperreactivity. This new coagulation balance, along with improvements in surgical techniques and critical support, has led to a dramatic reduction in transfusion requirements, and the intraoperative thromboembolic-favoring factors(venous stasis, vessels clamping, surgical injury) have increased the awareness of thrombotic complications and led clinicians to reconsider the limited use of anticoagulants or antiplatelets in the postoperative period of LT.

关键词： Anticoagulation Liver transplantation Antiplatelets Thrombosis Coagulation Heparin Thromboelastography Thromboprophylaxis Hepatic artery thrombosis Portal vein thrombosis

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The role of minimally invasive surgery in the treatment of HCC

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Hepatoma Research 2022年第1期8卷 301-312页

作者： Gianluca Cassese Ho-Seong Han Boram Lee Hae Won Lee Jai Young Cho roberto ivan troisi Department of HPB Surgery Seoul National University Bundang HospitalSeongnam-si 13620South Korea Department of Clinical Medicine and Surgery Minimally invasive and robotic HPB Surgery UnitFederico II UniversityNaples 80131Italy

Liver surgery is the first-line treatment for hepatocellular carcinoma(HCC).Minimally invasive liver resection(MILS)has become an attractive option thanks to reduced intraoperative blood losses,shortened length of hospital stay,and similar oncological outcomes when compared to open liver ***,the safety of MILS is still debated in challenging situations,such as in cirrhotic patients,difficult tumor locations,multiple or large tumors,and repeat *** aim of this review is to discuss current indications of laparoscopic liver resection for HCC treatment in the light of its outcomes,focusing on technical aspects of minimally invasive anatomic liver resection and state of the art of MILS in challenging situations.

关键词： Laparoscopic liver resection hepatocellular carcinoma minimally invasive liver surgery anatomic liver resection

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Outcomes of robotic vs laparoscopic hepatectomy:A systematic review and meta-analysis

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World Journal of Gastroenterology 2015年第27期21卷 8441-8451页

作者： roberto Montalti Giammauro Berardi Alberto Patriti Marco Vivarelli roberto ivan troisi Department of General and Hepato-Biliary Surgery Liver Transplantation Service Ghent University Hospital and Medical School Department of Gastroenterology and Transplantation Surgery Polytechnic University of Marche-Ospedali Riuniti Division of General Minimally Invasive and Robotic Surgery General Hospital of Spoleto

AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver ***: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria:(1) studies comparing robotic and laparoscopic liver resection;(2) studies reporting at least one perioperative outcome; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy ***: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time(MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital ***: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.

关键词： Laparoscopic liver resections Robotic liverresections Outcome Systematic review Meta-analysis

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