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Selective internal radiation therapy segmentectomy:A new minimally invasive curative option for primary liver malignancies?

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World Journal of Gastroenterology 2024年第18期30卷 2379-2386页

作者： riccardo Inchingolo Francesco Cortese Antonio Rosario Pisani Fabrizio Acquafredda Roberto Calbi riccardo memeo Fotis Anagnostopoulos Stavros Spiliopoulos Unit of Interventional Radiology “F.Miulli”Regional General HospitalBari 70021Italy Interdisciplinary Department of Medicine Section of Nuclear MedicineUniversity of Bari“Aldo Moro”Bari 70121Italy Department of Radiology General Regional Hospital“F.Miulli”Acquaviva delle Fonti 70021Italy Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalBari 70021Italy The Second Radiology Department National and Kapodistrian University of AthensChaidari Athens 12461Greece

Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of *** percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the *** employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation *** latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not *** segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy *** research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

关键词： Transarterial radioembolization Selective internal radiation therapy Radiation segmentectomy Hepatocellular carcinoma Primary liver malignancies Personalised dosimetry

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A new era for hepatocellular carcinoma

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Hepatobiliary Surgery and Nutrition 2023年第1期12卷 135-136页

作者： riccardo memeo Antonio Rosario Pisani Michele Ammendola Nicola de’Angelis riccardo Inchingolo Division of Hepato-Pancreato-Biliary Surgery “F.Miulli”General HospitalAcquaviva delle FontiBariItaly Nuclear Medicine Unit Interdisciplinary Department of MedicineUniversity of Bari‘Aldo Moro’BariItaly Science of Health Department Digestive Surgery UnitUniversity“Magna Graecia”Medical SchoolCatanzaroItaly Unit of Colorectal and Digestive Surgery DIGEST DepartmentBeaujon University Hospital(AP-HP)University Paris CiteClichyFrance Interventional Radiology Unit “F.Miulli”Regional General HospitalAcquaviva Delle FontiBariItaly

Hepatocellular carcinoma(HCC)is one of the most frequent cancers worldwide among patients with cirrhosis,and its management and treatment is in continuous evolution due to the introductions of new therapeutic *** represents most common primary malignancy of the liver,developing in 90%of cases of un underlying liver disease(1)[chronic HBV and HCV hepatitis,dysmetabolic liver disease].

关键词： Hepatocellular carcinoma(HCC) guidelines Consensus statement Japan Society of Hepatology

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Percutaneous insertion of a novel dedicated metal stent to treat malignant hilar biliary obstruction

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World Journal of Gastrointestinal Oncology 2022年第9期14卷 1833-1843页

作者： Francesco Cortese Fabrizio Acquafredda Andrea Mardighian Maria Teresa Zurlo Valentina Ferraro riccardo memeo Stavros Spiliopoulos riccardo Inchingolo Interventional Radiology Unit Miulli HospitalAcquaviva Delle Fonti 70124Italy Unit of Hepatobiliary Surgery Miulli hospitalAcquaviva Delle Fonti 70124Italy 2nd Radiology Department National and Kapodistrian University of AthensChaidari Athens 12461Greece

BACKGROUND Percutaneous bilateral biliary stenting is an established method for the management of unresectable malignant hilar biliary *** To evaluate the efficacy and safety of a novel uncovered biliary stent, specifically designed for hilar *** This, single-center, retrospective study included 18 patients(mean age 71 ± 11 years;61.1% male) undergoing percutaneous transhepatic Moving cell stent(MCS) placement for hilar reconstruction using the stent-in-stent technique for malignant biliary strictures, between November 2020 and July 2021. The Patients were diagnosed with cholangiocarcinoma(12/18;66.6%), gallbladder cancer(5/18;27.7%), and colorectal liver metastasis(1/18;5.5%). Primary endpoints were technical(appropriate stent placement) and clinical(relief from jaundice) success. Secondary endpoints included stent patency, overall survival, complication rates and stent-related *** The technical and clinical success rates were 100%(18/18 cases). According to Kaplan-Meier analysis, the estimated overall patient survival was 80.5% and 60.4% at 6 and 12 mo respectively, while stent patency was 90.9% and 68.2% at 6 mo and 12 mo respectively. The mean stent patency was 172.53 ± 56.20 d and median stent patency was 165 d(range 83-315). Laboratory tests for cholestasis significantly improved after procedure: mean total bilirubin decreased from 15.2 ± 6.0 mg/d L to 1.3 ± 0.4 mg/d L(P < 0.001);mean γGT decreased from 1389 ± 832 U/L to 114.6 ± 53.5 U/L(P < 0.001). One periprocedural complication was reported. Stent-related complications were observed in 5 patients(27.7%), including 1 occlusion(5.5%) and 1 stent migration(5.5 %).CONCLUSION Percutaneous hilar bifurcation biliary stenting with the MCS resulted in excellent clinical and technical success rates, with acceptable complication rates. Further studies are needed to confirm these initial positive results.

关键词： Malignant hilar biliary obstructions Hilar cholangiocarcinoma Self-expandable metallic stent Stent-in-stent technique Percutaneous approach Bilateral Y-stenting

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Navigated liver surgery:State of the art and future perspectives

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 226-233页

作者： Paschalis Gavriilidis Bjørn Edwin Egidijus Pelanis Ernest Hidalgo Nicola de’Angelis riccardo memeo Luca Aldrighetti Robert P Sutcliffe Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustB152THUK The Intervention Centre and Department of HPB Surgery Oslo University Hospital and Faculty of MedicineUniversity of OsloOsloNorway Department of Hepato-Pancreatico-Biliary Surgery and Transplantation Hospital Universitari Vall d’HebronBarcelonaSpain Department of Digestive Surgery University Hospital Henri Mondor(AP-HP)94010 Creteil and University of Paris EstCreteilFrance Department of Hepatobiliary and Pancreatic Surgery Miulli HospitalAcquaviva delle FontiBari 70021Italy Division of Hepatobiliary Surgery San Raffaele HospitalVia Olgettina 60Milan 20132Italy

Background:In recent years,the development of digital imaging technology has had a significant influence in liver *** ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital *** combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(Pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)***:Fifty-one pertinent articles were retrieved and *** different types of digital imaging technologies and the real-time navigated liver surgery were estimated and ***:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of ***,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor *** liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s live

关键词： Navigated Hepatic surgery 3D Computer assistance Image guidance Image guided surgery Indocyanine green 3D print Visual simulation Virtual reality Augmented reality Real-time navigated liver surgery

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Worldwide management of hepatocellular carcinoma during the COVID-19 pandemic

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World Journal of Gastroenterology 2021年第25期27卷 3780-3789页

作者： riccardo Inchingolo Fabrizio Acquafredda Michele Tedeschi Letizia Laera Gianmarco Surico Alessia Surgo Alba Fiorentino Stavros Spiliopoulos Nicola de'Angelis riccardo memeo Department of Interventional Radiology Unit “F.Miulli”General Regional HospitalAcquaviva delle Fonti 70021BariItaly Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”General Regional HospitalAcquaviva delle Fonti 70124BariItaly Gianmarco Surico Department of Oncology“F.Miulli”General Regional HospitalAcquaviva delle Fonti 70021BariItaly Department of Radiation Oncology “F.Miulli”General Regional HospitalAcquaviva delle Fonti 70021BariItaly Department of 2^(nd)Radiology National and Kapodistrian University of AthensAthens 12461Greece Unit of Minimally Invasive and Robotic Digestive Surgery “F.Miulli”General Regional HospitalAcquaviva delle Fonti 70021BariItaly

The coronavirus disease 2019(COVID-19)pandemic has impacted hospital organization,with the necessity to quickly react to face the *** management of the oncological patient has been modified by necessity due to different allocation of nurses and doctors,requiring new strategies to guarantee the correct assistance to the *** carcinoma,considered as one of the most aggressive types of liver cancer,has also required a different management during this period in order to optimize the management of patients at risk for and with this *** aim of this document is to review recommendations on hepatocellular carcinoma surveillance and management,including surgery,liver transplantation,interventional radiology,oncology,and *** and guidelines from the main scientific societies worldwide regarding the management of hepatocellular carcinoma during the COVID-19 pandemic were reviewed.

关键词： Hepatocellular carcinoma Interventional radiology Oncology Liver Management COVID-19

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Optimization of the future remnant liver:review of the current strategies in Europe

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 350-363页

作者： riccardo memeo Maria Conticchio Emmanuel Deshayes Silvio Nadalin Astrid Herrero Boris Guiu Fabrizio Panaro Division of Hepato-Pancreato-Biliary Surgery Department of Surgery“F.Miulli”General HospitalAcquaviva delle FontiBariItaly Policlinico di Bari Aldo Moro UniversityBariItaly Department of Nuclear Medicine Institute du Cancer de Montpellier(ICM)MontpellierFrance INSERM U1194 Montpellier Cancer Research InstituteMontpellier UniversityMontpellierFrance Department of General Visceral and Transplant SurgeryUniversity Hospital TübingenGermany Department of Surgery Division of HBP Surgery and Liver TransplantationSt-Eloi University HospitalMontpellierFrance Department of Radiology St-Eloi University HospitalMontpellierFrance

Liver resection still represent the treatment of choice for liver malignancies,but in some cases inadequate future remnant liver(FRL)can lead to post hepatectomy liver failure(PHLF)that still represents the most common cause of death after *** strategies in recent era have been developed in order to generate a compensatory hypertrophy of the FRL,reducing the risk of post hepatectomy liver *** vein embolization,portal vein ligation,and ALLPS are the most popular techniques historically adopted up to *** liver venous deprivation and the radio-embolization are the most recent promising *** even more precise tools to calculate the relationship among volume and function,such as scintigraphy with^(99m)Tc-mebrofenin(HBS),no consensus is still available to define which of the above mentioned augmentation strategy is more adequate in terms of kind of surgery,complexity of the pathology and quality of liver *** aim of this article is to analyse these different strategies to achieve sufficient FRL.

关键词： Liver resection future remnant liver(FRL) liver failure liver volume liver function hypertrophy

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Non-surgical treatment of hilar cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2021年第11期13卷 1696-1708页

作者： riccardo Inchingolo Fabrizio Acquafredda Valentina Ferraro Letizia Laera Gianmarco Surico Alessia Surgo Alba Fiorentino Stefania Marini Nicola de'Angelis riccardo memeo Stavros Spiliopoulos Interventional Radiology Unit "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70124Italy Unit of Hepato-Pancreatic-Biliary Surgery "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Department of Oncology "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Department of Radiation Oncology "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Department of Radiology "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Unit of Minimally Invasive and Robotic Digestive Surgery "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy 2^(nd) Department of Radiology School of MedicineNational and Kapodistrian University of AthensAthens 12461Greece

Cancer of the biliary confluence also known as hilar cholangiocarcinoma(HC)or Klatskin tumor,is a rare type of neoplastic disease constituting approximately 40%-60%of intrahepatic malignancies,and 2% of all *** prognosis is extremely poor and the majority of Klatskin tumors are deemed unresectable upon *** patients with unresectable bile duct cancer die within the first year after diagnosis,due to hepatic failure,and/or infectious complications secondary to biliary *** treatments include surgical resection and liver transplantation in highly selected ***,very few patients are eligible for surgery or transplant at the time of *** patients with unresectable HC,radiotherapy,chemotherapy,photodynamic therapy,and liver-directed minimally invasive procedures such as percutaneous image-guided ablation and intra-arterial chemoembolization are recommended treatment *** review focuses on currently available treatment options for unresectable HC and discusses future perspectives that could optimize outcomes.

关键词： Cholangiocarcinoma Interventional radiology Oncology Liver Radiotherapy Ablation

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Current status of non-surgical treatment of locally advanced pancreatic cancer

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2064-2075页

作者： Stavros Spiliopoulos Maria Teresa Zurlo Annachiara Casella Letizia Laera Giammarco Surico Alessia Surgo Alba Fiorentino Nicola de'Angelis Roberto Calbi riccardo memeo riccardo Inchingolo 2nd Radiology Department Interventional Radiology UnitNational and Kapodistrian University of AthensAthens 12461Greece Interventional Radiology Unit “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Department of Oncology General Regional Hospital“F.Miulli”Acquaviva delle Fonti 70021Italy Department of Radiation Oncology “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Unit of Minimally Invasive and Robotic Digestive Surgery “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Department of Radiology General Regional Hospital“F.Miulli”Acquaviva delle Fonti 70021Italy

Pancreatic cancer is the 7th leading cause of death due to cancer in industrializedcountries and the 11th most common cancer globally, with 458918 new cases (2.5%of all cancers) and 432242 deaths (4.5% of all cancer deaths) in 2018. Unfortunately,80% to 90% of the patients present with unresectable disease, and thereported 5-year survival rate range between 10% and 25%, even after successfulresection with tumor-free margins. Systemic chemotherapy, radiotherapy, andminimally invasive image-guided procedures that have emerged over the pastyears, are used for the management of non-operable PC. This review focuses oncurrently available non-surgical options of locally advanced pancreatic cancer.

关键词： Interventional radiology Oncology Radiotherapy Pancreatic cancer Ablation

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Vascular complications following liver transplantation:Aliterature review of advances in 2015

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World Journal of Hepatology 2016年第1期8卷 36-57页

作者： Tullio Piardi Martin Lhuaire Onorina Bruno riccardo memeo Patrick Pessaux Reza Kianmanesh DanieleSommacale Department of General Digestive and Endocrine SurgeryHôpital Robert DebréCentre Hospitalier Universitaire de ReimsUniversitéde Reims Champagne-Ardenne51100 ReimsFrance Department of Radiology Hôpital BeaujonAssistance Publique des Hôpitaux de Paris92110 ClichyFrance Department of Hepato-Biliary and Pancreatic Surgery Nouvel Hôpital Civil67000 StrasbourgFrance

Although vascular complications(VCs) following orthotopic liver transplantation(OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as they compromise the blood flow of the transplant(either inflow or outflow). Diagnosis and therapeutic management of VCs constitute a major challenge in terms of increasing the success rate of liver transplantation. While surgical treatment used to be considered the first choice for management, advances in endovascular intervention have increased to make this a viable therapeutic option. Considering VC as a rare but a major and dreadful issue in OLT history, and in view of the continuing and rapid progress in recent years, an update on these uncommon conditions seemed necessary. In this sense, this review comprehensively discusses the important features(epidemiological, clinical, paraclinical, prognostic and therapeutic) of VCs following OLT.

关键词： Vascular complications Orthotopic livertransplantation Liver transplantation Endovascularintervention

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Hyperthermic intraperitoneal chemotherapy and colorectal cancer:From physiology to surgery

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World Journal of Clinical Cases 2022年第30期10卷 10852-10861页

作者： Giorgio Ammerata Rosalinda Filippo Carmelo Laface riccardo memeo Leonardo Solaini Davide Cavaliere Giuseppe Navarra Girolamo Ranieri Giuseppe Currò Michele Ammendola Department Digestive Surgery UnitUniversity“Magna Graecia”Medical SchoolCatanzaro 88100Italy Interventional Oncology Unit with Integrated Section of Translational Medical Oncology National Cancer Research Centre“Giovanni Paolo Ⅱ”Bari 70124Italy Hepato-Biliary and Pancreatic Surgical Unit “F.Miulli”HospitalAcquaviva delle FontiBari 70124Italy Department of Medical and Surgical Sciences University of BolognaForlì40126Italy Department of General and Oncologic Surgery Morgagni-Pierantoni HospitalForlì47121Italy Department of Human Pathology of Adult and Evolutive Age Surgical Oncology Division“G.Martino”HospitalUniversity of MessinaMessina 98122Italy

The pursuit of this paper is to collect principal reviews and systematic reviews about hyperthermic intraperitoneal chemotherapy(HIPEC) and cytoreductive surgery(CRS) used in colorectal cancer(CRC).We focus on principal biological aspects of CRC,hyperthermia effects,and surgical *** searched PubMed/MEDLINE for the principal reviews and systematic reviews published from 2010 to 2021 regarding the bimodal treatment(CRS + HIPEC) against local and advanced *** the literature,from several studies,it seems that the efficacy of bimodal treatment with an accurate CRS can extend overall *** these studies,there are not still any straight guidelines more detailed and scheduled about the use of combined treatment in patients with *** if the concept is still not very clear and shared,after a careful evaluation of the published data,and after some technical and pathophysiological descriptions,we concluded that it is possible to improve the overall survival and quality of life and to reduce the tumor relapse in patients affected by locally advanced(pT4) CRC with peritoneal metastases.

关键词： Hyperthermic intraperitoneal chemotherapy Colorectal cancer Peritoneum Cytoreductive surgery

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