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Hepatobiliary Surgery and Nutrition 2020年第1期9卷 59-61页

作者： rodolfo sacco Antonio Facciorusso Gastroenterology Unit Department of Medical SciencesUniversity of FoggiaFoggiaItaly

In spite of the recent improvements in diagnostic and treatment options for hepatocellular carcinoma (HCC) patients, with an increasing number of patients diagnosed in early stage and offered more effective therapies, the high recurrence rates even after radical treatments, such as surgery or radiofrequency ablation, still represent an unsolved issue (1).

关键词： patients hepatocellular treatment

Endotics system vs colonoscopy for the detection of polyps

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World Journal of Gastroenterology 2010年第43期16卷 5452-5456页

作者： Emanuele Tumino rodolfo sacco Marco Bertini Michele Bertoni Giuseppe Parisi Alfonso Capria Operative Unit of Gastroenterology and Metabolic Diseases Department of Gastroenterology Pisa University Hospital Institute of Internal Medicine University of Foggia

AIM: To compare the endotics system (ES), a set of new medical equipment for diagnostic colonoscopy, with video-colonoscopy in the detection of polyps. METHODS: Patients with clinical or familial risk of colonic polyps/carcinomas were eligible for this study. After a standard colonic cleaning, detection of polyps by the ES and by video-colonoscopy was performed in each patient on the same day. In each single patient, the assessment of the presence of polyps was performed by two independent endoscopists, who were randomly assigned to evaluate, in a blind fashion, the presence of polyps either by ES or by standard colonoscopy. The frequency of successful procedures (i.e. reaching to the cecum), the time for endoscopy, and the need for sedation were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ES were also calculated. RESULTS: A total of 71 patients (40 men, mean age51.9 ± 12.0 years) were enrolled. The cecum was reached in 81.6% of ES examinations and in 94.3% of colonoscopies (P = 0.03). The average time of endoscopy was 45.1 ± 18.5 and 23.7 ± 7.2 min for the ES and traditional colonoscopy, respectively (P < 0.0001). No patient required sedation during ES examination, compared with 19.7% of patients undergoing colonoscopy (P < 0.0001). The sensitivity and specificity of ES for detecting polyps were 93.3% (95% CI: 68-98) and 100% (95% CI: 76.8-100), respectively. PPV was 100% (95% CI: 76.8-100) and NPV was 97.7% (95% CI: 88-99.9). CONCLUSION: The ES allows the visualization of the entire colonic mucosa in most patients, with good sensitivity/specificity for the detection of lesions and without requiring sedation.

关键词： Colonoscopy Diagnosis Endotics system Polyps Sedation

Transarterial chemoembolization as adjuvant treatment after surgery: The cure of huge hepatocellular carcinoma?

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Hepatobiliary & Pancreatic Diseases International 2021年第3期20卷 205-206页

作者： Andrea Chierici Andrew Ofosu Ivan Cincione rodolfo sacco Christian Cotsoglou Antonio Facciorusso General Surgery Department ASST-VimercateVimercate 20871Italy Division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCA 94305United States Department of Clinical and Experimental Medicine University of FoggiaFoggia 71122Italy Department of Surgical and Medical Sciences Gastroenterology UnitUniversity of FoggiaViale Pinto1Foggia 71122Italy

Hepatocellular carcinoma(HCC) represents the sixth common cancer and the second leading cause of cancer-related death. Its incidence is higher in Eastern countries. HCC is frequently detected at advanced stage of dise... 详细信息

关键词： mortality cancer surgery

Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma:A cohort study

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World Journal of Gastroenterology 2009年第15期15卷 1843-1848页

作者： rodolfo sacco Marco Bertini Pasquale Petruzzi Michele Bertoni Irene Bargellini Giampaolo Bresci Graziana Federici Luigi Gambardella Salvatore Metrangolo Giuseppe Parisi Antonio Romano Antonio Scaramuzzino Emanuele Tumino Alessandro Silvestri Emanuele Altomare Claudio Vignali Alfonso Capria Gastroenterology Department Pisa University Hospital Institute of Interna Medicine University of Foggia Department of Diagnostic and Interventional Radiology Pisa University Hospital

AIM:To prospectively evaluate the short and long term clinical impact of selective transarterial chemoembolization (TACE) on liver function in patients with hepatocellular carcinoma (HCC).To assess side effects in relation to *** analyze the overall survival and HCC progression free survival probability. METHODS:One hundred and seventeen cirrhotic patients with HCC were *** liver function included Child-Pugh score and serum levels of alanineaminotransferase (ALT),prothrombin time(PT)and *** to Cancer Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer (BCLC) staging systems,71 patients were eligible for TACE; 32 had previously received treatment for *** significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the *** hospitalized, patient sunder went clinical,hematologicand ultrasonographic *** month after TACE a CT scan was performed to assess tumor response. A second TACE was performed"on demand".Liver function tests were checked in all patients every four ***:After first TACE,the mean Child-Pugh score increased from a mean baseline 5.62±1.12 to 6.11±1.57 at discharge time (P<0.0001),decreasing after four months to 5.81±0.73 (not significant).ALT,PT and bilirubin significantly (P<0.0001)increased 24 h after TACE and progressively decreased until discharge. After the second TACE,variations in Child-Pugh score,ALT,PT and bilirubin were comparable to that described after the first *** major complications were *** mean follow-up was 14.7±6.3 mo (median:16 mo).Only one patient *** other patient experienced important long term worsening of clinical *** overall survival probability at twenty-four months was 98.18%with a correspondent HCC progression free survival probability of 69%. CONCLUSION:Selectiv TAC Emayproduce significant,but tra

关键词：肝动脉化疗栓塞术肝癌患者临床表现队列研究血清丙氨酸转氨酶肝动脉栓塞化疗肝功能试验肝硬化患者

Beneficial and detrimental effects of natural dietary products on the risk of hepatocellular carcinoma, and their roles in its management

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Hepatoma Research 2016年第1期2卷 53-61页

作者： rodolfo sacco Caterina Conte Sara Marceglia Valeria Mismas Giampaolo Bresci Antonio Romano Roberto Eggenhoffner Luca Giacomelli Department of Gastroenterology Cisanello University Hospital56127 PisaItaly Endocrinology and Metabolic Disease UniversitàCattolica del Sacro Cuore00168 RomeItaly Department of Engineering University of Trieste34100 TriesteItaly Department of Surgical Sciences and Integrated Diagnostics School of MedicineUniversity of Genoa16163 GenoaItaly

Hepatocellular carcinoma(HCC)is a common solid malignancy and a leading cause of cancer-related death *** mechanisms underlying the pathogenesis and development of HCC are complex and *** mainly related to hepatitis B and C chronic infection;HCC may also arise from diet-associated conditions such as non-alcoholic fatty liver disease and non-alcoholic ***,toxins and nutrients such as mycotoxins and alcohol have an established role in the pathogenesis of chronic liver diseases,whereas specific diet patterns or foods have been associated with a reduction in HCC *** aim of this review is to provide a thorough overview of the clinically relevant effects-either beneficial or detrimental-of natural products consumed by humans on HCC risk and management.

关键词： Hepatocellular carcinoma natural products diet dietary supplements

Management of hepatocellular carcinoma in the elderly

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World Journal of Hepatology 2015年第11期7卷 1521-1529页

作者： Mauro Borzio Elena Dionigi Giancarlo Parisi Ivana Raguzzi rodolfo sacco Unità di Gastroenterologia Azienda Ospedaliera di Melegnano Dipartimento di Medicina Ospedale Santa Maria del Prato Unità di Gastroenterologia Ospedale Cisanello

Mean age of hepatocellular carcinoma(HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under- or no-treatment of aged patients should not be longer justified.

关键词： Hepatocarcinoma Epidemiology Cirrhosis Elderly Treatment

Pulmonary or otolaryngologic extraesophageal manifestations in patients with gastroesophageal reflux disease

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World Journal of Gastrointestinal Endoscopy 2010年第2期2卷 47-49页

作者： Giampaolo Bresci rodolfo sacco Gastroenterology Department Cisanello Pisa University Hospital Pisa 56124 Italy Institute of Internal Medicine University of Foggia Viale Pinto Foggia 71100 Italy

The extraesophageal manifestations of gastroesophageal reflux disease that are similar to a heart attack or gastric diseases are well known, while those categorized as pulmonary or otolaryngological are less known and... 详细信息

关键词： Gastroesophageal reflux Extraesophageal symptoms Gastroesophageal reflux disease

Assessment of clinical and radiological response to sorafenib in hepatocellular carcinoma patients

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World Journal of Hepatology 2015年第1期7卷 33-39页

作者： rodolfo sacco Valeria Mismas Antonio Romano Marco Bertini Michele Bertoni Graziana Federici Salvatore Metrangolo Giuseppe Parisi Emanuele Tumino Giampaolo Bresci Luca Giacomelli Sara Marceglia Irene Bargellini Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio Azienda Ospedaliero Universitaria Pisana56124 PisaItaly Dipartimento di Elettronica Informazione e BioingegneriaPolitecnico di Milano20100 MilanItaly Dipartimento di Radiologia-Azienda Ospedaliero Universitaria Pisana 56124 PisaItaly

Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.

关键词： Hepatocellular carcinoma Sorafenib ResponseEvaluation Criteria in Solid Tumors Perfusioncomputed tomography Dynamic Contrast-Enhanced-UltraSound Volumetric assessment

Transarterial radioembolization for hepatocellular carcinoma:An update and perspectives

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World Journal of Gastroenterology 2015年第21期21卷 6518-6525页

作者： rodolfo sacco Valeria Mismas Sara Marceglia Antonio Romano Luca Giacomelli Marco Bertini Graziana Federici Salvatore Metrangolo Giuseppe Parisi Emanuele Tumino Giampaolo Bresci Ambra Corti Manuel Tredici Michele Piccinno Luigi Giorgi Carlo Bartolozzi Irene Bargellini Department of Gastroenterology Pisa University Hospital Department of Electronics Information technology and BioengineeringEngineering School of Milan Department of Nuclear Medicine Pisa University Hospital Division of Health Physics Pisa University Hospital Department of Radiology Pisa University Hospital

In the last decade trans-arterial radioembolization has given promising results in the treatment of patients with intermediate or advanced stage hepatocellular carcinoma(HCC),both in terms of disease control and tolerability *** technique consists of the selective intra-arterial administration of microspheres loaded with a radioactive compound(usually Yttrium90),and exerts its therapeutic effect through the radiation carried by these microspheres.A careful and meticulous selection of patients is crucial before performing the radioembolization to correctly perform the procedure and reduce the incidence of *** is a technically complex and expensive technique,which has only recently entered clinical practice and is supported by scant results from phase Ⅲ clinical ***,it may represent a valid alternative to transarterial chemoembolization(TACE) in the treatment of intermediate-stage HCC patients,as shown by a comparative retrospective assessment that reported a longer time to progression,but not of overall survival,and a more favorable safety profile for *** addition,this treatment has reported a higher percentage of tumor shrinkage,if compared to TACE,for pre-transplant downsizing and it represents a promising therapeutic option in patients with large extent of disease and insufficient residual liver volume who are not immediately eligible for *** might also be a suitable companion to sorafenib in advanced HCC or it can be used as a potential alternative to this treatment in patients who are not responding or do not tolerate sorafenib.

关键词： Hepatocellular carcinoma Radioembolization Transarterial chemoembolization Sorafenib Staging RECIST, Modified RECIST Downsizing Clinical trial

Clinical epidemiology of chronic viral hepatitis B:A Tuscany real-world large-scale cohort study

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World Journal of Hepatology 2018年第5期10卷 409-416页

作者： Cristina Stasi Caterina Silvestri Roberto Berni Maurizia Rossana Brunetto Anna Linda Zignego Cristina Orsini Stefano Milani Liana Ricciardi Andrea De Luca Pierluigi Blanc Cesira Nencioni Donatella Aquilini Alessandro Bartoloni Giampaolo Bresci Santino Marchi Franco Filipponi Piero Colombatto Paolo Forte Andrea Galli Sauro Luchi Silvia Chigiotti Alessandro Nerli Giampaolo Corti rodolfo sacco Paola Carrai Angelo Ricchiuti Massimo Giusti Paolo Almi Andrea Cozzi Silvia Carloppi Giacomo Laffi Fabio Voller Francesco Cipriani Observatory of Epidemiology Regional Health Agency of TuscanyFlorence 50141Italy Center for Systemic Manifestations of Hepatitis Viruses(MaSVE) Internal Medicine and Liver UnitDepartment of Experimental and Clinical MedicineCareggi University HospitalFlorence 50134Italy Web Solutions Data Visualization and Scientific DocumentationRegional Health Agency of TuscanyFlorence 50141Italy Hepatology Unit Department of Clinical and Experimental MedicineUniversity Hospital of PisaPisa 56100Italy Gastroenterology Research Unit Department of Experimental and Clinical Biomedical Sciences“Mario Serio”Careggi University HospitalFlorence 50134Italy Infectious Disease Unit Hospital of LuccaLucca 55100Italy Infectious Diseases Unit Department of Medical BiotechnologiesSiena University HospitalSiena 53100Italy Infectious Disease Unit “S.Maria Annunziata”HospitalPonte a Niccheri 50012Italy Infectious Disease Unit Hospital of GrossetoGrosseto 58100Italy Infectious Disease Unit Hospital of PratoPrato 59100Italy Infectious and Tropical Diseases Unit Department of Experimental and Clinical MedicineCareggi University HospitalFlorence 50134Italy Gastroenterology and Metabolic Disorders Department of SurgeryCisanello University HospitalPisa 56100Italy Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and SurgeryCisanello University Hospital of PisaPisa 56100Italy Liver Surgery and Transplantation Unit Department of Surgical PathologyMedicineMolecular and Critical AreaCisanello University HospitalPisa 56100Italy Internal Medicine Unit “San Jacopo”HospitalPistoia 51100Italy Infectious Diseases and Hepatology Unit Department of Internal and Specialized MedicineUniversity Hospital of SienaSiena 53100Italy Gastroenterology Unit San Giuseppe HospitalEmpoli 50053Italy Internal Medicine and Liver Unit Department of Experimental and Clinical MedicineCareggi University HospitalFlorence 50135Italy Department of Prevention Central Tuscany Local UnitFlorence 5

AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care *** This study used a cross-sectional cohort design. We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units. Information in the case report forms included main demographic data, blood chemistry data, viral hepatitis markers, instrumental evaluations, and eligibility for treatment or ongoing therapy and liver transplantation. RESULTS Of 4015 chronic viral hepatitis patients, 1096(27.3%) were HBV infected. The case report form was correctly completed for only 833 patients(64% males, 36% females; mean age 50.1 ± 15.4). Of these HBV-infected patients, 73% were Caucasian, 21% Asian, 4% Central African, 1% North African and 1% American. Stratifying patients by age and nationality, we found that 21.7% of HBV-infected patients were aged < 34 years(only 2.8% were Italian). The most represented routes of transmission were nosocomial/dental procedures(23%), mother-to-child(17%) and sexual transmission(12%). The most represented HBV genotypes were D(72%) and A(14%). Of the patients, 24.7% of patients were HBe Ag positive, and 75.3% were HBe Ag negative. Of the HBV patients 7% were anti-HDV positive. In the whole cohort, 26.9% were cirrhotic(35.8% aged < 45 years), and 47% were eligible for or currently undergoing treatment, of whom 41.9 % were cirrhotic. CONCLUSION Only 27.3% of chronic viral hepatitis patients were HBV infected. Our results provide evidence of HBV infection in people aged < 34 years, especially in the foreign population not protected by vaccination. In our cohort of patients, liver cirrhosis was also found in young adults.

关键词： Hepatitis B virus infection Liver fibrosis Cirrhosis Public health Epidemiology