December 2024
·
43 Reads
Pancreatology
This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.
December 2024
·
43 Reads
Pancreatology
October 2024
·
273 Reads
·
1 Citation
BJS (British Journal of Surgery)
August 2024
·
63 Reads
Updates in Surgery
The extension of liver transplantation to new oncologic indications might exacerbate the shortage of grafts. Living donor liver transplantation (LDLT) may emerge as a viable resource, although its diffusion in the Western world is still very limited. Several groups have advocated for minimizing the impact on donors by reducing the extent of donor hepatectomy, i.e., shifting from right-lobe to left-lobe or left-lateral segment donation (“shift-to-left”). This is particularly relevant when dealing with non-established indications and could make it more acceptable both for potential donors and for the recipients. Left grafts can be transplanted straightforward, despite a higher risk of small-for-size syndrome, or they can be used in the setting of dual-graft LDLT or RAPID procedures, despite technical complexity. This review will expose the most relevant features of each technique, highlighting their strengths and pitfalls and focusing on outcomes. This wide set of tools should be available at high-volume transplant centers, to propose the best technique to adapt to donor–recipient matching.
June 2024
·
64 Reads
Transplantology
Bacterial infections are a common complication in patients with decompensated liver cirrhosis. The complex landscape of cirrhosis, characterized by immune paralysis and an exhausted response to exogenous triggers, explains the higher prevalence of such infections, particularly in advanced disease stages. In clinical practice, the onset of a bacterial infection can lead to further deterioration of hepatic and extra-hepatic function, potentially resulting in acute decompensation or acute-on-chronic liver failure. This has significant clinical implications, particularly for patients awaiting a transplant. In this review, we will discuss the latest evidence on the diagnosis and therapy of bacterial infections in patients with decompensated cirrhosis. Additionally, we will analyze the impact of bacterial infections in the context of liver transplantation, discussing debated topics such as the timing of transplantation in patients with infections, potential implications for prioritization, effects on post-operative recovery, grafts, and patient survival.
June 2024
·
33 Reads
·
2 Citations
Updates in Surgery
Bacterial infections pose a life-threatening complication in patients with decompensated liver cirrhosis and acute-on-chronic liver failure. An increasing prevalence of infections caused by multidrug-resistant organisms (MDROs) has been observed in these patients, significantly impacting prognosis. A growing body of evidence has identified the most common risk factors for such infections, enabling the development of preventive strategies and therapeutic interventions. MDRO infections may also occur after liver transplantation (most commonly in the early post-operative phase), affecting both graft and patient survival. This review provides an overview of MDRO infections before and after liver transplantation, discussing epidemiological aspects, risk factors, prevention strategies, and novel therapeutic approaches. Furthermore, it examines the implications of MDRO infections in the context of prioritizing liver transplantation for the most severe patients, such as those with acute-on-chronic liver failure.
May 2024
·
25 Reads
·
5 Citations
Transplantation
Background Split liver transplantation is a valuable means of mitigating organ scarcity but requires significant surgical and logistical effort. Ex vivo splitting is associated with prolonged cold ischemia, with potentially negative effects on organ viability. Machine perfusion can mitigate the effects of ischemia–reperfusion injury by restoring cellular energy and improving outcomes. Methods We describe a novel technique of full-left/full-right liver splitting, with splitting and reconstruction of the vena cava and middle hepatic vein, with dual arterial and portal hypothermic oxygenated machine perfusion. The accompanying video depicts the main surgical passages, notably the splitting of the vena cava and middle hepatic vein, the parenchymal transection, and the venous reconstruction. Results The left graft was allocated to a pediatric patient having methylmalonic aciduria, whereas the right graft was allocated to an adult patient affected by hepatocellular carcinoma and cirrhosis. Conclusions This technique allows ex situ splitting, counterbalancing prolonged ischemia with the positive effects of hypothermic oxygenated machine perfusion on graft viability. The venous outflow is preserved, safeguarding both grafts from venous congestion; all reconstructions can be performed ex situ, minimizing warm ischemia. Moreover, there is no need for highly skilled surgeons to reach the donor hospital, thereby simplifying logistical aspects.
April 2024
·
85 Reads
European Journal of Transplantation
Liver transplantation is emerging as a promising strategy to treat several malignancies, in selected patients. However, expanding the indication for LT to oncologic indication exacerbates the persisting shortage of grafts. Living donor liver transplantation (LDLT) appears as a useful solution to enlarge the donor pool to meet this need. This review aims to comprehensively explore the current indications for LDLT in the context of hepatic malignancies, emphasizing reported outcomes and presenting future perspectives. A particular attention will be devoted to ethical considerations. The review will focus on the role of LDLT for hepatocellular carcinoma (HCC), for intrahepatic and perihilar cholangiocarcinoma (iCCA and pCCA), and for colo-rectal liver metastases (CRLM). Lastly, we will present new techniques of living transplantation using small left lateral grafts, namely RAPID Resection And Partial Liver segment II-III transplantation with Delayed total hepatectomy) and dual-graft transplantation (DG-LDLT).
September 2023
·
68 Reads
·
1 Citation
Cancer of the body-tail of the pancreas often involves adjacent structures. Thus, surgical treatment may be extended to other organs or vessels in order to achieve radical resection. The aim of this study is to evaluate the safety and efficacy of extended distal pancreatectomy for ductal adenocarcinoma of the body and tail of the pancreas. Between January 2000 and December 2016, 101 patients underwent distal pancreatectomy (DP) for pancreatic cancer: 65 patients underwent standard-DP and 36 extended-DP, including the resection of the partial stomach (n = 12), adrenal gland (n = 7), liver (n = 7), colon (n = 8), celiac axis (n = 6), portal vein (n = 5), jejunum (n = 4) and kidney (n = 4). The two groups were compared in terms of their TNM classification, pathological grade, nodal status, state of resection margins, age, sex and levels of preoperative serum carbohydrate antigen 19-9 (CA 19.9). The morbidity and mortality were not statistically different in the two groups. The two groups disease-free and overall survival rates were significantly influenced by the tumor’s stage, nodal status, pathological features and resection margins. Survival was not influenced by the extent of the surgical resection. However, when patients were stratified according to the type of extended resection, survival was worse in the group of patients undergoing vascular resection. Multivariate analysis showed that the stage and resection margins are independent predictors of disease-free and overall survival. Extended distal pancreatectomy may be performed with acceptable morbidity and mortality rates. Survival is not significantly different after standard or extended resection. However, the rate of tumor recurrence is high, and long-term survival is a rare event, especially in those patients who undergo distal pancreatectomy associated with vascular resection.
March 2023
·
74 Reads
European Journal of Transplantation
Hepatobiliary surgical oncology and liver transplantation (LT) surgery have mutually benefited from their technological progresses and technical achievements of the last decade. The application of machine perfusion (MP) to ex-situ hepatectomies allows more patients with primary unresectable tumours to have access to radical treatment. Furthermore, the growing need for liver grafts for transplant purpose engaged surgeons in finding new solutions such as liver splitting during dynamic storage through MP to preserve the possibility of two LTs when in-situ splitting is not feasible.
January 2023
·
94 Reads
·
3 Citations
In the context of spreading interest in textbook outcome (TO) evaluation in different fields, we aimed to investigate an uncharted procedure, that is, laparoscopic microwave ablation (MWA) for hepatocellular carcinoma (HCC). Absence of post-MWA complications, a hospital stay of three days, no mortality nor readmission within 30 days, and complete response of the target lesion at post-MWA CT scan defined TO achievement. Patients treated between January 2014 and March 2021 were retrospectively reviewed, and of the 521 patients eligible for the study, 337 (64.7%) fulfilled all the quality indicators to achieve the TO. The absence of complications was the main limiting factor for accomplishing TO. At multivariable analysis, Child–Pugh B cirrhosis, age of more than 70 years old, three nodules, and MELD score ≥ 15 were associated with decreased probabilities of TO achievement. A score based on these factors was derived from multivariable analysis, and patients were divided into three risk groups for TO achievement. At survival analysis, overall survival (OS) was significantly (p = 0.001) higher in patients who achieved TO than those who did not. Moreover, OS evaluation in the three risk groups showed a trend coherent with TO achievement probability. The present study, having assessed the first TO for laparoscopic MWA for HCC, encourages further broader consensus on its definition and, on its basis, on the development of clinically relevant tools for managing treatment allocation.
... 1 MDRO colonization in this vulnerable population amplifies the risk of infection, 2 which is associated with greater graft loss, longer hospital stays, higher healthcare costs, and increased mortality after transplant. 3 The significance of infection prevention and antibiotic stewardship in curbing the rise and spread of MDRO is widely acknowledged. Moreover, the role of environmental disinfection in the transmission of healthcare-associated infections (HAI) is within this framework. ...
June 2024
Updates in Surgery
... Mabrut and colleagues reported a 2-step technique of ex situ splitting during HOPE in 2 adult donors, resulting in the successful transplantation of 2 pediatric and 2 adult patients [32]. Cillo et al. successfully completed the first reported case of full right-left splitting during DHOPE, demonstrating the safety, feasibility and growing potential of ex situ splitting under hypothermic MP [33]. ...
May 2024
Transplantation
... Recently, an Italian study reported that when textbook outcomes are reached, LA may indeed prove to be a curative therapy [69]. The same study group conducted a large multicenter study (as yet unpublished), comparing three cohorts of patients undergoing pRFA, laparoscopic microwave ablation (LA), or TACE. ...
January 2023
... Significant heterogeneity is observed across various centers with respect to the incidence of positive margins, where rates of R1 resection might vary from 16.7-54.0% [2,8,[14][15][16]. The incidence of positive resection margin in the present study was 37.1%. ...
March 2022
... • Liver transplantation: A recent study revealed that incidence of MetS increased shortly after liver transplantation by 46%, 43%, and 49% at 6, 12, and 24 months, respectively (n = 63). Various MetS components were recorded including the raised levels of blood pressure, insulin, and triglycerides ( Becchetti et al., 2022 ). Accordingly, lifestyle adjustments should be recommended after liver transplantation to control various risk factors. ...
November 2021
Clinical Transplantation