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| 1 | Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria显示文摘BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or RFA.METHODS The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European centers.Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox regression.RESULTS After PSM,we compared 136 patients in the LR group with 136 patients in the RFA group.Overall survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence rate.CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria. | Maria Conticchio Riccardo Inchingolo Antonella Delvecchio Letizia Laera Francesca Ratti Maximiliano Gelli Ferdinando Anelli Alexis Laurent Giulio Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de'Angelis Javier Briceño AntonioRampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo | 2021 | World Journal of Gastroenterology2021，27，18： | 4 |
| 2 | Hilar Cholangiocarcinoma: Preoperative Liver Optimization with Multidisciplinary Approach. Toward a Better Outcome显示文摘 | Francesca Ratti Federica Cipriani Fabio Ferla Marco Catena Michele Paganelli Luca A. M. Aldrighetti | 2013 | World Journal of Surgery2013，，6： | 2 |
| 3 | LESS technique for liver resection: the progress of the mini-invasive approach: A single-centre experience显示文摘 | Federica Cipriani Marco Catena Francesca Ratti Michele Paganelli Fabio Ferla Luca Aldrighetti | 2012 | Minimally Invasive Therapy & Allied Technologies2012，，1： | 1 |
| 4 | Laparoendoscopic single site (LESS) surgery for left-lateral hepatic sectionectomy as an alternative to traditional laparoscopy: case-matched analysis from a single center显示文摘 | Luca Aldrighetti Francesca Ratti Marco Catena Carlo Pulitanò Fabio Ferla Federica Cipriani Gianfranco Ferla | 2012 | Surgical Endoscopy2012，，： | 1 |
| 5 | Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients显示文摘BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma.The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.AIM To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.METHODS A retrospective multicentric study was performed enrolling 77 patients age≥70-years-old with single hepatocellular carcinoma(≤30 mm),located in posterosuperior segments(4a,7,8).Patients were divided into liver resection and radiofrequency ablation groups and preoperative,peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.RESULTS After propensity score matching,twenty-six patients were included in each group.Operative time and overall postoperative complications were higher in the resection group compared to the ablation group(165 min vs 20 min,P<0.01;54%vs 19%P=0.02 respectively).A median hospital stay was significantly longer in the resection group than in the ablation group(7.5 d vs 3 d,P<0.01).Ninety-day mortality was comparable between the two groups.There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1,3,and 5 years.CONCLUSION Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay,better quality of life and does not modify the overall and disease-free survival. | Antonella Delvecchio Riccardo Inchingolo Rita Laforgia Francesca Ratti Maximiliano Gelli Massimiliano Ferdinando Anelli Alexis Laurent Giulio Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de'Angelis Javier Briceño Antonio Rampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo | 2021 | World Journal of Gastrointestinal Surgery2021，13，12： | 1 |
| 6 | Improving performance of robotic liver resections with high technical complexity by Robo-Lap approach显示文摘Introduction The hybrid robotic-laparoscopic technique has been described-in the field of hepatic surgery-in order to overcome procedural challenges related to the lack of the robotic ultrasonic dissector(1-4):Robo-Lap approach hence combines the use of the robotic platform(specifically robotic bipolar forceps for coagulation and scissors)with the laparoscopic dissector handled by the surgeon at the table. | Francesca Ratti Rebecca Marino Luca Aldrighetti | 2023 | Hepatobiliary Surgery and Nutrition2023，12，6： | 0 |
| 7 | Peri-operative score for elderly patients with resectable hepatocellular carcinoma显示文摘BACKGROUND Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma(HCC),also in elderly population.Despite this,the evaluation of patient condition,liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality.AIM To identify new perioperative risk factors that could be associated with higher 90-and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score.METHODS A multicentric,retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC;several independent variables correlated with death from all causes at 90 and 180 d were studied.The coefficients of Cox regression proportional-hazards model for sixmonth mortality were rounded to the nearest integer to assign risk factors'weights and derive the scoring algorithm.RESULTS Multivariate analysis found variables(American Society of Anesthesiology score,high rate of comorbidities,Mayo end stage liver disease score and size of biggest lesion)that had independent correlations with increased 90-and 180-d mortality.A clinical risk score was developed with survival profiles.CONCLUSION This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality. | Maria Conticchio Riccardo Inchingolo Antonella Delvecchio Francesca Ratti Maximiliano Gelli Massimiliano Ferdinando Anelli Alexis Laurent Giulio Cesare Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de'Angelis Javier Briceño Antonio Rampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo | 2023 | World Journal of Hepatology2023，15，12： | 0 |
| 8 | Have we really understood when the efforts of laparoscopic liver resection are justified?-a complexity-based appraisal of the differential benefit显示文摘Background:The implementation of minimally invasive liver resection surgery(MILS)programs starts from procedures with a low degree of technical difficulty.Data regarding the real short-term advantage of laparoscopy according to technical difficulty are still lacking.The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always justified.Methods:Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity(low,intermediate and high difficulty)and to approach(MILS or open)and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups(Pair 1:Low-MILS and Low-Open,including 274 cases respectively;Pair 2:Int-MILS and Int-Open,including 237 patients respectively;Pair 3:High-MILS and High-Open,including 226 patients respectively).Results:MILS approach resulted in a statistically significant lower blood loss,reduced morbidity,reduced and shorter time for functional recover and length of stay within all pairs.The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree,both in terms of blood loss(-250 and-200 mL respectively)and morbidity rate(-5.7%and-4.1%respectively).Conclusions:The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures.The commitment towards MILS approach should be therefore stronger in this setting,where the advantage of laparoscopy seems to be enhanced. | Francesca Ratti Federica Cipriani Guido Fiorentini Marco Catena Michele Paganelli Luca Aldrighetti | 2022 | Hepatobiliary Surgery and Nutrition2022，11，3： | 0 |
| 9 | Impact of body mass index in elderly patients treated with laparoscopic liver resection for hepatocellular carcinoma显示文摘BACKGROUND The impact of obesity on surgical outcomes in elderly patients candidate for liver surgery is still debated.AIM To evaluate the impact of high body mass index(BMI)on perioperative and oncological outcome in elderly patients(>70 years old)treated with laparoscopic liver resection for hepatocellular carcinoma(HCC).METHODS Retrospective multicenter study including 224 elderly patients(>70 years old)operated by laparoscopy for HCC(196 with a BMI<30 and 28 with BMI≥30),observed from January 2009 to January 2019.RESULTS After propensity score matching,patients in two groups presented comparable results,in terms of operative time(median range:200 min vs 205 min,P=0.7 respectively in non-obese and obese patients),complications rate(22%vs 26%,P=1.0),length of hospital stay(median range:4.5 d vs 6.0 d,P=0.1).There are no significant differences in terms of short-and long-term postoperative results.CONCLUSION The present study showed that BMI did not impact perioperative and oncologic outcomes in elderly patients treated by laparoscopic resection for HCC. | Maria Conticchio Riccardo Inchingolo Antonella Delvecchio Francesca Ratti Maximiliano Gelli Massimiliano Ferdinando Anelli Alexis Laurent Giulio Cesare Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de’Angelis Javier Briceño Antonio Rampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo | 2023 | World Journal of Gastrointestinal Surgery2023，15，1： | 0 |
| 10 | Liver resection for hepatocellular carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach显示文摘Aim:The study was designed to assess the implications of enhanced recovery after surgery(ERAS)approach in patients submitted to open liver resection for hepatocellular carcinoma(HCC)comparing their short term outcome with patients treated by laparoscopic approach,in a case-matched design.Methods:The open-group(n=60)was matched in a ratio of 1:1 with patients undergoing laparoscopic liver resection for HCC(Lap-group,n=60),with a matching achieved on a basis of propensity scores including 6 covariates representing patients characteristics and severity of the disease.Primary outcome analysis was performed in terms of ERAS-specific items and postoperative morbidity and mortality.Results:Overall morbidity and mortality were comparable between groups.Incidence of ascites was slightly higher in the open-compared with the Lap-group(respectively 11.7%and 13.3%),without statistical significance.The need for introduction or increase of chronic diuretic therapy was significantly higher in the open-compared with the Lap-group(16.7%vs.11.7%,P=0.046).Furthermore,ascites more frequently required percutaneous drainage in the open-compared with the Lap-group(5%vs.1.7%respectively,P=0.041).Conclusion:In patients who can’t benefit from minimally-invasive approach because of disease characteristics,ERAS management seems to be associated with an improved postoperative functional recovery and postoperative outcomes,comparable to those of the minimally invasive approach. | Francesca Ratti Federica Cipriani Raffaella Reineke Marco Catena Michele Paganelli Luigi Beretta Luca Aldrighetti | 2016 | Hepatoma Research2016，2，1： | 0 |
| 11 | Vascular occlusion to protect against intraoperative blood loss in liver surgeries: new perspectives on a traditional technique显示文摘The correlation between decreased blood loss and improved clinical and oncological outcomes has been described in liver surgery:considering that perioperative blood transfusions are associated with a higher rate of recurrence and lower survival after resection of colorectal liver metastases and hepatocellular carcinoma,any effort to address the task of bleeding control and reduce the need for blood transfusions is of outstanding importance(1). | Francesca Ratti Alessandro Nini Roberto Bertini Luca Aldrighetti | 2021 | Hepatobiliary Surgery and Nutrition2021，10，4： | 0 |
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