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Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and...
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Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and Beyond

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (26 April 2023) | Viewed by 15755

Special Issue Editors

Prof. Dr. Aldo Rocca

E-Mail Website
Guest Editor
Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
Interests: minimally invasive liver surgery; colorectal liver metastases; geriatric surgery; emergency surgery; robotic surgery
Dr. Gaetano Gallo

E-Mail Website
Guest Editor
Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
Interests: colorectal surgery; cancer; translational research; minimally invasive surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hepatobiliary surgery (HPBs) is one of the most challenging and rapidly expanding surgical fields. In the last twenty years, liver surgery has been completely revolutionized with the introduction, discovery and launch of new ultrasound-guided parenchyma-sparing techniques, new frontiers in transplant indications and minimally invasive approaches.

Furthermore, HPBs require an even deeper relationship with all other medical branches (e.g., radiology, oncology and pathology) which constitute the multidisciplinary team, whose role is crucial in improving patient outcomes.

At the same time, technology is already changing our lives in all fields. It is both subtly and obviously omnipresent. Thanks to the improvement of technology in all fields we are changing our behaviors in the management and indications of liver surgery. Therefore, it is up to us to understand its potential in investigating the new frontiers in all fields, from diagnosis to treatment.

We should investigate these novelties with special attention concerning minimally invasive and robot-assisted liver surgery, integrated oncological therapies and the implications of artificial intelligence, which will improve our knowledge in the near future.

In light of the above, the aim of this Special Issue is to provide a series of state-of-the-art manuscripts, including both original contributions and review articles, concerning HPB surgery.

We will be grateful to all colleagues who decide to contribute to this relevant topic.

Prof. Dr. Aldo Rocca
Dr. Gaetano Gallo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • HPB surgery
  • Liver cancer
  • Minimally invasive liver surgery
  • Colorectal liver metastases
  • Artificial intelligence
  • Translational research

Published Papers (6 papers)

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Research

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20 pages, 4340 KiB  
Article
Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience
by Matteo Pagani, Rosita De Vincenti, Carolina Cecchi, Alice Apollinari, Benedetta Pesi, Francesca Leo, Sandro Giannessi and Massimo Fedi
J. Clin. Med. 2023, 12(6), 2170; https://doi.org/10.3390/jcm12062170 - 10 Mar 2023
Viewed by 1347
Abstract
Introduction: Surgical resection has a fundamental role in increasing the chance of survival in patients with colorectal liver metastases. The guidelines have been modified and expanded in time in order to increase the number of patients that can benefit from this treatment. The [...] Read more.
Introduction: Surgical resection has a fundamental role in increasing the chance of survival in patients with colorectal liver metastases. The guidelines have been modified and expanded in time in order to increase the number of patients that can benefit from this treatment. The aim of this study is to analyze the main prognostic factors related to overall and disease-free survival of a series of consecutive patients undergoing liver resection for colorectal liver metastases (CRLM). Materials and Methods: A retrospective review of patients undergoing liver resection for CRLM between April 2018 and September 2021 was performed. Clinical data and laboratory parameters were evaluated using the log-rank test. OS and DFS were estimated using the Kaplan-Meier method. Results: A retrospective study on 75 patients who underwent liver resection for CRLM was performed. The OS and DFS at 1 and 3 years were 84.3% and 63.8% for OS, 55.6% and 30.7% for DFS, respectively. From the analysis of the data, the most significant results indicate that: patients with a lower CEA value <25 ng/mL had an OS of 93.6% and 80.1% at 1 and 3 years, with an average of 36.7 months (CI 95% 33.1–40.3); moreover, patients with a value equal to or greater than 25 ng/mL had a 1-year survival equal to 57.4%, with an average of 13.8 months (CI 95% 9.4–18.2) (p < 0.001); adjuvant chemotherapy increases by 3 years the overall survival (OS: 68.6% vs. 49.7%) (p = 0.013); localization of the primary tumor affects OS, with a better prognosis for left colon metastases (OS at 42 months: 85.4% vs. 42.2%) (p value = 0.056); patients with stage T1 or T2 cancer have a better 3 years OS (92.9–100% vs. 49.7–56.3%) (p = 0.696), while the N0 stage results in both higher 3 years OS and DFS than the N + stages (OS: 87.5% vs. 68.5% vs. 24.5%); metachronous metastases have a higher 3 years OS than synchronous ones (80% vs. 47.4%) (p = 0.066); parenchymal sparing resections have a better 3 years DFS than anatomical ones (33.7% vs. 0%) (p = 0.067); a patient with a parenchymal R1 resection has a much worse prognosis than an R0 (3 years OS: 0% vs. 68.7%) (p < 0.001). Conclusions: CEA value of less than 25 ng/mL, localization of the primary tumor in the left colon, primary tumor in stage T1/2 and N0, metachronous presentation, R0 resection, fewer than four metastases, and use of adjuvant chemotherapy are all parameters that in our analysis have shown a correlation with a better prognosis; moreover, the evaluation of the series is in line with the latest evidence in the literature in defining the non-inferiority of minimally invasive and parenchymal sparing treatment compared to the classic laparotomic approach with anatomic resection. Full article
(This article belongs to the Special Issue Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and Beyond)
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8 pages, 787 KiB  
Article
The Role of Dual-Energy CT for the Assessment of Liver Metastasis Response to Treatment: Above the RECIST 1.1 Criteria
by Alfonso Reginelli, Mariateresa Del Canto, Alfredo Clemente, Eduardo Gragnano, Fabrizio Cioce, Fabrizio Urraro, Erika Martinelli and Salvatore Cappabianca
J. Clin. Med. 2023, 12(3), 879; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12030879 - 22 Jan 2023
Cited by 1 | Viewed by 1204
Abstract
Imaging assessment of liver lesions is fundamental to predict therapeutic response and improve patient survival rates. Dual-Energy Computed Tomography (DECT) is an increasingly used technique in the oncologic field with many emerging applications. The assessment of iodine concentration within a liver lesion reflects [...] Read more.
Imaging assessment of liver lesions is fundamental to predict therapeutic response and improve patient survival rates. Dual-Energy Computed Tomography (DECT) is an increasingly used technique in the oncologic field with many emerging applications. The assessment of iodine concentration within a liver lesion reflects the biological properties of the tumor and provides additional information to radiologists that is normally invisible to the human eye. The possibility to predict tumor aggressiveness and therapeutic response based on quantitative and reproducible parameters obtainable from DECT images could improve clinical decisions and drive oncologists to choose the best therapy according to metastasis biological features. Moreover, in comparison with standard dimensional criteria, DECT provides further data on the cancer microenvironment, especially for patients treated with antiangiogenic-based drugs, in which tumor shrinkage is a late parameter of response. We investigated the predictive role of DECT in the early assessment of liver metastasis response to treatment in comparison with standard dimensional criteria during antiangiogenetic-based therapy. Full article
(This article belongs to the Special Issue Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and Beyond)
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14 pages, 2780 KiB  
Article
The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis
by Klara Komici, Micaela Cappuccio, Andrea Scacchi, Roberto Vaschetti, Giuseppe Delli Carpini, Vito Picerno, Pasquale Avella, Maria Chiara Brunese, Giuseppe Rengo, Germano Guerra and Leonardo Bencivenga
J. Clin. Med. 2022, 11(4), 1116; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11041116 - 20 Feb 2022
Cited by 16 | Viewed by 2006
Abstract
Background: Frailty has been associated with increased mortality among hepatobiliary pancreatic (HBP) cancer patients. Nevertheless, estimates of frailty prevalence in HBP cancers and the precise average effect regarding mortality remains uncertain. The present systematic review and meta-analysis aimed to quantify: (1) the prevalence [...] Read more.
Background: Frailty has been associated with increased mortality among hepatobiliary pancreatic (HBP) cancer patients. Nevertheless, estimates of frailty prevalence in HBP cancers and the precise average effect regarding mortality remains uncertain. The present systematic review and meta-analysis aimed to quantify: (1) the prevalence of frailty in patients with liver and pancreatic cancers and (2) the impact of frailty on mortality in patients affected by liver and pancreatic cancers. Methods: MEDLINE/PubMed database search was conducted from inception until 1 November 2021, the pooled prevalence and relative risk (RR) estimate were calculated. Results: A total of 34,276 patients were identified and the weighted prevalence of frailty was 39%; (95% [C.I.] 23–56; I2 = 99.9%, p < 0.0001). Frailty was significantly associated with increased mortality RR 1.98 (95% [C.I.] 1.49–2.63; I2 = 75.9%, p = 0.006). Conclusions: Frailty prevalence is common among HBP cancer patients and exerts a significant negative impact on survival. These findings are characterized by significant heterogeneity and caution is warranted on their interpretation. However, stratification of patients with HBP cancer by frailty status may provide prognostic information and may inform priorities for decision-making strategy. Full article
(This article belongs to the Special Issue Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and Beyond)
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10 pages, 2728 KiB  
Article
Early Diagnosis of Liver Metastases from Colorectal Cancer through CT Radiomics and Formal Methods: A Pilot Study
by Aldo Rocca, Maria Chiara Brunese, Antonella Santone, Pasquale Avella, Paolo Bianco, Andrea Scacchi, Mariano Scaglione, Fabio Bellifemine, Roberta Danzi, Giulia Varriano, Gianfranco Vallone, Fulvio Calise and Luca Brunese
J. Clin. Med. 2022, 11(1), 31; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010031 - 22 Dec 2021
Cited by 31 | Viewed by 3634
Abstract
Background: Liver metastases are a leading cause of cancer-associated deaths in patients affected by colorectal cancer (CRC). The multidisciplinary strategy to treat CRC is more effective when the radiological diagnosis is accurate and early. Despite the evolving technologies in radiological accuracy, the radiological [...] Read more.
Background: Liver metastases are a leading cause of cancer-associated deaths in patients affected by colorectal cancer (CRC). The multidisciplinary strategy to treat CRC is more effective when the radiological diagnosis is accurate and early. Despite the evolving technologies in radiological accuracy, the radiological diagnosis of Colorectal Cancer Liver Metastases (CRCLM) is still a key point. The aim of our study was to define a new patient representation different by Artificial Intelligence models, using Formal Methods (FMs), to help clinicians to predict the presence of liver metastasis when still undetectable using the standard protocols. Methods: We retrospectively reviewed from 2013 to 2020 the CT scan of nine patients affected by CRC who would develop liver lesions within 4 months and 8 years. Seven patients developed liver metastases after primary staging before any liver surgery, and two patients were enrolled after R0 liver resection. Twenty-one patients were enrolled as the case control group (CCG). Regions of Interest (ROIs) were identified through manual segmentation on the medical images including only liver parenchyma and eventual benign lesions, avoiding major vessels and biliary ducts. Our predictive model was built based on formally verified radiomic features. Results: The precision of our methods is 100%, scheduling patients as positive only if they will be affected by CRCLM, showing a 93.3% overall accuracy. Recall was 77.8%. Conclusion: FMs can provide an effective early detection of CRCLM before clinical diagnosis only through non-invasive radiomic features even in very heterogeneous and small clinical samples. Full article
(This article belongs to the Special Issue Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and Beyond)
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Review

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16 pages, 25355 KiB  
Review
Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Case Report and Literature Review of 890 Patients Affected by Uncommon Primary Liver Tumor Presentation
by Maria Conticchio, Nicola Maggialetti, Marco Rescigno, Maria Chiara Brunese, Roberto Vaschetti, Riccardo Inchingolo, Roberto Calbi, Valentina Ferraro, Michele Tedeschi, Maria Rita Fantozzi, Pasquale Avella, Angela Calabrese, Riccardo Memeo and Arnaldo Scardapane
J. Clin. Med. 2023, 12(2), 423; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12020423 - 04 Jan 2023
Cited by 5 | Viewed by 2008
Abstract
Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47-year-old male patient admitted to the University [...] Read more.
Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47-year-old male patient admitted to the University Hospital of Bari with abdominal pain. Blood tests revealed the presence of an untreated hepatitis B virus infection (HBV), with normal liver function and without jaundice. Abdominal ultrasonography revealed a cirrhotic liver with a segmental dilatation of the third bile duct segment, confirmed by a CT scan and liver MRI, which also identified a heterologous mass. No other focal hepatic lesions were identified. A percutaneous ultrasound-guided needle biopsy was then performed, detecting a moderately differentiated HCC. Finally, the patient underwent a third hepatic segmentectomy, and the histopathological analysis confirmed the endobiliary localization of HCC. Subsequently, the patient experienced a nodular recurrence in the fourth hepatic segment, which was treated with ultrasound-guided percutaneous radiofrequency ablation (RFA). This case shows that HCC with BDTT can mimic different types of tumors. It also indicates the value of an early multidisciplinary patient assessment to obtain an accurate diagnosis of HCC with BDTT, which may have prognostic value that has not been recognized until now. Full article
(This article belongs to the Special Issue Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and Beyond)
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Other

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6 pages, 1712 KiB  
Case Report
Vanishing Bile Duct Syndrome in an Adult Patient: Case Report and Review of the Literature
by Paolo Izzo, Gaetano Gallo, Massimo Codacci Pisanelli, Giuliano D’Onghia, Leonardo Macci, Raimondo Gabriele, Andrea Polistena, Luciano Izzo, Sara Izzo and Luigi Basso
J. Clin. Med. 2022, 11(12), 3253; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11123253 - 07 Jun 2022
Cited by 3 | Viewed by 4261
Abstract
Vanishing bile duct syndrome (VBDS) is a rare condition characterized by progressive loss, destruction, and disappearance of the intra-hepatic bile ducts, leading to cholestasis and ductopenia. The exact mechanism of development of VDBS has not been established yet. Diagnosis of VBDS mainly relies [...] Read more.
Vanishing bile duct syndrome (VBDS) is a rare condition characterized by progressive loss, destruction, and disappearance of the intra-hepatic bile ducts, leading to cholestasis and ductopenia. The exact mechanism of development of VDBS has not been established yet. Diagnosis of VBDS mainly relies on clinical and disease related presentations, but liver biopsy is compulsory for diagnosis. Due to the low incidence reported in the literature, a standardized treatment of VDBS has not been established; hence, this rare condition must be managed at a tertiary liver referral center. Here, we report the management and treatment of VBDS of an 81-year-old woman without any history of exposure to antibiotics, neoplasms, etc. Full article
(This article belongs to the Special Issue Current Challenges and Opportunities of Hepatobiliary Surgery in 2022 and Beyond)
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