Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive primary liver tumor, characterized by a range of different clinical manifestations and by increasing incidence and mortality rates even after curative treatment with radical resection. In recent years, growing attention has been devoted to this disease and some evidence supports liver transplantation (LT) as an appropriate treatment for intrahepatic cholangiocarcinoma; evolving work has also provided a framework for better understanding the genetic basis of this cancer. The aim of this study was to provide a clinical description of our series of patients complemented with Next-Generation Sequencing genomic profiling. From 1999 to 2021, 12 patients who underwent LT with either iCCA or a combined hepatocellular and cholangiocellular carcinoma (HCC-iCCA) were included in this study. Mutations were observed in gene activating signaling pathways known to be involved with iCCA tumorigenesis (KRAS/MAPK, P53, PI3K-Akt/mTOR, cAMP, WNT, epigenetic regulation and chromatin remodeling). Among several others, a strong association was observed between the Notch pathway and tumor size (point-biserial rhopb = 0.93). Our results are suggestive of the benefit potentially derived from molecular analysis to improve our diagnostic capabilities and to devise new treatment protocols, and eventually ameliorate long-term survival of patients affected by iCCA or HCC-iCCA.

Intrahepatic Cholangiocarcinoma

ARID1A

Alagille Syndrome

10.3390/cancers13236049

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Citations (5)

21st National Congress of the Italian Polyspecialist Society of Young Surgeons (IPSYS). June 15–18, 2008, Perugia

European Surgical Research (2008)

Simone Refice Umberto Benedetto Emiliano Angeloni Antonino Roscitano Carlos Simón

Background: Coronary artery bypass graft (CABG) surgery may result in perioperative myocardium injury during cardioplegic arrest.Angiotensin-converting enzyme (ACE) inhibitors protect myocardium from ischemia in several clinical conditions but no previous study has attempted to evaluate the impact of preoperative ACE inhibitor therapy on myocardium protection in patients undergoing CABG surgery.Methods: A propensity score-based analysis of 481 patients undergoing isolated on pump CABG surgery.245 patients received preoperative ACE inhibitors and 236 were not treated with ACE inhibitors.Peri-operative myocardial injury was assessed by ischemia marker cardiac troponin I (cTnI).Results: Preoperative cTnI concentration was similar for patients receiving ACE inhibitors and patients who did not (0.1 ng/mL [0.06-0.19]versus 0.1 ng/mL [0.06-0.19];P=0.3).At ICU admission, cTnI concentration was lower in patients receiving preoperative ACE inhibitors (0.8 ng/mL [0.44-0.1.35]versus 0.96 ng/mL [0.50-1.89];P=0.03) and this difference was more evident at the 1 st (1.6 ng/mL [1.05-3.4]versus 2.4 ng/mL [1.13-6.10];P=0.0006) and 2 nd postoperative day (0.8 ng/mL [0.5-1.8]versus 1.4 ng/mL [0.64-3.98];P=0.0015).After adjusting for propensity score and covariates, preoperative ACE inhibitors were found to decrease postoperative cTnI peak concentration (β=-0.12;P=0.004).Other independent predictors of postoperative cTnI peak concentration were female gender (β=0.15;P=0.009), emergency surgery (β=0.20;P=0.003), number of distal anastomoses (β=0.08;P=0.03) and aortic cross clamp time (β=0.002;P=0.03).Conclusions: ACE inhibitors prior to surgery confer added myocardial protection during surgical revascularization.Prospective, randomized clinical trials will be necessary to better define the role of ACE inhibitors in improving outcomes when they are prescribed prior to CABG surgery.

10.1159/000135352

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Impact of margin status on long-term results of liver resection for hepatocellular carcinoma: single-center time-to-recurrence analysis

Updates in Surgery (2019)

Salvatore Gruttadauria Duilio Pagano Lidia Rita Corsini Davide Cintorino Sergio Li Petri

Single Center

Grading (engineering)

Resection margin

Surgical margin

Univariate analysis

Log-rank test

10.1007/s13304-019-00686-5

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An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

Updates in Surgery (2021)

Riccardo Pravisani Paolo De Simone Damiano Patrono Andrea Lauterio Matteo Cescon

There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated.

10.1007/s13304-021-01019-1

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Citations (6)