Matteo Virdis

Fondazione IRCCS Istituto Nazionale dei Tumori

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Vincenzo Mazzaferro

Fondazione IRCCS Istituto Nazionale dei Tumori

Carlo Sposito

Fondazione IRCCS Istituto Nazionale dei Tumori

Michele Droz dit Busset

Fondazione IRCCS Istituto Nazionale dei Tumori

Enrico Opocher

Ospedale San Paolo

Marianna Maspero

Cleveland Clinic

Roberto Santambrogio

ASST Fatebenefratelli Sacco

Davide Citterio

Fondazione IRCCS Istituto Nazionale dei Tumori

Guido Torzilli

Humanitas University

Jorgelina Coppa

Fondazione IRCCS Istituto Nazionale dei Tumori

Fara Uccelli

Royal London Hospital

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Istituti di Ricovero e Cura a Carattere Scientifico

University of Milan

Humanitas University

IRCCS Humanitas Research Hospital

University of Bologna

Fondazione IRCCS Istituto Nazionale dei Tumori

Ospedale San Paolo

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University of Milano-Bicocca

Ospedale Maggiore

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Serum bile acid profiles after endogenous and exogenous loads of bile acid into the enterohepatic circulation of healthy subjects and patients with chronic liver disease

The Italian Journal of Gastroenterology (1986)

Roberto Testa A. R. Domina Matteo Virdis G Celle

Enterohepatic circulation

Chronic liver disease

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Permanent Pancreatic Duct Occlusion With Neoprene-based Glue Injection After Pancreatoduodenectomy at High Risk of Pancreatic Fistula

Annals of Surgery (2019)

Vincenzo Mazzaferro Matteo Virdis Carlo Sposito Christian Cotsoglou Michele Droz dit Busset

The aim of this study was to assess safety and efficacy of pancreatic duct occlusion (PDO) with neoprene-based glue in selected patients undergoing pancreatoduodenectomy (PD) at high risk of postoperative pancreatic fistula (POPF).PD is the reference standard approach for tumors of the pancreaticoduodenal region. POPF is the most relevant complication after PD. PDO has been proposed as an alternative to anastomosis to manage the pancreatic stump.A single-center, prospective, nonrandomized trial enrolled 100 consecutive PD for cancer. Patients at high risk for POPF according to Fistula Risk Score (FRS) >15% (≥6 points) were treated with PDO using neoprene glue (study cohort); patients with FRS ≤15% (≤5 points) received pancreaticojejunal anastomosis (PJA: control cohort). Primary endpoint was complication rate grade ≥3 according to Dindo-Clavien Classification (DCC). Other postoperative outcomes were monitored (ClinicalTrials.gov NCT03738787).Fifty-one patients underwent PDO and 49 PJA. DCC ≥3, postoperative mortality, and POPF grade B-C were 25.5% versus 24.5% (P = 0.91), 5.9% versus 2% (P = 0.62), and 11.8% versus 16.3% (P = 0.51) in the study versus control cohort, respectively. At 1 and 3 years, new-onset diabetes was diagnosed in 13.7% and 36.7% of the study cohort versu 4.2% and 12.2% in controls (P = 0.007).PDO with neoprene-based glue is a safe technique that equalizes early outcome of selected patients at high risk of POPF to those at low risk undergoing PJA. Neoprene-based PDO, however, triples the risk of diabetes at 1 and 3 years.

Pancreatic fistula

10.1097/sla.0000000000003514

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Readmission after distal pancreatectomy: An overlooked problem

Pancreatology (2016)

Giovanni Capretti Fara Uccelli Francesca Gavazzi Matteo Virdis Cristina Ridolfi

Pancreatic fistula

Distal pancreatectomy

10.1016/j.pan.2016.05.282

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Liver Transplantation for Hepatic Metastases from Colorectal Cancer: Current Knowledge and Open Issues

Cancers (2023)

Marianna Maspero Carlo Sposito Matteo Virdis Davide Citterio Filippo Pietrantonio

More than 40% of patients with colorectal cancer present liver metastases (CRLM) during the course of their disease and up to 50% present with unresectable disease. Without surgical interventions, survival for patients treated with systemic therapies alone is dismal. In the past, liver transplantation (LT) for patients with unresectable CRLM failed to show any survival benefit due to poor selection, ineffective chemotherapeutic regimens, unbalanced immunosuppression and high perioperative mortality. Since then and for many years LT for CRLM was abandoned. The turning point occurred in 2013, when the results from the Secondary Cancer (SECA I) pilot study performed at Oslo University were published reporting a 60% 5-year overall survival after LT in patients with unresectable CRLM. These results effectively reignited the interest in LT as a potential therapy for CRLM, and several trials are undergoing. The aims of this article are to give a comprehensive overview of the available evidence on LT for CRLM, discuss the open issues in this rapidly evolving field, and highlight possible ways to address the future of this fascinating therapeutic alternative for selected patients with CRLM.

Immunosuppression

10.3390/cancers15020345

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Liver Resection and Transplantation for Metastases from Gastroenteropancreatic Neuroendocrine Tumors

Updates in surgery/Updates in surgery series (2019)

Michele Droz dit Busset Matteo Virdis Christian Cotsoglou Jorgelina Coppa Roberta Rossi

Around 60% of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) present liver metastases (NELM), which highly impact on prognosis. Treatment options for NELM mainly depend on the liver disease burden. In this review we propose a treatment algorithm for NELM with disease extension within the interest of liver resection (LR) and liver transplantation (LT). Preliminary resection of the primary and all the extrahepatic disease eases the access to liver-directed treatments and possibly confers a prognostic advantage. Solitary and oligometastatic disease deemed resectable with a conventional surgical commitment should be treated by LR. Despite the prognostic advantage of LR as compared to non-surgical options (80% 5-year overall survival [OS]) and the potential for cure, LR is burdened by high rates of recurrence (40% 5-year recurrence-free survival [RFS]). Neoadjuvant strategies by systemic and locoregional therapies may improve patient selection, especially in cases of borderline resectable NELM. In such patients, the oncological advantage of LR should be weighed against the high surgical risks and has to be preceded by a risk-benefit assessment. In young patients (<55 years) with G1/G2 unresectable NELM limited to <50% of the liver and no extrahepatic disease (Milan-NET criteria), LT may be considered. Patient selection is instrumental for good long-term outcomes (89% 10-year OS). The survival benefit increases over time with respect to non-transplant options. For patients exceeding the Milan-NET criteria, locoregional treatments can downstage the disease and occasionally allow LT. In G3 NETs and in cases not responding to liver-directed treatments, a systemic approach is usually warranted; debulking surgery can be considered in syndromic patients.

Liver disease

10.1007/978-3-030-19762-9_22

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Parenchyma-sparing surgery for pancreatic endocrine tumors

Updates in Surgery (2016)

Fara Uccelli Francesca Gavazzi Giovanni Capretti Matteo Virdis Marco Montorsi

Pancreatic fistula

10.1007/s13304-016-0400-1

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Citations (5)

[Fasting and postprandial serum bile acids in chronic liver diseases].