Feasibility and safety of ALPPS procedure: our experience S. Caringi, A. Delvecchio, M. Dezio, A. Casella, V. Ferraro, et al. Surgical Endoscopy, 2025 Background The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a surgical strategy for patients with advanced liver tumors and inadequate future liver remnants (FLR). This study compares post-operative outcomes between open (oALPPS) and robotic (rALPPS) ALPPS in our institution. Methods This retrospective monocentric study includes eleven patients who underwent ALPPS procedure between January 2023 and February 2024. Demographics, tumor characteristics, and intra- and post-operative outcomes were collected and analyzed. Results In the first-stage ALPPS, the frequency of intermittent hilum clamp and the estimated blood loss were higher in the oALPPS group, while operative time and complications were similar, and total hospital stay was higher in the rALPPS group. In the second-stage ALPPS, the data regarding intraoperative and post-operative data were similar. In rALPPS, there were no post-discharge complications, readmissions, or deaths within 30 days. Conclusion This single-center study has an exploratory setting given the small cohort, but if confirmed in larger studies, rALPPS could be a viable alternative to oALPPS.
Hot Topics in the Surgical Treatment of Intrahepatic Cholangiocarcinoma: A Narrative Review of Current Managements Silvio Caringi, Antonella Delvecchio, Annachiara Casella, Valentina Ferraro, Michele Dezio, et al. Cancers, 2025 Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer with a poor prognosis. Negative-margin resection is presently the only potentially curative treatment option. Emerging trends with direct applicability to surgical strategy include margin thickness, lymphadenectomy, optimization of future liver remnant (FLR), minimally invasive techniques, incorporation of systemic therapy, and reconsideration of liver transplantation. This review emphasizes areas of consensus and ongoing debate. Margins ≥5–10 mm are associated with improved results, but biology generally takes precedence over prognosis. Regional lymphadenectomy enhances staging accuracy, although its therapeutic benefit remains unsettled. PVE is standard for FLR enlargement, LVD provides faster hypertrophy, and ALPPS remains reserved for highly selective cases. Minimally invasive and robotic hepatectomy share oncologic results in skilled institutions. Systemic therapies, including immunotherapy and biomarker-directed targeted therapy, are increasingly being incorporated perioperatively. Liver transplant may be of potential value in early-stage disease or on strict indications after neoadjuvant treatment. The modern surgical management of iCCA encompasses a blend of oncologic considerations, FLR optimization, minimally invasive surgery, and systemic therapy according to tumor biology. Multidisciplinary planning and participation in clinical trials are necessary to align surgical innovation with advancements in molecular and systemic treatments, ultimately leading to improved long-term outcomes.
Modern approach to hepatocellular carcinoma treatment Francesco Cortese, Fotis Anagnostopoulos, Maria Vittoria Bazzocchi, Silvio Caringi, Antonio Rosario Pisani, et al. World Journal of Hepatology, 2025 Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, necessitating innovative treatment strategies. Surgical resection and liver transplantation continue to be the gold standards for early-stage HCC; however, advances in imaging and minimally invasive techniques have improved patient selection and outcomes. Additionally, the emergence of targeted therapies and immunotherapy has transformed the treatment landscape for advanced HCC. This review highlights the efficacy of agents such as tyrosine kinase inhibitors, alongside emerging options like immune checkpoint inhibitors, which have shown promise in clinical trials. Furthermore, the role of locoregional therapies, including ablation in the setting of combined treatment, transarterial chemoembolization and transarterial radioembolization with flow catheters, cone-beam computed tomography and 4D navigation guidance, is examined in the context of bridging therapies for patients awaiting surgical intervention. The integration of multidisciplinary care approaches and personalized treatment plans is crucial for optimizing outcomes. Future directions for HCC treatment are discussed, including the potential of novel biomarkers in prognosis and treatment response. This comprehensive overview aims to equip clinicians with the latest insights and foster collaborative efforts to improve HCC patient management and survival rates.
Inferior Vena Cava Filter in Cancer-Associated Thrombosis: A Vade Mecum for the Treating Physicians: A Narrative Review Agnese Maria Fioretti, Daniele La Forgia, Pietro Scicchitano, Natale Daniele Brunetti, Riccardo Inchingolo, et al. Biomedicines, 2024 Cancer is a remarkable prothrombotic disease, and cancer-associated thrombosis acts as a dreadful omen for poor prognosis. The cornerstone of venous thromboembolism therapy is anticoagulation; however, in patients with venous thromboembolism who are not suitable for anticoagulation (contraindication, failure, or complication), the inferior vena cava filter appears a valuable option in the therapeutic arsenal. The recently heightened trend of steady rise in filter placement mirrors the spread of retrievable devices, together with improvements in physicians’ insertion ability, medico-legal issue, and novel and fewer thrombogenic materials. Nevertheless, the exact role of the inferior vena cava filter in cancer has yet to be endorsed due to a dearth of robust evidence. Indeed, data that support the inferior vena cava filter are weak and even controversial, resulting in discrepancies in the interpretation and application of guidelines in daily practice. In this narrative review, we aim at clarifying the state of the art on inferior vena cava filter use in malignancies. Furthermore, we provide a feasible, conclusive 4-step algorithm for the treating physicians in order to offer a practical strategy to successfully employ the inferior vena cava filter as a priceless device in the current armamentarium against cancer.
Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function? Chiara Floridi, Laura Maria Cacioppa, Nicolò Rossini, Marco Macchini, Alessandra Bruno, et al. Radiologia Medica, 2024 Purpose Microwave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described. Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function. Materials and methods All 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated. Results A total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate. Conclusion MWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.
Radiomics in colorectal cancer patients Riccardo Inchingolo, Cesare Maino, Roberto Cannella, Federica Vernuccio, Francesco Cortese, et al. World Journal of Gastroenterology, 2023
Imaging assessment of portal venous system: pictorial essay of normal anatomy, anatomic variants and congenital anomalies European Review for Medical and Pharmacological Sciences, 2017
Hepatic splenosis presenting as arterialised liver lesion in a patient with NASH European Review for Medical and Pharmacological Sciences, 2013
Post-natal ultrasound morpho-dynamic evaluation of mild fetal hydronephrosis: A new management European Review for Medical and Pharmacological Sciences, 2013
