Research

Liver surgery

Surgery

The Hepatobiliary Surgery Unit of Padova is a Regional Referral Centre for liver cancer and has a proven expertise in surgical treatment for primitive and metastatic liver cancer. It represents the center with the highest volume of oncological interventions for liver tumors in Italy according to last reports AGENAS. The clinical activity is based on solid contributions in basic, translational and clinical research. The continuous collaboration with other research groups is based on a stron commitment to innovation and guarantees the sharing of clinical and research protocols useful for training fellows and for providing care for patients with oncological liver diseases.

Overview of the research lines:

Minimally invasive liver surgery and laparoscopic thermal ablation
Ex-situ liver surgery (liver autotransplantation)
Two-staged hepatectomy

Minimally invasive liver surgery and laparoscopic thermal ablation

In the last two decades, minimally invasive liver surgery (MILS) has become a standard indication for the surgical treatment of both malignant and benign liver lesions. Specialized centers with solid background on hepatic and laparoscopic surgery are increasingly interested in this research area. Our institution is  particularly involved in an Italian MILS project: IgoMILS (Italian group of Minimally Invasive Liver Surgery) with the objective to share research and clinical protocols. Another special issue is represented by the use of heat for the treatment of small primary and secondary liver malignancies. Laparoscopic thermal ablation is standardized based in well codified guidelines.

Publications:

1: Aldrighetti L, Ratti F, Cillo U, Ferrero A, Ettorre GM, Guglielmi A, Giuliante F, Calise F; Italian Group of Minimally Invasive Liver Surgery (I GO MILS).Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery).Registry. Updates Surg. 2017 Sep;69(3):271-283.

2: Gringeri E, Boetto R, Bassi D, D'Amico FE, Polacco M, Romano M, Barbieri S,Feltracco P, Spampinato M, Zanus G, Cillo U. Totally laparoscopic caudate lobe resection: technical aspects and literature review. Surg Laparosc Endosc Percutan Tech. 2014 Dec;24(6):e233-6.

3: Cillo U, Vitale A, Dupuis D, Corso S, Neri D, D'Amico F, Gringeri E, Farinati F, Vincenzi V, Zanus G. Laparoscopic ablation of hepatocellular carcinoma in cirrhotic patients unsuitable for liver resection or percutaneous treatment: a cohort study. PLoS One. 2013;8(2):e57249. doi: 10.1371/journal.pone.0057249. Epub 2013 Feb 21.

4: Cillo U, Noaro G, Vitale A, Neri D, D'Amico F, Gringeri E, Farinati F,Vincenzi V, Vigo M, Zanus G; HePaTIC Study Group. Laparoscopic microwave ablationin patients with hepatocellular carcinoma: a prospective cohort study. HPB(Oxford). 2014 Nov;16(11):979-86. doi: 10.1111/hpb.12264. Epub 2014 Apr 18.

5: Aldrighetti L, Belli G, Boni L, Cillo U, Ettorre G, De Carlis L, Pinna A,Casciola L, Calise F; Italian Group of Minimally Invasive Liver Surgery (I GOMILS). Italian experience in minimally invasive liver surgery: a national survey.Updates Surg. 2015 Jun;67(2):129-40.

Funding:

Ordinary department funding.

People involved:
Umberto Cillo, Full Professor
Enrico Gringeri, Associate Professor

Group members:
Domenico Bassi, Riccardo Boetto, Francesco D’Amico, Alessandro Vitale, Marina Polacco (Hepatobiliary Surgeons), Alessandra Bertacco, Michela Di Giunta (Hepatobiliary Surgery Fellows)

 

Ex-situ liver surgery (liver autotransplantation)

Ex-situ liver resection is a complex technique for the treatment of liver malignancies critically localized within the liver and unresectable with conventional liver surgery. Ex-situ liver resection consists in the removal of the liver, liver resection outside the abdomen and implantation of the liver in the original position. During these phases the liver is continuously perfused using specific hypothermic preservation solutions. This particular surgical technique requests both liver surgery and liver transplantation expertise. The initial experience was described in the 80s by Pichlmayr but this technique was progressively abandoned due to his high morbidity and mortality rate. We recently are focusing our research in this specific area and a clinical protocol was approved by local ethical committee.

Publications:

1: Gringeri E, Polacco M, D'Amico FE, Bassi D, Boetto R, Tuci F, Bonsignore P,Noaro G, D'Amico F, Vitale A, Feltracco P, Barbieri S, Neri D, Zanus G, Cillo U. Liver autotransplantation for the treatment of unresectable hepatic metastasis:an uncommon indication-a case report. Transplant Proc. 2012 Sep;44(7):1930-3.

2: Gringeri E, Polacco M, D'Amico FE, Scopelliti M, Bassi D, Bonsignore P,Luisetto R, Lodo E, Carraro A, Zanus G, Cillo U. A new liver autotransplantation technique using subnormothermic machine perfusion for organ preservation in aporcine model. Transplant Proc. 2011 May;43(4):997-1000.

Funding:

Ordinary department funding.

People involved:
Umberto Cillo,Full Professor
Enrico Gringeri,Associate Professor)

Group members:
Domenico Bassi, Riccardo Boetto, Francesco D’Amico, Alessandro Vitale, Marina Polacco (Hepatobiliary Surgeons), Alessandra Bertacco, Michela Di Giunta (Hepatobiliary Surgery Fellows)

 

Two-staged hepatectomy

The liver is the unique organ of our organism with a particular characteristic: to regenerate itself. The liver is able to regenerate itself after a specific stimulus. Liver resection represent a proved stimulus to liver regeneration. This pathophysiological feature was used to increase the liver volume in order to avoid the fatal post-surgical liver failure. The first reports have been described by Adam for the surgical treatment of bilateral liver metastases. More recently new staged hepatectomies procedures are described: ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy). Our group for the first time described a new staged liver technique: LAPS (Laparoscopic Ablation and Portal vein ligation for staged hepatectomy).

Publications:

1: Cillo U, Gringeri E, Feltracco P, Bassi D, D'Amico FE, Polacco M, Boetto R.Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for StagedHepatectomy : A New Minimally Invasive Two-Stage Hepatectomy. Ann Surg Oncol.2015 Aug;22(8):2787-8.

2: Gringeri E, Boetto R, DʼAmico FE, Bassi D, Cillo U. Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS): a minimally invasive first-step approach. Ann Surg. 2015 Feb;261(2):e42-3.

3: Serenari M, Zanello M, Schadde E, Toschi E, Ratti F, Gringeri E, Masetti M,Cillo U, Aldrighetti L, Jovine E; ALPPS Italian Registry Group. Importance of primary indication and liver function between stages: results of a multicenter Italian audit of ALPPS 2012-2014. HPB (Oxford). 2016 May;18(5):419-27.

4: Aldrighetti L, Ratti F, Cillo U, Ferrero A, Ettorre GM, Guglielmi A, Giuliante F, Calise F; Italian Group of Minimally Invasive Liver Surgery (I GO MILS).Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery)Registry. Updates Surg. 2017 Sep;69(3):271-283. doi: 10.1007/s13304-017-0489-x.

Funding:

Ordinary department funding.

People involved:

Umberto Cillo, Full Professor
Enrico Gringeri, Associate Professor

Group members:
Domenico Bassi, Riccardo Boetto, Francesco D’Amico, Alessandro Vitale, Marina Polacco (Hepatobiliary Surgeons), Alessandra Bertacco, Michela Di Giunta (Hepatobiliary Surgery Fellows)