In candidates for hepatectomy, different techniques to induce liver hypertrophy and modulate the future liver remnant are available. However, their use in specific clinical scenarios is highly heterogeneous and there is no consensus about minimal safety standards needed to incorporate these strategies into routine clinical practice. The aim of this position paper was to summarize newly available evidence in the field and compare medical practice among different hepatobiliary surgical units to evaluate the transformative potential of liver hypertrophy techniques in surgical oncology. This paper sets the stage for a future structured consensus on the application of liver hypertrophy techniques before hepatectomy.

To evaluate the cost–benefit of Trans-Arterial Radio-Embolization (TARE) with Y-90 glass microspheres compared to Drug-Eluting Bead Trans-Arterial Chemo-Embolization (DEB-TACE) in patients with intermediate- and early-stage hepatocellular carcinoma (HCC) not eligible for surgery or ablation. A partitioned survival model estimated life years (LYs) and costs over a 2-year horizon, considering the complete initial care pathway. The analysis was conducted in two scenarios, TARE with standard (SD) or personalized dosimetry (PD). Clinical data were sourced and adapted from the TRACE study, and real-world resource utilization and costs were collected from five high-volume Italian oncology centers. A micro-costing approach assessed value for money from the hospital perspective, expressed as Incremental Net Monetary Benefit (INMB), applying a willingness-to-pay (WTP) threshold of 50,000€/LY. TARE showed greater survival (SD: 1.617 LYs, PD: 1.823 LYs vs 1.331 LYs DEB-TACE) and higher overall costs (SD: 32,381€, PD: 32,922€ vs 27,735€ DEB-TACE) at 2 years, reflecting its greater healthcare utilization driven by better outcomes. TARE was associated with a positive INMB (SD: 9,664€; PD: 19,429€), demonstrating cost-effectiveness. Due to improved survival and a positive INMB under both standard and personalized dosimetry, TARE is more cost-effective than DEB-TACE, showing greater value for money compared to DEB-TACE. These results aim to support informed decision-making on the treatment options for patients with unresectable HCC.

Refractory ascites (RA) is a rare but poorly understood complication following liver transplantation (LT). It is often associated with portal hyperperfusion, potentially driven by splenic hyperafflux. In such cases, splenic artery embolization (SAE) has been proposed as a minimally invasive and cost-effective therapeutic option to reduce splanchnic inflow and alleviate symptoms. This retrospective study analyzed patients who underwent LT between August 2010 and September 2023 at IRCCS Azienda Ospedaliera-Universitaria di Bologna and were subsequently diagnosed with refractory ascites. Embolization of the splenic artery was performed using coils or plugs of variable caliber. Laboratory assessments included bilirubin, albumin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and international normalized ratio (INR). Additionally, Child–Pugh and MELD scores were recorded. The severity and evolution of ascites were monitored through serial ultrasonographic follow-ups. A total of 12 patients met the inclusion criteria. No severe complications related to the procedure were observed. Among them, 9 patients (75

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD33)1 May 2024PD33-05 PROPOSAL AND INTERNAL VALIDATION OF A NOMOGRAM FOR THE PREDICTION OF LOCAL RECURRENCE-FREE SURVIVAL AFTER PERCUTANEOUS ABLATION FOR cT1 RENAL MASSES Angelo Mottaran, Luigi Nocera, Lorenzo Bianchi, Stefano Luzzago, Marco Bandini, Pietro Piazza, Antonio Celia, Carla Serra, Alberta Cappelli, Antonio De Cinque, Francesco Modestino, Rita Golfieri, Gennaro Musi, Andrea Gallina, Francesco De Cobelli, Giovanni Mauri, Franco Orsi, Umberto Capitanio, Riccardo Schiavina, Ottavio De Cobelli, Francesco Montorsi, and Eugenio Brunocilla Angelo MottaranAngelo Mottaran , Luigi NoceraLuigi Nocera , Lorenzo BianchiLorenzo Bianchi , Stefano LuzzagoStefano Luzzago , Marco BandiniMarco Bandini , Pietro PiazzaPietro Piazza , Antonio CeliaAntonio Celia , Carla SerraCarla Serra , Alberta CappelliAlberta Cappelli , Antonio De CinqueAntonio De Cinque , Francesco ModestinoFrancesco Modestino , Rita GolfieriRita Golfieri , Gennaro MusiGennaro Musi , Andrea GallinaAndrea Gallina , Francesco De CobelliFrancesco De Cobelli , Giovanni MauriGiovanni Mauri , Franco OrsiFranco Orsi , Umberto CapitanioUmberto Capitanio , Riccardo SchiavinaRiccardo Schiavina , Ottavio De CobelliOttavio De Cobelli , Francesco MontorsiFrancesco Montorsi , and Eugenio BrunocillaEugenio Brunocilla View All Author Informationhttps://doi.org/10.1097/01.JU.0001008912.25331.d7.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite local tumor ablation (LTA) for the treatment of cT1 renal masses is increasing, the role of the different techniques used in influencing local recurrence is still unclear. We aim to develop a nomogram predicting local recurrence-free survival after different type of percutaneous LTA. METHODS: We identified 433 patients who underwent percutaneous LTA with radiofrequency (RFA), cryoblation (Cryo) or microwave (MW) ablation at four tertiary referral centers for cT1 renal masses. All masses received a biopsy before treatment. Patients', as well as renal masses' characteristics were collected. The primary end point was local recurrence on follow-up imaging. Statistical analyses consisted of two steps. First, a nomogram predicting local recurrence was built relying on multivariate Cox regression analysis. Second, performance characteristics of the nomogram were assessed at a threshold of 60 months, and compared to model exclusively based on clinical size and tumor's histology, using Heagerty's C and decision curve analysis (DCA). RESULTS: Overall, 393 (90.8%) patients had a positive biopsy for renal cancer while 40 (9.2%) patients had an undetermined biopsy. Overall, 172 (39.7%), 123 (28.4%), 138 (31.9%) patients underwent Cryo, MW and RFA, respectively. No differences in terms of age, CCI, BMI, clinical size (cm) and histology at pre-ablative biopsy were recorded among the three groups (all p>0.05). Overall, 53 patients (12.2%) recurred after a median time of 34 (IQR 18-60) months. The nomogram relied on the following variables: tumor size (cm), histology (malignant or undetermined), type of ablative procedure (MW, Cryo or RFA), polar involvement, >50% vs ≤50% exophytic rate, rim location (lateral or medial), sinus involvement and BMI (Figure 1). The newly developed nomogram yielded an area under the curve of 0.82 vs 0.73 for the model based on clinical size and histology. Moreover, the new nomogram also exhibited greater net-benefit across all threshold probabilities at DCA. CONCLUSIONS: The proposed nomogram to predict local recurrence after different techniques of LTA for renal cancer provides valuable information for both patient's and technique's selection for focal ablation of renal masses. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e711 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Angelo Mottaran More articles by this author Luigi Nocera More articles by this author Lorenzo Bianchi More articles by this author Stefano Luzzago More articles by this author Marco Bandini More articles by this author Pietro Piazza More articles by this author Antonio Celia More articles by this author Carla Serra More articles by this author Alberta Cappelli More articles by this author Antonio De Cinque More articles by this author Francesco Modestino More articles by this author Rita Golfieri More articles by this author Gennaro Musi More articles by this author Andrea Gallina More articles by this author Francesco De Cobelli More articles by this author Giovanni Mauri More articles by this author Franco Orsi More articles by this author Umberto Capitanio More articles by this author Riccardo Schiavina More articles by this author Ottavio De Cobelli More articles by this author Francesco Montorsi More articles by this author Eugenio Brunocilla More articles by this author Expand All Advertisement PDF downloadLoading ...

Background Nowadays, there is a clear need for new viable therapeutic options to face complex perianal Crohn's disease (PCD). Results of our previous pilot study demonstrated the efficacy and safety of local injection of autologous microfragmented adipose tissue (MFat) in this setting. This study aims to evaluate the long-term follow-up results in the same cohort of patients.Methods Data on clinical and radiological remission and surgical recurrence rates were prospectively collected on the 15 patients with complex fistulizing PCD refractory to combined bio-surgical therapy, originally treated with local MFat injection, with a mean 6.7 years follow-up.Results In our previous study, at 24-week follow-up, combined remission was reported in 66.7% of patients, while clinical remission was achieved in 93% of cases. At a 6.7-year follow-up, 9 of the 10 healed patients maintained remission. The patient with recurrence was successfully reoperated. Three out of 5 patients who failed primary combined remission were retreated, with 2 obtaining combined remission and 1 failing. One patient refused any subsequent treatment due to good quality of life. The last patient presented delayed healing at a 1-year follow-up. Overall success rate after rescue therapy at the final follow-up reached 86.6%. Safety was maintained throughout all follow-up periods.Conclusions This is the longest follow-up published trial on MFat injection for PCD. Our results show that patients who achieved closure in the first 24 weeks sustained response at long-term evaluation. In addition, there may be a rationale in repeating treatment as rescue therapy in not responding to patients. Perianal Crohn's disease remains highly debilitating. New regenerative medicine treatments have shown conflicting results for patients resistant to conventional therapies. Our study with the combination of microfragmented adipose tissue injection and surgical drainage of sepsis, confirms the long-term safety and efficacy of this novel therapy.

Background The modern approach to treating rectal cancer, which involves total mesorectal excision directed by imaging assessments, has significantly enhanced patient outcomes. However, locally recurrent rectal cancer (LRRC) continues to be a significant clinical issue. Identifying LRRC through imaging is complex, due to the mismatch between fibrosis and inflammatory pelvic tissue. This work aimed to develop a machine learning model for predicting LRRC using radiomic features extracted from 18F-FDG Positron Emission Tomography/Computed Tomography (PET/CT). Methods CT and PET images of PET/CT examinations were retrospectively collected from 44 patients, with 29 cases of recurrence (66%) and 15 cases with no local recurrence (34%). The whole analysis was conducted separately for CT and PET images to evaluate their different predictive power. Radiomic features were extracted from suspected lesion volumes identified by physicians and the most relevant radiomic features were selected to predict the presence or absence of LRRC. Feature selection was performed using a novel approach derived from gene expression analysis, based on the DNetPRO algorithm. The prediction was done using a Support Vector Classifier (SVC) with a 10-fold cross-validation. The efficiency of the pipeline in predicting LRRC was evaluated according to the sensitivity, specificity, Balanced Accuracy Score (BAS) and Matthews’s Correlation Coefficient (MCC). Results CT features were found to be the most predictive, showing a sensitivity of 0.80, a specificity of 0.82, a BAS of 0.81 and an MCC of 0.61. PET features obtained a sensitivity of 0.93, a specificity of 0.61, a BAS of 0.77 and a MCC of 0.52. The combination of PET and CT features obtained a sensitivity of 0.80, a specificity of 0.75, a BAS of 0.77 and a MCC of 0.53. Conclusions To the best of our knowledge, the DNetPRO algorithm was applied for the first time to medical image analysis and proved suitable for the selection of radiomic features with the highest predictive power, a crucial step in a radiomic pipeline. Our results confirmed the efficiency of radiomic features in predicting LRRC, with CT features outperforming PET features in identifying the characteristic texture of LRRC. The combination of both yielded no performance improvement.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-17 PERIOPERATIVE AND LONG-TERM ONCOLOGICAL OUTCOMES AFTER LOCAL TUMOR ABLATION FOR COMPLEX (PADUA SCORE ≥10) RENAL TUMORS: A MULTICENTER ANALYSIS Pietro Piazza, Lorenzo Bianchi, Stefano Luzzago, Marco Bandini, Angelo Mottaran, Sasan Amirhassankhani, Stefano Puliatti, Bernardino De Concilio, Antonio Celia, Carla Serra, Alberta Cappelli, Rita Golfieri, Gennaro Musi, Andrea Gallina, Michele Rizzo, Giovanni Liguori, Carlo Trombetta, Riccardo Schiavina, Ottavio De Cobelli, Francesco Montorsi, and Eugenio Brunocilla Pietro PiazzaPietro Piazza , Lorenzo BianchiLorenzo Bianchi , Stefano LuzzagoStefano Luzzago , Marco BandiniMarco Bandini , Angelo MottaranAngelo Mottaran , Sasan AmirhassankhaniSasan Amirhassankhani , Stefano PuliattiStefano Puliatti , Bernardino De ConcilioBernardino De Concilio , Antonio CeliaAntonio Celia , Carla SerraCarla Serra , Alberta CappelliAlberta Cappelli , Rita GolfieriRita Golfieri , Gennaro MusiGennaro Musi , Andrea GallinaAndrea Gallina , Michele RizzoMichele Rizzo , Giovanni LiguoriGiovanni Liguori , Carlo TrombettaCarlo Trombetta , Riccardo SchiavinaRiccardo Schiavina , Ottavio De CobelliOttavio De Cobelli , Francesco MontorsiFrancesco Montorsi , and Eugenio BrunocillaEugenio Brunocilla View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complex renal masses have a non-negligible risk of perioperative complications due to their inherent anatomical characteristics. Local tumor ablation (LTA) could be an useful tool to approach these tumors in patients unfit for surgery or with hampered renal function. However, oncological and perioperative outcomes of these patients remain undereported. The objective of this study was to report the perioperative and long-term of LTA (including Radiofrequency ablation [RFA], Cryoablation [Cryo], Microwave ablation [MW]) for complex masses (PADUA score ≥10). METHODS: We retrospectively evaluated 102 patients treated with LTA for complex (PADUA ≥10) renal tumors at 5 European tertiary centers. Patients were treated with percutaneous RFA, Cryo or MW according to the technique available in each center. Categorical and continuous variables were reported as proportions and median±interquartile ranges (IQR), respectively. Kaplan-Meier estimate was used to investigate 5-years recurrence free survival (RFS). Multivariate Cox's proportional hazard regression was used to identify predictors of local recurrence. Multivariable logistic regression was used to identify predictors of post-operative complications. RESULTS: Overall, 40 (39%), 37 (36%) and 25 (25%) patients underwent RFA, Cryo and MW ablation, respectively. Of those, 55 (54%), 24 (24%), 22 (22%) and 1 (1%) had a PADUA score of 10, 11, 12 and 13, respectively. Median tumor size was 3 (2.2-3.7). At biopsy, 71 (70%), 12 (12%), 3 (3%) and 2 (2%) had clear cell, papillary, chromophobe and mixed renal carcinoma, respectively. In the perioperative period, 26 (25%) patients experienced post-operative complications. During a median follow-up of 60 months (IQR 49-87), 22 (24%) and 9 (12%) patients experienced local and systemic recurrence, respectively, with a 5-years RFS of 57.3%. At multivariable Cox's analysis, papillary histology (HR 0.15, CI 0.01-0.88, p=0.032) was the only independent predictors of RFS. At multivariable logistic regression, the use of RFA (OR 2.56, CI 1.58-8.6, p=0.045) was the only independent predictor of perioperative complications. CONCLUSIONS: LTA is a viable treatment for patients with complex (PADUA ≥10) renal masses, who are considered at higher risk for surgery. However, patients should be accurately counseled due to the higher rates of complication and disease recurrence these patients might experience, when compared with analogues cases treated with nephron sparing surgery. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1105 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Pietro Piazza More articles by this author Lorenzo Bianchi More articles by this author Stefano Luzzago More articles by this author Marco Bandini More articles by this author Angelo Mottaran More articles by this author Sasan Amirhassankhani More articles by this author Stefano Puliatti More articles by this author Bernardino De Concilio More articles by this author Antonio Celia More articles by this author Carla Serra More articles by this author Alberta Cappelli More articles by this author Rita Golfieri More articles by this author Gennaro Musi More articles by this author Andrea Gallina More articles by this author Michele Rizzo More articles by this author Giovanni Liguori More articles by this author Carlo Trombetta More articles by this author Riccardo Schiavina More articles by this author Ottavio De Cobelli More articles by this author Francesco Montorsi More articles by this author Eugenio Brunocilla More articles by this author Expand All Advertisement PDF downloadLoading ...

Locally Recurrent Rectal Cancer (LRRC) remains a major clinical concern; it rapidly invades pelvic organs and nerve roots, causing severe symptoms. Curative-intent salvage therapy offers the only potential for cure but it has a higher chance of success when LRRC is diagnosed at an early stage. Imaging diagnosis of LRRC is very challenging due to fibrosis and inflammatory pelvic tissue, which can mislead even the most expert reader. This study exploited a radiomic analysis to enrich, through quantitative features, the characterization of tissue properties, thus favoring an accurate detection of LRRC by Computed Tomography (CT) and 18F-FDG-Positron Emission Tomography/CT (PET/CT). Of 563 eligible patients undergoing radical resection (R0) of primary RC, 57 patients with suspected LRRC were included, 33 of which were histologically confirmed. After manually segmenting suspected LRRC in CT and PET/CT, 144 Radiomic Features (RFs) were generated, and RFs were investigated for univariate significant discriminations (Wilcoxon rank-sum test, p < 0.050) of LRRC from NO LRRC. Five RFs in PET/CT (p < 0.017) and two in CT (p < 0.022) enabled, individually, a clear distinction of the groups, and one RF was shared by PET/CT and CT. As well as confirming the potential role of radiomics to advance LRRC diagnosis, the aforementioned shared RF describes LRRC as tissues having high local inhomogeneity due to the evolving tissue's properties.

Background Intrahepatic cholangiocarcinoma (ICC) is the second most common primitive liver cancer and is rising in incidence worldwide. Given its low survival and resectability rates, locoregional therapies such as Yttrium-90 transarterial radioembolization (Y-TARE) are increasingly being employed. This retrospective study aim was to confirm and update our previous results about overall survival (OR), safety, and efficacy of Y-TARE in patients with unresectable/recurrent ICC. Materials and Methods OS was evaluated as primary endpoint while radiological tumor response at 3 months, based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, was considered as secondary endpoint. Results Over a total of 49 patients, the overall median survival was 16 months (27-41 months, 95% confidence interval [CI]) from Y-TARE procedure. A significantly longer survival was recorded in naive patients compared to patients previously submitted to any type of liver-directed treatment and radical surgery (18 vs 14 months, P =.015 and 28 vs 14 months, P =.001, respectively). Target lesion and overall objective response for RECIST 1.1 criteria were 64.6% and 52.1%, respectively. Low rates of postprocedural and late complications were recorded. Conclusions In unresectable and recurrent ICC, Y-TARE confirms its safety and its potential in increasing OS, especially in naive patients.