Edoardo Rosso

Bio: Edoardo Rosso is an academic researcher from University of Strasbourg. The author has contributed to research in topics: Hepatectomy & Pancreaticoduodenectomy. The author has an hindex of 28, co-authored 94 publications receiving 3040 citations. Previous affiliations of Edoardo Rosso include Louis Pasteur University & Royal Liverpool University Hospital.

A Two-Stage Hepatectomy Procedure Combined With Portal Vein Embolization to Achieve Curative Resection for Initially Unresectable Multiple and Bilobar Colorectal Liver Metastases

Abstract: Liver resection has been recognized as the treatment of choice for patients with colorectal liver metastases (CLM), offering long-term survival and the only hope for cure.1–3 However, hepatectomy can be performed only in approximately 10% to 20% of patients with CLM.4 In the majority of cases, liver surgery is contraindicated due to too small future remnant liver (FRL).5–7 During the last years, new multidisciplinary therapies have been proposed to increase safely the resectability rate in patients with initially nonresectable CLM. They include portal vein embolization (PVE),8–10 systemic or arterial hepatic neoadjuvant chemotherapy,11,12 transarterial neoadjuvant immunochemotherapy,13 and local tumoral destruction.14,15 However, these adjuvant therapies do not allow to achieve a curative resection in all patients and particularly in patients with multiple bilobar CLM (MBCLM). In these patients, the resection of MBCLM would result in a too small FRL. A 2-stage hepatectomy procedure (TSHP) without PVE was advocated to treat patients with unresectable multiple metastases.16 However, after resection of MBCLM, high mortality (9%–15%) was reported.16,17 Liver failure due to insufficient functional volume of the FRL is the main cause of postoperative mortality. Preoperative PVE has been proposed to induce compensatory hypertrophy of the FRL.8,9 Some successful cases undergoing right hepatectomy and simultaneous left hemiliver wedge resections after PVE have been reported in patients with MBCLM.18 However, growth of metastatic nodules in the FRL after PVE can be more rapid than that of the nontumoral remnant hepatic parenchyma.19 Therefore, metastases located in the FRL should be ideally resected before PVE in a first-stage hepatectomy; a major hepatic resection can then be performed, after PVE, in a second-stage hepatectomy. Therefore, a new strategy design has been developed to treat patients with initially unresectable MBCLM. Our preliminary results were previously reported.20 The present study reports feasibility, surgical outcome, recurrence rate, and long-term survival of patients presenting initially unresectable MBCLM undergoing a TSHP combined with PVE.

Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy.

Abstract: Objective:To investigate whether sinusoidal injury (SI) was associated with a worse outcome after hepatectomy in patients with colorectal liver metastases (CRLM).Background:Correlation between SI and oxaliplatin-based chemotherapy (OBC) was recently shown in patients with CRLM. However, it has yet t

Minimally invasive retroperitoneal pancreatic necrosectomy.

Abstract: Introduction: Open surgery for pancreatic necrosis is associated with considerable morbidity and mortality. We report the results of a recently developed minimally invasive techniqu

Two-stage hepatectomy for multiple bilobar colorectal liver metastases

Abstract: Background: As surgical resection of colorectal liver metastases (CLM) remains the only treatment for cure, efforts to extend the surgical indications to include patients with multiple bilobar CLM have been made. This study evaluated the long-term outcome, safety and efficacy of two-stage hepatectomy (TSH) for CLM in a large cohort of patients. Methods: Patients undergoing surgery between December 1996 and December 2009 were reviewed. The early postoperative and long-term outcomes as well as the patterns of failure to complete TSH and its clinical implications were analysed. Results: Eighty patients were scheduled to undergo TSH. Sixty-one patients had completion of TSH combined with (58 patients), or without (3) portal vein embolization/ligation (PVE/PVL). Five patients were excluded after first-stage hepatectomy and 14 after PVE/PVL. The 5-year overall survival rate and median survival in patients who completed TSH were 32 per cent and 39·6 months respectively, and corresponding recurrence-free values were 11 per cent and 9·4 months respectively. Six patients were alive beyond 5 years after TSH. Multivariable logistic regression analysis showed that failure to complete TSH was driven by two independent prognostic scenarios: three or more CLM in the future remnant liver (FRL) combined with age over 70 years predicted tumour progression after first-stage hepatectomy, and three or more CLM in the FRL combined with carcinomatosis at the time of first-stage hepatectomy predicted the development of additional FRL metastases after PVE/PVL. Conclusion: A therapeutic strategy using TSH provided acceptable long-term survival with no postoperative mortality. Further efforts are needed to increase the number of patients who undergo TSH successfully.

The Clavien-Dindo classification of surgical complications: five-year experience.

Abstract: Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co

Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases

Abstract: Purpose Chemotherapy before resection of hepatic colorectal metastases (CRM) may cause hepatic injury and affect postoperative outcome. Patients and Methods Four hundred six patients underwent hepatic resection of CRM between 1992 and 2005. Pathologic review of the nontumorous liver was performed using established criteria for steatosis, steatohepatitis, and sinusoidal injury. The effect of chemotherapy and liver injury on perioperative outcome was analyzed. Results One hundred fifty-eight patients (38.9%) received no preoperative chemotherapy, whereas 248 patients (61.1%) did. The median duration of chemotherapy was 16 weeks (range, 2 to 70 weeks). Chemotherapy consisted of fluoropyrimidine-based regimens (fluorouracil [FU] alone, 15.5%; irinotecan plus FU, 23.1%; and oxaliplatin plus FU, 19.5%) and other therapy (3.0%). On pathologic analysis, 36 patients (8.9%) had steatosis, 34 (8.4%) had steatohepatitis, and 22 (5.4%) had sinusoidal dilation. Oxaliplatin was associated with sinusoidal dilation compared with no chemotherapy (18.9% v 1.9%, respectively; P .001; odds ratio [OR] 8.3; 95% CI, 2.9 to 23.6). In contrast, irinotecan was associated with steatohepatitis compared with no chemotherapy (20.2% v 4.4%, respectively; P .001; OR 5.4; 95% CI, 2.2 to 13.5). Patients with steatohepatitis had an increased 90-day mortality compared with patients who did not have steatohepatitis (14.7% v 1.6%, respectively; P .001; OR 10.5; 95% CI, 2.0 to 36.4). Conclusion Steatohepatitis is associated with an increased 90-day mortality after hepatic surgery. In patients with hepatic CRM, the chemotherapy regimen should be carefully considered because the risk of hepatotoxicity is significant.