Enrico Sgotto

Bio: Enrico Sgotto is an academic researcher. The author has contributed to research in topics: Hepatectomy & Perioperative. The author has an hindex of 8, co-authored 9 publications receiving 572 citations.

Bile Leakage and Liver Resection: Where Is the Risk?

Abstract: Hypothesis The knowledge of risk factors for bile leakage after liver resection could reduce its incidence. Design Retrospective study. Setting Tertiary care referral center. Patients The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003. Interventions Liver resections without biliary anastomoses. Main Outcome Measures Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics. Results Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis ( P = .05) or intraoperative use of fibrin glue ( P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma ( P P = .03), left hepatectomy extended to segment 1 ( P P = .006), and hepatectomy including segment 1 ( P = .001) or segment 4 ( P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage. Conclusions Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.

Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: analysis of perioperative outcome and survival.

Abstract: The most accepted treatment for locally advanced pancreatic cancer is chemoradiotherapy. However, indications to and results of pancreatic resections after chemoradiation are not yet defined. From June 1999 to December 2003, 28 patients with locally advanced pancreatic cancer (group 1) were enrolled for institutional trials of gemcitabine-based chemoradiotherapy. Tumors were stratified as unresectable or borderline resectable according to the pattern of vascular involvement at pretreatment computed tomographic scan. Patients with partial response or stable disease and in-range Ca19-9 were surgically explored. Perioperative outcome and survival of group 1 were compared with 44 patients primary resected for localized cancer with or without adjuvant treatment in the same time period (group 2). Only one unresectable tumor was successfully resected compared to 7 out of 18 (39%) that were borderline resectable. Operations after chemoradiation were 1 hour longer and postoperative stays 5 days longer, but transfusion rate, morbidity, and mortality were not significantly different. Median survival was 15.4 months for group 1 (>21 for resected vs. 10 for not resected, P < 0.01) and 14 months for group 2. In both groups, a disease-free survival beyond 24 months was recorded only among patients resected with negative margins. The conversion of an unresectable cancer to a resectable one is a rare event. On the contrary, the resection of a borderline resectable tumor was successfully accomplished in one-third of cases. Chemoradiotherapy did not increase the operative risk, but the interventions were more technically demanding and required a longer postoperative stay. Patients resected after chemoradiation for a locally advanced tumor had at least the same survival as those primary resected for a localized one. Only R0 resections in both groups gave the chance of disease-free survival longer than 24 months.

Preoperative Biliary Drainage Increases Infectious Complications after Hepatectomy for Proximal Bile Duct Tumor Obstruction

Abstract: Background The role of preoperative biliary drainage before liver resection in jaundiced patients remains controversial. The objective of this study is to compare the perioperative outcome of liver resection for carcinoma involving the proximal bile duct in jaundiced patients with and without preoperative biliary drainage.

Prognostic Significance of Lymph Node Metastases in Pancreatic Head Cancer Treated with Extended Lymphadenectomy: Not Just a Matter of Numbers

Abstract: Background The prognostic significance of variables related to nodal involvement (node status, number of disease-positive nodes [posNn], node ratio [Nr], and site of nodal metastases) in patients with resected pancreatic head cancer remains poorly defined.

Bile leak after hepatectomy: predictive factors of spontaneous healing

Abstract: BACKGROUND: Bile leakage after hepatectomy usually has spontaneous healing, but some patients require interventional procedures. To identify early predictive factors of conservative management failure. METHODS: This study focused on patients with bile leak after hepatectomy without extrahepatic biliary resection from 1996 through 2006. RESULTS: Bile leakage occurred in 34 of 593 patients (5.7%). Conservative management was successful in 26 patients (76.5%). At univariate analysis overall associated resections, vascular associated resections, and drainage output on days 1, 3, and 10 from leak onset were significant negative predictors of spontaneous healing. At multivariate analysis drainage output greater than 100 mL on day 10 was the only independent prognostic factor of conservative management failure (relative risk, 55.985; P = .008) with 80% sensitivity, 93.3% specificity, and 90% accuracy. CONCLUSIONS: Wait-and-see treatment is successful in most cases. Patients with drainage output greater than 100 mL 10 days after bile leakage diagnosis should be scheduled for interventional treatments.

Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings.

Abstract: Objective:To evaluate a new 2-step technique for obtaining adequate but short-term parenchymal hypertrophy in oncologic patients requiring extended right hepatic resection with limited functional reserve.Background:Patients presenting with primary or metastatic liver tumors often face the dilemma th

Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis

Abstract: Background The safety of simultaneous resections of colorectal cancer and synchronous liver metastases (SCRLM) is not established. This multi-institutional retrospective study compared postoperative outcomes after simultaneous and staged colorectal and hepatic resections.