Luca Viganò

Bio: Luca Viganò is an academic researcher from Humanitas University. The author has contributed to research in topics: Hepatectomy & Survival rate. The author has an hindex of 38, co-authored 134 publications receiving 4923 citations. Previous affiliations of Luca Viganò include University of Paris & University of Turin.

The learning curve in laparoscopic liver resection: improved feasibility and reproducibility.

Abstract: Objective: To evaluate the "learning curve" effect on feasibility and reproducibility of laparoscopic liver resection (LLR). Summary Background Data: LLR is currently limited to few centers and to few procedures. Its reproducibility is still debated. Methods: Patients undergoing LLR between 1996 and 2008 were included. Indications and type of hepatectomies were compared with those of open resections performed in the same period, considering 3 periods (1996-1999, 2000-2003, and 2004-2008). LLRs were divided into 3 equal groups of 58 cases and technical data and outcomes were compared. Risk-adjusted Cumulative Sum model was used for determining the learning curve based on the need for conversion. Results: Of 782, 174 (22.3%) patients underwent LLR. Proportion of LLR progressively increased (17.5%, 22.4%, and 24.2%), such as hepatocellular carcinoma (17.6%, 25.6%, and 39.4%, P < 0.05), colorectal metastases (0%, 6.5%, and 13.1%, P < 0.05), major hepatectomies (1.1%, 9.1%, 8.5%, P < 0.05), and right hepatectomies (0%, 13.2%, and 13.1%, P < 0.05). Comparing groups, results of LLR significantly improved in terms of conversion rate (15.5%, 10.3%, and 3.4%, P < 0.05), operative time (210, 180, and 150 minutes, P < 0.05), blood loss (300, 200, and 200 mL, P < 0.05), and morbidity (17.2%, 22.4%, and 3.4%, P < 0.05). Pedicle clamping was less used over time (77.6%, 62.1%, and 17.2%, P < 0.05) and for shorter durations (45, 30, and 20 minutes, P < 0.05). Having adjusted for case-mix, the Cumulative Sum analysis demonstrated a learning curve for laparoscopic hepatectomies of 60 cases. Conclusion: A slow but constant evolution of LLR occurred: indications and magnitude of procedures increased and technical outcomes improved. The learning curve demonstrated in this study suggests that LLR is reproducible in liver units but specific training to advanced laparoscopy is required.

Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study.

Abstract: Background The future remnant liver (FRL) limit for safe major hepatectomy with low risk of postoperative liver failure has not yet been well defined. Methods Between April 2000 and September 2004, every patient scheduled for major hepatectomy in our institution underwent CT-volumetry of FRL. Patients with FRL 2 mg/100 ml) (group B). Liver dysfunction was defined as both PT 5 mg/100 ml for three or more consecutive days. Results A total of 119 patients were analyzed, 72 in group A and 47 in group B. The FRL value was the only significant risk factor for postoperative liver dysfunction in the univariate and multivariate analysis (p = 0.009). The FRL did not correlate with postoperative mortality and morbidity. Bilirubin and prothrombin time (PT) on days 3 and 7 were significantly correlated to FRL in both groups. In group A, patients with postoperative liver dysfunction had a FRL 26.5% in patients with healthy liver and >31% in patients with impaired liver function.

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.

Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity.

Abstract: Liver surgery is the gold-standard treatment of colorectal liver metastases. Five-year survival rates may be inadequate to evaluate surgical outcomes because some patients are alive with recurrence and late recurrences are possible. The aim of this study was to analyze 10-year survival outcome in terms of late recurrence rate and prognostic factors of survival. One hundred twenty-five patients underwent liver resection for colorectal liver metastases between 1985 and 1996. Four patients who experienced postoperative mortality were excluded. The analysis was performed on 121 patients. Five- and 10-year survival rates were 23.1% and 15.7%, respectively. Nineteen patients were alive 10 years after liver resection and 17 were disease-free (5 after re-resection). Five- and 10-year disease-free survival rates were 17.4% and 14.8%, respectively. In patients with recurrence, re-resection significantly improved survival (P 3 metastases (P < 0.001), metastatic infiltration of nearby structures (P < 0.001), and postoperative morbidity (P < 0.001). In 17 patients without negative prognostic factors the 10-year survival rate was 35.3%. Liver resection for colorectal liver metastases may be curative in more than one-third of patients without negative prognostic factors. Postoperative morbidity significantly worsens long-term outcomes. The risk of recurrence after liver resection is high even after 5 years of follow-up, but re-resection can improve the outcome.

Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka

Abstract: The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve.