PAULO HERMAN

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Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina

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  • article
    Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases
    (2023) CHEUNG, Tan-To; LIU, Rong; CIPRIANI, Federica; WANG, Xiaoying; EFANOV, Mikhail; FUKS, David; CHOI, Gi-Hong; SYN, Nicholas L.; CHONG, Charing C. N.; BENEDETTO, Fabrizio Di; ROBLES-CAMPOS, Ricardo; MAZZAFERRO, Vincenzo; ROTELLAR, Fernando; LOPEZ-BEN, Santiago; PARK, James O.; MEJIA, Alejandro; SUCANDY, Iswanto; CHIOW, Adrian K. H.; MARINO, Marco V.; GASTACA, Mikel; LEE, Jae Hoon; KINGHAM, T. Peter; D'HONDT, Mathieu; CHOI, Sung Hoon; SUTCLIFFE, Robert P.; HAN, Ho-Seong; TANG, Chung-Ngai; PRATSCHKE, Johann; TROISI, Roberto I.; WAKABAYASHI, Go; CHERQUI, Daniel; GIULIANTE, Felice; AGHAYAN, Davit L.; EDWIN, Bjorn; SCATTON, Olivier; SUGIOKA, Atsushi; Tran Cong Duy Long; FONDEVILA, Constantino; HILAL, Mohammad Abu; RUZZENENTE, Andrea; FERRERO, Alessandro; HERMAN, Paulo; CHEN, Kuo-Hsin; ALDRIGHETTI, Luca; GOH, Brian K. P.
    Background: The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours >= 10 cm. Methods: This was a retrospective review of 971 patients who underwent LLR and RLR for huge (>= 10 cm) tumors at 42 international centers between 2002-2020. Results: One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1: 3 propensity- score matching (PSM) (73 vs. 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 vs. 290 min, P=0.286), transfusion rate rate (19.2% vs. 16.9%, P=0.652), median blood loss (200 vs. 300 mL, P=0.694), open conversion rate (8.2% vs. 11.0%, P=0.519), morbidity (28.8% vs. 21.9%, P=0.221), major morbidity (4.1% vs. 9.6%, P=0.152), mortality and postoperative length of stay (6 vs. 6 days, P=0.435). Conclusions: RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR.
  • article 0 Citação(ões) na Scopus
    Impact of Liver Cirrhosis, Severity of Cirrhosis, and Portal Hypertension on the Difficulty and Outcomes of Laparoscopic and Robotic Major Liver Resections for Primary Liver Malignancies
    (2024) CIPRIANI, Federica; ALDRIGHETTI, Luca; RATTI, Francesca; WU, Andrew G. R.; KABIR, Tousif; SCATTON, Olivier; LIM, Chetana; ZHANG, Wanguang; SIJBERDEN, Jasper; AGHAYAN, Davit L.; SIOW, Tiing-Foong; DOKMAK, Safi; COELHO, Fabricio Ferreira; HERMAN, Paulo; MARINO, Marco V.; MAZZAFERRO, Vincenzo; CHIOW, Adrian K. H.; SUCANDY, Iswanto; IVANECZ, Arpad; CHOI, Sung-Hoon; LEE, Jae Hoon; GASTACA, Mikel; VIVARELLI, Marco; GIULIANTE, Felice; RUZZENENTE, Andrea; YONG, Chee-Chien; YIN, Mengqiu; FONDEVILA, Constantino; EFANOV, Mikhail; MORISE, Zenichi; BENEDETTO, Fabrizio Di; BRUSTIA, Raffaele; VALLE, Raffaele Dalla; BOGGI, Ugo; GELLER, David; BELLI, Andrea; MEMEO, Riccardo; GRUTTADAURIA, Salvatore; MEJIA, Alejandro; PARK, James O.; ROTELLAR, Fernando; CHOI, Gi-Hong; ROBLES-CAMPOS, Ricardo; WANG, Xiaoying; SUTCLIFFE, Robert P.; PRATSCHKE, Johann; LAI, Eric C. H.; CHONG, Charing C. N.; D'HONDT, Mathieu; MONDEN, Kazuteru; LOPEZ-BEN, Santiago; KINGHAM, T. Peter; FERRERO, Alessandro; ETTORRE, Giuseppe Maria; CHERQUI, Daniel; LIANG, Xiao; SOUBRANE, Olivier; WAKABAYASHI, Go; TROISI, Roberto I.; CHEUNG, Tan-To; KATO, Yutaro; SUGIOKA, Atsushi; HAN, Ho-Seong; Tran Cong duy Long; LIU, Qu; LIU, Rong; EDWIN, Bjorn; FUKS, David; CHEN, Kuo-Hsin; HILAL, Mohammad Abu; GOH, Brian K. P.
    BackgroundMinimally invasive liver resections (MILR) offer potential benefits such as reduced blood loss and morbidity compared with open liver resections. Several studies have suggested that the impact of cirrhosis differs according to the extent and complexity of resection. Our aim was to investigate the impact of cirrhosis on the difficulty and outcomes of MILR, focusing on major hepatectomies.MethodsA total of 2534 patients undergoing minimally invasive major hepatectomies (MIMH) for primary malignancies across 58 centers worldwide were retrospectively reviewed. Propensity score (PSM) and coarsened exact matching (CEM) were used to compare patients with and without cirrhosis.ResultsA total of 1353 patients (53%) had no cirrhosis, 1065 (42%) had Child-Pugh A and 116 (4%) had Child-Pugh B cirrhosis. Matched comparison between non-cirrhotics vs Child-Pugh A cirrhosis demonstrated comparable blood loss. However, after PSM, postoperative morbidity and length of hospitalization was significantly greater in Child-Pugh A cirrhosis, but these were not statistically significant with CEM. Comparison between Child-Pugh A and Child-Pugh B cirrhosis demonstrated the latter had significantly higher transfusion rates and longer hospitalization after PSM, but not after CEM. Comparison of patients with cirrhosis of all grades with and without portal hypertension demonstrated no significant difference in all major perioperative outcomes after PSM and CEM.ConclusionsThe presence and severity of cirrhosis affected the difficulty and impacted the outcomes of MIMH, resulting in higher blood transfusion rates, increased postoperative morbidity, and longer hospitalization in patients with more advanced cirrhosis. As such, future difficulty scoring systems for MIMH should incorporate liver cirrhosis and its severity as variables.
  • article 10 Citação(ões) na Scopus
    Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases
    (2023) LIU, Qu; ZHANG, Wanguang; ZHAO, Joseph J.; SYN, Nicholas L.; CIPRIANI, Federica; ALZOUBI, Mohammad; AGHAYAN, Davit L.; SIOW, Tiing-Foong; LIM, Chetana; SCATTON, Olivier; HERMAN, Paulo; COELHO, Fabricio Ferreira; V, Marco Marino; MAZZAFERRO, Vincenzo; CHIOW, Adrian K. H.; SUCANDY, Iswanto; IVANECZ, Arpad; CHOI, Sung-Hoon; LEE, Jae Hoon; PRIETO, Mikel; VIVARELLI, Marco; GIULIANTE, Felice; VALLE, Bernardo Dalla; RUZZENENTE, Andrea; YONG, Chee-Chien; CHEN, Zewei; YIN, Mengqiu; FONDEVILA, Constantino; EFANOV, Mikhail; MORISE, Zenichi; BENEDETTO, Fabrizio Di; BRUSTIA, Raffaele; VALLE, Raffaele Dalla; BOGGI, Ugo; GELLER, David; BELLI, Andrea; MEMEO, Riccardo; GRUTTADAURIA, Salvatore; MEJIA, Alejandro; PARK, James O.; ROTELLAR, Fernando; CHOI, Gi-Hong; ROBLES-CAMPOS, Ricardo; WANG, Xiaoying; SUTCLIFFE, Robert P.; SCHMELZLE, Moritz; PRATSCHKE, Johann; TANG, Chung-Ngai; CHONG, Charing C. N.; LEE, Kit-Fai; MEURS, Juul; D'HONDT, Mathieu; MONDEN, Kazuteru; LOPEZ-BEN, Santiago; KINGHAM, Thomas Peter; FERRERO, Alessandro; ETTORRE, Giuseppe Maria; SANDRI, Giovanni Battista Levi; SALEH, Mansour; CHERQUI, Daniel; ZHENG, Junhao; LIANG, Xiao; MAZZOTTA, Alessandro; SOUBRANE, Olivier; WAKABAYASHI, Go; I, Roberto Troisi; CHEUNG, Tan-To; KATO, Yutaro; SUGIOKA, Atsushi; D'SILVA, Mizelle; HAN, Ho-Seong; Phan Phuoc Nghia; Tran Cong Duy Long; EDWIN, Bjorn; FUKS, David; CHEN, Kuo-Hsin; HILAL, Mohammad Abu; ALDRIGHETTI, Luca; LIU, Rong; GOH, Brian K. P.
    Objective: To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH). Background: Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH. Methods: This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience volume, perioperative outcomes, and tumor characteristics were collected and analyzed. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were performed to minimize selection bias between both groups Results: A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; P = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; P < 0.001; CEM: 54.0% vs 65.0%; P = 0.007) and open conversion (PSM: 5.1% vs 11.9%; P < 0.001; CEM: 5.5% vs 10.4%, P = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; P = 0.02; CEM 10.4% vs 25.5%; P = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; P < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; P = 0.047]. Conclusions: This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.
  • article 3 Citação(ões) na Scopus
    Liver resection for hepatocellular carcinoma beyond the BCLC: are multinodular disease, portal hypertension, and portal system invasion real contraindications?
    (2022) BARROS, A. Z. de Almeida; FONSECA, G. M.; KRUGER, J. A. P.; COELHO, F. F.; HERMAN, P.
    Background: Barcelona Clinic Liver Cancer (BCLC) is a recognized guideline to standardize treatment allocation for hepatocellular carcinoma (HCC); however, many centers criticize its restrictive liver resection recommendations and have published good results after more liberal hepatectomy indications. The objective is to evaluate the results of HCC resection in a single center, with a more liberal indication for resection than proposed by the BCLC guideline. It was performed a retrospective cohort study including all patients who underwent liver resection for HCC in a single center between April 2008 and November 2018. Methods: The results of 150 patients who underwent hepatectomy were evaluated and compared facing both 2010 and 2018 BCLC guidelines. Overall and disease-free survival after resection in patients with none, one, two, or three of the risk factors, as proposed by the BCLC, as contraindications to resection (portal hypertension, portal invasion, and more than one nodule) were analyzed. Results: Nodule size and presence of portal invasion alone did not affect prognosis. If the BCLC 2010 and 2018 guidelines were followed, 46.7% and 26.7% of the patients, respectively, would not have received potentially curative treatment. The median overall and disease-free survival for patients with one BCLC contraindication factor were 43.3 and 15.1 months, respectively. The presence of two risk factors had a negative impact on overall survival (OS) and disease-free survival (DFS), although some patients had long-term survival. The only patient with the three risk factors had a poor outcome. Conclusions: Selected patients with one BCLC contraindication factor may undergo resection with good results, whereas those with two factors should be allocated for hepatectomy only in favorable scenarios. Patients with the three risk factors do not appear to benefit from resection.