Laparoscopic R1 vascular hepatectomy for hepatocellular carcinoma (with video)

Surgical resection is considered the standard of treatment for hepatocellular carcinoma (HCC), when realized with negative margins (R0)1. Not infrequently, R0 resection is unachievable, thus the concept of R1 vascular hepatectomy has been introduced and has been defined as exposure of the tumor on the specimen surface due to its detachment from vascular structure

Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients

Background: Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients. Aim: To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments. Methods: A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching. Results: After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years. Conclusion: Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival

Metodi di Supply Network Design in presenza di disruptions

Enterprises worldwide are facing significant challenges from the growing competition and the destabilising effects of climate, disease, and other external perils. Supply chain (SC) networks become more and more complex and widely geographical extended. SCs are exposed to a broad range of uncertainties, some of which may cause disruptions in the network. Neglecting this kind of risks may lead to adverse consequences such as negative financial effects, higher transportation costs, order delays, inventory shortages and loss of market shares. Disruption management is, therefore drawing significant attention from both academia and industry. The frequent disruption events that have been continuously increasing over recent years have clearly shown the key role of supply chain management as a critical capability to navigate such risk successfully, with the aim to design robust and resilient logistics network to help firms maintain and enhance their competitive advantages as they encounter environmental turbulence. To hedge against SC disruptions, a well-designed and reliable network that performs efficiently in normal situation and resiliently during unstable conditions is a top priority. This dissertation investigates how supply network design procedure should adapt due to disruption risks consideration. After an extensive analysis of the literature, a new mathematical model for the design and planning of three-echelon resilient SCs is proposed. Distinctively, a combination of proactive and reactive resilience actions were considered with the objective to analyse the effectiveness of adopting mitigation and contingency activities to efficiently plan for redundancies and recovery actions. This research work allowed to identify important relations between disruption duration/magnitude and efficiency of preparedness and adaptation strategies. The outcome of this research can be instructive for SC managers when deciding on investment in redundancy allocation and on efficient use of this redundancy at recovery stages and preparedness strategy.Enterprises worldwide are facing significant challenges from the growing competition and the destabilising effects of climate, disease, and other external perils. Supply chain (SC) networks become more and more complex and widely geographical extended. SCs are exposed to a broad range of uncertainties, some of which may cause disruptions in the network. Neglecting this kind of risks may lead to adverse consequences such as negative financial effects, higher transportation costs, order delays, inventory shortages and loss of market shares. Disruption management is, therefore drawing significant attention from both academia and industry. The frequent disruption events that have been continuously increasing over recent years have clearly shown the key role of supply chain management as a critical capability to navigate such risk successfully, with the aim to design robust and resilient logistics network to help firms maintain and enhance their competitive advantages as they encounter environmental turbulence. To hedge against SC disruptions, a well-designed and reliable network that performs efficiently in normal situation and resiliently during unstable conditions is a top priority. This dissertation investigates how supply network design procedure should adapt due to disruption risks consideration. After an extensive analysis of the literature, a new mathematical model for the design and planning of three-echelon resilient SCs is proposed. Distinctively, a combination of proactive and reactive resilience actions were considered with the objective to analyse the effectiveness of adopting mitigation and contingency activities to efficiently plan for redundancies and recovery actions. This research work allowed to identify important relations between disruption duration/magnitude and efficiency of preparedness and adaptation strategies. The outcome of this research can be instructive for SC managers when deciding on investment in redundancy allocation and on efficient use of this redundancy at recovery stages and preparedness strategy

Metodi di Supply Network Design in presenza di disruptions

Enterprises worldwide are facing significant challenges from the growing competition and the destabilising effects of climate, disease, and other external perils. Supply chain (SC) networks become more and more complex and widely geographical extended. SCs are exposed to a broad range of uncertainties, some of which may cause disruptions in the network. Neglecting this kind of risks may lead to adverse consequences such as negative financial effects, higher transportation costs, order delays, inventory shortages and loss of market shares. Disruption management is, therefore drawing significant attention from both academia and industry. The frequent disruption events that have been continuously increasing over recent years have clearly shown the key role of supply chain management as a critical capability to navigate such risk successfully, with the aim to design robust and resilient logistics network to help firms maintain and enhance their competitive advantages as they encounter environmental turbulence. To hedge against SC disruptions, a well-designed and reliable network that performs efficiently in normal situation and resiliently during unstable conditions is a top priority. This dissertation investigates how supply network design procedure should adapt due to disruption risks consideration. After an extensive analysis of the literature, a new mathematical model for the design and planning of three-echelon resilient SCs is proposed. Distinctively, a combination of proactive and reactive resilience actions were considered with the objective to analyse the effectiveness of adopting mitigation and contingency activities to efficiently plan for redundancies and recovery actions. This research work allowed to identify important relations between disruption duration/magnitude and efficiency of preparedness and adaptation strategies. The outcome of this research can be instructive for SC managers when deciding on investment in redundancy allocation and on efficient use of this redundancy at recovery stages and preparedness strategy.Enterprises worldwide are facing significant challenges from the growing competition and the destabilising effects of climate, disease, and other external perils. Supply chain (SC) networks become more and more complex and widely geographical extended. SCs are exposed to a broad range of uncertainties, some of which may cause disruptions in the network. Neglecting this kind of risks may lead to adverse consequences such as negative financial effects, higher transportation costs, order delays, inventory shortages and loss of market shares. Disruption management is, therefore drawing significant attention from both academia and industry. The frequent disruption events that have been continuously increasing over recent years have clearly shown the key role of supply chain management as a critical capability to navigate such risk successfully, with the aim to design robust and resilient logistics network to help firms maintain and enhance their competitive advantages as they encounter environmental turbulence. To hedge against SC disruptions, a well-designed and reliable network that performs efficiently in normal situation and resiliently during unstable conditions is a top priority. This dissertation investigates how supply network design procedure should adapt due to disruption risks consideration. After an extensive analysis of the literature, a new mathematical model for the design and planning of three-echelon resilient SCs is proposed. Distinctively, a combination of proactive and reactive resilience actions were considered with the objective to analyse the effectiveness of adopting mitigation and contingency activities to efficiently plan for redundancies and recovery actions. This research work allowed to identify important relations between disruption duration/magnitude and efficiency of preparedness and adaptation strategies. The outcome of this research can be instructive for SC managers when deciding on investment in redundancy allocation and on efficient use of this redundancy at recovery stages and preparedness strategy